€¦ · 1 NHS NENE CCG ANNUAL REPORT 2019-20 NHS NENE CCG ANNUAL REPORT 2019-20 Contents Contents

NHS Nene CCG Annual Report 2019/20

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NHS NENE CCG ANNUAL REPORT 2019-20 NHS NENE CCG ANNUAL REPORT 2019-20

Contents

Contents ..................................................................................................................... 1

Version Control .......................................................................................................... 3

PERFORMANCE REPORT ....................................................................................... 4

GP Chair’s Introduction .............................................................................................. 5

Foreword .................................................................................................................... 7

Our Local Population .......................................................................................... 10

Our Providers...................................................................................................... 11

How we Work...................................................................................................... 11

Corporate Objectives for 2019/2020 ................................................................... 11

Our Priorities for 2019/20 .................................................................................... 12

System Transformation ....................................................................................... 13

Working in Partnership with NHS Corby CCG .................................................... 14

How is the CCG Involved in the NHCP? ............................................................. 20

Going Concern Assessment ............................................................................... 34

Performance Analysis .............................................................................................. 38

Primary Care....................................................................................................... 38

Medicines Optimisation ....................................................................................... 45

Learning Disability Services ................................................................................ 48

Supporting our Armed Forces Community .......................................................... 56

Diabetes Services ............................................................................................... 59

Cancer ................................................................................................................ 60

How We Manage Performance ........................................................................... 62

Business Continuity ............................................................................................ 74

Sustainable Development ................................................................................... 77

Improving Quality ................................................................................................ 78

Engaging People and Communities .................................................................... 88

Reducing Health Inequality ................................................................................. 92

Health and Wellbeing Strategy ........................................................................... 96

ACCOUNTABILITY REPORT .................................................................................. 98

Corporate Governance Report ................................................................................. 99

Members Report ................................................................................................. 99

Statement of Accountable Officer’s Responsibilities .............................................. 102

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Governance Statement .......................................................................................... 104

Remuneration and Staff Report .............................................................................. 148

Remuneration Report ....................................................................................... 148

Staff Report ...................................................................................................... 163

The Trade Union ................................................................................................... 166

Parliamentary Accountability and Audit Report ...................................................... 175

ANNUAL ACCOUNTS ............................................................................................ 176

Appendices ........................................................................................................ 21754

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Version Control

V1 24.01.20 First draft HC

V2 06.02.20 Second draft (revisions to overall copy) LW

V3 08.02.20 Third draft (implementing amendments) HC

V4 21.03.20 Fourth draft, introductions, HR info, H&S, updated

performance & quality sections

DA

V5 10.04.20 Fifth draft, updated Governance statement, business

continuity, appendices

HC

V6 13.04.20 Final formatting and check HC

V7 14.04.20 Adding in financial information & Going Concern

Assessment

HC

V8 26.05.20 Trade union information added, performance section

updated & amendment to foreword

HC

V9 07.06.20 Formatting finalised HC

V10 18.06.20 Performance data and sustainability narrative added HC

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PERFORMANCE REPORT The performance report provides an explanation of how the CCG discharged its duties

and functions.

Toby Sanders

Chief Executive (Accountable Officer)

17th June 2020

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GP Chair’s Introduction

Welcome to our Annual Report where we look back at the activities that we have

undertaken over the last 12 months. It is my belief that by working together, as clinicians,

with our local population, we can improve the quality, outcomes and clinical standards of

care for all patients. We have a vision of helping every person lead the best possible life,

from beginning to end, and working tirelessly, together as an organisation.

We have built upon last year’s strategy by continuing to work collaboratively and

supporting the local providers of health and social care. Working continuously better as

a system, focusing on the needs of our Northamptonshire population. We have continued

over the past financial year to work alongside NHS Corby CCG, our social care and public

health colleagues.

And building on from last year, this year we have, with NHS England and Improvement’s

agreement, established NHS Northamptonshire CCG. Our single CCG for

Northamptonshire went live on 1 April 2020. I understand it has been a challenging

process, and would like to begin by thanking our member practices and our staff members

for their hard work and support. I would like to congratulate my counterpart, Dr Jo Watt,

Clinical Chair, Corby CCG who has been elected as the GP Chair of the new organisation.

I am delighted to advise you I have decided to take up a new role with Northamptonshire

CCG as a Locality Chair.

I also want to take this opportunity to thank those who have played a key role in

supporting our CCG and to our Governing Body members. I would also like to thank and

acknowledge the work of our Governing Body Lay members who left the organisation in

2019 Kevin Thomas, Paul Bevan, Tansi Harper and Tom Howseman. All worked

tirelessly to ensure the patient voice and those of our member practices was heard and

that we had effective governance as part of our decision-making processes. Tansi Harper

had been covering the Public and Patient Participation Lay Member role since the very

sad death of Roz Horton in December 2018 and we are very grateful to Tansi for

continuing Roz’s legacy.

As I am sure you are all aware and appreciate, it has been another challenging year for

the NHS with high demand on our services. During these times, it is important that we

uphold our values of being effective, compassionate, safe and supportive. I want to thank

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all of those within our organisation and across the NHS and social care system, for all of

their hard work and commitment.

And finally, I could not end this introduction without making reference to the COVID-19

pandemic. I have seen first-hand the dedication of not only frontline workers caring for

patients but the teams of support staff who are planning and managing the local NHS

response to COVID-19. These staff are across many agencies, all working tirelessly and

selflessly to protect as many people as possible from the virus and care for those who

are infected. This has been an exhausting and challenging time to be part of the NHS but

also a time where we have so much to be proud of.

Dr Darin Seiger

GP Chair

17th June 2020

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Foreword

Welcome to the annual report for NHS Nene Clinical Commissioning Group (CCG), which

covers the period 1 April 2019 to 31 March 2020.

This report aims to give you an overview of our organisation, our staff and GP member

practices. It shows how we work through robust governance arrangements and how we

assure ourselves and others that our services are delivered safely and to a high standard

of quality. Always working to ensure that the patient experience is positive. We will explain

our mission, goals and achievements, highlighting the partnerships that we rely on to

ensure the best possible outcomes for patients.

We have continued to work closely with Corby Clinical Commissioning Group, our

neighbouring CCG, ensuring that we work collaboratively across health and social care.

Following this through to our work with providers, commissioners, voluntary and

community sector and stakeholders, and most importantly, our patients. Working together

under the banner of the Northamptonshire CCGs, we have collaborated to improve the

health of our local communities. This integrated way of working has been vital in the

continued development of Northamptonshire’s Health and Care Partnership. Where

maintaining relationships with our clinical members and leadership team through our

Governing Body, Locality Groups and other significant groups has also been an integral

part of driving through new initiatives and projects.

This year we established a joint Senior Corporate Management team and recruited into

the newly established joint Lay Member roles. This work supported our direction of travel

towards establishing a single CCG for Northamptonshire. I am pleased to advise you our

application has been successful and Northamptonshire CCG officially went live on 1st

April 2020. I would like to take this moment to welcome our new members and to

acknowledge and thank those who left the organisation this year.

This report is retrospective by nature and showcases the achievements and challenges

of our organisation over the year gone by. There is a great deal to be proud of this year.

This includes the innovative Yellow Bracelet and Rapid Response team schemes, which

are helping to reduce unnecessary hospital admissions; our work to support people with

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learning disabilities and the development of the Northamptonshire Health, Care and

Wellbeing Plan, which a localised version of the nationally se Long-Term Plan.

At the time of writing, the world faces one of the largest health threats in over a century

in the form of the COVID-19 pandemic. In Northamptonshire, a Strategic Coordination

Centre has been established to manage and coordinate the local response to the

pandemic. Agencies have come together from across the county to deliver this response.

I am extremely proud of the way Northamptonshire has come together to tackle this crisis

and would like to thank everyone who is working tirelessly as part of this response to try

and protect as many people as possible from contracting the virus and caring for those

who are ill. I would also like to say the local response goes beyond the NHS and I would

also like to acknowledge the support of all the key workers who are ensuring essential

services are kept going and everyone in the county who has followed the Government

advice to stay at home, protect the NHS and save lives.

The progress made in 2019/20 has been delivered in a climate of change and

continuous financial and external pressure, which in some cases has resulted in us not

achieving some of our key constitutional standards and targets. It is also important to

note that some of the constitutional standards and targets were temporarily suspended

to enable the health service to focus on the fight against COVID-19. We have been

working with our providers to ensure our local population is able to access the best

possible health services available. You can read more about our performance on pages

62 – 73.

We do so much work that cannot be covered in this annual report, we have so much to

share but there are only so many pages. We hope that you find this Annual Report

information, providing you with an overview of the past 12 months. Please contact us if

you would like to know more about NHS Nene CCG.

Toby Sanders

Chief Executive

17th June 2020

https://www.northamptonshirehcp.co.uk/wp-content/uploads/2019/08/LTP-engagement-ppt-August-2019_staff-and-stakeholders-FINAL.pdf


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Performance Overview

NHS Nene Clinical Commissioning Group (alongside NHS Corby CCG) is responsible

for planning and funding the majority of health services across Northamptonshire. The

only parts of the county not covered by the two CCGs are the communities of Wansford

and Oundle in the east, who are members of the Peterborough and Cambridgeshire

CCG.

Services we fund include:

Elective hospital care (excluding some specialist services)

Urgent and emergency care

Most community health services

Mental health and learning disability services

Rehabilitation care

Prescribing

GP services

The diagram below shows in more detail how health services are set up in England

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NHS Nene CCG fund services on behalf of the 64 GP practices in the area we cover with

a budget that is set nationally, which was £885,269,000 in 2019/20. A list of our member

practices is available in the appendices on page 218.

We are clinically led by GPs and other healthcare professionals, including a registered

nurse and a secondary care (hospital) doctor. This is because we believe that local GPs

and clinicians working with local communities bring about the biggest improvements in

care and health outcomes. You can read more about the Governing Body membership

on page 99 - 100.

Our Local Population

Northamptonshire is one of the fastest growing areas in

the United Kingdom. Its population is getting older,

increasingly diverse and more people are benefitting

from longer life expectancy. However, there are still

significant differences in health and life expectancy

across the county.

The county’s population is around 747,622 (Office for

National Statistics Mid-Year Estimates 2018). In the last

30 years, the population of Northamptonshire has

increased by just over 30% compared to an 18% England average.

Health headlines include:

Average life expectancy for males is 80

Average life expectancy for females is 83

68% of adults are overweight or obese

22% of reception children are overweight or obese

15% of adults smoke

46 deaths (per 100,000 population) from cardiovascular disease (considered

preventable)

59 deaths per 100,000 population from Chronic Obstructive Pulmonary Disease

(COPD)

80 deaths per 100,000 population from cancer (considered preventable)

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Our Providers

Nene CCG uses the term ‘provider’ to describe any organisation commissioned to supply

a health or care-based service. Examples include; hospital trusts, mental and community

health trusts, GP Practices and Federations, voluntary and third sector organisations,

social work, home support (care) work, health visiting and district nursing.

Northampton General Hospital NHS Trust (NGH) and Kettering General Hospital

NHS Foundation Trust (KGH) are the main providers of acute care for

Northamptonshire residents.

Northamptonshire Healthcare NHS Foundation Trust (NHFT) provides the majority

of our community and mental health services.

We also commission services from other hospitals in nearby counties, social care

providers, community healthcare and the voluntary sector to give patients the

opportunity to choose the type of service they wish to receive.

We have three GP Federations in Nene, formed by our 64 member practices. These are

GP Alliance in Northampton, 3 Sixty Care in the north of the county and PML – DocMed

in the south of the county. Some practices also work in partnership with Northamptonshire

Healthcare Federation Trust (NHFT).

How we Work

NHS Nene Clinical Commissioning Group’s mission is:

“To create a culture where individuals are supported to manage their own

healthcare: enabling people in Corby to live healthier, fuller lives.”

Values

Corporate Objectives for 2019/2020

Quality

We will improve quality within all providers to ensure services are safe, efficient and

effective.

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Transformation

We will create the environment to enable the commissioning and delivery of high quality

services to reduce health inequalities and improve health outcomes and resilient

communities.

Commission Sustainable Services

We will ensure the development of seamless transition between providers, where patients

need the support or intervention of primary care, community care, secondary care, social

services or the voluntary sector, within resources available, ensuring high quality

provision and best value for money.

Engagement

We will engage patients, public, members and partner organisations to ensure that

services are delivered at the right time, in the right place and to the highest quality.

Workforce and Culture

We will develop and support a motivated workforce equipped with the required

capabilities, culture and competencies to meet the evolving needs of Primary Care and

the progression towards a strategic commissioning function.

Accountability

We will be truly accountable to our population and have appropriate arrangements in

place to discharge our functions effectively, efficiently and economically, and in

accordance with the statutory framework and best practice principles of good governance

and transparency.

Our Priorities for 2019/20

Our priorities for 2019/20 were clinically led and derived from evidence-based

opportunities, as identified in national guidance such as NHS RightCare. They are also

aligned to the strategic direction set by the wider Northamptonshire Health and Care

Partnership, including the move to adopt a strategic commissioning approach.

Pathways considered for such an approach included:

Respiratory care

Stroke services

Mental health services

Ophthalmology

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Musculoskeletal services (MSK) and

Frailty

Respiratory care has been designated the highest priority by the CCGs’ Joint Strategic

Commissioning Committee, and the local Public Health team have worked with us to

identify it as the largest effectible change for the county that has not yet been tackled.

The overarching goal of these commissioning intentions is to support improved patient

experience and better health outcomes through the commissioning of high quality,

responsive and sustainable services.

This will be achieved by:

Keeping the fundamental principles of patient experience at the forefront of our

plans

Enabling improvement, innovation and sharing best practice

Ensuring equal access for all

Ensuring that people are enabled to access the right health services in the most

appropriate way and

Ensuring the system meets national quality standards.

System Transformation

We continue to have challenges to meet the current and expected levels of future demand

within our health and care systems within our current shared resource. The funding is not

available to drive the scale and pace of transformation required to fix our immediate

issues and therefore we are having to think about different ways of working.

As our population increases, and more people live with long-term conditions, the

demands on our services are changing and increasing. Services are always designed for

current or future needs, and it is becoming harder to provide safe services against rising

costs. We need to maximise our opportunities to improve health and wellbeing, prevent

illness and support people to manage existing conditions and stay independent.

The NHS Long Term Plan sets out a national new service model for the 21st century; one

that provides patients with more options, better support, and joined up care at the right

https://www.longtermplan.nhs.uk/

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time in the most appropriate care setting. This plan provides us

with the guidance to implement the necessary changes locally.

The NHS Long Term Plan, within the current legal framework,

states that the NHS and our partners will create Integrated Care

Systems (ICSs) by April 2021, bringing local organisations

together at a ‘place’ level, making shared decisions and taking

collective responsibility for managing resources, delivering NHS

standards, and improving the health of the population they serve.

This builds on the work that has already been done by the

Northamptonshire Health and Care Partnership (NHCP),

Northamptonshire’s Sustainable Transformation Partnership

(STP).

The ICS will need streamlined commissioning arrangements to

enable a single set of commissioning decisions to be made for

the whole system and this will typically involve a single CCG for

the area. The system will need to ensure compliance with

statutory regulations and these regulatory functions will sit within

the strategic commissioning role. Our local response to the

requirements of the NHS Long Term Plan are set out on the

Northamptonshire Health, Care and Wellbeing Plan, which also

acts as our local Joint Health and Wellbeing Strategy.

Working in Partnership with NHS Corby CCG

In January 2019, following many years of collaboration and

integration, Nene CCG and Corby CCG Governing Bodies

formally agreed in principle to create a single strategic

commissioner for Northamptonshire from April 2020 by

disestablishing the current two statutory bodies. This

progression will enable us to play a pivotal role in the

establishment of our local ICS and lead the way on the

integration of health and social care in Northamptonshire.

In April 2019, we started communicating our aims and objectives

for becoming a single organisation, outlining our priorities and

What is an

Integrated Care

System?

In an Integrated

Care System, NHS

organisations will

work in partnership

with local councils

and others to take

collective

responsibility for

managing resources

and improving the

health of the

population they

serve.

Local services can

provide better and

more joined-up care

for patients, which is

tailored to individual

need with a better

understanding of

local health needs

when different

organisations work

together in this way.


https://www.northamptonshirehcp.co.uk/


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desired outcomes. Our main priority has always been on strengthening the delivery of the

two organisations so that we can increase our effectiveness as strategic, clinical

commissioners in leading quality improvement in services and outcomes for patients.

Following consultation with GP member practices, Healthwatch, local authorities and

other key stakeholders, we have widespread support to become one single strategic

commissioning organisation.

Our application to NHS England and Improvement (NHSE/I) to create a new strategic

commissioning organisation was in accordance with CCG governance arrangements,

and reflected a vote undertaken with member GP practices during August and September

2019. Of the five member practices of NHS Corby CCG, four responded and all were in

support of the proposal. Of the 66 member practices of NHS Nene CCG (the vote took

place before 2 practices closed or merged), 46 responded, of which 34 were in support

of the proposal. Both NHS Corby and NHS Nene CCGs achieved a majority vote in

support of the proposal to establish a single Northamptonshire CCG from April 2020.

Following submission of our application to NHSE/I, a review took place in October 2019

between the Northamptonshire CCGs and the regulator. This meeting resulted in

authorisation of the establishment of NHS Northamptonshire CCG, subject to a number

of conditions being met before April 2020. Between November 2019 and March 2020, the

Northamptonshire CCGs have been working with NHSE/I to meet these conditions to

ensure we receive our Grant of Merger confirming the dissolution of Corby CCG and

Nene CCG.

The Governing Body have agreed to adopt the mission vision and the Northamptonshire

Health and Care Partnership (NHCP) level mission, vision and values (as below):

Our vision for the future of Northamptonshire’s health and care services is for a positive

lifetime of health, wellbeing and care in our community.

Our mission in working together, the reason we do what we do, is to empower positive

futures. Wherever we work and whatever our role we all want people in Northamptonshire

to be able to choose well, stay well, live well.

Each day our shared values will help to guide our decisions and what is most important

to us:

Our patients and our local population come first

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We work together in an open and accountable way

We trust, challenge and support each other

We do what we say we will do

As strategic commissioners supporting the development of the local ICS, it is important

to provide effective and responsive leadership to ensure the NHCP vision, mission,

values and corporate objectives are demonstrated and to evidence our commitment to

aligning to, and where appropriate leading, system wide developments.

Case Study: Moving Towards Establishing a Single CCG in Northamptonshire

During 2019 we engaged with stakeholders, including patients and public, to understand

their views on proposals to establish a single CCG in Northamptonshire. In total 40 people

attended the public meetings and 79 responses were received via a survey. Overall, there

was explicit support for the move to a single CCG for Northamptonshire. The majority of

the public attending the meetings supported the proposal to move towards establishing

a single CCG and 42% of survey respondents supported the proposal.

Some consistent themes emerged from the engagement including:

The desire to retain a local focus within a county-wide CCG

The opportunity to address variation, both in terms of health inequalities and

consistent standards of service access and quality

Some nervousness about change

Some indifference about structural re-organisation

A desire for better CCG communication and engagement

The CCGs are listening to feedback, which will inform the new organisation moving

forward. The feedback can be read here.

Northamptonshire Health and Care Partnership

Northamptonshire Health and Care Partnership (NHCP) consists of key health and

care organisations in the county. While we all

remain separate organisations with our own local

responsibilities for the services we provide, we are

https://www.neneccg.nhs.uk/downloads/Have%20Your%20Say/Northamptonshire%20CCGs%20Transition%20Public%20Engagement%20results.pdf

https://www.northamptonshirehcp.co.uk/

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committed to working together towards a positive future for our services.

By working more closely, we are developing ambitious plans to do things differently and

are clear on our local priorities; so together, we can improve the quality of care and the

health and wellbeing of our community.

NHCP’s Vision and Mission

Our vision for the future of Northamptonshire’s health and care services is for a positive

lifetime of health, wellbeing and care in our community.

Our mission in working together, the reason we do what we do, is to empower positive

futures. Wherever we work and whatever our role, we all want people in

Northamptonshire to be able to choose well, stay well, live well.

A diagram of the NHCP’s achievements for 2019/20 is on the next page.

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Case study: Engagement Event Shapes Big Ideas

Feedback about experiences of health and care in Northamptonshire – and people’s

priorities for the future – are helping NHCP (of which the Northamptonshire CCGs are a

partner) to shape plans to develop and improve local services.

NCHP and Healthwatch Northamptonshire offered local people the opportunity to make

their views heard either by attending a community engagement event or by taking part in

a survey. Nearly 300 people shared their experiences and views on how to improve

health and care services in Northamptonshire.

This event, at the Park Inn in Northampton on Thursday 2 May 2019, was attended by 90

local people and gave them the chance to have their say on the current state of health

and care services – and talk about how we can work together to ensure they are fit for

the future.

Host David Jones, chair of Healthwatch Northamptonshire, began the day by introducing

presentations from key local health and care leaders. They described how organisations

are working in partnership towards a positive lifetime of health, wellbeing and care in our

community, and explained why the NHS Long Term Plan must inform planning at a local

level.

This led into a series of workshop

sessions, where delegates discussed

their experiences of local NHS and social

care services and suggestions for ways

they could be improved.

These discussions were then developed

into headline ‘big ideas’ on how we can

be supported to choose well, stay well and live well in Northamptonshire. There was a

particular focus through the day on supporting people to age well, on care at community

level, on mental health and on long-term conditions. Please see image above.

A selection of some of the key themes and priorities, which emerged from the event

included:


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The need to improve access to information about local health and care services

Better co-ordination to make it easier for people to access services seamlessly

across different organisations

Making it easier for authorised professionals to access people’s health and care

records to improve their experience of services

Reducing inequalities in health and care across the county

The event was well received by participants and this will support the planning of

future NHCP community engagement activity and listening events around the county.

You can read a copy of the report in full here and watch a video about the event here

How is the CCG Involved in the NHCP?

NHS Corby Clinical Commissioning Group and NHS Nene Clinical Commissioning Group

are partners in the Northamptonshire Health and Care Partnership. The CCGs’ have

been active in helping to deliver four priorities for the NHCP:

Musculoskeletal care

Urology

Respiratory care

Frailty services

Improving Musculoskeletal Care for People in Northamptonshire

Musculoskeletal health is important because it has a huge impact on patients and the

wider NHS. Around one in four of the adult population (many being young and of working

age) has an MSK condition and it accounts for 30% of GP consultations and a quarter of

all surgical interventions.

How Are We Making Musculoskeletal Health Better?

A number of schemes will improve access to and the quality of MSK services in the county

including:

Developing ‘First Contact Practitioners’ (physiotherapists) to support GPs

Improving referral processes

Refining processes in outpatients and therapy clinics

Supporting patients to help then with self-management.

http://www.healthwatchnorthamptonshire.co.uk/sites/default/files/northamptonshire_ltp_engagement_report_final_090919.pdf

https://www.youtube.com/watch?v=WMei_QAJvC4&feature=emb_logo

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First Contact Practitioners

Physiotherapists with advanced skills are now working alongside local GPs and others in

primary care to support people locally as part of a national programme to develop first

contact practitioners. The local model of care has been recognised as an exemplar by

NHS England and rollout of the first contact practitioner programme in Northamptonshire

is relatively advanced.

A new method for health professionals to refer patients for MSK treatment has been

launched in Northamptonshire – with an ambition to deliver joined-up and consistent

access to services for the whole of the county.

NHCP has supported the development of the new MSK referral hub, which provides a

single point of access for all the county’s referrals for patients with joint, bone and muscle

problems.

The new hub has been developed by a project team with membership from all NHCP

partner organisations. Its design was informed by engaging with local clinicians to

understand their experiences and views on previous referral methods. It is supported by

all Northamptonshire’s NHS providers and clinical commissioning groups, and will handle

more than 50,000 referrals every year.

By creating a single point of access for MSK referrals, with a standardised management

and assessment process, the new hub gives patients better and more equal access to

local services - regardless of where they live in the county - and will result in shorter waits.

The clinical assessment model directs referrals to the most appropriate service while

supporting patients to choose the best service for their individual needs. This allows clear

and joined-up pathways of care to be developed and empowers patients to manage their

wider health and wellbeing as part of a long-term care plan.

The new hub reduces GP workload, with one form covering all MSK referrals, and allows

a single point of contact for follow-up queries and patient treatment pathways are

managed fully within the service.

Clinical assessment for all orthopaedic and MSK therapy referrals is set to start in April

2020. Further development will continue throughout the year, including pain management

assessment, work to support patients with rheumatology and complex MSK needs, and

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establishment of links to public health services supporting improved health and wellbeing,

for example access to weight management services.

Refining Therapy Support

A dedicated project to tackle the growing workload for therapy support and help meet

patient need has been established. Two workshops set out a new approach to the

delivery of MSK Therapies, so as to improve care pathways and maximise the way

therapists support patients. Physiotherapists and OT’s from across Northamptonshire

have agreed to work together to remodel the hand service, develop the pre- and post-

operative therapist input for patients undergoing joint replacement, and to increase the

ability for patients to self-care and maintain their musculoskeletal health. The detail on

this work continues and will be fully developed in 2020/21.

Pain Management

Over the last year work has been undertaken to support people with long-term pain that

will not resolve. A model of care has been developed to provide patients with additional

physiotherapy and psychology support to help patients cope with their condition and so

maximise their quality of life. The aim is to introduce the model of care across

Northamptonshire in 2020.

Hand Surgery

Recent work has been focussed on hand therapy and surgery to streamline and agree a

single set of pathways in Northamptonshire for the diagnosis and treatment of carpal

tunnel, trigger finger and Dupuytren’s contracture. This work is currently underway and

again the aim is to introduce new models of care across Northamptonshire in 2020.

Improving Urology for People in Northamptonshire

Urology (the branch of medicine concerned with the function and disorders of the urinary

system) is important because it has a huge impact on patients and the wider NHS.

Urology electives have risen by 20% over the last 20 years and results in a quarter of all

surgical interventions. However, only 10-12% of patients need urology treatment and

70% of patients can be discharged with no further action once all tests are complete. It is

also one of the most innovative surgical specialties and was one of the first specialties to

routinely use keyhole surgery and laser technology.

How Are We Making Urology Better?

A number of scheme are being developed to improve urology services including:

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Developing one-stop urology services

Establishing Northamptonshire continence advisory services

Addressing urinary tract infections

One-Stop Urology

Faster diagnosis and quicker access to the right treatment are at the heart of a new-look

service being developed for people in Northamptonshire with urological conditions. More

and more people in our county are experiencing urological problems – conditions

affecting the kidneys, bladder, their connecting tubes and the male reproductive system.

Over the last five years alone, there has been a 27% increase in the number of people

referred to urology departments at Kettering and Northampton General Hospitals, and

this will continue to increase as our elderly population grows.

This rise in demand puts pressure on local services and makes it more difficult to meet

waiting time standards – but thanks to advances in technology and modern treatment

methods, it’s now possible to give more people the care they need without the

requirement for surgery or an overnight hospital stay. This has led to the growing

nationwide use of what is known as a ‘one-stop’ model of care for urological conditions –

where patients are seen, tested, diagnosed and given an individual treatment plan all in

the same hospital visit.

Not only does this mean shorter waiting times, faster treatment and fewer trips to hospital

for the patient, resulting in less stress and more convenient care, but it also helps to

reduce pressure on wider health and care services by managing demand more

effectively. This one-stop model has been tested at KGH and NGH, with the two trusts

working closely together through NHCP to develop standardised processes ensuring

patients throughout the county can access the same high-quality care.

Patient feedback on these one-stop clinics has been positive and the two trusts are

developing plans to implement permanent services in the near future.

Northamptonshire Continence Advisory Services

Continence is an issue which can be hard to talk about and when it is not well managed,

can have a very negative impact on someone’s quality of life. The development of the

Northamptonshire Continence Advisory Services will look to:

Reduce presentation for catheter issues in A&E

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Reduce GP workload

Support nursing staff in the community and in care homes

Offer direct support for patients who struggle to manage their continence needs

A proposal has been developed with the input and support of all NHCP partners to

establish a service that would cover the whole of the county, with the aim of having a full

service in place in the summer of 2020.

Urinary Tract Infections

Approximately 10,000 people a year present in emergency departments and at urgent

care centres and almost a third are admitted with a urinary tract infection (UTI). Many

more patients also present in GP surgeries with a UTI. Analysis has shown that

Northamptonshire has a much higher usage of hospitals for UTI than surrounding

counties. The NHCP urology workstream has brought people together from services

across the county to develop an action plan to reduce not only presentation in hospital,

but also the incidence of UTI by helping people to stay fit and well. This will be a major

piece of work in 2020.

Other Developments

The NHCP urology workstream has also completed work to refine the pathway for kidney

stone management so that more cases are managed as an urgent elective referral rather

than as an emergency admission. The work now starts to translate this into a new

operational model of care in local hospitals.

Work is almost complete to improve the monitoring of men with higher prostate specific

antigen levels (PSA) and to do this out of the main hospital so as to free up capacity. The

main focus of all this work is to reduce hospital activity, create capacity, see more new

patients and shorten waiting times.

The National Respiratory Challenge

Current challenges and opportunities in respiratory care locally include:

Improving referral processes and removing unwarranted variation in care access

and treatment success. Early and accurate diagnosis of respiratory diseases is

essential to improve outcomes and patient’s quality of life. Ensuring referral

pathways are clear, and supporting the training of staff to deliver tests such as

spirometry, both help to enable timely diagnosis. Local systems need to

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understand and address the needs of the local population and then target

interventions at vulnerable and high risk groups.

Addressing the lack of capacity in secondary care and improving processes in

outpatients. Early accurate diagnosis is an important part of managing capacity,

patient flow and optimal management of respiratory conditions, e.g. nurse-led

annual appointments and accredited professionals performing spirometry tests,

which measure how much air patients can breathe out in a set time.

Supporting patients to better manage their condition in the community. Respiratory

disease is amongst the top ten causes of emergency hospital admission in

England (NHS Digital, 2019), many of which could be avoided through better

diagnosis and self-management support for patients in the community. Pulmonary

rehabilitation should be expanded so that patients who would benefit are

supported to complete treatment in a good quality service. It is considered best

practice for patients diagnosed with Chronic Obstructive Pulmonary Disease

(COPD) and asthma to be provided with information about the management and

treatment of their condition. Care should be personalised to support patients to

manage their conditions themselves and personalised action plans should be

used.

Improving data collection. Collecting data is time consuming but is a crucial part

of improving quality and patient care (The Health Foundation, 2018).

Supporting patients with comorbidities. COPD exacerbations and comorbidities

(other health conditions) contribute to the overall severity of illness in individual

patients (COPD clinical audit report 2017/18: Royal College of Physicians and

National Asthma and Chronic Obstructive Pulmonary Disease Audit Programme,

2019).

Local Respiratory Challenge

In Northamptonshire, and across the country, people are living longer. However, many

are also living with long-term health problems, which need monitoring or treatment.

Among the most common types of long-term health problem affecting people in our

county are respiratory conditions – those that affect the lungs and breathing.

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NHCP wants everyone to be able to live the healthiest lives they can, wherever they live

in the county. When people become ill, they should get the care and support they need

in the right place at the right time – to help them get better or to make sure they can live

independent lives for as long as possible.

Northamptonshire has high rates of emergency hospital admissions for COPD1 and high

rates of premature death due to respiratory conditions2 when compared with other

counties with similar populations. While GP register data suggests that rates of smoking

are higher in Northamptonshire than in neighbouring counties, COPD diagnosis rates are

similar to the national average.

We know that the impact of respiratory disease, particularly COPD, is not evenly

distributed across populations. The conditions contributing most to the gap in life

expectancy between the most and least deprived areas in Northamptonshire are

circulatory disease, lung cancer and chronic lower respiratory disease.

The inequalities that exist in health outcomes are driven both by lifestyle and wider

determinants, but are also related to access to services. It is recognised that improving

respiratory health in the county will require actions to address risk factors (such as

smoking, air quality, etc.), improve the delivery of services and enable the population to

have more control over their own health.

1 Emergency hospital admissions for COPD (2017/18) Northamptonshire highest of CIPFA nearest neighbours www.fingertips.gov.uk 2 Under 75 mortality rate from respiratory disease (2016 – 18) Northamptonshire second highest of CIPFA nearest neighbours fingertips

https://fingertips.phe.org.uk/search/emergency%20admissions#page/3/gid/1/pat/6/par/E12000004/ati/102/are/E10000021/iid/92302/age/202/sex/4/nn/nn-1-E10000021

https://fingertips.phe.org.uk/search/under%2075#page/3/gid/1/pat/6/par/E12000004/ati/202/are/E10000021/iid/40701/age/163/sex/4/nn/nn-7-E10000021

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Why Did We Do This?

With the right support, people with lung conditions can manage their health and wellbeing

and live independently without needing lots of medical attention. We know that we can

do more to prevent respiratory illness in Northamptonshire, as well as to support those

with respiratory illness to manage their condition and to ensure they have access to better

care. NHCP has therefore established a group to look at respiratory services and to

deliver improvements to these services in 2019 and 2020.

Improving respiratory services also helps our hospitals. This is because in winter more

people with respiratory conditions are at increased risk of becoming ill and needing to be

admitted to hospital. If more people with respiratory illness are supported to manage their

condition, so they are less likely to need hospital care, this will help reduce the pressure

on our hospitals in winter.

Evidence also shows that many people living with long-term conditions are at higher risk

of developing depression. Treating people’s physical and mental health problems in a

more joined-up way can lead to better health outcomes.

What Were Our Priorities?

• Helping more people with lung conditions to stay well by getting their annual flu

vaccination

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• Supporting more people to give up smoking

• Improving rehabilitation services for people with respiratory illness

• Working with service users to develop local educational support for living

independently

Case Study: New Education Programme Supports Better Independence

During June, July and August 2019, NHCP talked to people who attend three Breathing

Space groups, as well as people who have COPD to gather views to inform a future

education programme.

With the support of Northamptonshire Carers, which runs the lung health support groups

Breathing Space, people with COPD were asked to help shape the programme. They

were asked what is important to them in helping to lead healthier and happier lives. We

also wanted to find out what they have learnt since being diagnosed that has really

improved their lives and what they wish they had known.

People with COPD have a range of lung conditions that cannot be cured however, they

can still lead happy and independent lives if their condition is managed well.

While some of this management is by health professionals, there are many ways people

can help themselves. Some of these ways include lifestyle changes and others are

through understanding their condition and what to do when it gets worse.

These findings will help shape the education programme that will be tested from October

2019 with the intention of rolling it out across the county from April 2020.

Frailty

Enabling All Frail People in Northamptonshire to Live Healthy, Independent Lives

at Home

We will deliver this aim by working with patients, carers, staff and the public to develop

and implement a range of improvements to the services that deliver care to our elderly

and frail population.

Why is Improving Services for Frail Adults Important?

In 2018, the Care Quality Commission (CQC) carried out a review of frailty services for

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Northamptonshire, identifying that there is opportunity for the system to implement and

embed more high impact interventions to benefit frail residents.

NHS RightCare, Model Hospital and NHS England (NHSE) System Transformation

Diagnostics (data collection and comparison tools) further identified the need for frailty to

be a Northamptonshire system priority in 2019/2020.

Northamptonshire has:

One of the UK’s fastest growing populations, with an increased proportion of the

residents aged 65+

Some areas of good practice, including ICT and START that the CQC report

identified. However, older people in Northamptonshire have a varied and

sometimes unsatisfactory experience of health and social care services.

Benchmarking data from NHS Rightcare, Model Hospital and NHSE System

Transformation Diagnostic that shows Northamptonshire has high rates of Non-

Elective (NEL) admissions for older people when compared to peers

Outcomes are lower than peers, whilst spend is higher.

The 2018 CQC report recommends that improvements need to be made in frailty service

provision and that the everyday experience for staff and patients’ needs to improve.

The current model of care for older and frail residents in Northamptonshire is not

sustainable and action is being taken.

What We Aim To Do

E-Frailty

Having a strategy to consistently identify and grade the severity of frailty is key to an

organised system. For Northamptonshire this will be done through the electronic frailty

index (eFI) by general practice.

The eFI has been implemented into the SystmOne GP electronic health record and

implementation into the two other main UK GP electronic health records (EMISWeb and

Vision) is at an advanced stage. We are asking practices to run the eFI tool and identify

those at potential risk of frailty (mild, moderate or severe). Whenever the patient record

is accessed, a pop up comes on screen stating the frailty status of the patient with a link

to a frailty template, including the Rockwood Scale.

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GP practices are using the eFI to understand the needs of their population and to identify

specific frailty cohorts within their practice population. This will allow them to offer

targeted evidence based interventions and will lead the way in terms of integrated care

are using the eFI and data linkage to develop new models of care for entire populations

of people living with frailty.

Care Homes

Joint Health and Social Care Quality Framework

The aim of this project is to have a joint health and social care framework that aligns the

CCG quality team with the County Council quality teams. The teams will work with the

same framework to allow a consistent approach to, and assessment of, care quality

across the county within both residential and nursing homes.

Initial conversations took place September with a view to having a fully agreed and

implemented framework in place by April 2020. A quality dashboard will be developed as

part of the process to monitor and track performance.

Care Home Training

The CCGs’ quality team has developed a targeted programme to support nursing homes

across the county. The CCG currently has a close partnership working agreement with

nursing care homes, although it should be noted that this does not currently exist for

residential care homes.

This targeted programme of work with nursing care homes has focused on driving up the

quality care for residents, ensuring early intervention and the prevention of crisis

conveyance and admissions to hospitals. The work has been supported through a

training and development programme for care home staff delivered in October and

November 2019.

There is a robust evidence base that these interventions are impacting on care home

delivery, reducing calls to the ambulance services and preventing unnecessary hospital

admissions. The work undertaken in this area locally has been highlighted for national

recognition and regular presentation to other systems in terms of sharing best practice.

There are evidenced outcomes of the bespoke Improving & Sustaining Nursing Home

Quality & Safeguarding programme through the implementation of an educational toolkit,

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which was developed following analysis of monitoring review visits undertaken by the

CCGs’ quality team.

Clinical Assessment Tool

Having a strategy to identify frailty using a clinical standard will ensure that, when

appropriately trained health and care staff suspect frailty, they can score a person’s frailty

status and there is a shared understanding across the system of how this is best

managed. Northamptonshire health services have committed to using Rockwood frailty

score and PRISMA-7 questionnaire within health. Public health services will continue to

use the Edmonton frailty assessment but have an agreed framework to match the

scoring. This is to ensure consistency of care and the ability to transfer assessment

through the system.

This has now been rolled out and tested in both Kettering General Hospital, Northampton

General Hospital and Northamptonshire Health Foundation Trust. Northamptonshire

Adult Care Services have rolled out the Edmonton frailty assessment whilst the

Ambulance Trust uses Prisma 7. The focus currently is on achieving a consistent

approach across all parties with appropriate clinical interpretation.

Acute Trust Frailty Assessment Areas

NHS RightCare opportunity suggest Northamptonshire is an outlier for non-elective

admissions, stranded (patients who have been in hospital for 7 days or longer), and super

stranded (patients who have been in hospital for 21 days or longer) patient numbers. We

have implemented a frailty assessment service at the front door of both acute trusts, to

reduce the number of NEL admissions and increase the ambulatory care activity for frail

adults. Patients are discharged home appropriately and swiftly, supported by a frailty

multi-disciplinary team (MDT). The key success of this programme is the

collaborative/integrated working of the teams to wrap around the patient and offer support

based on patient need, not service boundaries.

We have deliver this project through a NHSE/I frailty collaborative. This is an

improvement methodology based on a short-term learning system that brings together a

large number of teams seeking improvement in a focused topic area so they can share

learning and best practice. We have run two consecutive Plan-Do-Study-Act (PDSA)

cycles with fully integrated MDTs achieving between 40% and 60% of same day

discharges for frail adults. During winter 2019/2020 we will run the third cycle.

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The final clinical model will be confirmed through the PDSA cycles and the full model will

run from April 2021.

Delirium

Delirium is a common, serious condition that starts suddenly in someone who is unwell

and causes a person to become easily distracted and more confused than normal.

Delirium can be very distressing for the person and their family. Delirium is preventable

and treatable if dealt with urgently, however it is associated with increased hospital stay,

hospital acquired complications and higher mortality rates. People encountering other

frailty syndromes such as falls are more at risk of developing delirium.

In 2019/2020, the ambition of the frailty programme is to understand the demand and

capacity associated with delirium in Northamptonshire and map out current pathways to

understand gap in provision, especially after discharge from hospital. The project will link

the first phase of work to the frailty strategy and long-term plan.

The project will look at:

1. Have strategies in place to regularly observe people with risk factors of delirium to

look for signs of the condition, using an agreed tool to assess for delirium

2. If delirium is suspected try to identify a cause, have a supportive and quiet

environment, and involve carers. Assess the need for sedation using the NICE

guidance under CG103

3. Ensure appropriately trained staff undertake an assessment.

End of Life

People with severe frailty can be moving towards the end of their life. When an individual

is identified as having severe frailty their preferences and needs around their end of life

care should be fully understood.

In 2019/2020, the ambition of the frailty programme is to understand the demand and

capacity related to end of life care for the frail in Northamptonshire and map out current

pathways to understand gap in provision. The project will link the first phase of work to

the frailty strategy and long-term plan.

We will focus on advance care planning within the frailty programme. This includes:

1. Have a baseline of preferred place of death recorded

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2. Services and staff are equipped to support people to undertake or update an

advance care plan in a timely manner and ensure that this is known to the

family and carers as well as held by all agencies the person engages with

3. Staff working with people with frailty are confident to recognise that a person

is approaching the end of their life and act on this understanding

4. Staff working with people with frailty are confident in recognising that a person

is approaching the end of their life and feel equipped to engage effectively with

patients and carers to discuss end of life care

5. Work with organisations and individuals to develop quality improvement plans

where the above practice is not in place.

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Going Concern Assessment

NHS Nene CCG was dissolved on 31 March 2020 having joined with NHS Corby CCG

to establish NHS Northamptonshire CCG with effect from 1 April 2020. This followed

approval of the application at the NHS England and Improvement Regional Support

Group – Midlands Region on 11 October 2019 and again on 24 February 2020 to

confirm that conditions had been met.

Going Concern Assessment

Question

Management response

Has the management team

carried out an assessment of

the going concern basis for

preparing the financial

statements for CCG?

What was the outcome of that

assessment?

“Long Term Plans” (LTP) have been developed across the

local health system and agreed with NHS England setting

out funding and spending plans. The CCG elements of these

plans are updated and reviewed on a quarterly basis by the

Joint Finance Committee (JFC).

Information on the statements of Financial position including

the underlying financial position of the CCG are reported

monthly to the JFC and Governing Body (GB). With the NHS

Coby CCG was dissolved on 31 March 2020 having joined

with NHS Nene CCG to establish NHS Northamptonshire

CCG with effect from 1 April 2020. This followed approval of

the application at the NHS England and Improvement

Regional Support Group – Midlands Region on 11 October

2019 and again on 24 February 2020 to confirm that

conditions had been met.

Public sector bodies are assumed to be going concerns

where the continuation of the provision of a service in the

future is anticipated, as evidenced by inclusion of financial

provision for that service in published documents.

Where a clinical commissioning group ceases to exist, it

considers whether or not its services will continue to be

provided (using the same assets, by another public sector

entity) in determining whether to use the concept of going

concern for the final set of Financial Statements,

Management Team, etc. If services will continue to be

provided the Financial Statements are prepared on the

going concern basis and consider on that basis but both

Governing Body's and NHSIE. With all these statements

considering this.

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Are the financial assumptions

in that report (e.g., future

levels of income and

expenditure) consistent with

CCG’s Business Plan and the

financial information provided

to the CCG throughout the

year?

The LTP Financial Plan is updated and reviewed on a

quarterly basis by the JFC and GB to include progress made

against the plan reported in the monthly financial

statements.

Are the implications of

statutory or policy changes

appropriately reflected in

Business Plan, financial

forecasts and report on going

concern?

Yes the plans, financial forecasts and going concern reflect

the latest statutory and/or policy changes.

Have there been any

significant issues raised with

the Audit Committee during the

year which could cast doubts

on the assumptions made?

(Examples include adverse

comments raised by internal

and external audit regarding

financial performance or

significant weaknesses in

systems of financial control).

No significant assurance weaknesses in controls or

procedures have been raised by Internal Audit regarding

financial performance or weaknesses in financial control.

Does a review of available

financial information identify

any adverse financial

indicators including negative

cash flow or poor or

deteriorating performance

against the better payment

practice code?

If so, what action is being

taken to improve financial

performance?

Yes. The CCG has an underlying deficit financial position to

carry forward into 2020/21. Steps are being taken to

minimise this in 2019/20 through the Financial Management

Executive Group.

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Does the CCG have sufficient

staff in post, with the

appropriate skills and

experience, particularly at

senior manager level, to

ensure the delivery of the

CCG’s objectives?

The skill set within the senior management team of the CCG

has been modified during 2019/20 with changes in a number

of senior leadership roles within the CCG’s in

Northamptonshire.

The new leadership arrangement across the two CCGs

(Nene and Corby) allows us to focus on commissioning that

is truly integrated around the needs of local people, in line

with the expectations of the NHS Five Year Forward View

and strengthens the links with Public Health.

Does the CCG have

procedures in place to assess

their ability to continue as a

going concern?

Yes

Is management aware of the

existence of events or

conditions that may cast doubt

on CCG’s ability to continue as

a going concern?

No - The monthly reports to the JFC and GB include an

analysis of Financial risks which may impact on the CCG’s

financial position in the future.

Are arrangements in place to

report the going concern

assessment to the Audit

Committee?

How has the Audit Committee

satisfied itself that it is

appropriate to adopt the going

concern basis in preparing

financial statements?

The Chair of the Audit and Risk Committee is also a member

of the JFC and GB where statements of financial position

are presented and reviewed. The Audit & Risk Committee

seek assurances from Management i.e. CFO and

Accountable Officer where it would be appropriate to do so.

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The CCG achieved a small underspend of £23k at the end of 2019/20 and this was a

slight improvement on the planned control total of breakeven. This position however

was only achieved through the use of non-recurrent financial mitigations which were

implemented in-year to offset under delivery of system wide transformation savings and

significant under achievement of recurrent QiPP schemes, along with in-year cost

pressures on acute activity and continuing healthcare. As a result of this the CCG still

has a significant underlying deficit position to address moving into 2020/21.

In response to COVID-19 a temporary financial regime has been put in place to cover

the period 1st April 2020 to 31st July 2020. The principle of the approach is that clinical

commissioning groups are expected to breakeven on an in-year basis. Actual

expenditure will be reviewed on a monthly basis and a non-recurrent adjustment

(‘retrospective adjustment’) will be actioned for reasonable variances between actual

expenditure and the expected monthly expenditure.

Further guidance on the financial regime to be adopted from 1st August 2020 is

expected to be published imminently.

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Performance Analysis

Primary Care

In Northamptonshire there are 747,622 residents and 778,000 patients registered with

general practices in the Northamptonshire - 81,000 in NHS Corby CCG and 697,000 in

NHS Nene CCG. Access to primary medical services in Northamptonshire is provided

through 69 GP practices and including branch surgeries there are a total of 96 locations

where patients can access primary medical services.

Currently Corby CCG has fully delegated commissioning responsibilities for GP practices,

whereas Nene CCG is in joint commissioning arrangements with NHSE. In September

2019, the CCG consulted with the GP membership and asked if they would support the

creation of a single CCG and taking on fully delegated responsibilities for Nene CCG.

Both CCG membership practices voted positively, so we are now working towards this,

which will take effect from 1 April 2020.

During the next the five years (2019 to 2024), we expect the number of people living in

Northamptonshire to grow from 747,622 in 2018 to 831,168 by 2028 – that represents an

increase of just under 12% in 10 years. Over the next 5 years (2019 to 2024), the highest

population growth is projected in Corby (7.4%) and this is expected to continue over the

next 10 years.

In July 2019, the CCGs developed their primary care strategy, which is designed to

respond and support the future of primary care services in Northamptonshire and align

with the NHS Long Term Plan.

The strategy outlines the CCGs’ ambition to ensure that we commission strong, resilient

primary care services that are sustainable, flexible and that can respond to the changing

demands of patients, as well as a changing financial and political environment. A high

level summary of our ambitions is detailed below, along with the desired outcomes:

Through the implementation of our Support Framework we will develop

sustainable, resilient General Practice services that deliver consistent high quality

core services to the population

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Develop population based Primary Care Networks (PCNs) as the local element of

our ICS delivery

Commission appropriate local services at a PCN level that are co-produced with

PCN clinical leadership, patients and public

Introduce our integrated model of community and social care wrapped around

PCNs to support coordination of care

Utilise population health management approaches at PCN, place and system wide

levels to provide the basis of commissioning and service delivery decisions

Focus on delivering the countywide NHCP clinical strategic priority areas including

frailty, respiratory services, urology and MSK services

Support the countywide social prescribing initiative - a holistic, non-clinical

approach to support people and improve outcomes and experiences for

practitioners, people, their families and carers

Join up the urgent care system to provide seamless access for the population.

To achieve the following outcomes we must:

Improve quality, consistency of care and address inequalities

Improve recruitment and the retention of staff

• Reduce the number of people from going into hospital by providing additional

support in primary care and the community

• Increase service satisfaction for practitioners, people, families and carers

• Increase levels of empowerment and independence for patients and carers

• Ensure better use of resources.

In order to deliver the level of improvement we aspire to over the next five years, there

are a number of enabling work streams and a summary of what has been achieved during

2019/20 is highlighted below:

Workforce Development

Last year we reported on our progress against the Primary Care Workforce Strategy

under the themes of Attraction and Retention. Our work has continued this year and again

within 2019 we have experienced growth in our practice nurse numbers above the

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national rate.

Our practice nurse specialty training programme pilot, in partnership with Health

Education England and NHS England, successfully concluded in September 2019 and

we were the first county to launch this programme - what is now becoming the blueprint

for the national new to practice scheme. Spring boarding from the success of this, we

have now developed a sustainable plan that will see smaller cohorts of ‘New to Practice’

specialty nurse trainees enter our workforce year after year, supported by the County

Training Hubs.

Alongside this, we have worked alongside colleagues in our Local Workforce Action

Board and supported implementing apprenticeship levy transfer. This approach to larger

organisations in the county ‘gifting’ unspent levy to smaller organisations such as general

practice is now beginning to take effect, with our first nursing associate apprentices

starting their studies in February 2020.

This year, we also welcomed the first of our international GP colleagues, attracted

through a recruitment campaign held in April 2019. We now have nine international GPs

from the EU with us in the county, and a further three due to join imminently. We are in

the midst of planning our second campaign for April 2020 to bring us up to the planned

commitment of 22 International GPs by 2020.

To help support our existing workforce of GPs in the county, we have recruited a First5s

lead (who is developing a peer support network for GPs in the early stages of their

career), and an Education Lead (who will oversee our Protected Learning Time offer as

well as supporting GPs who wish to retire over the coming years to legacy plan and move

into educator roles).

The CCG is firmly committed to the ongoing continued professional development of our

general practice teams, this is vital to supporting retention whilst improving provision of

services for patients. Because of this we invest in Protected Learning Time (PLT) for all

practices in our county, and our PLT events are routinely attracting over 350 clinicians.

This not only provides an excellent opportunity to network but provides a great forum to

share best practice. In 2019, we also secured a much greater level of funding from Health

Education England, which we have invested in workforce development for HCAs,

https://www.northamptonshirehcp.co.uk/2019/06/general-practice-nurse-trainees-share-their-stories-from-pioneering-northamptonshire-programme/

https://www.northamptonshirehcp.co.uk/2019/05/new-international-recruits-set-to-boost-county-gp-workforce/

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Nursing, Pharmacists and practice administrative staff.

Furthermore, in 2019 we also embraced some of the biggest contractual reforms for

general practice which saw the establishment of Primary Care Networks (PCNs). To

assist with mobilising PCNs we have led on developing a countywide approach to the

recruitment to new roles such as Social Prescribing Link Workers. With the community

and voluntary sector, we have supported these emerging roles by delivering an induction

programme to help Social Prescribing Link Workers become established and form

peer2peer networks in their first 100 days.

We co-developed and implemented a Leadership Programme with the new Clinical

Directors of our networks, again to ensure they had dedicated time set aside to develop

practical skills to support them in their new roles. This has been well-received and

delivered in partnership with NHS England, who again see this as setting the scene for

their future offer to PCNs going forward. Through initiatives like this, our county has been

at the very forefront of innovation and developed initiatives that wrap support around our

workforce. Our Clinical Directors Leadership Programme will now form the foundation of

a wider leadership programme to be delivered across all work streams in our NHCP.

Estates

Nene and Corby CCGs have been successful in their bid to be included as a pilot site in

the first wave of the Primary Care Data Gathering Programme. The programme is being

undertaken by Northampton Care and Health Partnership on behalf of NHSE/I and will

enable a national approach for the collection of primary care data covering every

reimbursed GP practice across England. It is anticipated that the pilot wave will run from

November 2019 to February 2020.

NHS England’s Estates and Technology Transformation Fund (ETTF) is a multi-million

pound investment (revenue and capital funding) in general practice facilities and

technology across England (between 2015/16 and 2019/20).

It is part of the General Practice Forward View commitment for more modernised

buildings and better use of technology to help improve general practices services for

patients.

https://www.northamptonshirehcp.co.uk/2019/09/https-www-northamptonshirehcp-co-uk-2019-09-successful-recruworker-vacancies/

https://www.northamptonshirehcp.co.uk/2019/08/leadership-programme-to-aid-primary-care-network-success/

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NHS England has identified eight practices in Northamptonshire for funding and has met

with all of them. The grant paperwork and sign off will be completed during November

and December and works should commence early in the New Year.

The CCG primary care team are continuing to work with NHSE/I to develop and

implement a streamlined process to receive and respond to planning applications and

this will be implemented early in the New Year. They have also held initial meetings with

CDs to start to understand their local estates developments and s106 opportunities

(funding available from developers when new estates are built to support the creation of

community infrastructure).

Meetings will continue with local authority, CCG and developers to look at health

infrastructure in major developments and SUEs that will deliver the county new homes

targets.

Primary Care Networks

Significant progress has been made by GP Practices in Northamptonshire to form 16 new

Primary Care Networks (PCNs). This is an outstanding achievement with a considerable

amount of hard work from GP colleagues. A PCN consists of a group of practices working

together to offer greater collaboration across general practice and the wider NHS in order

to provide more personalised, coordinated care to local populations. Developing of PCNs

will continue over the next five years but this is a key first step.

In order to aid development of the PCNs, all 16 have submitted a self-assessment against

a national maturity matrix produced by NHSE/I. This is a very honest assessment of

where PCNs feel they are currently in their development, but with the aim of supporting

their further development over a number of years to achieve the higher maturity

levels. The spectrum is from Foundation to Step 3, at which point a PCN will have leaders

who are fully participating in the decision-making at the system level and have fully

integrated teams in place within the PCN, comprising of the appropriate clinical and non-

clinical skill mix with MDT working and is high functioning and supported by technology.

Using the responses from PCNs, the CCG is tailoring further support particularly in areas

where PCNs have highlighted common development needs to aid this development,

initially in year 1 but then continued over the following years to support the progress

through the maturity levels.

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In quarter 4 NHSE/I will be publishing five new services linked to the Network DES (local

contract) and this development will assist PCNs in their ability to deliver against these.

GP Forward View – Care Navigation

Around 550 members of staff are care navigators, helping to play a greater role in the

navigation of patient care and handling of clinical paper work. This releases GP time so

they can focus on the complex conditions only they have the skills to deal with.

A considerable amount of work has taken place to support the continued focus towards

care navigation in General Practice. A Care Navigation Task and Finish Group has been

set up and operating to support this further development.

A new clinical system template has been implemented to support practices (this includes

links to the Northamptonshire Directory of Services). Significant training has taken place

throughout the year, which has supported implementation and has included training in

the techniques and skills important in delivering care navigation.

Over 100 staff from 20 practices have attended training and further training continues to

take place including soft skills training for GPs and Practice Managers. Training for a

small set of Care Navigation Champions has also been arranged and they will continue

to support the CCG and member practices with the programmes to provide ongoing

development. As a result of this work there are now more opportunities and supported

skills to navigate patients to the most clinically appropriate maximising the appropriate

use of GP resource and improving the patient experience.

Seven GP practices across the county took part in a pilot using The Northamptonshire

Directory of Services. The directory is a web-based information search tool acting as a

directory of services, enabling care navigators to search for a wide range of health,

community and voluntary services across Northamptonshire. The pilot was greeted with

positive feedback and directory is now in use across the county.

Online Consultations

A number of practices within Northamptonshire have embedded one of two online

consultation solutions as a means of offering patients an alternative method of interacting

with their practice, whilst reducing demand on both clinical and non-clinical staff.

2019/2020 has seen good progress made towards improving the availability of online

consultations to General Practice. At the start of the year approximately nine practices

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were offering online consultations. We now have 23 practices who are offering online

consultations, with work continuing with the remaining practices to find a suitable solution

to ensure all practices are offering access to online consultations by April 2020.

NHS England and GPC England expect practices to make progress in 2019/20 towards

the digital changes that will become contractual requirements from April 2020 and April

2021. These are:

o All practices offering online consultations by April 2020 at the latest

o All practices will be offering consultations via video by April 2021 at the

latest.

Benefits to date have been:

A Reduction in Appointments Requests

Up to 21% of patients have been diverted away from their practice following completion

of a symptom checker assessment. These patients have been triaged and given

alternative options to contacting the surgery for an appointment, mainly being directed to

self-care options, which include pharmacy services.

Appointments Being Offered by Clinical Priority

The triage solution offers recommended timeframe in which patients should be seen by

a GP based on their symptoms. We found 40% of the patients that have been requesting

a same day appointment could have been seen by a GP within a longer timeframe of 48

hours or more. More specifically, 28% of patients could have been managed by the

practice to be seen within three days instead of the same day. In allowing patients to be

managed via clinical priority, the practice can ensure patients are seen by the right

clinician at the right time.

Time and Cost Saving Efficiencies for Practices

Practices have been able to benefit from time and cost saving efficiencies both clinically

and administratively. One of the ways in which this has been achieved is by the number

of requests forwarded to the surgeries being completed by telephone consultations,

rather than face-to-face consultations, with in some cases 33% converting from face to

face to telephone. GP’s benefit from having greater visibility of patient assessments

before the appointment that in turn can lead to more enriched consultations and/or

reduced consultation durations.

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Throughout the remainder of the financial year, we have scheduled a number of webinars

for practices and PCNs to see the products, speak with the providers and ask questions

about implementation. We are due to commence a pilot with some practices linking the

Northamptonshire Directory of Service with online consultations, which would then

provide a direct link for patients to the local services appropriate to them. Additionally we

will be piloting online consultations linked with care homes and trialling video consultation.

Medicines Optimisation

There have been several important developments about optimising the use of medicines

within the Northamptonshire CCGs during 2019/20.

During 2018/19, the vast majority of GP practices in Northamptonshire stopped routinely

accepting prescription orders from third parties e.g. community pharmacies. The reason

GP practices introduced this change was because local audit data had indicated that

there would be a reduction in “medicines waste” if patients ordered their own medication.

Analysis of the effects of the implementing this change were undertaken in the Autumn

of 2019 and it is estimated that it has resulted in 100,000 fewer prescription items being

ordered resulting in a saving of £875,000 (an anticipated £1.8 million full year effect).

Whilst a significant number of patients raised initial concerns about ordering their own

medicines, following support from GP practice staff and the CCG medicines management

team, it would appear that patients were accepting of change as only a minimal number

of patients subsequently contacted the CCGs regarding the service.

One of the initial concerns raised by patients was the inconvenience of ordering their own

medication, but for many the effects were minimised as they took the opportunity to

register for electronic access with their GP practice so that they could order their

prescription “on-line”. Another important benefit in patients ordering their own medication

that should be considered is the reduction in potential harm from patients having less

excess medication stored in their homes.

In March 2018, NHS England issued guidance to CCGs recommending that items of

medication available “over the counter” (OTC) from pharmacies etc. should not be

routinely prescribed for 33 minor conditions. The Northamptonshire CCGs subsequently

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agreed that the guidance should be implemented locally, as it was hoped that this would

help promote “self-care” and the use of community pharmacies, as well as reducing

prescribing expenditure.

To facilitate implementation of this change the Medicines Management Team produced

posters, texts and reception room videos in order to make patients aware that OTC items

for minor conditions would no longer be routinely prescribed. Support materials for

patients, including condition specific information leaflets, were also made available within

the “self-care” section on the CCGs’ websites.

During 2018/19, when this change was being introduced, approximately 70,000 (5%)

fewer items of OTC drugs were prescribed, resulting in a decrease in expenditure of

£143K. It was hoped that the outcomes will be even better during 2019/20 as patients

and health care professionals became familiar with the change in practice, and the results

from the first few months have confirmed this to be the case.

During the first six months of 2019/20 almost 80,000 (20%) fewer OTC drugs have been

prescribed which has resulted in a decrease in expenditure in excess of £400,000. This

significant reduction in prescribing of OTC items since April 2018 means that more

patients are choosing to “self-care” rather than make appointments with their GP for minor

conditions and this will have improved access to appointments for patients with more

serious illnesses.

In the last few years, there has been a growing realisation nationally about the need for

good “medicines management” within care homes. Part of the reason for this increase in

awareness has been due to certain CCGs, like those in Northamptonshire, being able to

demonstrate they had achieved significant benefits in residents’ quality of care by

implementing a Care Home Advice Pharmacy Service (CHAP) service.

In 2018, NHS England provided funding via their Medicines Optimisation in Care Home

(MOCH) scheme in order to promote such services nationally. This funding was gratefully

received by the Northamptonshire CCGs as it allowed them to double the capacity of their

pre-existing CHAP service. This increase in capacity enabled the team to undertake over

1,000 medication reviews with a GP or Advanced Nurse Practitioner in 2018/19, resulting

in over 3,000 improvements being made to the medication that residents were prescribed.

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The MOCH scheme also included an 18-month education programme aimed at further

developing the staff within these roles, with the ultimate aim of them becoming

independent practitioners. All of the staff within the Northamptonshire’s CHAP service

undertook this education programme and some of these staff have now successfully

completed this course. It is envisaged that the increase in focus nationally on improving

“management” of care home residents’ medication will result in further improvements in

their level of care.

Urgent Care

Case study: Rapid Response Team

The Rapid Response team launched in early November 2019 and aims to help the county

avoid up to 1,500 hospital admissions each year across Northamptonshire by changing

the way we respond to elderly people who fall in their homes or in a care home.

Too often today this leads to an ambulance being called and an admission to hospital,

even when the person would rather stay and recover at home. The new service will mean

people who fall can quickly access the safe treatment and support they need at home

while easing pressure on our ambulance services and hospital emergency departments.

People aged 65 and over are at increased risk of falls, which can result in serious injury

or fractures, and their risk increases as they get older. In Northamptonshire an average

of eight people per day are admitted to hospital following a fall, and frail older people

often end up experiencing long hospital stays even though the care and support they

needed might have been better provided where they live.

Evidence shows that staying in a

hospital bed for longer than is

medically necessary results in frail

people becoming even frailer –

leaving them less able to live

independently and stay well. The

Rapid Response Team is a group

of highly skilled individuals who

will provide short-term care to

patients who have experienced a

fall to support them to remain and recover at home, or assist them if they need to be

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admitted to hospital, and provide support once they are ready to be discharged to avoid

readmission.

Calls coming into the ambulance service will be allocated to the Rapid Response Team

where a patient has been reported as having fallen and identified as aged 65 and over

but have no life threatening symptoms. Partners expect three-quarters of patients will get

the care they need without having to go to hospital. This in turn will prevent around 11

unnecessary and often long hospital stays across the county each week.

As well as therapy and reablement, additional support will be provided including advice

and information about the services available to help them in their area, help with personal

care or the provision of equipment to support ongoing independence.

Learning Disability Services

NHS Nene and Corby Clinical Commissioning Groups (CCGs) continue to work in

partnership with the Local Authority and NHSE Specialised Commissioning to transform

learning disability (LD) services to meet national and local expectations. During 2019,

there has been a review and revision of all Northamptonshire Healthcare Foundation

Trust LD service specifications in line with Building the Right Support (2015) guidance.

The integration of health and social care to form Northamptonshire Learning Disability

Service continues to develop as a single service to improve the lives of people with

learning disabilities.

This year has focused on improving the provider market and there has been a series of

provider forums across the year, which aimed to enhance partnership working and the

quality of support. In December 2019 the procurement of a joint provider outcomes based

framework led by the local authority and Joint Quality Board has given further opportunity

to work together to continue to improve quality and gain assurance we are spending

money in the right places, on the things that matter most to people and which focus on

improving individual outcomes.

Other successes have been achieved within the following national key areas of work:

Transforming Care

The local Transforming Care Partnership has worked throughout the year to meet the

expectations of the Transforming Care Programme. This has been a challenging year,

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which has seen an increase in inpatient admissions. This being said, admissions for

people with learning disabilities have remained low and all parties continue to work

together to manage the risks within the community.

The Learning Disabilities Mortality Review (LeDeR)

The LeDeR programme was established to support local areas to review the deaths of

people with learning disabilities, identify learning from those deaths, and take forward the

learning into service improvement initiatives. As required by the NHS Long Term Plan,

CCGs are now expected to publish local LeDeR annual updates and reports which

describe their progress on completing reviews and the service improvements made from

learning. This LeDeR report is a combined update for Nene and Corby CCGs.

The persistence of health inequalities between different population groups has been well

documented, including the inequalities faced by people with learning disabilities. Today,

people with learning disabilities die, on average, 15-20 years sooner than people in the

general population, with some of those deaths identified as being potentially amenable

to good quality healthcare.

The programme has developed a review process for the deaths of people with learning

disabilities. All deaths receive an initial review; those where there are any areas of

concern in relation to the care of the person who has died, or if it is felt that further learning

could be gained, receive a full multi-agency review of the death.

Key processes and quality assurance to deliver and learn from the mortality reviews of

people with learning disabilities has been established. Northants commenced the

programme and established the local steering group September 2017. Since September

2017, 40 reviews have been completed. This year 20 reviews have been completed.

LeDeR Learning

The 3rd Annual LeDeR Report was published in spring 2019 and the recommendations

were very similar to NHSi LD Standards – co-ordination of care being highlighted in both

as a priority. As a result of this KGH will be implement the Co-Ordinate My Care process

in January 2020.

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In line with other recommendations, LD refresher training has been provided across

several wards and departments over the recent months with a particular emphasis on

constipation, aspiration pneumonia and sepsis.

Learning Disability Improvement Standards

In June 2018, NHS Improvement launched the National Learning Disability Improvement

Standards for NHS Trusts. These were designed with people with an LD, carers, family

members and healthcare professionals to drive rapid improvement of patient experience

and equity of care.

The standards measure quality of services and ensure consistency across the health

economy about the care and treatment of individuals with an LD, autism or both.

The standards cover:

Respecting and protecting rights

Inclusion and engagement

Workforce

Specialist LD Trusts

The standards were piloted in 2018 and both NGH and KGH who undertook data

collection against the standards.

The data collection included:

Organisational data – including processes, reasonable adjustments, leadership

and training

Staff questionnaires

Patient/carer questionnaires

Both hospitals received a bespoke report of findings from the benchmarking exercise and

have developed an action plan for areas of improvement identified.

Treat Me Well Campaign – Simple Adjustments Make a Big Difference

Following in NGH footsteps, KGH have adopted Mencap’s newest campaign ‘Treat me

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well’. The campaign focuses on transforming how the NHS treats people with a learning

disability in hospital.

Two workshops for people with learning disabilities their families

carers and supporters were held. The first session focused on

empowering people with learning disabilities including knowing

your rights, the Mental Capacity Act and reasonable adjustments.

The second session focused on local issues and concerns. Both

of the workshops were well attended and evaluated positively.

Over one hundred people working at KGH have signed up to

Mencap’s Treat me well campaign in the last two months.

RCN East Midlands event - Celebration of 100 years of Learning Disability Nursing.

In June, the Royal College of Nursing (RCN East Midlands) hosted an event to celebrate

100 years of Learning Disability Nursing. Paul Blake, a Learning Disability Project worker

at NGH, was asked to co-chair the event alongside RCN Professional Lead for Learning

and Development. Paul also talked about his role at NGH and the work we are doing to

support individuals with a learning disability.

Paul did really well presenting to an audience of approximately 80 professionals. He had

excellent feedback from RCN co-chair:

“Firstly a HUGE, HUGE thank you to you Paul for volunteering to chair the

event you were so calm, confident, professional and so fab. I really loved

presenting with you Paul; you were a pleasure to work with thank you.”

(left) Paul Blake – Learning Disability Project Worker NGH

Learning Disability Steering Group

The NGH LD Steering Group was established in February 2016 and meets quarterly to

have oversight of operational issues for patients with a LD. The group is co-chaired by

the Head of Safeguarding and the Learning Disability Project Worker.

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Membership includes divisional representation, service users and the LD community

team. The steering group has overseen a number of positive developments for patients

with a LD and their carers and a patient story is included at every meeting.

All minutes and reports for the meeting are presented in an easy read format to ensure

they are accessible for all steering group members. The Steering Group develop an

annual action plan of service developments, which is overseen by the Patient and Carer

Engagement and Experience Group, chaired by the Director of Nursing.

Learning Disability Project Worker

Paul Blake is the Learning Disability Project Worker at NGH, he works closely with Debbie

Wigley, Strategic Health Facilitator to support hospital staff provide best possible care to

patients with a learning disability. Paul is a valuable asset to Northampton General

Hospital and acts as expert by experience. His role includes:

Visiting patients with a learning disability and ensuring they feel safe and

supported

Checking individuals have a ‘Hospital Passport’ which makes staff aware of

their needs

Supporting Strategic Health Facilitator to provide learning disability awareness

training to hospital staff

Co-chairing Learning Disability Steering Group.

Annual Health Checks

People with a learning disability often have poorer physical and mental health than other

people. This does not need to be the case. Annual health checks are available for adults

and young people aged 14 or over with a learning disability. An annual health check helps

keep people well and to identify any potential problems early, so as to avoid ill health. We

have continued to work hard this year on supporting primary care to increase the number

of annual health checks they offer to people with learning disabilities registered at their

surgery.

We have assisted them to look at ways to improve their invite and follow up process with

the aim of increasing uptake. This year we have also worked with providers of care to

ensure they are aware of their responsibility to promote Annual Health Checks with their

service users. Also that they have a responsibility to work together with the GP or Nurse

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at the annual health check appointments to ensure accurate and useful information on

which the health professional can give appropriate advice, diagnosis and plan for

treatment.

Maternity Services

This year saw the launch of continuity teams across both Kettering General Hospital

(KGH) and Northampton General Hospital (NGH), which is part of ‘Better Births’.

The national ambition is that by March 2021 the majority of women will be cared for in a

continuity model, which means they will have already met the midwife who will be with

her at the birth of her baby. Nationally, the evidence is that women cared for in a continuity

model are 16% less likely to lose their baby, 19% less likely to lose their baby before 24

weeks, and 24% less likely to experience pre term birth.

Spring 2019 saw the launch of the planned caesarean section team at KGH. The intention

of this team was to give increased assurance around choice to this group of women, with

an opportunity to discuss evidence-based information and for a midwife who the women

had met to be present at her birth. The verbal feedback has been very positive as the

feeling was that this was a ’forgotten’ group of women who still wanted their experience

of birth to be as positive as possible.

And in July 2019, the Eden Team was launched. This group of six midwives is working

from Lakeside Surgery in Corby, where some of the more socially vulnerable women in

the county live.

The Home Birth Team at NGH have been doing a wonderful job of providing continuity to

a high number of the women they care for. They create an opportunity for women and

their partners to meet the team through regular ‘Meet the Midwife’ sessions held at

various locations in the town centre, including coffee shops.

The Sapphire and Emerald Teams were launched from NGH in November 2019 and

include newly qualified midwives (NQMs) as well as some very experienced midwives

too. It was agreed that this way of working would expose NQMs to all areas of maternity,

whilst working in a small supportive team.

The teams will be linked to surgeries in the town where higher numbers of women from

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black, Asian and ethnic minority population are living. These women are significantly

more likely to have poor outcomes and this inequality needs to be addressed as part of

the work around providing continuity of carer. Women who have experienced the loss of

a baby will also be offered care from one of the teams.

Continuity will impact on all areas of the delivery units as midwives will provide labour

care, and at least one postnatal check on the ward, take the triage calls for their teams

etc. Nationally, units are seeing significantly more women being discharged home from

labour ward when they belong to a continuity team.

A tool to measure the outcomes of these new approaches has been shared across the

Local Maternity System (LMS) and is being used by the continuity teams. The national

ambition is that by 2025 the numbers of stillbirths, birth-related brain injuries, maternal

deaths and premature births will be reduced by 50%.

Two new teams have launched at Northampton General Hospital to provide support for

women throughout their pregnancy and provide a familiar team of midwives caring for

them throughout antenatal appointments through to birth and postnatal care.

Case Study: Emerald Team

Rebecca Harris, the lead midwife of the Emerald team, explained why the new way of

working is so important: “Our home birth team have already been providing this type of

care to families and has seen fantastic outcomes. It provides our patients with this core

group of midwives who they will get to know throughout their journey.

“For staff too it makes a huge difference. We get to know families before the baby arrives,

we get to meet the baby and see the family come to life. It’s like we become part of that

family and the closeness you get and being there for delivery with these people you now

well is amazing”.

Tomasz, father of eight-month-old Oscar, explained how getting to know his midwifery

team helped him and his partner Agata.

He said: “Rebecca was our lead midwife and the whole leading up to the birth itself period

is brilliant. They see you when it is convenient and you create a bond and some sort of

friendship which is very important to the mother especially the first time mothers.

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“We’re from Poland so English isn’t our first language so having this safety of knowing

the people before the birth is very important to us. What we all tend to forget from our

perspective I am a parent too and being at home I can actually help and I do have an

active role rather than in a hospital environment, you feel like a guest.

“There are things you are kind of subconsciously scared or cautious to ask because it

seems private, but having a one to one session with someone you know, trust and have

met before helps enormously. You can talk about those little concerns of yours, its tailored

care it helps a lot.”

In October 2019, the Local Maternity System supported the national ‘Baby Loss

Awareness Week’ and helped to coordinate the lighting up of local iconic buildings in blue

and pink. As the LMS are working to reduce stillbirths, it seemed pertinent to support this

event. Displays and stands provided by the LMS, and operated by the bereavement

midwife and volunteers from charities such SANDS, were very visible in the community.

Not surprisingly, families and friends who had experienced the loss of a baby welcomed

the opportunity to talk and appreciated the highlighting of this devastating and life-

changing situation, which so many people are affected by.

During the summer, the LMS launched ‘Personalised Care Plans’ (PCPs) for all pregnant

women. These are shared with the women at their initial appointment with the midwife

and is a communication tool, which is completed by, and owned by the woman. It includes

what is important to the woman and her family.

This includes:

Her values and expectations about being pregnant

Giving birth and becoming a mother

Her home/family/professional life and support networks

Her previous experiences of pregnancy and childbirth

Any fears or concerns she might have.

The booklet is also be available in Bengali, Romanian, Lithuanian and Polish and the next

step will be the option for women to access this electronically if they prefer.

The booklet is divided into four separate plans:

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Health and Wellbeing in Pregnancy (Complete at the beginning, or any time during

pregnancy)

Personalised Birth Preferences (Complete 32-34 weeks of pregnancy)

After Your Baby is Born (Complete from 34 weeks of pregnancy)

Birth Reflections (Complete after your baby’s birth)

The pregnancy passport is already in place for women with a learning disability but a local

student nurse, Daniel White, created an ‘easy read’ version of a birth plan and it has been

well received. Nottingham LMS were so impressed with the version that they have also

adopted it.

Every woman is free to make choices about her own pregnancy and childbirth, even if

her caregivers do not agree with her. What is important is that she has evidence based

information, rather than opinion, on which to make her choices. The majority of

complaints come down to poor communication and women feeling that they are not

listened to. The PCPs will provide a tool for women to document and share what is

important to them about the care they receive and the decisions they make.

The PCP also gives women opportunities to identify, at different stages of their

pregnancy, if they need more information in order to make choices.

Earlier this year also saw the launch of Northamptonshire Maternity website. This

provides further information for women and their partners, to help them make decisions

about their care. The website can signpost to other agencies and websites, both locally

and nationally and will have a page for women to share their stories with each other.

Supporting our Armed Forces Community

Clinical commissioning groups are responsible

for the commissioning of health services for

veterans, reservists and service families

registered with NHS GPs in their area.

The Royal College of General Practitioners is working with NHSE/I to accredit GP

practices as 'veteran friendly'. This is just one of several initiatives being undertaken to

https://www.northamptonshirematernityservices.co.uk/

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improve NHS care for the Armed Forces community (which includes serving personnel,

regulars and reservists, veterans and their families).

We have fully supported this initiative by offering training to our practices and to date 18

practices have achieved their accreditation.

From a patient perspective we are investigating some targeted training for our new Social

Prescribing Link Workers on how best to manage, advise and treat our military community

and link them to appropriate NHS or voluntary/community organisations.

Defence Employer Recognition Scheme

The scheme encompasses bronze, silver and gold awards for employer organisations

that pledge, demonstrate or advocate support to defence and the armed forces

community, and who align their values with the Armed Forces

Covenant.

This year the CCG signed up to ‘Step into Health’ which provides

a contact for Armed Forces leavers to sign post opportunities

within Northamptonshire’s NHS, under the CCG Workforce

Team.

(above) Ben Manser, member of the Workforce Team

We have a rolling advert on the Careers Transition Partnership website, which points to

the Northamptonshire Best of Both World’s job website.

We also participate in a quarterly live chat with potential candidates interested in careers

in the NHS.

Our Military Family at Work

Last year Healthwatch Northamptonshire was commissioned to find out more about the

health and social care needs of the Armed Forces community. The survey emphasised

the need for greater awareness of the Armed Forces Covenant amongst health

professional in the count, more timely access to suitable health support, and further

preparation for civilian life when people leave the armed forces.

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Nene Clinical Commissioning Group has been integral in the development of a Veteran

Community Network, led by Dr Gillian le Page working alongside Northamptonshire

County Council, Northamptonshire Health Foundation Trust, Transition Intervention and

Liaison Service and our voluntary sectors. A Hub and Spoke ‘one stop shop’ service that

uses volunteer veteran peer mentors to support

veterans with mental health and/or substance misuse

issues has been developed to overcome the barriers

veterans can face engaging with, remaining in, and

benefiting from treatment.

Our volunteers have received accredited (OCN Credit4learning) peer mentor training so

that they can offer informal support and gain relevant knowledge, skills and experience

that could create opportunities for a career within the social care field.

Our project provides the following support to veterans:

Assessment of need/ risk

Evidence based psychosocial interventions providing advice, information and

guidance

Motivational enhancement to support veterans to access, engage and remain in

treatment

Post treatment ‘debrief’ and on-going support

Advocacy/treatment navigation

Raising awareness of veteran needs.

The Hub is based at Sixfields Stadium, the home of Northampton Town Football Club.

We work with other local veteran support services to offer a weekly drop-in ‘one stop

shop’ so that veterans and their families can have access to a range of services including

a qualified VCN peer mentor. The Hub will also provide opportunities for community

engagement as a result of the links with the football club.

The Spoke service covers the whole county and consists of a network of trained veteran

peer mentors who deliver an outreach service, which includes face-to-face, telephone,

email and Skype contact.

The benefits to veterans - and their families – is a better understanding of their own health

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and wellbeing needs; knowledge of when and how to access medical treatment plus

continued support throughout their treatment journey from the peer mentors.

Diabetes Services

There has been a steep rise in the number of both diabetic and pre-diabetic patients over

recent years, with new diagnoses rising at a rate faster than any other health issue1 and

resulting in nearly two thirds of adults in England being at risk of, or diagnosed with

diabetes. In order to manage this endemic, the CCGs shifted their resource to focus

primarily on education and prevention.

The aim was to give people ‘more control over their own health and more personalised

care when they need it’3, in line with the NHS Long Term Plan. This would improve quality

of care and reduce the burden on limited NHS resources. The plan was to utilise the

National Diabetes Prevention Programme (DPP) and current Structured Education

project to improve referrals and access.

The work this year on DPP has been a real success story for Northamptonshire CCGs.

An automated referral process, which ensures all patients eligible are offered a place,

has now been rolled out across all GP Practices. This process won the CCGs the

acknowledgement from NHSE and NHSI as being the chosen model of excellence for

other areas to follow, after it saw real quality of care improvements alongside an increase

of over 200% in referrals. Within that, Northamptonshire CCGs were also recognised as

having the highest black and minority ethnic (BAME) DPP uptake across the Midlands.

This was significant as BAME group’s risk of developing type 2 diabetes is up to six times

higher.

Alongside the work to improve referrals, research and improvements were made to

ensure venues running the course were accessible in terms of both location and times

offered. Changes included 20% of courses now being run out of normal working hours

and venues being spread across the county to ensure equity of access. To increase

access further, plans have been put in place with a trial currently underway to offer the

course digitally from 2020.

For those patients already diagnosed with type 1 or type 2 diabetes, Northamptonshire

CCGs have worked closely with our provider for structured education (Northamptonshire

3 https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf

https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf

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Healthcare Foundation Trust) to improve the model of care. This work has taken nearly

three years to complete, but has seen Northamptonshire offer the highest number of

places for the lowest cost within the Midlands, exceeding the national targets and leading

the way in BAME specific work.

It was recognised that whist an immediate response with education to support is now

excellent; patients require long-term education and assistance in order to maintain good

health both physically and mentally. A bid was put in for a new long-term Diabetes Digital

Support Programme run by NHSE/I, with Northamptonshire CCGs being selected as one

of five test sites nationally. Work has been on going with the national team to design this

support and the final package will be trialled in-year before being rolled out across the

county during 2020/21.

Another long-term support initiative Northamptonshire CCGs have led the way with was

being early adopters of utilising Flash Glucose Monitoring for those most in need (started

March 2018). These empower individuals, providing a much clearer picture of their

glucose levels throughout the day, as well as overnight, compared to traditional ‘snap

shot’ finger prick blood glucose testing, helping inform the person’s decision about any

action needed. This technology been described as “life changing” and is currently being

used by 1,117 patients across Northamptonshire.

Cancer

The Northamptonshire Cancer Board continues to bring together Nene CCG and Corby

CCG, primary care, Northampton General Hospital, Kettering General Hospital, East

Midlands Cancer Alliance and NHS England. All organisations’ individual strategies and

plans have been consolidated into a high-level work plan to ensure all services are

working on the same key priority areas to improve cancer services across the county. In

addition, both NGH and KGH have their improvement plans and their own internal Cancer

Boards.

Nene CCG and Corby CCG continues to work closely with the East Midlands Cancer

Alliance to drive a new approach to transforming care, including prevention, diagnosis,

early intervention and treatment.

In 2019/20 we:

Conducted reviews of cases where patients missed 62-day waiting time, to share

learning and make improvements

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Commenced implementation of the National Optimal Lung Pathway that aims to

reduce the time from referral to treatment for lung cancer patients

Commenced implementation of the RAPID Prostate pathway for quicker diagnosis

and treatment of prostate cancer

Fully implemented the Faecal Immunochemical Test (FIT) in Primary care, which

aims to ensure that signs of colorectal cancer are found at an early stage

Continued to implement the Living with Cancer programme (Personalised Care)

for the county to ensure that people who have cancer or have had treatment are

leading as healthy and active a life as possible.

Priorities for Cancer Care for 2020/21

The Cancer Improvement Group has identified key issues and pathways to drive

continued improvement in 20/21, including:

Continue to improve communication between GPs and acute hospitals regarding

patient choice and delays initiated by patients

Fully implement the National Optimal Lung Pathway to reduce referral to diagnosis

times for lung cancer patients

Fully implement the RAPID prostate pathway to streamline the referral process for

prostate cancers and cut treatment waiting times

Implement the Targeted Lung Health Checks national pilot in Corby to reduce the

time to diagnosis for those at high risk of developing lung cancer

Commence implementation of Rapid Diagnostics (RDC) to speed up

cancer diagnosis and achieve earlier diagnosis, with improved patient experience,

for all patients with cancer symptoms or suspicious results

Implement the national timed Upper GI pathway to reduce variation in patient

access to diagnostic and treatment options

Pilot the targeting of manual workers and providing interventions to help people

stop smoking

Recover performance at Northampton General Hospital.

In addition, the CCG will continue to monitor all aspects of the cancer pathway to ensure

rapid action is taken to correct any emerging issues.

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How We Manage Performance

Nene CCG measures its performance against national NHS standards. We and our

providers successfully delivered many of the required standards in 2019/20 including:

• 6 Week Diagnostic Wait – Nene CCG have ensured over 99% of patients have

access to a diagnostic test with 6 weeks of the referral

• Dementia prevalence diagnosis rate has recovered and is now above the required

standard

• Not a single patient waited more than 12 hours in A&E for admission to a hospital

bed

• Over 98% of patients requiring Psychological Therapies have had their treatment

completed within 18 weeks (standard 95%)

• Had no patients waiting 52 weeks or longer for elective care for the majority of the

year.

The challenging areas that require our continued focus in 2020/21 are:

• A&E four hour performance at both of Northamptonshire’s acute hospitals

• Delivery of the new Ambulance Response Programme waiting times

• 62-day waiting time standards at Northampton General Hospital NHS Trust (NGH)

• Recovering the decline in the 18-week Referral to Treatment time for planned

care

• Reducing the number of 52+ week waits for planned care to zero

• Improving Psychological Therapies, access and recovery rates.

All performance issues are escalated to the Nene CCG and Corby CCG Joint Quality

Committee and the CCG Governing Body in Common, which considers performance at

every meeting. More about performance is included in the section on the following pages.

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Key for Performance Tables

Standard met

Standard not met

Data not published

Year = Full year effect (FY)

Urgent Care - Patients Waiting Four Hours or Less in A&E NHS Constitution

measures - quarterly Std Organisation Q1 Q2 Q3 Q4 Year

A&E waits

Patients to be admitted,

transferred or discharged

within 4 hours of arrival at A&E

95%

NGH 82.85% 81.18% 72.07% 75.26% 77.89%

KGH 80.58% * * * *

Delivering the A&E four-hour standard is a national challenge and Northamptonshire is

no exception. There are a number of reasons: demand from patients with more complex

care needs (for example, the frail and elderly), internal hospital operational challenges

and delays in moving patients from NHS to social care services run by the local authority.

The CCG continues to work with partner organisations across the whole health and social

care system to improve urgent care performance and resilience.

Both acute trusts – Northampton General Hospital NHS Trust (NGH) and Kettering

General Hospital NHS Foundation Trust (KGH) - have experienced extreme pressure on

their urgent care systems during the winter period, in spite of robust plans and additional

funding. However, both trusts have managed to avoid any patients waiting more than 12

hours for a bed in A&E.

*KGH having been undertaking the National Clinical Review of Standards for A&E waits

since May 2019. During this trial, the no longer required to formally monitor or report their

A&E performance against the 4-hour transit standard. The CCG receive assurance

through the following mechanisms - AEDB Meetings, COO Meetings, regular reports

focused on UC performance which are presented at AEDB Monthly and CEO’s meetings

weekly. Performance and Quality Teams work jointly with the Trust to go through any

highlight areas etc.

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NHS Constitution measures

Std Organisation Q1 Q2 Q3 Q4 Year

No waits from decision to admit to admission

(trolley waits) over 12 hours

0

NGH 0 0 0 0 0

KGH 0 0 0 0 0

Nene CCG and our partners are committed to ensuring that the system is resilient, and

we have developed a number of initiatives focussing on three key areas:

• Inflow - reducing the number of patients arriving at the acute A&E

• Internal flow - ensuring patients move through the hospital assessment and

treatment systems efficiently

• Outflow – making sure that once acute hospital care is no longer required the

patient has a place to transfer to or the support they need in their own home.

Examples of the key inflow initiatives include:

• Rapid Response Project: This is a joint East Midlands Ambulance Service

(EMAS), Northamptonshire Healthcare Foundation Trust (NHFT) and

Northamptonshire Adult Social Services (NASS) team responding to 999 calls for

frailty patients who have had a fall, the joint response aims to give more options

to treatment and support in the community to prevent unneeded A&E attendances

• Emergency Care Centres in Town centres: EMAS have provided dynamic

treatment centres in Northampton on predicted busy nights in order to reduce

demand on 999 and A&E

• Frailty Assessment Teams: Based in A&E these multi-disciplinary teams aim to

support frail patients to be discharged from A&E and avoid being admitted. This

allows patients to be treated in their own home.

Examples of key internal flow initiatives include:

• Additional medical resources being placed at the front door: The hospitals have

placed senior specialist doctors in A&E to review patients early prior to admission.

This process reduces the number of patients requiring admission

• Criteria-led discharge: Senior medical staffs create a clear set of discharge criteria

for a patient; once this is met, the patient can be discharged without a further

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consultant review. This ensures patients can leave hospital as soon as they are

ready to

• Additional discharge facilitators: The additional discharge facilitators ensure

improved communication between hospital, community services and the patient.

This helps ensure patients can go home sooner.

Key outflow initiatives include:

• Spot purchase of community beds: Buying nursing or care home beds for patients

that do not require hospital care but are not able to return home. This ensures

beds are available for those who need them

• Commissioning of significant additional community bed capacity, which has

significantly reduced Delayed Transfer of Care (DTOC) patients

• Multi Agency Discharges Events (MADE) at both acute trusts: These events bring

in partners across the healthcare system to go to the acute hospitals to review

patients to ensure that they have a plan for discharge and unblock any issues

holding up discharge

• Commissioning additional care support capacity for patients to be discharged to

their own home

• Additional beds for community step down.

Ambulance Handovers

All handovers between ambulance and A&E must take place within 15 minutes and crews

should be ready to accept new calls within a further 15 minutes. Please note data for this

measure is EMAS data and can differ to the acute trusts A&E data.

NHS Constitution Support Measures

(Quarterly) Standard Trust Q1 Q2 Q3 Q4 Year

Handovers between ambulance and A&E

within 15 mins and crew ready for new calls within

15 mins (delays of over 30 mins)

0

NGH 1,153 1,109 2,217 760 5,239

KGH 998 1,496 2,304 2,164 6,962

Handovers between ambulance and A&E

within 15 mins and crew ready for new calls within 15 mins (delays of over 1

hour)

0

NGH 131 133 895 109 1,268

KGH 141 283 982 858 2,264

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What We Are Doing

The key driver of delays in ambulance handover is normally that A&E departments are

beyond capacity. The actions we are taking, which are detailed in the A&E sections, will

play a major role in resolving ambulance handover issues. In addition to those actions

the Urgent Care Board continue to work with EMAS and both A&Es to improve processes

on dealing with ambulance handover. The CCG has a clear escalation process for

management of long delays.

Cancer Waiting Times

NHS Constitution

measures Standard Organisation Q1 Q2 Q3 Q4 Year

Cancer waits – 2 week

wait

Maximum two-week

wait for first outpatient

appointment for

suspected cancer

93%

Nene CCG 88.25% 95.17% 91.89% 89.18% 91.17%

NGH 82.16% 93.43% 87.96% 83.52% 86.80%

KGH 97.58% 97.99% 97.75% 97.01% 97.59%

Maximum two-week

wait for first outpatient

appointment referred urgently

with breast symptoms

93%

Nene CCG 63.88% 98.34% 92.84% 90.03% 85.55%

NGH 39.87% 98.19% 86.00% 76.09% 72.86%

KGH 96.17% 98.43% 98.39% 97.93% 97.75%

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NHS Constitution


Cancer Waits – 31 days

Maximum one month wait from

diagnosis to first

definitive treatment

for all cancers

96%

Nene CCG 95.24% 93.63% 96.25% 96.01% 95.25%

NGH 95.51% 95.33% 97.27% 97.14% 96.30%

KGH 97.46% 96.99% 97.67% 97.89% 97.50%

Maximum one month

wait for subsequent

surgical treatment

94%

Nene CCG 90.63% 83.33% 79.41% 86.87% 85.63%

NGH 93.75% 92.86% 94.44% 93.33% 93.52%

KGH 100% 100% 100% 100% 100%

Maximum one month

wait for subsequent anti-cancer

drug treatment

98%

Nene CCG 99.31% 98.91% 100% 97.85% 99.02%

NGH 99.18% 98.68% 100% 97.22% 98.79%

KGH 100% 100% 100% 100% 100%

Maximum one month

wait for subsequent radiotherapy

treatment

94%

Nene CCG 95.62% 97.56% 95.85% 96.68% 96.47%

NGH 95.16% 96.83% 95.67% 95.71% 95.87%

KGH No pts No pts 100% No pts 100%

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NHS Constitution


Cancer Waits – 62 day

Maximum two month wait from urgent GP referral to

first definitive treatment

85%

Nene CCG 77.21% 77.89% 74.61% 74.60% 76.16%

NGH 72.79% 76.58% 70.42% 69.16% 72.51%

KGH 85.43% 86.55% 86.03% 87.43% 86.34%

Maximum two month wait from

referral from an NHS

screening service to

first definitive treatment

90%

Nene CCG 87.18% 92.06% 82.54% 88.57% 87.59%

NGH 84.62% 100% 86.44% 90.70% 89.89%

KGH 82.22% 87.80% 87.25% 87.37% 86.18%

Maximum two month wait for first

definitive treatment following a consultant’s decision to upgrade

None

Nene CCG 84.21% 72.38% 78.13% 81.44% 79.27%

NGH 86.07% 68.64% 78.29% 82.84% 79.91%

KGH 87.01% 86.16% 84.13% 87.50% 86.81%

Kettering General Hospital has met and maintained all the cancer standards and is

currently performing at or above the required standard. However, Northampton General

Hospital struggled consistently to meet the following targets: the 62-day wait from an

urgent GP referral for a patient with suspected cancer to first definitive treatment, 2-week

wait from GP to specialist referral time and 2 week wait for symptomatic breast referrals.

These delays were caused by issues with the way patients move through their care and

capacity restraints in diagnostics services.

What We Are Doing

While there are challenges specific to each hospital, some issues are faced by services

across the system. In response, the Northamptonshire Cancer Board was set up, bringing

together Nene and Corby CCGs, primary care, Northampton General Hospital, Kettering

General Hospital, East Midlands Cancer Alliance and NHS England. All organisations’

individual strategies and plans have been consolidated into a high-level work plan to

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ensure that all services are working on the same key priority areas to improve cancer

services across the county. In addition, both NGH and KGH have their improvement plans

and their own internal Cancer Boards.

Nene CCG has worked closely with the East Midlands Cancer Alliance to drive a new

approach to transforming care, including prevention, diagnosis, early intervention and

treatment.

In 2019/20 we:

• Conducted reviews of cases where patients missed 62-day waiting time, to share

learning and make improvements.

• Secured funding for the implementation of the National Optimum Lung Pathways

that aims to reduce the time from referral to treatment for lung cancer patients.

• Secured funding for the RAPID programme for diagnosis and treatment of

prostate cancer.

• Implemented the Faecal Immunochemical Test (FIT), which aims to ensure that

signs of colorectal cancer are found at an early stage.

• Commenced the Living with and Beyond Cancer programme for the county to

ensure that people who have cancer or have had treatment are leading as healthy

and active a life as possible.

Priorities for Cancer Care for 2020/21

The Cancer Pathways and Performance Working Group has identified key issues and

pathways to drive continued improvement in 2020/21, which are listed on page 61.

In addition, the CCG will continue to monitor all aspects of the cancer pathway to ensure

that rapid action is taken to correct any emerging issues.

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Planned Care

Referral to Treatment (RTT) (Quarter data based on Jun / Sep / Dec / Mar. Year based

on Q4)

NHS Constitution

measure Quarterly

Standard Data

Source Organisation Q1 Q2 Q3 Q4 Year

Patients on incomplete

non-emergency pathways

(yet to start treatment)

92%

NHS England

RTT Report

Nene CCG 86.03% 84.92% 83.27% 81.72% 81.72%

NGH 82.54% 81.34% 78.99% 80.66% 80.66%

KGH 88.82% 88.11% 88.13% 83.06% 83.06%

This standard requires that at least 92% of patients waiting for consultant-led treatment

have been waiting less than 18 weeks.

What We Are Doing

In order to improve performance in Northamptonshire, Northamptonshire CCGs have

worked to develop a plan to reduce long waits and recover RTT performance across the

NHCP footprint.

The CCG has worked to commission sufficient capacity to manage the elective care

demand, while addressing areas of priority including MSK, Urology and Frailty.

Since August 2019 NGH have been undertaking the Clinical Standards Review for

Elective Care, which measures RTT in a different way.

Referral to Treatment (RTT) (quarter data based on Jun / Sep / Dec / Mar. Year

based on Q4)


Standard Organisation Q1 Q2 Q3 Q4 Year

No patient should wait over 52 weeks from

Referral To Treatment (Incompletes)

0

Nene CCG 0 0 2 3 3

NGH 0 0 0 0 0

KGH 0 0 0 0 0

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Nene and Corby CCGs are working together to transform planned care in

Northamptonshire with the aim of reducing the pressure on the acute hospitals by looking

at alternative ways that patients with less complex needs can be safely treated.

Diagnostics (quarter data based on Jun / Sep / Dec / Mar. Year based on Q4)



Diagnostic test

waiting times

Patients waiting for a

diagnostic test

waiting less than 6 weeks

99%

Nene CCG 96.52% 97.79% 97.81% 96.46% 96.46%

NGH 94.10% 96.68% 97.14% 98.95% 98.955

KGH 99.47% 99.53% 99.01% 95.78% 95.78%

This standard requires that no more than 1% of patients wait over six weeks for a

diagnostic test.

Northampton General Hospital have not met the standard in Quarter 1 and Quarter 2 of

2019/20 due to a major unplanned estates problem within the endoscopy department.

Kettering General Hospital has been consistently meeting the standard.

Mental Health Care Programme Approach For information Quarter 4 data is yet to be published by NHS England.



Care Programme Approach -

Proportion of people under adult mental

illness specialties on CPA who were

followed up within 7 days of discharge.

95%

Nene CCG 95.65% 95.04% 98.13%

NHFT 98.32% 95.24% 99.09%

Dementia Diagnosis NHS Constitution


Dementia prevalence diagnosis rate 66.7% Nene CCG 66.45% 66.71% 66.70% 67.08% 66.74%

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What We Are Doing

We have delivered training for GPs to improve diagnosis of patients with dementia. This

has helped push diagnosis recognition above the standard. We will continue to monitor

this to ensure compliance is maintained.

Improved Access to Psychological Therapies (IAPT)

NHS Other Support Measures

Standard Org. Q1 Q2 Q3 Q4 Year

IAPT access (Monthly)

1.58% per month

Nene CCG 4.40% 4.28% 4.51% 4.32% 17.51%

IAPT access proportion (rolling)

22% FY 4.75% Qtr 1 / 9.50% by

Qtr 2

Nene CCG 4.40% 8.68% 13.19% 17.51% 17.51%

IAPT recovery rate 50% Nene CCG 50.51% 50.81% 50.56% 51.47% 50.83%

% completed treatment 6 weeks

75% by year end

Nene CCG 96.67% 98.08% 98.15% 97.84% 97.67%

% completed treatment 18 weeks

95% by year end

Nene CCG 99.67% 99.36% 99.63% 99.28% 99.48%

There are two performance standards for Improving Access to Psychological Therapies

(IAPT); one relates to ensuring appropriate access and the other to recovery rates

following IAPT. We did not consistently meet the standards in 2019/20.

What We Are Doing

We are working closely with Northamptonshire Healthcare NHS Foundation Trust

(NHFT), who provide the majority of our community and mental health services, to

address these issues.

The current referral and booking management systems have been overhauled. The Hubs

have had a positive impact on the quality of referrals and improved waiting list

management. The data quality issues identified by the review of the IAPT service are

being addressed by NHFT through improved processes and will be closely monitored by

Nene CCG.

Performance Against Other NHS Measures

NHS services are also required to meet the following standards from the NHS

Constitution:

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For information Quarter 4 data is yet to be published by NHS England.



No Mixed Sex Accommodation breaches

0

Nene CCG 14 24 91

NGH 0 0 0

KGH 0 13 107

NHFT 0 0 0




No urgent operation to be cancelled for a second time

0

NGH 1 0 0

KGH 0 0 0




Operations cancelled, on or after the day of admission to be offered other binding date

within 28 days

0

NGH 16 5 9

KGH 0 0 0

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Business Continuity

The CCG Emergency Preparedness, Resilience and Response (EPRR) and Business

Continuity Team have been fully involved with emergency planning internally, with

partners in the health and social care economy and with the wider multi-agency

community throughout 2019/20.

The EPRR and Business Continuity Team continue to engage with health and social care

partners and the wider multi-agency community to ensure that there is a joined up

approach to managing incidents at a local, regional and national level.

The Corporate Business Continuity Plan, Business Continuity Policy and staffing

disruption plans were subject to annual review and whilst the plans will continue to be

updated annually, it was decided to change the policy to a three-year review cycle to

reflect the minimal changes usually required.

Core Standards

NHS Nene CCG undertook the annual Core Standards review for EPRR. This is a formal

process led by NHSE/I. The process requires the CCG to complete a self-assessment

against national standards and attendance at a face-to-face review panel consisting of

NHS England, Public Health England and Northamptonshire County Council Director of

Public Health.

The Head of System Resilience and the Governance and Risk Manager completed the

self-assessment, which was reviewed by the Audit and Risk Committee and signed off

by Julie Curtis, the CCG Authorised Officer. The CCG assessed itself as being fully

compliant against the standards. We received confirmation from NHS England and

Improvement that they agreed with our assessment.

EU Exit Planning

The Department of Health and Social Security (DHSS) developed a number of

contingency plans focussing on:

Supply of medicines and vaccines

Supply of medical devices and clinical consumables

Supply of non-clinical consumables, goods and services

Workforce sustainability

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Reciprocal healthcare arrangements

Research and clinical trials

Data sharing, processing and access.

The CCG worked with local providers to ensure that the NHS locally was as prepared as

possible to respond to any issues that may have occurred if the UK left the European

Union without a deal. The CCG also worked with Northamptonshire County Council to

deliver workshops for Care Home and Domiciliary Care providers to enable them to

prepare appropriately.

We received confirmation from the DHSS that preparations for planning for a no deal EU

exit were to be stood down with immediate effect.

COVID-19 Response

Coronavirus disease (COVID-19) is an infectious disease, which is believed to have

originated in Wuhan, China with the first cases being recognised in early December 2019.

Most people infected with the COVID-19 virus will experience mild to moderate

respiratory illness and recover without requiring special treatment. Older people, and

those with underlying medical problems like cardiovascular disease, diabetes, chronic

respiratory disease, and cancer are more likely to develop serious illness.

The outbreak was declared a Public Health Emergency of International Concern by the

World Health Organisation (WHO) on 30 January 2020, with the first cases in the UK

reported the following day. On 11th March the WHO had declared a global pandemic.

In response to the outbreak in early March 2020 the Northamptonshire Local Resilience

Forum (LRF), of which Nene CCG is a partner, set up a Strategic Co-ordinating Group in

response to the Coronavirus (COVID-19) pandemic.

The multi-agency, multi-disciplinary team is working closely with incident co-ordination

centres set up across the county. The role of the Strategic Co-ordinating Group is to co-

ordinate the public sector response across the county in order to protect the public and

save lives. All activity aligned with the daily directive issued through COBR.

The effort focussed on three particular key areas:

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To support public messaging and encourage people to take responsibility and

follow the guidance and advice to help reduce the spread of infection and protect

the vulnerable.

To free up the maximum possible number of inpatient and critical care beds to

prepare for an anticipated increase of hospital patients due to Coronavirus.

To create local council run hubs to co-ordinate the volunteer and community efforts

to better support the vulnerable and those self-isolating.

These efforts are being supported by the public health department who are offering

scientific advice to ensure the national guidance being issued is interpreted for

Northamptonshire and to look for any trends that are happening locally. At the time of

writing COVID-19 is still assessed as a pandemic and national measures such as self-

isolating and social distancing are in place to curb the spread of the virus.

Tier 2 On-Call

A number of new staff have joined the CCG at a senior level, and along with Deputy

Directors have ensured that the Tier 2 On-Call rota (strategic level) is now sustainable.

Training is being provided to ensure all new staff have the appropriate skills to undertake

this role.

Incidents

Incidents involving NHS resources over the course of the year include responses to

hazardous materials and significant fires.

Exercises

The CCG has participated in a number of exercises over the course of the year. These

included exercises covering counter terrorism, cyber-attacks, psychosocial support,

pandemic flu, no deal EU exit, communications and accessing Resilience Direct.

Surge and Escalation

During the course of the year the NEL CSU Surge Senior Surge and Performance

Manager has been co-located in the Urgent Care Team Office. This has enabled a closer

working relationship, enhanced internal and external assurance and provided resilience

to the surge team when the system is under pressure.

The Single Health Resilience Early Warning Database (SHREWD) is continuously being

improved to support visibility of where system pressures are and where there is capacity

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to support. The CCG, supported by the NEL CSU Surge Team, organised and ran a

winter debrief session covering winter 2018/19 and a review of CCG and provider plans

going into winter 2019/20.

Sustainable Development

Sustainability means spending public money well, the smart and efficient use of natural

resources and building healthy, resilient communities. By making the most of social,

environmental and economic assets we can improve health both in the immediate and

long-term, even in the context of a rising cost of natural resources.

NHS Nene Clinical Commissioning Group (CCG) is committed to providing high quality

sustainable healthcare in Northamptonshire and is committed to embedding

sustainability into its operations and encouraging key partners and stakeholders to do

the same.

The CCG is committed to promoting environmental sustainability and to continually

improve the quality of their services and environmental performance.

The CCG headquarters is located within Francis Crick House, a relatively modern

building with a number of environmental features.

Paper and Cardboard is recycled including confidential waste (after shredding).

During 2019/20 all emergency lighting was replaced with LED units to save

energy.

A plan is in place to replace all fluorescent tubes with low energy LED units.

During 2019/20 the CCG has engaged with the Landlord via NHS Property

Services to investigate the installation of Electric Vehicle Charging Points.

Electric Vehicles are available via the CCG’s Vehicle Leasing Scheme

Cycle Parking is available at the building as are showers and lockers for staff.

PIN control of multi-functional devices (printer/copier/scanner) was introduced to

reduce unwanted printing

At a local level the CCG is committed to embedding sustainability into staff behaviour

and other partners in shared premises, concentrating on the reduction of paper,

increased recycling, car sharing and use of local public transport where possible.

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Policies

We cooperate with our landlord to ensure sustainable practices are adopted such as

recycling and good use of energy in our CCG headquarters and we continue to explore

the possibilities of increasing the range of recycling available in our building.

During 2019/20, we carried out a travel survey amongst staff to gain information on

commuting patterns.

Organisation Performance

As a part of the NHS, public health and social care system, it is our duty to contribute

towards the level of ambition set in 2014 of reducing the carbon footprint of the NHS,

public health and social care system by 34% (from a 1990 baseline) equivalent to a 28%

reduction from a 2013 baseline by 2020.

Improving Quality

Our strategy, agreed in 2019 outlines the framework for ensuring that quality is at the

heart of everything we do and is reflective of the national stance that “quality must be the

organising principle of our heath and care service”. As well as the Northamptonshire

Health and Care Partnership (NHCP) commitment “to deliver a population-based and

person centred health and social care model within our available collective resources”.

Our local framework for quality is informed by national policy and is set against four main

drivers:

Planning for high quality services

Working in keeping with the development of integrated care systems

Developing and commissioning high quality services

Assuring the services we have commissioned deliver a high quality service

Our strategy, processes and procedures are based on not only delivering national

standards but where possible innovating to exceed them. The CCG is focused on making

the care we commission safer and more effective as well as improving the experience for

local patients. This is underpinned by three overarching strategic quality priorities:

Patient safety is monitored across the county to ensure the risk of adverse

outcomes for patients are minimised and when they occur lessons are learnt,

shared and embedded

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Patient experience of NHS care across the county is monitored to ensure lessons

are learnt, shared and embedded

We secure continuous improvement in the quality of services provided and in the

outcomes that are achieved and, in particular, outcomes which show the

effectiveness of their services, the safety of the services provided, and the quality

of the experience of the patient

Quality Assurance Process

We have a system of quality assurance and early warning processes in place which

provides information about the safety, effectiveness and patient experience of services

we commission and escalation within the CCGs and to relevant stakeholders such as

NHS England and Improvement and the Care Quality Commission. This system enables

us to be proactive in identifying early signs of concerns and take action where standards

fall short of expectation. It also helps to inform our commissioning decisions at all stages

of the commissioning cycle.

The Joint Quality Committee plays a vital role in ensuring quality remains at the heart of

CCG decision-making. The committee is a joint committee between NHS Nene CCG and

NHS Corby CCG and reports directly to both Governing Bodies in common.

A key part of our assurance process is the countywide Strategic Clinical Quality Review

Meeting (SCQRM). This meeting promotes collaborative working to support delivery of

the Northamptonshire Health and Care Partnership (NHCP) to improve the quality of care

for specific patient groups.

This enables good practice and innovation to be shared so there can be improvement for

patients across the county. It also provides an opportunity to identify common themes

from operational Clinical Quality Review Meetings, which the group can work together to

resolve; supporting a common approach to quality assurance and improvement across

the county.

In 2019/2020 the CCGs developed an innovative countywide quality schedule based

upon the domains of patient safety, patient experience, and clinical effectiveness,

safeguarding and collective working.

The schedule has further developed collaborative working between organisations and

has supported those areas in which this ethos was already well established. Part of this

work has included the development of a Quality Improvement Memorandum of

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Understanding with each of our local NHS trusts to outline the principles of how we will

work together to share information about quality and safety across the system to ensure

continuous quality improvement (QI).

It provides an overarching framework for closer countywide quality improvement and

collaborative working across Northamptonshire.

Infection Prevention and Control

Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteraemia

One hospital case of MRSA bacteraemia was reported by NGH in 2019/2020. The

investigation determined that this was due to a contamination of the sample. The trust

has taken actions to minimise the risk of recurrence. No hospital cases of MRSA

bacteraemia were reported by KGH.

E Coli bacteraemia

E Coli bacteraemia all counts

(combined community and hospital)

Source: PHE data to Jan 2020 published

March 2020

2018-2019

(Jan 2019)

2019-2020

(Jan 2020)

Nene CCG 410 371

Northants combined 441 411

East Midlands 2,883 2,911

As with 2018/19 the incidence of E Coli bacteraemia within the county is currently below

2019/20 (to January 2020) set against a slight increase across the wider East Midlands.

Clostridium Difficle

Guidance for 2019-2020 provided revised ceilings for providers and CCGs and required

the attribution of both hospital onset healthcare associated (HOHA) and community onset

healthcare associated (COHA) i.e. cases that occur in the community (or within two days

of admission) when the patient has been an inpatient in the trust reporting the case in the

previous four weeks; to the acute provider.

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Organisation

2019/20 (to 29 Feb 20) C Difficle ceiling (full year)

Nene CCG 83 157

KGH Trust 50 39

NGH Trust 39 40

NHfT Trust 2 24

(Source national HCAI DBS)

Guidance for 2019-2020 provided revised ceilings for providers and CCGs and required

the attribution of both hospital onset healthcare associated (HOHA) and community onset

healthcare associated (COHA) i.e. cases that occur in the community (or within two days

of admission) when the patient has been an inpatient in the trust reporting the case in the

previous four weeks; to the acute provider.

The rise in numbers of investigations undertaken using the national investigation template

has increased the requirement on trusts to investigate and the CCGs to review submitted

investigations. The CCG quality team is working with providers to ensure that the required

attribution of cases by organisation is in place in accordance with changes to national

guidance and that there are systems in place to accommodate the increased number and

complexity of investigations required for the community onset hospital associated

(COHA) investigations. KGH exceeded the full year ceiling.

There is no nationally mandated ceiling for NHFT. The Trusts and CCG representatives

meet bi-monthly to collectively review cases and to determine whether any lapses

contributing to the development of C Difficile have been identified. One lapse in care at

KGH has been identified and agreed. This related to a failure to follow trust antibiotic

guidelines. An action plan to provide training and to monitor and assure compliance is in

place. Learning is shared through the whole health economy infection prevention and

control committee.

Staffing

All hospitals publish care hours per patient per day (CHPPD) information about the

number of nursing and midwifery staff working on each ward. CHPPD includes total staff

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time spent on direct patient care but also on activities such as preparing medicines,

updating patient records and sharing care information with other staff and departments.

It covers both temporary and permanent care staff. On its own, CHPPD does not reflect

the total amount of care provided on a ward nor does it directly show whether care is

safe, effective or responsive. The trusts review CHPPD alongside other measures of

quality and safety including validated tools and professional judgement to review staffing

levels across the trust at regular intervals throughout the day.

The quality team actively seek assurance regarding nurse staffing fill rates. Higher levels

of CHPPD may be completely justifiable and reflect the assessed level of acuity and

dependency. Lower levels of CHPPD may also reflect organisational efficiencies or

innovative staffing deployment models or patient pathways.

Any concerns are raised with the hospital trusts through Clinical Quality Review Meetings

(CQRMs) and when required quality visits are undertaken to gain further assurance.

Serious Incidents

Serious incidents in health care are defined as “adverse events, where the consequences

to patients, families and carers, staff or organisations are so significant or the potential

for learning is so great, that a heightened level of response is justified.” 4

There were 113 serious incidents reported by NHS and independent healthcare providers

in 2019/20 of which seven were subsequently downgraded as not meeting the national

criteria for serious incidents. Five of the serious incidents were never events (incidents

that prevent or threaten to prevent an organisation’s ability to continue to deliver an

acceptable quality of healthcare services and incidents that cause widespread public

concern resulting in a loss of confidence in healthcare services).5

The CCG has continued to support the joint investigation process, and have reinforced

and provided further direction on the requirement for providers to undertake joint

investigations when more than one provider has been involved in the patient’s care

leading to an incident. The CCG’s management of serious incidents policy and a

memorandum of understanding with providers support this.

4 https://www.england.nhs.uk/wp-content/uploads/2015/04/serious-incidnt-framwrk-upd.pdf, p.7 5 https://www.england.nhs.uk/wp-content/uploads/2015/04/serious-incidnt-framwrk-upd.pdf, p.8

https://www.england.nhs.uk/wp-content/uploads/2015/04/serious-incidnt-framwrk-upd.pdf

https://www.england.nhs.uk/wp-content/uploads/2015/04/serious-incidnt-framwrk-upd.pdf

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What We Did About It

All incidents have been subject to internal serious incident investigation scrutiny through

the CCG’s serious incident governance processes. Nene CCG always undertakes follow

up quality visits to the relevant clinical area to gain assurance on the implementation of

actions following never events. Learning is planned to be shared through our countywide

patient safety group, with a work stream identified to look at best practice and lessons

learned across all NHS and independent healthcare providers.

Assurance on Primary Care Quality

The status of outcome ratings as at the end of March 2020 is shown in the table below:

Rating Nene

Outstanding 2

Good 60

Requires Improvement 2

Inadequate 2

The two practices requiring improvement and the two rated as inadequate will be re-

inspected before the end of this financial year. Support has been offered to the practice

to embed improvement and prepare for re-inspection.

The primary care quality dashboard is now well established. The data is continually

refreshed as soon as national data becomes available and local indicators are updated

on a quarterly basis. Indicators to identify variation across the domains of compliance,

safety, experience and effectiveness are agreed by the Primary Care Operational Group.

This information is used to inform commissioning decisions and provide support and

education.

The outcomes of the dashboard identify where practices are outliers in the domains and

add up to a risk score that gives an indication of the potential reduced quality of care

provided. A report is provided to the Primary Care Risk Sharing Group on practices that

are flagging amber or red. It is at this meeting further information is shared by other

stakeholders, such as CQC and NHSE, to establish the overall risk of quality provision

by a practice. A plan of how to offer enhanced support the practice is developed and

agreed, with updates on progress monitored at future meetings. A report is then provided

to the Primary Care Joint Co-commissioning Committee for assurance.

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CQC reports on Acute Trusts and NHFT

Kettering General Hospital NHS Foundation Trust

KGH was inspected by the CQC in February 2019 with the latest report published in May

2019. The following areas of the trust were included within the inspection; urgent and

emergency care, medicine, maternity, outpatients, diagnostic imaging. The trust was

removed from special measures and rated overall as requires improvement. The CQC

rated the trust safe, effective, well led and responsive as ‘requires improvement’ and

caring as good. The trust has 14 actions they ‘must’ take to improve and 44 actions they

‘should’ take. Four requirement notices were issued to the trust.

Northampton General NHS Trust

NGH had a CQC inspection in the summer of 2019. Medical care, maternity services and

urgent and emergency services were inspected with the report published in October

2019. The trust was rated as requires improvement, the previous report published in 2017

rated the trust as good. The trust has three actions they ‘must’ take to improve and 27

actions they ‘should’ take. Three requirement notices were issued to the trust. Areas of

outstanding practice were found in maternity services and in nursing.

BMI Three Shires Hospital

The last CQC inspection for Three Shires Hospital was undertaken in 2018 and remains

rated as good.

Ramsay Woodland Hospital

The last CQC inspection for Woodland Hospital was published in January 2019, they

remain rated as good.

EMAS

EMAS had a CQC inspection in April and May 2019 and the report was published in July

2019 with an overall rating of good. Emergency and urgent care, patient transport

services, emergency operations centre and resilience services, including the hazardous

response team (HART), were inspected. The trust was told they had 24 actions they

should take to improve. Areas of outstanding practice were found in all areas that were

inspected.

https://www.cqc.org.uk/provider/RX9

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Care Home Providers

Work is currently being undertaken in partnership with Northamptonshire County Council

to develop a joint Framework Agreement for all care homes throughout

Northamptonshire. Forums have been held to ensure provider engagement. The aim is

to develop clear expectations and quality outcomes that will be jointly monitored. It is

hoped that this piece of work will be completed by July 2020.

Clinical quality reviews continue to take place with the average scoring for care homes

following a monitoring visit 92%. CQC ratings for nursing care homes in

Northamptonshire are detailed below

Area Inadequate R.I Good Outstanding Unrated

This LA 5% (3) 19% (12) 69% (43) 5% (3) 2% (1)

England 2% 20% 69% 4% 4%

Comparators 3% 20% 68% 6% 3%

Domiciliary Care Providers

The CQC ratings for domiciliary care providers are indicated in the table below:

Area Inadequate R.I Good Outstanding Unrated

This LA 0% 12% (23) 56% (112) 3% (5) 30% (59)

England 1% 11% 66% 4% 19%

Comparators 0% 8% 70% 5% 17%

There are a large number of domiciliary care providers throughout Northamptonshire

many of them very new and this can be seen by the number of unrated services which is

high against the England average or comparators.

Providers are monitored on a regular basis; there are currently preferred providers and

spot purchase providers to accommodate the various specialist care requirements of

individuals. All domiciliary providers are given recommendations with their monitoring

reports to ensure continued development and improved quality outcomes.

Case Study: Yellow Bracelet Scheme

A new scheme, which has been pioneered in Northamptonshire, aims to enable better

care for older and vulnerable patients. The Yellow Bracelet Scheme was developed to

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reduce unnecessary hospital admissions for the more than 4,600 patients with domiciliary

packages of care in the county. Data collected in 2016 showed a third of these patients

were taken to hospital when attended by the ambulance service – many needlessly.

The initiative is being rolled out to all domiciliary care providers. Each care provider loads

anonymised care plan data onto a system which changes the information into a QR code

that is put onto a Yellow Bracelet.

The ambulance service then place the Yellow Bracelet on the wrist of an individual if they

are conveyed to hospital and the A&E departments read the QR code, which then informs

them of the home care package in situ. The aim is to help avoid unnecessary admission

or facilitate a more speedy

discharge as hospital staff know their care at home is set up already.

The Yellow Bracelets will allow community teams to include district nurses, ambulance

crews and rapid response teams to easily see what support the patient has in place as

part of their domiciliary care package – and enable them to contact the care provider to

ask questions, if necessary.

If a trip to hospital is required, the Yellow Bracelet is placed on the person’s wrist and the

same information is therefore made available to support decisions about whether or not

they need to be admitted. By providing that

reassurance, we hope the scheme can

prevent unnecessary hospital stays and

enable timely discharge, once the service

user is medically ready.

Ross Sargent is a Registered Manager for

the Northampton Nursing and Carers

Agency (NNCA) in Northampton was an

early adopter of the Yellow Bracelet scheme. He said: “The reason we were keen to sign

up quickly is because we could see the benefits, not only for our service users but also

for the business, and we actively encouraged our service users to be on it. It has already

made such a difference. Our service users are being discharged much more easily from

hospital because the hospital can scan the bracelet and see there is a care package in

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place for them and which agency is delivering it.

“The Yellow Bracelet Scheme ensures service users come back to carers who know them

and with people who are familiar to them once they have been discharged. It removes

the risk of new care packages being unnecessarily set-up with a different care agency

because no-one was aware they already had a care package in place. We just want to

get them home and get them looked after – the Yellow Bracelet scheme always allows

us to do this.”

Safeguarding

The new Northamptonshire Children’s Safeguarding Strategic Partnership has confirmed

that they will retain the Section 11 audit process for 2019/20, with audits in early 2020.

During the year work has been underway across the CCG, providers and NCC to scope

the requirements of Liberty Protection Safeguards (LPS) training. Legal training and the

implications for the CCG have been provided to the Senior Executive Team. There is

likely to be increased pace in relation to LPS in early 2020 following publication of the

Code of Conduct.

We rolled out ‘Gangs’ training across the county to a range of health, police, education

and Social care professionals has been extremely successful. Gang related activity

remains a key priority for both the Adult Safeguarding Board and the Children’s

Safeguarding Partnership.

The Safeguarding Team continue to work well with local acute and community providers

in relation to safeguarding assurance visits. The team is developing a standardised

assessment tool for both children and adults, which will be co-produced. The aim is to

ensure consistency and transparency in the assurance visiting process. Visits have taken

place at both acute services with planned visits to the community provider. The Child

Protection - Information Sharing project (CP-IS) has been fully rolled out across

Northamptonshire.

NHSE/I have developed a new CCG self-assessment framework which commenced

rollout in October 2019, with submissions made by CCGs in November 2019. The

assessment tool is accessible via the ‘Future NHS Collaboration Platform’ with

submissions on a quarterly basis.

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One of the biggest successes for 2019/20 has been the implementation of ‘Working

Together 2018’ and the new partnership arrangements in the development of the new

Northamptonshire Children’s Safeguarding Strategic Partnership, which became a legal

entity in September 2019.

The safeguarding team have worked with teams internal to the CCG and with providers

to support and monitor safeguarding arrangements within current contracts. The team

have also supported procurement to ensure that safeguarding is embedded into all new

contracts with a clear indication of reporting requirements, training and development and

having relevant policies in place.

Complaints

NHS Nene CCG is responsible for investigating all complaints or concerns raised in

relation to services that we commission on behalf of our patients. Our Complaints

Procedure is consistent with the Parliamentary Health Service Ombudsman’s guidance.

The CCG welcomes complaints as a valuable means of receiving feedback on the

services we commission for local people and how we conduct our business. We aim to

use information gathered from complaints as a means of improving services and the

effectiveness of the organisations we commission. The CCG will seek to identify learning

points, which is translated into positive action, and where necessary provide redress to

set right any injustice that may have occurred.

Between 1 April 2019 and 31 March 2020 the CCG received:

No complaints were investigated by the Parliamentary Ombudsman.

Engaging People and Communities

Nene CCG has a legal duty under Section 14Z2 of the NHS Act 2006 (as amended)

Nene Complaints 48

Nene MP Complaints 44

Nene Concerns 107

TOTAL 199

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to ensure that individuals to whom our services are provided, or may be provided, are

involved in the planning, development and operation of commissioning arrangements. As

an organisation this duty is fundamental to everything that we do and at the heart of our

commissioning intentions.

We continue to engage with our local community through our CCG membership scheme,

which enables local people to be kept up-to-date about local developments in health and

care, as well as having their say.

Nene CCG contributed to a range of public engagement events in 2019/20, including:

Armed Forces Day and the Armed Forces Covenant

On 29th June 2019, Northamptonshire CCGs supported Armed Forces Day by taking

part in an annual event. The events are for all the men and women who make up our

Armed Forces community, from serving troops to service families, veterans and cadets.

Northamptonshire CCGs provided information to increase awareness among military

veterans of the healthcare and support that is available to them.

Northamptonshire CCGs are two of a number of local organisations that have signed the

Armed Forces Covenant. The Armed Forces Covenant partnership work with local

voluntary sector service and health and social care partner organisations to provide

support to our local armed forces veterans.

Winter Campaign

Winter is the busiest time of the year for the NHS and

it is a priority to keep patients well and prevent

avoidable or unnecessary admissions to hospital and

attendance at A&E.

During winter and throughout the festive season NHS

organisations, the local authority and voluntary sector

worked together to deliver the national ‘Help us Help you’ communications campaign

across Northamptonshire to raise awareness of the appropriate urgent and emergency

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care services in the area. The message was how to stay well and avoid inappropriate use

of NHS services.

We used a range of engagement tools including face to face, written materials, local

media and social media engagement.

Nene CCG took the winter campaign out to shopping centres in the county to promote

‘Stay Well this Winter’. These events targeted all ages, encouraging

members of the public to get the flu vaccine and providing health information on how to

stay well. At some of these events the team were accompanied by the Signing 4

Breathing Choir alongside Public Health Northampton’s Supporting Independence Team,

who provided free mini health checks and health and wellbeing advice.

Case Study: Annual General Meeting

On Thursday 5th September 2019, the Northamptonshire CCGs held a joint AGM. Over

60 people registered for the event and for the first time, it was live streamed on YouTube

to make it accessible for those who could not attend in person, including parents with

small children, frail and older people and those in rural communities.

The replay of the live stream is available via the link here.

We also held a number of round-table discussions

on key clinical priority areas of MSK, urology, frailty

and respiratory care. All the feedback from these

sessions is available to read on the website via this

link.

Developing a New Communications and Engagement Strategy

During 2019 we developed a new joint Communications and Engagement Strategy with

Corby CCG to cover all of Northamptonshire, which was formally approved by the

Governing Body in August 2019. Our aim is to give the public clear opportunities to get

involved with their local NHS in a way, which allowed them to see how their views have

shaped things.

The new strategy will outline the Northamptonshire CCGs’ aspirations, principles and

approach to ensuring good communications and engagement with everyone who has a

https://www.youtube.com/watch?v=b_R4aAXtz3w&feature=emb_logo

https://www.neneccg.nhs.uk/public-patient-involvement/engaging-all-our-communities.htm

https://www.neneccg.nhs.uk/downloads/ppi/Approved%20Corby%20and%20Nene%20CCGs%20Comms%20and%20Engagement%20Strategy%202019-2022.pdf

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stake in our NHS. It is supported by a detailed plan on what we are doing to make this

happen.

As we started work on this strategy, we talked to partners, stakeholders and people

across Northamptonshire about what we are doing now – what works and where we

could improve our conversations with you.

A summary of what you told us, which fed into the overall strategy can be found here.

Primary Care Engagement: Primary Care Portal

During 2019, Nene and Corby CCGs have continued to

add information to the Primary Care Portal based on

feedback received from practices.

During 2018, Nene and Corby CCGs developed the

Primary Care Portal for practices. The aim of the portal is

to provide a platform specifically for Primary Care colleagues to access information from

both CCGs in one place. It contains information such as:

Advice, guidance, leaflets and some referral forms for local services

News updates – this content has meant that the CCGs do not have to send as

many emails to general practice colleagues

Events – a calendar of events including local training dates from the CCGs, Local

Medical Council (LMC) and other organisation events that may be of interest to

General Practice staff

Access to specifications, claim forms and submission date for locally enhanced

services that practices provide

Information on how practices can support the Armed Forces Covenant

Access to past Protected Learning Time (PLT) presentations and the new

resource centre where practice will be able to access resources and contacts for

their in house PLTs

Access prescribing information, guidance and other documents

The facility to contact the CCG directly if practices are unable to locate the

information they are looking for.

https://www.neneccg.nhs.uk/public-patient-involvement/you-said-we-did.htm

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The CCGs plan to continue to develop the Primary Care Portal and add additional

information that is useful to Primary Care Colleagues based on their feedback.

Protected Learning Time Programme

Nene and Corby CCGs support on-going education for clinical staff to ensure best

medical practice for the safe and effective care of patients. Supported by a dedicated

Protected Learning Time Clinical Lead, GPs and other local primary care staff are

provided with opportunities to continue their professional development.

These include designated ‘Protected Learning Time’ (PLT) when practices close to allow

for staff training. Six sessions are provided off-site when staff join their colleagues for

updates on a broad range of topics delivered by local and national experts in their fields,

and five afternoons a year when mandatory training such as safeguarding and

resuscitation is provided in-practice. Training is very well attended, with on average 250

GPs and 100 practice nursing staff attending PLT events across the county.

In addition to this, the Primary Care Portal provides information on external training

available for practice staff plus resources for practices to use for their in-practice training

as required.

Reducing Health Inequality

Under section 14T of the Health and Social Care Act 2012 each clinical commissioning

group must, in the exercise of its functions, have regard to the need to:

(a) reduce inequalities between patients with respect to their ability to access health

services, and

(b) reduce inequalities between patients with respect to the outcomes achieved for them

by the provision of health services.

Promoting equality is at the heart of the NHS Nene CCG values, ensuring that we

commission services fairly and that no community or group is left behind when we make

commissioning decisions on behalf of our population, especially in relation to meeting the

challenges the NHS face, as outlined in the NHS Long Term Plan.

We are committed to taking Equality, Diversity and Inclusion, and Human Rights into

account in everything we do through commissioning services, employing people,

developing policies, communicating and engaging with local people in our work. As a

http://www.legislation.gov.uk/ukpga/2012/7/section/26/enacted

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public body, we work to ensure we meet our Public Sector Equality Duty (PSED), as set

out in the Equality Act 2010 and our obligations under the Human Rights Act 1998. We

will continue to promote and protect people’s dignity and rights by upholding the values

set out in the NHS Constitution.

In addition, NHS Nene CCG implements the NHS Equality Delivery System 2 (EDS2) to

support its work to tackle discrimination and health inequalities within local communities

and for staff. We have a positive culture toward employing disabled people and

developing a more diverse, inclusive and engaged workforce. You can read more about

this in the staff report on pages 165-166.

The Public Sector Equality Duty

NHS Nene CCG has worked to show how it is meeting the aims of the Public Sector

Equality Duty as set out in the Equality Act

to:

Eliminate discrimination

Advance equality of opportunity

Foster good relations between different

people when carrying out their activities.

This means NHS Nene CCG must work to

prevent discrimination as well as

harassment and victimisation from happening. We also take steps to meet the health

needs of people with certain Protected Characteristics.

As set out in the Equality Act 2010, the Protected Characteristics are:

Age

Disability

Gender reassignment

Marriage and civil partnership

Pregnancy and maternity

Race

Religion and belief

Sex

Sexual orientation.

https://www.gov.uk/guidance/equality-act-2010-guidance#public-sector-equality-duty

https://www.equalityhumanrights.com/en/human-rights/human-rights-act

https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england

https://www.england.nhs.uk/about/equality/equality-hub/eds/

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The CCG’s staff members participate in mandatory equality diversity and inclusion

training. The Equality Act requires public bodies to publish information about how it has

met the Equality Duty each year and to set specific measurable equality objectives. This

information is published on our website annually here.

Equality Objectives and Leadership

NHS Nene CCG has developed and published its refreshed Equality and Inclusion

Strategy 2019 – 2022, which outlines the on-going approach to equality and inclusion,

and serves as a basis to inform how we will implement our equality objectives 2019-2022.

To ensure that our equality objectives remain relevant to the CCG’s business and

changing priorities they are refreshed annually. We also prepare a progress report, which

outlines how the equality objectives are met and embedded across CCG activities (where

appropriate).

Our Equality and Inclusion Strategy implemented is published on the website. A

programme of work underpins our strategy and serves as a basis for delivering our

Statutory Equality Objectives 2019 – 2022. These objectives are outlined below.

Equality Analysis and Due Regard

NHS Nene CCG has embedded

equality and human rights by

developing an integrated Quality and

Equality Integrated Impact

Assessment (QEIIA) tool. This

continues to ensure the CCG

considers quality, equality and human

rights when undertaking decisions on

what healthcare to buy and what

Equality Objective 1: Continue to integrate inclusion and equality conditions

into the decisions we make

Equality Objective 2: Continue to develop as an inclusive employer to ensure

staff are aware of and supported to meet the evolving needs of the

organisation and local communities

Equality Objective 3: Continue to focus on understanding gaps in health

outcomes for the diverse local communities and working to reduce inequality

EDS2 GOAL 1

Better Health

Outcomes for all

EDS2 GOAL 2

Improved patient

access and experience

EDS2 GOAL 3

Representative and

supported workforce

EDS2 GOAL 4

Inclusive Leadership

https://www.neneccg.nhs.uk/about-us/quality/equality-inclusion-and-human-rights.htm

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services it might change in order to meet local needs. We have developed and delivered

training in Equality Impact Assessment/Equality Analysis to senior managers and staff,

who are directly involved in commissioning work and service reviews to ensure the CCG

gives appropriate Due Regard at every level of decision-making.

Implementing the NHS Equality Delivery System (EDS2)

NHS Nene CCG adopted the EDS2 Framework from an early stage, which supports our

work to understand and reduce health inequalities. During 2019/20, we have continued

to work towards improving our performance and outcomes against the four Goals of the

EDS2 (pictured above) by undertaking additional self-assessment and grading against

Goal 4. Our system leadership role will be further strengthened by undertaking grading

through planned EDS2 engagement events, which are expected to take place from

2020/21 against Goals 1 and 2.

The Way Forward

During 2020/21 we will continue to work closely with providers and partners to ensure

they are promoting Equality, Inclusion and Human Rights (meeting our duties under the

Equality Act 2010) and to demonstrate we are working together to reduce health

inequalities for the people of Northamptonshire. The development of a QEIIA tool that

can be utilised across the NHCP is supporting some early work to implement a consistent

approach in considering Equality Impact Assessment / Equality Analysis. We will review

and update the EDS2 Evidence Portfolio and progress during 2020 for annual publication

in 2021.

What Other Actions is Being Taken to Tackle Health Inequalities?

There are a number of activities the public health team and partners are working on to

reduce health inequalities. For example, the stop smoking service is undertaking targeted

work in both of the acute trusts to offer support and with specific GP practices where

smoking prevalence is high.

The NHS Health Check programme targets people who are at high risk of having a heart

attack or stroke in the next 10 years. It is currently offered across the County in GP

practices. It can help to tackle health inequalities, as the burden of early death from

cardiovascular disease is higher in the most deprived communities compared with the

least deprived. A new delivery model is currently being developed to improve uptake.

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To tackle inequalities by helping people to be more physically active, Northamptonshire

Sport continue to provide a universal, countywide activity programme. A range of

activities are offered to encourage people to be more active.

These include the provision of behavioural change training and approaches, making

better use of green open space for physical activity and making PE and School Sport

inclusive to all which helps to build a resilient physical activity habit for life. These actions

have a focus across the county, but with an increased emphasis on those living in the

most deprived areas where healthy life expectancy is known to be much worse. Eight

geographical hotspots have been identified where there will be an increased focus of

energy and effort.

Health and Wellbeing Strategy

Section 116B of the The Health and Social Care Act 2012 sets out the responsibilities

of local authorities and clinical commissioning groups for preparing joint health and

wellbeing strategies.

NHS Nene CCG is an active member of the Northamptonshire’s Health and Wellbeing

Board, which brings together leaders from across the county’s health and care system to

work together to:

Improve the health and wellbeing of local people

Reduce health inequalities

Promote the integration of services.

Key to this is Supporting Northamptonshire to Flourish, the five-year joint health and

wellbeing strategy, which was launched in 2016. The document sets out the partners’

vision to improve the health and wellbeing of all people in Northamptonshire and reduce

health inequalities by enabling people to help themselves.

The Board has agreed four strategic priorities:

Every child gets the best start

Taking responsibility and making informed choices

http://www.legislation.gov.uk/ukpga/2012/7/section/193/enacted?view=plain

https://www.northamptonshire.gov.uk/councilservices/health/health-and-wellbeing-board/Pages/default.aspx

https://www.northamptonshire.gov.uk/councilservices/health/health-and-wellbeing-board/Pages/default.aspx

https://www.northamptonshire.gov.uk/councilservices/health/health-and-wellbeing-board/Pages/health-and-wellbeing-strategy.aspx

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Promoting independence and quality of life for older adults

Creating an environment for all people to flourish.

By working together, we aim to create a better quality of life and improved outcomes for

the people of Northamptonshire. Supporting Northamptonshire to Flourish sets out the

vision for the county and provides an unrivalled opportunity to establish, for the first time,

a unified approach to health and wellbeing with real potential to achieve real and

meaningful change for the benefit of all.

While it must deliver progress within each priority, the Board recognises the connections

and interdependencies between them.

Prevention, early help and early intervention are fundamental to the strategy. Success

delivery depends on integrated plans delivered by local organisations. Seven subgroups

and seven geographical Health and Wellbeing Forums report into the Health and

Wellbeing Board and have action plans that feed into the Joint Health and Wellbeing

Strategy. The Joint Health and Wellbeing Strategy informs the work of the NHCP and will

be refreshed in 2020/21.

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ACCOUNTABILITY

REPORT

Toby Sanders,


17th June 2020

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Corporate Governance Report

Members Report

The following section contains information about how we are structured and

governed.

Member Profiles

Please see appendix 1 for the Governing Body member profiles on pages 214-217.

Member Practices

NHS Nene CCG has a membership of 64 GP practices, who all play a pivotal role in

clinically led commissioning. Clinicians and patients are at the heart of our decision-

making. A full list of the practices is available in appendix 2 on page 218.

Composition of Governing Body

Name Job Title Dates (if applicable)

Paul Bevan Lay Member for Primary Care

Until 30th September 2019

Dr Naomi Caldwell Interim Commissioning Membership Engagement Executive

Also has role of Clinical Executive Director, which does not sit on the GB. Covered CMEE role since 1st October 2019

Angela Dempsey Chief Nurse & Quality Officer

Dr Chris Ellis Commissioning Membership Engagement Executive

Professor Devaka Fernando

Secondary Care Doctor

Tansi Harper Lay Member for Patient & Public Involvement

Covered role on interim basis from 18th June 2019

Dr Tom Howseman Commissioning Membership Engagement Executive


Bev Messinger Lay Member for Patient & Public Involvement

From 2nd September 2019

Richard Moore Lay Member for Audit & Governance


Stuart Rees Joint Chief Finance Officer

Toby Sanders Joint Chief Executive

Dr Darin Seiger GP Chair

Dr Philip Stevens Commissioning Membership Engagement Executive

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Kevin Thomas Lay Member for Governance


Sam Turner Lay Member for Finance & Planning


Committee(s), including Audit Committee

Audit and Risk Committee in common

Joint Executive Management Team (with NHS Corby CCG)

Joint Finance Committee (with NHS Corby CCG)

Joint Quality Committee (with NHS Corby CCG)

Locality Boards

Patient and Public Participation Committee in Common

Primary Care Co-Commissioning Joint Committee

Remuneration and Terms of Service Committee

Joint Strategic Commissioning Committee

Register of Interests

NHS Nene CCG is aware of the importance its obligation to identify and address any

potential or actual conflict of interest when transacting its business. NHS Nene CCG

has an embedded and robust system for:

Registering interests of the Governing Body, its sub-committees and staff

Publication of its register of interests

Updating the register on a quarterly basis

Taking any actual or potential conflicts into account when transacting the

business of NHS Nene CCG.

NHS Nene CCG’s register of interests is available on its website via the link and

choose the file “Joint CCGs Register of Interests….”

Personal Data Related Incidents

There have been thirteen lapses in data security during 2019/20 Nene CCG including

one joint lapse in data security with Corby CCG.

The joint incident was assessed as having occurred, and that the impact is (at least)

minor therefore, the incident was reportable to the Information Commissioner. A full

https://www.neneccg.nhs.uk/document-library/conflicts-of-interest.htm

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report was submitted and the Information Commissioner has taken no further action

in this case.

Statement of Disclosure to Auditors

Each individual who is a member of the CCG at the time the Members’ Report is

approved confirms:

So far as the member is aware, there is no relevant audit information of

which the CCG’s auditor is unaware that would be relevant for the purposes

of their audit report

The member has taken all the steps that they ought to have taken in order

to make him or herself aware of any relevant audit information and to

establish that the CCG’s auditor is aware of it.

Modern Slavery Act

NHS Nene CCG fully supports the Government’s objectives to eradicate modern

slavery and human trafficking, but does not meet the requirements for producing an

annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act

2015.

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Statement of Accountable Officer’s

Responsibilities

The National Health Service Act 2006 (as amended) states that each Clinical

Commissioning Group shall have an Accountable Officer and that Officer shall be

appointed by the NHS Commissioning Board (NHS England). NHS England has

appointed the Chief Executive to be the Accountable Officer of NHS Nene CCG.

The responsibilities of an Accountable Officer are set out under the National Health

Service Act 2006 (as amended), Managing Public Money and in the Clinical

Commissioning Group Accountable Officer Appointment Letter. They include

responsibilities for:

The propriety and regularity of the public finances for which the Accountable

Officer is answerable

For keeping proper accounting records (which disclose with reasonable

accuracy at any time the financial position of the Clinical Commissioning Group

and enable them to ensure that the accounts comply with the requirements of

the Accounts Direction),

For safeguarding the Clinical Commissioning Group’s assets (and hence for

taking reasonable steps for the prevention and detection of fraud and other

irregularities)

The relevant responsibilities of accounting officers under Managing Public

Money

Ensuring the CCG exercises its functions effectively, efficiently and

economically (in accordance with Section 14Q of the National Health Service

Act 2006 (as amended)) and with a view to securing continuous improvement

in the quality of services (in accordance with Section14R of the National Health

Service Act 2006 (as amended))

Ensuring that the CCG complies with its financial duties under Sections 223H

to 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed

each Clinical Commissioning Group to prepare for each financial year a statement of

accounts in the form and on the basis set out in the Accounts Direction. The accounts

are prepared on an accruals basis and must give a true and fair view of the state of

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affairs of the Clinical Commissioning Group and of its income and expenditure,

Statement of Financial Position and cash flows for the financial year.

In preparing the accounts, the Accountable Officer is required to comply with the

requirements of the Government Financial Reporting Manual and in particular to:

Observe the Accounts Direction issued by NHS England, including the

relevant accounting and disclosure requirements, and apply suitable

accounting policies on a consistent basis

Make judgements and estimates on a reasonable basis

State whether applicable accounting standards as set out in the

Government Financial Reporting Manual have been followed, and disclose

and explain any material departures in the accounts and

Prepare the accounts on a going concern basis and

Confirm that the Annual Report and Accounts as a whole is fair, balanced

and understandable and take personal responsibility for the Annual Report

and Accounts and the judgements required for determining that it is fair,

balanced and understandable.

As the Accountable Officer, I have taken all the steps that I ought to have taken to

make myself aware of any relevant audit information and to establish that Nene CCG’s

auditors are aware of that information. So far as I am aware, there is no relevant audit

information of which the auditors are unaware.

I also confirm that:

As far as I am aware, there is no relevant audit information of which the

CCG’s auditors are unaware, and that as Accountable Officer, I have taken

all the steps that I ought to have taken to make myself aware of any relevant

audit information and to establish that the CCG’s auditors are aware of that

information.

Toby Sanders


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Governance Statement

Introduction and Context

NHS Nene CCG is a body corporate established by NHS England on 1 April 2013

under the National Health Service Act 2006 (as amended).

The clinical commissioning group’s statutory functions are set out under the National

Health Service Act 2006 (as amended). The CCG’s general function is arranging the

provision of services for persons for the purposes of the health service in England.

The CCG is, in particular, required to arrange for the provision of certain health

services to such extent as it considers necessary to meet the reasonable requirements

of its local population.

As at 1 April 2020, the clinical commissioning group is not subject to any directions

from NHS England issued under Section 14Z21 of the National Health Service Act

2006.

Scope of Responsibility

As Accountable Officer, I have responsibility for maintaining a sound system of internal

control that supports the achievement of the clinical commissioning group’s policies,

aims and objectives, whilst safeguarding the public funds and assets for which I am

personally responsible, in accordance with the responsibilities assigned to me in

Managing Public Money. I also acknowledge my responsibilities as set out under the

National Health Service Act 2006 (as amended) and in my Clinical Commissioning

Group Accountable Officer Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered

prudently and economically and that resources are applied efficiently and effectively,

safeguarding financial propriety and regularity. I also have responsibility for reviewing

the effectiveness of the system of internal control within the clinical commissioning

group as set out in this governance statement.

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Governance Arrangements and Effectiveness

The National Health Service Act 2006 (as amended), at paragraph 14L (2) (b) states:

The main function of the governing body is to ensure that the group has made

appropriate arrangements for ensuring that it complies with such generally accepted

principles of good governance as are relevant to it.

In accordance with this, we acknowledge within our Constitution the

following principles:

• 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 by adopting:

• The Good Governance Standard for Public Services

• The standards of behaviour published by the Committee on Standards

in Public Life (1995) known as the Nolan Principles

• The seven key principles set out in the NHS Constitution

• The Equality Act 2010

• Standards for Members of NHS Boards and Governing Bodies in England

The roles and responsibilities of the Governing Body and sub-committees of the CCG

are detailed within the CCG’s Constitution including the terms of reference. The CCG’s

Governance Structure can be found in the diagram below.

NHS Corby CCG and NHS Nene CCG Governance Structure

NHS Nene CCG (the CCG) is a clinically led and managerially supported membership

organisation made up of 64 member practices. Further detail in relation to the CCG

membership can be found in the Members’ Report above.

NHS Corby CCG and NHS Nene CCG are clinically led commissioning organisations

authorised by Government to plan, buy and monitor healthcare services for people

living in Northamptonshire. There are currently three NHS Clinical Commissioning

Groups with the above responsibilities within the geographical area of

Northamptonshire:

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NHS Nene CCG is responsible for East Northamptonshire, Wellingborough, Kettering,

Northampton, Daventry and South Northamptonshire.

NHS Corby CCG is responsible for Corby and NHS Cambridgeshire and Peterborough

CCG is responsible for the area of Oundle and Wansford. The practices that are

members of the NHS Cambridgeshire and Peterborough CCG made the decision in

2013 based upon the services their patients most frequently access.

The Northamptonshire CCGs have a strong track record of collaborative working

maximising their effectiveness as commissioners. This has included aligning:

A single operating plan

Programmes of work

Managerial and clinical leadership

Governance

Staffing

Provider contract and performance management

In the early years of the CCGs this joint working centred on the sharing of staff

resource and each CCG taking a lead role in the collaborative contracting and

management of services.

In 2018 the Northamptonshire CCGs significantly strengthened their joint working

arrangements through;

The alignment of individual CCG governance arrangements, via

constitutions and Terms of Reference, Schemes of Delegation and

Reservation, Standing Financial Instructions and Matters Delegated to

Officers

Establishment of all Governing Body sub committees being either a Joint

Committee or Committees in Common

Appointment of the Joint Chief Executive Officer and the Joint Chief Finance

Officer

Establishment of a shared Corporate Management Team

In 2019 the Northamptonshire CCGs further enhanced their joint operating model to

operate as a single organisation (where legislation allowed):

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Further alignment of governance arrangements through the establishment of

the Governing Bodies meeting in Common, with Northamptonshire CCGs

Governing Body and subcommittee meetings now held either jointly or in

common.

Further alignment of the constitutions and Terms of Reference, Schemes of

Delegation and Reservation, Standing Financial Instructions and Matters

Delegated to Officers,

Recruitment to a Joint Corporate Management Team

Recruitment to a Joint Lay Member structure

The Locality Boards (Nene) and the Council of Members meeting (Corby) are the

membership meetings of the CCGs, these do not currently meet under an in-common

or joint arrangement due to the nature and purpose of these meetings. Progress has

been made to date in aligning the content of these meetings to ensure a strong,

consistent and credible commissioner voice with our membership.

The Primary Care Committees did not meet under an in common or joint arrangement

due to the differing delegation status of the two CCGs.

During 19/20 the focus has been on making greater use of the significant clinical

expertise and capacity that we have across the two Boards, at the same time as

developing roles and processes for the new set of GP Board appointments that would

need to be in place for April 2020.

The new Corporate Management Structure for the new organisation was announced

in July 2019 to enable health population strategy/planning developments,

transformational delivery of the plans, increasing performance, efficiency and quality

through contracting for outcomes, focusing on integration of primary and community

services to support delivery of care in the community/closer to home and enables us

to monitor and drive quality, safety and equity of services throughout the organisation.

The Governing Bodies and Committees in blue, reflect the requirements of both

Governing Bodies as separate entities. The Joint Committee meetings are illustrated

in green, demonstrating the aligned reporting approach to both Governing Bodies.

Interim arrangements are illustrated in grey, as these are expected to be time limited.

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Further detail on the remit of the Governing Body and Sub-committees can be found

below.

CCG Governance Arrangements

The CCG has established robust governance arrangements and a system of internal

control. Corporate Governance is the system by which the CCG Governing Body

directs and controls the organisation at the most senior level in order to achieve its

objectives and meet the necessary standards of accountability and probity.

The CCG’s Constitution sets out the organisation’s commitment to good governance

and the arrangements the CCG has in place to help to deliver the vision, mission,

objectives and aims. The Constitution also sets out how the CCG will discharge the

organisation’s legal obligations and to engage with our members, our patients and our

community, and other key stakeholders and partners to achieve this. It states that the

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Governing Body of the group will throughout each year have an ongoing role in

reviewing the group’s governance arrangements to ensure principles of good

governance are reflected. This includes reviewing the effectiveness and the operation

of Governing Body meetings and the Sub-committees of this meeting. Further detail

on the Governing Body can be found later in this report.

Responsibilities and decision-making are defined in the CCG’s prime financial policies

and scheme of delegation, which are reviewed annually to maintain accuracy and

relevance.

The key features of the CCG Constitution in relation to governance are:

• Discharge of functions - the arrangements made to discharge the functions

of the CCG and the Governing Body. The Constitution describes how we

operate, the role of the Governing Body, the appointment of Committees and

the specific duties of the Chair, Joint Chief Executive (Accountable Officer)

and Joint Chief Finance Officer

• Primary decision-making processes - the primary decision-making

processes and procedures to be followed by the CCG and the Governing

Body including the arrangements for securing transparency in decision-

making such as the provision for Governing Body meetings to be held in

public

• Conflict of Interest management – how the CCG deals with conflicts of

interest, including the arrangements we have made to maintain and grant

public access to registers of interest and ensure that declarations of conflicts

or potential conflicts of interests are made. This is to ensure that conflicts or

potential conflicts do not and do not appear to affect the integrity of the

decision-making process. A copy of the CCG’s register of interests is

available on the CCG website. During 2019/20 a Joint Conflicts of Interests

(including Gifts & Hospitality) Policy was adopted across both CCGs

replacing the former individual policies

• Governing Body membership - details of how appointments are made to the

Governing Body and how the membership of the organisation is involved in

these appointments

• Scheme of Reservation and Delegation - sets out the decisions that are the

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responsibility of the Governing Body and its Committees, alongside the

decisions delegated to individual members and employees.

The Constitution sets out the arrangements the CCG has made for the discharge

of the Governing Body’s functions, including the following:

• Established committees of the Governing Body:

o Statutory Committees

Audit & Risk Committee

Primary Care Commissioning Committee


o Locally determined Committees

Locality Boards

Patient and Public Participation Committee

Joint Finance Committee

Joint Quality Committee


Joint Executive Management Team

• Delegated Governing Body functions for the approval of policies to the Joint

Quality Committee, Audit and Risk Committee, Joint Finance Committee and

Joint Executive Management Team, as committees of the Governing Body

• The Standing Orders and Scheme of Reservation and Delegation.

Effectiveness

The Governing Body throughout each year have an ongoing role in reviewing the

group’s governance arrangements and effectiveness of these, to ensure principles of

good governance are reflected. The Governing Body reporting structures have

embedded and communicated codes of conduct and defined standards of behaviour

for CCG members and staff by:

Having a code of conduct for the Governing Body members showing mutual

trust, respect and honesty

Members of the Governing Body adhere to the Nolan Principles for public life

Each Committee is authorised by and accountable to the Governing Body

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Each Committee is responsible for approving and keeping under review the

terms of reference and membership, and the Governing Body seek regular

assurance that this duty is discharged accordingly.

The Governing Body is subject to statutory and mandatory training. Training and

development is provided on a group basis through Governing Body workshops and

through individual need as identified through the annual appraisal process.

The Governing Body is provided with a range of information and using risk

management mechanisms, the Governing Body brings together the various aspects

of governance; corporate, clinical, financial and information to provide assurance on

its direction and control across the whole organisation.

In addition to the commitment by the Governing Body to assess and improve its own

performance, the Committee Chairs lead an annual review of committee effectiveness

review. The CCG use a tool to guide this review in the form of the Committee

Effectiveness and Meeting Checklist, which was designed to help in assessing the

effectiveness of each Sub-committee of the Governing Body.

The checklist focuses on three main areas; firstly committee administration; secondly

effective operation of the committee and; thirdly a free text section for each Chair to

provide any additional feedback on the effectiveness of the committee.

Below is an overview of the feedback provided by the Committee Chairs:

Committee/Meeting Process

Across all Committees most answers received were Agree or Strongly Agree.

However it was highlighted that there were opportunities to improve the links between

committees and aligning the emerging organisational and system priorities. It was also

identified that an improvement in proactive provision of information was required to

ensure that decision making can be effective.

Committee/Meeting Working

Responses received confirmed that there had been improvement in some areas of

112


delivery of actions however, there still remained opportunities improving the

consistency and strengthening the content of papers submitted for the Committees to

consider. During 2019/20 the Terms of Reference for each Committee were revised

to reflect the changes in Governing Body membership and senior leadership. This has

assisted in ensuring that meetings are quorate.

Committee/Meeting Engagement

Positive responses were received overall however there were some areas where

responses to challenges raised by the Committees of CCG officers and other

assurance providers could be improved.

Committee/Meeting Leadership

General feedback was positive for this section, with some indication that there may be

a need for Executive presence for Committees to enhance the delivery of the function

of the Committee and to provide the level of assurance required by the Committee.

Committee Effectiveness: Committee Chairs Comments

Commentary provided for this section identified some challenges faced regarding

additional presence or support from key assurance providers to ensure the

Committees can fulfil their objectives and have the constructive challenge required.

The Governing Body

The Governing Body is committed to assessing and improving its own performance.

All members of the Governing Body are able to demonstrate the leadership skills

necessary to fulfil the responsibilities of these key roles and have established

credibility with all stakeholders and partners. The CCG understands that the

Governing Body must be in tune with its member practices and must secure and

maintain their confidence and engagement.

The Governing Body sets the strategic direction for the CCG and focuses on gaining

assurance of the delivery of the CCG’s priorities, corporate objectives and statutory

duties. The Governing Body has focused on key performance issues throughout the

year, ensuring that the CCG has appropriate arrangements in place to exercise its

functions effectively, efficiently and economically in accordance with the CCG’s

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principles of good governance.

The Governing Body brings together the various aspects of governance to provide

assurance on the CCG’s direction of travel and control across the whole organisation,

acknowledging the collaborative working arrangements between NHS Corby CCG and

NHS Nene CCG.

2019/20 continued to be a challenging year for the CCG , which was reflected in the

focus of the Governing Body throughout the financial year on the effectiveness of

commissioning arrangements to ensure delivery of transformational and sustainable

change in place across Northamptonshire. This has been a particular area of

assurance sought through the CCG’s governance arrangements, in particular from the

Joint Finance Committee and Audit and Risk Committee. Further detail of this

approach can be found within the Head of Internal Audit Opinion later in the

Governance Statement.

Examples of the areas of review by the Governing Body are detailed below:

Development of strategy

Ensuring commissioning arrangements in place across Northamptonshire

Approving the annual Operational Plan and Financial Plan

Monitoring performance including the financial position, activity and progress

against key standards including NHS Constitutional Standards

Obtaining assurance the risk management process is effective to manage and

mitigate risk

Ensuring effective clinical leadership

Ensuring meaningful patient and public involvement in commissioning

decisions

Seeking assurance on Safeguarding

Monitoring of Quality and performance of services

Monitoring and seeking assurance on patient safety

Ensuring transparent remuneration arrangements are in place for employees

and others

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The Governing Body has met in public on a bi-monthly basis, alternated with Thinking

Time sessions for the Governing Body, which provide protected time to develop

understanding of key strategic issues. Six Governing Body meetings were held in

public in 2019/20.

During 2019/20, the Governing Bodies of NHS Corby CCG and NHS Nene CCG met

under an in-common arrangement to further strengthen the collaborative working

arrangements developed throughout the financial year.

Governing Body membership attendance is detailed in the table below, and

demonstrates that each meeting was quorate with good attendance from members

from April 2019 – March 2020.

NAME ORGANISATION/ PRACTICE

16/0

4/2

019

18/0

6/2

019

20/0

8/2

019

15/1

0/2

019

17/1

2/2

019

18/0

2/2

020 Total PERCENTAGE

Toby Sanders Nene and Corby CCG 1 1 1 1 1 1 6 100%

Angela Dempsey Nene and Corby CCG 1 1 1 1 1 0 5 83%

Devaka Fernando Nene and Corby CCG 1 0 1 1 0 0 3 50%

Richard Moore Nene and Corby CCG 0 1 0 1 33%

Sam Turner Nene and Corby CCG 1 1 1 3 100%

Bev Messinger Nene and Corby CCG 1 0 1 2 67%

Chris Ellis Nene CCG 1 0 1 0 1 0 3 50%

Darin Seiger Nene CCG 1 1 1 1 1 1 6 100%

Tansi Harper Nene CCG 1 1 100%

Kevin Thomas Nene CCG 1 1 1 3 100%

Paul Bevan Nene CCG 1 0 1 2 67%

Philip Stevens Nene CCG 0 0 1 1 1 1 4 67%

Stuart Rees Nene CCG and Corby CCG 1 1 1 0 1 1 5 83%

Tom Howseman Nene CCG 1 1 0 2 67%

Naomi Caldwell Nene CCG 1 1 1 3 100%

Tina Beardsworth Nene CCG 0 1 1 50%

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Committees of the Governing Body in Common

The established committees of the Governing Body are:

Statutory Committees

o Audit and Risk Committee

o Primary Care Commissioning Committee

o Remuneration and Terms of Service Committee

Locally determined Committees

o Locality Boards

o Patient and Public Participation Committee

o Joint Finance Committee

o Joint Quality Committee

o Joint Strategic Commissioning Committee

o Joint Executive Management Team

Audit and Risk Committee in Common

The Audit and Risk Committee’s work focuses on ensuring the organisation has

appropriate governance and internal control in place, and oversees the management

of risk. The Committee provides the Governing Body with an independent and

objective view of the CCG’s financial systems, financial information and compliance

with laws, regulations and directions governing the CCG. The Committee seeks to

provide assurance to the Governing Body that an appropriate system of internal

control is in place.

The membership of the Audit and Risk Committee as at 31 March 2020:

Lay Member for Audit & Governance (Chair)

Lay Member for Finance and Planning (Deputy chair)

Joint Secondary Care Doctor

During 2019/20, the NHS Corby CCG and NHS Nene CCG Audit and Risk Committees

met as Committees in Common six times. Audit and Risk Committee attendance is

detailed in the table below, and demonstrates that each meeting was quorate with

good attendance from members. The Joint Chief Finance Officer and External and

Internal Auditors, as well as the Local Counter Fraud Specialist, are regular attendees

at the Committee but do not form part of the membership.

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The minutes of each Audit and Risk Committee are presented to the Governing Body

and the Chair of the Committee draws attention to any issues that require disclosure

or executive action via the Chair’s highlight report.

Audit and Risk Committee membership attendance is detailed below from April 2019

– March 2020.

NAME ORGANISATION

16/0

4/2

019

23/0

5/2

019

23/0

7/2

019

17/0

9/2

019

26/1

1/2

019

18/0

2/2

020 Total Percentage

Kevin Thomas Nene CCG 1 1 1 1 4 100%

Richard Moore Corby and Nene 1 0 1 50%

Sam Turner Corby and Nene 0 0 0 0%

Andrew Hammond Corby and Nene 1 1 2 100%

Paul Bevan Nene CCG 1 1 1 1 4 100%

Devaka Fernando Corby and Nene 1 0 0 0 1 1 3 50%

Governance, Risk Management and Internal Control

Head of Internal Audit presented the Head of Internal Audit Opinion to the Audit and

Risk Committees in Common on 18 February 2020, which concluded that:

For the 12 months ended 31 March 2020, our head of internal audit opinion

for Nene Clinical Commissioning Group is as follows:

At each meeting the Audit and Risk Committee has considered the risks,

mitigations and assurance detailed within the Governing Body Assurance

Framework. To ensure adequate review of risks was undertaken against

identified risks to the achievement of organisational objectives a series of “deep

dives” were undertaken by the Committee. For each of these the Executive

Lead for the identified risk was invited to the Committee to provide assurance

on the risks and mitigations for the strategic objectives for which they are

responsible.

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The Committee approved the joint revised Governing Body Assurance

Framework (GBAF) and joint CCG risk management policy. The Committee

has also received assurance on the risk management system for the CCGs

The Audit and Risk Committee has regularly monitored the following during 2019/20:

Regular assurance reports on the Governing Body Assurance Framework

(GBAF) and delivery of associated mitigating actions, including review in line

with the deep dive programme

Regular review of the revised directorate level risk registers

Regular assurance reports on the progress of the Transition Programme Plan

Internal and External audit reports with focus on the implementation of agreed

management actions

Updates on the work of the Local Counter Fraud Specialist

Management of conflicts of interest and Register of Interests and Register of

Gifts and Hospitality, including approval of the revised Conflicts of Interest

Policy to reflect the collaborative working arrangements between the CCGs

Sources of assurance in support of the Annual Governance Statement and the

Annual Report and Accounts

Financial controls and monitoring correct application of the Standing Financial

Instruction and Scheme of Delegation

Governance in relation to third party governance and news ways of working

including primary care commissioning and the Northamptonshire Healthcare

Partnership

Single tender waivers correct use monitoring.

Progress against and compliance with the General Data Protection Regulations

2018 and the Data and Security Protection Toolkit submission.

Primary Care Co-Commissioning Joint Committee

The Primary Care Co-Commissioning Joint Committee is a joint Committee between

NHS England and NHS Nene CCG. The Committee has the primary purpose of

commissioning primary medical services for the people of Northamptonshire.

The Committee membership includes:

• Lay Member for Primary Care (Chair)

118


• Lay Member for Patient and Public Involvement (Deputy Chair)

• Lay Member for Finance and Planning

• GP Chair

• Chief Nurse & Quality Officer

• Clinical Executive Director

• Director of Primary and Community Integration

• Senior Contract Manager, NHS England

• Joint Accountable Officer

• Joint Chief Finance Officer/Deputy Chief Finance Officer

During 2019/20 the Committee met 5 times on a Bi-monthly basis. The minutes of the

Committee are reported to the Governing Body, with the Chair of the Committee

drawing attention to any issues that require Governing Body scrutiny via the Chair’s

highlight report.

The Primary Care Co-Commissioning Joint Committee meets in public and papers for

the meeting can be found on the CCG website.

The Primary Care Co-Commissioning Joint Committee membership attendance is

detailed below from April 2019 – March 2020.

NAME ORGANISATION/PRACTICE

14/0

5/2

019

Me

etin

g c

ancelle

d

11/0

7/2

019

12/0

9/2

019

14/1

1/2

019

09/0

1/2

020

12/0

3/2


Paul Bevan Nene CCG 1 0 1 50%

Tansi Harper Corby CCG (Deputy) 0 1 1 50%

Andrew Hammond Nene CCG and Corby CCG 1 1 1 3 100%

Bev Messinger Nene CCG and Corby CCG 1 0 0 1 33%

Naomi Caldwell Nene CCG and Corby CCG 1 1 1 1 1 5 100%

Julie Curtis Nene CCG and Corby CCG 1 1 1 0 1 4 80%

Stuart Rees Nene CCG and Corby CCG 1 0 1 1 0 3 60%

Jane Green NHS England and NHS Improvements

1 1 2 100%

Amanda Borland NHS England and NHS Improvements

1 1 0 2 67%

Toby Sanders Nene CCG and Corby CCG 0 0 0 0 0 0 0%

Darin Seiger Nene CCG 0 0 0 1 0 1 20%

https://www.neneccg.nhs.uk/about-us/primary-care-co-commissioning-joint-committee.htm

119



The Remuneration and Terms of Service Committee membership is made up of the

following:

Lay Member Finance and Planning (Chair)

Lay Member Primary Care

Lay Member Patient and Public Involvement

Lay Member Audit and Governance.

In case of all members being conflicted, decisions are made by the Secondary Care

Doctor and the Registered Nurse representatives on the Governing Body.

During 2019/20 the Committee met eight times. The Remuneration and Terms of

Service Committee makes recommendations to the Governing Body regarding the

remuneration, fees and other allowances for senior employees and for people who

provide services to the Group.

The Remuneration and Terms of Service Committee membership attendance is

detailed below from April 2019 – March 2020.


29/0

4/2

019

11/0

6/2

019

16/0

7/2

019

08/1

0/2

019

14/1

1/2

019

14/0

1/2

020

04/0

2/2

020

10/0

3/2


Angela Dempsey

NHS Nene and Corby CCGs

1 1 1 3 60%

Devaka Fernando


1 1 1 3 60%

Kevin Thomas NHS Nene CCG 1 1 1 3 100%

Paul Bevan NHS Nene CCG 1 0 1 2 67%

Sam Turner NHS Nene and Corby CCGs

0 0 0 1 1 2 40%

Bev Messinger NHS Nene and Corby CCGs

0 1 1 1 1 4 80%

Andrew Hammond


1 1 1 1 0 4 80%

Richard Moore NHS Nene and Corby CCGs

1 0 1 1 0 3 60%

120


Locality Boards

The CCG has established three Locality Boards which are Northampton Locality,

North Locality and South Locality. Each Board represents the working relationship

between the GP Member Practices and the CCG. Membership of the committee

includes:

Locality Commissioning & Membership Engagement Executive (CMEE) or

nominated deputy (who shall be voted in on the day if required)

At least one GP Practice representative from each member practice,. A GP

Practice representative will be considered to be a GP or Business/Practice

Manager Officers of the CCG and Practice Managers are also in attendance at

the Locality Boards as required.

The Locality Boards meet on a monthly basis. The purpose of the Locality Boards is

to:

Ensure the delivery of the CCGs commissioning and locality plans through

engagement with every member practice

Act as “clinical engine rooms” informing and guiding the work of the

organisation.

The Locality Board are tasked with ensuring that the CCG achieves its vision

of “helping people lead the best possible life from beginning to end” through its

mission of “Improving quality, outcomes and clinical standards for all patients”

Engage members on the delivery of the GP Forward View programme allowing

participation from every Member Practice in the Locality.

Support Primary Care within the Locality to continually innovate and improve

patient experience.

Understand and manage where appropriate variation and demand

Ensure that agreed Nene CCG-wide schemes and pathways are implemented

To enable effective communications between GP Member Practices and the

CCG

To contribute to the strategic direction and the CCG's Commissioning Intentions

121


To ensure that the views of Member Practices are heard and reflected in

commissioning plans and provide the CCG’s Governing Body with advice that

is informed by the membership

Be the principal forum for membership engagement in clinical commissioning,

providing clinical leadership to the formulation and implementation of the

strategy on behalf of the Governing Body and members.

Ensure engagement on the delivery of strategic commissioning plans and that

the organisation is responding to population health needs through all

commissioned services

Ensure that commissioning decisions support a continual improvement in the

quality, safety and performance of services and improving clinical and

population outcomes.

Inform the CCGs Quality Innovation Productivity and Prevention (QIPP) agenda

ensuring high quality and value for money are scrutinised in relation to

commissioned services.

Understand the associated finance, activity and workforce challenges and risks

across the health and social care system in relation to provider and partner

organisational QIPP plans.

To support the delivery of the Northamptonshire Health and Care Partnership

plans.

Patient and Public Participation Committee in Common

The Patient and Public Participation Committee (PPPCiC) provides assurance to the

Governing Body that all decisions made by the Governing Body have been informed

by the appropriate level of patients, carers and communities input, in accordance with

Section 14Z2 of the Health and Social Care Act 2012. The Committee upholds the

core values of the NHS Constitution.

The Committee membership includes:

Lay Member for Patient and Public Involvement (Chair)

Lay Member for Finance and Planning (Deputy Chair)

Lay Member Primary Care

GP Governing Body Member

122


Director Population Health Strategy

A public representative from the Corby GP Practice Patient Participation

Group or nominated deputies

Healthwatch representative

Northamptonshire Carers representative

Voluntary Impact Northamptonshire representative.

During 2019/20, the Committee met four times. From April 2019, NHS Corby CCG

and NHS Nene CCG Patient and Public Participation Committees met under

Committees in Common arrangement.

The Committee focus is on the development of an engagement strategy that ensures

engagement is embedded within the commissioning cycle, providing greater

involvement from the outset. The Committee in Common arrangement under which

the Committee now meets with NHS Nene CCG supports this development.

The minutes of the Committee are reported to the Governing Body, with the Chair of

the Committee drawing attention to any issues that require Governing Body scrutiny

via the Chair’s highlight report.

The Patient and Public Participation Committee membership attendance is detailed

below from April 2019 – March 2020.

NAME ORGANISATION 09/0

4/2

019

11/0

6/2

019

Cancelle

d

13/0

8/2

019

22/1

0/2

019

Cancelle

d

10/1

2/2

019

Can

cell

ed

14/0

1/2

020

25/0

2/2

020

Total Percentage

Tansi Harper

NHS Corby CCG & NHS Nene CCGs 1 1 2 100%

Angela Dempsey


Kathryn Moody


Darin Seiger NHS Nene CCG 1 1 2 100%

David Atkinson

NHS Nene CCG 0 1 1 0 2 50%

123


Pam Law NHS Nene CCG 1 1 1 0 3 75%

Sheila White NHS Nene CCG 0 1 1 1 3 75%

Jill Spilby

Healthwatch Northamptonshire 1 1 0 0 2 50%

Dawn Cummins

Voluntary Impact Northamptonshire 0 0 0 0 0 0%

Liz Cullinan Northamptonshire Carers 0 0 0 0 0 0%

Bev Messinger


Chris Ellis NHS Nene CCG 1 1 100%

Sam Turner


Andrew Hammond


Philip Stevens

NHS Nene CCG 1 1 100%

Naomi Caldwell

NHS Nene CCG 1 1 100%

Lucy Wightman


Joint Quality Committee

The Joint Quality Committee is a joint committee between NHS Corby CCG and NHS

Nene CCG. The Committee provides assurance to the Governing Body on the quality

of services commissioned in accordance with section 14R of the Health and Social

Care Act 2012, and promotes a culture of continuous improvement and innovation with

respect to safety of services, clinical effectiveness and patient experience to the

Governing Body.

Key issues debated and reviewed by the Committee during 2019/20 included:

Quality and Safeguarding Reports

Quality Directorate Risk Register

Complaints Annual report 2019/20

Safeguarding Annual Report 2019/20

Equality and inclusion updates

124


Review of complaints handling policy and safeguarding children and adults at

risk policy

Patient stories

Individual funding request Policy and Annual Report 2019/20

Policy for Service Review, Disinvestment and De-Commissioning Decisions

Never events and serious incidents

Quality Strategy

Workforce Race Equality Standard Report

Infection, Prevention and Control Strategy and Annual Report

The Committee membership is made up of:

Joint Secondary Care Doctor, (Chair)

Chief Nursing and Quality Officer (Deputy Chair)

GP Clinical Representative

Lay Member for Patient and Public Involvement

Joint Accountable Officer

Deputy Director of Quality

Head of Nursing and Safeguarding

Director of Public Health, Northamptonshire County Council

Health Watch Northamptonshire Representative

During 2019/20, the Committee met six times. The minutes of the Committee are

reported to the Governing Body with attention drawn to any issues that require

Governing Body scrutiny via the Chair’s highlight report.

The Joint Quality Committee membership attendance is detailed below from April 2019

– March 2020.


09/0

4/2

019

11/0

6/2

019

13/0

8/2

019

08/1

0/2

019

10/1

2/2

019

11/0

2/2

020

17/0

3/2

020

Can

cell

ed

Total PERCENTAGE

Prof Devaka Fernando (Chair)

Northamptonshire CCGs

1 1 1 1 1 1 N/A 6 100%

Bev Messinger Northamptonshire CCGs

N/A

N/A

N/A

1 1 1 N/A 3 50% New October 2019

125


Angela Dempsey (Vice Chair)

Northamptonshire CCGs

1 1 0 1 1 1 N/A 5 83%

Toby Sanders Northamptonshire CCGs

1 0 0 0 0 1 N/A 2 33%

Kathryn Moody Northamptonshire CCGs

0 1 1 1 N/A

N/A

N/A 3 50% Left October 2019

Joanne Brodrick Corby CCG 1 1 1 N/A

N/A

N/A

N/A 3 50% Left August 2019

Alison Jamson Northamptonshire CCGs

1 1 1 1 1 1 N/A 6 100%

Tina Swain Corby & Nene CCGs

1 1 1 1 1 1 N/A 6 100%

Lucy Wightman (Agreed deputy Kay King)

Public Health NCC

N/A

0 0 0 0 0 N/A 0 0% See Kay King

Kay King (Representing Lucy Wightman)

Public Health NCC

1 1 1 1 1 1 N/A 6 100%

Becky Calcraft Northamptonshire Healthwatch

1 1 1 N/A

N/A

N/A

N/A 3 50% Left Sept 2019

Sandra Bell Northamptonshire Healthwatch

N/A

N/A

N/A

0 1 1 N/A 2 33% New October 2019

Joint Finance Committee

The Joint Finance Committee is a joint committee between NHS Corby CCG and NHS

Nene CCG.


• Lay Member Finance and Planning (Chair)

• Lay Member Primary Care (Deputy Chair)

• Lay Member Audit and Governance

• Joint Chief Finance Officer

• Director of Outcome Based Contracting

• Director of Population Health Strategy

• GP Clinical Representation from NHS Corby CCG and NHS Nene CCG.

The Committee monitors contract activity, performance and budgets and makes

recommendations to the Governing Body regarding achievement of financial and

performance objectives. The Committee also makes recommendations on business

cases for the delivery of new investments.

During 2019/20, the Committee met 12 times, on a monthly basis. The Committee has

not been quorate for one meeting during 2019/20, however the CCG has enacted the

126


required governance processes in line with the CCG Constitution to ensure that

decisions have been ratified in a timely manner and business has been transacted as

required.

The minutes of the Joint Finance Committee are reported to the Governing Body

meeting, with the Chair of the Committee drawing attention to any issues that require

executive action via the Chair’s highlight report.

The Joint Finance Committee membership attendance is detailed below from April

2019 – March 2020.

NAME ORGANISATION

02

/04

/20

19

07

/05

/20

19

04

/06

/20

19

02

/07

/20

19

06

/08

/20

19

03

/09

/20

19

08

/10

/20

19

05

/11

/20

19

10

/12

/20

19

07

/01

/20

20

04

/02

/20

20

03

/03

/20

20 Total Percentage

Andrew Hammond NHS Corby CCG 1 1 1 0 1 1 1 1 0 1 1 0 9 75%

Caron Williams NHS Corby CCG and NHS Nene CCG

1 1 0 1 0 0 3 50%

Nathan Spencer NHS Corby CCG 0 1 1 1 1 1 1 1 1 0 1 0 9 75%

Miten Ruparelia NHS Corby CCG 1 1 1 1 1 0 5 83%

Joanne Broderick NHS Corby CCG 1 1 1 1 1 1 6 100%

Kathryn Moody NHS Corby CCG and NHS Nene CCG

1 1 1 1 1 1 1 7 100%

Kevin Thomas NHS Nene CCG 1 1 1 1 1 1 6 100%

Naomi Caldwell NHS Nene CCG 1 1 1 1 1 0 1 1 0 1 0 1 9 75%

Paul Bevan NHS Nene CCG 1 1 0 1 1 1 5 83%

Tansi Harper NHS Corby CCG 1 1 1 1 1 1 6 100%

Stuart Rees NHS Corby CCG and NHS Nene CCG

1 1 1 1 1 1 1 1 1 1 1 0 11 92%

Sam Turner NHS Corby CCG & NHS Nene CCG

0 1 1 1 1 1 5 83%

Richard Moore NHS Corby CCG and NHS Nene CCG

1 1 0 1 1 1 5 83%

Sarah Stansfield NHS Corby CCG and NHS Nene CCG

1 1 1 0 1 4 80%

Anna Dorothy NHS Corby CCG and NHS Nene CCG

0 0 1 0 1 25%

Alison Gilbert NHS Corby CCG & NHS Nene CCG

1 1 1 0 3 75%

127



The Joint Strategic Commissioning Committee is a joint committee between NHS

Corby CCG and NHS Nene CCG. The committee was established as part of the

Constitutional changes during 2018. The purpose of the Joint Strategic

Commissioning Committee is to provide commissioner leadership, oversight and

support to the strategic commissioning plans for Northamptonshire.

During 2019/20 the Joint Strategic Commissioning Committee has been in the early

establishment stage and to date, the Committee has not transacted any business for

the CCGs.

Joint Executive Management Team

The Joint Executive Management Team (JEMT) is a joint committee between NHS

Corby CCG and NHS Nene CCG. The purpose of the Committee is to bring together

the Executive and Clinical Leads who have the accountability and responsibility to

make decisions and ensure a single united commissioning voice within

Northamptonshire.


Joint Accountable Officer (Chair)

Joint Chief Finance Officer

Director of Primary and Community Integration

Director of Population Health Strategy

Director of Transformation Delivery

Director of Outcome Based Contracting

Chief Nurse and Quality Officer

GP Governing Body Members, NHS Corby CCG

Commissioning and Membership Engagement Executives (CMEEs) NHS Nene

CCG

Clinical Executive Director, NHS Nene CCG

The role of the Committee:

128


Ensuring successful delivery of the annual plan and delivery of key quality,

performance, and financial requirements

Shared approach across localities on financial discipline and value for money

is retained and further improved

Discuss and agree between the Executive Team and Clinical Leads the

sustainability for commissioning services and how these priorities will be

delivered

Ensure there is a shared approach across localities on financial discipline and

value for money is retained and further improved

Discharge delegated responsibility for decision-making through Executive and

Clinical Lead portfolios

Support a co-ordinated approach for the delivery of the annual commissioning

plan and the longer term objectives and priorities of the Northamptonshire

Healthcare Partnership

Develop and ensure alignment of the workforce and OD strategy, and through

the Joint Workforce Group improve organisational culture, robust and

competent leadership

Consider the requirement to establish a task and finish group to address under-

performance.

The Committee meets on a monthly basis and during 2019/20 has met 10 times. The

Committee has not been quorate for one meeting during 2019/20, however the CCG

has enacted the required governance processes in line with the CCG Constitution to

ensure that decisions have been ratified in a timely manner and business has been

transacted as required.

The minutes of the Committee are reported to the Governing Body with attention

drawn to any issues that require Governing Body scrutiny via the Chair’s highlight

report.

129


JEMT membership attendance is detailed below from April 2019 – March 2020.

NAME ORGANISATION /PRACTICE

02/0

4/2

019

07/0

5/2

019

04/0

6/2

019

02/0

7/2

019

06/0

8/2

019

03/0

9/2

019

Cancelle

d

01/1

0/2

019

Cancelle

d

05/1

1/2

019

03/1

2/2

019

07/0

1/2

020

04/0

2/2

020

03/0

3/2

020

Total PERCENTAGE

Toby Sanders Nene & Corby CCGs 0 1 1 1 1 1 0 1 1 1 8 80%

Az Ali Nene CCG 1 1 1 1 0 0 1 1 1 1 8 80%

Naomi Caldwell Nene CCG 1 1 1 1 1 1 0 1 1 1 9 90%

Julie Curtis Nene & Corby CCGs 1 1 1 1 1 1 1 1 0 0 8 80%

Emma Donnelly Nene CCG 1 1 0 1 0 1 1 1 1 0 7 70%

Chris Ellis Nene CCG 1 1 1 1 0 1 1 1 0 0 7 70%

Sanjay Gadhia Corby CCG 1 1 0 1 1 1 1 1 1 0 8 80%

Tom Howseman Nene CCG 1 1 1 1 1 5 100%

Kathryn Moody

Nene & Corby CCGs 1 1 1 1 1 5 100%

Stuart Rees Nene & Corby CCGs 1 1 1 1 1 1 1 1 1 0 9 90%

Nathan Spencer Corby CCG 1 1 1 1 0 1 1 0 1 1 8 80%

Philip Stevens Nene CCG 1 1 0 1 1 1 1 1 7 88%

Tina Beardsworth Nene CCG 1 1 1 3 100%

Angela Dempsey

Nene & Corby CCGs 1 1 1 0 1 1 0 5 71%

Caron Williams

Nene & Corby CCGs 1 1 0 1 0 3 60%

Lucy Wightman

Nene & Corby CCGs 1 1 1 1 1 0 5 83%

Sarah Stansfield

Nene & Corby CCGs 1 1 1 0 1 4 80%

Anna Dorothy Nene & Corby CCGs 1 1 2 100%

Miten Ruparelia Corby CCG 1 1 1 1 0 4 80%

Alison Gilbert Nene & Corby CCGs 1 1 1 3 100%

UK Corporate Governance Code

NHS Bodies are not required to comply with the UK Code of Corporate Governance;

however, the CCG draws upon best practice available, including those aspects of the

UK Code of Corporate Governance that we consider relevant to the CCG and best

practice. We comply with the key principles of the code, which set out good practice

130


in the areas of leadership, effectiveness, accountability, remuneration and

relationships with key stakeholders.

Discharge of Statutory Functions

In light of recommendations of the 1983 Harris Review, the CCG has reviewed, all of

the statutory duties and powers conferred on it by the National Health Service Act

2006 (as amended) and other associated legislative and regulations. As a result, I

can confirm that the clinical commissioning group is clear about the legislative

requirements associated with each of the statutory functions for which it is responsible,

including any restrictions on delegation of those functions.

Responsibility for each duty and power has been clearly allocated to a Lead Director.

Directorates have confirmed that their structures provide the necessary capability and

capacity to undertake all of the clinical commissioning group’s statutory duties.

Risk Management Arrangements and Effectiveness

The CCG is committed to having a risk management culture that underpins and

supports the business of the CCG. During 2019/20, the CCG reviewed and aligned

the risk management processes across NHS Corby CCG and NHS Nene CCG. The

work undertaken aligned the strategic and operational policies and practice, and

appropriately upskilled and trained staff. The revised Risk Management and

Governing Body Assurance Policy was developed to outline the CCGs’ approach to

risk management throughout the organisations.

The policy sets out managing risk, identifies accountability arrangements, resources

available and provides guidance on what may be regarded as acceptable risk within

the CCGs. The policy recognises that for the CCGs to successfully manage risk, the

CCG must:

Identify and assess risks

Take action to anticipate or manage risk

Monitor and regularly review risk to assess for the potential for further action

Ensure effective controls and contingencies are in place.

131


Risk management is part of the strategic planning process and managed operationally

through a robust process of governance around decision-making, set out in the

organisation’s scheme of delegation. Staff have received training and support through

group training and focussed one to one sessions, especially with those responsible for

maintaining risk registers. All employees are encouraged to highlight risks and report

incidents, and are provided with risk management training as required within their

roles.

The Governing Body and employees receive training in Equality and Diversity, and

Equality and Human Rights considerations are included in the development of all

strategies, policies and business cases to ensure impacts on protected groups are

understood and taken into account when making decisions.

The Local Counter Fraud Specialist ensures awareness and provides training for the

organisation as a deterrent to fraud risks arising. Further detail on counter fraud

arrangements can be found later in this report.

Under the collaborative working arrangements between NHS Corby CCG and NHS

Nene CCG, the Governing Body Assurance Framework (GBAF) records the strategic

risks for both CCGs, which are those risks, which significantly impact on the

achievement of the CCGs’ objectives.

The Governing Body are accountable and responsible for ensuring that the CCGs

have an effective programme of managing all types of risks, which is achieved via

review of the GBAF that reflects strategic risks and the Corporate Risk Register (CRR)

that identifies high scoring operational risks.

In 2019/20, the CCG has continued development of the risk management process,

including a review by the Governing Body of its risk appetite and the refresh of the

GBAF. The Governing Body continues to recognise risk management as an important

development area to improve internal controls and its own effectiveness, particularly

in light of the internal audit findings during the financial year and the Head of Internal

Audit Opinion received. A further review of the Governing Body Assurance Framework

132


(GBAF) was conducted during quarter four of 2019/20 to reflect changes in the

Corporate Management Team.

The refreshed GBAF brings together the strategic risks across both NHS Corby CCG

and NHS Nene CCGs, linked to the specific shared corporate objectives to which they

relate.

Each Directorate is responsible for reviewing and maintaining their risk register on a

regular basis, ensuring that the risk register accurately and appropriately reflects the

level of risk, the actions taken to manage the risks and records the effectiveness of

controls and the level of assurance that can be given. The Directorate Risk Registers

are reviewed by the Audit and Risk Committee on a rolling annual basis, with the

relevant Executive Risk Lead in attendance at the Committee to provide assurance

and undertaken scrutiny and challenge from the Committee. The Directorate Risk

Registers are reviewed in light of the Corporate Risk Register and GBAF to ensure

that risks are escalated appropriately. The Directorate Risk Registers are linked to

relevant Committees.

Individual Executive Risk Leads are responsible for each individual risk to which they

are linked on the GBAF, with support from the Clinical Commissioning Leaders Group.

However, the CCG understands that the mitigation of these risks cannot be done in

isolation and therefore the Joint Executive Management Team (JEMT) is responsible

for the support of operational delivery of the required actions in response to risks and

within the required timescales. Challenge and scrutiny of progress, non-completion

and slippage of actions is undertaken by JEMT. JEMT focuses on the delivery of key

actions within the required timescales in response to the risks recorded. Updates to

the GBAF are completed by the relevant Executive Risk Lead both individually and

collectively, ensuring the GBAF remains a live risk management tool for the

organisations.

The GBAF is presented and reviewed by the individual Directors as Risk Owners, then

collectively by the Corporate Management Team (CMT), Audit and Risk Committee

and Governing Body at each meeting, for detailed discussion and scrutiny. The NHS

Corby CCG and NHS Nene CCG Audit and Risk Committees have met as Committees

133


in Common throughout 2019/20. The Audit Chairs agreed that a focus on individual

actions would be undertaken by each meeting to seek assurance that actions are

being taken in mitigation of the identified strategic risks. A deep dive programme for

the year has been agreed and is part of the Committee workplanner.

As detailed above, the CCGs collaboratively carried out a complete review of the risk

management processes across both organisations, resulting in a refreshed and

revised Governing Body Assurance Framework. Revisions to the GBAF undertaken

as part of the risk management review process described are presented to the

Governing Body in public for consideration.

Capacity to Handle Risk

In 2019/20 the CCG has continued development of the risk management process as

detailed above. The Governing Body continues to recognise risk management as an

important development area to improve internal controls and its own effectiveness.

The internal audit of risk management and assurance recognises the extensive work

to develop the risk management process however has identified a number of

improvements and work continues to embed the use of the GBAF across the CCGs.

The internal audit opinion was substantial assurance.

Risk Assessment

The CCG’s Risk Management and Governing Body Assurance policy clearly sets out

how to assess risk. The policy and documentation ensures that each risk has a clearly

identified Executive Risk Lead, who is supported by the relevant Clinical Executive

linked to that area. Each strategic risk is mapped to the corporate objective to which

is relates.

As previously noted, the Governing Body Assurance Framework (GBAF) comprises

the CCG’s strategic risks, which would have impact upon the whole organisation and

the achievement of the CCG’s objectives. The most significant operational risks, which

are identified from key business activity at an operational level, which would have an

impact upon the whole organisation from an operational point of view, are managed

via the Corporate Risk Register.

134


NHS Corby CCG and NHS Nene CCG’s major risks to governance, risk management

and internal control are detailed below as at 31 March 2020:

GBAF Risk Description

Mitigations and Controls

Unable to ensure there is a sustainable, affordable healthcare system in Northamptonshire and the CCG's hit financial duties

Contract scrutiny - monthly technical, operational and strategic meetings with providers.

Disinvestment and decommissioning

Financial Management Executive (FME) – in year financial position

Improved reporting validation

Robust central challenge process on a monthly basis

Commissioned providers do not deliver required standards of performance

2019-20 NHS Standard Contracts in place with all key providers, identifying performance requirements. Monthly meetings to discuss performance and mitigations where performance deviates

Performance reporting focused on NHS Constitution and key performance requirements – presented at each GB, JFC, JQC.

Planned care board to identify and mitigate areas of service pressure and poor performance.

UECTB to review urgent care performance and address issues as required

Failure to ensure compliance with statutory engagement Requirements

Communication and Engagement Strategy approved by GBIC August 2019.

Engagement team in place with engagement workplan and processes established.

Use of CSU resource

Failure to ensure procurement activities are managed and delivered in line with CCG Policy and NHCP expectations

Monthly production of procurement pipeline to identify issues and opportunities – presented to EOG and JFC

Procurement register and contracts register on CCG websites.

Procurement Support via NEL – monthly performance reviews through CSU.

Revised Procurement strategy in place Procurement Policy in place

Failure to ensure commissioning and monitoring of services which are compliant with the CCG safeguarding statutory requirements

Additional safeguarding team members in post to provide additional capacity and capability within the team to provide safeguarding assurance

CCG has established safeguarding team covering required designated posts

CCG processes in place to gain assurance on provider compliance via quality schedule and designated safeguarding assurance visits.

Chief Nurse appointed to provide additional executive oversight of safeguarding and ensure the CCGs meet their statutory responsibilities

Safeguarding Strategy

The CCGs cannot continue to operate in a Business As Usual (BAU) due to loss of key resources

Business Continuity Plan • 24/7 on-call rota • Dedicated BC and EP team. • BC plan including Business Impact Analysis • BC and Emergency planning team • Daily reporting process to NHSE • Health Economy tactical co-ordinating group • Debriefs of all incidents to capture learning • Training of all on-call staff to support BC incidents • Exercising to support training

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Response Plans in place to deal with potential effects of Novel Corona Virus (n-Cov)

Failure to achieve full planning guidance delivery for 20/21 Plan

Commissioning Intentions

Development of agreed commissioning framework and delivery schedule to ensure deviation from provider performance is managed. In line with new planning guidance issued for 2019/20 and the Long Term Plan.

Directors of Strategy across providers and CCGs meet regularly.

Financial Management Executive (FME) established to ensure scrutiny group to ensure triangulation between finance, activity and contractual delivery, to ensure that QIPP and transformational responsibilities are covered off.

Long Term Plan for system includes key operational proposals for 2020/21

Maturing Delivery Group in place to oversee the implementation of the plan.

Right Care data used to identify priorities for LTP for 2020/21

Failure to achieve full planning guidance delivery for Long Term Plan that supports system development to time and intervention described in the guidance

Business Plan for 19/20 approved by Governing Body in June 2019

Joint Strategic Commissioning Committee (JSCC) established within the Governance structure to ensure appropriate priority is applied to our plans.

Failure to deliver of the strategic vision for primary care commissioning

Director of Primary Care and Community Integration and Primary Care Team responding to all correspondence and guidance from NHSE. PC team working closely with LMC, GP Federations and local practices.

Estates Strategy

OD plan for PCN

Primary Care Strategy

Failure of partner organisations to transform prevents the delivery of the Long Term Plan

CCGs Transition Programme – governance structure, programme plan and workforce in place.

NHCP Long Term Plan

Other Sources of Assurance

Internal Control Framework

A system of internal control is the set of processes and procedures in place in the

clinical commissioning group to ensure it delivers its policies, aims and objectives. It

is designed to identify and prioritise the risks, to evaluate the likelihood of those risks

being realised and the impact should they be realised, and to manage them efficiently,

effectively and economically.

The Audit and Risk Committee has oversight of the internal control mechanisms on

behalf of the Governing Body. Executive Directors oversee the management and

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delivery of internal control mechanisms. The Audit and Risk Committee bases its

assessments, and therefore assurances, on the effectiveness of the CCG’s controls

on assurances provided by the Governing Body and Committees’ work programmes;

Review of the Governing Body Assurance Framework (GBAF) which provides

an oversight of the effectiveness of controls in place to manage the CCG’s

principle risks

Reviews of CCG policies and procedures

Provision of assurance from internal and external audit and other identified

sources of assurance the committees of the Governing Body oversee the

management and delivery of the internal control mechanisms.

The system of internal control allows risk to be managed to a reasonable level rather

than eliminating all risk; it can therefore only provide reasonable and not absolute

assurance of effectiveness. During 2019/20, a number of areas of weakness in the

CCG’s arrangements were identified through the internal audit process, with particular

focus on the development of commissioning arrangements across Northamptonshire

and the effectiveness of these arrangements to enable the CCGs to commission

services effectively.

The CCG and its members recognise the importance of managing conflicts of interest.

Accordingly, a register of interests is maintained and updated regularly. A copy of the

register of interests is available on the CCG’s website. All meeting agendas of the

governing body and committees include guidance and definitions of interests and time

is allocated at the start of the meeting for such declarations to be made.

Control measures are in place to ensure that all of the CCG’s obligations under

equality, diversity and human rights legislation are complied with.

Annual Audit of Conflicts of Interest Management

The revised statutory guidance on managing conflicts of interest for CCGs (published

June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest

management. To support CCGs to undertake this task, NHS England has published a

template audit framework.

https://www.neneccg.nhs.uk/document-library/conflicts-of-interest.htm

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The CCG undertook its annual conflict of interest audit in February 2020, which

resulted in a reasonable assurance opinion. The implementation of the audit

recommendations will be reported to the Audit and Risk Committee, as part of the audit

implementation oversight of the Committee.

Data Quality

Information used by the Governing Body and its Committees enables the CCG to carry

out our responsibilities and discharge our statutory functions. This information relates

to operational, financial, performance, quality and patient experience.

The Governing Body and its Committees are committed to improving the quality of the

information received. There has been an improvement in the quality of data received

and the Governing Body has taken action to continue to improve this position.

Information Governance

The Data Security and Protection Toolkit is an online self-assessment tool that enables

health and social care organisations to measure and publish their performance

annually against the National Data Guardian’s (NDG) ten data security standards.

All organisations that have access to NHS patient data and systems – including NHS

Trusts, primary care and social care providers and commercial third parties – must

complete the Toolkit to provide assurance that they are practising good data security

and that personal information is handled correctly. By providing evidence and judging

whether they meet the assertions, will demonstrate that the organisation is working

towards or meeting the NDG standards.

We place high importance on ensuring there are robust data security and protection

systems and processes in place to help protect patient and corporate information.

We have an established Data Security and Protection management framework and

have developed processes and procedures in line with the Data Security and

Protection toolkit.

We have ensured all staff undertake annual data security training to ensure staffs

are aware of their data security and protection roles and responsibilities.

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The Information Governance Working Group (IGWG) supports and drives the broader

data security and protection agenda and provides the Audit and Risk Committee and

ultimately the Governing Body with the assurance that effective data security and

protection best practice mechanisms are in place within the organisation.

There are revised processes in place for incident reporting and investigation of serious

incidents in light of the new legislation. We have strengthened our information risk

assessment and management procedures, and a programme has been established to

fully embed an information risk culture throughout the organisation against identified

risks.

Business Critical Models

In the Macpherson report ‘Review of Quality Assurance of Government Analytical

Models’ published in March 2013, it was recommended that the Governance

Statement should include confirmation that an appropriate Quality Assurance

Framework is in place and is used for all business critical models. Business critical

models were deemed to be analytical models that informed government policy. The

CCG can confirm that in 2019/20 it has not developed any analytical models, which

have informed government policy.

The CCG receives Service Auditor Reports on the business-critical systems operated

by organisations that provide services to the CCG, which includes Shared Business

Services, the North East London Commissioning Support Unit (NELCSU) and Arden

GEM Commissioning Support Unit. This enables the CCG to place reliance on the

quality controls established relating to the business critical systems and models

delivered through the Service Level Agreement in place for 2019/20. Further detail is

described below.

Third party assurances

NHS Corby CCG and NHS Nene CCG rely on the NHS North East London (NEL)

Commissioning Support Unit (CSU) as a third-party provided of commissioning

support services. CSUs are part of NHS England and therefore the CCGs rely on NHS

England-led internal and external audit of CSUs. The CCGs hold quarterly contract

performance meetings with NELCSU.

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Control Issues

The DraftHead of Internal Audit Opinion has identified that the organisation has an

adequate and effective framework for risk management, governance and internal

control.

However, the work of the Head of Internal Audit has identified further enhancements

to the framework of risk management, governance and internal control to ensure that

it remains adequate and effective. This is further detailed in the Head of Internal Audit

Opinion Section of the Governance Statement further on.

Review of Economy, Efficiency and Effectiveness of the Use of

Resources

The CCG successfully managed its financial allocation throughout 2019/20. The

Financial Strategy and Budgets for 2019/20 were considered and approved by the

Governing Body at the start of the financial year, alongside the strategic and

operational plans for the CCG.

The CCG has an established system of financial control, which is led by the Joint Chief

Finance Officer with oversight from the Joint Finance Committee, the Audit and Risk

Committee and the Governing Body. The Joint Finance Committee considers financial

risks, including risk opportunities, which are reported to the Governing Body via the

Finance Report and risks are detailed within the Governing Body Assurance

Framework. This process is supported by the CCG’s prime and detailed financial

policies. Matters of concern are reviewed by the Governing Body and assurance

sought. Full copies of the Governing Body papers can be found on the CCG website

here.

The Joint Chief Finance Officer and the Finance Team have worked closely with

managers throughout the year to ensure that a robust annual budget has been

prepared and delivered. All budget managers have a responsibility to manage their

budgets and systems of internal control effectively and efficiently. The processes to

achieve this are examined by internal and external audit as part of their annual

activities, with a focus on the strategic risks and key financial control processes.

https://www.neneccg.nhs.uk/about-us/governing-body-meeting-and-papers.htm

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The CCG also ensures that an annual fraud risk assessment is undertaken by an

independent party, providing key actions. Further detail on the counter fraud

arrangements can be found later in this report.

NHS England has a statutory duty (under the Health and Social Care Act (2012)) to

conduct an annual assessment of every CCG. The CCG’s overall rating for the CCG

Improvement and Assessment Framework (IAF) 2018/19 was rated as good. More

detail can be found in the Performance Report under Chapter 1 of this annual report

and more detail on the individual indicators is available via the NHSE/I website here.

The CCG also works closely with health and social care providers and partners to

achieve financial balance and sustainability across the Northamptonshire health and

social care economy. The CCG works with our regulators and trusts to gain assurance

on processes to address areas of poor performance, the standard NHS contracts used

with providers include detailed financial, activity and quality schedules and require

providers to innovate to improve quality and efficiency. More detail of delivery of key

performance indicators and constitutional standards are detailed within the

Performance Report under Chapter 1 of this annual report.

Delegation of Functions

The CCG undertakes a regular process of review of its internal control mechanisms,

including an annual internal audit plan. All internal audit reports are agreed by senior

officers of the CCG and reviewed by the Audit and Risk Committee.

A review of the effectiveness of the CCG governance structure and processes has

been undertaken during the year, including a review of each Committee’s terms of

reference. This has formed part of the work undertaken to further strengthen the

collaborative working arrangements between the CCGs.

The CCG ensures that where functions are delegated either internally or externally,

that this is done in line with the CCG’s Scheme of Reservation and Delegation, which

sets out the decisions that are the responsibility of the Governing Body and its

Committees, alongside the decisions that are delegated to individual members and

employees.

https://www.england.nhs.uk/commissioning/regulation/ccg-assess/iaf/

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Where functions are formally delegated by the Governing Body to one of its Sub-

committees, this is formally recorded by the Governing Body through the minutes,

which are presented as a true and accurate record of the meeting.

Counter Fraud Arrangements

The Counter Fraud Service for the CCG is provided by RSM UK, who supply a

dedicated Local Counter Fraud Specialist (LCFS) to deliver an on-going programme

of work to counter fraud, bribery and corruption, in line with the national NHS Counter

Fraud Authority (NHSCFA) ‘Standards for Commissioners: Fraud, Bribery and

Corruption’. The programme is designed to ensure our staff are fully aware of the fraud

and bribery risks that the organisation faces and how to report concerns, as well as

ensuring relevant preventative and detection exercises are undertaken to mitigate

those risks. The Joint Chief Finance Officer provides executive leadership and

responsibility for the programme.

During the year, the LCFS has conducted a variety of tasks, ranging from awareness

initiatives as part of the annual ‘Fraud Awareness Month’ campaign in November,

through to undertaking a fraud risk assessment exercise. The Audit and Risk

Committee receives regular progress updates on the delivery of the counter fraud work

plan and an annual report which summarises activity undertaken during the year. The

CCG also completes an annual self-assessment against the NHSCFA Standards, in

order to monitor compliance and address any areas of identified risk during the

forthcoming year.

Head of Internal Audit Opinion

Following completion of the planned audit work for the financial year for the CCG, the

Head of Internal Audit issued an independent and objective opinion on the adequacy

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and effectiveness of the clinical commissioning group’s system of risk management,

governance and internal control.

Head of Internal Audit Opinion

Following completion of the planned audit work for the financial year for the clinical

commissioning group, the Head of Internal Audit issued an independent and objective

opinion on the adequacy and effectiveness of the clinical commissioning group’s

system of risk management, governance and internal control. The Head of Internal

Audit concluded that:

For the 12 months ended 31 March 2020, our head of internal audit opinion

for Nene Clinical Commissioning Group is as follows:

Scope and Limitations of our Work

The formation of our opinion is achieved through a risk-based plan of work, agreed

with management and approved by the audit committee. Our opinion is subject to

inherent limitations, as detailed below:

The opinion does not imply that internal audit has reviewed all risks and

assurances relating to the organisation;

The opinion is substantially derived from the conduct of risk-based plans

generated from a robust and organisation-led assurance framework. As

such, the assurance framework is one component that the board takes

into account in making its annual governance statement (AGS);

The opinion is based on the findings and conclusions from the work

undertaken, the scope of which has been agreed with management

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The opinion is based on the testing we have undertaken, which was

limited to the area being audited, as detailed in the agreed audit scope;

Where strong levels of control have been identified, there are still

instances where these may not always be effective. This may be due to

human error, incorrect management judgement, management override,

controls being by-passed or a reduction in compliance;

Due to the limited scope of our audits, there may be weaknesses in the

control system which we are not aware of, or which were not brought to

attention; and

It remains management's responsibility to develop and maintain a sound

system of risk management, internal control and governance , and for the

prevention and detection of material errors, loss or fraud. The work of

internal audit should not be seen as a substitute for management's

responsibilities around the design and effective operation of these

systems

Factors and Findings, Which Have Informed our Opinion

Factors and findings, which have informed our opinion:

Delivery of the Financial Plan (including QIPP): Whilst our work noted

improvements from the previous years audit in respect of Delivery of the Financial

Plan, the CCG continues to rely heavily on in-year transactional and non-recurrent

savings to balance the financial plan, this results in putting financial pressure on

the following year’s plan.

Personal Health Budgets: Our review found significant weaknesses in the

design of the control framework. This included policies not being actively

communicated, an inadequate process for setting indicative budgets, no process

for the review of risks and the approval of support plans and insufficient resource

for the completion of regular support plan reviews. We also noted instances where

the control framework was not being completed and approval of these forms

outside of agreed limits, a lack of sign off from the CCG of payment

agreements and non-compliance with the financial monitoring process for

individual packages.

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The financial pressure may be being intensified by the weaknesses in design and

compliance of the control framework, particularly with approved funding forms not

being in place for all packages and with ongoing reviews, as well as financial

monitoring of individual packages not routinely taking place. The low level of

compliance of ongoing reviews and individual package-financial monitoring

indicated that there was little opportunity for the CCGs to identify any reduction in

the needs of individuals and to reduce the value of the PHBs accordingly.

The following audits however resulted in a positive assurance opinion, and whilst

some weaknesses in controls were identified within these reviews, and

management actions agreed to address them, these weaknesses do not

significantly impact on the overall effectiveness of the control framework for

these areas:

Resilience – Surge and Escalation Planning

Delivery of the Urgent Care Service

Engagement

Primary Care Development and Engagement

Primary Care Delegated Commissioning

Risk Management and Assurance Framework

Conflict of Interest

Governance

Topics Judged Relevant for Consideration as Part of the Annual Governance

Statement

The CCG should not only consider our overall opinion detailed within the section

above, but also the underlying cause of the opinion, namely the opinions provided

for our Delivery of the Financial Plan and Personal Health Budgets audits. This

should be balanced with the actions that have been taken by the CCG during the

year, and planned for the future, in respect of addressing these weaknesses.

The following assignments have yet to be completed and reported in final and will

also be taken in to consideration when drafting our full end of year head of internal

145


audit opinion. Our opinion may therefore change between now and the year-end

dependent on the findings of these reviews:

Procurement LPF

Delivery of the Better Care Fund

Financial Planning and Commissioning

Annual Opinions

The following shows the full range of opinions available to us within our internal

audit methodology to provide you with context regarding your annual internal

audit opinion.

During the year, internal audit issued the following audit reports:

The factors which are considered when influencing our opinion are:

Inherent risk in the area being audited;

Limitations in the individual audit assignments

The adequacy and effectiveness of the risk management and I or governance

control framework

The impact of weakness identified

The level of risk exposure

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The response to management actions raised and timeliness of actions taken

Area of Audit Level of Assurance

Given

Primary Care Delegated Commissioning – Nene CCG

Substantial

Primary Care Development & Engagement

Substantial

Resilience - Surge and Escalation Planning

Reasonable

Delivery of Urgent Care Services

Reasonable

Personal Health Budgets Partial

Delivery of Financial Plans (including QIPP)

Partial

Engagement Reasonable

Conflict of Interest Reasonable

Governance Substantial

Delivery of the Better Care Fund

Postponed due to Covid-19

Risk Management and Assurance Framework

Reasonable

Financial Planning and Commissioning

No assurance

Approval of Annual Accounts and Annual Report

At the meeting of the Governing Body held on 21 April 2020 the draft annual accounts

and annual report for 2019/20 were received and approved. The Governing Body also

received the updated Letter of Representation and noted that other than the standard

disclosures the CCG were not asked to make any further disclosures

Review of the Effectiveness of Governance, Risk Management and Internal

Control

My review of the effectiveness of the system of internal control is informed by the work

of the internal auditors, executive managers and clinical leads within the clinical

commissioning group, who have responsibility for the development and maintenance

of the internal control framework. I have drawn on performance information available

to me. My review is also informed by comments made by the external auditors in their

annual audit letter and other reports.

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Our assurance framework provides me with evidence that the effectiveness of controls

that manage risks to the CCG achieving its principles objectives have been reviewed.

I have been advised on the implications of the result of this review by:

The Governing Body

The Audit and Risk Committee

Internal audit

Assurance mechanisms including the Governing Body Assurance

Framework (GBAF) and quality assurance processes.

The CCG have developed governance maturity and will continue to do so into 2020/21

following transition to a single CCG for Northamptonshire. The transition programme

undertaken by NHS Corby CCG and NHS Nene CCG has demonstrated the

collaborative approach adopted through the reporting period and reflects the

maturation of governance processes across the organisations. I am satisfied that the

CCG has developed appropriate plans to address weaknesses through the continued

development programme.

Conclusion

As the Accountable Officer, and based on the review processes outlined above, I can

confirm that the Governance Statement is a balanced reflection of the actual control

position within the CCG, apart from those issues raised under the Head of Internal

Audit Opinion.

Toby Sanders Chief Executive NHS Nene CCG

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Remuneration and Staff Report

As a commissioner of health services, we believe health and wellbeing applies as

much to our employees as it does to our local population. During 2019/20, we have

continued to remain fully committed to the health and positive wellbeing of our

employees and understand that the health and wellbeing of the workforce is crucial to

the delivery of the improvements in-patient care of local people.

Remuneration Report

Remuneration Committee

More information about the committee, including attendance, is available on page 119.

Policy on the Remuneration of Senior Managers

NHS Nene CCG’s remuneration policy sets out the organisation’s policy for directors,

senior managers and other staff. Where necessary we follow the recommendations of

the Senior Salaries Review Body on senior managers pay. This includes information

about:

Exit packages, severance packages and off payroll engagements

Compensation on early retirement or for loss of office

Payments to past Directors

Pay multiples

Other staff information (numbers, composition, sickness absence data,

consultancy, etc.)

Staff policies for giving full and fair consideration for the application,

employment and ongoing training/career development of disabled persons.

Remuneration of Very Senior Managers

NHS Nene CCG has established a Remuneration and Terms of Service Committee to

approve the remuneration and terms of service for the executive directors, other staff

on very senior manager (VSM) pay terms and conditions and other appointments to

the Nene CCG Governing Body.

The Committee also approves the pay rates offered to clinicians that work for Nene

149


CCG on a contract for services basis. It was established under the Constitution and

operates within terms of reference approved by our Governing Body.

Senior Manager Remuneration

From April 2018, NHS Nene CCG and NHS Corby CCG undertook to work closer

together culminating in a combined Management Team. To reflect the closer working

arrangements the costs of the senior managers from both CCGs have been crossed

charged on a basis of 89.84% to NHS Nene CCG and 10.16% to NHS Corby CCG.

The figures included in the table below reflect the costs attributable to NHS Nene CCG

with total costs shown in the second table below. The figures included in the tables on

149-151 and 153-155 reflect the costs attributable to NHS Corby CCG with total costs

shown in the tables on pages 152-153 and 155-157.

Salary Entitlements

Name and Title

2019-20 Salary & Allowances (subject to audit)

(a)

Salary

(bands of

£5,000)

(b)

Expense

payments

(taxable)

to nearest

£100**

(c)

Performance

pay and

bonuses

(bands of

£5,000)

(d)

Long term

performance

pay and

bonuses

(bands of

£5,000)

(e)

All pension-

related

benefits

(bands of

£2,500)

(f)

TOTAL

(a to e)

(bands of

£5,000)

£000 £ £000 £000 £000 £000

Azhar Ali - Clinical Executive Director 50 - 55 0 0 0 7.5 - 10 55 - 60

Tina Beardsworth - Interim GP Commissioning & Membership Engagement Executive (April to June 2019) 0 - 5 0 0 0 0 0 - 5

Paul Bevan - Lay Member (until September 2019) 0 - 5 0 0 0 0 0 - 5

Naomi Caldwell - Clinical Executive Director 50 - 55 0 0 0 2.5 - 5 55 - 60

Julie Curtis - Director of Primary & Community Integration

100 - 105 0 0 0 0 100 - 105

Angela Dempsey - Joint Registered Nurse & Quality Officer (until April 2019)

0 - 5 0 0 0 0 0 - 5

Angela Dempsey - Interim Joint Registered

n/a n/a n/a n/a n/a n/a

150


Name and Title


(a)

Salary

(bands of

£5,000)

(b)

Expense

payments

(taxable)

to nearest

£100**

(c)

Performance

pay and

bonuses

(bands of

£5,000)

(d)

Long term

performance

pay and

bonuses

(bands of

£5,000)

(e)

All pension-

related

benefits

(bands of

£2,500)

(f)

TOTAL

(a to e)

(bands of

£5,000)

£000 £ £000 £000 £000 £000

Nurse & Quality Officer (May to mid November 2019) (see Note 1)

Angela Dempsey - Joint Registered Nurse & Quality Officer (from mid November 2019)

40 - 45 0 0 0 2.5 - 5 45 - 50

Emma Donnelly - Clinical Executive Director

50 - 55 0 0 0 0 50 - 55

Anna Dorothy - Interim Director of Transformation Delivery (August to December 2019) (see Note 1)

n/a n/a n/a n/a n/a n/a

Chris Ellis - GP Commissioning & Membership Engagement Executive

25 - 30 0 0 0 0 25 - 30

Devaka Fernando - Joint Secondary Care Doctor

15 - 20 0 0 0 0 15 - 20

Sanjay Gadhia - GP Governing Body Member

50 - 55 0 0 0 0 50 - 55

Alison Gilbert - Director of Transformation Delivery (from December 2019)

35 - 40 0 0 0 0 35 - 40

Andrew Hammond - Lay Member (Joint)

5 - 10 0 0 0 0 5 - 10

Tom Howseman - GP Commissioning & Membership Engagement Executive (until September 2019)

10 - 15 0 0 0 0 10 - 15

Bev Messinger - Lay Member (from September 2019)

5 - 10 0 0 0 0 5 - 10

Kathryn Moody - Director of Contracting & Delivery (until October 2019) (see Note 2)

185 - 190 0 0 0 30 - 32.5 220 - 225

Richard Moore - Lay Member (from September 2019)

5 - 10 0 0 0 0 5 - 10

151


Name and Title


(a)

Salary

(bands of

£5,000)

(b)

Expense

payments

(taxable)

to nearest

£100**

(c)

Performance

pay and

bonuses

(bands of

£5,000)

(d)

Long term

performance

pay and

bonuses

(bands of

£5,000)

(e)

All pension-

related

benefits

(bands of

£2,500)

(f)

TOTAL

(a to e)

(bands of

£5,000)

£000 £ £000 £000 £000 £000

Stuart Rees - Joint Chief Finance Officer

110 - 115 0 0 0 47.5 - 50 160 - 165

Toby Sanders - Joint Chief Executive

130 - 135 0 0 0 0 130 - 135

Darin Seiger - GP Chair 75 - 80 0 0 0 0 75 - 80

Nathan Spencer - GP Governing Body Member

35 - 40 0 0 0 0 35 - 40

Sarah Stansfield - Director of Outcome Based Contracting (from November 2019)

40 - 45 0 0 0 10 - 12.5 55 - 60

Philip Stevens - GP Commissioning & Membership Engagement Executive 20 - 25 0 0 0 0 20 - 25

Kevin Thomas - Lay Member (until September 2019) 5 - 10 0 0 0 0 5 - 10

Sam Turner - Lay Member (from September 2019) 5 - 10 0 0 0 0 5 - 10

Lucy Wightman - Director of Population Health Strategy (from October 2019) (see Note 1) n/a n/a n/a n/a n/a n/a

Caron Williams - Director of Health Strategy & Planning (until August 2019) (see Note 3)

130 - 135 0 0 0 7.5 - 10 140 - 145

**Note: Taxable expenses and benefits in kind are expressed to the nearest £100.

Note 1: The CCGs contracted with RSM Risk Assurance Services LLP to provide an Interim Joint Registered Nurse & Quality

Officer, NHS NEL CSU to provide an Interim Director of Transformation & Delivery and Northamptonshire County Council for a

Director of Population Health Strategy. As such, the CCG does not hold the salary or pension costs for Angela Dempsey (in

the Interim role only), Anna Dorothy or Lucy Wightman.

Note 2: Included within Kathryn Moody's salary costs is redundancy payments. The total included in the above salary figure is

£137,755 for redundancy.

Note 3: Included within Caron William's salary costs is redundancy & in lieu of notice payments. The total included in the

above salary figure is £83,851 for redundancy and £15,706 for in lieu of notice.

152


Name and Title

2019-20 Total Salary & Allowances for Crossed Charged Posts (subject to audit)

(a) Salary

(bands of £5,000)

(b) Expense payments (taxable)

to nearest £100**

(c) Performance

pay and bonuses (bands of £5,000)

(d) Long term

performance pay and bonuses (bands of £5,000)

(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL (a to e)

(bands of £5,000)

£000 £ £000 £000 £000 £000

Azhar Ali - Clinical Executive Director 55 - 60 0 0 0 7.5 - 10 65 - 70

Tina Beardsworth - Interim GP Commissioning & Membership Engagement Executive (April to June 2019) 0 - 5 0 0 0 0 0 - 5

Paul Bevan - Lay Member (until September 2019)

NHS Nene CCG post

only


Julie Curtis - Director of Primary & Community Integration 110 - 15 0 0 0 0 110 - 115

Angela Dempsey - Joint Registered Nurse & Quality Officer (until April 2019) 0 - 5 0 0 0 0 0 - 5

Angela Dempsey - Interim Joint Registered Nurse & Quality Officer (May to mid November 2019) n/a n/a n/a n/a n/a n/a

Angela Dempsey - Joint Registered Nurse & Quality Officer (from mid November 2019) 45 - 50 0 0 0 2.5 - 5 50 - 55

Emma Donnelly - Clinical Executive Director 55 - 60 0 0 0 0 55 - 60

Anna Dorothy - Interim Director of Transformation Delivery (August to December 2019) n/a n/a n/a n/a n/a n/a

Chris Ellis - GP Commissioning & Membership Engagement Executive 25 - 30 0 0 0 0 25 - 30

Devaka Fernando - Joint Secondary Care Doctor 20 - 25 0 0 0 0 20 - 25

Sanjay Gadhia - GP Governing Body Member 55 - 60 0 0 0 0 55 - 60

Alison Gilbert - Director of Transformation Delivery (from December 2019) 35 - 40 0 0 0 0 35 - 40

Andrew Hammond - Lay Member (Joint) 5 - 10 0 0 0 0 5 - 10

Tom Howseman - GP Commissioning & Membership Engagement Executive (until September 2019) 10 - 15 0 0 0 0 10 - 15

Bev Messinger - Lay Member (from September 2019) 0 - 5 0 0 0 0 5 - 10

Kathryn Moody - Director of Contracting & Delivery (until October 2019) (see Note 1) 210 - 215 0 0 0 32.5 - 35 240 - 245

153


Name and Title

2019-20 Total Salary & Allowances for Crossed Charged Posts (subject to audit)

(a) Salary

(bands of £5,000)


to nearest £100**

(c) Performance


(d) Long term


(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL (a to e)

(bands of £5,000)

£000 £ £000 £000 £000 £000

Richard Moore - Lay Member (from September 2019) 5 - 10 0 0 0 0 5 - 10

Stuart Rees - Joint Chief Finance Officer 125 - 130 0 0 0 52.5 - 55 175 - 180

Toby Sanders - Joint Chief Executive 145 - 150 0 0 0 0 145 - 150

Darin Seiger - GP Chair

NHS Nene CCG post

only

Nathan Spencer - GP Governing Body Member 40 - 45 0 0 0 0 40 - 45

Sarah Stansfield - Director of Outcome Based Contracting (from November 2019) 45 - 50 0 0 0 12.5 - 15 60 - 65


Kevin Thomas - Lay Member (until September 2019)

NHS Nene CCG post

only

Sam Turner - Lay Member (from September 2019) 5 - 10 0 0 0 0 5 - 10

Lucy Wightman - Director of Population Health Strategy (from October 2019) n/a n/a n/a 0 n/a n/a

Caron Williams - Director of Health Strategy & Planning (until August 2019) (see Note 2) 145 - 150 0 0 0 10 - 12.5 155 - 160

Note 1: Included within Kathryn Moody's salary costs is redundancy payments. The total included in the above salary figure is £153,333 for redundancy.

Note 2: Included within Caron William's salary costs is redundancy & in lieu of notice payments. The total included in the above salary figure is £93,333 for redundancy and £17,483 for in lieu of notice.

Name and Title

2018/19 Salary & Allowances (subject to audit)

(a) Salary

(bands of £5,000)


to nearest £100**

(c) Performance


(d) Long term


(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL (a to e)

(bands of £5,000)

£000 £ £000 £000 £000 £000

Azhar Ali - Clinical Executive Director

50 - 51 0 0 0 5 - 7.5 55 - 60

Paul Bevan - Lay Member 10 - 15 0 0 0 0 10 - 15

Naomi Caldwell - Clinical Executive Director

55 - 60 0 0 0 57.5 - 60 115 - 120

154


Name and Title


(a) Salary

(bands of £5,000)


to nearest £100**

(c) Performance


(d) Long term


(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL (a to e)

(bands of £5,000)

£000 £ £000 £000 £000 £000

Julie Curtis - Director of Primary & Community Integration (started Jan 2019)

20 - 25 0 0 0 0 20 - 25

Carole Dehghani - Interim Accountable Officer (up to Sept 2018) (See Note 1)

140 - 145 0 0 0 0 140 - 145

Angela Dempsey - Joint Registered Nurse (started Nov 2018)

0 - 5 0 0 0 0 0 - 5


50 - 55 0 0 0 65 - 67.5 115 - 120

Matthew Davies - Medical Director (up to Mar 2019)

45 - 50 0 0 0 40 - 42.5 90 - 95

Christoper Ellis - GP Commissioning & Membership Engagement Executive

25 - 30 0 0 0 0 25 - 30

Devaka Fernando - Secondary Care Doctor (started Oct 2018)

5 - 10 0 0 0 0 5 - 10

Charlotte Fry - Director of Primary Care Transformation (up to Sept 2018)

30 - 35 0 0 0 0 30 - 35

Sanjay Gadhia - GP Member

50 - 55 0 0 0 0 50 - 55

Sebastian Hendricks - Secondary Care Doctor (up to Aug 2018)

5 - 10 0 0 0 0 5 - 10

Roz Horton - Lay Member (up to Dec 2018)

5 - 10 0 0 0 0 5 - 10

Tom Howseman - GP Commissioning & Membership Engagement Executive

25 - 30 0 0 0 0 25 - 30

Alison Hulme - Registered Nurse (up to July 2018)

0 - 5 0 0 0 0 0 - 5

Alison Kemp - Director of Partnerships, People & Integration (up to Sept 2018)

35 - 40

0

0

0

0

35 - 40

Kathryn Moody - Director of Contracting & Delivery

95 - 100 0 0 0 15 - 17.5 110 - 115

Stuart Rees - Joint Chief Finance Officer (See Note 2)

105 - 110 0 0 0 50 - 52.5 155 - 160

155


Name and Title


(a) Salary

(bands of £5,000)


to nearest £100**

(c) Performance


(d) Long term


(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL (a to e)

(bands of £5,000)

£000 £ £000 £000 £000 £000

Toby Sanders - Joint Chief Executive (started Nov 2018)

55 - 60 0 0 0 0 55 - 60

Darin Seiger - GP Chair 90 - 95 0 0 0 0 90 - 95

Nathan Spencer - GP Member

35 - 40 0 0 0 0 35 - 40

Philip Stevens - GP Commissioning & Membership Engagement Executive

25 - 30 0 0 0 0 25 - 30

Kevin Thomas - Lay Member

15 - 20 0 0 0 0 15 - 20

Caron Williams - Director of Health, Stategy and Planning

85 - 90 0 0 0 22.5 - 25 110 - 115

Name and Title

2018/19 Salary & Allowances for Crossed Charged Posts (subject to audit)

(a) Salary

(bands of £5,000)


to nearest £100**

(c) Performance


(d) Long term


(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL (a to e)

(bands of £5,000)

£000 £ £000 £000 £000 £000

Azhar Ali - Clinical Executive Director 55 - 60 0 0 0 5 - 7.5 60 - 65

Paul Bevan - Lay Member

NHS Nene CCG post

only


Julie Curtis - Director of Primary & Community Integration (started Jan 2019) 20 - 25 0 0 0 0 20 - 25

Carole Dehghani - Interim Accountable Officer (up to Sept 2018) (See Note 1) 155 - 160 0 0 0 0 155 - 160

Angela Dempsey - Joint Registered Nurse (started Nov 2018) 5 - 10 0 0 0 0 5 - 10

Emma Donnelly - Clinical Executive Director 55 - 60 0 0 0 72.5 - 75 130 - 135

Matthew Davies - Medical Director (up to Mar 2019) 55 - 60 0 0 0 42.5 - 45 100 - 105

25 - 30 0 0 0 0 25 - 30

156


Name and Title

2018/19 Salary & Allowances for Crossed Charged Posts (subject to audit)

(a) Salary

(bands of £5,000)


to nearest £100**

(c) Performance


(d) Long term


(e) All pension-

related benefits

(bands of £2,500)

(f) TOTAL (a to e)

(bands of £5,000)

£000 £ £000 £000 £000 £000

Christoper Ellis - GP Commissioning & Membership Engagement Executive

Devaka Fernando - Secondary Care Doctor (started Oct 2018) 5 -10 0 0 0 0 5 - 10

Charlotte Fry - Director of Primary Care Transformation (up to Sept 2018) 35 - 40 0 0 0 0 35 - 40

Sanjay Gadhia - GP Member 55 - 60 0 0 0 0 55 - 60

Sebastian Hendricks - Secondary Care Doctor (up to Aug 2018) 5 - 10 0 0 0 0 5 - 10


NHS Nene CCG post

only

Tom Howseman - GP Commissioning & Membership Engagement Executive 25 - 30 0 0 0 0 25 - 30

Alison Hulme - Registered Nurse (up to July 2018) 0 - 5 0 0 0 0 0 - 5

Alison Kemp - Director of Partnerships, People & Integration (up to Sept 2018) 40 - 45 0 0 0 0 40 - 45

Kathryn Moody - Director of Contracting & Delivery 105 - 110 0 0 0 17.5 - 20 125 - 130

Stuart Rees - Joint Chief Finance Officer 115 - 120 0 0 0 55 - 57.5 175 - 180

Toby Sanders - Joint Chief Executive (started Nov 2018) 60 - 65 0 0 0 0 60 - 65


NHS Nene CCG post

only

Nathan Spencer - GP Member 40 - 45 0 0 0 0 40 - 45



NHS Nene CCG post

only

Caron Williams - Director of Health, Stategy and Planning 95 - 100 0 0 0 27.5 - 30 120 - 125

157


Note 1: Included within Carole Dehgahni's salary costs is redundancy & in lieu of notice payments. The total included in the above salary figure is £48,769 for redundancy and £42,500 for in lieu of notice.

Pension Benefits as at 31 March 2020

2019-20 Pension Benefits (subject to audit)

Name and Title (a)

Real increase in pension at

pension age

(bands of £2,500)

(b)

Real increase in

pension lump sum at pension age

(bands of £2,500)

(c)

Total accrued

pension at pension age at 31 March

2020

(bands of £5,000)

(d)

Lump sum at pension age

related to accrued

pension at 31 March

2020

(bands of £5,000

(e)

Cash Equivalent Transfer

Value at 1 April 2019

(f)

Real Increase in


Value

(g)


Value at 31 March 2020

(h)

Employers Contribution

to partnership

pension

£000 £000 £000 £000 £000 £000 £000 £000

Azhar Ali - Clinical Executive Director 0 - 2.5 0 15 - 20 30 - 35 240 5 259 0

Tina Beardsworth - Interim GP Commissioning & Membership Engagement Executive (April to June 2019)

Non pensionable

Paul Bevan - Lay Member (until September 2019)

Non pensionable

Naomi Caldwell - Clinical Executive Director 0 - 2.5 0 20 - 25 50 - 55 351 5 372 0

Julie Curtis - Director of Primary & Community

Integration Opted out

Angela Dempsey - Joint Registered Nurse & Quality Officer (until April 2019)

Non pensionable

Angela Dempsey - Interim Joint Registered Nurse & Quality Officer (May to mid November 2019) n/a

Angela Dempsey - Joint Registered Nurse & Quality Officer (from mid November 2019) 0 - 2.5 0 10 - 15 30 - 35 228 0 251 0

158



0

0

0

0

0

0

0

0

Anna Dorothy - Interim Director of Transformation Delivery (August to December 2019) n/a

Chris Ellis - GP Commissioning & Membership Engagement Executive

Non pensionable

Devaka Fernando - Joint Secondary Care Doctor

Non pensionable

Sanjay Gadhia - GP Governing Body Member

Non pensionable

Alison Gilbert - Director of Transformation Delivery (from December 2019) Opted out

Andrew Hammond - Lay Member (Joint)

Non pensionable

Tom Howseman - GP Commissioning & Membership Engagement Executive (until September 2019)

Non pensionable

Bev Messinger - Lay Member (from September 2019)

Non pensionable

Kathryn Moody - Director of Contracting & Delivery (until October 2019) 0 - 2.5 0 30 - 35 70 - 75 512 28 559 0

Richard Moore - Lay Member (from September 2019)

Non pensionable

Stuart Rees - Joint Chief Finance Officer 2.5 - 5 2.5 – 5 40 - 45 90 - 95 703 51 789 0

Toby Sanders - Joint Chief Executive Opted out

159



Non pensionable

Nathan Spencer - GP Governing Body Member

Non pensionable

Sarah Stansfield - Director of Outcome Based Contracting (from November 2019) 0 - 2.5 0 20 - 25 0 181 1 206 0


Non pensionable

Kevin Thomas - Lay Member (until September 2019)

Non pensionable

Sam Turner - Lay Member (from September 2019)

Non pensionable

Lucy Wightman - Director of Population Health Strategy (from October 2019) n/a

Caron Williams - Director of Health Strategy & Planning (until August 2019) 0-2.5 0 15-20 0 205 11 226 0

2018/19 Pension Benefits (subject to audit)

Name and Title (a)

Real increase in pension at

pension age

(bands of £2,500)

(b)

Real increase in

pension lump sum at pension age

(bands of £2,500)

(c)

Total accrued

pension at pension age at 31 March

2019

(bands of £5,000)

(d)

Lump sum at pension age

related to accrued

pension at 31 March

2019

(bands of £5,000

(e)


Value at 1 April 2018

(f)

Real Increase in


Value

(g)


Value at 31 March 2019

(h)

Employers Contribution

to partnership

pension

£000 £000 £000 £000 £000 £000 £000 £000

Azhar Ali - Clinical Executive Director 0 - 2.5 0 10 - 15 30 - 35 198 28 240 0

Paul Bevan - Lay Member

Non Pensionable

Naomi Caldwell - Clinical Executive Director 2.5 - 5 7.5 – 10 15 - 20 50 - 55 248 85 351 0

Julie Curtis - Director of Primary & Community Integration (started Jan 2019) Opted Out

160


Carole Dehghani - Interim Accountable Officer (up to Sept 2018) 0 - 2.5 0 - 2.5 40 - 45 125 - 130 n/a n/a n/a 0

Angela Dempsey - Joint Registered Nurse (started Nov 2018)

Non Pensionable

Emma Donnelly - Clinical Executive Director 2.5 - 5 5 - 7.5 15 - 20 30 - 35 178 79 271 0

Matthew Davies - Medical Director (up to Mar 2019) 0 - 2.5 5 - 7.5 10 - 15 35 - 40 212 65 297 0

Christopher Ellis - GP Commissioning & Membership Engagement Executive

Non Pensionable

Devaka Fernando - Secondary Care Doctor (started Oct 2018)

Non Pensionable

Charlotte Fry - Director of Primary Care Transformation (up to Sept 2018) 0 0 25 - 30 65 - 70 461 18 528 0

Sanjay Gadhia - GP Member

Non Pensionable

Sebastian Hendricks - Secondary Care Doctor (up to Aug 2018)

Non Pensionable


Non Pensionable

Tom Howseman - GP Commissioning & Membership Engagement Executive

Non Pensionable

Alison Hulme - Registered Nurse (up to July 2018)

Non Pensionable

Alison Kemp - Director of Partnerships, People & Integration (up to Sept 2018) 0 0 15 - 20 30 - 35 284 0 251 0

Kathryn Moody - Director of Contracting & Delivery 0 - 2.5 0 - 2.5 30 - 35 70 - 75 415 70 512 0

Stuart Rees - Joint Chief Finance Officer 2.5 - 5 2.5 – 5 35 - 40 85 - 90 556 114 703 0

Toby Sanders - Joint Chief Executive (started Nov 2018) Opted Out


Non Pensionable

161


Nathan Spencer - GP Member

Non Pensionable


Non Pensionable


Non Pensionable

Caron Williams - Director of Health, Stategy and Planning 0 - 2.5 0 10 - 15 0 151 36 205 0

Cash Equivalent Transfer Values

A cash equivalent transfer value (CETV) is the actuarially assessed capital value of

the pension scheme benefits accrued by a member at a particular point in time. The

benefits valued are the member’s accrued benefits and any contingent spouse’s (or

other allowable beneficiary’s) pension payable from the scheme.

A CETV is a payment made by a pension scheme or arrangement to secure pension

benefits in another pension scheme or arrangement when the member leaves a

scheme and chooses to transfer the benefits accrued in their former scheme. The

pension figures shown relate to the benefits that the individual has accrued as a

consequence of their total membership of the pension scheme, not just their service

in a senior capacity to which disclosure applies.

The CETV figures and the other pension details include the value of any pension

benefits in another scheme or arrangement, which the individual has transferred to the

NHS pension scheme. They also include any additional pension benefit accrued to the

member as a result of their purchasing additional years of pension service in the

scheme at their own cost. CETVs are calculated within the guidelines and framework

prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETV

This reflects the increase in CETV that is funded by the employer. It does not include

the increase in accrued pension due to inflation or contributions paid by the employee

(including the value of any benefits transferred from another scheme or arrangement).

Compensation on Early Retirement of for Loss of Office (Subject to audit)

There were no compensation payments for early retirement. Please refer to the 2019-

20 Total Salary and Allowances on page 149-151 for compensation payments for loss

162


of office as the details are disclosed at the end of the table.

Payments to Past Members (Subject to audit)

There were no payments to past members.

Pay Multiples (Subject to audit)

Reporting bodies are required to disclose the relationship between the remuneration

of the highest-paid director/member in their organisation and the median

remuneration of the organisation’s workforce.

The banded remuneration of the highest paid member of the Governing Body in Nene

CCG in the financial year 2019/20 was £127,500 (2018/19: £117,500). This was 2.84

times (2018/19: 2.35) the median remuneration of the workforce, which was £44,962

(2018/19: £49,969).

In 2019/20, no employee received remuneration in excess of the highest-paid

director/member. Remuneration ranged from £1,246 to £120,000 (2018/19: £585 to

£110,000).

Total remuneration includes salary, non-consolidated performance-related pay,

benefits-in-kind, but not severance payments. It does not include employer pension

contributions and the cash equivalent transfer value of pensions.

The year on year movement is due to the creation of a single management team

across NHS Nene CCG and NHS Corby CCG and the alignment of the staffing

establishment in readiness for the establishment of a single CCG (NHS

Northamptonshire CCG) on 1 April 2020.

163


Staff Report

Number of Senior Managers

On 31st March 2020, Corby CCG had one Senior Manager at VSM grade and Nene

CCG had five Senior Managers at a VSM grade. Please note the VSM roles are joint

positions across Nene and Corby CCGs.

Staff Numbers and Costs (subject to audit)

*Senior Managers = 8c and above including VSM

As at 31 March 2020 the distribution of Nene CCG’s staffs as per the NHS Digital NHS

Occupational Code Manual is as follows. This table is subject to audit.

Total

The Governing Body Total Members 17

Male Members 71%

Female Members 29%

Senior Managers (including all managers at Grade VSM but not including the Governing Body) 25

Male Members 36%

Female Members 64%

All other employees not included in the other two categories Total 113

Male Members 20%

Female Members 80%

Employee

Group Band 3 Band 4 Band 5 Band 6 Band 7 Band 8A Band 8B Band 8C Band 8D Band 9Ad Hoc

SalaryVSM

GB Members Medical and Dental 1 1

Administrative and Clerical 4 4

Medical and Dental 1 1

Clinical Lead Medical and Dental 11 11

Add Prof Scientific and Technic 11 5 8 24

Administrative and Clerical 2 8 12 8 16 17 11 11 7 5 97

Nursing and Midwifery Registered 3 9 3 1 1 17

2 8 12 22 25 22 22 12 8 0 17 5 155

Staff Group

Staff Banding

Total

Office Holder

Substantive

Grand Total

164


Staff Costs (subject to audit)

2019-20 2018-19

Total Total

Permanent Employees Other Total

Permanent Employees Other Total

£'000 £'000 £'000 £'000 £'000 £'000

Salaries and wages 6,566 431 6,998 6,006 522 6,528

Social security costs 723 8 731 669 7 676

Employer contributions to the NHS Pensions Scheme 1,145 6 1,151 777 9 786

Apprenticeship Levy 18 0 18 16 0 16

Termination benefits 307 0 307 0 0 0

Gross employee benefits expenditure 8,760 445 9,205 7,468 537 8,005

Less: recoveries in respect of employee benefits (87) 0 (87) (162) 0 (162)

Net employee benefits expenditure including capitalised costs 8,673 445 9,118 7,306 537 7,843

Less: employee costs capitalised 0 0 0 0 0 0

Net employee benefits expenditure excluding capitalised costs 8,673 445 9,118 7,306 537 7,843

Sickness Absence Data

Month Long Term Absence FTE % Short Term Absence FTE %

2019 / 04 2.38% 1.45%

2019 / 05 2.22% 0.49%

2019 / 06 2.65% 0.83%

2019 / 07 2.87% 0.48%

2019 / 08 3.25% 0.28%

2019 / 09 2.27% 1.70%

2019 / 10 1.55% 1.58%

2019 / 11 2.78% 1.57%

2019 / 12 2.35% 1.26%

2020 / 01 1.92% 2.13%

2020 / 02 3.34% 0.84%

2020 / 03 3.44% 0.00%

165


Staff Policies

Positive about Disability in the Workplace

As an employer, NHS Nene CCG demonstrates a positive

commitment to disabled employees and continues to be a

recognised Disability Confident Employer. This is an annual

accreditation given by the Department for Work and

Pensions that provides assurance the CCG welcomes applications from disabled

people, and existing staff who have disabilities will have their Reasonable Adjustments

reviewed and assessed.

NHS Workforce Race Equality Standard (WRES)

In line with NHS England guidance we have continued to implement the NHS WRES

and have published our findings on WRES Action Plan for the year which can be

found on our website. In accordance with the WRES requirements for 2019, the CCG

has submitted detailed Workforce data to the Strategic Data Collection Service

(SDCS) – NHS Digital, to enable further development of the CCG’s WRES Action Plan

aligned to workforce ambitions of the Interim NHS People Plan and the Long Term

Plan. The CCG also continued to have ‘Due Regard’ to the principles of WRES in

terms of its workforce and through proactive arrangements with our Providers as

holders of the NHS Standard Contract.

Using the WRES indicators as a basis, we will report on progress with regard to WRES

and closing the gaps and differences of treatment, experiences and outcomes of White

and Black and Minority Ethnic (BME) staff. NHS Nene CCG will continue to work with

NHS Provider organisations to seek assurance of effective implementation of WRES

and progress against action plans.

NHS Workforce Disability Equality Standard (WDES)

The CCG has begun initial oversight of our provider organisations to gain assurance

for implementation of the NHS Workforce Disability Equality Standard (WDES). The

WDES is a set of specific measures (metrics) that will enable NHS organisations to

compare the experiences of disabled and non-disabled staff, making a difference for

disabled staff.

https://www.gov.uk/government/collections/disability-confident-campaign

https://www.neneccg.nhs.uk/downloads/about-us/quality/equality/WRES%20Report%202018-19%20and%20Action%20Plan%20NENE%20CORBY%20CCGs%20FINAL%2003.10.19.pdf

https://improvement.nhs.uk/resources/interim-nhs-people-plan/



https://www.england.nhs.uk/about/equality/equality-hub/wdes/

166


The WDES is important because research shows that a motivated, included and

valued workforce helps to deliver high quality patient care, increased patient

satisfaction and improved patient safety.

The implementation of the WDES will enable NHS Trusts and Foundation Trusts to

better understand the experiences of their disabled staff. Within our local providers,

we will continue to review to gain assurance that gaps between the experiences of

disabled and non-disabled staff are being closed.

Implementation of the WDES will support positive change for existing employees and

enable a more inclusive environment for disabled people working in the NHS. Like the

Workforce Race Equality Standard (WRES) on which the WDES is in part modelled,

will also allow us to identify good practice and compare performance.

Freedom to Speak Up Arrangements

The CCG has introduced a new Freedom to Speak Up Policy during 2019/2020

(formerly known as a Whistleblowing Policy). As part of this revised policy a Speak Up

Guardian has been appointed, which is Richard Moore, the Risk and Audit Chair. This

is an important role identified in the Freedom to Speak Up review to act as an

independent and impartial source of advice to staff at any stage of raising a concern,

with access to anyone in the organisation, including the Chief Executive, or if

necessary, outside the organisation.

To date there have been no reports from staff under this policy.

The Trade Union (Facility Time Publication Requirements) Regulations 2017

Under the Trade Union (Facility Time Publication Requirements) regulations 2017,

Nene CCG is required to publish the following information as laid out in Schedule 2 of

the regulations:

Number of employees who were relevant union officials during the relevant period

Full-time equivalent employee number

None Nil

167


Percentage of time spent on facility time

Number of employees

0% 0

1%-50% 0

51%-99% 0

100% 0

Percentage of pay bill spent on facility time Figures

The total cost of facility time £0

The total pay bill £0

The total pay bill spent on facility time, calculated as: (total cost of facility time ÷ total pay bill) x 100

0%

Time spent on paid trade union activities as a percentage of total paid facility time hours calculated as: (total hours spent on paid trade union activities by relevant union officials during the relevant period ÷ total paid facility time hours) x 100

0

Other Employee Matters

Staff Engagement

Nene CCG engages with its staff to ensure continuous consultation and engagement

on changes that will affect them. These include:

Monthly formal staff briefings led by the Chief Executive including a regular

briefing from the GP Chair and recent Governing Body meetings

A Workforce Committee chaired by a Governing Body Member

A new staff intranet – the aim of this site is to provide staff with access to regular

and detailed information such as policies, supporting documents and toolkits

alongside a platform to share best practice and good news stories.

Staff Forum

The Staff Forum was set up in April 2017 for the

benefit of all staff of Nene and Corby CCGs, NEL

CSU and all other embedded staff, and meets

regularly to raise issues affecting all staff. During

this time, the forum has organised a number of

events for staff including Health and Wellbeing

events and fun events.

168


During 2019/20, the forum has changed direction to focus on staff health and

wellbeing, while still being a conduit between staff and the executive team. Several

areas of wellbeing have been looked at including working with Northants Carers to

improve conditions for working carers, the setup of the ‘Thrive’ garden and the

production of a volunteering policy.

For 2020/21, the focus will be to continue to push improving staff wellbeing and

development with the introduction of Healthy Workplace Standards and supporting

individuals and teams with fund raising and awareness

Case Study: Gardening Club

Pete Watson, Chair of the Gardening Club said: “I got into gardening a few years ago

when I moved into a home that had a jungle out the back. Since then I have struck up

conversations with several colleagues about gardening, most of whom know a lot more

than I do. I enjoy the satisfaction of improving an area and learning new things all the

time through gardening. When I started I naively, thought I could buy a few books and

learn all there is to know in a few months, how wrong I was! There is no substitute for

learning from fellow gardeners.

“From talking to various colleagues I could see

there was actually quite a few people who shared

my interest. Then one day it occurred to me, we

have the ‘Thrive’ garden out the back of Francis

Crick House, that was a little neglected - why do

not we get together and do something to freshen

up. I spoke to people and they were keen on

getting people together to share a common

interest, knowledge and tips and cuttings and

seedlings.

“We collected feedback from people before we started as I wanted people to feel that

they could input into it and I didn’t want it to feel like a formal ‘club’ as such. Just an

opportunity for people who shared a common interest, or who wanted to learn more

about gardening to spend some time together, whilst at the same time improving the

environment around Francis Crick House.

169


“We thought that it would be a good opportunity to do something to promote health

and wellbeing in the workplace. From the physical aspect of digging and working in

the garden, to the mental wellbeing aspect of growing plants, improving the

environment and promoting nature. Gardening is a good way of connecting people

from the different teams and organisations at Francis Crick House, everybody is

welcome.

“We were a bit limited starting it in the autumn, but we’ve been able to plant bulbs for

the spring. The sessions were great; it was nice to see people taking a bit of time out

of their busy days to work with each other in the garden, with people passing on their

tips for successful bulb planting.

“We are looking at having a “Francis Crick Gardener’s Question Time” over the winter

where some of the more experienced members can help out colleagues with their

gardening knowledge. We will be working at planning over the next few months so that

when the weather (hopefully) improves we can really hit the ground running!”

National Staff Survey

The staff survey was made available to employees of NHS Corby CCG and NHS Nene

CCG to complete in November 2019. This is the second joint staff survey for the

CCGs.

77 per cent of staff completed the survey for 2019 compared to 73 per cent for 2018;

the national average for 2019 was 80 per cent.

The 2019 Survey highlighted the following key areas for improvements:

Appraisals

Training & Development

Communication

Talent Management

Health and Wellbeing

Senior Management Communications and Staff Engagement

Staff Turnover

Turnover is a useful barometer of employee engagement and resilience, with higher

levels of turnover potentially suggesting lower levels of engagement. The 12 month

170


rolling turnover rate is 12.40%.

Health and Safety

The health and safety of our staff is fundamental to the delivery of our vision and

objectives. To ensure that the CCG has the appropriate level of expertise in this area,

the role of Competent Person for Health and Safety is undertaken internally by the

CCG’s Governance and Risk Manager who holds the National Council for Risk

Qualifications (NCRQ) Certificate in Applied Health and Safety.

The annual health and safety audit in July 2019 was conducted successfully, with no

areas requiring action. One health and safety incident was reported in 2019/20, it was

not reportable under RIDDOR (the Reporting of Injuries, Diseases and Dangerous

Occurrences Regulations 2013).

The latter part of the year was subject to major changes in our ways of working due to

the Covid-19 outbreak but this did not result in any additional incidents and the CCG

remains a low risk work environment.

Expenditure on Consultancy

A total of £1,001,000 was spent on consultancy in 2019-20 for a number of specific

projects including GP Forward View and Sustainability Transformation Programme

support.

Off-Payroll Engagements

Table 1: Off-Payroll Engagements Longer than Six Months

For all off-payroll engagements as at 31 March 2020 for more than £245 per day and

that last longer than six months:

Number

Number of existing engagements as of 31 March 2020 1

Of which, the number that have existed:

for less than one year at the time of reporting 1

for between one and two years at the time of reporting

for between 2 and 3 years at the time of reporting

for between 3 and 4 years at the time of reporting

for 4 or more years at the time of reporting

171


All existing off-payroll engagements have at some point been subject to a risk based

assessment as to whether assurance is required that the individual is paying the

right amount of tax and, where necessary, that assurance has been sought.

Table 2: New Off-Payroll Engagements

Where the reformed public sector rules apply, entities must complete Table 2 for all

new off-payroll engagements, or those that reached six months in duration, between

1 April 2019 and 31 March 2020, for more than £245 per day and that last for longer

than 6 months:

Number

Number of new engagements, or those that reached six months in

duration, between 1 April 2019 and 31 March 2020 1

Of which:

Number assessed as caught by IR35

Number assessed as not caught by IR35 1

Number engaged directly (via PSC contracted to department) and are

on the departmental payroll

Number of engagements reassessed for consistency / assurance

purposes during the year 1

Number of engagements that saw a change to IR35 status following

the consistency review

172


Table 3: Off-Payroll Engagements/Senior Official Engagements

For any off-payroll engagements of Board members and/or senior officials with

significant financial responsibility, between 01 April 2019 and 31 March 2020:

Number of off-payroll engagements of board members, and/or

senior officers with significant financial responsibility, during the

financial year (1)

0

Total no. of individuals on payroll and off-payroll that have been

deemed “board members, and/or, senior officials with significant

financial responsibility”, during the financial year. This figure should

include both on payroll and off-payroll engagements (2)

0

Note

(1) There should only be a very small number of off-payroll engagements of board

members and/or senior officials with significant financial responsibility,

permitted only in exceptional circumstances and for no more than six months

(2) As both on payroll and off-payroll engagements are included in the total figure,

no entries here should be blank or zero.

In any cases where individuals are included within the first row of this table the

department should set out:

Details of the exceptional circumstances that led to each of these arrangements

Details of the length of time each of these exceptional engagements lasted.

173


Exit Packages, Including Special (Non-Contractual) Payments

Table 1: Exit Packages (subject to audit)

2019-20 2018-19 Exit package

cost band (inc. any special

payment element

Number of compulsory

redundancies

Cost of compulsory

redundancies

Number of other

departures agreed

Cost of other departures

agreed

Total number of exit

packages

Total cost of exit packages

Number of departures

where special payments have

been made

Cost of special payment element

included in exit packages

Total

Number £s Number £s Number £s Number £s Number £s

Less than £10,000

0 0 0 0 0 0 0 0 0 0

£10,000 - £25,000

0 0 0 0 0 0 0 0 0 0

£25,001 - £50,000

0 0 1 27,500 1 27,500 0 0 0 0

£50,001 - £100,000

0 0 0 0 0 0 0 0 0 0

£100,001 - £150,000

0 0 0 0 0 0 0 0 0 0

£150,001 –£200,000

2 306,667 0 0 2 306,667 0 0 0 0

>£200,000 0 0 0 0 0 0 0 0 0 0

TOTALS 2 306,667 1 27,500 3 334,167 0 0 0 0

Redundancy and other departure cost have been paid in accordance with the provisions of NHS Pensions Scheme. Exit costs in this note are accounted for in

full in the year of departure. Where the Nene CCG has agreed early retirements, the additional costs are met by the Nene CCG and not by the NHS Pensions

Scheme. Ill-health retirement costs are met by the NHS Pensions Scheme and are not included in the table.


174


Table 2: Analysis of Other Departures (subject to audit)

2019-20 2018-19

Agreements Total Value of agreements

Agreements Total Value of agreements

Number £000s Number £000s

Voluntary redundancies including early retirement contractual costs

0 0 0 0

Mutually agreed resignations (MARS) contractual costs

0 0 0 0

Early retirements in the efficiency of the service contractual costs

0 0 0 0

Contractual payments in lieu of notice*

1 27,500 0 0

Exit payments following Employment Tribunals or court orders

0 0 0 0

Non-contractual payments requiring HMT approval**

0 0 0 0

TOTAL 1 27,500 0 0

As a single exit package can be made up of several components each of which will be counted

separately in this Note, the total number above will not necessarily match the total numbers in Table 1

which will be the number of individuals.

*any non-contractual payments in lieu of notice are disclosed under “non-contracted payments

requiring HMT approval” below.

**includes any non-contractual severance payment made following judicial mediation, and 0 (list

amounts) relating to non-contractual payments in lieu of notice.

0 non-contractual payments (£0,000) were made to individuals where the payment value was more

than 12 months’ of their annual salary.

The Remuneration Report includes disclosure of exit packages payable to individuals named in that

Report.


175


Parliamentary Accountability and Audit Report

Nene CCG is not required to produce a Parliamentary Accountability and Audit Report.

Disclosures on remote contingent liabilities, losses and special payments, gifts, and

fees and charges are included as notes in the Financial Statements of this report at

and audit certificate and report is also included in this Annual Report.


176


ANNUAL ACCOUNTS

Toby Sanders


17th June 2020

2019-20

Annual AccountsNHS Nene CCG

177

2019-20 2018-19

Note £'000 £'000

Income from Sale of Goods and Services 2 (15,592) (10,797)

Other Operating Income 2 (1,128) (1,415)

Total Operating Income (16,720) (12,212)

Staff Costs 4 9,205 8,005

Purchase of Goods and Services 5 892,467 832,232

Depreciation and Impairment Charges 5 97 131

Provision Expense 5 0 0

Other Operating Expenditure 5 196 137

Total Operating Expenditure 901,966 840,505

Net Operating Expenditure 885,246 828,293

Financing 0 0

Net Gain/(Loss) on Transfer by Absorption 0 0

Other Comprehensive Expenditure 0 0

Comprehensive Expenditure for the Year Ending 31 March 2020 885,246 828,293

Statement of Comprehensive Net Expenditure

Year Ending 31 March 2020

178

2019-20 2018-19

Note £'000 £'000

Non-Current Assets

Property, plant & equipment 8 0 97

Total Non-Current Assets 0 97

Current Assets

Trade & other receivables 9 6,107 13,227

Cash & cash equivalents 10 2,159 0

Total Current Assets 8,266 13,227

Total Assets 8,266 13,325

Current Liabilities

Trade & other payables 11 (77,947) (87,384)

Borrowings 12 0 (1,063)

Total Current Liabilities (77,947) (88,448)

Total Assets less Current Liabilities (69,681) (75,123)

Non-Current Liabilities

Trade & other payables 11 0 0

Borrowings 12 0 0

Total Non-Current Liabilities 0 0

Total Assets Employed (69,681) (75,123)

Financed by Taxpayers' Equity

General fund (69,681) (75,123)

Revaluation reserve 0 0

Other reserves 0 0

Total Taxpayers' Equity (69,681) (75,123)

The notes on pages 182 to 211 form part of this statement.

Toby Sanders

Chief Executive

Statement of Financial Position


The financial statements on pages 178 to 181 were approved on 19 May 2020 by the Governing Body and signed on its

behalf by:

179

2019-20 General Fund

Revaluation

Reserve

Other

Reserves Total

£'000 £'000 £'000 £'000

Balance at 1 April 2019 (75,123) 0 0 (75,123)

Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0

Adjusted Balance at 1 April 2019 (75,123) 0 0 (75,123)

Changes in Taxpayers' Equity for 2019-20

Impact of applying IFRS 9 to Opening Balances 0 0

Net operating costs for the reporting period (885,246) (885,246)

Net Recognised Expenditure for the Financial Year (885,246) 0 0 (885,246)

Net parliamentary funding 890,688 0 0 890,688

Balance at 31 March 2020 (69,681) 0 0 (69,681)

2018-19 General Fund

Revaluation

Reserve

Other

Reserves Total

£'000 £'000 £'000 £'000

Balance at 1 April 2018 (63,073) 0 0 (63,073)

Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0 0

Adjusted Balance at 1 April 2018 (63,073) 0 0 (63,073)

Changes in Taxpayers' Equity for 2018-19

Impact of applying IFRS 9 to Opening Balances 2,985 2,985

Net operating costs for the financial year (828,293) (828,293)

Net Recognised Expenditure for the Financial Year (825,308) 0 0 (825,308)

Net parliamentary funding 813,258 0 0 813,258

Balance at 31 March 2019 (75,123) 0 0 (75,123)

Statement of Changes in Taxpayers' Equity


180

2019-20 2018-19

Note £'000 £'000

Cash Flows from Operating Activities

Net operating costs for the reporting period (885,246) (828,293)

Depreciation and amortisation 97 131

Non-cash movements arising on application of new accounting standards 0 2,985

(Increase)/decrease in trade & other receivables 7,120 (3,206)

Increase/(decrease) in trade & other payables (9,437) 14,287

Net Cash Outflow from Operating Activities (887,466) (814,096)

Cash Flows from Investing Activities 0 (171)

Net Cash Outflow from Investing Activities 0 (171)

Net Cash Outflow before Financing (887,466) (814,267)

Cash Flows from Financing Activities

Net parliamentary funding received 890,688 813,258

Other loans received 0 0

Other loans repaid 0 0

Capital element of payments in respect of finance leases and on SoFP PFI and LIFT 0 0

Capital grants and other capital receipts 0 0

Capital receipts surrendered 0 0

Non-cash movements arising on application of new accounting standards 0 0

Net Cash Inflow from Financing Activities 890,688 813,258

Net Increase/(Decrease) in Cash and Cash Equivalents 3,222 (1,009)

Cash and Cash Equivalents at the Beginning of the Financial Year (1,063) (54)

Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign

currencies 0 0

Cash and Cash Equivalents at the End of the Financial Year 10 2,159 (1,063)

Statement of Cash Flows


181

182

Notes to the Financial Statements

1. Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall

meet the accounting requirements of the Group Accounting Manual issued by the Department

of Health and Social Care. Consequently, the following financial statements have been prepared

in accordance with the Group Accounting Manual 2019-20 issued by the Department of Health

and Social. The accounting policies contained in the Group Accounting Manual follow

International Financial Reporting Standards to the extent that they are meaningful and

appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised

by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a

choice of accounting policy, the accounting policy which is judged to be most appropriate to the

particular circumstance of the clinical commissioning group for the purpose of giving a true and

fair view has been selected. The particular policies adopted by the clinical commissioning group

are described below. They have been applied consistently in dealing with the items considered

material in relation to the accounts.

1.1. Going Concern

These accounts have been prepared on the going concern basis.

Public sector bodies are assumed to be going concerns where the continuation of the

provision of a service in the future is anticipated, as evidenced by inclusion of financial

provision for that service in published documents.

Where a clinical commissioning group ceases to exist, it considers whether or not its

services will continue to be provided (using the same assets, by another public sector

entity) in determining whether to use the concept of going concern for the final set of

Financial Statements. If services will continue to be provided the Financial Statements

are prepared on the going concern basis.

NHS Nene CCG was dissolved on 31 March 2020 having joined with NHS Corby CCG to

establish NHS Northamptonshire CCG with effect from 1 April 2020. This followed

approval of the application at the NHS England and Improvement Regional Support

Group – Midlands Region on 11 October 2019 and again on 24 February 2020 to

confirm that conditions had been met.

1.2. Accounting Convention

These accounts have been prepared under the historical cost convention modified to

account for the revaluation of property, plant and equipment, intangible assets,

inventories and certain financial assets and financial liabilities.

183

1.3. Movement of Assets within the Department of Health Group

As Public Sector Bodies are deemed to operate under common control, business

reconfigurations within the Department of Health and Social Care Group are outside the

scope of IFRS 3 Business Combinations. Where functions transfer between two public

sector bodies, the Department of Health and Social Care GAM requires the application

of absorption accounting. Absorption accounting requires that entities account for their

transactions in the period in which they took place, with no restatement of

performance required when functions transfer within the public sector. Where assets

and liabilities transfer, the gain or loss resulting is recognised in the Statement of

Comprehensive net Expenditure and is disclosed separately from operating costs.

Other transfers of assets and liabilities within the Department of Health and Social Care

Group are accounted for in line with IAS20 and similarly give rise to income and

expenditure entries.

1.4. Pooled Budgets

Where the clinical commissioning group has entered into a pooled budget arrangement

under Section 75 of the NHS Act 2006 the clinical commissioning group accounts for its

share of the assets, liabilities, income and expenditure arising from the activities of the

pooled budget, identified in accordance with the pooled budget agreement.

If the clinical commissioning group is in a jointly controlled operation, the clinical

commissioning group recognises:

● The assets the clinical commissioning group controls;

● The liabilities the clinical commissioning group incurs;

● The expenses the clinical commissioning group incurs; and,

● The clinical commissioning group’s share of the income from the pooled budget

activities.

1.5. Critical Accounting Judgements & Key Sources of Estimation Uncertainty

In the application of the clinical commissioning group’s accounting policies,

management is required to make judgements, estimates and assumptions about the

carrying amounts of assets and liabilities that are not readily apparent from other

sources. The estimates and associated assumptions are based on historical experience

and other factors that are considered to be relevant. Actual results may differ from

those estimates and the estimates and underlying assumptions are continually

reviewed. Revisions to accounting estimates are recognised in the period in which the

estimate is revised if the revision affects only that period or in the period of the revision

and future periods if the revision affects both current and future periods.

184

1.5.1. Critical Judgements in Applying Accounting Policies

The following are the critical judgements, apart from those involving estimations

(see 1.5.2) that management has made in the process of applying the clinical

commissioning group’s accounting policies that have the most significant effect on

the amounts recognised in the financial statements:

Operating Segments

NHS Nene CCG operates under one segment which is the Commissioning of

Healthcare. Management information is produced on a monthly basis to enable the

CCG to make informed decisions.

Accounting Treatment of Pooled Budgets

Where NHS Nene CCG has entered into pooled budget arrangements under Section

75 of the NHS Act 2006 the pooled budgets are governed under joint control

arrangements and therefore the individual pooled budgets are accounted for as a

joint operation. The CCG has therefore accounted for its share of the assets,

liabilities, income and expenditure arising from the activities of the pooled budget.

1.5.2. Key Sources of Estimation Uncertainty

The following are the key estimations that management has made in the process of

applying the clinical commissioning group’s accounting policies that have the most

significant effect on the amounts recognised in the financial statements:

Prescribing Creditor

Prescribing expenditure data is received from the Prescription Pricing Division (PPD)

of the NHS Business Services Authority two months in arrears. Therefore at the end

of the reporting period, NHS Nene CCG needed to take an accrual for the likely

prescribing costs for February and March. The accrual is based on forecast

expenditure provided by the PPD and amounted to £18,240,251 (31 March 2019:

£18,778,996).

Estimation Techniques for Accruals

Included within the accounts are a number of accruals which the CCG has had to

take a view on the likely level of liability. The main areas of assumption concern the

Prescribing creditor (detailed above) and the final level of activity completed by the

CCG’s healthcare providers as at 31 March 2020. Due to the time lag in receiving

actual activity data, the CCG has agreed a year end position with its main providers,

Northampton General Hospital NHS Trust, Kettering General Hospital NHS

Foundation Trust and Northamptonshire Healthcare NHS Foundation Trust. Smaller

accruals were based on commitment accounting i.e. where goods or services were

received on or before 31 March 2020, an accrual was taken for the expected liability.

185

1.6. Revenue and Funding

In the application of IFRS 15 a number of practical expedients offered in the Standard

have been employed. These are as follows:

● As per paragraph 121 of the Standard the clinical commissioning group will not

disclose information regarding performance obligations part of a contract that has an

original expected duration of one year or less;

● The clinical commissioning group is to similarly not disclose information where

revenue is recognised in line with the practical expedient offered in paragraph B16 of

the Standard where the right to consideration corresponds directly with value of the

performance completed to date;

● The FReM has mandated the exercise of the practical expedient offered in C7(a) of

the Standard that requires the clinical commissioning group to reflect the aggregate

effect of all contracts modified before the date of initial application.

The main source of funding for the clinical commissioning group is from NHS England.

This is drawn down and credited to the general fund. Funding is recognised in the

period in which it is received.

Revenue in respect of services provided is recognised when (or as) performance

obligations are satisfied by transferring promised services to the customer, and is

measured at the amount of the transaction price allocated to that performance

obligation. Where income is received for a specific performance obligation that is to be

satisfied in the following year, that income is deferred.

1.7. Employee Benefits

1.7.1. Short-Term Employee Benefits

Salaries, wages and employment-related payments, including payments arising from

the apprenticeship levy, are recognised in the period in which the service is received

from employees, including bonuses earned but not yet taken.

The cost of leave earned but not taken by employees at the end of the period is

recognised in the financial statements to the extent that employees are permitted to

carry forward leave into the following period.

1.7.2. Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pension

Schemes. The schemes are unfunded, defined benefit schemes that cover NHS

employers, General Practices and other bodies, allowed under the direction of the

Secretary of State, in England and Wales. The schemes are not designed to be run in

a way that would enable NHS bodies to identify their share of the underlying scheme

186

assets and liabilities. Therefore, the schemes are accounted for as though they were

defined contribution schemes: the cost to the clinical commissioning group of

participating in a scheme is taken as equal to the contributions payable to the

scheme for the accounting period.

For early retirements other than those due to ill health, the additional pension

liabilities are not funded by the scheme. The full amount of the liability for the

additional costs is charged to expenditure at the time the clinical commissioning

group commits itself to the retirement, regardless of the method of payment.

1.8. Operating Expenditure

Operating expenditure, including expenditure on healthcare services with NHS and Non

NHS organisations, is recognised when, and to the extent that, the goods or services

have been received. They are measured at the fair value of the consideration payable.

Where grant funding is not intended to be directly related to activity undertaken by a

grant recipient in a specific period, the clinical commissioning group recognises the

expenditure in the period in which the grant is paid. All other grants are accounted for

on an accruals basis.

1.9. Property, Plant & Equipment

1.9.1. Recognition

Property, plant and equipment is capitalised if:

● It is held for use in delivering services or for administrative purposes;

● It is probable that future economic benefits will flow to, or service potential will

be supplied to the clinical commissioning group;

● It is expected to be used for more than one financial year;

● The cost of the item can be measured reliably; and,

● The item has cost at least £5,000; or,

● Collectively, a number of items have a cost of at least £5,000 and individually

have a cost of more than £250, where the assets are functionally interdependent,

they had broadly simultaneous purchase dates, are anticipated to have simultaneous

disposal dates and are under single managerial control; or,

● Items form part of the initial equipping and setting-up cost of a new building,

ward or unit, irrespective of their individual or collective cost.

Where a large asset, for example a building, includes a number of components with

significantly different asset lives, the components are treated as separate assets and

depreciated over their own useful economic lives.

187

1.9.2. Measurement

All property, plant and equipment are measured initially at cost, representing the

cost directly attributable to acquiring or constructing the asset and bringing it to the

location and condition necessary for it to be capable of operating in the manner

intended by management. All assets are measured subsequently at valuation.

Fixtures and equipment are carried at depreciated historic cost as this is not

considered to be materially different from fair value.

An increase arising on revaluation is taken to the revaluation reserve except when it

reverses an impairment for the same asset previously recognised in expenditure, in

which case it is credited to expenditure to the extent of the decrease previously

charged there. A revaluation decrease that does not result from a loss of economic

value or service potential is recognised as an impairment charged to the revaluation

reserve to the extent that there is a balance on the reserve for the asset and,

thereafter, to expenditure. Impairment losses that arise from a clear consumption

of economic benefit should be taken to expenditure. Gains and losses recognised in

the revaluation reserve are reported as other comprehensive income in the

Statement of Comprehensive Net Expenditure.

1.9.3. Subsequent Expenditure

Where subsequent expenditure enhances an asset beyond its original specification,

the directly attributable cost is capitalised. Where subsequent expenditure restores

the asset to its original specification the expenditure is capitalised and any existing

carrying value of the item replaced is written-out and charged to operating

expenses.

1.10. Depreciation, Amortisation & Impairments

Freehold land, properties under construction, and assets held for sale are not

depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation

of property, plant and equipment and intangible non-current assets, less any residual

value, over their estimated useful lives, in a manner that reflects the consumption of

economic benefits or service potential of the assets. The estimated useful life of an

asset is the period over which the clinical commissioning group expects to obtain

economic benefits or service potential from the asset. This is specific to the clinical

commissioning group and may be shorter than the physical life of the asset itself.

Estimated useful lives and residual values are reviewed each year end, with the effect of

any changes recognised on a prospective basis. Assets held under finance leases are

depreciated over their estimated useful lives.

188

At each reporting period end, the clinical commissioning group checks whether there is

any indication that any of its tangible or intangible non-current assets have suffered an

impairment loss. If there is indication of an impairment loss, the recoverable amount of

the asset is estimated to determine whether there has been a loss and, if so, its

amount. Intangible assets not yet available for use are tested for impairment annually.

A revaluation decrease that does not result from a loss of economic value or service

potential is recognised as an impairment charged to the revaluation reserve to the

extent that there is a balance on the reserve for the asset and, thereafter, to

expenditure. Impairment losses that arise from a clear consumption of economic

benefit are taken to expenditure. Where an impairment loss subsequently reverses, the

carrying amount of the asset is increased to the revised estimate of the recoverable

amount but capped at the amount that would have been determined had there been

no initial impairment loss. The reversal of the impairment loss is credited to

expenditure to the extent of the decrease previously charged there and thereafter to

the revaluation reserve.

1.11. Leases

Leases are classified as finance leases when substantially all the risks and rewards of

ownership are transferred to the lessee. All other leases are classified as operating

leases.

1.11.1. The Clinical Commissioning Group as Lessee

Property, plant and equipment held under a finance lease are initially recognised, at

the inception of the lease, at fair value or, if lower, at the present value of the

minimum lease payments, with matching liability for the lease obligation to the

lessor. Lease payments are apportioned between finance charges and reduction of

the lease obligation so as to achieve a constant rate of interest on the remaining

balance of the liability. Finance charges are recognised in calculating the clinical

commissioning group’s surplus or deficit.

Operating lease payments are recognised as an expense on a straight-line basis over

the lease term. Lease incentives are recognised initially as a liability and

subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are

incurred.

Where a lease is for land and buildings, the land and building components are

separated and individually assessed as to whether they are operating or finance

leases.

189

1.11.2. The Clinical Commissioning Group as Lessor

Amounts due from lessees under finance leases are recorded as receivables at the

amount of the clinical commissioning group’s net investment in the leases. Finance

lease income is allocated to accounting periods so as to reflect a constant periodic

rate of return on the clinical commissioning group’s net investment outstanding in

respect of the leases.

Rental income from operating leases is recognised on a straight-line basis over the

term of the lease. Initial direct costs incurred in negotiating and arranging an

operating lease are added to the carrying amount of the leased asset and recognised

on a straight-line basis over the lease term.

1.12. Cash & Cash Equivalents

Cash is cash-in-hand and deposits with any financial institution repayable without

penalty on notice of not more than 24 hours. Cash equivalents are investments that

mature in 3 months or less from the date of acquisition and that are readily convertible

to known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank

overdrafts that are repayable on demand and that form an integral part of the clinical

commissioning group’s cash management.

1.13. Clinical Negligence Costs

NHS Resolution operates a risk pooling scheme under which the clinical commissioning

group pays an annual contribution to NHS Resolution which in return settles all clinical

negligence claims. The contribution is charged to expenditure. Although NHS

Resolution is administratively responsible for all clinical negligence cases the legal

liability remains with the clinical commissioning group.

1.14. Non-Clinical Risk Pooling

The clinical commissioning group participates in the Property Expenses Scheme and the

Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the

clinical commissioning group pays an annual contribution to NHS Resolution and, in

return, receives assistance with the costs of claims arising. The annual membership

contributions, and any excesses payable in respect of particular claims are charged to

operating expenses as and when they become due.

1.15. Financial Assets

Financial assets are recognised when the clinical commissioning group becomes party to

the financial instrument contract or, in the case of trade receivables, when the goods or

190

services have been delivered. Financial assets are derecognised when the contractual

rights have expired or the asset has been transferred.

Financial assets are classified into the following categories:

● Financial assets at amortised cost;

● Financial assets at fair value through other comprehensive income; and,

● Financial assets at fair value through profit and loss.

The classification is determined by the cash flow and business model characteristics of

the financial assets, as set out in IFRS 9, and is determined at the time of initial

recognition.

1.16. Financial Liabilities

Financial liabilities are recognised on the Statement of Financial Position when the

clinical commissioning group becomes party to the contractual provisions of the

financial instrument or, in the case of trade payables, when the goods or services have

been received. Financial liabilities are de-recognised when the liability has been

discharged, that is, the liability has been paid or expired.

1.17. Value Added Tax

Most of the activities of the clinical commissioning group are outside the scope of VAT

and, in general, output tax does not apply and input tax on purchases is not

recoverable. Irrecoverable VAT is charged to the relevant expenditure category or

included in the capitalised purchase cost of fixed assets. Where output tax is charged or

input VAT is recoverable, the amounts are stated net of VAT.

1.18. Losses & Special Payments

Losses and special payments are items that Parliament would not have contemplated

when it agreed funds for the health service or passed legislation. By their nature they

are items that ideally should not arise. They are therefore subject to special control

procedures compared with the generality of payments. They are divided into different

categories, which govern the way that individual cases are handled.

Losses and special payments are charged to the relevant functional headings in

expenditure on an accruals basis, including losses which would have been made good

through insurance cover had the clinical commissioning group not been bearing its own

risks (with insurance premiums then being included as normal revenue expenditure).

1.19. Joint Operations

Joint operations are activities undertaken by the clinical commissioning group in

191

conjunction with one or more parties but which are not performed through a separate

entity. The clinical commissioning group records its share of the income and

expenditure, gains and losses, assets, liabilities and cash flows.

1.20. Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Department of Health and Social Care GAM does not require the following IFRS

Standards and Interpretations to be applied in 2019-20. These standards are still

subject to HM Treasury FReM adoption, with IFRS 16 implementation being deferred to

2021-22, and the government implementation date for IFRS 17 still subject to HM

Treasury consideration.

● IFRS 16: Leases – The Standard as adapted and interpreted by the FReM has been

deferred to 2020-21.

● IFRS 17: Insurance Contracts – Application required for accounting periods

beginning on or after 1 January 2021, but not yet adopted by the FReM: early adoption

is therefore not permitted.

● IFRIC 23: Uncertainty Over Income Tax Treatments - Application required for

accounting periods beginning on or after 1 January 2019.

The application of the Standards would not have a material impact on the accounts for

2019-20, were they applied in that year.

Note 2: Other Operating Revenue

2019-20 2018-19

Total Total

£'000 £'000

Income from Sale of Goods and Services (Contracts)

Education, training and research 112 140

Non-patient care services to other bodies 14,382 10,353

Other contract income 1,011 142

Recoveries in respect of employee benefits 87 162

Total Income from Sale of Goods & Services 15,592 10,797

Other Operating Income

Charitable and other contributions to revenue expenditure: Non NHS 0 5

Other non contract revenue 1,128 1,410

Total Other Operating Income 1,128 1,415

Total 16,720 12,212

Note 3: Contract Income Recognition

3.1 Disaggregation of Income - Income from Sale of Goods and Services (Contracts)

2019-20

Education

Training &

Research

Non-Patient

Care Services

to Other

Bodies

Other

Contract

Income

Recoveries in

Respect of

Employee

Benefits

£'000 £'000 £'000 £'000

Source of Revenue

NHS 112 3,134 478 66

Non NHS 0 11,248 533 21

Total 112 14,382 1,011 87

Timing of Revenue

Point in Time 112 14,382 1,011 87

Over Time 0 0 0 0

Total 112 14,382 1,011 87

2018-19

Education

Training &

Research

Non-Patient

Care Services

to Other

Bodies

Other Contract

Income

Recoveries in

Respect of

Employee

Benefits

£'000 £'000 £'000 £'000

Source of Revenue

NHS 140 2,045 68 131

Non NHS 0 8,308 74 31

Total 140 10,353 142 162

Timing of Revenue

Point in Time 140 10,353 142 162

Over Time 0 0 0 0

Total 140 10,353 142 162

3.2 Transaction Price to Remaining Contract Performance Obligations

NHS Nene CCG did not have any balances to declare under this note for 2019-20 or for 2018-19.

192

Note 4: Employee Benefits & Staff Numbers

4.1.1 Employee Benefits Expenditure

Permanent

Employees Other Total

Permanent


£'000 £'000 £'000 £'000 £'000 £'000

Salaries and wages 6,566 431 6,998 6,006 522 6,528

Social security costs 723 8 731 669 7 676

Employer contributions to the NHS Pensions Scheme 1,145 6 1,151 777 9 786

Apprenticeship Levy 18 0 18 16 0 16

Termination benefits 307 0 307 0 0 0

Gross employee benefits expenditure 8,760 445 9,205 7,468 537 8,005

Less: recoveries in respect of employee benefits (Note 4.1.2) (87) 0 (87) (162) 0 (162)

Net employee benefits expenditure including capitalised costs 8,673 445 9,118 7,306 537 7,843

Less: employee costs capitalised 0 0 0 0 0 0

Net employee benefits expenditure excluding capitalised costs 8,673 445 9,118 7,306 537 7,843

4.1.2 Recoveries in Respect of Employee Benefits

Permanent


Permanent


£'000 £'000 £'000 £'000 £'000 £'000

Salaries and wages (69) 0 (69) (130) 0 (130)

Social security costs (8) 0 (8) (15) 0 (15)

Employer contributions to the NHS Pensions Scheme (10) 0 (10) (18) 0 (18)

Total recoveries in respect of employee benefits (87) 0 (87) (162) 0 (162)

4.2 Average Number of People Employed

Permanent


Permanent


Number Number Number Number Number Number

Total 126 4 130 124 4 128

Of the above:

Number of whole time equivalent people engaged on capital projects 0 0 0 0 0 0

2018-192019-20

2018-192019-20

2019-20 2018-19

Total Total

193

Note 4: Employee Benefits & Staff Numbers (continued)

4.3 Exit Packages Agreed in the Reporting Period

Number £s Number £s Number £s Number £s Number £s

Less than £10,000 0 0 0 0 0 0 0 0 0 0

£10,001 to £25,000 0 0 0 0 0 0 0 0 0 0

£25,001 to £50,000 0 0 1 27,500 1 27,500 0 0 0 0

£50,001 to £100,000 0 0 0 0 0 0 0 0 0 0

£100,001 to £150,000 0 0 0 0 0 0 0 0 0 0

£150,001 to £200,000 2 306,667 0 0 2 306,667 0 0 0 0

Over £200,001 0 0 0 0 0 0 0 0 0 0

Total 2 306,667 1 27,500 3 334,167 0 0 0 0

Number £s Number £s

Voluntary redundancies including early retirement contractual costs 0 0 0 0

Mutually agreed resignations (MARS) contractual costs 0 0 0 0

Early retirements in the efficiency of the service contractual costs 0 0 0 0

Contractual payments in lieu of notice 1 27,500 0 0

Exit payments following Employment Tribunals or court orders 0 0 0 0

Non-contractual payments requiring HMT approval 0 0 0 0

Total 1 27,500 0 0

Where the clinical commissioning group has agreed early retirements, the additional costs are met by the clinical commissioning group and not by the NHS Pension Scheme, and are included in the tables. Ill health retirement

costs are met by the NHS Pension Scheme and are not included in the tables.

Exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure.

Compulsory

Redundancies Other Agreed Departures Total

Departures where Special

Payments have been

made

These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been recognised in part or in full in a previous period.

2018-19

Total

2020-19 2018-19

Other AgreedOther Agreed Departures

2019-20

194

Note 4: Employee Benefits & Staff Numbers (continued)

4.4 Pension Costs

4.4.1 Accounting Valuation

4.4.2 Full Actuarial (Funding) Valuation

Past and present employees are covered by the provisions of the two NHS Pension Schemes. Details

of the benefits payable and rules of the schemes can be found on the NHS Pensions website at

www.nhsbsa.nhs.uk/pensions. Both are unfunded defined benefit schemes that cover NHS employers,

GP practices and other bodies, allowed under the direction of the Secretary of State for Health and

Social Care in England and Wales. They are not designed to be run in a way that would enable NHS

bodies to identify their share of the underlying scheme assets and liabilities. Therefore, each scheme

is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating

in each scheme is taken as equal to the contributions payable to that scheme for the accounting

period.

A valuation of scheme liability is carried out annually by the scheme actuary (currently the

Government Actuary's Department) as at the end of the reporting period. This utilises an actuarial

assessment for the previous accounting period in conjunction with updated membership and financial

data for the current reporting period, and is accepted as providing suitably robust figures for financial

reporting purposes. The valuation of the scheme liability as at 31 March 2020, is based on valuation

data as at 31 March 2019, updated to 31 March 2020 with summary global member and accounting

data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM

interpretations, and the discount rate prescribed by HM Treasury have also been used.

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the

schemes (taking into account recent demographic experience), and to recommend contribution rates

payable by employees and employers.

The latest actuarial valuation undertaken for the NHS Pension Scheme was completed as at 31 March

2016. The results of this valuation set the employer contribution rate payable from April 2019 to

20.6% and the Scheme Regulations were amended accordingly.

The 2016 funding valuation was also expected to test the cost of the Scheme relative to the employer

cost cap set following the 2012 valuation. Following a judgement from the Court of Appeal in

December 2018 Government announced a pause to that part of the valuation process pending

conclusion of the continuing legal process.

The latest assessment of the liabilities of the scheme is contained in the report of the scheme actuary,

which forms part of the annual NHS Pension Scheme Accounts. These accounts can be viewed on the

NHS Pensions website and are published annually. Copies can also be obtained from The Stationery

Office.

In order that the defined benefit obligations recognised in the financial statements do not differ

materially from those that would be determined at the reporting date by a formal actuarial valuation,

the FReM requires that “the period between formal valuations shall be four years, with approximate

assessments in intervening years”. An outline of these follows:

195

Note 5: Operating Expenditure

2019-20 2018-19

Total Total

£'000 £'000

Purchase of Goods and Services

Services from other CCGs and NHS England 8,538 8,896

Services from Foundation Trusts 323,203 297,161

Services from Other NHS Trusts 296,188 263,337

Services from Other WGA Bodies 116 1

Purchase of Healthcare from Non-NHS Bodies 138,081 138,598

Purchase of Social Care 6,586 4,632

Prescribing costs 94,163 91,611

Pharmaceutical services 25 29

General ophthalmic services 133 106

GPMS/APMS and PCTMS 18,278 15,010

Supplies and services - clinical 997 630

Supplies and services - general 2,232 6,587

Consultancy services 1,001 685

Establishment 1,692 1,952

Transport 5 3

Premises 1,060 2,167

Audit fees 59 59

Other auditor's remuneration

● Other services 10 0

Other professional fees ex audit (334) 446

Legal fees 24 3

Education and training 410 318

Total Purchase of Goods and Services 892,467 832,232

Depreciation and Impairment Charges

Depreciation 97 131

Total Depreciation and Impairment Charges 97 131

Other Operating Expenditure

Chair & Non-Executive Members 150 150

Expected credit loss on receivables 47 (12)

Total Other Operating Expenditure 196 137

Total Operating Expenditure 892,761 832,500

Note 6: Better Payment Practice Code

6.1 Measure of Compliance

Number Number £'000

Non-NHS Payables

Total Non-NHS trade invoices paid in the Reporting Period 25,821 20,657 124,832

Total Non-NHS trade invoices paid within target 25,678 20,452 123,354

Percentage of Non NHS trade invoices paid within target 99.45% 99.01% 98.82%

NHS Payables

Total NHS trade invoices paid in the Reporting Period 6,377 4,377 564,414

Total NHS trade invoices paid within target 6,356 4,353 562,951

Percentage of NHS trade invoices paid within target 99.67% 99.45% 99.74%

2018-192019-20

In accordance with SI 2008 no.489, The Companies (Disclosure of Auditor Remuneration and Liability Limitation Agreements)

Regulations 2008, the CCG must disclose the principal terms of the limitation of the auditors liability. This is detailed as follows:

For all defaults resulting in direct loss or damage to the property of the other party - £2m limit.

In respect of all other defaults, claims, losses or damages arising from breach of contract, misrepresentation, tort, breach of

statutory duty or otherwise - not exceed the greater of the sum of £2m or a sum equivalent to 125% of the contract charges paid or

payable to the supplier in the relevant year of the contract.

The Better Payment Practice Code requires NHS Nene CCG to aim to pay all valid invoices by the due date or within 30 days of

receipt of a valid invoice, whichever is later.

£'000

148,708

147,682

99.31%

649,015

648,622

99.94%

196

Note 7: Operating Leases

7.1 As Lessee

7.1.1 Payments Recognised as an Expense

2018-19

Land Buildings Other Total Total

£'000 £'000 £'000 £'000 £'000

Minimum lease payments 0 379 9 387 2,108

Contingent rents 0 0 0 0 0

Sub-lease payments 0 0 0 0 0

Total 0 379 9 387 2,108

7.1.2 Future Minimum Lease Payments

2018-19

Land Buildings Other Total Total

£'000 £'000 £'000 £'000 £'000

Payable:

● No later than one year 0 0 9 9 0

● Between one and five years 0 0 11 11 0

● After five years 0 0 0 0 0

Total 0 0 20 20 0

7.2 As Lessor

NHS Nene CCG has nothing to disclose under this note for 2019-20 or for 2018-19.

At 31 March 2020, NHS Nene CCG has recognised a total liability of £379,000 (2018-19: £2,101,000) with

NHS Property Services Ltd in respect of non healthcare properties. Due to a change in reporting of

payments made to NHS Property Services Ltd for healthcare properties, the amount reported under this

note shows a decrease in 2019-20. This is a reclassification issue only as the CCG continues to make

payments to NHS Property Services Ltd for these items and they are reported under Premises in Note 5 to

these accounts.

Whilst the arrangements with NHS Property Services Ltd fall within the definition of operating leases, the

rental charge for future years has not yet been agreed. Consequently this note does not include future

minimum lease payments for these arrangements.

2019-20

NHS Nene CCG has incurred expenditure for the hire of photocopiers of £9,000 as at 31 March 2020 (2018-

19: £7,000). A new lease was signed with Konica Minolta for the hire of the photocopiers in July 2019.

The lease is for three years in duration and the future expected lease payments are disclosed in Note

7.1.2 below.

2019-20

197

Note 8: Property, Plant & Equipment

2019-20

Information

Technology

Fixture &

Fittings Total 2018-19

Information

Technology

Fixture &

Fittings Total

£'000 £'000 £'000 £'000 £'000 £'000

Cost or valuation at 1 April 2019 200 230 429 Cost or valuation at 1 April 2018 200 230 429

Cost of valuation at 31 March 2020 200 230 429 Cost of valuation at 31 March 2019 200 230 429

Depreciation at 1 April 2019 102 230 332 Depreciation at 1 April 2018 2 199 201

Charged during the reporting period 97 0 97 Charged during the reporting period 100 31 131

Depreciation at 31 March 2020 200 230 429 Depreciation at 31 March 2019 102 230 332

Net Book Value at 31 March 2020 0 0 0 Net Book Value at 31 March 2019 97 0 97

2019-20

Information

Technology

Fixture &

Fittings Total 2018-19

Information

Technology

Fixture &

Fittings Total

£'000 £'000 £'000 £'000 £'000 £'000

Purchased 0 0 0 Purchased 97 0 97

Donated 0 0 0 Donated 0 0 0

Government granted 0 0 0 Government granted 0 0 0

Total at 31 March 2020 0 0 0 Total at 31 March 2019 97 0 97

Asset Financing Asset Financing

Owned 0 0 0 Owned 97 0 97

Held on finance lease 0 0 0 Held on finance lease 0 0 0

On-SoFP PFI & LIFT contracts 0 0 0 On-SoFP PFI & LIFT contracts 0 0 0

PFI residual interests 0 0 0 PFI residual interests 0 0 0

Total at 31 March 2020 0 0 0 Total at 31 March 2019 97 0 97

198

Note 8: Property, Plant & Equipment (continued)

● Revaluation Reserve for Property, Plant & Equipment,

● Additions to Assets Under Construction,

● Donated Assets,

● Government Granted Assets,

● Property Revaluation,

● Compensation to Third Parties,

● Write Down to Recoverable Amount,

● Temporarily Idle Assets,

8.1 Economic Lives

Minimum Life Maximum Life

Years Years

Information technology 2 2

Furniture & fittings 10 10

8.2 Cost or Valuation of Fully Depreciated Assets

31 March

2020

31 March

2019

£'000 £'000

Land 0 0

Buildings excluding dwellings 0 0

Dwellings 0 0

Plant & machinery 0 0

Transport equipment 0 0

Information technology 200 0

Furniture & fittings 397 397

Total 597 397

NHS Nene CCG did not hold any balances or incur any expenditure under the following categories

during 2019-20 or 2018-19:

199

Note 9: Trade & Other Receivables

Current Non-Current Current Non-Current

31 March 2020 31 March 2020 31 March 2019 31 March 2019

£'000 £'000 £'000 £'000

NHS receivables: revenue 891 0 3,187 0

NHS prepayments 2,123 0 2,128 0

NHS accrued income 466 0 2,721 0

Non-NHS and Other WGA receivables: revenue 1,652 0 1,780 0

Non-NHS and Other WGA prepayments 0 0 494 0

Non-NHS and Other WGA accrued income 888 0 2,732 0

Expected credit loss allowance-receivables (62) 0 (16) 0

VAT 148 0 201 0

Total 6,107 0 13,227 0

Total Current and Non-Current 6,107 13,227

Included in NHS receivables are pre-paid pension contributions 0 0

9.1 Receivables Past Their Due Date But Not Impaired

31 March 2020 31 March 2020 31 March 2019

DHSC Group Bodies

Non DHSC Group

BodiesAll Receivables

£'000 £'000 £'000

By up to three months 1,267 41 875

By three to six months 214 2 31

By more than six months 570 112 440

Total 2,051 155 1,346

The great majority of trade is with NHS England. As NHS England is funded by Government to provide funding to clinical commissioning groups to commission services, no credit

scoring of them is considered necessary.

NHS Nene CCG did not hold any collateral against receivables outstanding at 31 March 2020 (31 March 2019: None).

200

Note 9: Trade & Other Receivables (continued)

9.3 Loss Allowance on Asset Classes

Trade & Other

Receivables - Non

DHSC Group Bodies

Other Financial

Assets Total

£'000 £'000 £'000

Balance at 1 April 2019 (16) 0 (16)

Allowance for credit losses at 1 April 2019 0

Lifetime expected credit loss on credit impaired financial assets 0 0

Lifetime expected credit loss on trade and other receivables - Stage 2 (47) (47)

Lifetime expected credit loss on trade and other receivables - Stage 3 0 0

Credit losses recognised on purchase originated credit impaired financial assets 0 0 0

Amounts written off 0 0 0

Financial assets that have been derecognised 0 0 0

Changes due to modifications that did not result in derecognition 0 0 0

Other changes 0 0 0

Allowance for credit losses at 31 March 2020 (62) 0 (47)

Trade & Other

Receivables - Non

DHSC Group Bodies

Other Financial

Assets Total

£'000 £'000 £'000

Balance at 1 April 2018 (3,012) 0 (3,012)

Allowance for credit losses at 1 April 2018

Recognition of loss allowance on application of IFRS9 2,985 0 2,985

Lifetime expected credit loss on credit impaired financial assets 0 0



Credit losses recognised on purchase originated credit impaired financial assets 0 0 0

Amounts written off 0 0 0

Financial assets that have been derecognised 0 0 0

Changes due to modifications that did not result in derecognition 0 0 0

Other changes 0 0 0

Allowance for credit losses at 31 March 2019 (16) 0 (16)

9.4 Provision Matrix on Lifetime Credit Loss

31 March 2019

Lifetime Expected

Credit Loss Rate

Gross Carrying

Amount

Lifetime Expected

Credit Loss

Lifetime Expected

Credit Loss

% £'000 £'000 %

Up to 90 days 0% 74 0 0%

Between 90 & 360 days 15% 9 1 15%

Between 360 & 720 days 50% 85 42 50%

Over 720 days 90% 20 18 90%

Total Expected Credit Loss 188 62

31 March 2020

201

Note 10: Cash & Cash Equivalents

2019-20 2018-19

£'000 £'000

Balance at 1 April (1,063) (54)

Net Change during the reporting period 3,222 (1,009)

Balance at 31 March 2,159 (1,063)

31 March 2020 31 March 2019

£'000 £'000

Made up of:

Cash with the Government Banking Service 2,159 0

Cash with Commercial Banks 0 0

Cash in Hand 0 0

Current Investments 0 0

Cash and Cash Equivalents as in SoFP 2,159 0

Bank Overdraft: Government Banking Service 0 (1,063)

Bank Overdraft: Commercial Banks 0 0

Balance at 31 March 2020 2,159 (1,063)

Patients' money held by NHS Nene CCG not included above 0 0

202

Note 11: Trade & Other Payables



£'000 £'000 £'000 £'000

NHS payables: revenue 5,751 0 9,391 0

NHS accruals 6,885 0 9,017 0

Non-NHS & Other WGA payables: revenue 6,445 0 8,499 0

Non-NHS & Other WGA accruals 58,594 0 60,148 0

Social security costs 109 0 100 0

Tax 90 0 89 0

Other payables 72 0 139 0

Total 77,947 0 87,384 0

Total Current and Non-Current 77,947 87,384

Note 12: Borrowings



£'000 £'000 £'000 £'000

Bank overdrafts:

● Government Banking Service 0 0 1,063 0

● Commercial banks 0 0 0 0

Total 0 0 1,063 0

Total Current and Non-Current 0 1,063

12.1: Repayment of Principal Falling Due

Department of

Health Other

Department of

Health Other

£'000 £'000 £'000 £'000

Within one year 0 0 1,063 0

Between one and two years 0 0 0 0

Between two and five years 0 0 0 0

After five years 0 0 0 0

Total 0 0 1,063 0

Note 13: Provisions

Note 14: Contingencies

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities

relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the CCG. However, the legal

liability remains with the CCG. The total value of the legacy NHS Continuing Healthcare provisions accounted for by NHS England

on behalf of NHS Nene CCG at 31 March 2020 is £380,400 (31 March 2019: £452,790). NHS Nene CCG had no other provisions as

at 31 March 2020 or 31 March 2019.

NHS Nene CCG did not have any contingent assets or liabilities to disclose as at 31 March 2020 (31 March 2019: None).

There are no liabilities included above that are due in future years under the arrangements to buy out the liability for early

retirement over 5 years as at 31 March 2020 or 31 March 2019. Other payables include £120,000 outstanding pension

contributions at 31 March 2020 (31 March 2019: £116,000).

31 March 2020 31 March 2019

203

Note 15: Financial Instruments

15.1 Financial Risk Management

15.1.1 Currency Risk

15.1.2 Interest Rate Risk

15.1.3 Credit Risk

15.1.4 Liquidity Risk

NHS Nene CCG is required to operate within revenue and capital resource limits agreed with NHS England,

which are financed from resources voted annually by Parliament. NHS Nene CCG draws down cash to

cover expenditure, from NHS England, as the need arises, unrelated to its performance against resource

limits. NHS Nene CCG is not, therefore, exposed to significant liquidity risks.

International Financial Reporting Standard 7: Financial Instrument: Disclosure requires disclosure of the

role that financial instruments have had during the period in creating or changing the risks a body faces in

undertaking its activities.

Because NHS Nene CCG is financed through parliamentary funding, it is not exposed to the degree of

financial risk faced by business entities. Also, financial instruments play a much more limited role in

creating or changing risk than would be typical of listed companies, to which the financial reporting

standards mainly apply. NHS Nene CCG has limited powers to borrow or invest surplus funds and financial

assets and liabilities are generated by day-to-day operational activities rather than being held to change

the risks facing NHS Nene CCG in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined

formally within NHS Nene CCG's standing financial instructions and policies agreed by the Governing Body.

Treasury activity is subject to review by NHS Nene CCG's internal auditors.

NHS Nene CCG is principally a domestic organisation with the great majority of transactions, assets and

liabilities being in the UK and sterling based. NHS Nene CCG has no overseas operations. NHS Nene CCG

therefore has low exposure to currency rate fluctuations.

NHS Nene CCG borrows from government for capital expenditure, subject to affordability as confirmed by

NHS England. The borrowings are for 1 to 25 years, in line with the life of the associated assets, and

interest is charged at the National Loans Fund rate, fixed for the life of the loan. NHS Nene CCG therefore

has low exposure to interest rate fluctuations.

Because the majority of NHS Nene CCG's revenue comes from parliamentary funding, NHS Nene CCG has

low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables

from customers, as disclosed in the trade and other receivables note.

Disclosure of Fair Value is not required when the carrying amount is a reasonable approximation of Fair

Value.

204

Note 15: Financial Instruments (continued)

15.2 Financial Assets

2019-20

Financial

Assets

Measured at

Amortised

Cost

Equity

Instruments

Designated at

FVOCI Total

£'000 £'000 £'000

Trade and other receivables with NHSE bodies 1,034 1,034

Trade and other receivables with other DHSC group bodies 1,213 1,213

Trade and other receivables with other external bodies 1,651 1,651

Cash and cash equivalents 2,159 2,159

Total at 31 March 2020 6,057 0 6,057

2018-19

Financial

Assets

Measured at

Amortised

Cost

Equity

Instruments

Designated at

FVOCI Total

£'000 £'000 £'000

Trade and other receivables with NHSE bodies 5,707 5,707

Trade and other receivables with other DHSC group bodies 2,934 2,934

Trade and other receivables with other external bodies 1,778 1,778

Cash and cash equivalents 0 0

Total at 31 March 2019 10,420 0 10,420

15.3 Financial Liabilities

2019-20

Financial

Liabilities

Measured at

Amortised

Cost Other Total

£'000 £'000 £'000

Trade and other payables with NHSE bodies 1,023 1,023

Trade and other payables with other DHSC group bodies 32,137 32,137

Trade and other payables with other external bodies 44,587 44,587

Other financial liabilities 0 0

Total at 31 March 2020 77,748 0 77,748

2018-19

Financial

Liabilities

Measured at

Amortised

Cost Other Total

£'000 £'000 £'000

Trade and other payables with NHSE bodies 3,043 3,043

Trade and other payables with other DHSC group bodies 37,765 37,765

Trade and other payables with other external bodies 46,247 46,247

Other financial liabilities 1,203 1,203

Total at 31 March 2019 88,258 0 88,258

15.4 Maturity of Financial Liabilities

2019-20 Payable to DH

Payable to

Other Bodies Total

£'000 £'000 £'000

In one year or less 33,160 44,587 77,748

In more than one year but not more than two years 0 0 0

In more than two years but not more than five years 0 0 0

In more than five years 0 0 0

Total at 31 March 2020 33,160 44,587 77,748

2018-19 Payable to DH

Payable to

Other Bodies Total

£'000 £'000 £'000

In one year or less 40,809 47,449 88,258

In more than one year but not more than two years 0 0 0

In more than two years but not more than five years 0 0 0

In more than five years 0 0 0

Total at 31 March 2019 40,809 47,449 88,258

205

Note 16: Operating Segments

NHS Nene CCG consider there is only one segment: commissioning healthcare services.

Note 17: Pooled Budgets

17.1 Adult Mental Health Pooled Budget

17.2 Children and Adolescent Mental Health Pooled Budget

17.3 Better Care Fund (Including Community Equipment)

Note 1.4 Pooled Budgets and Note 1.19 Joint Operations of these accounts provide further information on

Pooled Budgets.

NHS Nene CCG is the host of a pooled budget for the commissioning of Adult Mental Health Services

across the county with Northamptonshire County Council, NHS Corby CCG and NHS Cambridgeshire &

Peterborough CCG. Under the arrangement, funds are pooled under S75 of the NHS Act 2006 for mental

health commissioning activities. An unaudited memorandum note to the accounts detailing the joint

income and expenditure in the form of a memorandum trading account is included at the end these

accounts. These do not form part of the financial statements. Partners are solely liable for any

overspends to services commissioned in exercise of their statutory functions.

NHS Nene CCG is the host of a pooled budget for the commissioning of Children and Adolescent Mental

Health Services across the county with Northamptonshire County Council (Public Health), NHS Corby CCG

and NHS Cambridgeshire & Peterborough CCG. Under the arrangement, funds are pooled under S75 of

the NHS Act 2006 for mental health commissioning activities. An unaudited memorandum note to the

accounts detailing the joint income and expenditure in the form of a memorandum trading account is

included at the end of these accounts. These do not form part of the financial statements.

Northamptonshire County Council host the Better Care Fund pooled budget for the county. Under the

arrangements, funds are pooled under S75 of the NHS Act 2006. NHS Nene CCG contribute to the pool for

services to be delivered as a provider of healthcare. Members to the BCF pool account for transactions and

balances directly with providers. The pooled budget memorandum trading account is not available for

inclusion in the accounts.

206

Note 17: Pooled Budgets (continued)

17.4 Pooled Budgets Income & Expenditure

Name of Arrangement Parties to the Arrangement Description of Principal Activities Assets Liabilities Income Expenditure Assets Liabilities Income Expenditure

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Adult Mental Health NHS Nene CCG, NHS Corby CCG, NHS

Cambridgeshire & Peterborough

CCG, Northamptonshire County

Council

Provision of support and services for

adults with mental health needs,

providing inpatient and community

specialist services.

0 0 0 58,234 0 0 0 53,990

Children and Adolescent Mental Health NHS Nene CCG, NHS Corby CCG, NHS



Council (Public Health)

Provision of specialist mental health

support for children within the

community.

0 0 0 5,607 0 0 0 5,425

Better Care Fund NHS Nene CCG, NHS Corby CCG, NHS



Council

Provision of services which are

enablers to reduce non elective

admissions, to reduce delayed

transfers of care.

0 0 0 40,522 0 0 0 38,506

NHS Nene CCG's shares of assets/liabilities and income/expenditure handled by the pooled budgets in the financial year were:

Amounts Recognised in CCG's Accounts Only

2019-20

Amounts Recognised in CCG's Accounts Only

2018-19

207

Note 18: Related Party Transactions

Senior Manager Position Related Party Relationship to Related Party

Payments to

Related Party

Receipts from

Related Party

Amounts Owed to

Related Party

Amounts Due

from Related

Party

£'000 £'000 £'000 £'000

Azhar Ali Clinical Executive Director Abbey Medical Practice GP at practice 567 0 0 0

3Sixty Care Ltd GP Federation Member 510 (1) 0 (86)

Tina Beardsworth Interim GP Commissioning & Membership Engagement Executive

(from April to June 2019)

Brackley Medical Centre GP at practice 427 0 0 0

Principal Medical Shareholder 4,288 0 31 0

Joanne Brodrick Lay Member (until September 2019) Birmingham Women & Children's Hospital NHS Foundation Trust Apprenticeship delivery consultancy 114 0 16 0

University Hospitals Birmingham NHS Foundation Trust Apprenticeship delivery consultancy 605 0 220 0

Birmingham Community Healthcare NHS Foundation Trust Apprenticeship delivery consultancy 53 0 19 0

Naomi Caldwell Clinical Executive Director Langham Place Surgery GP at practice 187 0 0 0

Royal Parks PCN Member 560 0 0 0

General Practice Alliance GP Federation Member 363 (19) 0 (0)

Julie Curtis Director of Primary & Community Integration Rushden Medical Centre Daughter employed by Practice 234 0 0 0

Angela Dempsey Joint Registered Nurse & Quality Officer RSM UK Associate Director 200 0 0 0

Emma Donnelly Clinical Executive Director St Lukes Primary Care Centre GP at practice 688 0 0 0

Principal Medical GP Federation Member 4,288 0 31 0

BUPA Pension interest from previous employment 92 0 0 0

Anna Dorothy Interim Director of Transformation Delivery (from August to

December 2019)

NHS NEL CSU Director of Clinical Services and Chief Nurse 5,024 (273) 679 (275)

Chris Ellis GP Commissioning & Membership Engagement Executive Queensway Medical Centre GP at practice 254 0 0 0


Devaka Fernando Joint Secondary Care Doctor Sherwood Forest Hospital NHS Foundation Trust Consultant 818 0 800 0

Sanjay Gadhia GP Governing Body Member Lakeside Healthcare Partner 182 0 0 0

Lakeside Plus Shareholder 101 0 0 0

One Medicare Locum Doctor at Corby UCC 1,305 0 0 0

Kettering General Hospital NHS Foundation Trust Honorary contract 149,580 (73) 1,342 (850)

Nuffield Health Wife is Physiotherapist 108 0 1 0

Tansi Harper Lay Member (until September 2019) Richmond Fellowship Non Executive Director 165 0 0 0

Tom Howseman GP Commissioning & Membership Engagement Executive (until

September 2019)

St Lukes Primary Care Centre GP at practice 688 0 0 0

Blue PCN Clinical Director 1,216 0 0 (1)

Principal Medical GP Federation Member 4,288 0 31 0


Bev Messinger Lay Member (from September 2019) Northampton General Hospital NHS Trust Husband has supervisory position 248,200 (78) 2,377 (1,129)

208

Note 18: Related Party Transactions (continued)

Senior Manager Position Related Party Relationship to Related Party

Payments to

Related Party

Receipts from

Related Party

Amounts Owed to

Related Party

Amounts Due

from Related

Party

£'000 £'000 £'000 £'000

Darin Seiger GP Chair Moulton Surgery GP at practice 432 0 0 0


Nathan Spencer GP Governing Body Member Great Oakley Medical Centre GP at practice 50 0 0 0


Philip Stevens GP Commissioning & Membership Engagement Executive (from

June 2019)

Washington House Surgery GP at practice 330 0 0 0

Brackley Medical Centre GP at practice 427 0 0 0

Principal Medical Shareholder 4,288 0 31 0

Joanne Watt Clinical Chair Great Oakley Medical Centre GP at practice 50 0 0 0

Northamptonshire Healthcare NHS Foundation Trust Independent contractor 137,133 (1,938) 984 (315)

Kettering General Hospital NHS Foundation Trust Husband is consultant 149,580 (73) 1,342 (850)


Lucy Wightman Director of Population Health Strategy (from October 2019) Northamptonshire County Council Director 24,171 0 12,751 0

University Hospitals of Leicester NHS Trust Spouse is Director 8,457 (11,396) 376 (2,293)

● NHS England, NHS Corby CCG, NHS Cambridgeshire & Peterborough CCG, NHS NEL CSU, NHS Arden & GEM CSU

● Kettering General Hospital NHS Foundation Trust, Northamptonshire Healthcare NHS Foundation Trust, Oxford University Hospitals NHS Foundation Trust

● Northampton General Hospital NHS Trust, University Hospitals of Leicester NHS Trust, University Hospitals Coventry & Warwickshire NHS Trust, East Midlands Ambulance Services NHS Trust

● NHS Resolution; and,

● NHS Business Service Authority.

Due to the close working arrangements adopted by NHS Nene CCG & NHS Corby CCG during 2019-20, senior managers from both CCGs who have a declared an interest in a third party have been included within this note.

The Department of Health & Social Care is regarded as a related party. During the reporting period, NHS Nene CCG has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. For example:

In addition, NHS Nene CCG has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Northamptonshire County Council.

NHS Nene CCG has not received any revenue or capital payments from charitable funds where members of the Governing Body are trustees of the Charitable Funds.

209

Note 19: Events After the Reporting Period

The estimated financial effect of the merger is set out in the table below:

NHS Nene CCG NHS Corby CCG

£'000 £'000

Property, Plant and Equipment as at 31 March 2020 0 0

Intangibles as at 31 March 2020 0 0

Inventories as at 31 March 2020 0 0

Cash and cash equivalents as at 31 March 2020 2,159 318

Receivables as at 31 March 2020 6,107 453

Payables as at 31 March 2020 (77,947) (18,462)

Provisions as at 31 March 2020 0 0

General Fund Balance at 31 March 2020 (69,681) (17,691)

NHS Nene CCG was dissolved on 31 March 2020 having merged with NHS Corby CCG to establish NHS Northamptonshire CCG with effect

from 1 April 2020. This followed approval of the application at the NHS England and Improvement Regional Support Group – Midlands

Region on 11 October 2019 and again on 24 February 2020 to confirm that conditions had been met.

The merger of the CCGs within the NHS England group is regarded as a transfer of function. The DHSC Group Accounting Manual directs

that such changes should be accounted for as a transfer by absorption. The new NHS Northamptonshire CCG will recognise the assets and

liabilities received as at the date of transfer (1 April 2020) after taking into account inter company transactions.

210

Note 20: Losses & Special Payments

Note 21: Financial Performance Targets

Clinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended).

NHS Nene CCG's performance against those duties was as follows:

NHS Act Section Target Performance Duty Target Performance Duty

£'000 £'000 Achieved £'000 £'000 Achieved

223H (1) Expenditure not to exceed income - Surplus/(Deficit) 901,989 901,966 Yes 840,534 840,505 Yes

223I (2) Capital resource use does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes

223I (3) Revenue resource use does not exceed the amount specified in Directions 885,269 885,246 Yes 828,322 828,293 Yes

223J (1) Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes

223J (2) Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 Yes 0 0 Yes

223J (3) Revenue administration resource use does not exceed the amounts specified in Directions 14,163 10,245 Yes 13,901 10,607 Yes

NHS Nene CCG did not have any losses or special payments to disclose as at 31 March 2020 (31 March 2019: None).

2019-20 2018-19

Note 1: For the purposes of 223H(1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and, income is defined as the aggregate of the notified maximum revenue resource,

notified capital resource and all other amounts accounted as received in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis).

Duty

211

Source of Funds 2019/20 2018/19

£000's £000's

NHS Nene Clinical Commissioning Group 59,332 53,404

NHS Corby Clinical Commissioning Group 6,762 6,057

NHS Cambridgeshire & Peterborough Clinical Commissioning Group 1,233 1,201

Northamptonshire County Council 10,196 8,805

Northamptonshire County Council contribution to over (+) underspend (-) 828 1,320

78,351 70,787

Application of Funds 2019/20 2018/19

£000's £000's

Contracts

Northamptonshire Healthcare NHS Trust 54,421 48,401

Primary Care Services

Section 12 arrangements 180 147

Community & Primary Care Developments 45 45

Individual Packages of Care

Mental Health & Social Care IPC Expenditure 21,941 22,440

Grant Payments

Service Purchase and Grant Payments 484 349

Management Costs

Commissioning Team Management Costs 56 57

77,128 71,440

Net Position (-) underspend -1,223 653

Notes to the memorandum trading account:

1)

grouping expenditure against the objectives of the pool.

2) Partners are solely liable for any overspends to services commissioned in exercise of their statutory functions.

CERTIFICATE OF CHIEF FINANCE OFFICER

Signed ……………………………………………………………………………………..

Chief Finance Officer

variations, entered into under section 75 of the Health Act 2006.

Section 75 Memorandum Trading Account for the period 1st April 2019 to 31st March 2020

Adult Mental Health Services Commissioning Pool

Hosted by Nene Clinical Commissioning Group

The format of the memorandum trading account has been agreed by all partners but does not represent the standard practice of

I certify that the above pooled fund memorandum trading account accurately discloses the income received and expenditure

expenditure incurred in accordance with the Partnership Agreement, as amended by any subsequent agreed

Source of Funds

2019/20 2018/19

£000's £000's

NHS Nene Clinical Commissioning Group 5,607 5,423

NHS Corby Clinical Commissioning Group 660 632

NHS Cambridgeshire & Peterborough Clinical Commissioning Group 18 18

Northamptonshire County Council (Public Health) 610 685

Total 6,895 6,758

Application of Funds 2019/20 2018/19

£000's £000's

Contracts

Northamptonshire Healthcare NHS Foundation Trust 6,285 6,073

Targeted Services

Youth Counselling 533 532

Rapid Response 0 75

533 607

Management Costs

Commissioning Team Management Costs 0 0

Other

Communications / Conferences / Publications 22 23

22 23

Participation

Stigma & Participation 55 55

Total Expenditure 6,895 6,758

Net Position (-) underspend 0 0

Notes to the memorandum trading account:1)

CERTIFICATE OF CHIEF FINANCE OFFICER

Signed

Chief Finance Officer

Partnership Agreement, as amended by any subsequent agreed variations, entered into under section 75 of the Health Act 2006.

Section 75 Memorandum Trading Account for the period 1st April 2019 to 31st March 2020

Child Adolescent Mental Health Services Commissioning Pool

Hosted by NHS Nene Clinical Commissioning Group

The format of the memorandum trading account has been agreed by all partners but does not represent the standard practice of grouping expenditure against the

objectives of the pool.

I certify that the above pooled fund memorandum trading account accurately discloses the income received and expenditure


214


APPENDICES

Appendix One: Governing Body Profiles

Paul Bevan, Lay Member (until 30th September 2019) Paul is the lead analyst on data centre infrastructure and services for Bloor Research. In addition to his career in the IT industry Paul joined NHS Northamptonshire Primary Care Trust as a Non-Executive Director in 2009 and moved to NHS Nene CCG on its creation in 2013.

Dr Naomi Caldwell, Interim Commissioning Membership Engagement Executive (from 1st October 2019)

Naomi has been a GP Partner at Langham Place Surgery since 2001 and was appointed as a Macmillan GP in 2013, in addition to her GP roles she was appointed as Clinical Executive Director for Primary Care in June 2015. Naomi continues to work in these three roles and is passionate about improving quality and equity of care for local residents.

Angela Dempsey, Joint Registered Nurse Angela is a passionate and committed nurse leader with over 30 years of experience delivering and/or overseeing acute, community and primary care. She is an experienced Governing Body Nurse with six years’ experience of holding the position for Enfield CCG.

Dr Chris Ellis, GP Commissioning Membership Engagement Executive Chris has been a partner at Queensway Medical Practice, Wellingborough since 2000. He is the GP Registrar Trainer, and became the Senior Partner in 2017. He was appointed the Commissioning Membership Engagement Executive for the North Locality (Kettering, Wellingborough and East

Northants areas) at the end of December 2016

Professor Devaka Fernando, Joint Secondary Care Doctor Professor Devaka Fernando was a consultant physician in diabetes and endocrinology at Sri Jayewardenepura General Hospital and a professor of medicine in the University of Sri Jayewardenepura faculty of health sciences. Since 2005, he has been the head of the Sherwood Forest Hospitals Foundation Trust's Department of Diabetes and Endocrinology. He has held clinical and research fellowships and senior

research fellowships at the University of Manchester, visiting professorships with the University of Newcastle Upon Tyne and the University of Sheffield and an honorary professorship at Sheffield Hallam University.


215


Tansi Harper, Lay Member for Patient & Public Involvement (covered role on interim basis from 18th June 2019)

Tansi's professional career was in education and she was Principal of two colleges as well as working in other public sector and voluntary sector positions before becoming a Regional Consultant for HEFCE for the East Midlands and Northern Ireland. Since retiring Tansi has been Chair of Northamptonshire Probation

Trust and was Chair of CAN, a Northamptonshire based Substance misuse and Crisis Housing Charity, until late 2016 when she merged it with Aquarius. Between the Summer of 2016 to Nov 2017 Tansi chaired the Northamptonshire Sustainable Transformational Plan and she now chairs the STP Collaborative Stakeholder Forum (CSF).

Dr. Tom Howseman, GP Commissioning Membership Engagement Executive (until 30th September 2019)

Tom has been a GP partner with the team at St. Luke’s Primary Care Centre for over a decade. Tom is the Clinical Lead for Learning Disabilities and Dementia for NHS Nene CCG. He was appointed the Commissioning, Membership Engagement, Executive for Northampton, in December 2016. His focus is to help

NHS Nene CCG work towards developing local sustainable General Practice.

Bev Messinger, Lay Member for Patient and Public Involvement (from 2nd September 2019)

Bev is the Chief Executive of the Institution of Occupational Safety and Health (IOSH). A HR/OD professional by background, Bev is a Fellow of the CIPD (Chartered Institute of Personnel and Development) and has focussed in the last decade on major organisational transformation in local and central government, most recently as Senior Director Business Improvement at OFWAT.

Bev is an experienced Charity Trustee and Non-Executive Director having served as a Trustee at KeyRing, and until January 2019 she was a Non-Executive Director and Vice Chair at Northamptonshire Healthcare Foundation Trust.

Richard Moore, Lay Member for Audit and Governance (from 2nd September 2019)

Richard trained as a Chartered Accountant with Ernst & Young and has extensive experience from a number of senior finance and audit based roles at Rolls-Royce plc, Oxfam, BBC Children in Need and Barnardos. He has developed and sold a number of businesses and was CEO of SoccerWorld Group an international leisure retail operator. He has

also held several Non-Executive roles, two within NHS Trusts, firstly at South Staffs and Shropshire Healthcare NHS Foundation Trust and more recently for University Hospitals of Leicester NHS Trust, where he was also Chair of Audit & Risk.


216


Stuart Rees, Joint Chief Finance Officer Stuart has previously been Director of Finance, Contracting and Performance of Shropshire Community Health Trust and Director of Finance & Performance of Shropshire County PCT, having previously held a number of senior positions in the NHS. He has had significant experience in finance, including Deputy

Director of Finance in both secondary and primary care settings after joining the NHS as part of the National Finance Management Training Scheme.

Toby Sanders, Joint Chief Executive Toby Sanders joined as Joint Chief Executive for both NHS Corby and NHS Nene Clinical Commissioning Groups (CCGs) in November 2018. With 15 years of experience in the NHS Toby was previously the Managing Director (Accountable Officer) of West Leicestershire Clinical Commissioning Group, an organisation which he successfully helped

set up and lead for seven years working with its 48 Member Practices to service the 366,000 local population.

Dr. Darin Seiger, GP Chair Dr Darin Seiger is the GP Chair of Nene CCG and has been heavily involved in the management of local NHS commissioning and provider organisations since 2000, having previously been the Medical Director of the GP Out of Hours service for 10 years. He has also been the vice-chair of Northamptonshire’s Health and

Wellbeing Board since 2012.

Dr. Philip Stevens, GP Commissioning Membership Engagement Executive (South Locality)

Philip Stevens as a GP who is committed to Primary Care delivery and the development of Community based care. He has worked as a GP in South Northants since completing GP training and in addition to his work with NHS Nene is involved as a GP trainer. He was appointed the Commissioning, Membership

Engagement, Executive for the South Locality, in December 2016.

Kevin Thomas, Lay Member - Governance (until 30th September 2019) After initially spending the first 12 years of his professional career in professional practice with a firm of chartered accountants. Over the last 20 years, Kevin has subsequently held senior

leadership roles in a number of complex, regulated, customer focused businesses, including an airport and a number of international energy groups.

http://www.neneccg.nhs.uk/profile/50

http://www.neneccg.nhs.uk/profile/undefined-seiger





217


Sam Turner, Lay Member for Finance and Planning ( from 2nd September 2019)

Sam is a qualified Management Accountant (CIMA) and has held a number of executive roles at Network Rail including Finance Director for Property, where she was Finance Lead for the Asset disposals programme totalling c£2bn of sales proceeds before taking on the role of Finance Director – Strategy and Transformation.


218


Appendix Two: Member practices

Abbey House M.C. Abbey Medical Practice

Abington Medical Centre Abington Park Surgery

Albany House Brackley Medical Centre

Brook M.C. The Brook H.C.

Bugbrooke Medical Practice Burton Latimer H.C.

Byfield M.C. Castlefield Surgery

The Cottons M.C. County Surgery

Crescent Medical Centre Crick Medical Practice

Danes Camp Surgery Danetre Medical Practice

Denton Village Surgery Dryland Medical Centre

Earls Barton and Penvale Park M.C. Eleanor Cross Healthcare

Eskdaill Medical Favell Plus Surgery

Greens Norton & Weedon M.P. Greenview Surgery

Harborough Field Surgery Headlands Surgery

Higham Ferrers Surgery Irchester

King Edward Road Surgery Kingsthorpe M.C.

Langham Place Surgery Leicester Terrace H.C.C.

Linden Medical Group Long Buckby Practice

Maple Access Partnership Marshalls Road Surgery

Mawsley Surgery The Meadows Surgery

Moulton Surgery The Mounts M.C.

Nene Valley Surgery Park Avenue M.C

Parklands M.C The Parks Surgery

The Pines Surgery Queensview M.C

Queensway M.C Redwell M.C.

Rillwood M.C. Rothwell & Desborough Health Care Group

Rushden M.C. The Saxon Spires Practice

Spinney Brook M.C. Springfield Surgery

St Lukes Primary Care Centre Summerlee Medical Centre

Towcester M.C. Weavers Medical

Weston Favell H.C. (Dr Jameel) Wollaston Medical Practice

Woodview M.C. Wootton M.C.


219


Other languages and formats

Should you require a copy of the annual report in an alternative language or reading

format, please contact us via one of the methods below:

NHS Nene Clinical Commissioning Group,

Francis Crick House,

Summerhouse Road,

Northampton,

NN3 6BF.

01604 651100

[email protected]

http://www.neneccg.nhs.uk/

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