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NHS BIRMINGHAM AND SOLIHULL CLINICAL COMMISSIONING GROUP

C O N S T I T U T I O N

1 April 2018

Version Status

1.0 Approved by NHS England. Effective 1st April 2018

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TABLE OF CONTENTS

Part Description Page

Foreword 4

1 Introduction and Commencement

1.1 Name 6

1.2 Statutory Framework 6

1.3 Status of this Constitution 6

1.4 Amendment and Variation of this Constitution 7

1.5 Liability and Indemnity 7

2 Area Covered

2.3 Map showing Birmingham & Solihull CCG 8

3 Membership

3.1 Membership of the Clinical Commissioning Groups 9

3.2 Eligibility 9

3.3 Applications for Membership 9

3.4 Termination of Membership 9

3.5 Nature of Membership and Relationship with CCG 9

3.6 Members’ Rights 10

3.7 Members’ Meeting 11

4 Mission, Vision and Values

4.1 Our Mission 12

4.2 Our Vision 12

4.3 Our Values 12

4.4 Our Principles of Good Governance 13

4.5 Our Accountability 14

5 Functions and General Duties

5.1 Our Functions 16

5.2 Our General Duties 18

5.3 Our General Financial Duties 23

5.4 Other Relevant Regulations, Directions and Documents 24

6 The Governing Structure

6.1 Authority to Act: the CCG 25

6.2 Authority to Act: the Governing Body 25

6.3 Scheme of Reservation and Delegation 25

6.4 General 26

6.5 Committees and Sub-Committees 27

6.6 Committees of the Governing Body 27

6.7 Joint Commissioning Arrangements 28

6.8 The Governing Body 33

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Part Description Page

6.9 Elections to the Governing Body 35

7 Roles and Responsibilities

7.1 Member Practices 36

7.2 Practice Representatives 36

7.3 Locality Structure 36

7.4 The Role of Members of the Governing Body 37

7.5 The Chair of the Governing Body 37

7.6 The Lay Vice-Chair of the Governing Body 38

7.7 Elected Governing Body Member Practice Representatives 38

7.8 Role of the Independent Lay Members 39

7.9 Secondary Care Specialist 39

7.10 Role of the Chief Executive 40

7.11 Role of the Chief Finance Officer 40

7.12 Role of the Chief Nursing Officer 41

7.13 Chief Medical Officer 41

7.14 The Director of Public Health Representative 42

7.15 Joint Appointments with Other Organisations 42

8 Standards of Business Conduct and Managing Conflicts of Interest

8.1 Standards of Business Conduct 43

8.2 Conflicts of Interest 43

8.3 Declaring and Registering Interests 43

8.4 Managing Conflicts of Interest: General 44

8.5 Transparency in Procuring Services 44

9 The CCG as Employer

9.1 – 9.10 The CCG as an Employer 46

10 Transparency, Ways of Working and Standing Orders

10.1 General 48

10.2 Speaking, Writing or Acting in the Name of the CCG 48

10.3 Standing Orders, Scheme of Reservation and Delegation and Prime financial policies

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Appendix Description Page

A Definitions of Key Descriptions used in this Constitution 50

B List of Member Practices - Western Birmingham Practices

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C Standing Orders 59

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Appendix Description Page

D Scheme of Reservation and Delegation 75

E Prime Financial Policies 95

F Terms of Reference:

Audit & Risk Committee

Remuneration & Nominations Committee

Primary Care Commissioning Committee

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G Nolan Principles 127

H Seven Key Principles of the NHS Constitution 128

I Local Super Output Areas 130

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FOREWORD

Our Constitution is the foundation of our organisation. It is the written embodiment of all that we are setting out to achieve, and how we intend to achieve it. The development of NHS Birmingham and Solihull Clinical Commissioning Group is the culmination of the formal merger of three different CCGs coming together in recognition that the future of clinical commissioning lies in strength and unity. In bringing together the three CCGs we have created a unique opportunity to take what is best of each, and develop a truly special membership organisation with patients at the heart. As such a large organisation, we must take a focused view on the needs of our patients at a community level. As the most diverse area of the country, the principles of place-based commissioning are important to ensure that we commission effectively and for the best possible outcomes for our population. This includes working in partnership with our general practice membership, the two local authorities, the many local trusts and other health providers, the voluntary sector and the citizens of Birmingham and Solihull. This Constitution sets out clearly:

Who we are as an organisation;

Who are our membership;

How we form our Governing Body and the standards those individuals must uphold;

How and when we make decisions;

Who within the organisation has the delegated authority to make decisions on behalf of the organisation; and

How we will manage conflicts of interest. I ask each of our member practices, staff and colleagues to read through our Constitution, and agree to uphold its principles.

Dr Peter Ingham Clinical Chair

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1. INTRODUCTION AND COMMENCEMENT

1.1 Name

1.1.1 The name of this Clinical Commissioning Group is NHS Birmingham and Solihull Clinical Commissioning Group (the CCG).

1.2 Statutory Framework

1.2.1 Clinical Commissioning Groups are established under the National Health Service Act 2006 (“the 2006 Act”), as amended by the Health and Social Care Act 2012 (“the 2012 Act”).1 The CCG is a Statutory Body with the function of commissioning services for the purposes of the health service in England and we are treated as an NHS body for the purposes of the 2006 Act.2 The powers and duties of the CCG are to commission certain health services as set out in Sections 3 and 3A of the 2006 Act3, and the regulations made under those provisions.4

1.2.2 Our status as a CCG is determined by NHS England5 and is subject to an annual assessment of our performance.6 NHS England has powers to intervene where it is satisfied that our CCG is failing or has failed to discharge any of our functions or that there is a significant risk that we will fail to do so.7

1.2.3 CCGs are clinically led membership organisations made up of general practices. The Members of the CCG are responsible for determining the governing arrangements for the CCG, which are set out in this Constitution.8

1.3 Status of this Constitution

1.3.1 This Constitution is made between the Members of the CCG and has effect from first day of April 2018, when the CCG was established by NHS England.

1.3.2 The Constitution will be published on the CCG’s website: www.birminghamandsolihullccg.nhs.uk or can be obtained by writing to: Birmingham and Solihull CCG, Bartholomew House, 142 Hagley Road, Birmingham, B16 9PA or by sending an email to bsol.comms@nhs.net.

1.3.3 The Constitution is supported by a number of operational documents, including the CCG Handbook and policies and procedures. These documents are not part of the Constitution but are available on the CCG’s website and on request as above in 0.

1 See section 1I of the 2006 Act

2 See section 275 of the 2006 Act

3 Sections 3 and 3A of the 2006 Act

4 See section 275 of the 2006 Act

5 See section 14C of the 2006 Act

6 See section 14Z16 of the 2006 Act

7 See sections 14Z21 and 14Z22 of the 2006 Act

8 See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, and Part 1 of Schedule 1A to the 2006 Act and any regulations issued

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1.4 Amendment and Variation of this Constitution

1.4.1 This Constitution can only be varied in the following circumstances.9

a) when an application is made to NHS England, following a request by the Governing Body for a variation to be made, and that application is granted and;

b) where, in the circumstances set out in legislation, NHS England varies the Constitution other than by application by the CCG.

1.5 Liability and indemnity

1.5.1 The CCG is a body corporate established and existing under the 2006 Act. All financial or legal liability for decisions or actions of the CCG resides with the CCG as a public statutory body and not with its Member practices.

1.5.2 No Member or former Member, nor any person who is at any time a proprietor, officer or employee of any Member or former Member, shall be liable (whether as a Member or as an individual) for the debts, liabilities, acts or omissions, howsoever caused by the CCG in discharging its statutory functions.

1.5.3 No Member or former Member, nor any person who is at any time a proprietor, officer or employee of any Member of former Member, shall be liable on any winding-up or dissolution of the CCG to contribute to the assets of the CCG, whether for the payment of its debts and liabilities or the expenses of its winding-up or otherwise.

1.5.4 The CCG may indemnify any Member practice representative or other officer or individual exercising powers or duties on behalf of the CCG in respect of any civil liability incurred in the exercise of the CCGs’ business, provided that the person indemnified shall not have acted recklessly or with gross negligence.

9 See sections 14E and 14F of the 2006 Act, and any regulations issued

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2. AREA COVERED

2.1 The geographical area covered by the CCG is shown on the map below.

2.2 There are a number of practices in West Birmingham, who are members of Sandwell and West Birmingham CCG and are aligned to the West Birmingham locality of Birmingham and Solihull CCG. The CCG will ensure that its commissioning is aligned within West Birmingham and arrangements have been put in place, as part of the overall locality arrangements, to facilitate equality of access to West Birmingham patients and enable representation for Member practices in the Western Birmingham locality.

2.3 Map of Birmingham and Solihull showing the area of the CCG:

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3. MEMBERSHIP

3.1 Membership of the Clinical Commissioning Group

3.1.1 The CCG is a membership organisation. The practices which make up the membership

of the CCG are listed in Appendix B. Those Members listed in Appendix B are the founding Members of the CCG, which has been formed through the formal merger of three former CCGs: Birmingham CrossCity CCG, Birmingham South Central CCG, and Solihull CCG.

3.2 Eligibility

3.2.1 All practices who provide primary medical services to a registered list of patients

under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract will be eligible to apply for membership of this CCG.10

3.3 Applications for Membership

3.3.1 Any GP practice wishing to become a Member of the CCG can request to do so at any

time by contacting the Chair. A prospective Member will be asked to identify a preferred Locality that they wish to join.

3.3.2 Applications for membership will be considered by the Chair, in consultation with the relevant Locality lead(s). The Primary Care Commissioning Committee will be asked to make a recommendation on the application for the Governing Body to take a decision on. Any changes to CCG membership are subject to Constitutional change and approval by NHS England.

3.4 Termination of Membership

3.4.1 Practices wishing to leave the CCG should submit their notice of intent in writing, this is purely so that the CCG is aware of the move. The transfer of membership will be in accordance with Procedures for clinical commissioning group constitution change, merger or dissolution11 (or equivalent as amended or superseded).

3.4.2 In the event of a practice leaving, then NHS England will be informed by both the CCG and the practice concerned.

3.4.3 Any Practice which ceases (for whatever reason) to hold a contract or be party to any arrangement to provide any services referred to in Section 14A(4) of the 2006 Act within the CCG Area shall also then cease to be a Member of the CCG with immediate effect. In such instances, discussions regarding future management and continuity of service to

10 See section 14A(4) of the 2006 Act.

11 Procedures for clinical commissioning group constitution change, merger or dissolution NHS England November 2016

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patients affected by such a change would take place between the CCG and NHS England immediately prior to removal of the Practice.

3.5 Nature of Membership and Relationship with CCG

3.5.1 The CCG’s Members are integral to the functioning of the CCG. Those exercising delegated functions on behalf of the Membership, including the Governing Body, remain accountable to the Membership.

3.5.2 The CCG has established a system of Locality governance, through which the Membership provide strategic direction on commissioning and through which the Governing Body is accountable. Locality arrangements are set out in more detail in the CCG Handbook.

3.6 Members’ Rights

3.6.1 Notwithstanding any other provision in this Constitution but subject to the procedural requirements set out in the Standing Orders, the Members shall have the following inalienable rights:-

a) Call a general meeting of the Members;

b) Submit a proposal for amendment of the Constitution to the Governing Body. Such a proposal must be submitted by at least half (50%) of all the Governing Body Member Practice Representatives (including the Chair);

c) Elect the Chair of the Governing Body and other elected Members of the Governing Body;

d) Remove the Chair of the Governing Body on the basis of the Grounds for removal from office, as set out in this Constitution,

e) Remove any elected Member of the Governing Body on the basis of the Grounds for removal from office, as set out in this Constitution;

f) Raise concerns regarding any appointed Member of the Governing Body on the basis of the grounds for removal from office that applies to that Member, as set out in this Constitution.

g) Participate in the development of the CCG Handbook and submit a proposal for amendment of the Handbook to the Governing Body. Such a proposal must be submitted by at least half (50%) of all the Governing Body Member Practice Representatives (including the Chair).

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3.6.2 If any Member practice has a dispute or concern with regard to any issues concerning the work of their CCG this should be raised in the first instance with their Locality Lead who will liaise with other Member practices, appropriate governing body Members, other clinician leads or CCG management to seek resolution, following the process agreed at locality level.

3.6.3 If the issue cannot be resolved at Locality level, then the dispute will be notified to the Lay Vice-Chair of the CCG who may be able to resolve the issue. Should the Member practice so wish they can appoint the LMC to mediate with the Lay Vice-Chair on their behalf, or at any point up to the commencement of formal arbitration as described below.

3.6.4 If the Lay Vice-Chair cannot find a resolution to the dispute they will then:

a) convene a panel made up of the Chair and Vice-Chair of the Governing Body and another Member Governing Body nominated by the complainant. If the Chair and/ or Lay Vice Chair are party to this dispute another Member of the Governing Body will take their place on the panel;

b) this panel will make recommendations on how the concern should be addressed;

c) should the concern not be resolved through this process then the Member practice will have recourse to external arbitration by NHS England;

d) any Member practice can seek to be represented by the LMC at any stage of the proceedings.

3.6.5 If NHS England is unwilling or unable to arbitrate, then any dispute may be referred to an alternative arbitrator appointed jointly by the parties to the dispute or (in the absence of agreement within 14 days on the identity of a suitable arbitrator or forum) may be determined by a Court of competent jurisdiction pursuant to proceedings brought by any party to the dispute.

3.6.6 Nothing in Chapter 3 shall be taken:-

a) as depriving a person removed under it of compensation or damages payable to him or her in respect of the termination of his appointment (or of any related appointments terminated by or as a consequence of such removal); or

b) as derogating from any power that may exist apart from that paragraph, to remove any person from any appointment.

3.7 Members’ Meetings

3.7.1 Meetings of the Members shall be held at such times and in such manner as is provided in this Constitution, in the Standing Orders and in the CCG Handbook.

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4. MISSION, VISION AND VALUES

4.1 Our Mission

Our strategic intent is to deliver the best possible outcomes for local people; tackling health inequalities and meeting the health and wellbeing needs of a diverse population, as well as improving CCG and provider performance and providing financial sustainability across Birmingham and Solihull.

4.2 Our Vision

The CCG has played in full role in developing the STP vision and our role going forward is to align

our focus and resources to making the vision a reality for everyone in Birmingham and Solihull.

To deliver the vision requires a transformed health and care system. A heath and care system that

1. Focuses on prevention

2. Promotes independence and

3. Delivers excellence in health and care

Leading to:

4. Improved health and well being

5. Improved access to quality services

6. Maximised resources and productivity

4.3 Our Values

Working together for patients Patients will come first in everything we do.

Respect and dignity We will treat every individual who comes into contact with us with respect and dignity, regardless of whether they are a patient, carer or member of staff.

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Commitment to quality of care We aspire to the highest standards of excellence and professionalism in the provision of high-quality care that is safe, effective and focused on patient experience.

Compassion As well as respect and dignity we will treat individual patients, carers and relatives with sensitivity and kindness.

Improving lives We seek to improve the health and wellbeing of patients, communities and staff through professionalism, innovation and excellence in care.

Everyone counts We have a responsibility to maximise the benefits we obtain from NHS resources, ensuring they are distributed fairly to those most in need. Nobody should be discriminated or disadvantaged, and everyone should be treated with equal respect and importance.

We expect that all providers that we contract with will share our values and will seek to ensure that contracts require this and that the values are demonstrated through regular reporting, monitoring and observation of service delivery,

4.4 Our Principles of Good Governance

4.4.1 The CCG will at all times observe “such generally accepted principles of good governance” as are relevant to us. 12These include:13-

a) the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business;

b) the Good Governance Standard for Public Services;14

c) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’ ;

d) the seven key principles of the NHS Constitution;

e) the Equality Act 2010;15 and

12 As per section 14L(2)(b) of the 2006 Act,

13 More detail about each example is included in the CCG Handbook

14 The Good Governance Standard for Public Services, The Independent Commission on Good Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004

15 See http://www.legislation.gov.uk/ukpga/2010/15/contents

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f) the standards set out in the guidance Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England16.

4.5 Our Accountability

4.5.1 The CCG will demonstrate its accountability to its Members, local people, stakeholders and NHS England in a number of ways, including:

a) publishing its Constitution and other key documents, including the CCG Handbook;

b) appointing Independent Lay Members and non-GP clinicians to the Governing Body.

c) holding meetings of the Governing Body in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting);

d) publishing annually a commissioning strategy taking account of priorities in the Health & Wellbeing strategy;

e) complying with the local authorities health overview and scrutiny requirements;

f) meeting annually in public to present an annual report, which is then published;

g) producing annual accounts in respect of each financial year, which are externally audited;

h) having a published and clear complaints process;

i) complying with the Freedom of Information Act 2000;

j) providing information to the NHS England, as required;

k) being an active Member of the Health & Wellbeing Boards in Birmingham and Solihull.

4.5.2 In addition to these statutory requirements, the CCG will demonstrate its accountability by:

a) holding regular events to involve and inform patients, carers and voluntary and community sector groups about the work of the CCG and inviting comment;

b) holding regular membership involvement events for Member practices;

c) committing to continuing to work alongside Birmingham and Solihull Local Medical Committees regarding the provision, delivery and quality of primary care; and

16 Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England

Professional Standards Agency November 2013

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d) providing information to the public at large about the work of the CCG through our website and other means by request.

4.5.3 The Governing Body will throughout each year have an on-going role in reviewing the group’s governance arrangements to ensure that the CCG continues to reflect the principles of good governance.

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5. FUNCTIONS AND GENERAL DUTIES

5.1 Our Functions

5.1.1 The functions that we are responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in NHS England’s The Functions of Clinical Commissioning Groups17. They relate to:

a) commissioning certain health services (where NHS England is not under a duty to do so) that meet the reasonable needs of:

i. all people registered with Member GP practices; and

ii. people who are usually resident within the area and are not registered with a Member of any Clinical Commissioning Group.

b) commissioning emergency care for anyone present in the group’s area;

c) paying its employees’ remuneration, fees and allowances in accordance with the determinations made by the Governing Body and determining any other terms and conditions of service of the group’s employees;

d) determining the remuneration and travelling costs or other allowances of Members of its Governing Body.

5.1.2 In discharging its functions the CCG will:

a) Act,18 when exercising its functions to commission health services, consistently with the discharge by the Secretary of State and the NHS England of their duty to promote a comprehensive health service19 and with the objectives and requirements placed on NHS England through the mandate20 published by the Secretary of State before the start of each financial year:

i. establish and maintain a CCG Governing Body which has statutory functions conferred on it by the 2006 Act21, together with any other functions connected with its main functions as may be specified in regulations or in this Constitution;

ii. draw up and maintain a Scheme of Reservation and Delegation, outlining those matters which are reserved to the Membership or the CCG Governing Body, and ensuring that management arrangements are in place to enable responsibility to be clearly delegated by the Governing Body in accordance with the powers given to it under this Constitution;

iii. establish and maintain appropriate Committees and Sub-Committees of the CCG Governing Body as set out in the Constitution, Scheme of Reservation and Delegation and the CCG Handbook.

17 https://www.england.nhs.uk/wp-content/uploads/2013/03/a-functions-ccgs.pdf

18 See section 3(1F) of the 2006 Act

19 See section 1 of the 2006 Act

20 See section 13A of the 2006 Act

21 Sections 14L(2) and (3) of the 2006 Act

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iv. develop a Commissioning Plan before the start of each financial year in accordance with the Act and any guidance published by NHS England.

v. publish the Commissioning Plan and supply a copy to NHS England and to the Birmingham and Solihull Health and Wellbeing Boards;

vi. make copies of the Commissioning Plan available through the CCG website: www.birminghamandsolihullccg.nhs.uk and upon request in writing to: Birmingham and Solihull CCG, Bartholomew House, 142 Hagley Road, Birmingham B16 9PA.

vii. where the CCG is preparing a Commissioning Plan or making significant revisions to our Commissioning Plan, we will consult individuals and groups for whom we have responsibility for under Section 3 of the NHS Act 2006, and involve Birmingham and Solihull Health and Wellbeing Boards in revising or preparing the Commissioning Plan.

viii. in drafting the Commissioning Plan, the CCG will have regard to the Procurement Guide for Commissioners of NHS-funded Services’ and ‘Operational Guidance to the NHS - Extending Patient Choice of Provider’ or any superseding documents; and any other documentation setting out how the Any Qualified Provider model is to function.

ix. when commissioning services from those providers who are qualified to do so under the national list of services, the CCG will ensure that those qualified still meet the requirements, namely that they:

are registered with the Care Quality Commission and licensed by Monitor where required, or meet equivalent assurance requirements;

accept the Terms and Conditions of the NHS Standard Contract which includes a requirement to have regard to the NHS Constitution, relevant guidance and law;

agree appropriate mechanisms in relation to the payment for services provided in line with NHS guidance;

can provide assurances that they are capable of delivering the agreed service requirements and comply with referral protocols;

reach agreement with local commissioners on supporting schedules to the standard contract including any local referral thresholds or patient protocols.

5.1.3 We will meet the public sector equality duty22 by: a) delegating responsibility for ensuring that the CCG meets the public sector equality

duty to the Governing Body;

c) developing and implementing a comprehensive equality strategy, that sets out how the CCG will eliminate unlawful discrimination, victimisation and other conduct prohibited by the Equality Act 2010;

c) using the Equality Delivery System as a tool to advance equality and opportunity between people who share a protected characteristic and those who do not and

22 See section 149 of the Equality Act 2010

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foster good relations between people who share a protected characteristic and those who do not;]

d) publishing, at least annually, sufficient information to demonstrate compliance with this general duty across all functions;

e) preparing and publishing specific and measurable equality objectives and revising these regularly as is appropriate;

f) having regard to any guidance or requirements published by NHS England.

5.1.4 Work in partnership with Birmingham City Council and Solihull Metropolitan Borough Council to develop an assessment of Joint Strategic Needs (JSNA)23 and a Joint Health and Wellbeing Strategy24 by:

a) delegating responsibility for ensuring that the CCG take account of the JSNA and Joint Health & Wellbeing Strategy to the Governing Body

b) being active members of the Birmingham and Solihull Health and Wellbeing Boards, which will act as a focus of leadership and coordination of strategic commissioning for the Local Authorities and the CCG, in relation to the spending and service priorities of these bodies and the advantages and opportunities of joint working;

c) giving the Birmingham and Solihull Health and Wellbeing Boards a draft of the Commissioning Plan or, as the case may be, a copy of the revised Commissioning Plan;

d) consulting the Health and Wellbeing Boards on whether the draft Commissioning Plan takes proper account of the Joint Health and Wellbeing Strategy, published by the Health and Wellbeing Board, which relates to the period (or any part of the period) to which the Commissioning Plan relates;

e) including in the published Commissioning Plan or, in circumstances where the CCG revises a published plan in a way in which the CCG considers significant, the revised Commissioning Plan, a summary of the views expressed by individuals consulted; an explanation of how the CCG took account of those views; and a statement of the final opinion of the Health and Wellbeing Board consulted in relation to the Commissioning Plan.

5.2 Our General Duties - in discharging its functions the CCG will:

a) Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements25 by:

23 See section 116 of the Local Government and Public Involvement in Health Act 2007

24 See section 116A of the Local Government and Public Involvement in Health Act 2007

25 See section 14Z2 of the 2006 Act

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i. appointing a Member of the Governing Body to oversee Public Involvement and ensure that CCG developments are informed by such involvement.

ii. delegating responsibility to the Governing Body to ensure the CCG:

develops and implements a comprehensive strategy which sets out how patients and the public will be involved in decisions about local health services, including:

adapt engagement activities to meet specific needs of the different patient groups and communities, wherever possible taking a direct and personalised approach;

publishes information about health services, the aims and ambitions and its performance on the group’s website and through other media;

demonstrating how the group is effectively involving patients, the public and other stakeholders through quarterly reports to the Governing Body, and through the publication of an annual review of all communication and engagement activity.

5.2.1 Promote awareness of, and act with a view to securing health services that are provided in a way that promotes awareness of, and have regard to the NHS Constitution26 by:

a) delegating responsibility for ensuring the discharge of the duty to the Governing Body;

b) having regard to any guidance or requirements published by NHS England.

5.2.2 Act effectively, efficiently and economically27 by:

a) appointing a Member of the Governing Body to oversee Audit and Governance;

b) requiring that the Audit and Governance Committee ensures that the CCG:

i. operates within our Corporate Governance Framework, which includes its Standing Orders, Schemes of Reservation and Delegation and Prime Financial Policies, which are set out in the Constitution and/or the CCG Handbook;

ii. develops and implements a system of internal control which ensures that:

business is conducted in accordance with the law and proper standards;

public money is safeguarded and properly accounted for;

affairs are managed to secure economic, efficient and effective use of resources;

reasonable steps are taken to prevent and detect fraud and other irregularities;

26 See section 14P of the 2006 Act and section 2 of the Health Act 2009

27 See section 14Q of the 2006 Act

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conflicts of interest are effectively managed.

c) there is a fit-for-purpose performance framework that proactively manages the CCG’s financial, performance and Quality, Innovation, Productivity and Prevention (QIPP);

d) actively seeking assurance that any decisions taken with regard to commissioning and/or decommissioning of services is evidence based and complies with national and local requirements;

e) the requirements set out in guidance or requirements published by the NHS England are met.

5.2.3 Make ourselves accountable to public scrutiny by:

a) holding meetings of the Governing Body in public to ensure appropriate scrutiny and accountability;

b) publishing via the CCG’s website and other media our aims and objectives and our performance towards achieving those aims and objectives;

c) informing our decision making through the engagement undertaken as detailed in our strategy;

d) publishing annually, sufficient information to demonstrate compliance with this general duty across all functions;

e) holding an Annual General Meeting in public;

f) maintaining an on-going liaison with the Birmingham City Council and Solihull Metropolitan Borough Council Health and Social Care Scrutiny Committees.

5.2.4 Act with a view to securing continuous improvement to the quality of services,28 by:

a) appointing a Chief Nursing Officer as a Member of the Governing Body to oversee our work on quality;

b) delegating responsibility for this function to the Governing Body, which will make sure that the CCG:

i. develops and implements a comprehensive approach to quality that sets out how the CCG will be assured that commissioned services are being delivered in a high quality and safe manner, ensuring that quality sits at the heart of everything the CCG does;

ii. ensures everything we do is underpinned by quality and governance; iii. develops and implements the CCG’s approach to quality assurance;

28 See section 14R of the 2006 Act

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iv. demonstrates regard to any guidance or requirements published by NHS England and any recommendations as a result of inquiries into the quality of healthcare services.

5.2.5 The CCG will work with NHS England in improving the quality of primary medical services, by:

a) Delegating responsibility for this to the Governing Body, who will ensure that appropriate arrangements are in place to enable the CCG to monitor the quality of primary care services and develop a strategy for continuous improvement.

b) Our approach to this will be developmental and informed by an on-going dialogue.

c) Having regard to any guidance or requirements published by NHS England.

5.2.6 Have regard to the need to reduce inequalities,29 by:

a) delegating responsibility to the Governing Body to have regard for the need to reduce inequalities as part of all that the CCG does;

b) undertaking an annual review and update of integrated plan;

c) developing Commissioning Plans taking full account of the Joint Strategic Needs Assessment (JSNA);

d) through its membership of both the Birmingham and Solihull Health and Wellbeing Boards;

e) streamlining and simplify all healthcare pathways;

f) maintaining a focus on improving health outcomes in areas where the CCG is an outlier.

5.2.7 Promote the involvement of patients, their carers and representatives in decisions about their healthcare30 and act with a view to enabling patients to make choices by:

a) delegating responsibility to the Governing Body, for ensuring that patients, carers and representatives are given the right to choose a GP and change to another if they are not happy; the right to choose which hospital they go to if referred to a specialist; and the right to be involved in decisions about their healthcare and to be given the information they need to do this;

b) having regard to any guidance or requirements published by NHS England.

29 See section 14T of the 2006 Act

30 See section 14U of the 2006 Act

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5.2.8 Obtain appropriate advice31 from persons who, taken together, have a broad range of professional expertise in healthcare and public health, by:

a) including a range of clinical and non-clinical expertise, including experienced and capable officers and Independent Lay Members with a range of skills and expertise on the Governing Body;

b) ensuring that local healthcare professionals and others with experience and expertise are widely consulted on the development of the CCG’s Commissioning Plan and in the development and implementation of any other commissioning or decommissioning plans;

c) ensuring that the views of a range of clinicians from different specialities and areas of expertise are taken into account when considering issues relating to quality and quality improvement;

d) taking account of the proceedings of the Birmingham and Solihull Health and Wellbeing Boards, the Local Medical Committees and other local expert bodies, including Clinical Senates.

5.2.9 Promote innovation,32 33promote research and the use of research34 by:

5.2.9.1 Delegating to the Govenring Body responsibility for:

a) using an evidence-based best practice approach to the commissioning of services;

b) ensuring that services commissioned are outcome-focused;

c) measuring improvements in patient health and experience;

d) keeping abreast of any new advances in technology;

e) being proactive in the management of medicines;

f) ensuring that research informs the CCG decision-making.

5.2.10 Have regard to the need to promote education and training35 for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England, so as to assist the Secretary of State for Health in the discharge of his related duty36 by:

31 See section 14W of the 2006 Act

32 See section 14X of the 2006 Act

33 See section 14Y of the 2006 Act

34 See section 14U of the 2006 Act 35 See section 14Z of the 2006 Act

36 See section 1F(1) of the 2006 Act

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a) developing and implementing an organisational development plan, implementation of which will be monitored by the Governing Body, with regular updates on progress reported to the group.

5.2.11 Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the CCG considers that this would improve the quality of services or reduce inequalities,37 by:

a) delegating responsibility to the Governing Body for ensuring that services (health and social care) are provided in an integrated way to:

i. improve the quality of services, including the outcomes that are achieved from their provision; and

ii. reduce inequalities between persons with respect to their ability to access those services or with respect to the outcomes achieved for them by the provision of those services. reporting progress to the Governing Body on a regular basis.

b) utilising opportunities to participate in collaborative, joint or other integrated care arrangements where appropriate to achieving the CCG’s vision and consistent with the CCG’s statutory powers and duties;

c) having regard to any guidance or requirements published by the NHS England.

5.3 Our General Financial Duties – the CCG will perform its functions so as to:

5.3.1 Ensure our expenditure does not exceed the aggregate of our allotments for the financial year and ensure our use of resources (both our capital resource use and revenue resource use) does not exceed the amount specified by NHS England for the financial year;

5.3.2 Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by NHS England; and

5.3.3 Publish an explanation of how the CCG spent any payment in respect of quality made to it by NHS England.38.

5.3.4 The CCG will discharge these duties by:

a) delegating delivery of these responsibilities to the Chief Finance Officer and the Governing Body with regard to performance and the in-year financial position and year end forecasts;

b) delegating responsibility to the Audit and Governance Committee, tasking it to ensure the CCG delivers its responsibilities with regard to our conduct of public

37 See section 14Z1 of the 2006 Act

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business, and the funds under its control. In particular the Committee will seek to provide assurance to the CCG Governing Body on at least an annual basis that an appropriate system of internal control is in place to ensure that:

i. business is conducted in accordance with the law and proper standards; ii. public money is safeguarded and properly accounted for; iii. financial statements are prepared in a timely fashion, and give a true and

fair view of the financial position of the group; iv. affairs are managed to secure economic, efficient and effective use of

resources; v. reasonable steps are taken to prevent and detect fraud and other

irregularities.

c) having regard to any guidance or requirements published by NHS England.

5.4 Other Relevant Regulations, Directions and Documents

5.4.1 The CCG will:

a) comply with all relevant regulations;

b) comply with directions issued by the Secretary of State for Health or NHS England; and

c) take account, as appropriate, of documents issued by NHS England.

5.4.2 The CCG will develop and implement the necessary systems and processes to comply with national regulations and directions, setting out a scheme of reservation and delegation, relevant group policies and procedures as required.

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6. THE GOVERNING STRUCTURE

6.1 Authority to act: the CCG

6.1.1 The CCG may grant authority to act on its behalf to:

a) any of its Members or employees;

b) its Governing Body, or

c) a Committee or sub-committee of the CCG.

6.2 Authority to act: the Governing Body

6.2.1 The Governing Body may grant authority to act on its behalf to:

a) any Member of the Governing Body;

b) a committee or sub-committee of the Governing Body;

c) a Member of the CCG who is an individual (but not a Member of the Governing Body); and

d) any other individual who may be from outside the organisation and who can provide assistance to the CCG in delivering functions.

6.2.2 The Governing Body is accountable to the Members for the exercise of its functions, primarily through the Locality governance system. Locality arrangements are set out in more detail in the CCG Handbook.

6.3 Scheme of Reservation and Delegation

6.3.1 The CCG’s Scheme of Reservation and Delegation sets out:

a) those decisions that are reserved for the membership as a whole;

b) those decisions that are the responsibilities of the CCG Governing Body and its Committees, individuals.

6.3.2 The CCG remains accountable for all of its functions, including those that it has delegated.

6.3.3 Those functions of the CCG which have not been retained as reserved by either the CCG or the Governing Body shall be exercised as set out in the Scheme of Reservation and Delegation.

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6.3.4 The Chief Executive may periodically propose amendments to the Scheme of Reservation and Delegation, which shall be considered and approved by the Governing Body unless:

a) Changes are proposed to the reserved powers;

b) At least half (50%) of all the Governing Body Member Representatives (including the Chair) formally request that the amendments be put before the membership for approval.

6.4 General

6.4.1 In discharging functions of the CCG that have been delegated such arrangements must:

a) comply with the CCG’s principles of good governance;

b) operate in accordance with the CCG’s Scheme of Reservation and Delegation;

c) comply with the CGG’s Standing Orders and other procedural documents;

d) comply with the CCG’s arrangements for discharging its statutory duties;

e) where appropriate and required by the Constitution, ensure that Member practices have had the opportunity to contribute.

6.4.2 When discharging their delegated functions, Committees and Sub-Committees must also operate in accordance with their approved terms of reference.

6.4.3 Where delegated responsibilities are being discharged collaboratively, the collaborative arrangements, whether formal joint working or informal collaboration, must:

a) identify the roles and responsibilities of those Clinical Commissioning Groups or other partner organisations that have agreed to work together;

b) specify how performance will be monitored and assurance provided to the Governing Body on discharge of responsibilities and enable the Governing Body to have appropriate oversight as to how system integration and strategic intentions are being implemented;

c) identify any pooled budgets and how these will be managed and reported in annual accounts;

d) specify under which Clinical Commissioning Group’s supporting policies the collaborative working arrangements that will operate;

e) specify how the risks associated with the collaborative working arrangement will be managed between the respective parties;

f) identify how disputes will be resolved and the steps required to terminate the working arrangements;

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g) specify how decisions are communicated to the collaborative partners.

6.5 Committees and Sub-Committees

6.5.1 The CCG may establish Committees and Sub-Committees of the CCG.

6.5.2 The Governing Body may establish Committees and Sub-Committees.

6.5.3 Each Committee and Sub-Committee established by either the CCG or the Governing Body operates under terms of reference and membership agreed by the CCG or Governing Body as relevant. Appropriate reporting and assurance mechanisms must be developed as part of agreeing terms of reference for Committees and Sub-Committees.

6.5.4 Any Sub-Committees established will assist with the delivery of the CCG responsibilities or, in the case of the Governing Body, its delegated responsibilities and to progress its work as appropriate. Such Sub-Committees do not have executive powers, unless this has been agreed in advance by the CCG or the Governing Body.

6.5.5 Any Committee or Sub-Committee established in accordance with clause 6.5 may consist of or include persons other than Members or employees of the CCG.

6.5.6 Committees (including joint Committees established under clause 6.7 below) and Sub-Committees established by the CCG or the Governing Body may operate on a committees-in-common basis with one or more other CCG or other partner organisation. Where such arrangements are put in place, the terms of reference must ensure that the statutory responsibilities of each party are maintained.

6.5.7 The CCG has established a system of Locality governance through which the Membership provide strategic direction on commissioning and through which the Governing Body is accountable. Locality arrangements are set out in more detail in the CCG Handbook.

6.6 Committees of the Governing Body

6.6.1 The Governing Body will maintain the following statutory or mandated Committees:

a) Audit & Governance Committee. This Committee is accountable to the Governing Body and provides the Governing Body with an independent and objective view of the CCG’s compliance with its statutory responsibilities. The Committee is responsible arranging appropriate internal and external audit. The Committee will be chaired by the CCG’s Independent Lay Member for Governance;

b) Remuneration & Nominations Committee. This Committee is accountable to the Governing Body and makes recommendations to the Governing Body about the remuneration, fees and other allowances (including pension schemes) for employees and other individuals who provide services to the CCG. The Committee will be chaired by the CCG’s Clinical Chair; and

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c) Primary Care Commissioning Committee, which is required by the terms of its delegation from NHS England in relation to primary care commissioning functions. The Primary Care Commissioning Committee reports to NHS England and the Governing Body and is chaired by the CCG’s Independent Lay Member for Public and Patient Participation.

6.6.2 Each of the above Committees may operate as Committees-in-common with the Committees of NHS Sandwell & West Birmingham CCG, in accordance with section 0 above. The Primary Care Commissioning Committee and any other Committee established to discharge delegated functions on behalf of NHS England is not able to operate as a joint committee.

6.6.3 The terms of reference for each of the above Committees are included as Appendices to the Constitution. The overall governance architecture and terms of reference for any additional Committees and Sub-Committees established by the Governing Body are listed and details set out in the CCG Handbook.

6.6.4 The Governing Body has also established a number of other Committees to assist it with the discharge of its functions. At the time of the CCG being established, these Committees are:

Commissioning Investment and Disinvestment Committee: acts as a focal point for investment and disinvestment decisions associated with all case for change proposals.

Finance and Performance Committee: provides assurance to the Governing Body on all areas of finance and performance.

Quality and Safety Committee: provides assurance to the Governing Body on all areas of quality and safety; in particular, that the services commissioned by the CCG are safe, effective and provided in accordance with strategy, local and national standards.

6.6.5 Further information about these Committees, including terms of reference, is included in the CCG Handbook. Over time, the CCG’s Committee and Sub-Committee structure will evolve, in accordance with the powers and process set out in the Constitution. The CCG Handbook will be kept under regular review to ensure that the operational structure is accurate.

6.7 Joint Commissioning Arrangements

6.7.1 The CCG may wish to work jointly with its partner organisations. The following provisions set out the framework that will apply to such arrangements. In addition to the formal mechanisms envisaged below, the Governing Body may enter into strategic or other transformation discussions with its partner organisations, on behalf of the CCG. The Governing Body must ensure that appropriate reporting and assurance mechanisms are developed as part of any partnership or other collaborative arrangements. This should include

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reporting arrangements to the Governing Body, at appropriate intervals;

engagement events or other review session to consider the aims, objectives, strategy and progress of the arrangements; and

progress reporting against identified objectives.

(A): Joint Commissioning Arrangements with Local Authority Partners

6.7.2 The CCG will work in partnership with Birmingham City Council, Solihull Metropolitan Borough Council and its other Local Authority partners to reduce health and social inequalities.

6.7.3 Partnership working between the CCG, its Local Authority partners might include collaborative commissioning arrangements, including joint commissioning under section 75 of the 2006 Act, where permitted by law. In this instance, the CCG empowers the Governing Body to make arrangements with one or more relevant Local Authority in respect of:

Delegating any of the CCG’s commissioning functions to the Local Authority as permitted by law;

Exercising any of the commissioning functions jointly with the Local Authority as permitted by law.

6.7.4 For purposes of the arrangements described in 6.6.3, the Governing Body may:

Agree formal and legal arrangements to make payments to, or receive payments from the Local Authority, or pool funds for the purpose of joint commissioning;

Make the services of its employees or any other resources available to the Local Authority; and

Receive the services of the employees or the resources from the Local Authority.

Where the Governing Body makes an agreement with one or more Local Authority as described above, the agreement will set out the arrangements for joint working, including details of:

How the parties will work together to carry out their commissioning functions;

The duties and responsibilities of the parties; How risk will be managed and apportioned between the parties;

Financial arrangements, including payments towards a pooled fund and management of that fund;

Contributions from each party, including details of any assets, employees and equipment to be used under the joint working arrangements; and

The liability of the CCG to carry out its functions, notwithstanding any joint arrangements entered into.

6.7.5 The responsibility of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to this clause.

(B): Joint Commissioning Arrangements – Other CCGs

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6.7.6 The CCG may wish to work together with other Clinical Commissioning Groups in the exercise of its Commissioning Functions. The CCG delegates its powers and duties under 6.7 B to the Governing Body and all references in this part to the CCG should be read as the Governing Body, except to the extent that they relate to the continuing liability of the CCG under any joint arrangements.

6.7.7 The CCG may make arrangements with one or more Clinical Commissioning Groups in respect of:

Delegating any of the CCG’s commissioning functions to another Clinical Commissioning Group;

Exercising any of the Commissioning Functions of another Clinical Commissioning Group; or

Exercising jointly the Commissioning Functions of the CCG and another Clinical Commissioning Group

6.7.8 For the purposes of the arrangements described at 6.7.7, the CCG may:

Make payments to another Clinical Commissioning Group;

Receive payments from another Clinical Commissioning Group; or

Make the services of its employees or any other resources available to another Clinical Commissioning Group; or

Receive the services of the employees or the resources available to another Clinical Commissioning Group.

6.7.9 Where the CCG makes arrangements which involve all the CCGs exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions.

6.7.10 For the purposes of the arrangements described above, the CCG may establish and maintain a pooled fund made up of contributions by any of the Clinical Commissioning Groups working together jointly pursuant to paragraph 0 above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.7.11 Where the CCG makes arrangements with another Clinical Commissioning Group as described at paragraph 0 above, the CCG shall develop and agree with that Clinical Commissioning Group an agreement setting out the arrangements for joint working including details of:

How the parties will work together to carry out their commissioning functions;

The duties and responsibilities of the parties;

How risk will be managed and apportioned between the parties;

Financial arrangements, including payments towards a pooled fund and management of that fund;

Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

6.7.12 The responsibility of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 0 above.

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6.7.13 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 0 above.

6.7.14 The CCG will also reflect any further guidance on joint commissioning within our Constitution.

6.7.15 Only arrangements that are safe and in the interests of patients registered with Member practices will be approved by the Governing Body.

6.7.16 The Governing Body shall require, in all joint commissioning arrangements, that the lead Governing Body Member for the joint arrangements:

make a quarterly written report to the Governing Body;

hold at least one annual engagement event to review the aims, objectives, strategy and progress of the joint commissioning arrangements; and

publish an annual report on progress made against objectives.

6.7.17 Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year.

(C): Joint commissioning arrangements with NHS England for the exercise of CCG functions

6.7.18 The CCG may wish to work together with NHS England in the exercise of its commissioning functions. The CCG delegates its powers and duties under 6.7 C to the Governing Body and all references in this part to the CCG should be read as the Governing Body, except to the extent that they relate to the continuing liability of the CCG under any joint arrangements.

6.7.19 The CCG and NHS England may make arrangements to exercise any of the CCG’s commissioning functions jointly.

6.7.20 The arrangements referred to in paragraph 0 above may include other CCGs.

6.7.21 Where joint commissioning arrangements pursuant to 0 above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question.

6.7.22 Arrangements made pursuant to 0 above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG.

6.7.23 Where the CCG makes arrangements with NHS England (and another CCG if relevant) as described at paragraph 6.7.19 above, the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of:

How the parties will work together to carry out their commissioning functions;

The duties and responsibilities of the parties;

How risk will be managed and apportioned between the parties;

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Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund;

Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements; and

6.7.24 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 6.7.19 above.

6.7.25 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning.

6.7.26 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body.

6.7.27 The Governing Body of the CCG shall require, in all joint commissioning arrangements that the lead Governing Body Member for the joint arrangements make;

make a quarterly written report to the Governing Body;

hold at least one annual engagement event to review the aims, objectives, strategy and progress of the joint commissioning arrangements; and

publish an annual report on progress made against objectives.

6.7.28 Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

(D): Joint commissioning arrangements with NHS England for the exercise of NHS England’s functions

6.7.29 The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specified NHS England functions. The CCG delegates its powers and duties under 6.6 D to the Governing Body and all references in this part to the CCG should be read as the Governing Body, except to the extent that they relate to the continuing liability of the CCG under any joint arrangements.

6.7.30 The CCG may enter into arrangements with NHS England and, where applicable, other CCGs to:

Exercise such functions as specified by NHS England under delegated arrangements;

Jointly exercise such functions as specified with NHS England.

6.7.31 Where arrangements are made for the CCG and, where applicable, other CCGs to exercise functions jointly with NHS England a joint Committee may be established to exercise the functions in question. For the avoidance of doubt, this provision does not apply to any functions fully delegated to the CCG by NHS England, including but not limited to those relating to primary care commissioning.

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6.7.32 Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties.

6.7.33 For the purposes of the arrangements described at paragraph 0 above, NHS England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.7.34 Where the CCG enters into arrangements with NHS England as described at paragraph 0 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of:

How the parties will work together to carry out their commissioning functions;

The duties and responsibilities of the parties;

How risk will be managed and apportioned between the parties;

Financial arrangements, including payments towards a pooled fund and management of that fund;

Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

6.7.35 The liability of NHS England to carry out its functions will not be affected where it and the CCG enter into arrangements pursuant to paragraph 0 above.

6.7.36 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning.

6.7.37 Only arrangements that are safe and in the interests of patients registered with Member practices will be approved by the Governing Body.

6.7.38 The Governing Body of the CCG shall require that all joint Committees of the CCG:

make a quarterly written report to the Governing Body

hold at least one annual engagement event to review the aims, objectives, strategy and progress of primary care commissioning; and

publish an annual report on progress made against objectives.

6.7.39 Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

6.8 The Governing Body

6.8.1 The Governing Body has the following statutory functions38 together with any other functions connected with its main functions as may be specified in regulations or in this Constitution.39 The Governing Body has responsibility for:

38 See sections 14L(2) and (3) of the 2006 Act

39 See section 14L(3)(c) of the 2006 Act

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a) ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the groups principles of good governance40 (its main function);

b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme established pursuant to the powers set out in paragraph 11 of Schedule 1A of the 2006 Act;

c) approving any functions of the CCG that are specified in regulations;41

d) leading the development of vision and strategy for the CCG;

e) overseeing and monitoring quality improvement;

f) approving the CCG’s Commissioning Plans and its consultation arrangements;

g) stimulating innovation and modernisation;

h) overseeing and monitoring performance;

i) overseeing risk assessment and securing assurance actions to mitigate identified strategic risks.

j) promoting a culture of strong engagement with patients, their carers, Members, the public and other stakeholders about the activity and progress of the CCG;

k) ensuring good governance and leading a culture of good governance throughout the CCG.

6.8.2 The Governing Body members are:

a) The Clinical Chair (directly elected by Member practices and annually endorsed by Members of the Governing Body);

b) Lay Vice Chair;

c) One Member Representative from each of the 6 localities, each of whom must be a GP working in clinical practice. Member Representatives are directly elected by Member practices;

d) Chief Executive (appointed);

e) Chief Finance Officer (appointed);

f) Chief Nursing Officer (appointed);

40 See section 4.6 on Principles of Good Governance above

41 See section 14L(5) of the 2006 Act

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g) Chief Medical Officer (appointed)

h) Secondary Care Specialist;

i) Four additional Independent Lay Members each having specific responsibilities as listed in section 7.8.1, and one further Independent Lay Member to support the first year of the CCG’s transition,

6.8.3 Each Member listed above will have one vote, with the Chair having the casting vote if required.

6.8.4 The CCG Governing Body may invite or co-opt such other person(s) to attend all or any of its meetings, or part(s) of a meeting, in order to assist it in its decision-making and in its discharge of its functions as it sees fit. Any such person may speak and participate in debate, but may not vote.

6.8.5 The CCG Governing Body will regularly invite the following individuals to attend any or all of its meetings as attendees:

a) Director of Organisational Development and Partnerships;

b) Director of Integration;

c) Director of Planning and Performance;

d) GP representative from Sandwell and West Birmingham CCG.

e) A Director of Public Health representative on behalf of the Local Authorities.

6.9 Elections to the Governing Body

6.9.1 The process governing the election of the Chair, and Governing Body Member Practice Representatives onto the CCG Governing Body and the appointment procedure for other Governing Body Members is set out in the Standing Orders.

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7. ROLES AND RESPONSIBILITIES

7.1 Member Practices

7.1.1 CCGs are clinically led membership organisations made up of general practices. The CCG is therefore constituted and empowered by its Membership.

7.1.2 The CCG has developed a Locality Governance system to ensure that all Member practices are involved and are able to participate in decision-making through the Governing Body Member Practice Representatives.

7.1.3 We expect our Member Practices to meet the following standards:

a) to be involved in shaping the CCGs mission, vision, values and objectives;

b) to uphold the CCG’s mission, vision and values;

c) to support delivery of the objectives of the CCG;

d) to act in good faith and in accordance with the Nolan Principles; and

e) to understand and comply with the CCG Standing Orders, Prime Financial Policies and other key policies when carrying out activities on behalf of the CCG.

7.2 Practice Representatives

7.2.1 Each Member practice is required to nominate a commissioning lead who must be a clinician to represent their practice’s views on commissioning to the CCG.

7.3 Locality Structure

7.3.1 The CCG will maintain a Locality structure, consisting of 6 Localities based on Parliamentary constituencies.

7.3.2 Each Locality will return an elected Member Practice Representative to the Governing Body. The process for elections is set out in the Standing Orders and supplemented by the CGC Handbook.

7.3.3 Each Locality can determine its own local governance arrangements, provided that they are consistent with the principles set out in the CCG Handbook.

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7.4 The Role of Members of the Governing Body

7.4.1 Guidance on the roles of Members of the Governing Body is set out in national guidance42, individual Governing Body Member job descriptions and in the CCG Handbook.

7.4.2 In summary, each Member of the Governing Body, whether appointed or elected, should share responsibility as part of a team to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this Constitution. Each Member brings their unique perspective, informed by their expertise and experience. In the CCG this is interpreted as, but is not limited to:-

a) demonstrating commitment to continuously improving outcomes, tackling health inequalities and delivering the best value for money for the taxpayer, in line with the CCG’s vision and values;

b) demonstrating commitment to clinical commissioning and to the wider interests of the health services;

c) a commitment to ensuring that the Governing Body is effective, including the ability to providing purposeful, constructive scrutiny and challenge;

d) bringing a sound understanding of the NHS principles and values as set out in the NHS Constitution;

e) demonstrating a commitment to upholding the Nolan Principles of Public Life along with an ability to reflect them in his/her leadership role and the culture of the CCG;

f) a commitment to ensuring that the organisation values diversity and promotes equality in all aspects of its business.

7.5 The Chair of the Governing Body

7.5.1 The Chair of the Governing Body, as Clinical Leader of the CCG is responsible for:

a) leading the Governing Body, ensuring it remains continuously able to discharge its duties and responsibilities as set out in this Constitution;

b) developing the Governing Body, agreeing individual objectives of all Members of the Governing Body and monitoring progress;

c) developing the membership of the CCG;

42 Clinical Commissioning Groups CCG Governing Body Members : Role Outlines Attributes and Skills, NHS

England, April 2012

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d) ensuring that the group has proper Constitutional and governance arrangements in place and that high standards of governance and probity prevail across all aspects of the CCG’s work;

e) ensuring that, through the appropriate support, information and evidence, the CCG Governing Body is able to discharge its duties;

f) securing the services of an effective management team to support the work of the CCG;

g) supporting the Chief Executive in discharging the responsibilities of the organisation;

h) contributing to building and enacting a shared vision of the aims, values and culture of the organisation;

i) leading and influencing to achieve clinical and organisational change to enable the group to deliver its commissioning responsibilities;

j) overseeing governance and particularly ensuring that the Governing Body and the wider group behaves with the utmost transparency and responsiveness at all times;

k) ensuring that public and patients’ views are heard and their expectations understood and, where appropriate as far as possible, met;

l) ensuring that the organisation is able to account to its local patients, stakeholders and NHS England;

m) forming and sustaining relationships and partnerships needed for effective delivery of the CCG’s aims;

7.6 The Lay Vice-Chair of the Governing Body

7.6.1 The Lay Vice-Chair of the Governing Body will be a Lay person and will deputise for the Chair of the CCG Governing Body when the Chair has a conflict of interest or is otherwise unable to act. The Lay Vice-Chair is equally responsible with the Chair for ensuring that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this Constitution. The Lay Vice-Chair will work closely with the Chair to ensure that the CCG remains continuously able to discharge its duties and responsibilities, as set out in this Constitution. The full job-description for the Lay Vice-Chair role is set out in the CCG Handbook.

7.7 Elected Governing Body Member Practice Representatives

7.7.1 The Governing Body has six positions for Member Practice Representatives, elected by their peers. One representative will be elected from each Locality. The elected Member Practice Representatives are in addition to the Chair.

7.7.2 In addition to their general duties as Members of the Governing Body, these Member Practice Representatives will:

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a) represent the views and opinions of Member practices, promoting effective communication between the Membership and the Governing Body;

b) actively seek the views of Members and their patients to better inform and shape the clinical commissioning strategy and account for delivery; ;

c) Chair Locality Group meetings and be accountable for ensuring that Locality functions are delivered;

d) Actively engage with Member practices, primarily through Locality Group meetings;

e) Support Member practices.

7.8 Role of Independent Lay Members

7.8.1 The Governing Body has four Independent Lay Members, in addition to the Lay Vice-Chair and the Independent Lay Member supporting the first year of the CCG’s transition. Each Independent Lay Member has role-specific responsibilities in addition to their general role as Members of the Governing Body. The Independent Lay Member roles and their key responsibilities are as follows:

Independent Lay Member (Patient and Public Engagement): oversees arrangements across the CCG that seek to ensure the patient voice is captured and changes in commissioning strategies are recommended to improve patient experience,

Independent Lay Member (Finance): ensures that the Governing Body and wider CCG behaves with probity and that there are appropriate systems of control, scrutiny and assurance in place for all aspects of financial control and management. Also seeks assurance that appropriate arrangements are in place to support staff to speak up and that their concerns are taken seriously and managed appropriately.

Independent Lay Member (Governance): oversee key elements of governance, including audit, remuneration and managing conflicts of interest. The Lay Member (Governance) will act as the CCG’s Conflict of Interest Guardian and, in that capacity, wll have a key role in supporting the rigorous application of conflict of interest principles and policies as set out in NHS England’s statutory guidance Managing Conflicts of Interest: Revised Statutory Guidance for CCGs (June 2016).

The fourth Independent Lay Member will provide support as required to the Governing Body.The Independent Lay Member supporting transition will assist with the first year of the CCG’s establishment, as required.

7.9 Secondary Care Specialist

7.9.1 The Secondary Care Specialist brings to the Governing Body a broader view on health and care issues to underpin the work of the CCG.

7.9.2 In particular, they will bring to the Governing Body an understanding of patient care in the secondary care setting and provide an understanding of how secondary care

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providers work within the health system to bring appropriate insight to discussions regarding service re-design, clinical pathways and system reform.

7.10 Role of the Chief Executive

7.10.1 The Chief Executive is a Member of the Governing Body.

7.10.2 This role of the Chief Executive43 is:

a) to take responsibility for ensuring that the CCG fulfils its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money;

b) to ensure that, at all times, requirements with regard to regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems.

c) to work closely with the Chair of the Governing Body, to ensure that proper Constitutional, governance and development arrangements are put in place to assure the Members (through the Governing Body) of the organisation’s on-going capability and capacity to meet its duties and responsibilities. This will include arrangements for the on-going developments of its Members and staff.

7.10.3 The Chief Executive is the CCG’s statutory Accountable Officer who is accountable to both the Governing Body and to NHS England.

7.11 Role of the Chief Finance Officer

7.11.1 The Chief Finance Officer is a Member of the Governing Body and is responsible for providing financial advice to the CCG and for supervising financial control and accounting systems

7.11.2 This role of Chief Finance Officer44 is:

a) to provide professional expertise with regard to finance to the Governing Body and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged;

b) making appropriate arrangements to support and monitor the CCG’s finances;

43 Clinical Commissioning Groups CCG Governing Body Members: Role Outlines, Attributes and Skills NHS

England April 2012

44 Clinical Commissioning Groups CCG Governing Body Members: Role Outlines, Attributes and Skills NHS England April 2012

41

c) overseeing robust audit and governance arrangements leading to propriety in the use of the CCG’s resources;

d) advising the Governing Body on the effective, efficient and economic use of the CCG’s allocation to remain within that allocation and deliver required financial targets and duties; and

e) producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to NHS England.

7.12 Role of the Chief Nursing Officer

7.12.1 The Chief Nursing Officer is an appointed Member of the Governing Body, responsible for leading on all issues relating to safeguarding, quality and patient safety and has the responsibility to:

a) work with clinical colleagues in the wider health and social care economy to develop quality standards for commissioning of services which are informed by the views of current and future service users, evidence based research and value for money.

b) provide professional leadership and clinical support to the CCG, including the practice nurse workforce, engaging them and acting as a conduit to the Governing Body to ensure that the voice of nurses is heard and acted on by the CCG.

c) assure the Governing Body that integrated governance arrangements are robust and that services are commissioned to provide high quality responsive and efficient services for patients and communities, improving the outcomes of individuals.

d) hold Governing Body level accountability for the Infection Prevention and Control role, responsible and accountable to the Governing Body, for all matters relating to Healthcare Associated Infection prevention and control as a commissioner.

e) hold Governing Body level accountability and provide CCG management leadership for the safeguarding of children and vulnerable adults, working with the local safeguarding Governing Bodies and ensuring that the accountability arrangement between the CCG and the Governing Bodies is delivered effectively.

7.13 Chief Medical Officer

7.13.1 The Chief Medical Officer (CMO) will be a practicing GP, with responsibility for GPs, Quality and Safety, providing strategic clinical and professional leadership to support decisions made by the Governing Body.

7.13.2 The CMO will lead on the development and delivery of robust systems for identifying, investigating and managing any areas of concern in the delivery of clinical services and ensuring that remedial plans are developed and implemented to ensure patient safety. The CMO is also responsible for developing, delivery and overseeing the clinical leadership work of the CCG and will work closely with the Chief Nursing Officer.

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7.14 The Director of Public Health Representative

7.14.1 A mutually agreed Director or Public Health representative from the Public Health Department of the Local Authorities will be invited to attend meetings of the Governing Body as a non-voting attendee.

7.15 Joint Appointments with Other Organisations

7.15.1 The Governing Body is authorised to make joint appointments with other organisations as appropriate.

7.15.2 All these joint appointments will be supported by an agreement between the organisations that are party to these joint appointments.

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8. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST

8.1 Standards of Business Conduct

8.1.1 Employees, members, committee and sub-committee members of the CCG and members of the Governing Body (and its committees, sub-committees, joint committees) will at all times comply with this Constitution and be aware of their responsibilities as outlined in it. They should act in good faith and in the interests of the CCG and should follow the Seven Principles of Public Life; set out by the Committee on Standards in Public Life (the Nolan Principles) The Nolan Principles are incorporated into this constitution at Appendix G.

8.1.2 They must comply with the CCG’s Standards of Business Conduct, including the requirements set out in the policy for managing conflicts of interest. This policy will be available on the CCG’s website at www.birminghamandsolihullccg.nhs.uk and will be made available on request.

8.1.3 Individuals contracted to work on behalf of the CCG or otherwise providing services or facilities to the CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services and is also outlined in the CCG’s Standards of Business Conduct policy.

8.2 Conflicts of Interest

8.2.1 As required by section 14O of the 2006 Act, the CCG will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the CCG will be taken and seen to be taken without any possibility of the influence of external or private interest.

8.2.2 Where an individual (see 8.1 above) , including any individual directly involved with the business or decision-making of the CCG and not otherwise covered by one of the categories in 8.1 above, has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this constitution and the Standards of Business Conduct Policy.

8.2.3 If in doubt, the individual concerned should assume that a potential conflict of interest exists.

8.3 Declaring and Registering Interests

8.3.1 The CCG will maintain one or more registers of the interests of those individuals listed in the CCG’S Standards of Business Conduct Policy.

8.3.2 As a minimum, CCGs should publish the registers of conflicts of interest and gifts and hospitality of decision making staff at least annually in a prominent place on the Group’s

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website at www.birminghamandsolihullccg.nhs.uk and make them available at their headquarters upon request.

8.3.3 Individuals will declare any interest that they have, in relation to a decision to be made in the exercise of the commissioning functions of the CCG, in writing to the Governing Body, as soon as they are aware of it and in any event no later than 28 days after becoming aware.

8.3.4 All relevant persons for the purposes of NHS England’s statutory guidance for CCG’s Managing Conflicts of Interest in the NHS: Guidance for staff and organisations must declare any interests. Declarations should be made as soon as reasonably practicable and by law within 28 days after the interest arises. This could include interests an individual is pursuing.

8.3.5 The CCG will ensure that, as a matter of course, declarations of interest are made and

confirmed or updated at least annually. All persons required to, must declare any interests as soon as reasonable practicable and by law within 28 days after the interest arises.

8.3.6 Interests (including gifts and hospitality) of decision making staff should remain on the public register for a minimum of six months. In addition the CCG must retain a record of historic interests and offers/receipt of gifts and hospitality for a minimum of 6 years after the date on which it expired. The CCG’s published register of interests should state that historic interests are retained by the CCG for the specified timeframe and details of whom to contact to submit a request for this information.

8.4 Managing Conflicts of Interest: general

8.4.1 All individuals as per 8.1 above will comply with the arrangements determined by the CCG for managing conflicts or potential conflicts of interest.

8.4.2 The Chief Executive will ensure that for every interest declared, either in writing or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the CCG’s decision making processes.

8.4.3 The CCG manages conflicts of interest of in line with statutory guidance, as outlined in its Standards of Business Conduct Policy available on its website at www.birminghamandsolihullccg.nhs.uk

8.5 Transparency in Procuring Services

8.5.1 The CCG recognises the importance in making decisions about the services it procures in a way that does not call into question the motives behind the procurement decision that has been made. The CCG will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

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8.5.2 The CCG will publish a Procurement Strategy approved by its Governing Body which will ensure that:

8.5.3 All relevant clinicians (not just members of the CCG) and potential providers, together with local members of the public are engaged in the decision-making processes used to procure services.

8.5.4 Service redesign and procurement processes are conducted in an open, transparent, non-discriminatory and fair way.

8.5.5 Copies of this Procurement Strategy will be available on the CCG’s website at www.birminghamandsolihullccg.nhs.uk and will be made available on request.

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9. THE CCG AS EMPLOYER

9.1 The CCG recognises that our most valuable asset is our people. We will seek to enhance the skills and experience of the people who work for and with us and we are committed to their development in all ways relevant to the work of our CCG.

9.2 The CCG will seek to set an example of best practice as an employer and we are committed to offering all staff equality of opportunity. We will ensure that our employment practices are designed to promote diversity and to treat all individuals equitably.

9.3 The CCG will ensure that we employ suitably qualified and experienced staff who will discharge their responsibilities in accordance with the high standards expected of staff employed by us. All staff will be made aware of this Constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

9.4 The CCG will maintain and publish policies and procedures, as appropriate, on the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The CCG will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters. Matters relating to the recruitment and remuneration of staff will be managed in line with the Scheme of Reservation and Delegation.

9.5 The CCG will ensure that our rules for recruitment and management of staff provide for the appointment and advancement on merit, on the basis of equal opportunity for all applicants and staff.

9.6 The CCG will ensure that employees' behaviour reflects, as far as possible, the values, aims and principles set out above.

9.7 The CCG will ensure that it complies with all aspects of employment law.

9.8 The CCG will ensure, within the resources available and the needs of the organisation that its employees have access to such expert advice and training opportunities as are necessary in order to exercise their responsibilities effectively.

9.9 The CCG will maintain and promote effective 'whistleblowing' procedures to ensure that concerned staff have means through which their concerns can be voiced.

9.10 The CCG recognises and confirms that nothing in or referred to in this Constitution (including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any Member of the group, any Member of its Governing Body, any Member of any of its Committees or Sub-Committees or the Committees or Sub-Committees of its Governing Body, or any employee of the group or of any of its Members, nor will it affect the rights of any worker (as defined in that Act) under that Act. Copies of all relevant

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policies and procedures outlined in this chapter, will be available on the CCG’s website and by postal request to the CCG headquarters.

48

10. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS

10.1 General

10.1.1 The CCG will comply with the Information Commissioner Office requirements regarding the publication of information relating to the CCG.

10.1.2 The CCG will publish annually a Commissioning Plan and an annual report, presenting the CCG’s annual report to a public meeting.

10.1.3 Key communications issued by the CCG, including notices of procurements, public consultations, governing body meeting dates, times, venues, and certain papers will be published on the CCG’s website www.birminghamandsolihullccg.nhs.uk and in other forums as appropriate.

10.1.4 The CCG may use other means of communication, including circulating information by post, or making information available in venues or services accessible to the public.

10.2 Speaking, Writing or Acting in the name of the CCG

10.2.1 All communications by Members made in the name of the CCG must reflect the view of the Governing Body.

10.2.2 When views are sought at short notice the view agreed between at least any two of the following is deemed to be the view of the Governing Body: the Chair, the Vice-Chair and the Chief Executive. The view of one of these with the view of one other Member of the Governing Body is also deemed to be the view of the Governing Body.

10.2.3 Members are not restricted from giving personal views but it should be remembered that their views may be interpreted as the views of the CCG and Members should be clear that any personal view is not necessarily the view of the CCG.

10.3 Standing Orders, Scheme of Reservation and Delegation and Prime financial policies

10.3.1 This Constitution is also informed by a number of documents which provide further details on how the CCG will operate.

They are the CCG’s:

a) Standing orders – which sets out the arrangements for meetings and the appointment processes to elect the CCG’s representatives and appoint to the CCG’s Committees, including the CCG Governing Body;

b) The Scheme of Reservation and Delegation – sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the CCG Governing Body, the CCG Governing Body’s Committees and Sub-Committees, individual Members and employees;

49

c) Prime financial policies– which sets out the arrangements for managing the CCG’s financial affairs.

d) The CCG Handbook, which includes:

Standards of Business Conduct Policy – which sets out the arrangements the CCG has made for the management of conflicts of interest.

Committee terms of reference

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APPENDIX A

DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

2006 Act National Health Service Act 2006

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act)

Chief Executive An individual, fulfilling the role of Accountable Officer, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by NHS England, with responsibility for ensuring the group:

Complies with its obligations under:

sections 14Q and 14R of the 2006 Act (as inserted by section 26 of the 2012 Act),

sections 223H to 223J of the 2006 Act (as inserted by section 27 of the 2012 Act),

paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006 (as inserted by Schedule 2 of the 2012 Act), and

any other provision of the 2006 Act (as amended by the 2012 Act) specified in a document published by the Governing Body for that purpose;

Exercises its functions in a way which provides good value for money.

Annual Report An annual report to be approved by the CCG Governing Body each year – to report on achievement of the Objectives, key decisions taken by the Governing Body, performance against the CCG Annual Operating Plan for the previous Year and any recommended changes to the constitution – and which shall be published on the CCG website following the AGM for that Year.

Area The geographical area that the group has responsibility for, as defined in Chapter 2 of this constitution

Chair of the CCG Governing Body

The individual elected by Member practices to act as Chair of the CCG Governing Body

Chief Finance Officer (CFO)

The qualified accountant employed by the group with responsibility for financial strategy, financial management and financial governance

Clinical Commissioning Groups (CCG)

A body corporate established by NHS England in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act). In this Constitution, “CCG” means the Birmingham and Solihull CCG,

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Committee A Committee created and appointed by the Governing Body of the CCG or a sub-committee created or appointed by a Committee CCG Governing Body

Financial year This usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act, it can for the purposes of audit and accounts run from when a Clinical Commissioning Groups is established until the following 31 March

Governing Body The body appointed under section 14L of the NHS Act 2006, with the main function of ensuring that a Clinical Commissioning Group has made appropriate arrangements for ensuring that it complies with:

Its obligations under section 14Q under the NHS Act 2006 (as inserted by section 26 of the 2012 Act), and

Such generally accepted principles of good governance as are relevant to it.

Governing Body Member Any Member appointed to the Governing Body of the CCG

Healthcare Professional

A Member of a profession that is regulated by one of the following bodies:

the General Medical Council (GMC)

the General Dental Council (GDC)

the General Optical Council;

the General Osteopathic Council

the General Chiropractic Council

the General Pharmaceutical Council

the Pharmaceutical Society of Northern Ireland

the Nursing and Midwifery Council

the Health Professions Council

any other regulatory body established by an Order in Council under Section 60 of the Health Act 1999

Lay Member A lay Member of the CCG Governing Body, appointed by the CCG. A lay Member is an individual who is not a Member of the CCG or a healthcare professional (i.e. an individual who is a Member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations

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GB GP representative Governing Body GP Representatives are the intermediate tier between Member practices and the CCG board, with important roles relating to:

Providing a structure of support in which practices can work together, sharing knowledge, experience and good practice;

Enabling Member practices to understand and formulate their contribution to the aims and purpose of the CCG;

Providing an interface of commissioning decisions and communications to local Members

Engaging in a GP Leader’s Forum thereby ensuring an appropriate level of communication between the Governing Body and GPs as providers;

The opportunity to developing wider local partnerships with fellow health professionals, other stakeholders patients and the public

Local Medical Committee

LMCs are recognised by successive NHS Acts as the professional organisation representing individual GPs and GP Practices as a whole to the Primary Care Organisation

Member A provider of primary medical services to a registered patient list, who is a Member of this group (see tables in Appendix B). Member practices may appoint a clinician to act as their practice representative in dealings between it and the CCG, under regulations made under section 89 or 94 of the 2006 Act or directions under section 98A of the 2006 Act.

NHS England The operational name for the National Health Service Commissioning Board.

Registers of interests Registers a group is required to maintain and make publicly available under section 14O of the 2006 Act, of the interests of:

the Members of the group;

the Members of its CCG Governing Body;

the Members of its Committees or Committees and Committees or Committees of its CCG Governing Body; and

Its employees.

STP Sustainability and Transformation Partnerships – the framework within which the NHS and local authorities have come together to plan to improve health and social care over the next few years. STP can also refer to the formal proposals agreed between the NHS and local councils – a “Sustainability and Transformation Plan”.

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APPENDIX B: LIST OF MEMBER PRACTICES

CODE Constituency / Locality

PRACTICE NAME

M81062 South Frankley Health Centre

M85001 North SHAH ZAMAN SURGERY

M85005 East Park Medical Centre

M85006 Central GREENRIDGE SURGERY

M85007 South West Heath Road Medical Centre

M85008 East POOLWAY MEDICAL CENTRE (New address 15/09/17

M85011 East SWAN MEDICAL CENTRE

M85013 East CHURCH LANE - KHAN

M85014 North KINGSBURY ROAD MEDICAL CENTRE

M85016 West HILLCREST SURGERY (twickenham Road)

M85018 Central YARDLEY WOOD HEALTH CENTRE

M85021 South MOSELEY MEDICAL CENTRE

M85023 South MILLENNIUM MEDICAL CENTRE

M85024 West The Limes Medical Centre

M85025 South Bath Row Medical Practice

M85026 North ASHFIELD SURGERY

M85027 South LEACH HEATH MEDICAL CENTRE

M85028 South LORDSWOOD HOUSE GROUP MEDICAL PRACTICE (Lordswood House)

M85029 South GRANTON MEDICAL CENTRE

M85030 South St Heliers Medical Practice (DR ROSS AND PARTNERS)

M85031 East HARLEQUIN SURGERY

M85033 North MANOR PRACTICE

M85034 East OMNIA PRACTICE

M85035 South WOODGATE VALLEY HEALTH CENTRE

M85037 Central Kingsfield Medical Centre

M85038 North FOUR OAKS MEDICAL CENTRE

M85041 Central Bournbrook Varsity Medical Centre

M85042 Central Selly Park Surgery

M85043 South Hawkesley Medical Practice

M85046 North TUDOR SUTTON COLDFIELD

M85047 South Woodland Rd Surgery

M85048 Solihull Church Road Surgery

M85051 Central Firstcare Health Centre

M85052 South Dr Ali and Partners (Northfield Health Centre)

M85053 North ST.CLEMENTS SURGERY

M85055 Central Selly Oak Health Centre

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CODE Constituency / Locality

PRACTICE NAME

M85056 South Weoley Park Surgery

M85058 South Harborne Medical Practice

M85060 North THE OAKS MEDICAL CENTRE

M85061 East YARDLEY GREEN MEDICAL CTR

M85062 South SHENLEY GREEN SURGERY

M85063 South MMP-Eaton Wood Medical Centre

M85065 North POPLARS SURGERY

M85066 East WARD END MEDICAL CENTRE

M85068 North VESEY PRACTICE

M85070 North RESERVOIR ROAD SURGERY

M85071 South Wychall Lane Surgery

M85074 Central WAKE GREEN SURGERY

M85075 West Birmingham Heartlands Surgery

M85076 South Hollymoor Medical Centre

M85077 Central Northwood Medical Practice

M85078 Central Oakwood Surgery

M85079 East EDEN COURT MEDICAL PRACTICE

M85081 North DOVE MEDICAL PRACTICE

M85083 North LEY HILL SURGERY

M85084 South The Wand Medical Practice

M85086 South Cofton Medical Centre

M85087 North COLLEGE ROAD SURGERY

M85088 South Karis Medical Centre

M85092 Central GOODREST CROFT SURGERY

M85094 East YARDLEY MEDICAL CENTRE

M85097 East Cranes Park surgery

M85103 North SUTTON PARK SURGERY

M85105 East VICTORIA ROAD SURGERY

M85107 East FIRS SURGERY

M85108 West SMALL HEATH MEDICAL PRACTICE

M85110 East SALTLEY HEALTH CENTRE (Dr AC BAJPAI )

M85113 East BUCKLANDS END LANE SURGERY

M85115 North SUTTON ROAD SURGERY

M85116 Central Fernley Medical Centre

M85117 South BARTLEY GREEN MEDICAL PRACTICE

M85118 Central BALDWINS LANE SURGERY

M85123 West Al-Shafa Medical Centre

M85127 Central College Road Surgery

M85128 Central Balsall Heath Health Centre (W)

M85134 South West Heath PCC

55

CODE Constituency / Locality

PRACTICE NAME

M85136 Central Druids Heath Surgery

M85139 East ALPHA MEDICAL CENTRE

M85141 East SCHOOLACRE ROAD SURGERY

M85142 South KEYNELL COVERT

M85143 South JIGGINS LANE SURGERY

M85146 Central Khattak Memorial Surgery

M85149 East ALUM ROCK MEDICAL CENTRE

M85153 Central Weather Oak Medical Centre

M85154 West Lozells Medical practice

M85155 North KINGSTANDING CIRCLE SURGERY

M85156 Central Riverbrook Medical Centre

M85158 North APOLLO SURGERY

M85159 South BG Health (Bunbury Road)

M85167 South UNIVERSITY MEDICAL PRACTICE

M85170 East GATE MEDICAL CENTRE

M85171 East ROWLANDS ROAD SURGERY

M85172 South RIDGACRE HOUSE SURGERY

M85174 Central Sparkbrook Community & Health Centre

M85175 North HAWTHORNS SURGERY

M85177 Central SWANSWELL MEDICAL CENTRE

M85179 Central Maypole Health Centre (Yap)

M85600 South Kings Norton Surgery

M85624 North KINGSDALE AND PERRY PARK (Kingdale Surgery)

M85642 West Summerfield PCC

M85652 West Cavendish Medical Practice

M85669 North TUDOR STOCKLAND GREEN LTD

M85670 East GREENFIELD MEDICAL PRACTICE

M85671 Central Bournville Surgery

M85677 East FERNBANK MEDICAL PRACTICE

M85679 Central Charles Road Surgery

M85680 East COTTERILS LANE SURGERY

M85686 West Summerfield Family Practice (Dr Kulshretha)

M85689 South DOVECOTE SURGERY

M85693 Central FEATHERSTONE MEDICAL CENTRE

M85694 East GARRETTS GREEN LANE SURGERY

M85699 West HEATHFORD GROUP PRACTICE

M85701 West Burbury Medical Centre

M85706 East Druids Group

56

CODE Constituency / Locality

PRACTICE NAME

M85711 South City Health Centre

M85713 Central Highgate Medical Centre

M85716 North STOCKLAND GREEN PRACTICE

M85717 East DOWNSFIELD MEDICAL CENTRE

M85722 East NASEBY MEDICAL CENTRE

M85730 South Ley Hill surgery

M85732 North DR MCQUILLAN PRACTICE

M85733 Central Moor Green Lane MC

M85735 Central Greet Medical Practice

M85736 East ACOCKS GREEN MEDICAL CENTRE

M85739 East Pak Health Centre

M85746 East MIRFIELD SURGERY - SAHAY

M85749 East THE SURGERY

M85753 Central Vicarage Road Surgery

M85756 Central Springfield Medical Practice

M85759 West NECHELLS PRACTICE

M85766 Central Balsall Heath Health Centre (S)

M85770 East THE SHELDON PRACTICE

M85774 Central Springfield Surgery

M85776 East LEA VILLAGE MEDICAL CENTRE

M85779 North AYLESBURY PRACTICE

M85781 Central BORDESLEY GREEN SURGERY

M85782 Central University Southgate Practice

M85783 Central Strensham Road Surgery

M85792 North COTMORE SURGERY

M85794 Central The Balaji Surgery, Sparkbrook Community & Health Centre

M85803 East Pearl Medical Centre

M88006 West CAPE HILL MEDICAL CENTRE

M88020 South SHERWOOD HOUSE MEDICAL PRACTICE

M89001 Solihull Parkfield Medical Centre

M89002 Solihull Kingshurst Medical Practice

M89003 Solihull GPS Healthcare - Tanworth Lane

M89004 Solihull Haslucks Green Medical Centre

M89005 Solihull St Margaret's Medical Practice

M89007 Solihull Richmond Medical Centre

M89008 Solihull Bosworth Medical Centre

M89009 Solihull Manor House Lane Surgery

M89010 Solihull Dorridge Surgery

M89012 Solihull Croft Medical Centre

M89013 Solihull Arran Medical Centre

57

CODE Constituency / Locality

PRACTICE NAME

M89015 Central Northbrook Group Practice

M89016 Solihull Balsall Common and Meriden Group Practice

M89017 Solihull Bernays & Whitehouse Group Practice - Grove Surgery

M89019 Solihull Hobs Moat Medical Centre

M89021 Solihull Coventry Road Practice

M89024 Solihull Grafton Road Surgery

M89026 Solihull The Castle Practice

M89027 Solihull Green Lane Surgery

M89028 Solihull Monkspath Surgery

M89030 Solihull Arden Medical Centre

M89601 Solihull The Jacey Practice

M89602 Solihull Chester Road Surgery

M89608 Solihull Hampton Surgery

M91642 West Queslett Medical Centre

Y00075 South Grange Hill Surgery

Y00159 Central HALL GREEN HEALTH

Y01068 East AMAANAH MEDICAL PRACTICE

Y02567 East HODGE HILL FAMILY PRACTICE

Y02571 Central POPLAR PRIMARY CARE CENTRE

Y02794 East OAKLEAF MEDICAL PRACTICE

Y02893 East IRIDIUM MEDICAL PRACTICE, RICHMOND PCC

Y03597 East HAMD MEDICAL PRACTICE

Y05826 East The Hill General Practice

WESTERN BIRMINGHAM

The following table identifies practices which are within the Western Birmingham locality, but are members of NHS Sandwell and West Birmingham CCG. Similarly, this includes two practices within the central and one practice within the south localities, as identified below.

CODE Constituency / Locality

PRACTICE NAME

M85002 West (Sandwell) MODALITY Handsworth Wood Medical Centre

M85009 West (Sandwell) Hamstead Road Surgery

M85019 West (Sandwell) Tower Hill Partnership Medical Practice

M85020 West (Sandwell) RAYDOCS Newtown Health Centre

M85064 West (Sandwell) Five Ways Health Centre

M85069 West (Sandwell) MODALITY Laurie Pike Health Centre

M85072 West (Sandwell) MODALITY St James Medical Practice

M85082 West (Sandwell) Handsworth Medical Practice

58

CODE Constituency / Locality

PRACTICE NAME

M85085 Central (Sandwell) MODALITY Ann Jones Family HC

M85098 West (Sandwell) Rotton Park Medical Centre

M85100 West (Sandwell) MODALITY Shanklin House

M85124 South (Sandwell) MODALITY Bellevue Medical Practice

M85133 West (Sandwell) MODALITY Crompton Road Surgery

M85145 West (Sandwell) The Surgery, The Slieve

M85164 Central (Sandwell) Newport Medical Practice

M85176 West (Sandwell) Kirpal Medical Practice,Soho Health Centre

M85178 West (Sandwell) MODALITY Enki Medical Practice

M85611 West (Sandwell) MODALITY Attwood Green Health Centre (The Hyman Practice)

M85634 West (Sandwell) Heathfield Family Centre

M85663 West (Sandwell) Bloomsbury Health Centre

M85676 West (Sandwell) Victoria Road Medical Centre

M85684 West (Sandwell) City Road Medical Centre

M85697 West (Sandwell) Church Road Surgery

M85715 West (Sandwell) Soho Health Centre GP & Yellow Fever Travel Centre, Soho Health Centre

M85721 West (Sandwell) Holyhead Primary Healthcare Centre

M85757 West (Sandwell) Saini and Saini - Soho Medical Services, Soho Health Centre

M85778 West (Sandwell) Halcyon Medical Centre

M85797 West (Sandwell) Hockley Medical Practice

M85801 West (Sandwell) Holly Road Surgery

Y00412 West (Sandwell) Dr Bhalla's Practice, Soho Health Centre

Y00471 West (Sandwell) Broadway Health Centre

Y00492 West (Sandwell) Summerfield Group Practice

Y02961 West (Sandwell) Summerfield GP and Urgent Care Centre

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APPENDIX C: STANDING ORDERS

1. STATUTORY FRAMEWORK AND STATUS

1.1 Introduction

1.1.1 These standing orders have been drawn up to regulate the proceedings of the CCG so that it can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date the group is established.

1.1.2 The standing orders, together with the CCG scheme of reservation and delegation), the CCG’s prime financial policies and the CCG Handbook, provide a procedural framework within which the group discharges its business. They set out:

a) The arrangements for conducting the business of the CCG;

b) The appointment of Member practice representatives;

c) The procedure to be followed at meetings of the CCG, the Governing Body and any committees or sub-committees of the CCG or the Governing Body;

d) The process to delegate powers,

e) The declaration of interests and standards of conduct.

1.1.3 These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act and related regulations and take account as appropriate45 of any relevant guidance.

1.1.4 Employees, Members of the Governing Body, Members of the Governing Body’s Committees and sub-committees, and persons working on behalf of the CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the standing orders, scheme of reservation and delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal.

1.2 Schedule of matters reserved to the CCG and the scheme of reservation and delegation

1.2.1 The 2006 Act provides the CCG with the power to delegate its functions and those of the Governing Body to certain bodies (such as Committees) and certain persons. These decisions and also those delegated are contained in the group’s scheme of reservation and delegation with the CCG Handbook.

45 Under some legislative provisions the group is obliged to have regard to particular guidance but under other

circumstances guidance is issued as best practice guidance.

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2. THE CCG: COMPOSITION OF MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS

2.1 Composition of membership

2.1.1 Chapter 3 of the CCG’s Constitution provides details of the membership of the CCG.

2.1.2 Chapter 6 of the CCG’s Constitution provides details of the governing structure used in the CCG’s decision-making processes, whilst Chapter 7 of the Constitution outlines certain key roles and responsibilities within the Governing Body,

2.2 Key Roles

2.2.1 The Constitution sets out the composition of Governing Body and identifies certain key roles and responsibilities within the CCG and its Governing Body. These standing orders set out how the CCG appoints individuals to these key roles.

2.2.2 Where voting is used to fill Governing Body roles, a weighting system will be applied. Each Member practice will have 1 vote per 1,000 registered patients. When a practice is within 100 patients of the next threshold they will receive the additional vote. The expectation is that a discussion will take place within the practice before the votes are cast so that all salaried GPs and non GP partners are included in the decision, with the practice being viewed as the “Member”. There will be a single vote per CCG practice as constituted within the Locality. No split votes will be permitted, except as required to give effect to Locality arrangements, for example where a practice is located in more than one Locality.

2.2.3 The Chair is subject to the following election process:

a) Nominations i. Nominations will be sought from CCG Member practices.

b) Eligibility i. Any GP principal who is a partner of one of our Member practices may

nominate themselves to stand for election as Chair; ii. Self-nomination must be accompanied by statements of support provided

by two GP principals from two different Member practices (neither from the nominee’s practice);

iii. Nominees must complete the competency assessment for all Governing Body Members to the satisfaction of NHS England;

c) Election process i. The Chair will be elected by a majority of the votes cast by CCG Member

practices. In the event of a tie, a draw of equal chance will be held. ii. If only one individual is nominated, CCG Member practices will be asked to

endorse the candidate by way of a yes or no vote. The candidate who receives more than 50% of the votes cast will be considered to be elected as Chair.

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d) Term of office i. The initial maximum term for the Chair will be four years. Thereafter, the

term of office for the Chair will be three years, with the possibility of a fourth year with the support of the Governing Body. The Chair will have a maximum of two consecutive terms, unless the Membership vote to grant an additional term.

d) Eligibility for re-election

Re-election as Chair of the Governing Body by the CCG membership will depend on: i. An expression of interest to re-apply following completion of the preceding

term(s) to the satisfaction of the Governing Body, expressed by a majority vote of the Governing Body;

ii. Satisfactory completion of the competency re-assessment for all Governing Body Members.

f) Grounds for removal from office i. Gross misconduct, to be determined by the Governing Body, on the advice

of the Remuneration & Nomination Committee; ii. Being or becoming disqualified from office; iii. Not having or losing clinical registration; iv. Not attending Governing Body meetings for three months, unless in

extenuating circumstances; v. Failing to disclose a relevant interest; vi. Where continuation in the role is not in the interests of either the public or

the CCG.

g) Notice period i. A minimum of three months’ notice in writing to the Chief Executive and Lay

Vice Chair is required, if the Chair wishes to terminate his/her role. ii. Subject to 2.2.3(h)(iii) below, if the Governing Body or Members pass a vote

to remove the Chair, the Chair shall be given three months’ notice in writing. iii. In the event of gross misconduct, disqualification from office, or loss of

clinical registration, no such notice shall be required.

2.2.4 The Lay Vice Chair: a Lay Member will be appointed as Lay Vice Chair

a) Term of office i. One to three years, with the possibility of extension to a fourth year with the

support of the Governing Body. The Lay Vice Chair will have a maximum of two consecutive terms.

b) Eligibility for reappointment i. The Lay Vice Chair may nominate themselves to stand for re-appointment as

Lay Vice Chair ii. Completion of the preceding term(s) to the satisfaction of the CCG

Governing Body; iii. Satisfactory re-completion of the competency assessment for all Governing

Body Members.

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c) Grounds for removal from office

i. Gross misconduct, to be determined by the Governing Body, on the advice of the Remuneration Committee;

ii. Becoming disqualified from office; iii. Not attending Governing Body meetings for three months, unless in

extenuating circumstances; iv. Failing to disclose a relevant interest; v. Where continuation in the role is not in the interests of either the public or

the CCG.

d) Notice period

i. A minimum of three months’ notice in writing to the Chair is required is required, if the Lay Vice Chair wishes to terminate his/her role.

ii. Subject to 2.2.4(d)(iii) below, if the Governing Body or Members pass a vote to remove the Lay Vice Chair, the Lay Vice Chair shall be given three months’ notice in writing.

iii. In the event of gross misconduct, disqualification from office, or loss of clinical registration, no such notice shall be required.

2.2.5 The Member Practice Representatives are subject to the following election process to be a Member of the Governing Body:

a) Nominations i. Nominations will be sought from all practising GPs in CCG Member practices,

with one representative being sought for each Locality.

b) Eligibility i. Any GP providing or employed to perform, NHS primary medical services in

a CCG Member practice can nominate themselves. Any person who does nominate themselves for election will be representing the locality that their practice is currently located in and the practice will not be permitted to change their locality at a later date;

ii. Not a Member of another CCG Governing Body; iii. Ability to meet the competencies required of all Governing Body Members.

c) Election process

i. Self-nomination ii. Discussion with the Chair regarding the requirements of the role and the

suitability of the individual for the role; iii. Election by the locality CCG Membership. Voting may take place ‘virtually’,

depending on the process developed by the localities and detailed in the CCG Handbook.

iv. If only one individual is nominated, CCG Member practices will be asked to endorse the candidate by way of a yes or no vote. The candidate who receives more than 50% of the votes cast, after weighting as described in section 2.2.2 has been applied, will be considered to be elected as Chair.

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v. Where there is more than one candidate per locality, the membership will be asked to vote for their preferred candidate. The candidate with more than 50% of the votes cast will be appointed.

vi. In the event of a tie or no candidate achieving a majority of all votes cast, a draw of equal chance will be held.

vii. A modified version of this process will be used in West Birmingham for those practices within Sandwell & West Birmigham CCG,this is set out in the CCG handbook:

d) Term of office i. Terms will be on a staggered basis. The ordinary term will be for a three year

period with a one-year extension available by agreement with the Chair and support of the whole Governing Body. Member Practice Representatives will have a maximum of two consecutive terms, unless the Membership vote to grant an additional term.

e) Eligibility for re-election Re-election as a Governing Body Member by the CCG membership will depend on:

i. Completion of the preceding term(s) to the satisfaction of the Governing Body;

ii. Satisfactory re-completion of the competency assessment for all Governing Body Members.

f) Grounds for removal from office i. Gross misconduct, to be determined by the Governing Body, on the advice

of the Remuneration & Nominations Committee; ii. Becoming disqualified from office; iii. Not having or losing clinical registration; iv. Not attending Governing Body meetings for three months, unless in

extenuating circumstances; v. Failing to disclose a relevant interest; vi. Where continuation in the role is not in the interests of either the CCG.

g) Notice period i. A minimum of three months’ notice in writing to the Chair is required, if the

representative wishes to terminate his/her role. ii. Subject to 2.2.5(g)(iii) below, if the Governing Body or Members pass a vote

to remove the representative, the representative shall be given three months’ notice in writing.

iii. In the event of gross misconduct, disqualification from office, or loss of clinical registration, no such notice shall be required.

2.2.6 All formally appointed employees will be managed in line with Terms & Conditions of NHS Employment and therefore subject to performance management processes.

2.2.7 The Chief Executive will be an employee of the CCG, appointed by NHS England.

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2.2.8 The Chief Finance Officer, and Chief Nursing Officer, and Chief Medical Officer are subject to the following appointment process:

a) Nominations, Eligibility & Appointment process i. This appointment will be subject to NHS recruitment and selection policies

and relevant national guidance. It is not subject to a fixed term appointment;

ii. Ability to meet the competencies required of all Governing Body Members.

b) Term of office i. Not applicable as is a substantive role.

c) Eligibility for reappointment i. Not applicable as is a substantive role.

d) Grounds for removal from office i. As a substantive postholder, this will be in accordance with NHS/CCG

policies, other relevant guidance and employment law. The Members are not able to remove substantive post holders by passing a resolution.

e) Notice period i. In accordance with the post-holder’s contract of employment.

2.2.9 The Secondary Care Specialist appointment is subject to the following appointment process:

a) Nominations, Eligibility & Appointment process i. The Governing Body Secondary Care Specialist representative will be either

a retired medical consultant from within the CCG area or a practicing medical consultant with no direct links to the CCG area. Candidates must comply with the requirements of the National Health Service (Clinical Commissioning Groups) Regulations 2012 and will be subject to a conflict of interest assessment;

ii. Ability to meet the competencies required of all Governing Body Members.

b) Term of office i. Ordinarily for a three year period with a one-year extension available by

agreement with the Chair and support of the whole Governing Body.

c) Appointment process i. Appointment to be made by a small panel.

d) Eligibility for reappointment i. Completion of the preceding term(s) to the satisfaction of the CCG

Governing Body; ii. Satisfactory re-completion of the competency assessment for all Governing

Body Members. e) Grounds for removal from office

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i. Appointment to a post with a local provider or otherwise no longer compliant with the National Health Service (Clinical Commissioning Groups) Regulations 2012;

ii. Gross misconduct to be determined by the Governing Body, on the advice of the Remuneration & Nominations Committee;

iii. Being or becoming disqualified from office; iv. If appointed as a practicing clinician, losing clinical registration; v. Not attending Governing Body meetings for three months, unless in

extenuating circumstances; vi. Failing to disclose a relevant interest; vii. Where continuation in the role is not in the interests of either the public or

CCG.

f) Notice period i. A minimum of three months notice in writing to the Chair is required.

2.2.10 The Independent Lay Members are subject to the following appointment process:

a) Eligibility i. Relevant experience and expertise; ii. Commitment to the NHS and personal development so as to contribute to

the effective working of the Governing Body; iii. Ability to meet the competencies required of all Governing Body Members

and compliant with the requirements of the National Health Service (Clinical Commissioning Groups) Regulations 2012.

b) Appointment process i. Appointments to be made by a small panel of Birmingham and Solihull CCG

Governing Body Members and an external assessor.

c) Term of office i. Ordinarily for a three year period with a one-year extension available by

agreement with the Chair and support of the whole Governing Body.

d) Eligibility for reappointment i. Independent Lay Members may nominate themselves to stand for

reappointment; ii. Completion of the preceding term(s) to the satisfaction of the CCG

Governing Body; iii. Satisfactory re-completion of the competency assessment for all Governing

Body Members; iv. Subject to a maximum of two consecutive terms of office.

e) Grounds for removal from office

i. Gross misconduct to be determined by the Governing Body, on the advice of the Remuneration Committee;

ii. Not attending Governing Body meetings for three months, unless in extenuating circumstances;

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iii. Failing to disclose a relevant interest; iv. Where continuation in the role is not in the interests of either the public or

CCG.

f) Notice period i. A minimum of three months’ notice in writing to the Chair is required.

2.2.11 The Public Health representative will be a Director of Public Health with the Faculty of Public Health and employed by Birmingham City Council and/or Solihull MBC.

2.3 Eligibility

2.3.1 For the purposes of this Constitution and the Standing Orders, the National Health Service (Clinical Commissioning Groups) Regulations 2012 sets out the individuals excluded from being Members of the Governing Body and/or holding specific roles on the Governing Body. All Governing Body Members are expected to be familiar with the statutory exclusions and to comply with them at all times.

MEETINGS OF THE CLINICAL COMMISSIONING GROUP

2.4 Meetings of the Members

2.4.1 The CCG shall hold an Annual General Meeting in each calendar year. Not more than 15 months shall elapse between the date of one Annual General Meeting and the next. The AGM is a non-decision making meeting. The approved CCG Annual Accounts and Annual Report will be presented to the AGM. Papers will be uploaded to the CCG website in advance of the AGM. Locality leads are expected to encourage Member attendance at the AGM to enable strategic discussion.

2.4.2 Subject to paragraph 0 above and to the other provisions of the Constitution, the Annual General Meeting shall be held at such time and place as the Governing Body may appoint on giving not less than 14 days’ notice to the Members.

2.4.3 The Governing Body may also convene, at any such time as they consider appropriate in relation to the business to be considered, an extraordinary general meeting of the Members. Not less than 14 days’ notice must be given for any extraordinary general meeting at which the removal of any Member of the Governing Body is to be considered.

2.4.4 The Members may requisition general meeting of the Members by notice in writing to the Chair of the Governing Body, as follows:-

a) where notice of an Annual General Meeting has not been given by the Governing Body by the date falling 15 calendar months after the date of the last Annual General Meeting, the calling of the Annual General Meeting may be requisitioned by notice signed by one Member from each Locality, acting on behalf of the Locality, and after agreement within the Locality to sign the notice;

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b) an extraordinary general meeting to consider the filling of any vacancy for, or the removal of, the Chair of the Governing Body or any Member of the Governing Body may be requisitioned by notice signed by one Member from each Locality, acting on behalf of the Locality, and after agreement within the Locality to sign the notice; and

c) an extraordinary general meeting to consider any other business may be requisitioned by notice signed by one Member from each Locality, acting on behalf of the Locality, and after agreement within the Locality to sign the notice.

2.4.5 The Governing Body shall promptly call any meeting validly requisitioned by the Members, subject to any applicable notice periods for the meeting or business in question. If the Governing Body fails to call any general meeting within 14 days of delivery of a valid requisition, then any Member who signed the relevant requisition may (subject to the requirements of this Constitution, and at the cost of the CCG) call the meeting.

2.4.6 Except where the Governing Body properly considers that the holding any meeting of the Members in public would not be in the public interest, notice of the Annual General Meeting shall be advertised in local newspapers covering the Area or a substantial part of it no later than 14 days prior to the date of the meeting.

2.4.7 Notice of any extraordinary general meetings of the Members (whether called by the Governing Body or requisitioned by Members) shall also be advertised in such manner and on such notice as the Governing Body considers appropriate in the circumstances.

2.4.8 Where the Governing Body seeks the views of the Members on any issue and/or where a vote of the Members is required, virtual mechanisms may be used. Where a vote is taken, a simple majority will be sufficient to pass the motion. In the event of a tie, the Chair and the Locality leads will agree an appropriate course of action.

2.4.9 Members will have opportunity to engage on a regular basis via the locality governance arrangements as set out in the CCG Handbook.

2.5 Meetings of the Governing Body

2.5.1 The Chair of the Governing Body may call a meeting of the Governing Body at any time, giving notice to Governing Body Members of no less than seven days, unless the matter is urgent in which case the procedure set out below under 2.12 shall apply.

2.5.2 Meetings of the Governing Body will ordinarily take place on a bi-monthly basis.

2.5.3 One-third or more Members of the CCG Governing Body may requisition a meeting in writing. If the Chair refuses, or fails, to call a meeting within seven days of a requisition being presented the Members signing the requisition may forthwith call a meeting of the CCG Governing Body.

2.6 Agenda, supporting papers and business to be transacted

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2.6.1 Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the Chair (copied to the Governing Body Administrator) at least ten days before the meeting takes place. The agenda and supporting papers will be circulated to all Members of a meeting at least seven days before the date of the meeting.

2.6.2 By exception for urgent items for consideration by the Governing Body, and subject to 2.12, items of business may be submitted just three days before a meeting of the Governing Body and circulated just two days before a meeting.

2.6.3 Agendas and certain papers for the Governing Body will be published on the CCG’s website

2.7 Petitions

2.7.1 Where a petition has been received by the CCG, the Chair of the Governing Body shall include the petition as an item for the agenda of public part of the next appropriate meeting of the CCG Governing Body. The Governing Body may resolve into private session to discuss the details of the Petition, in accordance with 2.16 below.

2.8 Chair of a meeting

2.8.1 At any meeting of the CCG Governing Body, the Chair of the Governing Body, shall preside. If the Chair is absent from the meeting, the Lay Vice Chair shall preside.

2.8.2 If the Chair is absent temporarily on the grounds of a declared conflict of interest the Lay Vice Chair shall preside. If both the Chair and Lay Vice Chair are absent, or are disqualified from participating, another Member of the Governing Body shall be chosen to take the Chair by the majority of Members present.

2.9 Chair's ruling

2.9.1 The decision of the Chair of the Governing Body on questions of order, relevancy and regularity and their interpretation of the Constitution, Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies at the meeting, shall be final.

2.10 Quorum

2.10.1 The quorum necessary for the transaction of business by the Governing Body shall be six Members of the Governing Body and this must include at least one lay Member, one executive and one GP Member. In addition, when making decisions the Chair will endeavour to ensure a clinical majority, unless such a clinical majority is not possible due to conflicts of interest or other exceptional circumstances, in which case the conflicts of interest provisions as set out in this Constitution and in the Standards of Business Conduct Policy shall be followed. The Chair may resolve to use virtual decision-making in order to meet quorum requirements and appropriate clinical input.

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2.10.2 A duly convened meeting of the Governing Body at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the CCG. This will include meetings convened virtually.

2.10.3 Members of the Governing Body are, subject to agreement, able to nominate a deputy to attend in their place and count towards quorum should they exceptionally be unable to attend a meeting. Any deputy shall be subject to the agreement of the Chair, or in their absence the Lay Vice Chair, must declare their interests and are permitted to vote in place of the relevant Governing Body Member.

2.10.4 In such an event when all elected Member Practice Representatives are conflicted, an independent GP clinical lead, the Secondary Care Specialist, the Director of Public Health or another clinical member of the CCG Executive may provide clinical input and count towards quorum, with the approval of the Independent Lay Vice Chair of their nominated deputy. Those agreed individuals who are from outside of the CCG, may be counted a voting member for this purpose, in accordance with section 6.2.1

2.10.5 For all other of the CCG or Governing Body’s Committees or Sub-Committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference

2.11 Decision making process of the Governing Body

2.11.1 Chapter 6 of the group’s constitution, together with the Scheme of Reservation and Delegation, sets out the governing structure for the exercise of the CCG’s statutory functions. Generally it is expected that at all meetings of the CCG or the Governing Body decisions will be reached by consensus. In the case of meetings of the Governing Body, if it is not possible to reach a consensus decision then a vote of Members will be required, the process for which is set out below:

a) Eligibility

i. Only Members of the CCG Governing Body, or their approved nominated deputy are eligible to vote, as set out in the Constitution.

ii. The Chair or Lay Vice Chair must be present in the case of a vote. Should they be unavailable the vote should be held at the earliest practicable time, when they are available or virtual decision-making may be utilised to enable a decision to be taken.

b) Majority necessary to confirm a decision i. Decisions will be made on a majority of votes cast.

c) Casting vote

i. In case of a tie, the Chair will have a second and casting vote.

d) Dissenting views i. Governing Body Members taking a dissenting view to the result of a vote

may take the opportunity, should they choose, to have their dissent recorded in the minutes of the meeting. Should such request not be made,

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the minutes will record a statement of the outcome of the vote, including the numbers of votes for and against.

2.11.2 All other of the CCG’s and Governing Body’s Committees and Sub-Committees will follow these same principles.

2.12 Emergency powers and urgent decisions

2.12.1 The powers which the Governing Body has reserved to itself within these Standing Orders, may in an emergency or for an urgent decision be exercised by the Chair having consulted, at least, the Chief Executive and the Lay Vice-Chair, or another Independent Lay Member if the Lay Vice-Chair cannot be reached.

2.12.2 Before exercising such emergency powers, the Chair should consider the extent to which virtual decision-making can be used to meet the standard decision-making requirements for Governing Body decisions, as set out above.

2.12.3 The exercise of such powers by the Chair will be reported to the next meeting of the Governing Body for formal ratification.

2.12.4 Should the Governing Body be unwilling to ratify a decision taken by the Chair using his emergency powers, this would trigger a vote on whether Governing Board Members have confidence in the Chair.

2.13 Suspension of Standing Orders

2.13.1 Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or NHS England, any part of these Standing Orders may be suspended by the Chair (or Lay Vice Chair where acting in place of the Chair) at any meeting.

2.13.2 A decision to suspend Standing Orders together with the reasons for doing so shall be recorded in the minutes of the meeting.

2.13.3 A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Governing Body’s Audit and Governance Committee for review of the reasonableness of the decision to suspend Standing Orders at the next appropriate meeting.

2.14 Record of Attendance

2.14.1 The names of all Members present at a meeting of the Governing Body and of its Committees shall be recorded in the minutes of the respected meetings.

2.15 Minutes

2.15.1 The names of the Chair, all Members, deputies and attendees will be recorded in the minutes of each meeting.

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2.15.2 The minutes of the preceding meeting shall be prepared and submitted for agreement at each meeting, where they will be subject to amendment and approval by any Members present at the preceding meeting. When agreed a copy of the agreed minutes will be signed by the Chair or Lay Vice Chair.

2.15.3 Minutes of public meetings will posted on the CCG website and thus accessible to all Members of the CCG and the public.

2.16 Admission of public and the press

2.16.1 Subject to Standing Order 2.16.2, meetings of the Governing Body shall be open to the public.

2.16.2 The Governing Body may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

2.16.3 In the event the public could be excluded from a meeting of the Governing Body pursuant to Standing Order 0 above, the group shall consider whether the subject matter of the meeting would in any event be subject to disclosure under the Freedom of Information Act 2000, and if so, whether the public should be excluded in such circumstances.

2.16.4 The Chair, Lay Vice Chair or other person presiding over the meeting shall give such directions as they thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press such as to ensure that the Governing Body’s business shall be conducted without interruption and disruption.

2.16.5 Without prejudice to the power to exclude the public pursuant to Standing Order 0 above the Governing Body may resolve (as permitted by Section 1(8) Public Bodies (Admissions to Meetings) Act 1960 as amended from time to time) to exclude the public from a meeting (whether during whole or part of the proceedings) to suppress or prevent disorderly conduct or behaviour.

2.16.6 Matters to be dealt with by the Governing Body following the exclusion of representatives of the press, and other Members of the public shall be confidential to the Members of the Governing Body.

2.16.7 Members and officers or any employee of the Governing Body in attendance shall not reveal or disclose the contents of minutes or papers indicated as either ‘Private’ or ‘In-Confidence’ without the express permission of the Chair of the Governing Body. This prohibition shall apply equally to the content of any discussion during the Governing Body meeting which may take place on such reports or papers.

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3. APPOINTMENT OF COMMITTEES

3.1 Appointment of Governing Body Committees

3.1.1 The Constitution sets out the ability of the CCG and the Governing Body to appoint Committees, sub-committees and joint Committees, and enables meetings of such Committees to be held “in common”. Where the Governing Body appoints a Committee, sub-committee or joint Committee it may determine the membership of any such committee it deems required, subject to any statutory requirements, including any regulations made by the Secretary of State46.

3.1.2 The Governing Body will require, receive and consider reports of all its Committees at the next appropriate meeting of the Governing Body.

3.2 Terms of Reference

3.2.1 Terms of reference for all non-statutory or otherwise mandated Committees and Sub-Committees are set out in the CCG Handbook.

3.3 Meetings held “in common”

3.3.1 The CCG and the Governing Body may hold committee meetings as a ‘meeting in common’ with other organisations. In the main this would be with NHS Sandwell & West Birmingham CCG. The holding of a ‘meeting in common’ will not affect the individual terms of the CCG’s Governing Bodies as set out in their constitution and the decisions of the Governing Body will be made and recorded in accordance with the Standing Orders.

3.4 Joint Committees

3.4.1 Where Joint Committees are established, the requirements for such Committees set out in the Constitution must be complied with.

3.5.2 Joint committees may operate as committees-in-common with other partner organisations.

4. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS

4.1 If for any reason these Standing Orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All Members of the group and staff have a duty to disclose any non-compliance with these standing orders to the Chief Executive as soon as possible.

5. USE OF SEAL AND AUTHORISATION OF DOCUMENTS

46 See section 14N of the 2006 Act

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5.1 The Clinical Commissioning Group’s seal

5.1.1 The CCG may have a seal for executing documents where necessary.

5.1.2 The CCG’s seal will be kept by the Accountable Officer or a nominated manager in a secure place.

5.1.3 Where it is necessary that a document be sealed, the seal shall be affixed in the presence of two of the following individuals or officers are authorised to authenticate its use by their signature:

a) The Chief Executive;

b) The Chair of the Governing Body;

c) The Chief Finance Officer;

d) The Lay Vice Chair of the Governing Body.

5.1.4 Where two signatures are required one of the signatures should be that of the Chief Executive or Chief Finance Officer.

5.1.5 The Chief Executive shall keep a register that records the use of the seal with a record of all documents to which it is applied.

5.2 Execution of a document by signature

5.2.1 The following individuals are authorised to execute a document on behalf of the CCG by their signature:

a) The Chief Executive; b) The Chair of the Governing Body; c) The Chief Finance Officer; d) The Lay Vice Chair of the Governing Body.

74

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75

APPENDIX E – SCHEME OF RESERVATION AND DELEGATION

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1 REGULATION AND CONTROL

Determine the membership of the CCG.

(via the Chair)

2

REGULATION AND CONTROL

Determine the arrangements by which Members of the CCG approve those decisions that are reserved for the membership

3

REGULATION AND CONTROL

Consideration and approval of applications to NHS England on any matter concerning changes to the CCG’s Constitution. At least half of the Governing Body elected Member Practice Representatives (including the Chair), acting as a group, have the right to refer any decision made under ref 3 to the Membership

76

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4

REGULATION AND CONTROL

Consideration and approval of the CCG Handbook.

At least half of the Governing Body Member Practice Representatives (including the Chair), acting as a group, have the right to refer any decision made under ref 4 to the Membership

5

REGULATION AND CONTROL

Promote awareness of NHS Constitution and act with a view to securing health services that promote and regard the NHS Constitution.

6

REGULATION AND CONTROL

Exercise or delegation of those functions of the CCG that have not been retained as reserved by the CCG Governing Body or Committee of the Governing Body, or other specified person.

77

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7

REGULATION AND CONTROL

Approve the CCG’s overarching scheme of reservation and delegation, which sets out those decisions of the CCG reserved to the membership and those delegated to the:

CCG’s Governing

Body

Committees or sub-

committees, or

Members or

employees

and sets out those decisions of the Governing Body reserved to the Governing Body and those delegated to the:

Governing Body’s

Committees and sub-

committees

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78

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Members of the

Governing Body,

An individual who is a

Member of the CCG

but not the

Governing Body or

specified person

for inclusion in the CCG Handbook .

At least half of the Governing Body Member Practice Representatives, including the Chair, acting as a group have the right to refer any decision made under ref to the Membership in the circumstances set out in the Constitution.

8

REGULATION AND CONTROL

Require and receive the declaration of Governing Body and Members’ interests which may conflict with those of the organisation and, taking

Conflict of Interest Guardian

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account of any waiver which the Secretary of State for Health may have made in any case , determining the extent to which that a Member may remain involved with the matter under consideration

9

REGULATION AND CONTROL

Receive reports from Committees including those that the Governing Body is required by the Secretary of State or other regulation to establish and to action appropriately

10

REGULATION AND CONTROL

Appoint members and approve terms of reference and reporting arrangements of all Committees and Sub-Committees that are established by the Governing Body, including Joint Committees

80

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11

REGULATION AND CONTROL

Approve any urgent decisions taken by the Chair of the organisation and Chief Executive for ratification by the Governing Body in public session.

12

REGULATION AND CONTROL

Approval of the CCG’s operational scheme of delegated limits and the detailed financial policies that underpin the CCG’s prime financial policies

Approve

Revie

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13

REGULATION AND CONTROL

Approve the process by which the CCG determines investment and disinvestment decisions

14

REGULATION AND CONTROL

Approve arrangements for managing exceptional funding requests

Review

15

REGULATION AND CONTROL

Set out who can execute a document by signature in accordance with the Constitution

81

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16

REGULATION AND CONTROL

Approves any changes to the provision or delivery of assurance services to the CCG (internal & external audit)

(acting as Auditor Panel)

17

PRACTICE MEMBER REPRESENTATIVES AND MEMBERS OF THE CCG GOVERNING BODY

Approve the arrangements for

identifying practice

Members to

represent practices in

matters concerning

the work of the CCG;

determine the

arrangements for

each Locality; and

appointing Member

Practice

Representatives to

the Governing Body,

through election.

18

PRACTICE MEMBER REPRESENTATIVES AND MEMBERS OF

Approve proposals for amendment to the Constitution, scheme of

82

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THE CCG GOVERNING BODY

reservation or other strategic issues where referred to the Membership

19

PRACTICE MEMBER REPRESENTATIVES AND MEMBERS OF THE CCG GOVERNING BODY

In accordance with the agreed process set out in the Constitution, to approve removal or dismissal of an elected clinical Governing Body representative.

20

STRATEGY AND PLANNING

Agree the vision, values and overall strategic direction of the CCG.

21

STRATEGY AND PLANNING

Approve the CCG’s financial strategy and plan

Approve

Revie

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Prep

are

22

STRATEGY AND PLANNING

Ensure there is regular and reliable monitoring of the QIPP programme, with regular reports on progress and risks to the Governing Body

Approve

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23

STRATEGY AND PLANNING

Review all commissioning development and disinvestment proposals; ensuring proposals have a robust business case that enables the GB/CID (subject to value) to make effective decisions .

Subject to value

24

STRATEGY AND PLANNING

Approval of the CCG’s commissioning plan.

Approve

Revie

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25

STRATEGY AND PLANNING

Approval of the CCGs’ budgets

Approve R

eview

Prep

are

26

STRATEGY AND PLANNING

Approval of variations to the approved budget where variation would have a significant impact on the overall approved levels of income and expenditure or the CCG’s ability to achieve its agreed strategic aims.

Approve Review

84

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27

ANNUAL REPORTS AND ACCOUNTS

Approval of the CCG’s annual report and annual accounts.

Ap

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P

repare

28

ANNUAL REPORTS AND ACCOUNTS

Oversight of compliance of Standing Orders, Prime Financial Policies and Scheme of Reservation and Delegation

29 ANNUAL REPORTS AND ACCOUNTS

Approve the opening of bank accounts

30

ANNUAL REPORTS AND ACCOUNTS

Approval of the arrangements for discharging the CCG’s statutory financial duties.

Ap

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31

ANNUAL REPORTS AND ACCOUNTS

Approve the appointment (and where necessary dismissal) of External Auditors.

(Acting as Auditor Panel)

32

ANNUAL REPORTS AND ACCOUNTS

Receive the annual management letter from the External Auditor.

85

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33

ANNUAL REPORTS AND ACCOUNTS

Receive an annual report from the Internal Auditor and agree action on recommendations

34

HUMAN RESOURCES

Approve the terms and conditions, remuneration and travelling or other allowances for CCG Governing Body Members and clinical leads, including pensions and gratuities. This will include approving redundancy arrangements

(AfC staff only)

35

HUMAN RESOURCES

Approve terms and conditions of employment for all employees of the CCG including, pensions, remuneration, fees and travelling or other allowances payable to employees and to other persons providing services to the CCG

(AfC staff only)

36

HUMAN RESOURCES

Approve any other terms and conditions of service for the CCG’s employees

86

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and other persons providing services to the CCG

(AfC staff only)

37

HUMAN RESOURCES

Approve disciplinary arrangements for CCG employees, including the Accountable Officer, and for other persons working on behalf of the CCG.

(A

O o

nly)

(for AfC staff only)

(line management in accordance with HR policies)

38

HUMAN RESOURCES

Appoint, appraise, discipline and dismiss the Accountable Officer

Chair and/or NHS England

39

HUMAN RESOURCES

Appoint, appraise, discipline and dismiss employees

(line management in accordance with HR policies)

40

HUMAN RESOURCES

Monitor and evaluate outcome of Governing Body appraisal process

87

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41

HUMAN RESOURCES

Approval of the arrangements for discharging the CCGs’ statutory duties as an employer.

42

HUMAN RESOURCES

Approve the human resources policies for employees and for other persons working on behalf of the CCG.

Ap

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ve via

SMT

Revie

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foru

m

43 HUMAN RESOURCES

Approve individual compensation payments

NHSE

44

QUALITY AND SAFETY

Approve arrangements to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes.

Prep

are

45

QUALITY AND SAFETY

Scrutinize all available information relevant to quality of care commissioned by the CCGs and provide assurance that services for patients are safe and effective, and provided in

88

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accordance with national requirements.

46

QUALITY AND SAFETY

Ensure the CCG has a strategy and plan to take forward the quality improvement agenda, in particular increasing the use of patient experience to inform commissioning.

Approve

Prep

are

47

QUALITY AND SAFETY

Develop a strategy for promoting education and research across the CCG area, supporting the CCG as a learning organisation.

48

QUALITY AND SAFETY

Support for research projects (including the use of research capacity funding)

Ap

pro

ve

Chief Medical Officer / Chief Nurse

49

QUALITY AND SAFETY

Approval for excess treatment costs

Executive Team

50

QUALITY AND SAFETY

Approve policies relating to patient safety and improvement in quality and patient outcomes.

Ap

pro

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Prep

are

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51

QUALITY AND SAFETY

Approve arrangements for supporting NHS England in discharging its responsibilities in relation to securing continuous improvement in the quality of general medical services.

Sup

po

rt

Ap

pro

ve

52

OPERATIONAL AND RISK MANAGEMENT

Approve the CCG’s counter fraud and security management arrangements.

53

OPERATIONAL AND RISK MANAGEMENT

Approval of the CCG’s risk management arrangements.

54

OPERATIONAL AND RISK MANAGEMENT

Review of the CCG’s risk management arrangements and related disclosure statements.

55

OPERATIONAL AND RISK MANAGEMENT

Ensure that there is an effective internal audit function in place that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance.

90

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56

OPERATIONAL AND RISK MANAGEMENT

Review the findings of external audit and other significant assurance functions, both internal and external and consider the implications for the governance of the CCG.

57

OPERATIONAL AND RISK MANAGEMENT

Approve arrangements for risk sharing and or risk pooling with other organisations

58

OPERATIONAL AND RISK MANAGEMENT

Approve arrangements for pooled budgets, including under section 75 of the NHS Act 2006.

59

OPERATIONAL AND RISK MANAGEMENT

Approval of a comprehensive system of internal control, including budgetary control that underpins the effective, efficient and economic operation of the CCG.

Ap

pro

ve

Prep

are

60

OPERATIONAL AND RISK MANAGEMENT

Approve proposals for action on litigation against or on behalf of the CCG

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De

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61

OPERATIONAL AND RISK MANAGEMENT

Approve the CCG’s arrangements for business continuity and emergency planning.

62

INFORMATION GOVERNANCE

Approve the CCG’s arrangements for handling complaints.

Revie

w

63

INFORMATION GOVERNANCE

Approval of the arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data.

Prep

are SIRO

and

app

roved

by IG

ST

64

TENDERING AND CONTRACTING

Approval of the CCG’s’ contracts for any commissioning support

65

TENDERING AND CONTRACTING

Approval of the CCG’s contracts for corporate support (including consultancy support)

Subject to value

92

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66

PARTNERSHIP WORKING

Approve arrangements for the CCG to work together with other CCGs and/or NHS England in the exercise of the relevant commissioning functions

67

PARTNERSHIP WORKING

Approve delegations to individuals participating in joint arrangements on behalf of the CCG.

Ap

pro

ve

68

PARTNERSHIP WORKING

Approve delegations to Joint Committees, including partnership boards established under section 75 of the 2006 Act

Ap

pro

ve

Relevant Committee

69

PARTNERSHIP WORKING

Approve arrangements for participating in any other joint or collaborative arrangements, including holding committee meetings as “committees-in-common”, which support delivery of the CCGs’ responsibilities.

93

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70

COMMISSIONING AND CONTRACTING - CLINICAL SERVICES

Approval of the arrangements for discharging the CCG’s statutory duties associated with its commissioning functions, including but not limited to promoting the involvement patients and carers, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation.

Revie

w

71

COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES

Approve arrangements for making decisions in line with delegated limits in respects of continuing healthcare

Approve Review

Individuals subject to delegated limits

72

COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES

Decisions in relation to continuing healthcare (subject to an initial decision on eligibility and then value)

Decisions on value of CHC packages

94

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subject to value

73 COMMISSIONING OF PRIMARY MEDICAL CARE

Decisions delegated from NHS England in relation to primary medical care

74

COMMUNICATIONS AND ENGAGEMENT

Approve arrangements for handling requests for information (including under the Freedom of Information Act 2000).

Approve IGST

75

COMMUNICATIONS AND ENGAGEMENT

Approve arrangements to ensure that patients, carers and the public are able to influence decision-making on proposals likely to have an impact on service delivery or the range of services available.

95

Appendix E: PRIME FINANCIAL POLICIES

INTRODUCTION

1.1. General

1.1.1. These prime financial policies and supporting standing financial instructions provide operational detail to supplement the framework set out in the CCG’s Constitution. They sit alongside but are not part of the CCG’s Constitution.

1.1.2. The prime financial policies are part of the CCG’s control environment for managing the organisation’s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration, lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Chief Executive and Chief Finance Officer to perform their responsibilities effectively. They should be used in conjunction with the CCG’s Scheme of Reservation and Delegation.

1.1.3. In support of these prime financial policies, the CCG has prepared more detailed financial policies, approved by the Chief Finance Officer and the Audit Committee, known as standing financial instructions. The CCG refers to these prime and detailed financial policies together as the Clinical Commissioning CCG’s financial policies.

1.1.4. These prime financial policies identify the financial responsibilities which apply to

everyone working for the CCG and its constituent organisations in relation to the activities of the CCG. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies. The Chief Finance Officer is responsible for approving all detailed financial policies.

1.1.5. A list of the CCG’s detailed financial policies will be published and maintained on the

CCG’s website at www.bhamandsolihullccg.nhs.uk/. Copies of the document are available from the CCG’s offices at Bartholomew House, 142 Hagley Road, Birmingham, B16 9PA or by emailing infobsol@nhs.net.

1.1.6. Should any difficulties arise regarding the interpretation or application of any of the prime financial policies then the advice of the Chief Finance Officer should be sought before acting. The user of these prime financial policies should also be familiar with and comply with the provisions of the CCG’s Constitution, Standing Orders and Scheme of Reservation and Delegation.

1.1.7. Failure to comply with prime financial policies and standing orders can in certain

circumstances be regarded as a disciplinary matter that could result in dismissal.

1.2. Overriding Prime Financial Policies

1.2.1. If for any reason these prime financial policies are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances

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around the non-compliance shall be reported to the next formal meeting of the governing body’s Audit Committee for referring action or ratification. All of the CCG’s members and employees have a duty to disclose any non-compliance with these prime financial policies, in relation to the activities of the CCG, to the Chief Finance Officer as soon as possible.

1.3. Responsibilities and delegation

1.3.1. The roles and responsibilities of the CCG’s members, employees, members of the governing body, members of the governing body’s committees and sub-committees, and persons working on behalf of the CCG are set out in the CCG’s Constitution.

1.3.2. The financial decisions delegated by members of the CCG are set out in the CCG’s Scheme of Reservation and Delegation.

1.4. Contractors and their employees

1.4.1. Any contractor or employee of a contractor who is empowered by the CCG to commit the CCG to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the Chief Executive to ensure that such persons are made aware of this.

1.5. Amendment of Prime Financial Policies

1.5.1. To ensure that these prime financial policies remain up-to-date and relevant, the Chief Finance Officer will review them at least annually. Following consultation with the Chief Executive and scrutiny by the governing body’s Audit Committee, the Chief Finance Officer will recommend amendments, as fitting, to the governing body for approval.

2 INTERNAL CONTROL

POLICY – the CCG will put in place a suitable control environment and effective internal controls that provide reasonable assurance of effective and efficient operations, financial stewardship, probity and compliance with laws and policies

2.1. The governing body is required to establish an Audit Committee with terms of reference agreed by the governing body.

2.2. The Chief Executive has overall responsibility for the CCG’s systems of internal control.

2.3. The Chief Finance Officer will ensure that:

a) financial policies are considered for review and update annually;

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b) a system is in place for proper checking and reporting of all breaches of financial policies; and

c) a proper procedure is in place for regular checking of the adequacy and effectiveness of the control environment.

3 AUDIT

POLICY – the CCG will keep an effective and independent internal audit function and fully comply with the requirements of external audit and other statutory reviews

3.1. In line with the terms of reference for the governing body’s Audit Committee, the persons appointed by the CCG to be responsible for internal audit and external audit respectively, will have direct and unrestricted access to Audit Committee members and the Chair of the governing body, Chief Executive and Chief Finance officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

3.2. The persons appointed by the CCG to be responsible for internal audit and external audit respectively, will have access to the Audit Committee and the Chief Executive to review audit issues as appropriate. All Audit Committee members, the chair of the governing body and the Chief Executive will have direct and unrestricted access to the head of internal audit and external auditors.

3.3. The Chief Finance Officer will ensure that:

a) the CCG has a professional and technically competent internal audit function; and

b) the Governing Body’s Audit Committee approves any changes to the provision or delivery of assurance services to the CCG.

4 FRAUD AND CORRUPTION

POLICY – the CCG requires all staff to always act honestly and with integrity to safeguard the public resources they are responsible for. The CCG will not tolerate any fraud perpetrated against it and will actively chase any loss suffered

4.1. The governing body’s Audit Committee will satisfy itself that the CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

4.2. The governing body’s Audit Committee will ensure that the CCG has arrangements in place to work effectively with the NHS Counter Fraud Authority.

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5. EXPENDITURE CONTROL

5.1. The CCG is required by statutory provisions47 to ensure that its expenditure does not exceed the aggregate of allotments from NHS England and any other sums it has received and is legally allowed to spend.

5.2. The Chief Executive has overall executive responsibility for ensuring that the CCG complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money.

5.3. The Chief Finance Officer will:

a) provide reports in the form required by NHS England;

b) ensure money drawn from NHS England is required for approved expenditure only is drawn down only at the time of need and follows best practice;

c) be responsible for ensuring that an adequate system of monitoring financial performance is in place to enable the CCG to fulfil its statutory responsibility not to exceed its expenditure limits, as set by direction of NHS England.

6 ALLOTMENTS48

6.1. The CCG’s Chief Finance Officer will:

a) periodically review the basis and assumptions used by NHS England for distributing allotments and ensure that these are reasonable and realistic and secure the CCG’s entitlement to funds;

b) prior to the start of each financial year, submit to the governing body for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and

c) regularly update the governing body on significant changes to the initial allocation and the uses of such funds.

7 COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL AND MONITORING

POLICY – the CCG will produce and publish an annual commissioning plan49 that explains how it proposes to discharge its financial duties. The CCG will support this with comprehensive medium term financial plans and annual budgets

47 See section 223H of the 2006 Act

48 See section 223(G) of the 2006 Act

49 See section 14Z11 of the 2006 Act

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7.1. The Chief Executive will compile and submit to the governing body a commissioning strategy which takes into account financial targets and forecast limits of available resources.

7.2. Prior to the start of the financial year the Chief Finance Officer will, on behalf of the Chief Executive, prepare and submit budgets for approval by the governing body.

7.3. The Chief Finance Officer shall monitor financial performance against budget and plan, periodically review them, and report to the governing body. This report should include explanations for variances. These variances must be based on any significant departures from agreed financial plans or budgets.

7.4. The Chief Executive is responsible for ensuring that information relating to the CCG’s accounts or to its income or expenditure, or its use of resources is provided to NHS England as requested.

7.5. The governing body will approve consultation arrangements for the CCG’s commissioning plan50.

8 ANNUAL ACCOUNTS AND REPORTS

POLICY – the CCG will produce and submit to NHS England accounts and reports in accordance with all statutory obligations51, relevant accounting standards and accounting best practice in the form and content and at the time required by NHS England

8.1. The Chief Finance Officer will ensure the CCG:

a) prepares a timetable for producing the annual report and accounts and agrees it with external auditors and the Audit Committee;

b) prepares the annual report and accounts according to the timetable approved by the Audit Committee;

c) complies with statutory requirements and relevant directions for the publication of the annual report and accounts;

d) considers the external auditor’s annual audit letter and fully address all issues within agreed timescales; and

e) publishes the external auditor’s annual audit letter on the CCG’s website at www.bhamandsolihull.nhs.uk and makes the letter available to patients and members of the public, on request.

50 See section 14Z13 of the 2006 Act

51 See paragraph 17 of Schedule 1A of the 2006 Act

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9 INFORMATION TECHNOLOGY

POLICY – the CCG will ensure the accuracy and security of the CCG’s computerised financial data

9.1. The Chief Finance Officer is responsible for the accuracy and security of the CCG’s computerised financial data and shall:

a) devise and implement any necessary procedures to ensure adequate (reasonable) protection of the CCG's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998 (and as amended or superseded) and any other relevant legal requirements including but not limited to the EU General Data Protection Regulation and guidance issued on data protection;

b) ensure that adequate (reasonable) controls exist over data entry, processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system;

c) ensure that adequate controls exist such that the computer operation is separated from development, maintenance and amendment;

d) ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the Chief Finance Officer may consider necessary are being carried out.

e) ensure that contracts or agreements with third party suppliers, including any shared service providers, include requirements in respect of the accuracy and security of the CCG’s data.

9.2. In addition, the Chief Finance Officer shall ensure that new financial systems and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.

10 ACCOUNTING SYSTEMS

POLICY – the CCG will run an accounting system that creates management and financial accounts

10.1. The Chief Finance Officer will ensure:

a) the CCG has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of NHS England;

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b) that contracts for computer services for financial applications with another health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes.

10.2. Where another health organisation or any other agency provides a computer service for financial applications, the Chief Finance Officer shall periodically seek assurances that adequate controls are in operation.

11 BANK ACCOUNTS

POLICY – the CCG will keep enough liquidity to meet its current commitments

11.1. The Chief Finance Officer will:

a) review the banking arrangements of the CCG at regular intervals to ensure they are in accordance with Secretary of State directions52, best practice and represent best value for money;

b) manage the CCG's banking arrangements and advise the CCG on the provision of banking services and operation of accounts;

c) prepare detailed instructions on the operation of bank accounts.

11.2. The Audit Committee shall approve the banking arrangements.

52 See section 223H(3) of the NHS Act 2006

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12 INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS.

POLICY – the CCG will

operate a sound system for prompt recording, invoicing and collection of all monies due

seek to maximise its potential to raise additional income only to the extent that it does not interfere with the performance of the CCG or its functions53

ensure its power to make grants and loans is used to discharge its functions effectively54

12.1. The Chief Financial Officer is responsible for:

a) designing, maintaining and ensuring compliance with systems for the proper recording, invoicing, and collection and coding of all monies due;

b) establishing and maintaining systems and procedures for the secure handling of cash and other negotiable instruments;

c) approving and regularly reviewing the level of all fees and charges other than those determined by NHS England or by statute. Independent professional advice on matters of valuation shall be taken as necessary;

d) for developing effective arrangements for making grants or loans.

13 TENDERING AND CONTRACTING PROCEDURE

POLICY – the CCG: 50. will ensure proper competition that is legally compliant within all purchasing

to ensure we incur only budgeted, approved and necessary spending 51. will seek value for money for all goods and services 52. shall ensure that competitive tenders are invited for

a. the supply of goods, materials and manufactured articles; b. the rendering of services including all forms of management

consultancy services (other than specialised services sought from or provided by the Department of Health); and

c. for the design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals

53 See section 14Z5 of the 2006 Act

54 See section 14Z6 of the 2006 Act

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13.1 The CCG shall ensure that suitably qualified firms / individuals are invited to tender (and where appropriate, quote) having gone through a formal pre-qualification process (PQQ) to establish suitably approved providers shortlist prior to (ITT) Invitation to Tender or where necessary invite bids from framework agreement providers. Where in the opinion of the Chief Finance Officer it is desirable to seek tenders from other firms, the reason shall be recorded in writing to the Chief Officer or the CCG’s Audit Committee.

13.2 The Chief Executive or Chief Finance Officer may negotiate contracts on behalf of the CCG, and the CCG may enter into contracts, only within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with:

a) the CCG’s standing orders;

b) the Public Contracts Regulation 2006, any successor legislation and any other applicable law; and

c) take into account, as appropriate, any applicable NHS England or NHS Improvement guidance that does not conflict with (b) above.

13.3 In all contracts entered into, the CCG shall endeavour to obtain best value for money. The Chief Executive shall nominate an individual who shall oversee and manage each contract on behalf of the CCG.

13.4 The circumstances in which the requirement for tendering may be waived shall be subject to a formal policy on single tender waivers, approved by the Audit Committee. The use of single tender waivers shall be periodically reviewed by the Audit Committee.

13.5 In respect of procurement from, and contracting with, Member Practices of the CCG under delegated arrangements for Primary Care Commissioning, the Chair of the Primary Care Committee will ensure that the CCG complies with NHS Statutory Guidance on Managing Conflicts of Interest.

14 COMMISSIONING

POLICY – working in partnership with relevant national and local stakeholders, the CCG will commission certain health services to meet the reasonable requirements of the persons for whom it has responsibility

14.1 The CCG will co-ordinate its work with NHS England, other clinical commissioning CCGs, local providers of services, local authorities, including through Health & Wellbeing Boards, patients and their carers and the voluntary sector and others as appropriate to develop robust commissioning plans.

14.2 The Chief Executive will establish arrangements to ensure that regular reports are provided to the Finance & Performance Committee, detailing actual and forecast expenditure and activity for each contract.

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14.3 The Chief Finance Officer will maintain a system of financial monitoring to ensure the effective accounting for expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality.

14.4 Commissioning of Primary Care from Member Practices of the CCG will be the responsibility of the Primary Care Committee. The Committee Chair will ensure that the CCG complies with requirements under section 13Z of the 2006 Act.

14.5 In respect of commissioning of primary care in particular, the Chief Executive will ensure that the CCG complies with the requirements of NHS guidance on managing Conflicts of Interest.

15 RISK MANAGEMENT AND INSURANCE

POLICY – the CCG will put arrangements in place for evaluation and management of its risks

15.1 The Chief Executive will ensure that the CCG’s risk management arrangements comprise, as a minimum:

a) a risk management strategy which sets out how risks will be identified, quantified, managed and reported on;

b) a corporate risk register setting out the significant risks facing the CCG, together with mitigating actions;

c) an assurance framework which provides assurance to the governing body on the management and mitigation of significant risks and identifies any gaps in controls or assurances;

d) arrangements for the corporate risk register and assurance framework to be reviewed by both the Audit Committee and the governing body, as a minimum, on a quarterly basis;

e) an annual statement on internal control within the CCG’s annual report and accounts, as required by the Department of Health.

15.2 The Chief Finance Officer will determine whether the CCG should insure risks through the schemes administered by the NHS Litigation Authority or self-insure for some or all of the risks. If the NHS Litigation Authority schemes are not used, this decision shall be reviewed annually by the Audit Committee.

16 PAYROLL

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POLICY – the CCG will put arrangements in place for an effective payroll service

a.1 The Chief Finance Officer will ensure that the payroll service selected: a) is supported by appropriate (i.e.contracted) terms and conditions;

b) has adequate internal controls and audit review processes;

c) has suitable arrangements for the collection of payroll deductions and payment of these to appropriate bodies.

16.2 In addition, the Chief Finance Officer shall set out comprehensive procedures for the effective processing of payroll. Where another health organisation or any other agency provides a payroll service to the CCG, the Chief Finance Officer shall at least annually seek assurances that adequate controls are in operation.

17 NON-PAY EXPENDITURE

POLICY – the CCG will seek to obtain the best value for money goods and services received

17.1 The governing body will approve the level of non-pay expenditure on an annual basis and the Chief Executive will determine the level of delegation to budget managers.

17.2 The Chief Executive shall set out procedures on the seeking of professional advice regarding the supply of goods and services.

17.3 The Chief Finance Officer will:

a) advise the Governing Body on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the scheme of reservation and delegation;

b) be responsible for the prompt payment of all properly authorised accounts and claims;

c) be responsible for designing and maintaining a system of verification, recording and payment of all amounts payable.

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18 CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF ASSETS

POLICY – the CCG will put arrangements in place to manage capital investment, maintain an asset register recording fixed assets and put in place polices to secure the safe storage of the CCG’s fixed assets

18.1 The Chief Executive will:

a) ensure that there is an adequate appraisal and approval process in place for determining capital expenditure priorities and the effect of each proposal upon plans;

b) be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

c) shall ensure that the capital investment is not undertaken without confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges;

d) be responsible for the maintenance of registers of assets, taking account of the advice of the Chief Finance Officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year.

18.2 The Chief Finance Officer will prepare detailed procedures for the disposal of assets.

19 RETENTION OF RECORDS

POLICY – the CCG will put arrangements in place to retain all records in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance

19.1 The Chief Executive shall:

a) be responsible for maintaining all records required to be retained in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance;

b) ensure that arrangements are in place for effective responses to Freedom of Information requests;

c) publish and maintain a Freedom of Information Publication Scheme.

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20 TRUST FUNDS AND TRUSTEES

POLICY – the CCG will put arrangements in place to provide for the appointment of trustees if the CCG holds property on trust

20.1 The Chief Finance Officer shall ensure that each trust fund which the CCG is responsible for managing is managed appropriately with regard to its purpose and to its requirements.

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APPENDIX F TERMS OF REFERENCE:

a) AUDIT & RISK COMMITTEE

b) REMUNERATION & NOMINATIONS COMMITTEE

c) PRIMARY CARE COMMISSIONING COMMITTEE

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NHS Birmingham and Solihull CCG

Audit and Risk Committee

Terms of Reference

1. Authority

1.1 The Audit and Risk Committee (the Committee) is established in accordance with the NHS Birmingham and Solihull Clinical Commissioning Group (the CCG) Constitution. These Terms of Reference set out the membership, remit and responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution.

1.2 The Committee is authorised by the Governing Body of the CCG to investigate any activity within its Terms of Reference. It is authorised to seek any information it requires from any member, officer, employee or agent/consultant who is directed to co-operate with any request made by the Committee.

1.3 The Committee is authorised to obtain such internal information as is necessary and expedient to the fulfilment of its functions. If deemed necessary, the Committee is authorised to obtain external legal advice to fulfil its functions.

1.4 The Committee will undertake ‘deep dives’ in to specific issues that will enable the Committee to gain a greater level of understanding and assurance into specific issues that fall within its remit.

2. Purpose of the Committee

2.1 The Committee is responsible for providing assurance to the Governing Body on the CCG’s system of internal control. It will do this by means of an independent and objective review of financial and corporate governance and risk management arrangements, including compliance with law, guidance, and regulations governing the NHS.

3. Membership

3.1 The Committee shall be appointed by the Governing Body as set out in the CCG’s Constitution and may include individuals who are not members of the Governing Body.

3.2 The Lay Member on the Governing Body, with a lead role in overseeing key elements of governance, namely the Lay Member for Governance, will chair the Committee and must have qualifications, expertise or experience such as to enable the person to express informed views about financial management and audit matters.

3.3 There will be two other Independent Members of the Governing Body on the Committee, namely the Lay Member for Patient and Public Participation and the Lay Member for Finance.

3.4 The Committee will nominate a Vice Chair who will be a Lay Member.

4. Attendance and Quorum

4.1 In addition to the Committee members, the Chief Finance Officer and any other relevant persons, where appropriate, shall generally attend routine meetings of the Committee.

4.2 The Chief Finance Officer will act as the lead director for the Committee, in conjunction with the Director of Organisational Development and Partnerships, to the extent required.

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4.3 Staff usually expected to attend each meeting (in a non-voting capacity) are:

a) Chief Finance Officer (or their nominee)

b) Head of Governance/equivalent (or their nominee)

c) Internal and External Audit Representatives

d) Anti-Fraud Representative

4.4 Members of the Governing Body shall be invited to attend those meetings in which the Committee will consider areas of risk or operation that are their responsibility.

4.5 The Clinical Chairman of the CCG and the Chief Executive may be invited to attend meetings of the Committee as required.

4.6 The quorum for the transaction of business shall be two committee members.

5. Frequency of Meetings

5.1 Meetings shall be held at least four times per year, with additional meetings where necessary.

5.2 The Committee members shall be afforded the opportunity to meet at least once per year with no others present.

5.3 Arrangements for calling meetings will be in writing to the Chair of the Committee with a minimum of ten days’ notice.

6. Specific Duties and Responsibilities

6.1 The Committee shall critically review the CCG’s financial and corporate reporting, and internal control systems and risk management arrangements, and ensure an appropriate relationship with both internal and external auditors is maintained.

Integrated Governance, Risk Management and Internal Control

6.2 The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities to ensure these systems support the achievement of the CCG’s objectives.

6.3 In particular, the Committee will review the adequacy and effectiveness of:

a) All risk and control related disclosure statements (in particular the Annual Governance Statement or equivalent), together with any appropriate independent assurances, prior to endorsement by the Governing Body;

b) The underlying assurance processes which indicate the degree of achievement of the CCG’s objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements;

c) The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification;

d) The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by NHS Counter Fraud Authority.

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6.4 The Committee shall seek reports and assurances from members of the Governing Body and senior employees as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness evidenced through the Committee’s use of an effective Board Assurance Framework to guide its work and that of the audit and assurance functions that report to it.

6.5 The Committee will review the adequacy of the CCG’s arrangements by which staff may, in confidence, raise concerns about possible improprieties in matters of financial reporting and control, or related matters or other matters of concern, for example under the CCG Whistleblowing Policy.

6.6 The Committee will assure that the CCG meets the requirements for Information Governance.

Internal Audit

6.7 The Committee shall ensure that there is an effective internal audit function which meets mandatory Public Sector Internal Audit Standards (Department of Health, December 2012) and provides appropriate independent assurance to the Committee, Chief Accountable Officer, the Governing Body and the CCG.

6.8 The Committee shall achieve an effective internal audit function by:

a) Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal of that service;

b) Review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the Board Assurance Framework;

c) Considering the major findings of internal audit work (and the senior team's response) and ensuring co-ordination between the internal and external auditors to optimise audit resources;

d) Ensuring that the internal audit function is adequately resourced and has appropriate standing within the CCG;

e) An annual review of the effectiveness of internal audit.

External Audit

6.9 The Committee shall review the work and findings of the external auditors and consider the implications and the senior team's responses to their work.

6.10 The Committee shall achieve this by:

a) Consideration of the performance of the external auditors, as far as the rules governing the appointment permit;

b) Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy;

c) Discussion with the external auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee;

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d) Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Governing Body and any work undertaken outside the annual audit plan, together with the appropriateness of management responses;

e) Overseeing the conduct of a market testing exercise for the appointment of an auditor at least once every five years and, based on the outcome, acting as the CCG Auditor Panel with respect to the appointment of the auditor;

f) Developing and implementing a policy on the engagement of the external auditor to supply non-audit services;

g) Considering the provision of the external audit service, the cost of the audit and any questions of resignation and dismissal.

Financial Reporting

6.11 The Committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance.

6.12 The Committee shall ensure that the systems for financial reporting to the Governing Body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Governing Body.

6.13 The Committee shall review and approve the annual report and financial accounts before submission, focusing particularly on:

a) The wording in the Annual Governance Statement and other disclosures relevant to the Terms of Reference of the Committee;

b) Changes in, and compliance with, accounting policies, practices and estimation techniques;

c) Unadjusted misstatements in the financial accounts;

d) Significant judgements in preparing of the financial accounts;

e) Significant adjustments resulting from the audit;

f) Letter of representation;

g) Qualitative aspects of financial reporting.

Anti-Fraud

6.14 The Committee shall satisfy itself that the CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the anti-fraud work programme.

NHS Counter Fraud Authority and Information Governance

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6.15 The Committee shall satisfy itself that the CCG has adequate arrangements (including policies, audit and assessment processes), capability and capacity in place for security and information governance and shall review the outcomes of security and information governance assessments.

Freedom of Information

6.16 The Committee shall review the arrangements for handling Freedom of Information Act requests, the same having been prepared by the Chief Executive or their nominee.

Other Assurance Functions

6.17 The Committee shall review the findings of other significant assurance functions, both internal and external, including but not limited to:

a) Any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Resolution);

b) Professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).

Management

6.18 The Committee shall request and review reports and positive assurances from members of the Governing Body and senior employees on the overall arrangements for governance, risk management and internal control.

6.19 The Committee may also request specific reports from individual functions within the CCG as they may be appropriate to the overall arrangements.

7. Sub-Committees

7.1 The Information Governance Steering Group is a Sub-Committee of the Committee.

8. Meetings in common

8.1 The Committee may hold its meetings as a ‘meeting in common’ with other organisations. In the main this would be with NHS Sandwell & West Birmingham CCG. In these instances the role of co-ordinating ‘Chair’ for the meeting will be agreed between the two CCG Committee Chairs. At no time will a meeting take place if the respective chair or nominated deputy for each CCG is not in attendance. The holding of a ‘meeting in common’ will not affect the individual terms of the CCG Governing Bodies as set out in their constitution and the decisions of the Committee will be made and recorded in line with the clauses above.

8.2 Where items are pertinent to both the CCGs items will be discussed and reflected in the minutes accordingly with decisions reached being recorded respectively for each Committee.

8.3 Where items are pertinent to one CCG only, the respective Committee Chair or deputy will take that item, lead the discussion and ensure that the decision making is reached and recorded by those Committee members associated with that CCG.

8.4 The CCGs have in place collaborative working arrangements and it is anticipated that ‘in common’ meeting arrangements will support further alignment with regards to West Birmingham. However, each Committee will continue to be accountable for its own decisions and each CCG may hold individual Committee meetings as appropriate, for example to discuss business specific to that CCG.

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9. Administrative Support

9.1 The Secretary to the Committee will ensure:

a) Collation of all Committee papers and their circulation in a timely manner;

b) Taking the minutes and keeping a record of matters arising and issues to be carried forward;

9.2 The Chief Finance Officer will be responsible for supporting the Chair in forward planning, agenda-setting, follow up of actions and circulation of minutes.

10. Accountability and Reporting Arrangements

10.1 The Committee shall be directly accountable to the Governing Body.

10.2 The minutes of all meetings of the Committee shall be formally recorded and submitted, together with recommendations where appropriate, to the Governing Body. The submission to the Governing Body shall include details of any matters in respect of which actions or improvements are needed. This will include details of any evidence of potentially ultra vires, otherwise unlawful or improper transactions, acts, omissions or practices or any other important matters. To the extent that such matters arise, the Chair of the Committee shall present details to a meeting of the Governing Body in addition to submission of the minutes.

10.3 The Committee will review the work of the other Governing Body Committees annually by reviewing their formal report on their work over the past year.

10.4 There will be close links between the Committee and the Quality and Safety Committee and the Finance and Performance Committee, with regular meetings between the Chair of the Committee and the Chairs of the Quality and Safety Committee and Finance and Performance Committee to ensure that there are no assurance gaps.

11. Conduct of the Committee

11.1 At the beginning of each meeting, the Chair will ask members whether they have any interests to declare, in accordance with the CCG’s Gifts, Hospitality and Declarations of Interests Policy.

11.2 If any member has an interest, financial or otherwise, in any matter and is present at the meeting at which the matter is under discussion, they will declare that interest as early as possible and act in accordance with the CCG’s Standards for Business Conduct Policy. Subject to any previously agreed arrangements for managing a conflict of interest, the Chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual must comply with these arrangements, which must be recorded in the minutes of the meeting.

11.3 Decision making will be by a simple majority of those present and voting at the relevant meeting. In the event that a vote is tied, the Chair will have the casting vote.

11.4 Members of the Committee have a duty to demonstrate leadership in the observation of the NHS Code of Conduct and to work to the Nolan Principles, which are: selflessness, integrity, objectivity, accountability, openness, honesty and leadership.

11.5 Committee papers will be stored and archived. Where not exempted from the Freedom of Information Act 2000, papers will be available for disclosure.

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11.6 When there is an urgent matter where a decision is required outside of the meeting, the Chair may make a decision after conferring with at least one other member ("Chair's Action"). When Chair’s Action has been taken then it must be ratified by the next quorate meeting of the Committee. Urgent decisions will only be taken when there is insufficient time available for the decision to be delayed until the next meeting.

11.7 The Committee will apply best practice in its deliberations and in the decision making processes. It will conduct its business in accordance with national guidance and relevant codes of conduct and good governance practice.

12. Monitoring Effectiveness and Compliance with Terms of Reference

12.1 The Committee will carry out an annual review of its functioning and provide an annual report to the Governing Body on its work in discharging its responsibilities, delivering its objectives and complying with its terms of reference, specifically commenting on relevant aspects of the Board Assurance Framework and relevant regulatory frameworks.

13. Review of Terms of Reference

13.1 The terms of reference of the Committee shall be reviewed by the Governing Body at least annually.

Version Control:

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Document Owner: Chief Finance Officer

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NHS Birmingham and Solihull CCG

Remuneration and Nominations Committee

Terms of Reference

1. Authority

1.1 The Remuneration and Nominations Committee (the Committee) is established in accordance with the NHS Birmingham and Solihull Clinical Commissioning Group (the CCG) Constitution, Standing Orders and Scheme of Reservation and Delegation. These terms of reference set out the membership, remit and responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the CCGs Constitution and Standing Orders.

1.2 The Committee is authorised by Governing Body to act within its terms of reference. All Members and employees of the CCG are directed to co-operate with any request made by the Committee.

1.3 The Committee can compel the Lead Director for the Committee to instruct professional advisors and request the attendance of individuals and authorities from outside the CCG with relevant experience and expertise if it considers this necessary for or expedient to the exercise of its functions.

1.4 The Committee is authorised to obtain such internal information as is necessary and expedient to the fulfilment of its functions.

2. Purpose of the Committee

2.1 The Committee shall make recommendations to the Governing Body on determinations about remuneration, benefits and allowances under any pension scheme it might establish as an alternative to the NHS pension scheme for employees and members of the Governing Body of the CCG.

3. Membership

3.1 The Committee shall be appointed by the Governing Body as set out in the CCG's Constitution and may include individuals who are not members of the Governing Body.

3.2 An Independent Lay Member will chair the Committee.

3.3 The membership of the Committee shall consist of:

An Independent Lay Member who will chair the Committee;

All of the other Governing Body Independent Lay Members.

3.4 The Committee may co-opt two clinical Governing Body Members (for instance two of the Member Practice Representatives and/or the Secondary Care Specialist) to act as members of the Committee, nominating one as Chair, when issues relating to independent lay member pay are being considered. The Committee may also involve such clinical expertise where it would be helpful in discharging its functions.

3.5 The Committee will nominate a Vice Chair who will be Lay Member, except for determinations of Independent Lay Member pay in accordance with section 3.4.

4. Attendance and Quorum

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4.1 The Chief Executive will attend the meeting but should leave the meeting during any discussions about their own remuneration.

4.2 The Director of Organisational Development and Partnerships (or their nominee) will attend the meeting and provide support to ensure the Committee functions effectively but should leave the meeting during any discussions about their own remuneration.

4.3 Other Directors, CCG members or external advisors (such as HR) may be invited to attend the meeting for the purpose of providing advice and/or clarification to the Committee. No individual should be in attendance for discussion of their own remuneration.

4.4 A quorum shall be two members including the Committee chair or delegated chair.

5. Frequency of Meetings

5.1 Meetings shall be held at least every six months and additional meetings shall be held as and when required, including to give consideration to nominations and confirming changes to the membership of the Governing Body.

5.2 Arrangements for calling meetings will be in writing to the chair of the Committee with a minimum of ten days’ notice.

6. Specific Duties and Responsibilities

6.1 The Committee shall:

a) Make recommendations on determinations of the remuneration and conditions of service of employees of the CCG, the members of the Governing Body including:

Salary, including any performance-related pay or bonus;

Provisions for other benefits, including pensions and cars;

Allowances under any pension scheme it might establish as an alternative to the NHS pension scheme;

Other allowances;

b) Apply best practice to the decision making process. When considering remuneration the Committee will:

Adhere to the CCG Standards for Business Conduct Policy;

Where necessary seek independent advice about remuneration for individuals, including the use of benchmarking data;

Ensure that decisions are based on clear and transparent procedures.

c) Consider the severance payments of Governing Body members and other senior employees, seeking HM Treasury approval as appropriate in accordance with HM Treasury guidance;

d) Consider the terms of compromise agreements, which fall outside the provisions of the contract of employment before submission through the necessary approval process;

e) Agree any recruitment and retention premia or any retention schemes, subject to national guidance and/or relevant terms and conditions of service;

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f) Monitor and evaluate the performance of members of the Governing Body;

g) Adhere to all relevant laws, regulations and policy in all respects, including:

National guidance;

The management cost cap;

Benchmarked information of other CCG’s costs;

The competing earnings potential in primary care.

h) To determine levels of remuneration that are sufficient to attract, retain and motivate members of the Governing Body and senior employees whilst remaining cost effective;

i) Ensure proper calculation and scrutiny of termination payments taking account of appropriate national guidance, advise on and oversee appropriate contractual arrangements for such staff;

j) Advise on and oversee appropriate contractual arrangements for staff, including redundancy arrangements in line with national or local contracts of employment and appropriate guidance or legislation;

k) Ensure that the Governing Body has the right balance of skills, knowledge and perspectives required for the Governing Body to function effectively;

l) Oversee the appointment or election process for members of the Governing Body, and consider nominations and confirm changes to the membership of the Governing Body;

m) Develop an approach to succession planning for key members of the Governing Body;

Set the terms of office for members of the Governing Body;

Oversee the performance review process for all members of the Governing Body including the Clinical Chairman of the CCG;

Undertake any other appropriate duties as directed by the CCG Governing Body.

7. Sub-Committees

7.1 The Committee has no established sub-committees.

8. Meetings in common

8.1 The Committee may hold its meetings as a ‘meeting in common’ with other organisations. In the main this would be with NHS Sandwell & West Birmingham CCG. In these instances the role of co-ordinating ‘Chair’ for the meeting will be agreed between the two CCG Committee Chairs. At no time will a meeting take place if the respective chair or nominated deputy for each CCG is not in attendance. The holding of a ‘meeting in common’ will not affect the individual terms of the CCG Governing Bodies as set out in their constitution and the decisions of the Committee will be made and recorded in line with the clauses above.

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8.2 Where items are pertinent to both the CCGs items will be discussed and reflected in the minutes accordingly with decisions reached being recorded respectively for each Committee.

8.3 Where items are pertinent to one CCG only, the respective Committee Chair or deputy will take that item, lead the discussion and ensure that the decision making is reached and recorded by those Committee members associated with that CCG.

8.4 The CCGs have in place collaborative working arrangements and it is anticipated that ‘in common’ meeting arrangements will support further alignment with regards to West Birmingham. However, each Committee will continue to be accountable for its own decisions and each CCG may hold individual Committee meetings as appropriate, for example to discuss business specific to that CCG.

9. Administrative Support

9.1 The Director of Organisational Development and Partnerships will ensure that a suitably appointed person, shall record the minutes of all meetings of the Committee. These will be retained by the chair and will be shared with members of the Committee and relevant attendees as determined by the chair. Minutes will not be shared with members of the Governing Body who are not members of the Committee. Summary notes will be made available to the Governing Body.

9.2 The Chief Executive and the Director of Organisational Development and Partnerships will be responsible for supporting the chair in forward planning, agenda-setting, follow up of actions and circulation of minutes.

10. Accountability and Reporting Arrangements

10.1 The Committee will report to the Governing Body after each meeting.

11. Conduct of the Committee

11.1 At the beginning of each meeting, the chair will ask members whether they have any interests to declare, in accordance with the CCG’s Gifts, Hospitality and Declarations of Interests Policy.

11.2 If any member has an interest, financial or otherwise, in any matter and is present at the meeting at which the matter is under discussion, he/she will declare that interest as early as possible and act in accordance with the CCG’s Conflicts of Interests Policy. Subject to any previously agreed arrangements for managing a conflict of interest, the chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual must comply with these arrangements, which must be recorded in the minutes of the meeting.

11.3 Decision making will be by a simple majority of those present and voting at the relevant meeting. In the event that a vote is tied, the chair will have the casting vote.

11.4 Members of the Committee have a duty to demonstrate leadership in the observation of the NHS Code of Conduct and to work to the Nolan Principles, which are: selflessness, integrity, objectivity, accountability, openness, honesty and leadership.

11.5 Committee papers will be stored and archived. Where not exempted from the Freedom of Information Act 2000, papers will be available for disclosure.

11.6 When there is an urgent matter where a decision is required outside of the meeting, the chair may make a decision after conferring with at least two other members ("chair's action"). When chair’s

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action has been taken then it must be ratified by the next quorate meeting of the Committee. Urgent decisions will only be taken when there is insufficient time available for the decision to be delayed until the next meeting.

11.7 The Committee will apply best practice in its deliberations and in the decision making processes. It will conduct its business in accordance with national guidance and relevant codes of conduct and good governance practice.

12. Monitoring Effectiveness and Compliance with Terms of Reference

12.1 The Committee will carry out an annual review of its functioning and provide an annual report to the Audit and Risk Committee on its work in discharging its responsibilities, delivering its objectives and complying with its terms of references.

13. Review of Terms of Reference

13.1 The terms of reference of the Committee shall be reviewed by the Governing Body at least annually.

Version Control:

Date approved by the Remuneration and Nominations Committee: 13/02/2018 (HCB) Date approved by the Governing Body: 13/02/2018 (HCB)

Next review date: Annual Document Owner: Director of Organisational Development and Partnerships

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NHS Birmingham and Solihull CCG

Primary Care Commissioning Committee

Terms of Reference 1. Purpose

1.1 In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England (NHSE) has delegated the exercise of the functions specified below to NHS Birmingham & Solihull CCG (the CCG).

1.2 The CCG has established the Primary Care Commissioning Committee (the Committee). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

2. Statutory Framework

2.1 NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out below in accordance with section 13Z of the NHS Act. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG.

2.2 Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2).

2.3 The CCG will also need, in respect of the delegated functions from NHS England, to specifically exercise those set out below:

a) Duty to have regard to impact on services in certain areas (section 13O); b) Duty in respects of variation in provision of health services (section 13P).

2.4 The Committee is established as a committee of the Governing Body of the CCG in accordance with Schedule 1A of the “NHS Act”.

2.5 The committee members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

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3. Role of the Committee

3.1 The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services under delegated authority from NHS England.

3.2 In performing its role the Committee will exercise its management of the functions in accordance with the agreements entered into between NHS England and the CCG, which will sit alongside the delegation and terms of reference.

3.3 The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

3.4 The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act.

3.5 This includes the following:

a) Managing GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing breach/remedial notices, and removing a contract);

b) Managing the design and commissioning of enhanced services (“Local Enhanced/Incentive Services” and “Directed Enhanced Services”);

c) Design of local incentive schemes in addition to or as an as an alternative to the national framework, including the Quality Outcomes Framework (QOF);

d) Decision making on whether to establish new GP practices in an area;

e) Approving practice mergers and closures ; and

f) Making decisions on ‘discretionary’ payments (e.g., returner/retainer schemes).

3.6 The Committee will also carry out the following activities:

a) To make decisions on commissioning of primary care medical services;

b) To receive information on the quality of commissioned primary care medical services and identifying any actions needed to address concerns, working in conjunction with the Quality and Safety Committee;

c) To plan, including needs assessment, primary care medical services;

d) To undertake reviews of primary medical care services;

e) To co-ordinate a consistent approach to the commissioning of primary care services generally;

f) To manage the budget for commissioning of primary medical care services, including in relation to IT services and premises;

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g) The Committee should ensure an appropriate level of patient participation and engagement, and to take account of patient experience.

4. Geographical Coverage

4.1 The Committee will comprise the NHS Birmingham and Solihull CCG

5. Membership

5.1 The Committee will, in accordance with NHS England guidance, be so constituted so as to ensure that the majority is held by lay and executive members.

5.2 The Committee will include the following voting membership:

a) Independent Lay Member for Public and Patient Participation on the Governing Body (Chair); b) Independent Lay Member for Governance; c) A third Independent Lay Member (who shall be the Vice Chair); d) Chief Finance Officer (who may nominate a primary care finance lead); e) Chief Nursing Officer (or their nominated representative); f) Chief Medical Officer (or their nominated representative); g) Director of Integration (or their nominated representative) who will be the lead director for the

Committee; h) An Independent GP

5.3 In addition to the list of Members above, the following non-voting members shall be invited to all meetings of the Committee:

a) Up to 3 Governing Body GP Members

b) NHS England c) HealthWatch Birmingham and Healthwatch Solihull; d) A representative of the Birmingham and Solihull Health & Wellbeing Boards, which is requested

to be the Director of Public Health or their nominee; e) Local Medical Committee representatives for Birmingham and Solihull.

5.4 On occasion, other non-voting representatives may be invited including, but not exclusively:

a) CCG Staff; b) Members of the Primary Care workforce within Birmingham and Solihull; c) Other Stakeholders.

5.5 The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.

5.6 Members can nominate a deputy to attend on their behalf when required. However, the deputy should be suitably qualified to represent the interests of the member and will have authority to vote unless stated otherwise.

5.7 The Chair can determine whether the nominated deputy is suitable and if not in agreement with the member, the Chair can revoke the decision making rights of the deputy.

5.8 In the event of the Committee Chair being unable to attend all or part of a meeting, they will nominate a non-conflicted replacement from within the membership to act as Vice Chair and put the nomination to Committee for approval.

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5.9 Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

5.10 The Committee may delegate tasks, to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the CCG's relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

5.11 Members of the Committee shall respect confidentiality requirements as set out in the CCG Constitution and approved policies.

6. Meetings and Voting

6.1 The Committee will operate in accordance with the CCG Standing Orders. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than seven days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

6.2 Each voting member shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible.

7. Meetings in common

7.1 The Committee may hold its meetings as a ‘meeting in common’ with other organisations. In the main this would be with NHS Sandwell & West Birmingham CCG. In these instances the role of co-ordinating ‘Chair’ for the meeting will be agreed between the two CCG Committee Chairs. At no time will a meeting take place if the respective chair or nominated deputy for each CCG is not in attendance. The holding of a ‘meeting in common’ will not affect the individual terms of the CCG Governing Bodies as set out in their constitution and the decisions of the Committee will be made and recorded in line with the clauses above.

7.2 Where items are pertinent to both the CCGs items will be discussed and reflected in the minutes accordingly with decisions reached being recorded respectively for each Committee.

7.3 Where items are pertinent to one CCG only, the respective Committee Chair or deputy will take that item, lead the discussion and ensure that the decision making is reached and recorded by those Committee members associated with that CCG.

7.4 The CCGs have in place collaborative working arrangements and it is anticipated that ‘in common’ meeting arrangements will support further alignment with regards to West Birmingham. However, each Committee will continue to be accountable for its own decisions and each CCG may hold individual Committee meetings as appropriate, for example to discuss business specific to that CCG.

8. Quorum

8.1 The quorum necessary for the transaction of business by the Committee shall be three of the voting members and a lay and executive majority. A duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.

8.2 When meeting in common, Committees have no authority to make decisions on behalf of each other.

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9. Frequency of Meetings

9.1 Meetings of the Committee shall be held as a minimum bi-monthly, with further meetings being held as and when required.

9.2 Working groups will be formed as necessary from the members of the Committee to focus on specific projects and advise the membership as appropriate, such meetings taking place at a frequency commensurate with the work of the group and the direction of the Committee.

9.3 Meetings of the Committee shall:

a) be held in public;

b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

10. Reporting Arrangements

10.1 The Committee will present its report to its Governing Body and NHS England meetings for information, including the reports of any sub-committees to which responsibilities are delegated under paragraph 0 above. Full Committee minutes can be made available on request.

10.2 The CCG will also comply with any other Committee reporting requirements set out in its constitution.

11. Declaration of Interests, Conflicts And Potential Conflicts

11.1 The provisions of Managing Conflicts of Interest: Statutory Guidance for CCGs 55or any successor document will apply at all times.

11.2 Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.

11.3 The Chair of the meeting will determine how this should be managed and inform the member of their decision. The Chair may require the individual to withdraw from the meeting or part of it. Where the Chair is aware that they themselves have such an interest, conflict or potential conflict of interests they will bring it to the attention of the Committee, and the Vice-Chair will act as Chair for the relevant part of the meeting.

11.4 Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.

11.5 Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the Standards for Business Conduct Policy and may result in suspension from the Committee.

12. Decisions

55 https://www.england.nhs.uk/publication/managing-conflicts-of-interest-revised-statutory-guidance-for-ccgs-2017/

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12.1 The Committee will make decisions within the bounds of its remit and these will be reported in accordance with section 10.

12.2 The decisions of the Committee shall be binding on NHS England and the CCG.

13. Accountability of the Committee

13.1 The Committee will have unlimited authority to make decisions in relation to primary medical care commissioning in accordance with the Delegation Agreement as reflected in the CCG’s Scheme of Reservation and Delegation and the CCG’s Constitution. The Committee’s authority extends to primary medical care healthcare and non-healthcare investments.

13.2 Procurement decisions will be reported to the CCG Governing Body through the Committee’s report. A record of all procurement decisions will be kept in accordance with the Standards of Business Conduct Policy.

13.3 For the avoidance of doubt, in the event of any conflict between the Terms of Reference and the Scheme of Reservation and Delegation, Standing Orders, or Standing Financial Instructions of the CCG, the terms of the Delegation Agreement will prevail.

13.4 Where required, consultation will take place with members of the public and/or other CCGs.

14. Procurement of Agreed Services

14.1 The detailed arrangements regarding procurement are set out in the Delegation Agreement.

15. Review

15.1 These terms of reference and the effectiveness of the Committee will be reviewed at least annually and earlier if required.

Version Control:

Date approved by the Remuneration and Nominations Committee: 13/02/2018 (HCB) Date approved by the Governing Body: 13/02/2018 (HCB)

Next review date: Annual Document Owner:

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APPENDIX G: NOLAN PRINCIPLES

1. The ‘Nolan Principles’ set out the ways in which holders of public office should behave in discharging their duties. The seven principles are:

a) Selflessness – Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

b) Integrity – Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

c) Objectivity – In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

d) Accountability – Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

e) Openness – Holders of public office should be as open as possible about all the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

f) Honesty – Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

g) Leadership – Holders of public office should promote and support these principles by leadership and example.

Source: The First Report of the Committee on Standards in Public Life (1995)56

56 Available at www.public-standards.gov.uk

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APPENDIX H – SEVEN KEY PRINCIPLES OF THE NHS CONSTITUTION

The NHS Constitution sets out seven key principles that guide the NHS in all it does:

1. The NHS provides a comprehensive service, available to all irrespective of gender, race,

disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and

maternity or marital or civil partnership status. The service is designed to diagnose, treat

and improve both physical and mental health. It has a duty to each and every individual

that it serves and must respect their human rights. At the same time, it has a wider social

duty to promote equality through the services it provides and to pay particular attention

to groups or sections of society where improvements in health and life expectancy are not

keeping pace with the rest of the population.

2. Access to NHS services is based on clinical need, not an individual’s ability to pay. NHS

services are free of charge, except in limited circumstances sanctioned by Parliament.

3. The NHS aspires to the highest standards of excellence and professionalism – in the

provision of high quality care that is safe, effective and focused on patient experience; in

the people it employs, and in the support, education, training and development they

receive; in the leadership and management of its organisations; and through its

commitment to innovation and to the promotion, conduct and use of research to improve

the current and future health and care of the population. Respect, dignity, compassion and

care should be at the core of how patients and staff are treated not only because that is

the right thing to do but because patient safety, experience and outcomes are all improved

when staff are valued, empowered and supported.

4. The NHS aspires to put patients at the heart of everything it does. It should support

individuals to promote and manage their own health. NHS services must reflect, and should

be coordinated around and tailored to, the needs and preferences of patients, their families

and their carers. Patients, with their families and carers, where appropriate, will be

involved in and consulted on all decisions about their care and treatment. The NHS will

actively encourage feedback from the public, patients and staff, welcome it and use it to

improve its services. encourage feedback from the public, patients and staff, welcome it

and use it to improve its services. encourage feedback from the public, patients and staff,

welcome it and use it to improve its services.

5. The NHS works across organisational boundaries and in partnership with other

organisations in the interest of patients, local communities and the wider population.

The NHS is an integrated system of organisations and services bound together by the

principles and values reflected in the Constitution. The NHS is committed to working jointly

with other local authority services, other public sector organisations and a wide range of

private and voluntary sector organisations to provide and deliver improvements in health

and wellbeing.

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6. The NHS is committed to providing best value for taxpayers’ money and the most

effective, fair and sustainable use of finite resources. Public funds for healthcare will be

devoted solely to the benefit of the people that the NHS serves.

7. The NHS is accountable to the public, communities and patients that it serves. The NHS is

a national service funded through national taxation, and it is the Government which sets

the framework for the NHS and which is accountable to Parliament for its operation.

However, most decisions in the NHS, especially those about the treatment of individuals

and the detailed organisation of services, are rightly taken by the local NHS and by patients

with their clinicians. The system of responsibility and accountability for taking decisions in

the NHS should be transparent and clear to the public, patients and staff. The Government

will ensure that there is always a clear and up-to-date statement of NHS accountability for

this purpose.

Source: The NHS Constitution: The NHS belongs to us all (March 2013)57

57 www.gov.uk/government/uploads/system/uploads/attachment_data/file/170656/NHS_Constitution.pdf

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APPENDIX I: LOCAL SUPER OUTPUT AREAS

E01008940 E01008896 E01009400 E01009459 E01009467 E01009155 E01009163

E01008941 E01009008 E01009032 E01009194 E01009135 E01009475 E01009331

E01008942 E01008897 E01009104 E01009127 E01009313 E01009427 E01009233

E01008943 E01008898 E01009451 E01009040 E01009046 E01009322 E01009075

E01008944 E01009009 E01009401 E01009411 E01009204 E01009225 E01009484

E01008945 E01009011 E01009105 E01009460 E01009314 E01009069 E01009435

E01008946 E01008917 E01009452 E01009306 E01009420 E01009476 E01009164

E01008947 E01008918 E01009403 E01009195 E01009468 E01009157 E01009244

E01008948 E01009012 E01009033 E01009128 E01009136 E01009226 E01009332

E01008949 E01008919 E01009106 E01009412 E01009064 E01009428 E01009485

E01008963 E01009013 E01009299 E01009041 E01009315 E01009323 E01009077

E01008982 E01008920 E01009453 E01009307 E01009207 E01009477 E01009333

E01008986 E01009015 E01009404 E01009461 E01009421 E01009070 E01009436

E01008987 E01008921 E01009121 E01009197 E01009469 E01009158 E01009248

E01008988 E01009016 E01009034 E01009129 E01009137 E01009324 E01009165

E01008989 E01009018 E01009122 E01009413 E01009316 E01009429 E01009486

E01008990 E01008923 E01009405 E01009462 E01009208 E01009227 E01009079

E01008881 E01009019 E01009454 E01009308 E01009470 E01009478 E01008936

E01008882 E01008924 E01009035 E01009042 E01009138 E01009071 E01009249

E01008991 E01008925 E01009186 E01009198 E01009422 E01009325 E01009437

E01008883 E01009020 E01009300 E01009130 E01009065 E01009159 E01009334

E01008992 E01009021 E01009123 E01009414 E01009317 E01009430 E01009167

E01008884 E01008927 E01009455 E01009309 E01009471 E01009228 E01009487

E01008994 E01008928 E01009301 E01009463 E01009220 E01009479 E01009499

E01008885 E01009022 E01009187 E01009199 E01009139 E01009326 E01009335

E01008995 E01009023 E01009406 E01009415 E01009423 E01009229 E01009250

E01008886 E01008929 E01009036 E01009131 E01009066 E01009160 E01008950

E01008997 E01009024 E01009302 E01009043 E01009318 E01009431 E01009169

E01008887 E01008930 E01009124 E01009310 E01009221 E01009480 E01009438

E01008998 E01008931 E01009456 E01009200 E01009472 E01009072 E01009488

E01008888 E01009025 E01009188 E01009464 E01009143 E01009327 E01009080

E01008999 E01008934 E01009407 E01009416 E01009424 E01009230 E01009500

E01008889 E01009026 E01009037 E01009132 E01009319 E01009161 E01009081

E01009000 E01009028 E01009189 E01009311 E01009067 E01009432 E01009501

E01008890 E01008937 E01009408 E01009045 E01009222 E01009481 E01009489

E01009001 E01008938 E01009457 E01009201 E01009473 E01009073 E01009251

E01008891 E01009029 E01009125 E01009465 E01009146 E01009231 E01009337

E01009002 E01008939 E01009303 E01009417 E01009425 E01009328 E01009439

E01008892 E01009030 E01009304 E01009133 E01009320 E01009162 E01009171

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E01009003 E01009385 E01009409 E01009418 E01009223 E01009482 E01008951

E01008893 E01009102 E01009458 E01009202 E01009426 E01009433 E01009440

E01009005 E01009449 E01009192 E01009466 E01009474 E01009329 E01009252

E01008894 E01009390 E01009126 E01009134 E01009147 E01009074 E01008952

E01009006 E01009031 E01009039 E01009312 E01009068 E01009232 E01009172

E01008895 E01009103 E01009410 E01009203 E01009321 E01009434 E01009490

E01009007 E01009450 E01009305 E01009419 E01009224 E01009483 E01009338

E01009502 E01009088 E01033631 E01009444 E01009217 E01010156 E01010188

E01009082 E01009261 E01009107 E01009521 E01009218 E01010157 E01010217

E01009441 E01009364 E01033632 E01008973 E01009397 E01010158 E01010189

E01009253 E01009498 E01009108 E01009096 E01009219 E01010159 E01010218

E01008953 E01008961 E01033633 E01009445 E01009280 E01010160 E01010108

E01009339 E01009510 E01009109 E01009178 E01009399 E01010161 E01010190

E01009173 E01009291 E01033639 E01008974 E01009281 E01010162 E01010109

E01009503 E01009378 E01033640 E01032589 E01009282 E01010163 E01010191

E01009491 E01008962 E01009110 E01009446 E01033634 E01010202 E01010219

E01009083 E01009089 E01033642 E01009182 E01009283 E01010164 E01010192

E01008954 E01009511 E01009111 E01008975 E01009284 E01010165 E01010110

E01009254 E01009379 E01033644 E01033557 E01033641 E01010203 E01010220

E01009340 E01009294 E01009112 E01009097 E01009286 E01010166 E01010193

E01009492 E01008964 E01033646 E01009447 E01009288 E01010167 E01010111

E01009504 E01009512 E01009113 E01009183 E01033643 E01010204 E01010194

E01009084 E01009090 E01033647 E01008976 E01009289 E01010168 E01010112

E01009255 E01009297 E01009114 E01033561 E01033645 E01010205 E01010221

E01008955 E01009380 E01033649 E01009098 E01009290 E01010169 E01010113

E01009341 E01008965 E01009115 E01009448 E01009292 E01010170 E01010195

E01009493 E01009513 E01008932 E01009184 E01009293 E01010206 E01010222

E01009505 E01009384 E01009116 E01033562 E01033648 E01010171 E01010114

E01009256 E01008966 E01008933 E01008977 E01009295 E01010207 E01010196

E01008956 E01009298 E01009117 E01009185 E01033650 E01010172 E01010223

E01009085 E01009091 E01008935 E01033564 E01009296 E01010173 E01010115

E01009342 E01009514 E01009118 E01008978 E01009363 E01010208 E01010197

E01009506 E01009515 E01009119 E01009099 E01009365 E01010174 E01010225

E01009257 E01008967 E01009120 E01008979 E01009366 E01010209 E01010116

E01009494 E01009092 E01009166 E01033567 E01009367 E01010175 E01010198

E01008957 E01009516 E01009168 E01009100 E01009368 E01010176 E01010117

E01009343 E01008968 E01009170 E01008980 E01009371 E01010210 E01010199

E01009258 E01009093 E01009176 E01033615 E01009372 E01010177 E01010226

E01009507 E01009517 E01009179 E01033616 E01009373 E01010211 E01010200

E01009495 E01008969 E01009205 E01009101 E01009374 E01010178 E01010118

E01009086 E01009518 E01009206 E01008981 E01009375 E01010179 E01010227

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E01008958 E01008970 E01009209 E01033617 E01009376 E01010212 E01010201

E01009344 E01009094 E01009210 E01008984 E01009377 E01010180 E01010119

E01009259 E01009174 E01009211 E01033618 E01009382 E01010181 E01010228

E01009496 E01009442 E01009393 E01033624 E01009383 E01010213 E01010120

E01009508 E01009519 E01009212 E01008996 E01009389 E01010183 E01010229

E01008959 E01008971 E01009213 E01033626 E01009391 E01010184 E01010121

E01009087 E01009443 E01009394 E01009014 E01009392 E01010214 E01010122

E01009260 E01009175 E01009214 E01033629 E01010151 E01010185 E01010230

E01009497 E01009095 E01009395 E01009017 E01010152 E01010215 E01010123

E01009362 E01009520 E01009215 E01033630 E01010153 E01010186 E01010124

E01009509 E01008972

E01008960 E01009177

E01010126 E01009216

E01010232 E01009396

E01010127 E01009044

E01010233 E01009078

E01010128 E01010154

E01010129 E01010155

E01010234 E01010216

E01010130 E01010187

E01010131 E01010231

E01010235 E01010125

E01010132 E01032885

E01010133 E01010145

E01010236 E01032886

E01010134 E01010146

E01010237 E01010147

E01010135 E01010148

E01010136 E01010149

E01010137 E01010150

E01010238

E01010138

E01010239

E01010139

E01010140

E01010240

E01010141

E01010142

E01032590

E01010143

E01010144

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