Constitution...Wrythe Green Surgery Wrythe Lane, Carshalton, Surrey SM5 2RE 3.1.2 Appendix B of this...

Sutton Clinical Commissioning Group

Sutton CCG Constitution 1st April 2018 Draft (Updated Feb 2018)

Constitution



- 2 - Sutton CCG Constitution 1st April 2018 Draft

CONTENTS

1. INTRODUCTION AND COMMENCEMENT ................................................................................ - 3 -

2. AREA COVERED ........................................................................................................................ - 3 -

3. MEMBERSHIP ............................................................................................................................. - 4 -

4. MISSION, VALUES AND AIMS ................................................................................................... - 7 -

5. FUNCTIONS AND GENERAL DUTIES ...................................................................................... - 9 -

6. DECISION MAKING: THE GOVERNING STRUCTURE .......................................................... - 14 -

7. ROLES AND RESPONSIBILITIES ............................................................................................ - 24 -

8. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST .... - 28 -

9. CONSULTATION....................................................................................................................... - 30 -

10. EXTERNAL BODIES ................................................................................................................. - 30 -

11. CONFIDENTIALITY ................................................................................................................... - 30 -

12. NOTICE ..................................................................................................................................... - 31 -

13. PUBLICATION ........................................................................................................................... - 32 -

14. DISPUTE RESOLUTION PROCEDURE .................................................................................. - 32 -

15. THE CCG AS EMPLOYER ........................................................................................................ - 32 -

16. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS ................................... - 33 -

APPENDIX A DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION .................. - 35 -

APPENDIX B LIST OF MEMBER PRACTICES .................................................................................... - 39 -

APPENDIX C AREA OF THE CCG ....................................................................................................... - 40 -

APPENDIX D STANDING ORDERS ..................................................................................................... - 42 -

ANNEX 2: THE SUTTON CCG BOARD .....................................................................................................54

ANNEX 3: LOCALITIES ..............................................................................................................................58

ANNEX 4: BOARD AUDIT COMMITTEE TERMS OF REFERENCE .....................................................67

ANNEX 5: BOARD REMUNERATION COMMITTEE TERMS OF REFERENCE ..................................72

ANNEX 6: COMMITTEES IN COMMON: REMUNERATION COMMITTEE TERMS OF REFERENCE....75

ANNEX 7: BOARD NOMINATIONS COMMITTEE TERMS OF REFERENCE ..........................................76

ANNEX 8: BOARD QUALITY COMMITTEE TERMS OF REFERENCE ....................................................79

ANNEX 9: FINANCE COMMITTEE – TERMS OF REFERENCE .......................................................... - 84 -

ANNEX 10: COMMITTEE FOR COLLABORATIVE DECISION MAKING ............................................. - 88 -

ANNEX 11: PRIMARY CARE COMMISSIONING COMMITTEE – TERMS OF REFERENCE ............. - 93 -

APPENDIX E SCHEME OF RESERVATION & DELEGATION ........................................................... - 104 -

APPENDIX F PRIME FINANCIAL POLICIES ...................................................................................... - 118 -

APPENDIX G NOLAN PRINCIPLES .................................................................................................... - 127 -

APPENDIX H NHS CONSTITUTION ................................................................................................... - 128 -

APPENDIX I DISPUTE RESOLUTION PROCEDURE ........................................................................ - 129 -



1. INTRODUCTION AND COMMENCEMENT

1.1 Name

1.1.1 The name of the CCG is NHS Sutton Clinical Commissioning Group.

1.2 Statutory Framework

1.2.1 Clinical commissioning groups are established under the Health and Social Care Act 2012 (the "2012 Act”). They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 (the "2006 Act”). The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision.

1.2.2 The NHS England is responsible for determining applications from prospective groups to be established as clinical commissioning groups and undertakes an annual assessment of each established group. It has powers to intervene in a clinical commissioning group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.

1.2.3 Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution that meets the requirements of legislation, complies with regulations and takes account of guidance and the model constitution.

1.3 Status of this Constitution

1.3.1 This Constitution is made between the Members of NHS Sutton Clinical Commissioning Group and has effect from 15th February 2013, when it is envisaged the NHS England will establish the CCG. The Constitution is published on the CCG’s website at www.suttonccg.nhs.uk.

1.4 Amendment and Variation of this Constitution

1.4.1 This Constitution can only be varied in two circumstances.

(a) where, following the passing of a Special Resolution by the Members, the Sutton CCG Board applies to the NHS England and that application is granted;

(b) where in the circumstances set out in legislation the NHS England varies the CCG’s Constitution other than on application by the CCG.

2. AREA COVERED

2.1 The geographical Area covered by the CCG and the boundaries of the Localities of the CCG are represented in Appendix C.



3. MEMBERSHIP

3.1 Membership of the Clinical Commissioning Group

3.1.1 The following Practices comprise the Members of the CCG.

Practice Name Address

Beeches Surgery 9 Hill Road, Carshalton, Surrey SM5 3RB

Benhill & Belmont GP Surgery 54 Benhill Avenue, Sutton, Surrey SM1 4EB

Bishopsford Road Medical Centre 191 Bishopsford Road, Morden, Surrey SM4 6BH

Carshalton Fields Surgery 11 Crichton Road, Carshalton Beeches, Surrey SM5 3LS

Cheam Family Practice The Knoll, Parkside, Cheam, Sutton, Surrey SM3 8BS

Chesser Surgery 121 Wrythe Lane, Carshalton, Surrey SM5 2RT

Dr Grice and Partners Old Court House, Throwley Way, Sutton, Surrey SM1 4AF

Faccini House Surgery 64 Middleton Road, Morden, Surrey SM4 6RS

Dr R Scott and Partners 322 Malden Road, North Cheam, Sutton, Surrey SM3 8EP

Dr Muktar and Dr Al-Sanjary 322 Malden Road, North Cheam, Sutton, Surrey SM3 8EP

Dr Jolley and Dr Dutta 322 Malden Road, North Cheam, Sutton, Surrey SM3 8EP

Green Wrythe Surgery Green Wrythe Lane, Carshalton, Surrey SM5 1JF

Grove Road Practice 83 Grove Road, Sutton, Surrey SM1 2DB

Hackbridge Medical Centre 138 London Road, Hackbridge, Carshalton Surrey SM6 7HF

Maldon Road Surgery 35 Maldon Road, Wallington, Surrey SM6 8BL

Manor Practice 57 Manor Road, Wallington, Surrey SM6 0DE

Mulgrave Road Surgery 48 Mulgrave Road, Sutton, Surrey SM2 6LX

Park Road Medical Centre 1a Park Road, Wallington, Surrey SM6 8AW

Robin Hood Lane (Dr Seyan) Robin Hood Lane, Sutton, Surrey SM1 2RJ

Shotfield Medical Practice Jubilee Health Centre, Shotfield, Wallington, Surrey SM6 0HY

Sutton Medical Practice 181 Carshalton Road, Sutton, Surrey SM1 4NG

Wallington Family Practice Jubilee Health Centre, Shotfield, Wallington, Surrey SM6 0HY

Wallington Medical Centre 52 Mollison Drive, Wallington, Surrey SM6 9BY

Well Court Surgery 6 Well Court, 740 London Rd, Cheam, Surrey SM3 9BX

Wrythe Green Surgery Wrythe Lane, Carshalton, Surrey SM5 2RE

3.1.2 Appendix B of this Constitution contains the list of Practices, together with the signatures of the Member Representatives confirming their agreement to this Constitution.

3.2 Eligibility

3.2.1 Providers of primary medical services to a registered list of patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, will be eligible to apply for membership of the CCG.

3.3 Application for Membership

3.3.1 No Practice shall become a Member of the CCG unless that Practice:

(a) is eligible to become a Member in accordance with paragraph 3.2 above;

(b) has completed the application form for membership set out in Annex 1 of Appendix B;

(c) has had its application approved by the NHS England; and



(d) (following approval of the application in accordance with paragraph (c)) has been entered into the Register of Members set out in Appendix B to this Constitution.

3.4 Rights and Responsibilities of Members

3.4.1 Members are entitled to the following benefits:

(a) access to training schemes and on-going skills development;

(b) access to a pooled budget for management of high risk and high cost patients;

(c) access to information and analytical support;

(d) access to management skills to improve commissioning effectiveness and efficiency;

(e) representation of interests via the Locality Leads in the Executive Management Team; and

(f) access to centrally managed savings for on-going service development.

3.4.2 Members are required to deliver the following membership obligations:

(a) to nominate a Member Representative in accordance with paragraph 7.1.1;

(b) to attend via their Member Representative (or their proxy) Locality Meetings and Plenary Meetings;

(c) to manage patient care within the budget delegated to Practice level and to put in place plans to address any overspend;

(d) to attend training or otherwise ensure education appropriate to their Practice development plans and compliance with accredited pathways, protocols and policies;

(e) to work towards adherence to pathways, policies and protocols including the prescribing formulary as agreed by the CCG;

(f) to share information via Locality Leads, QIPP Leads, other key leads and via email cascade, internet and intranet, attendance at key meetings and minutes of meetings.

(g) for each Locality, to elect a Locality Lead to the Sutton CCG Board and the Executive Management Team.

3.5 Cessation of Membership

3.5.1 A Member ceases to be a Member if:

(a) that Member is a sole practitioner GP and he/she:

(i) dies;

(ii) is declared bankrupt;

(iii) ceases to be registered as a medical practitioner;



(iv) enters into partnership with any other medical practitioner, except where that medical practitioner or the partnership is an existing Member;

(v) is suspended from the Performers List other than in the event of a contingent removal;

(vi) is contingently removed from the Performers List, where the Sutton CCG Board, in its absolute discretion, determines that the conditions placed on the Member’s continued inclusion in the Performers List would prevent or inhibit his/her ability to fulfil effectively his/her functions as a Member; and

(vii) is suspended from the Performers List but only during the period of such suspension;

(b) that Member is two or more individuals practising in partnership and:

(i) the conditions in Section 86(2) of the 2006 Act are no longer satisfied.

(c) that Member is a company limited by shares and:

(i) the conditions in Section 86(3) of the 2006 Act are no longer satisfied; or

(ii) in respect of that company any one of the following occurs:

(A) a resolution is passed for voluntary winding up by reason of insolvency;

(B) a winding up order is granted;

(C) a resolution by its directors or members is passed to apply for an administration order;

(D) an administrator is appointed under the Insolvency Act 1986;

(E) a receiver or an administrative receiver is appointed over any of its assets or income;

(F) a statutory demand is issued under the Insolvency Act 1986 which is not discharged before it is advertised; or

(G) it is unable to pay its debts as they fall due as determined by section 123 of the Insolvency Act 1986;

(iii) the Practice ceases to be eligible for membership in accordance with paragraph 3.2.

(d) that Practice merges with any other practice, unless that other practice is an existing Member (and for the avoidance of doubt where two Practices that are Members merge they shall be one Member thereafter for the purposes of this Constitution); or

(e) a Notice of Termination is served on the Member by the NHS England or other relevant regulating body.



4. MISSION, VALUES AND AIMS

4.1 Mission

4.1.1 The mission of the CCG is:

Achieving the best affordable health and wellbeing for the people of Sutton

4.1.2 The CCG will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties.

4.2 Values

4.2.1 We are committed to serving our local population and will ensure they receive safe, committed, compassionate and caring services

4.2.2 We reaffirm the core value and beliefs set out in the NHS Constitution (please see Appendix H)

4.2.3 Our first and most important commitment is to listen to patients.

4.2.4 We also commit to:

• Putting patients first

• Delivering high quality care

• Working together with our providers

• Providing system leadership

• Preventing Problems

• Taking action promptly

4.2.5 Good corporate governance arrangements are critical to achieving the CCGs objectives

4.2.6 We will ensure financial control and provide value for tax payers money

4.3 Aims

4.3.1 The CCG’s aims are to commission high quality cohesive health care services for the population of Sutton through joint working between health and social care organisations, ensuring that patients’ physical, mental and social well-being needs are met.

4.3.2 The CCG believes that patients should be at the heart of decision-making and the CCG will work in partnership with individuals, patient representative groups, families and carers to deliver high quality, accessible services that tackle inequalities and respond to personal needs.

4.3.3 The CCG will strive to establish an efficient and financially stable local healthcare system by improving primary care and community services and working closely with secondary care to redesign and deliver integrated services that bring healthcare into the community and closer to the homes of patients.

4.3.4 The CCG will carry out a process of review and organisational development to develop our capacity to commission high quality services

4.3.5 The CCG will review our culture to ensure that we are all putting patients first.



4.4 Principles of Good Governance

4.4.1 In accordance with section 14L (2)(b) of the 2006 Act, the CCG will at all times observe “such generally accepted principles of good governance” in the way it conducts its business. These include:

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

(b) the Good Governance Standard for Public Services;

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

(d) the seven key principles of the NHS Constitution; and

(e) the Equality Act 2010.

(f) The Standards for Members of NHS Boards and Governing Bodies in England1.

4.5 Accountability

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

(a) publishing this Constitution;

(b) appointing independent Lay Members and non GP clinicians to the Sutton CCG Board;

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

(d) publishing annually a commissioning plan;

(e) complying with local authority health overview and scrutiny requirements;

(f) meeting annually in public to publish and present its annual report (which must be published);

(g) producing annual accounts in respect of each financial year which must be externally audited;

(h) having a published and clear complaints process;

(i) complying with the Freedom of Information Act 2000; and

(j) providing information to the NHS England as required.

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

(a) working collaboratively between the practices and Board, using a range of tools including:

1 Standards for members of NHS boards and CCG governing bodies in England

http://www.professionalstandards.org.uk/publications/detail/standards-for-members-of-nhs-boards-andclinical-commissioning-group-governing-bodies-in-england



• the committee structure of the Sutton CCG Board

• locality structures; and

• plenary dialogue between practices and the CCG Board

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

5. FUNCTIONS AND GENERAL DUTIES

5.1 Functions

5.1.1 The functions that the CCG is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health’s Functions of clinical commissioning groups: a working document. They relate to:

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

(i) all people registered with member GP practices; and

(ii) people who are usually resident within the area and are not registered with a member of any clinical commissioning group;

(b) commissioning emergency care for anyone present in the CCG’s Area;

(c) paying its employees’ remuneration, fees and allowances in accordance with the determinations made by the Sutton CCG Board and determining any other terms and conditions of service of the CCG’s employees;

(d) determining the remuneration and travelling or other allowances of members of the Sutton CCG Board.

5.1.2 In discharging its functions the CCG will:

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

(b) meet the public sector equality duty by:

(i) developing a equality and diversity strategy and monitoring delivery against the associated implementation plan

(c) work in partnership with its local authority, London Borough of Sutton, to develop joint strategic needs assessments and joint health and wellbeing strategies by:

(i) contributing to the work of the Health & Wellbeing Board and to underpinning committees including the One Sutton Board

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

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



(a) the CCG will make arrangements to secure that individuals to whom the services are being or may be provided are involved (whether by being consulted or provided with information in other ways): in the planning of the CCG’s commissioning arrangements;

(b) in the development and consideration of proposals by the CCG for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which the services are delivered to the individuals or the range of health services available to them; and in decisions of the CCG affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact;

(c) the CCG will develop and maintain annually a Patient and Public Involvement/Engagement plan. The plan will outline: how the CCG will work with the Patient Engagement Forum, Healthwatch and other patient organisations; and how the CCG will ensure that the views of patients and their carers will inform commissioning decisions.

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

(a) adhering to the NHS Constitution’s seven principles which are as follows:

The NHS provides a comprehensive service, available to all; Access to NHS services is based on clinical need, not an individual’s ability to pay; The NHS aspires to the highest standards of excellence and professionalism in the provision of high-quality care that is safe, effective and focused on the patient experience; The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population; The NHS is committed to providing best value for taxpayers’ money and the most cost-effective, fair and sustainable use of finite resources; and The NHS is accountable to the public, communities and patients it serves.

The CCG shall, in the exercise of its functions:

• act with a view to securing that health services are provided in a way which promotes the NHS Constitution; and

• promote awareness of the NHS Constitution amongst patients, staff and members of the public.

5.2.3 Act effectively, efficiently and economically by:

(a) securing the most efficient use of resources for patients as determined by the Sutton CCG Board, consistent with statutory obligations

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



(a) exercising functions with a view to securing continuous improvement in the quality of services provided to individuals for or in connection with the prevention, diagnosis or treatment of illness. In particular the CCG must act with a view to securing continuous improvement in the outcomes that are achieved from the provision of the services. These outcomes include, in particular, outcomes which show the: effectiveness of the services; safety of the services and quality of the experience undergone by patients;

(b) learning from complaints by developing a complaints policy with proactive monitoring by a committee of the Sutton CCG Board;

(c) developing a clear line of accountability for patient safety through the Quality committee of the Sutton CCG Board including regular reporting to the National Reporting and Learning System;

(d) ensure effective arrangements are in place to learn from serious incidents and never events;

(e) ensure a clear line of accountability for safeguarding is reflected in the governance arrangements through the Quality Committee and to co-operate with the local authority in the operation of the Local Safeguarding Children Board and the Safeguarding Adults Board;

5.2.5 Assist and support the NHS England in relation to the Board’s duty to improve the quality of primary medical services by:

(a) assisting and supporting the NHS England Authority in discharging its duty under Section 13 E of the Act (NHS England Authority’s duty as to improvement in quality of services) so far as it relates to securing continuous improvement in the quality of primary medical services.

5.2.6 Have regard to the need to reduce inequalities by:

(a) carefully considering inequalities between patients with respect to their ability to access health services;

(b) reduce inequalities between patients with respect to the outcomes achieved for them by the provision of health services;

(c) eliminate discrimination; harassment, victimisation and any other conduct that is prohibited under the Equality Act 2010;

(d) advance equality of opportunity between persons who share a relevant protected characteristic (under the Equality Act 2010) and persons who do not share it;

(e) foster good relations between persons who share a relevant protected characteristic (under the Equality Act 2010) and persons who do not share it; and;

(f) report annually on the CCG’s progress in respect of the Equality & Diversity strategy;

(g) The Equality Delivery System (“EDS”) or future variation shall be used to enable the CCG to meet its requirements in relation to the public sector Equality Duty and aspects of the NHS Constitution and the NHS Outcomes Framework;

(h) The CCG shall champion the use of the EDS to embed areas for improvement within commissioned services;



(i) The Sutton CCG Board will agree a number of equality objectives for the CCG to implement annually, which will be derived from stakeholder consultation. These will be published on the CCG’s website and will form the basis of an action plan for the CCG to improve performance against equality standards and outcomes.

5.2.7 Promote the involvement of patients, their carers and representatives in decisions about their healthcare by:

(a) The CCG shall in the exercise of its functions, promote the involvement of patients, and their carers and representatives (if any), in decisions which relate to the prevention or diagnosis of illness in the patients, or their care or treatment;

(b) The CCG shall have regard to any guidance published by the NHS England in respect of its duty;

(c) The CCG will develop the Patient Engagement Forum to be a key advisory body in the development of the CCG’s commissioning strategy;

5.2.8 Act with a view to enabling patients to make choices by:

(a) Enabling patients to make choices with respect to aspects of health services provided to them;

(b) The CCG will uphold the principles of patient choice in ensuring that services it directly commissions promote patient choice;

(c) The CCG will ensure its Complaints function supports patients with issues over patient choice;

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

(a) ensuring the CCG effectively discharges its functions from persons who together have a broad range of professional expertise in the prevention, diagnosis and treatment of illness and the protection or improvement of public health;

(b) having regard to any Guidance issued by the NHS England Authority in respect of this duty;

(c) obtaining appropriate specialist (e.g. legal) advice when required in order to execute its legislative requirements fully.

5.2.10 Promote innovation by:

(a) promoting continuous improvement in its commissioned services - this will ensure better health outcomes are attained;

(b) promote health outcomes through a commitment to increasing the use of alternatives to block contracts, for example, payment by outcomes.

5.2.11 Promote research and the use of research by:

(a) encouraging research on matters relevant to the health service and the use of the health service of evidence obtained from research;



(b) work with local providers and across organisational boundaries to understand how the latest evidence can be commissioned within its contracts

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

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

(a) fostering an improvement in the quality of those services (including the outcomes that are achieved from their provision);

(b) reducing inequalities between persons with respect to their ability to access those services; or

(c) reducing inequalities between persons with respect to the outcomes achieved for them by the provision of those services;

(d) The CCG will work with local stakeholders and across organisational boundaries to develop needs and evidence based services;

(e) The CCG will ensure understanding of whole-system pathways and explore opportunities for integration to improve overall outcomes.

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

5.3.1 Ensure its expenditure does not exceed the aggregate of its allotments for the financial year

5.3.2 Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by the NHS England for the financial year

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

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

5.4 Other Relevant Regulations, Directions and Documents

5.4.1 The CCG will:

(a) comply with all relevant regulations;

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

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

(d) The CCG will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this Constitution, its Scheme of Reservation and Delegation and other relevant CCG policies and procedures.



6. DECISION MAKING: THE GOVERNING STRUCTURE

6.1 Authority to act

6.1.1 The CCG is accountable for exercising the statutory functions of the CCG. It may grant authority to act on its behalf to:

(a) any of its Members;

(b) the Sutton CCG Board;

(c) employees; and

(d) a committee or sub-committee of the CCG.

6.1.2 The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the CCG as expressed through:

(a) the CCG’s Scheme of Reservation and Delegation; and

(b) for committees, their terms of reference.

6.2 Scheme of Reservation and Delegation

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

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

(b) those decisions that are the responsibilities of the Sutton CCG Board (and its committees), the CCG’s committees and sub-committees, individual members and employees.

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

6.3 General

6.3.1 In discharging functions of the CCG that have been delegated to them, the Sutton CCG Board, its committees and individuals must:

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

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

(c) comply with the CCG’s Standing Orders;

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

(e) where appropriate, ensure that Member practices have had the opportunity to contribute to the CCG’s decision making process.

6.3.2 When discharging their delegated functions CCG committees must also operate in accordance with their approved terms of reference.

6.3.3 Where delegated responsibilities are being discharged collaboratively with any organisation other than a CCG or NHS England, the collaborative arrangements must:



(a) identify the roles and responsibilities of those groups who are working together;

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

(c) specify under which group’s Scheme of Reservation and Delegation and supporting policies the collaborative working arrangements will operate;

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

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

(f) specify how decisions are communicated to the collaborative partners.

6.4 Committees of the CCG

6.4.1 The following committees have been established by the CCG:

(a) Audit Committee – accountable to the Sutton CCG Board The Audit Committee may meet as a “Committees in Common” with other

CCGs using additional Terms of Reference as set out in the Audit Committee ToR Addendum;

(b) Remuneration Committee – accountable to the Sutton CCG Board; The Remuneration Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Remuneration Committee ToR Addendum;

(c) Nominations Committee – accountable to the Sutton CCG Board; The Nominations Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Nominations Committee ToR Addendum;

(d) Quality Committee – accountable to the Sutton CCG Board; The Quality Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Quality Committee ToR Addendum;

(e) Finance Committee – accountable to the Sutton CCG Board

The Finance Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Remuneration Committee ToR Addendum;

(f) Committees in Common for Collaborative Decision Making – accountable to the Sutton CCG Board

The Committee for Collaborative Decision Making always meets using a “Committees in Common” arrangement with other CCGs;

(g) Primary Care Commissioning Committee - accountable to the Sutton CCG Board

The Primary Care Commissioning Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Primary Care Commissioning Committee ToR Addendum;



The Terms of Reference for these committees can be found as annexes of the Sutton CCG Standing Orders

6.4.2 Committees will only be able to establish their own sub-committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the CCG or the committee they are accountable to.

Joint Arrangements

Joint commissioning arrangements with other Clinical Commissioning Groups

6.4.3 The CCG may wish to work together with other CCGs in the exercise of its commissioning functions.

6.4.4 The CCG may make arrangements with one or more CCGs in respect of:

• delegating any of the CCG’s commissioning functions to another CCG;

• exercising any of the commissioning functions of another CCG; or

• exercising jointly the commissioning functions of the CCG and another CCG

6.4.5 For the purposes of the arrangements described at paragraph 6.5.2, the CCG may:

• make payments to another CCG;

• ii. receive payments from another CCG;

• make the services of its employees or any other resources available to another CCG; or

• receive the services of the employees or the resources available to another CCG.

6.4.6 No arrangements may be made under clause 6.5.2.i without the approval of the Sutton CCG Board, which may only be given following approval of the proposed arrangements at a meeting of the plenary.

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

6.4.8 For the purposes of the arrangements described at paragraph 6.5.2 above, the CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph 6.5.2.iii above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.4.9 Where the CCG makes arrangements with another CCG as described at paragraph 6.5.2 above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of:

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

• The duties and responsibilities of the parties;

• How risk will be managed and apportioned between the parties;

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

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

6.4.10 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 6.5.2 above.



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

6.4.12 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Sutton CCG Board.

6.4.13 The Sutton CCG Board shall require, in all joint commissioning arrangements, that the lead clinician and lead manager of the lead CCG make a quarterly written report to the Sutton CCG Board and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

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

Joint commissioning arrangements with NHS England for the exercise of CCG functions

6.4.15 The CCG may wish to work together with NHS England in the exercise of its commissioning functions.

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

6.4.17 The arrangements referred to in paragraph 6.5.14 above may include other CCGs.

6.4.18 Where joint commissioning arrangements pursuant to 6.5.14 above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question.

6.4.19 Arrangements made pursuant to 6.5.14 above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG.

6.4.20 Where the CCG makes arrangements with NHS England (and another CCG if relevant) as described at paragraph 6.5.14 above, the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of:

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

• The duties and responsibilities of the parties;

• How risk will be managed and apportioned between the parties;

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

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

6.4.21 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 6.5.14 above.





6.4.24 The Sutton CCG Board shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a quarterly written report to the Sutton CCG Board and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

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

Joint commissioning arrangements with NHS England for the exercise of NHS England’s functions

6.4.26 The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specified NHS England functions.

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

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

▪ Jointly exercise such functions as specified with NHS England.

6.4.28 Where arrangements are made for the CCG and, where applicable, other CCGs to exercise functions jointly with NHS England a joint committee may be established to exercise the functions in question.

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

6.4.30 For the purposes of the arrangements described at paragraph 6.5.25 above, NHS England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.4.31 Where the CCG enters into arrangements with NHS England as described at paragraph 6.5.25 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of:

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

▪ The duties and responsibilities of the parties;

▪ How risk will be managed and apportioned between the parties;

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

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

6.4.32 The liability of NHS England to carry out its functions will not be affected where it and the CCG enter into arrangements pursuant to paragraph 6.5.25 above.





6.4.35 The Sutton CCG Board shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a quarterly written report to the Sutton CCG Board and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

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

Existing arrangements (April 2018)

6.4.37 The CCG has entered into joint arrangements with the following clinical commissioning group(s):

a) NHS South West London CCG Groups – Framework for Collaboration

• Croydon CCG

• Kingston CCG

• Merton CCG

• Richmond CCG

• Wandsworth CCG These joint arrangements are supported by a SW London Collaboration Framework and Memorandum of Understanding between the above CCGs to ensure opportunities for developing and implementing the Sustainability and Transformation Plan.

b) SWL Committees in Common for – Collaborative Decision Making

• Croydon CCG

• Kingston CCG

• Merton CCG

• Richmond CCG

• Wandsworth CCG A Committees in Common arrangement established for the purpose of Collaborative Decision Making of organisational and health care plans with nearby CCGs.

c) SWL Committees in Common Remuneration Committee

• Kingston CCG

• Merton CCG

• Richmond CCG

• Wandsworth CCG A Committees in Common arrangement has been established for a common approach to decisions made by the Remuneration Committees of the participating organisation.

d) SWL Alliance Shared Executive Management

• Kingston CCG

• Merton CCG

• Richmond CCG

• Wandsworth CCG The SWL Alliance has a Memorandum of Understanding that sets out how the functions delegated to the Accountable Officer and Chief Finance Officer will be managed across all five organisations including the option of appointing shared post holders.



6.4.38 The CCG has entered into joint arrangements with NHS England:

• Primary Care Commissioning Committee

The Governing Body shall, in partnership with NHS England establish a Primary Care Commissioning Committee. The composition of the Primary Care Commissioning Committee shall accord with any published national guidance.

The Primary Care Commissioning Committee shall be chaired by a Lay member, and the duties and responsibilities of the Primary Care Commissioning Committee shall include:

o Carrying out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act except those relating to individual GP performance management, which have been reserved to NHS England.

o Exercise its management of the functions in accordance with the agreement entered into between NHS England and the CCGs, which will sit alongside the delegation and terms of reference

o Participating in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

6.4.39 The CCG has entered into joint arrangements with the London Borough of Sutton:

• Health and Wellbeing Board.

6.5 The Sutton CCG Board

6.5.1 Functions - the Sutton CCG Board has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this Constitution. The Sutton CCG Board may also have functions of the CCG delegated to it by the CCG. Where the CCG has conferred additional functions on the Sutton CCG Board connected with its main functions, or has delegated any of the CCG’s functions to its Sutton CCG Board, these are set out from paragraph 6.6.1(d) below. The Sutton CCG Board has responsibility for:

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

(b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act;

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

(d) promote the involvement of all Members in the work of the CCG in securing improvements in commissioning of care and services;

(e) in a collaborative approach within the local health system with patients, the public and other stakeholders and promote the involvement of patients and their carers and representatives (if any) in decisions about the provision of health services to patients;



(f) engage with each relevant Health and Wellbeing Board and nominate a member of the Sutton CCG Board to act as its representative in relation to each such Health and Wellbeing Board;

(g) secure effective clinical engagement in the decisions of the CCG;

(h) prepare the Annual Plan to present to the Members at the AGM;

(i) keep proper accounts and proper records and prepare the Accounts to present to the Members acting through their Member Representatives at the AGM;

(j) prepare the Annual Report to present to the Members acting through their Member Representatives at the AGM;

(k) ensure quality governance arrangements are working effectively;

(l) ensure Members are familiar with and undertake training in procurement law and ensure Members are familiar with all relevant policy and guidance, in particular the “Procurement guide for commissioners of NHS-funded services” and the “Principles and Rules for Co-operation and Competition”

(m) establish any links and working arrangements with other clinical commissioning groups or strategic, regional or other commissioning groups, as may from time to time be deemed appropriate;

(n) ensure that the register of interest is reviewed, regulated and updated as necessary;

(o) co-ordinate and plan for demand, financial and investment needs of the CCG;

(p) participate in and monitor clinical networks;

(q) confirm or amend the boundaries of the Localities annually.

6.5.2 Members of the Sutton CCG Board

The following may become members of the Sutton CCG Board:

(a) a Member of the CCG who is an individual;

(b) an individual appointed by virtue of Regulations in the Act;

(c) individuals who are Health Care Professionals;

(d) individuals who are Lay Persons; and

(e) individuals who are otherwise specified in this Constitution.

Further provisions detailing the eligibility requirements for membership of the Sutton CCG Board and the circumstances in which membership of the Sutton CCG Board may be terminated are described in Appendix D.

6.6 Composition of the Sutton CCG Board

6.6.1 The Sutton CCG Board shall have no more than fifteen (15) members and comprises of:

(a) the Accountable Officer;



(b) the Chair;

(c) the Chief Finance Officer ("CFO");

(d) the Managing Director (“MD”)

(e) the Vice Chair (the role of Vice Chair may be filled by a Lay Member)

(f) five (5) Independent Members that shall be:

(i) three (3) Lay Members - Governance & Audit, PPI & Quality and Performance

(ii) a registered independent nurse; and

(iii) an independent secondary care doctor;

(g) three (3) GP Members, mandated by CCG practices

(h) Medical Director

(i) Director of Public Health for Sutton; and

(j) Allied Health Professional/Primary Care Nurse, mandated by local primary care nurses/Allied Health Professionals

6.6.2 The Sutton CCG Board shall have the power to co-opt other non-voting attendees as it sees fit from time to time. This could include the Local Medical Committee and Sutton Healthwatch.

6.6.3 The members of the Sutton CCG Board shall be required to abide by the Nolan Principles as befits the CCG being a public body and shall abide by any other values and behaviours agreed by the Sutton CCG Board.

6.6.4 In acting as a member of the Sutton CCG Board, each member of the Sutton CCG Board shall:

(a) promote the success of the CCG for the benefit of the Members as a whole;

(b) act within the powers set out in this Constitution;

(c) exercise independent judgement;

(d) exercise reasonable care, skill and diligence;

(e) declare any interest (and, if relevant, of the Member they represent) in any proposed transaction or arrangement with or being considered by the CCG;

(f) avoid conflicts of interest; and

(g) not accept benefits from third parties.

6.7 Committees of the Sutton CCG Board

6.7.1 The Sutton CCG Board has appointed the following committees and sub-committees. These committees may operate using a Committees in Common arrangement, as described in their Terms of Reference.

• Audit Committee – the Audit Committee, which is accountable to the Sutton CCG Board, provides the Sutton CCG Board with an independent and objective view of the CCG’s financial systems, financial information and compliance with laws, regulations and



directions governing the CCG in so far as they relate to finance. The Sutton CCG Board has approved and keeps under review the terms of reference for the Audit Committee, which includes information on the membership of the Audit Committee.

• Remuneration Committee – the Remuneration Committee, which is accountable to the Sutton CCG Board makes recommendations to the Sutton CCG Board on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme. The Sutton CCG Board has approved and keeps under review the terms of reference for the Remuneration Committee, which includes information on the membership of the Remuneration Committee.

• Nominations Committee – the Nominations Committee, which is accountable to the Sutton CCG Board, which oversees the election and/or appointment of the members of the Sutton CCG Board and the Locality Leads. The Sutton CCG Board has approved and keeps under review the terms of reference for the Nominations Committee, which includes information on the membership of the Nominations Committee.

• Executive Management Team – the Executive Management Team is responsible for recommending to the Sutton CCG Board the strategic, business and financial plan for the CCG taking into account the input of the Localities and Patient Engagement Forum and implementing the business plan within the constraints of the financial plan. The Sutton CCG Board has approved and keeps under review the terms of reference for the Executive Management Team, which includes information on the membership of the Executive Management Team.

• Quality Committee – the Quality Committee, which is accountable to the CCG’s Sutton CCG Board, provides assurance on the quality of services commissioned, promotes a culture of continuous improvement and innovation with respect to clinical effectiveness and patient experience, safeguarding, equality, infection control, information governance and risk. The Sutton CCG Board has approved and keeps under review the terms of reference for the Quality Committee, which includes information on the membership of the Quality Committee.

• Finance Committee - The Finance Committee which is accountable to the Sutton CCG Board is to ensure a robust financial strategy is in place and to oversee the organisation-wide system of financial management. The Sutton CCG Board has approved and keeps under review the terms of reference for the Finance Committee, which includes information on the membership of the Finance Committee.

• Primary Care Commissioning Committee – The Primary Care Commissioning Committee which is accountable to the Sutton CCG Board is to ensure the delivery of functions relating to the commissioning of primary medical services under section 83 of the NHS Act except those relating to individual GP performance management, which have been reserved to NHS England. The Sutton CCG Board has approved and keeps under review the terms of reference for the Primary Care Commissioning Committee, which includes information on the membership of the Primary Care Commissioning Committee.

• Committee for Collaborative Decision Making – The Committee for Collaborative Decision Making which is accountable to the Sutton CCG Board is to take decisions on any healthcare service changes proposed as part of the current South West London Strategic Commissioning Plan. (In 2017, this is called the Sustainability and Transformation Plan.). The Sutton CCG Board has approved and keeps under review the terms of reference for the Committee for Collaborative Decision Making, which includes information on the membership of the Committee for Collaborative Decision Making Committee. The Committee for Collaborative Decision Making always operates



in a Committees in Common arrangement.

7. ROLES AND RESPONSIBILITIES

7.1 Member Representatives

7.1.1 Each Member shall nominate one (1) Member Representative who is either a GP partner or salaried GP of that Practice. The name of the Member Representative must be submitted in writing to the Sutton CCG Board.

7.1.2 Each Member may remove and replace their Member Representative at any time, by notice in writing to the Sutton CCG Board.

7.1.3 For the avoidance of doubt, the Sutton CCG Board shall be entitled to treat any Member Representative as having the continuing authority given to him until it is notified in writing of the removal of that Member Representative in accordance with paragraph 7.1.2 and any provision of this Constitution that requires delivery or notification to a Member shall be deemed to have been satisfied if delivery or notification is made to or served on the relevant Member Representative.

7.1.4 The role of each Member Practice is to:

(i) represent their appointing Member views and act on behalf of them in respect of CCG matters;

(ii) be the representative of their appointing Member on the Locality Team and at Plenary Meetings;

(iii) manage patient care within the budget delegated to them;

(iv) adhere to pathways, policies and protocols developed by the CCG;

(v) share information;

(vi) identify a practice lead Member Representative;

(vii) secure attendance at locality meetings and the quarterly plenary;

(viii) elect a Locality Lead to the Sutton CCG Board and Executive Management Team;

(ix) support practice nurse and practice manager involvement in commissioning;

(x) attend appropriate training;

(xi) contribute to the overall development of the CCG at a practice level;

(xii) allow interested individuals the personal development to contribute to the CCGs work.

7.2 All Members of the CCG’s Sutton CCG Board

7.2.1 Each member of the Sutton CCG Board should share responsibility as part of a team to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this



Constitution. Each should bring their unique perspective, informed by their expertise and experience

7.3 The Chair and Vice Chair of the Sutton CCG Board

7.3.1 The Chair of the Sutton CCG Board is responsible for:

(a) leading the Sutton CCG Board, ensuring it remains continuously able to discharge its duties and responsibilities as set out in this Constitution;

(b) building and developing the CCG’s Sutton CCG Board and its individual members;

(c) ensuring that the CCG has proper constitutional and governance arrangements in place;

(d) ensuring that, through the appropriate support, information and evidence, the Sutton CCG Board is able to discharge its duties;

(e) supporting the Accountable Officer in discharging the responsibilities of the organisation;

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

(g) leading and influencing to achieve clinical and organisational change to enable the CCG to deliver its commissioning responsibilities;

(h) overseeing governance and particularly ensuring that the Sutton CCG Board and the wider CCG behaves with the utmost transparency and responsiveness at all times;

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

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

(k) ensuring that the CCG builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the relevant local authority(ies).

7.3.2 Where the Chair of the Sutton CCG Board is also the senior clinical voice of the CCG they will take the lead in interactions with stakeholders, including the NHS England.

7.3.3 The Chair and Vice Chair shall be appointed by the Sutton CCG Board.

7.3.4 The Chair shall be a GP if the Accountable Officer is not a GP and the Vice Chair shall be a Lay Member if the Chair is a GP.

7.3.5 The Vice Chair shall take the Chair’s role for discussions and decisions involving a conflict of interest for the Chair or where he or she is otherwise unable to act.

7.3.6 The Chair and Vice Chair may be removed from office by a week’s written notice to all voting members, the Sutton CCG Board has the authority to remove the post holder by 75% majority vote of a quorate meeting or by the direct intervention of the Secretary of State.

7.4 Role of the Accountable Officer

7.4.1 The Accountable Officer of the CCG is a member of the Sutton CCG Board.



7.4.2 The role of the Accountable Officer2 is:

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

(b) at all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through the National Audit Office and internal and external audit) is embodied and that safeguarding of funds is ensured through effective financial and management systems

(c) working closely with the Chair of the Sutton CCG Board, the Accountable Officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the Members (through the Sutton CCG Board) of the organisation’s ongoing capability and capacity to meet its duties and responsibilities. This will include arrangements for the ongoing developments of its Members and staff

(d) ensuring the CCG complies with its obligations under:

(i) section 14P of the 2006 Act to promote the NHS Constitution;

(ii) sections 223H to 223J of the 2006 Act;

(iii) paragraphs 16 to 18 of Part 1 of Schedule 1A of the 2006 Act; and

(e) Other duties also include:

• leading and influence clinical and organisational change to enable the

CCG to deliver commissioning responsibilities;

• having the respect and authority of the CCG member practices;

• working closely with the senior management of the CCG and be able

to do so in a constructive and supportive manner

7.4.3 The Accountable Office is a Clinician (Clinical Accountable Officer) will take the lead in interactions with stakeholders, including the NHS England.

7.4.4 The Sutton CCG Board may authorise the Accountable Officer to fulfil this role for more than one clinical commissioning group (such an appointment is referred to as a “joint appointment”) at its discretion.

7.5 Role of the Chief Finance Officer

7.5.1 The Chief Finance Officer is a member of the Sutton CCG Board and is responsible for providing financial advice to the CCG and for supervising financial control and accounting systems.

7.5.2 This role of the Chief Finance Officer 3 is:

(a) being the Sutton CCG Board’s professional expert on finance and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged

2 See the latest version of the NHS England Authority’s Clinical commissioning group Sutton CCG Board members: Role outlines,

attributes and skills 3 See the latest version of the NHS England Authority’s Clinical commissioning group Sutton CCG Board members: role outlines,

attributes and skills



(b) making appropriate arrangements to support, monitor on the CCG’s finances

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

(d) being able to advise the Sutton CCG Board on the effective, efficient and economic use of the CCG’s allocation to remain within that allocation and deliver required financial targets and duties;

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

(f) ensuring the discharge of obligations by the CCG under relevant financial directions including:

• implementing the CCG's financial policies and for co-coordinating any corrective action necessary to further these policies;

• maintaining an effective system of internal financial control including ensuring that detailed financial procedures and systems incorporating the principles of separation of duties and internal checks are prepared, documented and maintained to supplement these instructions;

• ensuring that sufficient records are maintained to show and explain the CCG's transactions, in order to disclose, with reasonable accuracy, the financial position of the CCG at any time; and

• the preparation and maintenance of such accounts, certificates, estimates, records and reports as the CCG may require for the purpose of carrying out its statutory duties; and

(g) other duties also include:

• ensuring the CCG commissions the highest quality services with a view

to securing the best possible outcomes for their patients within their

resource allocation and maintains a consistent focus on quality,

integration and innovation

• ensuring the CCG, when exercising its functions, acts with a view to

securing that health services are provided in a way which promotes the

NHS Constitution, that it is there to improve our health and wellbeing,

supporting us to keep mentally and physically well, to get better when we

are ill and when we cannot fully recover, to stay as well as we can to the

end of our lives; and

• ensuring good governance remains central at all times

• leading the development of a culture of effective financial stewardship at

all levels of the CCG including the delivery of relevant training and

support mechanisms for GP practices and localities to monitor and

manage commissioning budgets

• building up a knowledge base of the respective financial positions and

performance of all key partner agencies engaged in health and well-being

in Sutton

• contribute to resources planning across agency boundaries to enable the

most effective deployment of resources for optimal health gain for the

Sutton population.

7.5.3 The Sutton CCG Board may permit the CFO to hold this role for more than one clinical commissioning group (such an appointment is referred to as a “joint appointment”) at its discretion.



7.6 Role of the Medical Director

7.6.1 The Medical Director is a non-executive with clinical expertise who provides independent clinical leadership to the Sutton CCG Board.

7.6.2 The Medical Director, in addition to generic Sutton CCG Board responsibilities, will:

• Oversee the leadership development of Locality and Clinical Leads;

• Chair Board committees that benefit from independent clinical expertise.

7.7 Role of the Managing Director

7.7.1 The Managing Director will

• provide local leadership and direction to develop and implement local commissioning strategies and plans that progressively improve and transform health care for local people;

• together with the Accountable Officer and Chair, share responsibility for the continuous development of the CCG, including enabling increased involvement of the member practices and the professional development of employees.

7.8 Joint Appointments with other Organisations

7.8.1 The CCG will seek to establish joint appointments with other organisations where it is best able to fulfil commissioning functions:

7.8.2 All joint appointments will be supported by a memorandum of understanding between the organisations who are party to these joint appointments.

8. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST

8.1 Standards of Business Conduct

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

8.1.2 They must comply with the CCG’s policy on business conduct, including the requirements set out in the policy for managing conflicts of interest. This policy is available on the CCG’s website.

8.1.3 Individuals contracted to work on behalf of the CCG or otherwise providing services or facilities to the CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services.

8.2 Conflicts of Interest

8.2.1 As required by section 14O of the 2006 Act, as inserted by section 25 of the 2012 Act, the CCG will make arrangements to manage conflicts and potential conflicts of

http://www.suttonccg.nhs.uk/News-Publications/publications/Key%20publications/GB%20Approved%20SCCG%20Conflicts%20Of%20Interest%20Policy.pdf



interest to ensure that decisions made by the CCG will be taken and seen to be taken without any possibility of the influence of external or private interest.

8.2.2 All nominations for a decision-making role within the CCG must make a Declaration of Interests and during the selection (ie before appointment) an assessment must be made whether the candidate can fulfil the role with their other interests.

8.2.3 Where an individual, i.e. an employee, Member, member of the Sutton CCG Board, or a member of a committee or a sub-committee of the CCG or the Sutton CCG Board has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this Constitution.

8.2.4 The CCG shall appoint a Conflict of Interest Guardian who will normally be the Audit Committee Chair and whose responsibilities shall be to:

o Act as a conduit for GP practice staff, members of the public and healthcare

professionals who have any concerns with regards to conflicts of interest;

o Be a safe point of contact for employees or workers of the CCG to raise any

concerns in relation to this policy;

o Support the rigorous application of conflict of interest principles and policies;

o Provide independent advice and judgment where there is any doubt about

how to apply conflicts of interest policies and principles in an individual

situation;

o Provide advice on minimising the risks of conflicts of interest.

8.2.5 Managing Breaches in the Conflict of Interest Policy

8.2.6 All Group members and staff are encouraged to report a suspected breach of the Conflicts of Interest Policy to the Director of Governance and Compliance or the Conflict of Interest Guardian. A suspected breach may also be reported by a patient, member of the public or the media.

8.2.7 An investigation of the suspected breach will take place using the “Process for managing breaches of the Group’s Conflict of Interest Policy”. This available as an appendix of the Group’s Conflict of Interest Policy and is available on the Group’s website.

8.3 Transparency in Procuring Services

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

8.3.2 The CCG will publish a Procurement Strategy approved by its Sutton CCG Board which will ensure that:

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



(b) service redesign and procurement processes are conducted in an open, transparent, non-discriminatory and fair way.

8.3.3 Copies of this Procurement Strategy will be available on the CCG’s website.

9. CONSULTATION

9.1 The CCG shall promote among its Members and shall itself abide by the Duty of Candour.

9.2 The CCG will be responsible for ensuring that patients and the public are fully consulted and involved in the annual commissioning plan. This will include publishing an engagement strategy.

10. EXTERNAL BODIES

10.1 The CCG shall in line with the 2006 Act ensure that its plans are shaped and informed by the Health and Wellbeing Board’s strategy and priorities.

10.2 The CCG will play a full and active involvement in the Health and Wellbeing Board attending meetings and contributing to the development of the local Health and Wellbeing Strategy.

10.3 The CCG shall have ongoing relationships and discussions with other clinical commissioning groups and provider organisations to enable the development of long term strategy and plans for the wider transformation of services.

10.4 The CCG will look to further develop integrated care arrangements including the pooling of budgets with local partners where this is deemed in the best interests of the people of the Area and is in line with legislation including section 75 agreements under the 2006 Act.

10.5 The CCG recognises the role of the Sutton and Merton Local Medical Committee (LMC) in representing the professional interests of GPs in the Borough. The LMC and CCG share a common membership. The CCG shall aim to build and maintain a strong, open and effective collaborative relationship with the LMC.

10.6 In discharging its functions, the CCG, through the Board and committees, shall engage the LMCs on decisions that impact on their practices in their delivery of primary care services, and individual general practitioners in their professional role; this will include regular attendance at meetings, by agreement.

10.7 The CCG will seek to comply with any requirements set out by the NHS England as a requirement of authorisation.

11. CONFIDENTIALITY

11.1 Sutton Clinical Commissioning Group supports the need for openness and transparency when carrying out its functions. However there is an absolute need to balance openness with the need to protect information that is deemed to be properly confidential

11.2 While conversations about confidentiality often revolve around person identifiable information (about patients, staff or others), it is also not always possible to have complete openness about some non-person identifiable information. For example, tenders submitted by potential providers are commercially confidential, and “what if” discussions on, for example provider



reconfiguration or the investigation of a Serious Incident might well cause unnecessary public anxiety if released prematurely.

11.3 To balance the need for openness with the need to preserve confidentiality on some matters, Sutton CCG will corporately and individually work to the following principles

11.3.1 Person identifiable information (patients, staff, others) will be handled by Sutton CCG according to the standards set for the NHS as a whole and in accordance with the law

11.3.2 It is accepted that some information gained during the course of negotiations, discussions and investigations will need to be treated as confidential for commercial reasons or because it is incomplete and premature public release would be misleading. In such situations any requests that information remains confidential must be carefully considered. One test that may be applied is whether there would be legitimate reason to withhold the information in response to a Freedom of Information Act request.

11.3.3 The CCG (in the form of a nominated officer or officers) may advise that the confidentiality of a particular piece of non-person identifiable information should be maintained. A clear reason for the decision must be given. All such instances will be reported to the Sutton CCG Quality Committee for their consideration and a record should be kept. This will act as a check that information is not being held back inappropriately.

11.3.4 Sutton CCG recognizes and confirms that nothing in or referred to in this Constitution

(including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any Member Practice (or individual within that Member Practice) of the Sutton Clinical Commissioning Group, any member of its Governing Body, any member of its Committees or sub-committees or any employee, nor will it affect the rights of any worker (as defined in that Act) under that Act.

11.4 Sutton CCG will draw up internal guidelines on this area to support individuals and organisations listed in 11.3.4 above.

12. NOTICE

12.1 A notice under this Constitution:

12.1.1 shall be in writing in the English language (or be accompanied by a properly prepared translation into English);

12.1.2 shall be sent for the attention of the person, and to the address, or fax number, for that member of the Sutton CCG Board, Member or Member Representative stated in the Register of Members from time to time; and

12.1.3 shall be:

(a) delivered personally; or

(b) sent by fax; or

(c) sent by pre-paid first-class post, recorded delivery or registered post.



(d) By email..

12.2 A notice is deemed to have been received:

12.2.1 if delivered personally, at the time of delivery;

12.2.2 if sent by fax or email, two (2) hours after transmission;

12.2.3 in the case of pre-paid first class post, recorded delivery or registered post, forty eight (48) hours from the date of posting.

12.3 If deemed receipt under paragraph 12.2 is not within business hours (meaning 9.00 am to 5.30 pm) on a Business Day, deemed receipt will be at 9.00am on the next Business Day.

12.4 To prove service it is sufficient to prove that:

12.4.1 in the case of a delivery by hand, that the notice was delivered to or left at the correct address;

12.4.2 in the case of posting, that the envelope containing the notice was properly addressed and posted; or

12.4.3 in the case of fax that the notice was properly addressed and dispatched to the correct number.

13. PUBLICATION

13.1 This Constitution, and any variation to the Constitution, shall be published on the website of the CCG.

14. DISPUTE RESOLUTION PROCEDURE

14.1 The CCG shall apply the Dispute Resolution Procedure set out at Appendix I to this Constitution in regard to disputes relating to the CCG:

14.1.1 between Members and/or potential Members in relation to matters of eligibility and disqualification;

14.1.2 with Member Representatives and/or members of the Sutton CCG Board in relation to matters of eligibility, disqualification and termination of tenure; and

14.1.3 between the Members and the Sutton CCG Board in relation to the interpretation and application of their respective powers and obligations under this Constitution.

15. THE CCG AS EMPLOYER

15.1 The CCG recognises that its most valuable asset is its people. It will seek to enhance their skills and experience and is committed to their development in all ways relevant to the work of the CCG

15.2 The CCG will seek to set an example of best practice as an employer and is committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally

15.3 The CCG will ensure that it employs suitably qualified and experienced staff who will discharge their responsibilities in accordance with the high standards expected of staff employed by the



CCG. All staff will be made aware of this Constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work

15.4 The CCG will maintain and publish policies and procedures (as appropriate) on the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The CCG will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters

15.5 The CCG will ensure that its rules for recruitment and management of staff provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff

15.6 The CCG will ensure that employees' behaviour reflects the values, aims and principles set out above

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

15.8 The CCG will ensure that its employees have access to such expert advice and training opportunities as they may require in order to exercise their responsibilities effectively

15.9 The CCG will adopt a Code of Conduct for staff and will maintain and promote effective 'whistleblowing' procedures to ensure that concerned staff have means through which their concerns can be voiced

15.10 Copies of this Code of Conduct, together with the other policies and procedures outlined in this chapter, will be available on the CCG’s website

16. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS

16.1 General

16.1.1 The CCG will publish annually a commissioning plan and an annual report, presenting the CCG’s annual report to a public meeting.

16.1.2 Key communications issued by the CCG, including the notices of procurements, public consultations, Sutton CCG Board meeting dates, times, venues, and certain papers will be published on the CCG’s website.

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

16.2 Standing Orders

16.2.1 This Constitution is also informed by a number of documents which provide further details on how the CCG will operate. They are the CCG’s:

(a) Standing Orders (Appendix D) – which sets out the arrangements for meetings and the appointment processes to elect the CCG’s representatives and appoint to the CCG’s committees, including the Sutton CCG Board;

(b) Scheme of Reservation and Delegation (Appendix E) – which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the CCG’s Sutton CCG Board, the Sutton CCG Board’s committees and sub-committees, the CCG’s committees and sub-committees, individual members and employees;



(c) Prime Financial Policies (Appendix F) – which sets out the arrangements for managing the CCG’s financial affairs.



APPENDIX A DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

• In this Constitution, unless the context requires otherwise, the following words or phrases shall have the following meanings:

"2006 Act" the National Health Service Act 2006 after amendment by the 2012 Act;

"2012 Act" the Health and Social Care Act 2012;

"Accountable Officer" a person appointed in accordance with paragraph 7.4 to be responsible for the CCG complying with its obligations under the 2006 Act and any other provision of the 2006 Act specified in a document published by the NHS England and for the CCG exercising its functions in a way which provides good value for money;

"AGM" the Annual General Meeting of the CCG;

"Area" the geographical area covered by the CCG as defined within Appendix C;

"Audit Committee" a committee of the Sutton CCG Board set up in accordance with paragraph 6.8.1;

"Business Day" 9.00am to 5.00pm on a day (other than a Saturday or Sunday) on which clearing banks in the City of London are open for the transaction of normal sterling banking business;

"CCG" means the NHS Sutton Clinical Commissioning Group governed by this Constitution and to be formed in accordance with the 2006 Act and authorised by the NHS England;

"Chair" the person appointed as chair by the Sutton CCG Board in accordance with paragraph 7.2.1;

"Constitution" this constitution as amended from time to time in accordance with its terms;

"Executive Management Team"

the operational team of the CCG;

“Finance Committee” a committee of the Sutton CCG Board set up in accordance with paragraph 6.8.1;

"Governance Framework"

guidance published by the Department of Health on governance for clinical commissioning groups;

"Sutton CCG Board" the group comprised as set out in paragraph 0 to fulfil the functions of the Governing Body of the CCG as set out in the 2006 Act and also as further set out in this Constitution;

"GP" a medical practitioner whose name is included in the General Practice Register kept by the General Medical Council who is either a Member or engaged by a Member of the CCG;

"Health and Wellbeing a body established by London Borough of Sutton for the purpose of



Board" advancing the health and wellbeing of the people in its area and encouraging persons who arrange for the provision of any health or social care services in that area to work in an integrated manner;

"Health and Wellbeing Strategy"

a strategy developed with London Borough of Sutton for the purpose of purpose of advancing the health and wellbeing of the people in its area and implemented by the Health and Wellbeing Board;

"Healthcare Professional"

an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002;

"Independent Members" those members of the Sutton CCG Board that are independent of the Members and which shall comprise of two (2) Lay Members, one secondary care specialist and a registered nurse;

"Lay Member" an individual member of the Sutton CCG Board who is not a Member of the CCG, a Healthcare Professional or an individual of a description prescribed in regulations made under Section 14N of the 2006 Act;

"Locality" a sub-divided area of the Area of the CCG as set out in Appendix C;

"Locality Lead" a person appointed in accordance with paragraph 6 of Annex 3 of the Standing Orders;

"Locality Meeting" a meeting of the Locality Team carried out in accordance with paragraph 7 of Annex 2 of the Standing Orders;

"Locality Team" the group comprised of Members as set out in paragraph 5 of Annex 2 of the Standing Orders to represent the interests of the Members and patients of the Locality;

"Member Representative"

the person nominated by a Member to represent that Member at AGMs and Plenary Meetings of the Members and generally to act on behalf of that Member in accordance with paragraph 7.1;

"Members" the members from time to time of the CCG, being in each case a Practice as listed in the Register of Members at the relevant time and “Member” shall mean any one of them;

"NHS England " the National Health Service Commissioning Board (operating as the National Health Service Commissioning Board Authority prior to its formal establishment as a non-departmental public body);

"Nominations Committee"

a committee of the Sutton CCG Board set up in accordance with paragraph 6.8.1;

"Notice of Termination" a notice issued by the NHS England in accordance with paragraph 3.5.1(e);

Patient Reference Group

paragraph 3 of Annex 2 of the Standing Orders;

"Patient Lead" a person appointed in accordance with paragraph 3.3 of Annex 2 of the Standing Orders to represent the Patient Panel at Locality Meetings;



"Patient Panel" a group of Patient Representatives set up in accordance with paragraph 3.2 of Annex 2 of the Standing Orders to represent the interests of Patient Engagement Forums within a Locality;

"Patient Representative"

a person appointed in accordance with paragraph 3.1 of Annex 2 of the Standing Orders to represent a Patient Engagement Forum on the Patient Panel;

"PCT" Sutton and Merton Primary Care Trust 4;

"PCT Cluster" NHS South West London PCT Cluster;

"Performers List" the performers list of the PCT or such list as shall replace that held by the PCT after 1 April 2013;

"Plenary Meeting" any meeting of the Member Representatives, including its AGM;

"Practice" a provider of primary medical services in accordance with section 14A of the 2006 Act;

"Practice Manager Forum"

a group of practice managers representing the interests of practice managers set up in accordance with paragraph 4.1 of Annex 2 of the Standing Orders;

"Practice Manager Lead"

a person appointed in accordance with paragraph 4.2 of Annex 2 of the Standing Orders to represent the Practice Manager Forum on the Locality Team;

"Practice Nurse Forum" a group of practice nurses representing the interests of practice nurses set up in accordance with paragraph 4.1 of Annex 2 of the Standing Orders;

"Practice Nurse Lead" a person appointed in accordance with paragraph 4.2 of Annex 2 of the Standing Orders to represent the Practice Nurse Forum on the Locality Team;

"Prime Financial Policies"

the prime financial policies of the CCG from time to time set out in Appendix F of this Constitution;

"Quality Committee" a committee of the Sutton CCG Board set up in accordance with paragraph 6.8.1;

"Remuneration Committee"

a committee of the Sutton CCG Board set up in accordance with paragraph 6.8.1;

"Scheme of Reservation and Delegation"

the scheme of reservation and delegation of the CCG from time to time set out in Appendix E of this Constitution;

"Shadow Health and Wellbeing Board"

the Health and Wellbeing Board at any time before it becomes statutorily operational;

"Special Resolution" a resolution of the Members passed by at least seventy five percent (75%) of the votes cast by Member practices attending (by their Member

4 Health and Wellbeing Boards are expected to be statutorily operational in March 2013.



Representative or by proxy) at a Plenary Meeting or by the execution of a written resolution by Members holding at least seventy five percent (75%) of the votes of all of the Members; and

"Standing Orders" the standing orders of the CCG from time to time set out in Appendix of this Constitution;

• Words in the singular include the plural and in the plural include the singular.

• A reference to any gender includes a reference to the other gender.

• A reference to a statute or statutory provision is a reference to it as it is in force for the time being taking account of any amendment, extension, or re-enactment and includes any subordinate legislation for the time being in force made under it.

• Writing or written includes faxes and e-mail but not text messaging or any form of social media.

• Where the words include(s) or including are used in this Constitution, they are deemed to have the words ‘without limitation’ following them.

• Reference to any person shall include natural persons and partnerships, firms and other incorporated bodies and all other legal persons of whatever kind and however constituted and their successors, permitted assigns or transferees.



APPENDIX B LIST OF MEMBER PRACTICES

Practice Name Address Member

Representative

Locality

Beeches Surgery 9 Hill Road, Carshalton, Surrey SM5 3RB Dr A Froley Wallington

Benhill & Belmont Surgery 54 Benhill Avenue, Sutton, Surrey SM1 4EB Dr A Malik Sutton and Cheam

Bishopsford Road Medical

Centre

191 Bishopsford Road, Morden, Surrey SM4 6BH Dr S Durgam Carshalton

Carshalton Fields Surgery 11 Crichton Road, Carshalton Beeches, Surrey SM5

3LS

Dr M Carrasco Carshalton

Cheam Family Practice The Knoll, Parkside, Cheam, Sutton, Surrey SM3

8BS

Dr J Scerri Sutton and Cheam

Chesser Surgery 121 Wrythe Lane, Carshalton, Surrey SM5 2RT Dr J Cockbain Carshalton

Dr Grice and Partners Old Court House Surgery, Throwley Way, Sutton,

Surrey SM1 4AF

Dr T Jones Sutton and Cheam

Faccini House Surgery 64 Middleton Road, Morden, Surrey SM4 6RS Dr D Mirza Carshalton

GP Centre - Dr Scott &

Partners

322 Malden Road, North Cheam, Sutton, Surrey SM3

8EP

Dr R Scott Sutton and Cheam

GP Centre - Dr Muktar & Dr

Al-Sanjary


8EP

Dr D Muktar Sutton and Cheam

GP Centre - Dr Jolley & Dr

Dutta


8EP

Dr J A W Jolley Sutton and Cheam

Green Wrythe Surgery Green Wrythe Lane, Carshalton, Surrey SM5 1JF Dr I Said Carshalton

Grove Road Practice 83 Grove Road, Sutton, Surrey SM1 2DB Dr B Hudson Sutton and Cheam

Hackbridge Medical Centre 138 London Road, Hackbridge, Wallington, Surrey

SM6 7HF

Dr C Carroll Carshalton

Maldon Road Surgery 35 Maldon Road, Wallington, Surrey SM6 8BL Dr K Sugumar Wallington

Manor Practice 57 Manor Road, Wallington, Surrey SM6 0DE Dr M Amjad Wallington

Mulgrave Road Surgery 48 Mulgrave Road, Sutton, Surrey SM2 6LX Dr D Pardhanani Sutton and Cheam

Park Road Medical Centre 1a Park Road, Wallington, Surrey SM6 8AW Dr R Toosy Wallington

Robin Hood Lane (Dr Seyan) Robin Hood Lane, Sutton, Surrey SM1 2RJ Dr M Rodin Sutton and Cheam

Shotfield Medical Practice Jubilee Health Centre, Shotfield, Wallington, Surrey

SM6 0HY

Dr H Lings Wallington

Sutton Medical Practice 181 Carshalton Road, Sutton, Surrey SM1 4NG Dr K Aziz Carshalton

Wallington Family Practice Jubilee Health Centre, Shotfield, Wallington, Surrey

SM6 0HY

Dr L Roberts Wallington

Wallington Medical Centre 52 Mollison Drive, Wallington, Surrey SM6 9BY Dr F Rabbani Wallington

Well Court Surgery 6 Well Court, 740 London Rd, Cheam, Surrey

SM3 9BX

Dr S Kathirgama Sutton and Cheam

Wrythe Green Surgery Wrythe Lane, Carshalton, Surrey SM5 2RE Dr M Wells Carshalton



APPENDIX C AREA OF THE CCG

Map of CCG location The map below shows the location of this CCG within the country.

The black outline shows the proposed geographical boundaries of CCGs.



Map of CCG area

The map above shows practices with different symbols/colours according to CCG. This CCG's practices are shown as bright yellow triangles. Practices are located according to the centroid of their postcode recorded by the Organisation Data Service (branch practices are not shown). LA boundaries are shown as yellow lines and CCG's proposed geographical boundaries as thick red lines (mixed red/yellow lines indicate shared LA/CCG boundaries). Maps from NHS England Profile of NHS Sutton CCG 25/5/2012



APPENDIX D STANDING ORDERS

1. STATUTORY FRAMEWORK AND STATUS

1.1 Introduction

1.1.1 These Standing Orders have been drawn up to regulate the proceedings of the NHS Sutton Clinical Commissioning Group ("CCG") so that the CCG can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date the CCG is established.

1.1.2 The Standing Orders, together with the CCG’s Scheme of Reservation and Delegation and the CCG’s Prime Financial Policies, provide a procedural framework within which the CCG discharges its business. They set out:

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

(b) the appointment of Member Representatives;

(c) the procedure to be followed at meetings of the CCG, the Sutton CCG Board and any committees or sub-committees of the CCG or the Sutton CCG Board;

(d) the process to delegate powers; and

(e) the declaration of interests and standards of conduct.

These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate of any relevant guidance.

1.1.3 The Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies have effect as if incorporated into the CCG’s Constitution. Members, employees, members of the Sutton CCG Board, members of the Sutton CCG Board’s committees and sub-committees, members of the CCG’s committees and sub-committees and persons working on behalf of the CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the Standing Orders, Scheme of Reservation and Delegation and Prime Financial Policies may be regarded as a disciplinary matter that could result in dismissal.

1.2 Schedule of matters reserved to the CCG and the Scheme of Reservation and Delegation

1.2.1 The 2006 Act (as amended by the 2012 Act) provides the CCG with powers to delegate the CCG’s functions and those of the Sutton CCG Board to certain bodies (such as committees) and certain persons. The CCG has decided that certain decisions may only be exercised by the CCG in formal session. These decisions and also those delegated are contained in the CCG’s Scheme of Reservation and Delegation (see Appendix E).



2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS

2.1 Composition of Membership

2.1.1 Chapter 3 of the CCG’s constitution provides details of the membership of the CCG (also see Appendix B).

2.1.2 Chapter 6 of the CCG’s Constitution provides details of the governing structure used in the CCG’s decision-making processes, whilst Chapter 7 of the Constitution outlines certain key roles and responsibilities within the CCG and the Sutton CCG Board, including the role of Member Representatives (paragraph 7.1 of the Constitution).

2.2 Key Roles

2.2.1 Paragraph 6.7 of the CCG’s Constitution sets out the composition of the CCG’s Sutton CCG Board whilst Chapter 7 of the CCG’s Constitution identifies certain key roles and responsibilities within the Sutton CCG and the Sutton CCG Board. These Standing Orders set out how the CCG appoints individuals to these key roles.

2.2.2 The Accountable Officer as listed in paragraph 7.4 of the CCG’s Constitution, is subject to the following appointment process:

(a) Nominations – by CCG Chair following appointment process involving NHS England representative;

(b) Eligibility – The Accountable Officer shall be either:

(i) an individual who is a Member of the CCG or of anybody that is a Member of the CCG or, in the case of a joint appointment, an individual who is a member of any of the clinical commissioning groups in question or of anybody that is a member of any of those clinical commissioning groups; or

(ii) an employee of the CCG or of any Member of the CCG or, in the case of a joint appointment, an employee of any of the clinical commissioning groups in question or of any member of those clinical commissioning groups.

(c) Appointment process – The Accountable Officer is to be appointed by the Sutton CCG Board and the initial Accountable Officer of the CCG will be Dr C Elliott.

(d) Term of office - [two (2) years];

(e) Eligibility for reappointment - [subject to Nominations Committee support];

(f) Grounds for removal from office - With two week’s written notice to all voting members, the Sutton CCG Board has the authority to remove the postholder by 75% majority vote of a quorate meeting.

(g) Notice period – six (6) months served by CCG Chair.

2.2.3 The CFO as listed in paragraph 7.5 of the CCG’s Constitution, is subject to the following appointment process:

(a) Nominations – following recruitment and appointment process;

(b) Eligibility – Only individuals that

(i) have been formally accredited through the assessment process; and



(ii) are not the CCG's Accountable Officer

will be eligible to be appointed as the CFO by the Sutton CCG Board.

(c) Appointment process – The CFO is to be appointed by a recruitment and appointment process

(d) Grounds for removal from office - The CFO may be removed from office by the Sutton CCG Board. With two week’s written notice to all voting members, the Sutton CCG Board has the authority to remove the postholder by 75% majority vote of a quorate meeting.

(e) Notice period – six (6) months served by Accountable Officer.

2.2.4 Other members of Sutton CCG Board are subject to the following appointment process:

(a) Nominations – following recruitment and appointment process;

(b) Eligibility – Only individuals that:

(i) are not the CCG's Accountable Officer or CFO

(ii) will be eligible to be appointed as members by the Sutton CCG Board.

(c) Appointment process – Members are to be appointed by a recruitment and appointment process.

(d) Grounds for removal from office – Members may be removed from office by the Sutton CCG Board. With two week’s written notice to all voting members, the Sutton CCG Board has the authority to remove the postholder by 75% majority vote of a quorate meeting.

(e) Term of office: The term of office is for 2 – 4 years enabling a phased turnover of these posts on the Board. Board members may not hold office for longer than 8 years in total.

(f) Notice period – six (6) months served by Accountable Officer.

(g)

2.2.5 The roles and responsibilities of each of these key roles are set out either in paragraph 6.6.2 or Chapter 7 of the CCG’s constitution.

3. MEETINGS OF THE CLINICAL COMMISSIONING GROUP

3.1 Annual General Meeting of the Members (AGM)

3.1.1 The CCG shall hold an AGM of the Members:

(a) once in each year provided that not more than fifteen (15) months shall elapse between the date of one AGM and that of the next;

(b) on a Business Day; and

(c) at such a time and place as the Sutton CCG Board shall determine.

3.1.2 Minutes of all AGMs will be a matter of public record.



3.1.3 The matters to be discussed at the AGM shall be set out in the notice, and shall without limitation include the presentation and consideration of:

(a) the Annual Accounts

(b) the Annual Report

(c) the Annual Plan; and

(d) the transaction of any other business included in the notice convening the meeting.

3.1.4 The AGM shall be open to the public.

3.2 Other Plenary Meetings

3.2.1 The Sutton CCG Board or Executive Management Team shall call a Plenary Meeting of the Members at least three (3) times a year by giving all Members at least fourteen (14) days notice.

3.2.2 If at any time there are not within the United Kingdom sufficient members of the Sutton CCG Board or Executive Management Team capable of acting to form a quorum of the Sutton CCG Board or Executive Management Team, any member of the Sutton CCG Board or Executive Management Team may call a Plenary Meeting.

3.2.3 Unless agreed specifically to the contrary minutes of all formal Plenary Meetings will be a matter of public record.

3.3 Notice of meetings

3.3.1 Every notice calling a Plenary Meeting must:

(a) specify the place, day and time of the meeting, whether it is an AGM or Plenary Meeting, and the general nature of the business to be transacted;

(b) set out in full any resolution to be passed;

(c) if the notice relates to an AGM, be published at least twenty eight (28) days prior to the meeting;

(d) be given to all Member Representatives in writing; and

(e) be published at the offices of the CCG and on the CCG website.

3.3.2 The following local bodies may also be notified directly of any Plenary Meeting via an appropriate mechanism depending on relevance of Plenary agenda.

(a) Patient Engagement Forums;

(b) Practice Nurse Forums; and

(c) Practice Manager Forums.

3.4 Petitions

3.4.1 Where a petition has been received by the CCG, the Chair of the Sutton CCG Board shall include the petition as an item for the agenda of the next meeting of the Sutton CCG Board.



3.5 Chair of a meeting

3.5.1 The Chair shall chair Plenary Meetings if present and willing to do so. If the Chair is not present or unwilling to chair the meeting, the Vice Chair shall chair the Plenary Meeting if present and willing to do so.

3.5.2 If the Chair and Vice Chair are unwilling to chair the meeting or are not present within ten (10) minutes of the time at which a meeting was due to start the Member Representatives present at the meeting must appoint an alternate chair of the meeting, and the appointment of the chair of the meeting must be the first business of the meeting. Where Member Representatives are present at the meeting then the chair of the meeting shall be appointed from amongst their number.

3.5.3 If the Chair is absent temporarily on the grounds of a declared conflict of interest the Vice Chair, if present, shall preside. If both the Chair and Vice Chair are disqualified from participating, a chair shall be appointed in accordance with paragraph 3.5.2 above.

3.6 Chair's ruling

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

3.7 Attendance and speaking at Plenary Meetings

3.7.1 The Sutton CCG Board may make whatever arrangements it considers appropriate to enable those attending a Plenary Meeting to listen and contribute including to exercise their rights to speak or vote.

3.7.2 Member Representatives may participate in Plenary Meetings by telephone or by the use of video conferencing facilities and/or webcam, where such facilities are available (subject to prior approval of the Chair. Participation in a meeting in any of these manners shall be deemed to constitute presence in person at the meeting.

3.7.3 The accidental omission to give notice of a meeting to, or the non-receipt of notice of a meeting by, any person entitled to receive notice shall not invalidate proceedings at that meeting.

3.7.4 Any Member Representative may speak at a Plenary Meeting.

3.7.5 Other public attendees may only ask questions at Plenary Meetings or at the AGM by invitation of the Chair.

3.8 Quorum

3.8.1 Member Representatives equating to at least half of all the practices within the CCG having the right to vote at the meeting shall be a quorum for the Plenary Meeting.

3.8.2 No business other than the appointment of the chair of the meeting is to be transacted at a Plenary Meeting if the persons attending do not constitute a quorum.

3.8.3 For all other of the CCG’s committees and sub-committees, including the Sutton CCG Board’s committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference



3.9 Decision making

3.9.1 Chapter 6 of the CCG’s constitution, together with the Scheme of Reservation and Delegation, sets out the governing structure for the exercise of the CCG’s statutory functions. Generally it is expected that at the CCG’s / Sutton CCG Board’s meetings decisions will be reached by consensus. Should this not be possible then a vote of members will be required.

3.9.2 At any Plenary Meeting (including the AGM) a resolution put to a vote of the meeting shall be decided on a show of hands unless a poll is duly demanded (before or on determination of the result of the show of hands). A poll may be demanded by:

(a) the chair of the meeting;

(b) at least two Member Representatives present or via proxy entitled to vote at the meeting; or

(c) Member Representatives representing at least one tenth of the total voting rights of all the Members having the right to vote at the meeting.

3.9.3 The chair of the meeting may also demand a poll before a resolution is put to the vote on a show of hands.

3.9.4 At Plenary Meetings resolutions shall be put to the vote by the chair of the meeting and there shall be no requirement for the resolution to be proposed or seconded by any person.

3.9.5 Unless a poll is duly demanded and the demand is not withdrawn, a declaration by the chair at a Plenary Meeting that a resolution has on a show of hands been carried or lost and an entry into the minutes of the meeting shall be conclusive evidence of the fact.

3.9.6 On a show of hands every Member present in person shall have one vote. On a poll Member Representatives (or their proxy) shall each hold the number of votes depending on the size of the Practice of the Member Representative (or proxy) on the basis of one vote per 1,000 patients. Practices with less than 1,000 patients shall have one vote.

3.9.7 The voting rights set out in this paragraph 0 will be reviewed annually by the Sutton CCG Board / Executive Management Team and will be based on the practice patient list size as at the end of the previous financial year.

3.9.8 Every question put to a vote at a Plenary Meeting (including the AGM) shall be determined by a majority of the votes of those Member Representatives present and voting on the question. In the case of an equality of votes, the chair of the meeting shall be entitled to a casting vote.

3.9.9 Should a vote be taken the outcome of the vote, and any dissenting views, must be recorded in the minutes of the meeting.

3.9.10 For all other of the CCG’s committees and sub-committees, including the Sutton CCG Board’s committees and sub-committee, the details of the process for holding a vote are set out in the appropriate terms of reference.

3.10 Proxy Notices

3.10.1 Proxies for a Member Representative may only validly be appointed by a notice in writing (a "proxy notice") which:



(a) states the name and address of the Member Representative appointing the proxy;

(b) identifies the person appointed to be that Member Representative’s proxy and the Plenary Meeting (or the AGM) in relation to which that person is appointed;

(c) is signed by or on behalf of the Member Representative appointing the proxy, or is authenticated by the relevant Member; and

(d) is delivered to the Plenary Meeting (or the AGM) in accordance with this Constitution and any instructions contained in the notice of the Plenary Meeting (or the AGM) to which they relate.

3.10.2 The Sutton CCG Board may require proxy notices to be delivered in a particular form, and may specify different forms for different purposes.

3.10.3 Proxy notices may specify how the proxy appointed under them is to vote (or that the proxy is to abstain from voting) on one or more resolutions.

3.10.4 Unless a proxy notice indicates otherwise, it must be treated as:

(a) allowing the person appointed under it as a proxy discretion as to how to vote on any ancillary or procedural resolutions put to the meeting; and

(b) appointing that person as a proxy in relation to any adjournment of the Plenary Meeting (or the AGM) to which it relates as well as the meeting itself.

3.10.5 An appointment under a proxy notice may be revoked by delivering to the Sutton CCG Board a notice in writing given by or on behalf of the Member Representative by whom or on whose behalf the proxy notice was given.

3.10.6 A notice revoking a proxy appointment only takes effect if it is delivered before the start of the meeting or adjourned meeting to which it relates.

3.10.7 If a proxy notice is not executed by the Member Representative appointing the proxy, it must be accompanied by written evidence of the authority of the person who executed it to execute it on the relevant Member’s behalf.

3.11 Resolutions in writing

3.11.1 A resolution in writing signed or approved by such number of Member Representatives as would have been required to pass the resolution had it been voted on at a Plenary Meeting shall be as valid and effectual as if it had been passed at a Plenary Meeting duly convened and held. The resolution may consist of more than one document in the same form each signed or approved by one or more persons.

3.12 Adjournment

3.12.1 If the persons attending a Plenary Meeting (including the AGM) within half an hour of the time at which the meeting was due to start do not constitute a quorum, or if during a meeting a quorum ceases to be present, the chair of the meeting must adjourn it.

3.12.2 The chair of the meeting may adjourn a Plenary Meeting (including the AGM) at which a quorum is present if:

(a) the meeting consents to an adjournment; or

(b) it appears to the chair of the meeting that an adjournment is necessary to ensure that the business of the meeting is conducted in an orderly manner.



3.12.3 The chair of the meeting must adjourn a Plenary Meeting (including the AGM) if directed to do so by a simple majority of the Member Representatives present at the meeting.

3.12.4 When adjourning a Plenary Meeting (including the AGM), the chair of the meeting must:

(a) either specify the time and place to which it is adjourned or state that it is to continue at a time and place to be fixed by the Sutton CCG Board; and

(b) have regard to any directions as to the time and place of any adjournment which have been given by the meeting.

3.12.5 If the continuation of an adjourned meeting is to take place more than fourteen (14) days after it was adjourned, the Sutton CCG Board must give at least fourteen (14) clear days’ notice of it (that is, excluding the day of the adjourned meeting and the day on which the notice is given):

(a) to the same persons to whom notice of Plenary Meeting (including the AGM) is required to be given; and

(b) containing the same information which such notice is required to contain.

3.12.6 At an adjourned Plenary Meeting (including the AGM) only that business that formed the business to be transacted at the original meeting can be transacted.

3.13 Emergency powers and urgent decisions

3.13.1 In an emergency, where a decision must be made by the Group or the Sutton CCG Board before its next meeting, the powers and duties of the group or Sutton CCG Board may be exercised by the Chair of the Sutton CCG Board (Emergency Action).

3.13.2 For this purpose “emergency” means circumstances in which:-

(a) the group will be unable to discharge its statutory functions or be exposed to a significant level of risk if urgent action is not taken; or

(b) urgent action must be taken to prevent loss, damage or significant disadvantage to the group;

and, for the avoidance of doubt, a matter is not an emergency solely because it has been omitted from inclusion in the agenda for a Members Plenary meeting or a meeting of the Sutton CCG Board or any committee or sub-committee on a particular occasion.

3.13.3 Before taking any Emergency Action, the Chair of the Sutton CCG Board must consult the Accountable Officer (or in the Accountable Officer’s absence the Managing Director) and a Lay Member.

3.13.4 The Emergency Action must be ratified at the next meeting of the Sutton CCG Board.

3.13.5 The Emergency Action functions of the Chair of the Sutton CCG Board and Accountable Officer (or in the Accountable Officers absence the Managing Director) may be exercised by such other persons as the Chair of the Sutton CCG Board and Accountable Officer may respectively nominate in writing.

3.14 Suspension of Standing Orders

3.14.1 Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or the NHS England, any part of these Standing Orders may be suspended at a Sutton CCG Board meeting, provided 75% (seventy five percent) of Members are in agreement.



3.14.2 Any decision to suspend these Standing Orders together with the reasons for doing so shall be recorded in the minutes of the relevant meeting.

3.14.3 A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Audit Committee for review of the reasonableness of the decision to suspend these Standing Orders.

3.15 Record of Attendance

3.15.1 The names of all Members present at the Plenary Meeting shall be recorded in the minutes of the Plenary Meeting. The names of all members of the Sutton CCG Board present shall be recorded in the minutes of the Sutton CCG Board meetings. The names of all members of the Sutton CCG Board’s committees / sub-committees present shall be recorded in the minutes of the respective Sutton CCG Board committee / sub-committee meetings.

3.16 Minutes

3.16.1 Minutes of CCG Plenary sessions shall be available within 3 (three) weeks of the meeting.



3.17 Admission of public and the press

3.17.1 Admission of the public and the press requires approval of the CCG Chair.

4. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES

4.1 Appointment of committees and sub-committees

4.1.1 The CCG may appoint committees and sub-committees of the CCG, subject to any regulations made by the Secretary of State, and make provision for the appointment of committees and sub-committees of the Sutton CCG Board. Where such committees and sub-committees of the CCG, or committees and sub-committees of the Sutton CCG Board, are appointed they will be included in Chapter 6 of the CCG’s Constitution.

4.1.2 Other than where there are statutory requirements, such as in relation to the Audit Committee, Finance Committee or Remuneration Committee, the CCG shall determine the membership and terms of reference of committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the CCG.

4.1.3 The provisions of these Standing Orders shall apply where relevant to the operation of the Sutton CCG Board, the Sutton CCG Board’s committees and sub-committee and all committees and sub-committees unless stated otherwise in the committee or sub-committee’s terms of reference.

4.2 Terms of Reference

4.2.1 The terms of reference set out as Annexes to these Standing Orders shall have effect as if incorporated into the Constitution.

4.3 Delegation of Powers by Committees to Sub-committees

4.3.1 Where committees are authorised to establish sub-committees they may not delegate executive powers to the sub-committee unless expressly authorised by the CCG.

4.4 Approval of Appointments to Committees and Sub-Committees

4.4.1 The CCG shall approve the appointments to each of the committees and sub-committees which it has formally constituted including those of the Sutton CCG Board. The CCG shall agree such travelling or other allowances as it considers appropriate.

5. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES

5.1 If for any reason these Standing Orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Sutton CCG Board for action or ratification. All Members of the CCG and staff have a duty to disclose any non-compliance with these Standing Orders to the Accountable Officer as soon as possible.



6. SEALING AND SIGNATURE OF DOCUMENTS

6.1 The CCG shall not have a Seal. All deeds executed by the CCG shall unless otherwise so determined be signed by two (2) duly authorised members of the Sutton CCG Board. The Accountable Officer shall keep a register in which he/she, or another manager of the CCG authorised by him/her, shall enter a record of the sealing of every document.

6.2 Where any document will be a necessary step in legal proceedings on behalf of the CCG, it shall, unless any enactment otherwise requires or authorises, be signed by the Accountable Officer.

6.3 In land transactions, the signing of certain supporting documents will be delegated to managers and set out clearly in the Scheme of Reservation and Delegation but will not include the main or principal documents effecting the transfer (e.g. sale/purchase agreement, lease, contracts for construction works and main warranty agreements or any document which is required to be executed as a deed).

7. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS/ PROCEDURES AND REGULATIONS

7.1 Policy statements: general principles

7.1.1 The CCG will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by the CCG. The decisions to approve such policies and procedures will be recorded in an appropriate CCG minute and will be deemed where appropriate to be an integral part of these Standing Orders.


53 Sutton CCG Constitution 1st April 2018 Draft

Sutton CCG Standing Order – List of Annexes

ANNEX 1: Not used

ANNEX 2: THE SUTTON CCG BOARD

ANNEX 3: LOCALITIES

ANNEX 4: BOARD AUDIT COMMITTEE TERMS OF REFERENCE

ANNEX 5: BOARD REMUNERATION COMMITTEE TERMS OF REFERENCE

ANNEX 6: COMMITTEES IN COMMON: REMUNERATION COMMITTEE TERMS OF REFERENCE

ANNEX 7: BOARD NOMINATIONS COMMITTEE TERMS OF REFERENCE

ANNEX 8: BOARD QUALITY COMMITTEE TERMS OF REFERENCE

ANNEX 9: FINANCE COMMITTEE TERMS OF REFERENCE

ANNEX 10: COMMITTEE FOR COLLABORATIVE DECISION MAKING-

ANNEX 11: PRIMARY CARE COMMISSIONING COMMITTEE TERMS OF REFERENCE



ANNEX 2: THE SUTTON CCG BOARD

1. DUTIES OF THE SUTTON CCG BOARD

1.1 Subject to the limits in the Constitution the Sutton CCG Board shall be responsible for the power to conduct the overall management and strategic direction of the CCG and the achievement and furtherance of the functions of the CCG.

2. APPOINTMENT OF MEMBERS OF THE SUTTON CCG BOARD

2.1 The Sutton CCG Board shall issue a job description and minimum requirements for the role of the GP members of the Sutton CCG Board. Candidates for the role shall submit their names to the Nominations Committee.

2.2 Candidates for the role of GP member of the Sutton CCG Board must be a Member, a partner of a partnership that is a Member or a shareholder, officer or employee of a Member CCG, and for the avoidance of doubt may be, but need not be, a Member Representative.

2.3 The Nominations Committee shall assess the candidates' suitability by holding interviews. The Nominations Committee shall produce a shortlist of suitable candidates for the Sutton CCG Board.

2.4 The Members shall, by Special Resolution at a Plenary Meeting elect the GP members of the Sutton CCG Board and shall be entitled to remove and replace any GP members of the Sutton CCG Board at any time and from time to time in accordance with paragraph 2.7 below.

2.5 The Sutton CCG Board may act notwithstanding any vacancies in their number, but, if the number of members of the Sutton CCG Board is less than the number fixed for the quorum, the Sutton CCG Board may only act for the purpose of filling vacancies or of calling a Plenary Meeting or of delivering statutory obligations.

2.6 A person shall not be eligible to be a member of the Sutton CCG Board and shall cease to be a member of the Sutton CCG Board as soon as that person:

2.6.1 ceases to be engaged by a Member of the CCG (for example if the Practice that the relevant GP is engaged by or owns ceases to be a Member of the CCG);

2.6.2 where that person is a GP and ceases to be included on the Performers List other than in the event of a contingent removal;

2.6.3 where that person is a GP and is contingently removed from the Performers List and the Sutton CCG Board in its absolute discretion determines that the conditions placed on the member would prevent or inhibit their ability to fulfil effectively their functions as a member of the Sutton CCG Board;

2.6.4 where that person is a GP and is suspended from the Performers List but only during the period of suspension;

2.6.5 where that person is a GP and ceases to be registered as a medical practitioner; or

2.6.6 is or becomes an officer of the Local Medical Council executive committee.

2.7 Any Member with the support of at least 20% of other Members can at a Plenary Meeting call for a motion of no confidence in any member of the Sutton CCG Board. If at least 75% of Members approve such a motion the person concerned must stand down from the Sutton CCG Board.



3. MEETINGS OF THE SUTTON CCG BOARD

3.1 The Sutton CCG Board shall meet in public on a regular basis at least five (5) times per year and no more than three (3) months apart.

3.2 The Secretary (on receiving a request from six (6) members of the Sutton CCG Board to call a meeting of the Sutton CCG Board), or, if no Secretary has been appointed, any member of the Sutton CCG Board receiving such a request, shall call a meeting of the Sutton CCG Board by issuing a notice within five (5) Business Days of being requested to do so.

3.3 Notice of any Sutton CCG Board meeting must indicate:

3.3.1 its proposed date and time, which must be at least fourteen (14) days after the date of the notice, except where a meeting to discuss an urgent issue is required (in which case as much notice as reasonably practicable in the circumstances should be given);

3.3.2 where it is to take place;

3.3.3 an agenda of the items to be discussed at the meeting and any supporting papers; and

3.3.4 if it is anticipated that members of the Sutton CCG Board participating in the meeting will not be in the same place, how it is proposed that they should communicate with each other during the meeting.

3.4 The agenda will be agreed between the Chair and Accountable Officer.

3.5 The date, time, venue, agenda and all papers related to the agenda of all Sutton CCG Board meetings will be made public with at least seven (7) days notice on the CCG website.

3.6 Notice of a Governing Board meeting must be given to each member of the Governing Board in writing.

3.7 Failure to effectively serve notice on all members of the Governing Board does not affect the validity of the meeting, or of any business conducted at it.

3.8 The Chair can determine items that need to be discussed in private in line with statute and national guidance for example matters of staff discipline, or where patient or commercial confidentiality is likely to be breached. A list of the items (without content) discussed in such a way will be published at the AGM.

3.9 The quorum of the meeting of the Sutton CCG Board shall be six (6) persons at least two (2) of whom shall be practising clinicians, at least one Lay Member and one voting Director (either the Chief Officer, the Chief Finance Officer or the Managing Director). No business shall be transacted at a meeting unless the following are present:

• Chief Officer, the Chief Finance Officer or the Managing Director; and

• Chair or Vice Chair.

3.10 If the total number of members of the Sutton CCG Board for the time being is less than the quorum required, the Sutton CCG Board must not take any decision other than a decision to call a Plenary Meeting so as to enable the Members acting through their Member Representatives to appoint further members of the Sutton CCG Board to fill any vacancies.

3.11 If the Chair is not participating in a Sutton CCG Board meeting within ten (10) minutes of the time at which it was to start, the Vice Chair shall chair that meeting or, if the Vice Chair is not participating, the participating members of the Sutton CCG Board must appoint one of the present members of the Sutton CCG Board to chair that meeting.

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



3.13 Members of the public will be allowed to ask questions at Sutton CCG Board meetings by invitation of the Chair and will not be allowed to contribute to the discussion unless expressly invited to do so by the Chair.

4. VOTING AT SUTTON CCG BOARD MEETINGS

4.1 At any meeting of the Sutton CCG Board, on a show of hands or a poll, every member of the Sutton CCG Board (present or by proxy) shall have one vote. If the numbers of votes for and against a proposal are equal, the Chair or other person chairing the meeting has a casting vote.

4.2 At any Sutton CCG Board meeting a resolution put to a vote of the meeting shall be decided on a show of hands unless a poll is duly demanded (before or on determination of the result of the show of hands). A poll may be demanded by:

4.2.1 the chair of the meeting;

4.2.2 at least two members of the Sutton CCG Board present or via proxy entitled to vote at the meeting; or

4.2.3 members of the Sutton CCG Board representing at least [one tenth] of the total voting rights of all the members of the Sutton CCG Board having the right to vote at the meeting.

4.3 The chair of the meeting may also demand a poll before a resolution is put to the vote on a show of hands.

4.4 At Sutton CCG Board meetings resolutions shall be put to the vote by the chair of the meeting and there shall be no requirement for the resolution to be proposed or seconded by any person.

4.5 Unless a poll is duly demanded and the demand is not withdrawn, a declaration by the chair of the meeting that a resolution has on a show of hands been carried or lost and an entry into the minutes of the meeting shall be conclusive evidence of the fact.

5. WRITTEN RESOLUTIONS

A resolution in writing signed or approved by all the members of the Sutton CCG Board entitled to receive notice of a meeting of the Sutton CCG Board or all the members of any committee or sub-committee of the Sutton CCG Board entitled to vote on the resolution shall be as valid and effective as if it had been passed at a meeting of the Sutton CCG Board or (as the case may be) a committee or sub-committee of the Sutton CCG Board duly convened and held. The resolution may consist of more than one document in the same form each signed or approved by one or more persons.

6. RECORD KEEPING

6.1 The Sutton CCG Board must keep:

6.1.1 minutes of all:

• AGM, Plenary Meetings and Locality Meetings;

• meetings of the Sutton CCG Board and any committee or sub-committee carrying out functions or powers on its behalf, including:

• the names of persons present at the meeting;

• the decisions made at the meeting; and

• where appropriate the reasons for the decision;



6.1.2 a register of all Members showing Member Representatives;

6.1.3 a register of members of the Sutton CCG Board; and

6.1.4 a register of interests of all Member Representatives and all members of the Sutton CCG Board.

6.2 Any such minutes shall be made available or copied to on request to any Member or member of the Sutton CCG Board.

6.3 Any such minutes agreed at the subsequent meeting shall be sufficient evidence without further proof of the facts stated in such minutes.



ANNEX 3: LOCALITIES

1. CONFIGURATION OF LOCALITIES

1.1 The Area of the CCG shall be divided into three (3) Localities. The Localities shall be referred to as:

1.1.1 Carshalton;

1.1.2 Sutton and Cheam;

1.1.3 Wallington;

1.2 Each Member of the CCG shall be a member of a Locality in which their Practice is based.

1.3 The Sutton CCG Board / Executive Management Team shall determine the boundaries of the Localities and the configuration of Practices within each Locality. The Sutton CCG Board / Executive Management Team shall confirm or amend the boundaries of each Locality not more than once annually.

2. PURPOSE OF LOCALITIES

2.1 The division of the CCG into Localities contributes to shaping the commissioning strategy for the CCG by ensuring that decisions of the CCG are taken as close to Practice level as possible.

3. PATIENT ENGAGEMENT FORUMS

3.1 The Board shall set up a Patient Reference Group to encourage feedback from its patients. Member practices will be encouraged to ensure two patient representatives are identified from each practice to sit on the Patient Reference Group.

4. PRACTICE NURSE AND PRACTICE MANAGER FORUMS

4.1 There is a single CCG Practice Nurse Forum and a Practice Manager Forum to encourage feedback from practice managers and practice nurses from the Members of the CCG on the provision of healthcare in the Area.

4.2 The Practice Nurse Forum and Practice Manager Forum shall elect a Practice Nurse Lead

and Practice Manager Lead respectively to serve on the Locality Team and attend the Locality Meeting.

5. LOCALITY TEAM

5.1 There shall be one Locality Team for each Locality comprising of:

5.1.1 the Member Representatives from each Member in the Locality;

5.1.2 the Locality Lead (elected in accordance with paragraph 6 below);

5.1.3 the Locality Manager;

5.1.4 the Practice Nurse Lead;



5.1.5 the Practice Manager Lead.

5.2 The role of the Locality Team is to:

5.2.1 hold Locality Meetings to decide matters delegated to the Locality as set out in the Scheme of Delegation;

5.2.2 feed the views of its Members into the management and governance processes of the

CCG;

5.2.3 communicate emerging priorities from the Sutton CCG Board and the Executive Management Team to its Members;

5.2.4 support its Members so that they contribute to their relevant Locality Meetings and

Plenary Meetings and the delivery of objectives and priorities;

5.2.5 implement agreed CCG strategies and priorities at Locality and Practice level;

5.2.6 create opportunities for exchanges of ideas between Members and encourage a positive learning environment; and

5.2.7 provide an opportunity for emerging clinical leaders to develop strategy and

leadership skills.

5.3 The Locality Team shall have the power to co-opt other non-voting persons from the Members to attend its meetings as it sees fit from time to time.

5.4 The Locality Team shall be entitled to appoint a Locality Manager to carry out administrative

tasks on behalf of the Locality Team.

5.5 The Locality Lead shall be elected in accordance with paragraph 6.

5.6 A person shall not be eligible to be a member of the Locality Team and shall cease to be a member of the Locality Team as soon as that person:

5.6.1 (if a Member Representative) ceases to be a Member Representative;

5.6.2 (if a Locality Lead) ceases to be Locality Lead or is removed in accordance with paragraph 6.6; and/or

5.6.3 (if a Locality Manager, a Practice Nurse Lead, a Practice Manager Lead) ceases to be the Locality Manager, the Practice Nurse Lead or the Practice Manager Lead.

6. LOCALITY LEAD

6.1 The Locality Lead is a member of the Sutton CCG Board and provides the clinical leadership for the Locality.

6.2 The Sutton CCG Board shall issue a job description and minimum requirements for the role of Locality Lead. Candidates for the role shall be required to submit their names to the Nominations Committee.

6.3 Candidates for the role of Locality Lead must be a partner of a partnership that is a Member or a shareholder, officer or employee of a Member in the relevant Locality, and for the avoidance of doubt may be, but need not be, a Member Representative.



6.4 The Nominations Committee shall assess the candidates' suitability by holding interviews. The Nominations Committee shall produce a shortlist of suitable candidates for the position of Locality Lead and shall circulate the list with a ballot paper to all Members in the Locality. The Members shall return the ballot papers to the Sutton CCG Board within thirty (30) days indicating which candidate they choose. The Sutton CCG Board shall announce the names of the elected Locality Leads from votes received by Members in accordance with this paragraph and indicate the identity of the Locality Leads in the Register of Members.

6.5 A Locality Lead shall serve for a term not exceeding two (2) years.

6.6 A Locality Lead may be removed from office by the CCG Chair where there is significant evidence that the Locality Lead is not meeting the requirements of the job description as deemed by the majority of Member practices of the Locality or by agreement between the CCG Chair and Accountable Officer.

7. LOCALITY MEETINGS

7.1 The three Locality Teams shall hold Locality Meetings on a regular basis:



Carshalton Locality Meeting Terms of Reference

Members: Member practices are as follows:

• Bishopsford Road Medical Centre

• Carshalton Fields Practice

• Chesser Surgery

• Hackbridge Medical Centre

• Faccini House Surgery

• Green Wrythe Surgery

• Sutton Medical Centre

• Wrythe Green Surgery

• Locality Lead

• Locality Practice Manager Lead

• Locality Nurse Lead

• Locality Management member(s) and structure – Grade 8a Managerial Position has been created and is soon to be appointed. This will be jointly shared as a single full time post across the three Locality groups of NHS Sutton Clinical Commissioning Group (SCCG).

• Lead Roles are for a two year tenure only and may be re-elected for further two year terms. The lead roles to be elected from among the locality Practices.

Goals

1. To support and implement the decisions of the SCCG Executive team. 2. To achieve a reduction in referrals of patients, through more appropriate referrals, reducing patient

hospitalisation and embracing intermediate services and pathway re-design. 3. To reduce Accident and Emergency attendance through more effective patient engagement and

greater education about use of Out of Hours Services. 4. To take ownership of the QIPP agenda and work towards its goals and objectives. 5. To promote education amongst the clinicians and encourage educational achievements through

support and courses. 6. To act as a platform for discussing topics relevant to the daily working of the practices, such as

QOF, QP and Medicines Management.

IF DESIRED EACH LOCALITY WILL DEVELOP ARRANGEMENTS:-

• To implement agreed key indicators of performance that are monitored, developed and obtained.

• To develop financial structures and financial framework to support clinical pathways at a locality level.

ANY SUCH ARRANGEMENT TO BE APPROVED BY THE SCCG BOARD. Accountability

• Each member practice is accountable to the Locality Lead and subsequently to the Executive Management Team of the SCCG.

Meetings

• 11-12 Meetings will take place per year (average of one meeting per month).

• Practice Members will be required to attend all locality meetings and the plenary meetings and may send a deputy if notified to the Chair of that meeting.

• The Locality Lead will organise and Chair the meetings.



• Management support from the SCCG will be provided, for example minute taking, agendas. Decision making and voting

• A minimum of five out of the eight Practices are to be represented in order to declare the meeting quorate and decisions binding.

Information Sharing and Communication

• Information will be shared and communicate to the group via email and supported with telephone contact.

These terms of reference will be reviewed annually and amended in light of experience and circumstances



Sutton and Cheam Locality Meeting Terms of Reference

Members:

• Member practices are as follows:

• Benhill and Belmont GP Centre, Sutton

• Dr Grice & Partners, Old Court House Surgery, Sutton

• Grove Road Surgery, Sutton

• GP Centre, Cheam (three Practices)

• Well Court Surgery, Cheam

• Robin Hood = - Dr Seyan, Sutton

• Mulgrave Road Surgery, Cheam

• Cheam Family Practice, Cheam

• Locality Lead



• Locality Management member(s) and structure – Grade 8a Managerial Position has been created and is soon to be appointed. This will be jointly shared as a single full time post across the three Locality groups of Sutton Clinical Commissioning Group (SCCG).

• Lead Roles are for a two year tenure only and may be re-elected for further two year terms. The lead roles to be elected from among the locality Practices. Goals

1. To support and implement the decisions of the SCCG Executive Team. 2. To achieve a reduction in referrals of patients, through more appropriate referrals, reducing patient

hospitalisation and embracing intermediate services and pathway re-design. 3. To reduce Accident and Emergency attendance through more effective patient engagement,

greater education about use of Out of Hours Services. 4. To take ownership of the QIPP agenda and work towards its goals and objectives. 5. To promote education amongst the clinicians and encourage educational achievements through

support and courses. 6. To act as a platform for discussing topics relevant to the daily working of the practices, such as

QOF, QP and Medicines Management. IF DESIRED EACH LOCALITY WILL DEVELOP ARRANGEMENTS:-

• To implement agreed key indicators of performance that are monitored, developed and obtained.

• To develop financial structures AND A FINANCIAL FRAMEWORK to support clinical pathways at a locality level. ANY SUCH ARRANGEMENT TO BE APPROVED BY THE SCCG BOARD.

Accountability

Each member practice is accountable to the Locality Lead and subsequently to the Executive Management Team of the SCCG.

Meetings

• 11-12 Meetings will take place per year (average of one meeting per month).

• Practice Members will be required to attend all locality meetings and the plenary meetings and may send a deputy if notified to the Chair of that meeting.

• The Locality Lead will organise and chair the meetings.

• Management support from the SCCG will be provided, for example minute taking, agendas.



Decision making and voting

• A minimum of seven of the ten practices are to be represented in order to declare the meeting quorate and decisions binding.


• Information will be shared and communicate to the group via email and supported with telephone contact.




Locality of Wallington Meeting- Terms of Reference Members: Member practices are as follows:

• Beeches Surgery

• Maldon Road

• Manor Practice

• Park Road Medical Centre

• Shotfield Medical Practice

• Wallington Family Practice

• Wallington Medical Centre

• Locality Lead



• Locality Management member(s) and structure – Grade 8a Managerial Position has been created and is soon to be appointed. This will be jointly shared as a single full time post across the three Locality groups of Sutton CCG.

• Lead Roles are for a two year tenure only and may be re-elected for further two year terms. The lead roles to be elected from among the locality Practices.

Goals

• To support and implement the decisions of the Sutton Clinical Commissioning Group (SCCG) Executive team.

• To achieve a reduction in referrals of patients, through more appropriate referrals, reducing patient hospitalisation and embracing intermediate services and pathway re-design.

• To reduce Accident and Emergency attendance through more effective patient engagement and greater education about use of Out of Hours Services.

• To take ownership of the QIPP agenda and work towards its goals and objectives.

• To promote education amongst the clinicians and encourage educational achievements through support and courses.

• To act as a platform for discussing topics relevant to the daily working of the practices, such as QOF, QP and Medicines Management.

IF DESIRED EACH LOCALITY WILL DEVELOP ARRANGEMENTS:-

i. To implement agreed key indicators of performance that are monitored, developed and obtained. ii. To develop financial structures and financial framework to support clinical pathways at a locality

level. ANY SUCH ARRANGEMENT TO BE APPROVED BY THE SCCG BOARD. Accountability

• Each member practice is accountable to the Locality Lead and subsequently to the Executive Management Team of the SCCG. Meetings

o 11-12 Meetings will take place per year (average of one meeting per month) o Practice Members will be required to attend all locality meetings and the plenary meetings and may

send a deputy if notified to the Chair of that meeting. o The Locality Lead will organise and chair the meetings o Management support from the SCCG will be provided, for example minute taking, agendas



Decision making and voting

• A minimum of five out of the eight Practices are to be represented in order to declare the meeting quorate and decisions binding.


• Information will be shared and communicate to the group via email and supported with telephone contact




Annex 4: Audit Committee Terms of Reference 1. Purpose of the Committee The Audit Committee (the Committee) is established in accordance with NHS Sutton Clinical Commissioning Group’s (SCCG) Constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution. 2. Remit and responsibilities of the Committee The key duties of the Committee are: 2.1. Integrated governance, risk management and internal control The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the SCCG’s activities that support the achievement of the SCCG’s objectives. Its work will dovetail with that of the Quality Committee. In particular, the Committee will review the adequacy and effectiveness of:

i. All risk and control related disclosure statements (in particular the governance statement), together with any appropriate independent assurances, prior to endorsement by the SCCG.

ii. The underlying assurance processes that indicate the degree of achievement of SCCG objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.

iii. The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.

iv. The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the NHS Counter Fraud and Security Management Service.

v. In carrying out this work the Committee will use primarily the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

vi. This will be evidenced through the Committee’s use of an effective assurance framework to guide its work and that of the audit and assurance functions that report to it.

2.2. Internal audit The Committee shall ensure that there is an effective internal audit function that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Accountable Officer and the Board. This will be achieved by:

• Consideration of the provision of the internal audit function, the cost of the audit and any questions of resignation and dismissal.

• Review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework.

• Considering the major findings of internal audit work (and management’s response) and ensuring co-ordination between the internal and external auditors to optimise audit resources.

• Ensuring that the internal audit function is adequately resourced and has appropriate standing within the SCCG. An annual review of the effectiveness of internal audit.

2.3. External audit The Committee shall review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:



• Consideration of the performance of the external auditors, as far as the rules governing the appointment permit.

• Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy.

• Discussion with the external auditors of their local evaluation of audit risks and assessment of the SCCG and associated impact on the audit fee.

• Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the SCCG and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

2.4. Other assurance functions The Audit Committee shall review the findings of other significant assurance functions, both internal and external and consider the implications for the governance of the SCCG. These will include, but will not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies). 2.5. Counter fraud The Committee shall satisfy itself that the SCCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme. 2.6. Management The Committee shall request and review reports and positive assurances from directors and managers on the overall arrangements for governance, risk management and internal control. The Committee may also request specific reports from individual functions within the SCCG as they may be appropriate to the overall arrangements. 2.7. Financial reporting The Audit Committee shall monitor the integrity of the financial statements of the SCCG and any formal announcements relating to the SCCG’s financial performance. The Committee shall ensure that the systems for financial reporting to the SCCG, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the SCCG.

• The Audit Committee shall review the annual report and financial statements before submission to the Board and the SCCG, focusing particularly on:

• The wording in the governance statement and other disclosures relevant to the terms of reference of the Committee;

• Changes in, and compliance with, accounting policies, practices and estimation techniques;

• Unadjusted mis-statements in the financial statements;

• Significant judgements in preparing of the financial statements;

• Significant adjustments resulting from the audit;

• Letter of representation;

• Qualitative aspects of financial reporting. 3. Membership Members of the Committee shall be appointed by the Board. The Committee shall comprise three members at least one of whom shall have recent and relevant financial experience. The Committee shall not include full time employees or individuals who claim a significant proportion of their income from the SCCG. The member practices shall not be in the majority. The Lay Member – Governance will be appointed as Chair to the Audit Committee. In the absence of the Chairman from the meeting of the Committee, a chairman shall be nominated by other members attending that meeting.



The Chairman of the SCCG shall not be a member of the Committee. 4. Attendance The following individuals shall normally attend meetings:

• The Chief Financial Officer,

• Internal and External Audit representatives

• Local counter fraud and security management (NHS Protect) representatives should attend at least one meeting a year

The Accountable Officer will be invited to attend, at least annually, to discuss with the Audit Committee the process for assurance that supports the Statement on Internal Control. He or she would also normally attend when the Committee considers the draft internal audit plan and the annual accounts. The Accountable Officer / Chief Operating Officer and other members of the SCCG Board (Board) / senior managers should be invited to attend meetings as necessary, but particularly when the Committee is discussing areas of risk or operation that are the responsibility of that individual. At least once a year the Committee should meet privately with the external and internal auditors. Regardless of attendance, external audit, internal audit, local counter fraud and security management (NHS Protect) providers will have full and unrestricted rights of access to the Audit Committee. The chair of the Board will be invited to attend one meeting each year in order to form a view on, and understanding of, the Committee’s operations. 5. Secretary The Chief Finance Officer shall nominate a person to act as secretary to the Committee. 6. Quorum The quorum necessary for the transaction of business shall be two members. A duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee. 7. Frequency and notice of meetings The Committee shall meet not less than three times a year and otherwise as requested. The appointed external auditors or Head of Internal Audit may request a meeting if they consider that one is necessary. Meetings of the Committee shall be summoned by the secretary to the Committee at the request of any of its members, or at the request of external or internal auditors. Unless otherwise agreed, notice of each meeting confirming the venue, time and date together with an agenda of items to be discussed, shall be forwarded to each member of the Committee, and other persons required to attend no later than five working days before the date of the meeting. Supporting papers shall be sent to Committee members and other attendees as appropriate, at the same time. 8. Conduct of meetings Except as outlined in these Terms of Reference, meetings of the Committee shall be conducted in accordance with the provisions of Standing Orders, Reservation and Delegation of Powers and Standing Financial Instructions approved by the Board and reviewed from time to time. The secretary shall minute the proceedings of all meetings of the Committee, including recording the names of those present and in attendance. Minutes of Committee meetings shall be circulated promptly to all attendees of the Committee and, once agreed, presented to the Board.



9. Reporting relationships The Committee Chairman shall report formally to the Board of the Board on its proceedings after each meeting on all matters within its duties and responsibilities. The Committee shall make any such recommendations to the Board it deems appropriate on any area within its remit where action or improvement is needed. The Committee will report to the Board annually on its work in support of the Annual Governance Statement, specifically commenting on the completeness and degree of integration of risk management and the holistic nature of governance arrangements. The Committee shall compile a report to the Board on its activities to be included in the Annual Report. 10. Other matters The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee may seek authorisation from the Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary, within its terms of reference within a cost limit determined by the Chief Finance Officer. The Committee shall:

• Have access to sufficient resources to carry out its duties.

• Be provided with appropriate and timely training, both in the form of an induction programme for new members and an ongoing basis for all members.

• Give due consideration to laws and regulations impacting on the work of the Committee.

• Be responsible for co-ordination of the internal and external auditors.

• At least once a year, review its own performance and terms of reference to ensure it is operating at maximum effectiveness and recommend any changes it considers necessary to the Board.

11. Audit Committees in Common The Audit Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Audit Committee ToR Addendum.



Audit Committee

Terms of Reference Addendum

Committees in Common

To be added, if required



Annex 5: Remuneration Committee Terms of Reference

1. Introduction The Remuneration Committee (the Committee) is established in accordance with NHS Sutton Clinical Commissioning Group’s (SCCG) Constitution, Standing Orders and Scheme of Delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the SCCG’s constitution and standing orders. 2. Remit and responsibilities of the Committee The actions of the Committee must be publicly defensible. The Committee should bear in mind the need for properly defensible remuneration packages - which are linked to clear statements of responsibilities – and with rewards linked to the measurable discharge of those responsibilities. In all of their decisions and recommendations, the Committee should also remain aware that each individual NHS organisation is corporately responsible for ensuring that its pay arrangements are appropriate in terms of Equal Pay requirements and other relevant legislation. SCCG Remuneration Committee and SCCG Board, to which it reports, are public bodies. As such, they must at all times:

• Observe the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds and the management of the bodies concerned.

• Maximise value for money through ensuring that services are delivered in the most efficient and economical way, within available resources, and with independent validation of performance achieved wherever practicable.

• Be accountable to Parliament, to users of services, to individual citizens, and to staff for the activities of the bodies concerned, for their stewardship of public funds and the extent to which key performance targets and objectives have been met.

• Comply fully with the principles of the Citizen's Charter and the Code of Practice on Access to Government Information, in accordance with Government policy on openness.

• Bear in mind the necessity of keeping comprehensive written records of their dealings, in line with general good practice in corporate governance.

The Committee shall make recommendations to the Board on determinations about remuneration and conditions of service for:

• Employees of the SCCG.

• People who provide services to the SCCG.

• Allowances under any pension scheme it might establish as an alternative to the NHS pension scheme.

• Reviewing the performance of the Accountable Officer and other senior team members and determining annual salary awards, if appropriate.

• Considering the severance payments of the Accountable Officer and usually of other senior staff, seeking HM Treasury approval as appropriate in accordance with the guidance ‘Managing Public Money’ (available on the HM Treasury.gov.uk website).

All aspects of salary will be considered by the Committee, including:

• Performance-related elements and bonuses.

• Provisions for other benefits, including pensions and cars.

• Arrangements for termination of employment and other contractual terms (decisions requiring dismissal shall be referred to the Board).

The Committee will also consider and approve the following issues for submission to the NHS England Remuneration Committee:

• Severance payments to the Accountable Officer and other directors.

• Termination payments requiring Treasury approval.



• Redundancy/early retirement payments to the Accountable Officer and other Directors, together with any others costing over £50,000.

3. Membership Members of the Committee shall be appointed by the SCCG from amongst its Board members. The Committee should normally consist of three members; additional members should be at the discretion of the Board. The Committee should not include full time employees or individuals who claim a significant proportion of their income from the CCG. The member practices should not be in the majority. The Lay Member – Governance will be appointed as Chair to the Committee. The composition of the Committee should be recorded in the annual report. In the absence of the Chairman from the meeting of the Committee, a chairman shall be nominated by other members attending that meeting. 4. Attendance Only members of the Committee have the right to attend Committee meetings. However, other individuals such as the Accountable Officer, any HR lead and external advisers may be invited to attend for all or part of any meeting as and when appropriate. No senior managers should be present for discussions about their own remuneration (although it is reasonable for the Accountable Officer, the HR Lead, and other senior managers where appropriate, to attend meetings of the Committee during which the remuneration of other staff is discussed). In this context, 'senior managers' are those persons in senior positions having authority or responsibility for directing or controlling the major activities of SCCG. 5. Secretary The Secretary to the Board or Chief Operating Officer will provide administrative support to the Committee. In the case of the latter, such support will exclude presence when matters relating to the Chief Operating Officer are discussed The secretary will be responsible for supporting the chair in the management of remuneration business and for drawing the Committee’s attention to best practice, national guidance and other relevant documents, as appropriate. 6. Quorum A quorum shall be two members, but the Chairman of the Committee shall reserve the right to reconvene and rearrange a meeting should he/she feel this necessary. A duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee. 7. Frequency and notice of meetings The Committee shall normally meet at least twice a year, but additional meetings may be requested by the Chairman at any time. Unless otherwise agree, notice of each meeting confirming the venue, time and date together with an agenda of items to be discussed, shall be forwarded to each member of the Committee, and other persons required to attend no later than five working days before the date of the meeting. Supporting papers shall be sent to Committee members and other attendees as appropriate, at the same time. 8. Conduct of meetings Except as outlined in these Terms of Reference, meetings of the Committee shall be conducted in accordance with the provisions of Standing Orders, Reservation and Delegation of Powers and Standing Financial Instructions approved by the Board and reviewed from time to time. The secretary shall minute the proceedings of all meetings of the Committee, including recording the names of those present and in attendance.



Minutes of Committee meetings shall be circulated promptly to all attendees of the Committee and, once agreed, presented to the Board. Minutes of meetings will be taken by the Board Secretary or representative, who will service the Committee. The minutes of the Committee meeting are confidential to members of the Board and the Secretary or representative in line with exemptions from the Freedom of Information Act 2000 under section 40 (Personal Information). 9. Reporting relationships It is likely that regulations will require SCCG to make available annually:

• Information on the total salary (in bands of £5,000), fees, pensions, travelling and other allowances and gratuities paid to senior managers of the SCCG, and the chair, and members of the Board who are employees of the SCCG, the lay members, the hospital doctor and the nurse. This should include arrangements for the provision of pensions, allowances or gratuities by way of compensation to or in respect of any members of the Board who suffer loss or diminution of emoluments.

• All recommendations of the Committee to the Board as to the discharge of its functions under section14L(3)(a) and (b) [i.e. its functions to determine the remuneration of SCCG employees] of the NHS Act 2006, except for recommendations which the SCCG considers that would not be in the public interest to publish.

• All decisions of the Board in the exercise of its functions section 14L(3)(a) and (b) of the NHS Act 2006, except where the SCCG considers that it would not be in the public interest.

• The Committee Chair shall report formally to the SCCG Board on its proceedings after each meeting on all matters within its duties and responsibilities. The report shall be presented to the confidential meeting of the Board, respecting individual confidentiality. The Committee shall make recommendations to the Board on any area within its remit where action or improvement is needed.

10. Other matters The Committee will have delegated powers to act on behalf of the SCCG within the approved Terms of Reference. The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee may apply to the Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary, within its terms of reference within a cost limit determined by the Chief Finance Officer. The Committee shall:

• Have access to sufficient resources to carry out its duties.




11. Remuneration Committees in Common The Remuneration Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Remuneration Committee ToR Addendum.



Addendum 1: Remuneration Committee - Committees in Common Terms of Reference




Annex 6: Board Nominations Committee Terms of Reference 1. Purpose of the Committee The Nominations Committee (the Committee) is established in accordance with NHS Sutton Clinical Commissioning Group (SCCG) Constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution. 2. Remit and responsibilities of the Committee The remit of the Committee is to:

• Ensure that the Board has the right balance of skills, knowledge and perspectives required for Board members.

• Set the terms of office for independent members and other members.

• Oversee the appointment/election process for Board members and Locality Leads.

• Develop an approach to succession planning for key members of the Board

• Oversee the performance review process for all members including the chair.

• Arrange a regular performance evaluation of the effectiveness of the Board and its committees as a whole.

The key duties of the Committee are to:

• Regularly review the structure, size and composition (including the skills, knowledge and experience) required of the Board compared to its current position and make recommendations to the Board with regard to any changes.

• Give full consideration to succession planning for Board Members. Accountable Officer, Chief Operating Officer and other senior managers in the course of its work, taking into account the challenges and opportunities facing the SCCG, and what skills and expertise are therefore needed on the Board in the future.

• Develop a competency profile or skill matrix to guide succession planning and recruitment.

• Be responsible for initiating and overseeing the election / selection process for members including:

• approval of role descriptions and person specifications.

• conducting screening interviews to ensure applicants meet the essential - requirements of the role.

• ensuring the election process is conducted according to the requirements agreed in the Constitution.

• Be responsible for initiating the selection process and making recommendations to the Board on the appointment of independent Board members, the Accountable Officer, Chief Operating Officer and other senior managers as and when vacancies arise.

• Before any appointment is made by the Board, evaluate the balance of skills, knowledge and experience on the Board, and, in the light of this evaluation prepare a description of the role and capabilities required for a particular appointment. In identifying suitable candidates the committee shall:

• Use open advertising or the services of external advisers to facilitate the search.

• Consider candidates from a wide range of backgrounds.

• Consider candidates on merit and against objective criteria, taking care that appointees have enough time available to devote to the position.

• Keep under review the leadership needs of the organisation, with a view to ensuring the continued ability of the organisation to deliver its responsibilities as a commissioner.

• Develop and oversee the performance review process for all members including the chair, ensuring that outputs are fed into the annual remuneration review process.

• Review annually the time required from members. Performance evaluation should be used to assess whether members are spending enough time to fulfil their duties.

• Ensure that on appointment to the Board, members receive a formal letter of appointment setting out clearly what is expected of them in terms of time commitment, committee service and involvement outside meetings.



The Committee shall also make recommendations to the Board concerning:

• Formulating plans for succession for members and in particular for the key roles of Chairman, Accountable Officer and Chief Operating Officer.

• Suitable candidates for the membership of the Audit and Remuneration Committees, in consultation with the chairmen of those committees.

• The re-appointment of any member at the conclusion of their specified term of office having given due regard to their performance and ability to continue to contribute to the Board in the light of the knowledge, skills and experience required.

• Any matters relating to the continuation in office of any member at any time including the suspension or termination of service of any member subject to the provisions of the law and their service contract.

• The appointment of any member to executive or other office.

3. Membership Members of the Committee shall be appointed by the SCCG Board. The Committee shall comprise three members, two of whom should be independent members (i.e. the member practices shall not be in the majority). The Board shall appoint the chair of the Committee who should be either the Chair of the Board or an Independent member. If the Board Chair is a GP and is appointed as chair of the Committee, the remaining members may not be GPs. Membership shall exclude full time employees or individuals who claim a significant proportion of their income from the group. Appointments to the Committee will be made for a period of up to three years. 4. Attendance Only members of the Committee have the right to attend meetings. However, the Accountable Officer / Chief Operating Officer / HR representative and other external advisers may be invited to attend meetings as necessary. 5. Secretary The Secretary to the Board or Chief Operating Officer shall act as secretary to the Committee. 6. Quorum The quorum necessary for the transaction of business shall be two members. A duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee. 7. Frequency and notice of meetings The Committee shall meet not less than two times a year and otherwise as requested. Unless otherwise agreed, notice of each meeting confirming the venue, time and date together with an agenda of items to be discussed, shall be forwarded to each member of the Committee, and other persons required to attend no later than five working days before the date of the meeting. Supporting papers shall be sent to Committee members and other attendees as appropriate, at the same time. 8. Conduct of meetings Except as outlined in these Terms of Reference, meetings of the Committee shall be conducted in accordance with the provisions of Standing Orders, Reservation and Delegation of Powers and Standing Financial Instructions approved by the Board and reviewed from time to time. The secretary shall minute the proceedings of all meetings of the Committee, including recording the names of those present and in attendance. Minutes of Committee meetings shall be circulated promptly to all attendees of the Committee and once agreed, presented to the Board.



9. Reporting relationships The Committee Chairman shall report formally to the Board of the Board on its proceedings after each meeting on all matters within its duties and responsibilities. The Committee shall make any such recommendations to the Board it deems appropriate on any area within its remit where action or improvement is needed. The Committee shall compile a report to the Board on its activities to be included in the Annual Report. 10. Other matters The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee may apply to the Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary, within its terms of reference within a cost limit determined by the Chief Finance Officer. The Committee shall:

• have access to sufficient resources to carry out its duties.




These terms of reference will be reviewed annually and amended in light of experience and circumstances.



Annex 7: Board Quality Committee Terms of Reference

1. Purpose of the Committee The Quality Committee (the Committee) is established in accordance with NHS Sutton Clinical Commissioning Group’s (SCCG) Constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution. 2. Remit and responsibilities of the Committee The key duties of the Committee are:

• To provide strategic oversight of and assurance to the Board on continual quality improvement of all commissioned services5, including safety, effectiveness, patient experience, safeguarding, equality, infection control, information governance and risk including learning from complaints, serious untoward incidents and never events.

• To promote a culture of continuous improvement and innovation with respect to patient safety, clinical effectiveness and patient experience.

• To provide assurance to the Board that robust processes and controls are in place to ensure delivery of safe and effective services to the SCCG’s registered population

• To scrutinise and provide assurance to the SCCG of arrangements relating to engagement with the public and stakeholders.

• To provide strategic overview of patient and public involvement and engagement in commissioning processes and decisions, assuring the SCCG that patient and public engagement is driving decision making on any proposals which may have a significant impact on service delivery or the range of services available.

• To ensure the SCCG takes an integrated approach to clinical, research, corporate and information governance.

• Its work will dovetail with that of the Audit Committee. 2.1 Scope The scope of the Committee will include:

• Maintenance of an overview and provision of strategic vision, leadership and assurance for elements of quality, governance and risk relating to NHS Sutton SCCG covering all commissioned services public health and organisational functions.

• Consideration of how these relate to patients and carers, staff, the wider community and partner organisations, including joint commissioning arrangements in accordance with the rights and pledges of the NHS Constitution.

• Oversight of strategies or policies to ensure compliance with safety, quality, patient experience, safeguarding, equality, infection control, information governance and risk.

2.2 Duties The Committee shall have the following specific duties: Quality, safety and patient experience

• To oversee the development of a framework for monitoring and improving quality in all commissioned services which supports clinical commissioners and commissioning support services to set out specific, measurable and challenging goals around patient experience, clinical effectiveness and patient safety.

• To undertake scrutiny on behalf of the Board to establish all their commissioned services are of an acceptable quality, that quality driven national requirements are met and that nationally produced evidence on quality and patient safety is being implemented locally through borough or cluster based commissioning arrangements

5 This will include all services commissioned for the Sutton SCCG population, including not only those commissioned directly by the SCCG but also services commissioned by other bodies, including the NHSCB (such as Specialised Health Services, Independent Contractor services within the CCG’s remit) Local Authorities, and those commissioned under other collaborative arrangements



• To provide additional focus on quality issues highlighted locally or nationally and to address the key issues as appropriate.

• To receive assurance on how commissioned organisations meet the Care Quality Commission’s requirements for registration, and through the NHS England’s arrangements for Primary Care Contracting, how primary care providers meet registration requirements for independent contractors

• To provide assurance to the Board on:

• how the SCCG meets quality governance requirements as commissioners

• how the SCCG’s duties in regard to patient and public involvement, particularly in the planning of services, are being met both within the SCCG and commissioning support services, including assurance on independent contractors’ Duty to Report on Involvement.

• the arrangements for equality, diversity and human rights, including meeting statutory requirements, in the commissioning of services, primary care contracting, public health and organisational functions.

• To review and assure the arrangements for Safeguarding (Children and Vulnerable Adults) including ensuring compliance with all statutory requirements and ensuring response to and implementation of lessons from national or local reviews and recommendations.

• To consider the trends and lessons from Serious Incident reporting within commissioned services and give assurance on the robustness of action plans and organisational learning to prevent recurrence, including benchmarking information, trends or themes.

• Ensure clinical governance, including NICE and National Patient Safety Agency Alerts implementation, clinical audit, education and training, research governance is integrated, monitored and reported in a coherent way.

• To receive reports from regulatory and other competent bodies, e.g. the Care Quality Commission, Monitor, etc. and respond appropriately.

• To monitor performance against standards, outcome domains and benchmarked best practice relating to patient safety and patient experience.

• Where there are serious failures in quality, to report by exception, to the Board and monitor agreed remedial actions/plans.

Patient and public engagement

• To establish a successful and effective mechanism to ensure full public and patient engagement in commissioning decision making.

• To ensure that services commissioned meet the quality and engagement standards within the service specifications and that these are continually monitored.

Organisational governance and risk

• To provide assurance to the Board on clinical and corporate governance arrangements. This may include areas such as the arrangements for the management of conflict of interest, the requirements for clinical commissioners to work collaboratively with each other and partner organisations; arrangements for clinical governance and governance within primary care.

• To receive assurance about risk management, including compliance with all statutory and regulatory organisational requirements including the programme of risk management training for board members, executives and senior managers.

• To recommend for annual approval by the Board the Risk Management Policy Annual review.

• To review the Board Assurance Framework and Corporate Risk Register, give assurance on and make recommendations for action to improve the effectiveness of controls and actions for mitigation.

• To receive assurance, including Annual Reports and exception reports regarding the arrangements for:

• Risk Management e.g. Incident reporting, claims management.

• Health & Safety and Fire including local security management.

• Infection Control.

• Emergency Planning including Pandemic Flu.

• Information Governance, including the Information Governance Toolkit and Freedom of Information Act requests.

• Complaints.

• Implementation of NICE Guidance:

• Research Governance

• Medicines Management



• To address any other aspects of governance remitted by the Board.

3. Membership The membership of the Committee shall comprise:

• Lay Member (Patient and Public Involvement and Quality Lead)

• Accountable Officer

• Three Clinical Board Members

• Managing Director

• Independent Nurse

• Head of Risk Management (or equivalent)

• Medicines Management Lead (or equivalent)

• Quality and Engagement Lead (or equivalent)

• Patient Reference Group

• Local Healthwatch

• Patient and Public Involvement Forum representative

• Other members of staff will be invited to attend as required

• The Chair should be the Lay Member (Patient and Public Involvement and Quality) with a clinical member of the Board as vice chair.

• SL CSU Representative

• Patient Reference Group representative

• CCG Commissioning Manager for Mental Health 4. Quorum The meeting shall be deemed quorate when no less than half of the core membership is present including the Chairman and a minimum of two Clinicians. 5. Frequency of meetings Meetings shall be held monthly. 6. Secretary The Chief Operating Officer shall act as secretary to the Committee (or will delegate this to an appropriate senior level member of staff). 7. Agenda The agenda will be developed by the secretary to the Committee in liaison with the Chairman of the Sub Committee. The agenda and all relevant papers will be circulated five working days prior to the meeting. Papers tabled at the meeting will be at the discretion of the Chairman. 8. Reporting mechanisms and links The minutes of previous meetings will be issued to all members of the Committee within 10 working days of the meeting, highlighting actions by individual members of the committee or staff in attendance. The Committee will report into the SCCG Board through its minutes. The minutes will be presented at each SCCG Board formal meeting for information purposes. 9. Other matters The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee may apply to the Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary, within its terms of reference within a cost limit determined by the Chief Finance Officer.



The Committee shall: ▪ Have access to sufficient resources to carry out its duties. ▪ Be provided with appropriate and timely training, both in the form of an induction programme for new

members and an ongoing basis for all members. ▪ Give due consideration to laws and regulations impacting on the work of the Committee. ▪ At least once a year, review its own performance and terms of reference to ensure it is operating at

maximum effectiveness and recommend any changes it considers necessary to the Board.

• Quality Committees in Common The Board Quality Committee may meet as a “Committees in Common” with other CCGs using additional Terms of Reference as set out in the Board Quality ToR Addendum.

These terms of reference will be reviewed annually and amended in light of experience and circumstances.



Quality Committee







Annex 9: Finance Committee – Terms of Reference

• Introduction

The Finance Committee (the Committee) is established by the CCG Board to ensure a robust financial strategy is in place and to oversee the organisation-wide system of financial management. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution.

• Authority

The Committee is authorised by the CCG Board to pursue any activity within these Terms of Reference and within the Scheme of Reservation and Delegation, including (without limiting the generality of the foregoing) to:

• seek any information it requires from CCG employees, in line with its responsibility under these terms

of references and the Scheme of Reservation and Delegation

• require all CCG employees to co-operate with any reasonable request made by the Committee, in line with its responsibility under these terms of references and the Scheme of Reservation and Delegation

• review and investigate any matter within its remit and grants freedom of access to the CCG’s records, documentation and employees. The Committee must have due regard for the Information Policies of the CCG, regarding personal health information and the CCG’s duty of care to their employees when exercising its authority.

• Remit and responsibilities of the Committee

The remit and responsibilities of the Committee are to:

a. Keep under review strategic and operational financial plans and the current and forecast

financial position of the CCG

b. Oversee the arrangements in place for the allocation of resources and the scrutiny of all

expenditure. This will include actual and forecast expenditure and activity on commissioning

contracts.

c. Consider and review the financial report to be presented to the CCG Board, incorporating

financial performance against budget, financial risk analysis, forecasts and robustness of

underlying assumptions.

d. Provide assurance to the Governing Body and the Audit Committee of the

completeness and accuracy of the financial information provided to the Governing Body.

e. Consider and review any external financial monitoring returns and commentary.

f. Ensure any financial improvement plan is monitored and reviewed and appropriate actions

are taken.

g. Review by exception performance report summaries and consider performance issues in

so far as they impact on financial resource.

h. Receive a monthly report on the progress of the QIPP plan

i. Review, scrutinise and recommend business cases to the CCG Board.

j. Review and agree or ratify procurement decisions as appropriate in accordance with Prime



Financial Policies and the Scheme of Delegation and recommend to the CCG Board.

k. Approve thresholds above which quotations or formal tenders should be obtained.

l. Review and approve tender waivers or seek tenders from firms not on approved lists and

ensure these are reported to the Audit Committee. m. Review the transition of f inancial resources and responsibilities from NHS Sutton and Merton

to the inception of the CCG and related parties.

n. Receive minutes of the meeting of the trustees of the Sutton and Merton joint

Char itable Funds.

o. Where appropriate provide recommendations and actions to the CCG Board.

p. Where appropriate refer issues to other committees of the CCG Board.

• Membership

The Committee shall be appointed by the CCG Board and will consist of:

Members:

The Chair who will be a Lay Member

The Chair of the Audit Committee

Another lay member of the CCG Board In attendance:

The Managing Director

The Chief Finance Officer

If a member is unable to attend then a suitable delegate with appropriate authority should attend in their place. The executive lead officer for the committee is the Chief Finance Officer. The Committee may require other officers of the CCG to attend on an ad hoc basis as appropriate.

• Quorum

The meeting will be quorate when two (2) members are present, and the Chief Finance Officer or delegated representative also present.

5. Reporting Procedures

Formal minutes of meetings shall be recorded and will go to the CCG Board.

6. Declarations of Interest

If any member has an interest, pecuniary or otherwise, in may matter and is present at the meeting at which the matter is under discussion, he/she will declare that interest as early as possible and shall not participate in the discussions. The Chair will have the power to request that member to withdraw until the committee consideration has been completed. All members will be expected to adhere to and comply with any relevant policy; including but not exclusive to Declarations of Interest and Anti- Bribery.

• Attendance and Administration

In addition to the standing members of the Committee, any other CCG Board Member may attend with the agreement of the Chair of the CCG Board.

8. Frequency and notice of meetings

Meetings shall be held monthly.



9. Review

These Terms of Reference will be reviewed after six months and on an annual basis thereafter. Any resulting changes to the terms of reference should be approved by the CCG Board.

10. Transition

It should be noted that until the CCG takes on full statutory responsibility (1st

April 2013)

the Committee will be operating in shadow form under the authority of NHS Sutton and Merton.

11. Finance Sub Committees in Common:

The Finance Sub Committee may meet as a “Committees in Common” with other CCGs using

additional Terms of Reference as set out in the Finance Sub ToR Addendum.



Finance Committee






Annex 10: Committee for Collaborative Decision Making

Version 1.0 July 2017

(The Committee for Collaborative Decision Making always operates using the Committees in Common arrangement with one or more other CCGs.)

Introduction 1. The six Clinical Commissioning Groups (CCGs) in South West London (Croydon, Kingston, Merton,

Richmond, Sutton, Wandsworth) have agreed the establishment of a “Committees in Common” (CiC) arrangement for the purpose of collaborative decision making, including the decisions for recommendations made by the South West London Sustainability and Transformation Partnership. The governing body of each of the CCGs has resolved to create a “Committee for Collaborative Decision Making” that will participate in a Committees in Common arrangement. The participant CCGs for a particular CIC meeting will be determined by the nature of issue delegated to the committee. The participants may range from one other CCG to all SWL CCGs and neighbouring CCGs.

Statutory Framework 2. Under paragraph 3(3) of Schedule 1A of the National Health Service Act 2006 (inserted by the Health

and Social Care Act 2012) CCGs’ constitutions may provide for their functions to be exercised by any members or employees of the CCG. Each of the CCGs provides in its Constitution a mechanism that allows specified functions to be delegated to a designated committee, which may meet with identical Committees of other CCGs in a CiC arrangement. Where the decisions of the CiC are unanimously made, the decisions are binding on the constituent CCGs.

Role of CiC 3. The effective planning & commissioning of health care or organisational capacity sometimes requires

decisions to be made for populations much larger than a single CCG. The six South West London CCGs wish to collaborate, and where appropriate with neighbouring CCGs to make collaborative organisational or commissioning decisions.

4. The role of the CiC is to make decisions on behalf of the constituent CCG Governing Bodies as set out below. Such decisions will be taken by individual committees of each Governing Body that have been instructed to meet in common.

(Each individual CCG Committee will make informal arrangements with its CCG Governing Body on considering the issues and the engagement of its CCG membership before the Committee makes a decision at a CiC meeting.)

Accountability for the Committee for Collaborative Decision Making: 5. The Committee for Collaborative Decision Making is accountable to the CCG Governing Body. The

Committee operates in a Committees in Common arrangement with other CCGs but remains as the decision making committee for the delegated Collaborative Decision Making functions. (For clarity – The CIC does not make decisions for the CCG but the CCG’s Committee for Collaborative Decision Making does make decisions for the CCG.)



Functions Delegated to the Committee for Collaborative Decision Making: 6. The CiC enables the participating Committees to make the same decision for issues delegated by their

Governing Bodies in relation to:

• Any significant change in healthcare service that affects the population of more than one CCG;

• Any significant commissioning strategy/plan that affects the population of more than one CCG;

• Any CCG organisational development of more than one CCG. 7. The CiC will ensure that best commissioning practice is followed in making decisions including:

• Evidence-based proposals

• Effective stakeholder engagement

• Appropriate consultation

Membership – CCG Committee for Collaborative Decision Making 8. The CCG Committee for Collaborative Decision Making will comprise of three individuals:

• 1 Lay member of the Governing Body

• 1 Clinical governing body member

• 1 Managerial governing body member

9. Where a member of the Committee for Collaborative Decision Making is unable to attend a meeting, they may nominate as their deputy another member (of the same class) of the governing body.

Membership - CiC for Collaborative Decision Making 10. The CiC for Collaborative Decision Making will comprise of:

• A non-voting CIC Convenor (Either an externally appointed individual or a lay member drawn from a CCGs Governing Body)

• The SWL CCG Committees for Collaborative Decision Making who have chosen to participate in the CiC meeting.

• Other CCG Committees for Collaborative Decision Making for whose populations the proposals may amount to a substantial change or development in services

Non-voting attendees: 11. The following individuals will be invited to attend a CiC meeting:

• Up to 3 NHS England Representatives as a commissioner of relevant services.

• 1 Healthwatch Patient Representative • 1 Public Engagement Representative

12. There will be an annual review of the CiC’s membership to support its efficient functioning.

Meetings - Procedure 13. The CiC will adopt the Wandsworth CCG Standing Orders relating to the conduct of meetings, agendas

and declaration of interest with the exception of the following clauses in this section.



14. The CCG Governing Bodies will decide when to delegate an issue for decision to its Committee for Collaborative Decision Making. (The number of CCG Governing Bodies, who make this delegation, will depend on the nature of the issue being delegated.)

15. The Committee for Collaborative Decision Making will only make decisions when it formally meets as a Committees in Common with other CCG Committees.

16. The Committee for Collaborative Decision Making meeting as a CiC will be held in public except where the CiC resolve to exclude the public on grounds of the confidential nature of the business to be discussed, in the interests of public order or because the CiC consider that it would otherwise not be in the public interest for the public to be admitted to all or part of a meeting.

17. The Committee for Collaborative Decision Making may hold private seminars with other similar committees but may not make decisions at these meetings.

18. When a CiC meeting is held, an agenda for the CCG Committee for Collaborative Decision Making will be prepared that is identical in content to the agendas for the other participating Committees.

19. A CIC meeting quorum has three components:

a. All participating CCGs are present; b. Each Committee for Collaborative Decision Making has at least 2 members present; (An

individual may be a member of more than one Committee.) c. One lay member is present.

20. The CIC may call additional experts to attend meetings on an ad hoc basis to inform discussions as

appropriate.

21. The CIC will ensure the declaration and management of any conflicts of interest by ensuring the relevant CCG register is up to date. In addition, a verbal declaration should be made at the start of each meeting in relation to any conflict relevant to the discussion.

22. For a decision to be taken:

• The decision is within the bounds of the CIC delegated functions;

• Each CCG Committee has one vote;

• A decision has been unanimously agreed. 23. The unanimous decisions made at a CIC meeting shall be binding on the constituent CCGs.

24. Where the CIC is unable to reach a unanimous decision then:

• This will be recorded in the meeting minutes; • The CIC chair will convene a meeting of the CCG chairs to agree a process that will allow all the

CCGs to vote for a decision. 25. The Committee for Collaborative Decision Making will undertake preparation work before a CIC meeting

to minimise the risk of a decision not achieving consensus.

Meetings - Frequency 26. The CIC chair, with the chairs of the participating CCGs Committee for Collaborative Decision Making,

will agree a programme of meetings to reach a decision on the delegated issue. This programme may be amended.

Further Delegation of Functions



27. The CIC meeting may delegate tasks to such individuals or sub-committees as it shall see fit, provided that:

• any such delegations are consistent with the delegation of functions to the Committee for Collaborative Decision Making;

• any delegated work undertaken is formally reported to a CIC meeting.

Reporting 28. The minutes of each CIC meeting will consist of individual sets of minutes for each CCG Committee with

exactly the same content. The CIC will formally verify the minutes at their next meeting.

29. Each Committee will present the agreed minutes to its Governing Body, including the minutes of any sub-committees to which responsibilities are delegated.

30. The CIC Convenor will, in addition, provide a written summary report to each Governing Body following each meeting of the CIC business. This should highlight:

• Issues

• Decisions

• Risks & Assurance

Confidentiality 31. Individuals attending CIC meeting shall respect confidentiality requirements as set out in the

Wandsworth CCG Constitution or Standing Orders.

The CIC Convenor Appointment of CIC Convenor 32. The CCG Governing Body Chairs shall appoint a CIC Convenor by either:

• Advertising and selecting an external independent individual with excellent chairmanship skills or

• Inviting a lay member of a CCG Governing Body

The term of office for the CIC convenor is one calendar year from appointment with possible reselection.

33. The CIC Convenor is responsible for agenda setting, resolving differences, overseeing voting arrangements and maintaining order.

34. The Chairs of the participating Committee for Collaborative Decision will invite the CIC Convenor to be an independent chair of their Committee for Collaborative Decision Making for the meeting. (For clarity, the CIC Chair is not a member of the Committee of the Collaborative Decision Making and does not contribute to any vote.)

35. The CIC Convenor does not have a vote or a casting separate vote.

36. The chairs of the Committee for Collaborative Decision Making are the vice convenors of the CiC.

Role – CIC Vice Chair 37. A CiC vice convenor will act as the CiC convenor, when necessary.



Administration 38. Support for the CiC will be provided by the South West London STP Programme Office. Papers for each

meeting will be sent to CiC members no later than one week prior to each meeting.

39. A full set of original papers will be supplied to the constituent CCG Corporate offices for filing and audit purposes.



Annex 11 : Primary Care Commissioning Committee – Terms of Reference

FEBRUARY 2016

Introduction

1. Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS

England was inviting CCGs to expand their role in primary care commissioning and to submit

expressions of interest setting out the CCG’s preference for how it would like to exercise

expanded primary medical care commissioning functions. One option available was that

NHS England would delegate the exercise of certain specified primary care commissioning

functions to a CCG.

2. In accordance with its statutory powers under section 13Z of the National Health Service Act

2006 (as amended), NHS England has delegated the exercise of the functions specified in

Schedule 2 of the Delegation Agreement to these Terms of Reference to NHS Sutton CCG

(the CCG).

3. The CCG has established the CCG Primary Care Commissioning Committee (“Committee”).

The Committee will function as a corporate decision-making body for the management of the

delegated functions (Schedule 2 of the Delegation Agreement) and the exercise of the

delegated powers.

4. The ongoing relationship the Committee will have with NHS England will be revised on an

ongoing basis, though is currently outlined as in Schedule 2 of the Delegation Agreement.

5. It is a committee comprising representatives of the following organisations:

• NHS Sutton Clinical Commissioning Group

• NHS England

• London Borough of Sutton

• Local Medical Committee

• Sutton Healthwatch

• A non-partner, salaried GP from a practice in Sutton

Statutory Framework

6. NHS England has delegated to the CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 of the Delegation Agreement in accordance

with section 13Z of the NHS Act.



7. Arrangements made under section 13Z may be on such terms and conditions (including

terms as to payment) as may be agreed between the NHSE Board and the CCG.

8. Arrangements made under section 13Z do not affect the liability of NHS England for the

exercise of any of its functions. However, the CCG acknowledges that in exercising its

functions (including those delegated to it), it must comply with the statutory duties set out in

Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

9. The CCG will also need to specifically, in respect of the delegated functions from NHS

England, exercise those set out below:

a) Duty to have regard to impact on services in certain areas (section 13O);

b) Duty as respects variation in provision of health services (section 13P)

10. The Committee is established as a Committee of the CCG Governing Body (which in the

remainder of this document is referred to as the CCG Board) in accordance with Schedule

1A of the “NHS Act”.

11. The Committee, in common with all CCG Board Committees is formally accountable for

furnishing the Finance and Audit Committees with the formal reports it requires to assure the

CCG Board that Primary Care Co-Commissioning is being effectively governed and

managed.

12. The members acknowledge that the Committee is subject to any directions made by NHS

England or by the Secretary of State.



Role of the Committee

13. The Committee has been established in accordance with the above provisions to enable the

members to make collective decisions on the review planning and procurement of primary

care services in Sutton under delegated authority from NHS England.

14. The overall scope of the Committee draws together three core functions as follows:

a) The primary care co-commissioning functions formally delegated by NHS England to

the CCG as a new CCG function from 1st April 2016

b) The duty to improve quality in primary care-already an existing CCG function since

April 2013

c) Oversight and assurance of the development of the CCG's overarching

Primary Care Strategy - a new function

15. In performing its role the Committee will exercise its management of the functions in

accordance with the agreement entered into between NHS England and the CCG, which will

sit alongside the delegation and terms of reference.

16. The functions of the Committee are undertaken in the context of a desire to promote

increased co- commissioning to increase quality, efficiency, productivity and value for money

and to remove administrative barriers.

17. The role of the Committee shall be to carry out the functions relating to the commissioning of

primary medical services under section 83 of the NHS Act.

18. This includes the following:

a) GMS, PMS and APMS contracts (including the design of PMS and APMS contracts,

monitoring of contracts, taking contractual action such as issuing breach/remedial

notices, and removing a contract);

b) Newly designed enhanced services (“Local Enhanced Services” and “Directed

Enhanced Services”);

c) Design of local incentive schemes as an alternative to the Quality Outcomes

Framework (QOF);

d) Decision making on whether to establish new GP practices in an area;

e) Approving practice mergers; and

f) Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).



19. The CCG will also carry out the following activities:

See Schedule 2 of the Delegation Agreement for the scope of the delegated co-commissioning

functions.

20. The Committee is accountable for exercising the agreed delegated functions from NHS

England; these functions operate at practice level and not at individual Primary Care

Contractor level.

Geographical Coverage

21. The Committee will comprise of decisions relating to primary care in Sutton.

Membership

22. The Committee shall consist of:

Voting members:

• CCG Board Lay Member (Chair) Lay

• CCG Board Lay Member (Vice Chair) Lay

• CCG Board Lay Member Lay

• CCG Managing Director Executive

• CCG Chief Finance Officer Executive

• CCG Board Independent Nurse Clinician

• CCG Board Secondary Care Consultant Clinician

• Independent GP Advisor Clinician

Non-voting attendees:

• Health and Wellbeing Board (’HWBB’) representative

• London Borough of Sutton Public Health representative

• Sutton Healthwatch representative

• Local Medical Committee (‘LMC’) representative

• Salaried Sutton CCG GP (non-partner)

• Sutton CCG GP Partner

• NHS England Representative

• Sutton CCG Patient Reference Group (‘PRG)’ Representative



No person who is a practising clinician in the CCG area may be a voting member of the

Committee.

23. The Chair of the Committee shall be a CCG Board Lay Member, however this should not be

the Chair of the Audit Committee.

24. The Vice Chair of the Committee shall be a CCG Board Lay Member, who could be the

Chair of the Audit Committee.

25. Voting members will be CCG Managing Director, CCG Chief Finance Officer, Independent

GP Advisor, CCG Board Secondary Care Consultant and CCG Board Independent Nurse.

26. Non-voting attendees will be Sutton Healthwatch representative, LMC representative,

Public Health representative, HWBB representative, Sutton CCG GP (non-partner), Sutton

CCG GP Partner, NHS England representative and Sutton CCG PRG representative.

27. The Committee may appoint ad-hoc members to advise it on specific matters within its terms

of reference from time to time as appropriate.

28. There will be an annual review of the Committee’s membership to support its efficient

functioning.

Conflicts of Interest

29. Conflicts of Interests will be managed in accordance with the CCG Constitution that outlines

the current policy; ‘Standards of Business Conduct and Managing Conflicts of Interest

Policy’.

30. Where a Committee member has, or may have, a conflict of interest, arrangements will be

put into place to manage that conflict of interest in accordance with the Constitution and the

Conflicts of Interest Policy.

Meetings and Voting

31. The Committee will operate in accordance with the CCG’s Constitution and Standing Orders.

The Secretary to the Committee will be responsible for giving notice of meetings. This will be

accompanied by an agenda and supporting papers and sent to each member representative

no later than 5 days before the date of the meeting. When the Chair of the Committee

deems it necessary in light of the urgent circumstances to call a meeting at short notice, the

notice period shall be such as s/he shall specify.

32. The Committee will make decisions within the bounds of its remit.

33. The decisions of the Committee shall be binding on NHS England and the CCG.



34. Each voting member of the Committee shall have one vote. The Committee shall reach

decisions by a simple majority of members present, but with the Chair having a second and

deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus

decision-making wherever possible.

35. Members of the Committee have a collective responsibility for the operation of the

Committee. They will participate in discussion, review evidence and provide objective expert

input to the best of their knowledge and ability, and endeavour to reach a collective view.

36. Meetings of the Committee:

a) shall be held in public, subject to the application of 36(b);

b) the Committee may resolve to exclude the public and non-voting attendees from a

meeting that is open to the public (whether during the whole or part of the

proceedings) whenever publicity would be prejudicial to the public interest by reason

of the confidential nature of the business to be transacted or for other special

reasons stated in the resolution and arising from the nature of that business or of the

proceedings or for any other reason permitted by the Public Bodies (Admission to

Meetings) Act 1960 as amended or succeeded from time to time.

Quorum

37. The Committee will be Quorate with four of the eight voting members in attendance, with at

least one Lay member and one Clinician present (see paragraph 22). Where a Sutton CCG

GP or other non-voting members have a conflict of interest they may be excluded from the

agenda item discussion and decision.

Confidentiality

38. Members of the Committee shall respect confidentiality requirements as set out in the CCG

Constitution or Standing Orders.

Frequency of meetings

39. The committee shall meet monthly, though the format of these meetings will usually alternate

between a formal meeting in public and a seminar in private for developmental

purposes. At least four meetings will be held in public over the financial year.

Urgent Decision Making

40. The Committee has a statutory duty to make a range of decisions relating to the

commissioning of primary care medical services.



41. In the vast majority of cases these decisions can be made by the committee as part of

business as usual. However, there may be occasion, when an urgent situation arises that

requires a decision or actions to be agreed either immediately or before the next

Committee takes place.

42. Urgent Decision Making (UDM) meetings, in person or via teleconference, can be called by

the chair (or vice-chair in their absence) and the Managing Director and the Chief Finance

Officer. This is outlined in Schedule 5 of the Delegation Agreement.

43. A minimum of two voting members of the Committee must be present in person or on the

teleconference, one of whom should be a Board Lay Member and the other should be a

clinician, for it to be quorate.

44. A meeting will be convened by the Committee Chair (or Committee Vice-Chair in their

absence) and the Managing Director and the Chief Finance Officer. Consultation will be

made with the Committee Vice-Chair and all other available members of the Committee

unless in exceptional circumstances where a time delay cannot be permitted. If other

Committee members are not consulted they will be informed at the earliest possible time.

45. All decisions will be reported at the next available Committee meeting.

Other Matters

46. The Committee may delegate tasks to such individuals, sub-committees or individual

members as it shall see fit, provided that any such delegations are consistent with the

parties’ relevant governance arrangements, are recorded in a scheme of delegation, are

governed by terms of reference as appropriate and reflect appropriate arrangements for the

management of conflicts of interest.

47. The Committee may call additional experts to attend meetings on an ad hoc basis to inform

discussions.

Reporting

48. The Committee will present its agreed minutes and an executive summary report to the

London Area Team of NHS England and the Board of Sutton CCG, following each meeting,

for information, including the minutes of any sub-committees to which responsibilities are

delegated under paragraph 47 above.

49. There is a statutory requirement that the Committee publishes a register of its decisions,

outlining the management of any Conflicts of Interest.

50. The CCG will also comply with any reporting requirements set out in its constitution.



Review of Terms of Reference

51. It is envisaged that these Terms of Reference will be reviewed annually, reflecting

experience of the Committee in fulfilling its functions. NHS England may also issue revised

model terms of reference from time to time.

Role of Primary Care Programme Board

52. A Primary Care Programme Board has been formed to support the Committee in the

execution of its functions. It is accountable to the Committee and its functions include:

a) Supporting the development of the Primary Care strategy including the strategic

approach to improving quality.

b) Constructing the annual work plan for the Committee to approve.

c) The CCG core members of the Primary Care Programme Board are:

• Associate Director of Primary Care (Chair)

• Chief Finance Officer

• Head of Primary Care Commissioning

• Independent GP advisor

• Sutton CCG GP Partner (not a Governing Body Member)

• Salaried Sutton CCG GP (non-partner)

• Lead Locality Practice Nurse

• Lead Locality Practice Manager

• Locality Manager

• Commissioning Manager

• Local Medical Committee Representative

• NHS England Primary Care Commissioner

Other members of the CCG and NHS England Primary Care teams on an ad hoc basis

as required.



[Schedule 1 – Delegation agreement -to be added when final arrangements confirmed]

Schedule 2 – Delegated functions

Delegated Functions from 1st April 2016:

a) decisions in relation to the commissioning, procurement and management of Primary Medical

Services Contracts, including but not limited to the following activities:

• decisions in relation to Enhanced Services;

• decisions in relation to Local Incentive Schemes (including the design of such schemes);

• decisions in relation to the establishment of new GP practices (including branch

surgeries) and closure of GP practices;

• decisions about ‘discretionary’ payments;

• decisions about commissioning urgent care (including home visits as required) for out of

area registered patients;

b) the approval of practice mergers;

c) planning primary medical care services in the Area, including carrying out needs

assessments;

d) undertaking reviews of primary medical care services in the Area;

e) decisions in relation to the management of poorly performing GP practices and including,

without limitation, decisions and liaison with the CQC where the CQC has reported non-

compliance with standards (but excluding any decisions in relation to the performers list);

f) management of the Delegated Funds in the Area;

g) Premises Costs Directions functions;

h) co-ordinating a common approach to the commissioning of primary care services with other

commissioners in the Area where appropriate; and

i) such other ancillary activities as are necessary in order to exercise the Delegated

Functions.

Reserved Functions remaining with NHS England:

a) management of the national performers list;

b) management of the revalidation and appraisal process;



c) administration of payments in circumstances where a performer is suspended and related

performers list management activities;

d) Capital Expenditure functions;

e) section 7A functions under the NHS Act;

f) functions in relation to complaints management;

g) decisions in relation to the Prime Minister’s Challenge Fund; and

h) such other ancillary activities that are necessary in order to exercise the Reserved

Functions;

Schedule 3 - List of Members of Primary Care Commissioning Committee

From 1st April 2017, the Committee shall consist of:

Voting members:

• CCG Board Lay Member (Chair)

• CCG Board Lay Member (Vice Chair)

• CCG Board Lay Member (Vice Chair)

• CCG Managing Director

• CCG Chief Finance Officer

• CCG Board Independent Nurse

• CCG Board Secondary Care Consultant

• Independent GP Advisor

Non-voting attendees:

• Health and Wellbeing Board (’HWBB’)

• London Borough of Sutton Public Health

• Sutton Healthwatch

• Local Medical Committee (‘LMC’)

• Sutton CCG Salaried GP (non-partner)

• Patient Reference Group representative



• NHS England

Version Date Author Amendments

V0.1 Oct-15 Siân Hopkinson / Carolyn Reynolds

First draft

V0.2 4/2/16 Siân Hopkinson Minor amendments following Governing Body review

V0.3 26/2/16 Siân Hopkinson Further drafting for approval

V0.4 30/3/16 Carolyn Reynolds Final drafting for approval

V0.5 6/4/16 Carolyn Reynolds Final approved

V1.1 06/02/17 Siân Hopkinson Amendments for review by PCCC



APPENDIX E SCHEME OF RESERVATION & DELEGATION

1. SCHEDULE OF MATTERS RESERVED TO THE CLINICAL COMMISSIONING GROUP AND SCHEME OF RESERVATION AND DELEGATION

1.1 The arrangements made by the CCG as set out in this Scheme of Reservation and Delegation of decisions shall have effect as if incorporated in the CCG's Constitution.

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

2. MATTERS RESERVED TO THE MEMBERS

2.1 Any of the following matters require the prior consent of a Special Resolution of the Plenary Meeting and no action can be taken by the Sutton CCG Board (except the calling of such a Plenary Meeting or circulation of a written resolution to seek such consent) without such consent:

2.1.1 propose an amendment to this Constitution for the CCG in accordance with paragraph 1.4 of the Constitution;

2.1.2 change (by whatever means) the nature of the business of the CCG or do anything that is not consistent with the functions of the CCG;

2.1.3 use any name other than the name specified in paragraph 1.1.1 of the Constitution in relation to the activities of the CCG;

2.1.4 merge, amalgamate or federate the CCG with any other clinical commissioning group; and

2.1.5 remove any member of the Sutton CCG Board.

3. DELEGATION

3.1 The Sutton CCG Board may arrange for any of its functions to be exercised on its behalf by any Member or any employee or any committee or sub-committee as it thinks fit, but the terms of any such delegation must be recorded in the minutes of the Sutton CCG Board.

3.2 If any function of the Sutton CCG Board is being exercised on its behalf by a Member, employee, committee or sub-committee, any reference in this Constitution to the exercise by the Sutton CCG Board of that function shall be interpreted as if it was a reference to the exercise by said person, committee or sub-committee.

3.3 Any Member, committee or sub-committee or individual appointed under paragraph 3.1 above shall, when discharging any function of the Sutton CCG Board, abide by any restrictions or conditions imposed by the Sutton CCG Board which may then subsist. In relation to committees or sub-committees exercising functions on behalf of the Sutton CCG Board, any such restrictions or conditions may provide for or permit the co-option onto the committee or sub-committee of persons other than members of the Sutton CCG Board and for such persons to have voting rights as members of that committee or sub-committee, but no resolution of the committee or sub-committee will be valid unless it has been approved by a majority of the votes cast on that resolution and that majority included at least one member of the Sutton CCG Board.

3.4 The quorum for any committee meeting is specified in the relevant Committee’s Terms of Reference at least one of whom must be a member of the Sutton CCG Board.



3.5 The Sutton CCG Board may impose restrictions and/or conditions when arranging for the discharge of functions on its behalf, including the conditions that:

3.5.1 the relevant functions are to be exercised exclusively by the committee or sub-committee to which the functions are delegated;

3.5.2 no expenditure may be incurred on behalf of the CCG except in accordance with a budget previously agreed with the Sutton CCG Board.

3.5.3 Unless agreed specifically to the contrary minutes of all formal meetings will be a matter of public record.

3.5.4 The Sutton CCG Board may revoke or alter a delegation at any time.

3.5.5 All acts and proceedings of any committees and sub-committees must be fully and promptly reported to the Sutton CCG Board.

4. Table 1 below sets out decisions that the CCG has agreed to include in the scheme of reservation and delegation.



Table 1

Policy Area Decision Reserved to Membership

Reserved or delegated to Sutton CCG Board

Accountable Officer

Chief Financial Officer

Remuneration Committee

(or RCIC)

Audit Committee

(or ACIC)

Other Committee

Regulation and control

Determine the arrangements by which the members of the group approve those decisions that are reserved for the membership.

✓


Consideration and approval of applications to the NHS England on any matter concerning changes to the group’s constitution, including terms of reference for the groups committees, membership of committees, the overarching scheme of reservation and delegated powers, arrangements for taking urgent decisions, standing orders and prime financial policies.

✓


Exercise or delegation of those functions of the CCG which have not been retained as reserved by the group, delegated to the Board

✓



or other committee or subcommittee or [specified] member or employee


Prepare the group’s overarching scheme of reservation and delegation, which sets out those decisions reserved to the membership and those delegated to the Sutton CCG Board, committees and sub-committees, individuals or specified persons, for inclusion in the group’s constitution.

✓

Regulation and Control

Approval of the group’s overarching scheme of reservation and delegation.

✓


Prepare the group’s operational scheme of delegation, which sets out those key operational decisions delegated to individual employees of the CCG, not for inclusion in the group’s constitution.

✓




Approval of the group’s operational scheme of delegation that underpins the group’s ‘overarching scheme of reservation and delegation’ as set out in its constitution.

✓


Prepare detailed financial policies that underpin the CCGs Prime Financial Policies.

✓


Approve detailed financial policies.

✓


Approve arrangements for managing exceptional funding requests

✓

Practice Member’ Representatives and Members of the Board

Approve the arrangements for:

• identifying practice members to represent practices in matters concerning the work of the group; and

• appointing clinical leaders to represent the group’s membership on the Sutton CCG Board,

✓



for example through election (if desired).


Approve the appointment of Sutton CCG Board members, the process for recruiting and removing non-elected members to the Sutton CCG Board (subject to any regulatory requirements) and succession planning.

✓


Approve arrangements for identifying the Group’s proposed Accountable Officer.

✓


Agree new additions to membership or removals from CCG ✓

Strategy and Planning

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

✓


Approval of the group’s operating structure. ✓


Approval of the group’s commissioning plan. ✓




Approval of the group’s corporate budgets that meet the financial duties as set out in 5.3 of the constitution.

✓


Approval of variations to the approved budget where variation would have a significant impact on the overall approved levels of income and expenditure.

✓


Approval of neighbourhood specific implementation plans

✓


Agree plans for provision of services, such as pathway redesign.

✓


Determine plans for monitoring delivery of CCG objectives.

✓


Development & approval of organisational and healthcare service changes with other nearby CCGs.

Committee for Collaborative

Decision Making

Strategy & Planning

Development and local implementation of organisational and health care strategies and plans.

Executive Management

Team



Annual Reports and Accounts

Approval of the CCG's Annual Report and Annual Accounts.

✓

Annual Reports and Accounts

Approval of the arrangements for discharging the group’s statutory financial duties

✓

Human Resources

Approve the terms and conditions, remuneration and travelling or other allowances for Sutton CCG Board members, including pensions and gratuities.

✓

Human Resources

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

✓

Human Resources

Approve any other terms and conditions of services for the group’s employees.

✓

Human Resources

Determine the terms and conditions of employment for all

✓



employees of the group

Human Resources

Determine pensions, remuneration, fees and allowances payable to employees and to other persons providing services to the group.

✓

Human Resources

Recommend pensions, remuneration, fees and allowances payable to employees and to other persons providing services to the group.

✓

Human Resources

Approve disciplinary arrangements for employees, including the Accountable officer (where he/she is an employee or member of the CCG) and for other persons working on behalf of the group.

✓

Human Resources

Review disciplinary arrangements where the Accountable officer is an employee or member of another CCG.

✓

Human Resources

Approval of the arrangements for discharging the group’s

✓



statutory duties as an employer

Human Resources

Approve HR policies for employees and for other persons working on behalf of the group.

✓

Human Resources

To approve plans and policies that consider succession planning for CCG leadership.

✓

Quality and Safety

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

✓

Quality and Safety

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

✓

Quality and Safety

Recommend and approve quality and value outcomes that influence clinical effectiveness, cost effectiveness and quality standards.

✓



Operational and Risk Management

Prepare and recommend an operational scheme of delegation that sets out who has responsibility for operational decisions within the group.

✓



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

✓


Approval of the group’s risk management arrangements.

✓


Approve arrangements for risk sharing and or risk pooling with other organisations (for example arrangements for pooled funds with other CCGs or pooled budget arrangements under section 75 of the NHS Act 2006).

✓


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

✓




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

✓


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

✓

Information Governance

Approve the group’s arrangements for handling complaints.

✓

Information Governance

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

✓

Tendering and Contracting

Approval of the group’s contracts for any commissioning support.

✓

Tendering and Contracting

Approval of the group’s contracts for corporate support (for example finance provision

✓

Partnership Working

Approve decisions that individual members or employees of the group participating in joint arrangements on behalf of the group can make. Such delegated decisions must be

✓



disclosed in this scheme of reservation and delegation. Approve decisions delegated to joint committees established under section 75 of the NHS Act 2006.

Commissioning and Contracting for Clinical Services

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

✓

Commissioning and Contracting for Clinical Services

Approve arrangements for co-ordinating the commissioning of services with other groups and or with the local authority, where appropriate.

✓

Commissioning and Contracting

Review planning and procurement of primary care services

Primary Care Commissioning

Committee



for Clinical Services

Communication Approving arrangements for handling Freedom of Information requests.

✓

Communication Determining arrangements for handling Freedom of Information requests.

✓


APPENDIX F PRIME FINANCIAL POLICIES

1. INTRODUCTION

1.1 General

1.1.1 These Prime Financial Policies and supporting detailed financial policies shall have effect as if incorporated into the CCG’s Constitution.

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

1.1.3 In support of these Prime Financial Policies, the CCG has prepared more detailed policies, approved by the Accountable Officer and Chief Finance Officer, known as detailed financial policies. The CCG refers to these prime and detailed financial policies together as the CCG’s financial policies.

1.1.4 These Prime Financial Policies identify the financial responsibilities which apply to everyone working for the CCG and its constituent organisations. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies. The Chief Finance Officer is responsible for approving all detailed financial policies.

1.1.5 A list of the CCG’s detailed financial policies will be published and maintained on the CCG’s website at www.suttonccg.nhs.uk.

(a) Should any difficulties arise regarding the interpretation or application of any of the Prime Financial Policies then the advice of the Chief Finance Officer must be sought before acting. The user of these Prime Financial Policies should also be familiar with and comply with the provisions of the CCG’s Constitution, Standing Orders and Scheme of Reservation and Delegation.

1.1.6 Failure to comply with Prime Financial Policies and Standing Orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal.

1.2 Overriding Prime Financial Policies

1.2.1 If for any reason these Prime Financial Policies are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance shall be reported to the next formal meeting of the Audit Committee for referring action or ratification. All of the CCG’s Members and employees have a duty to disclose any non-compliance with these Prime Financial Policies to the Chief Finance Officer as soon as possible.

1.3 Responsibilities and delegation

1.3.1 The roles and responsibilities of CCG’s Members, employees, members of the Sutton CCG Board, members of the Sutton CCG Board’s committees and sub-committees, members of the CCG’s committee and sub-committee (if any) and persons working on behalf of the CCG are set out in chapters 6 and 7 of this Constitution.

1.3.2 The financial decisions delegated by members of the CCG are set out in the Scheme of Reservation and Delegation (see Appendix E).

1.4 Contractors and their employees


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

1.5 Amendment of Prime Financial Policies

1.5.1 To ensure that these Prime Financial Policies remain up-to-date and relevant, the Chief Finance Officer will review them at least annually. Following consultation with the Accountable Officer and scrutiny by the Audit Committee, the Chief Finance Officer will recommend amendments, as fitting, to the Sutton CCG Board for approval. As these Prime Financial Policies are an integral part of the CCG’s Constitution, any amendment will not come into force until the CCG applies to the NHS England and that application is granted.

2. INTERNAL CONTROL

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

2.1 The Sutton CCG Board is required to establish an Audit Committee with terms of reference agreed by the Sutton CCG Board (see paragraph 6.8.1 of the CCG’s Constitution for further information).

2.2 The Accountable Officer has overall responsibility for the CCG’s systems of internal control.

2.3 The Chief Finance Officer will ensure that:

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

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

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

3. AUDIT

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

3.1 In line with the terms of reference for the Audit Committee, the person appointed by the CCG to be responsible for internal audit and the appointed external auditor will have direct and unrestricted access to Audit Committee members and the Chair of the Sutton CCG Board, Accountable Officer and Chief Finance Officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

3.2 The person appointed by the CCG to be responsible for internal audit and the external auditor will have access to the Audit Committee and the Accountable Officer to review audit issues as appropriate. All Audit Committee members, the Chair of the Sutton CCG Board and the Accountable Officer will have direct and unrestricted access to the head of internal audit and external auditors.

3.3 The Chief Finance Officer will ensure that:


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

(b) the Sutton CCG Board and Audit Committee approves any changes to the provision or delivery of assurance services to the CCG.

4. FRAUD AND CORRUPTION

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

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

4.2 The Audit Committee will ensure that the CCG has arrangements in place to work effectively with NHS Protect.

5. EXPENDITURE CONTROL

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

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

5.3 The will:

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

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

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

6. ALLOTMENTS

6.1 The Chief Finance Officer will:

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

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

(c) regularly update the Sutton CCG Board on significant changes to the initial allocation and the uses of such funds.


7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL AND MONITORING

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

7.1 The Accountable Officer will compile and submit to the Sutton CCG Board a commissioning strategy which takes into account financial targets and forecast limits of available resources.

7.2 Prior to the start of the financial year the Chief Finance Officer will, on behalf of the Accountable Officer, prepare and submit budgets for approval by the Sutton CCG Board.

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

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

7.5 The Accountable Officer will approve consultation arrangements for the CCG’s commissioning plan.

8. ANNUAL ACCOUNTS AND REPORTS

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

8.1 The Chief Finance Officer will ensure the CCG:

(a) prepares a timetable for producing the annual report and accounts and agrees it with external auditors and the Sutton CCG Board;

(b) prepares the accounts according to the timetable approved by the Sutton CCG Board;

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

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

(e) publishes the external auditor’s management letter on the CCG’s website at www.suttonccg.nhs.uk.

9. INFORMATION TECHNOLOGY


POLICY – the CCG will ensure the accuracy and security of the CCG’s computerised financial data.

9.1 The Chief Finance Officer is responsible for the accuracy and security of the CCG’s computerised financial data and shall:

(a) devise and implement any necessary procedures to ensure adequate (reasonable) protection of the CCG's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998;

(b) ensure that adequate (reasonable) controls exist over data entry, processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system;

(c) ensure that adequate controls exist such that the computer operation is separated from development, maintenance and amendment; and

(d) ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the Chief Finance Officer may consider necessary are being carried out.

9.2 In addition the Chief Finance Officer shall ensure that new financial systems and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.

10. ACCOUNTING SYSTEMS

POLICY – the CCG will run an accounting system that creates management and financial accounts.

10.1 The Chief Finance Officer will ensure:

(a) the CCG has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of the NHS England;

(b) that contracts for computer services for financial applications with another health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes.

10.2 Where another health organisation or any other agency provides a computer service for financial applications, the Chief Finance Officer shall periodically seek assurances that adequate controls are in operation.


11. BANK ACCOUNTS

POLICY – the CCG will keep enough liquidity to meet its current commitments.


(a) review the banking arrangements of the CCG at regular intervals to ensure they are in accordance with Secretary of State directions, best practice and represent best value for money;

(b) manage the CCG's banking arrangements and advise the CCG on the provision of banking services and operation of accounts; and

(c) prepare detailed instructions on the operation of bank accounts.

11.2 The Accountable Officer shall approve the banking arrangements.

12. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS.

POLICY – the CCG will:

1. operate a sound system for prompt recording, invoicing and collection of all monies due

2. seek to maximise its potential to raise additional income only to the extent that it does not interfere with the performance of the CCG or its functions

3. ensure its power to make grants and loans is used to discharge its functions effectively.

12.1 The Chief Financial Officer is responsible for:

(a) designing, maintaining and ensuring compliance with systems for the proper recording, invoicing, and collection and coding of all monies due;

(b) establishing and maintaining systems and procedures for the secure handling of cash and other negotiable instruments;

(c) approving and regularly reviewing the level of all fees and charges other than those determined by the NHS England or by statute. Independent professional advice on matters of valuation shall be taken as necessary; and

(d) for developing effective arrangements for making grants or loans.

13. TENDERING AND CONTRACTING PROCEDURE

POLICY – the CCG:

• will ensure proper competition that is legally compliant within all purchasing to ensure it incurs only budgeted, approved and necessary spending;

• will seek value for money for all goods and services;

• shall ensure that competitive tenders are invited for;


o the supply of goods, materials and manufactured articles;

o the rendering of services including all forms of management consultancy services (other than specialised services sought from or provided by the Department of Health); and

o for the design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals.

13.1 The CCG shall ensure that the firms / individuals invited to tender (and where appropriate, quote) are among those on approved lists or where necessary a framework agreement. Where in the opinion of the Chief Finance Officer it is desirable to seek tenders from firms not on the approved lists, the reason shall be recorded in writing to the Accountable Officer.

13.2 The Sutton CCG Board may only negotiate contracts on behalf of the CCG, and the CCG may only enter into contracts, within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with:

(a) the Standing Orders;

(b) the Public Contracts Regulation 2006, any successor legislation and any other applicable law; and

(c) take into account as appropriate any applicable NHS England or the Independent Regulator of NHS Foundation Trusts (Monitor) guidance that does not conflict with (b) above.

13.3 In all contracts entered into, the CCG shall endeavour to obtain best value for money. The Accountable Officer shall nominate an individual who shall oversee and manage each contract on behalf of the CCG.

14. COMMISSIONING

POLICY – working in partnership with relevant national and local stakeholders, the CCG will commission certain health services to meet the reasonable requirements of the persons for whom it has responsibility.

14.1 The CCG will coordinate its work with the NHS England, other clinical commissioning groups, local providers of services, local authority(ies), including through Health and Wellbeing Boards, patients and their carers and the voluntary sector and others as appropriate to develop robust commissioning plans.

14.2 The Accountable Officer will establish arrangements to ensure that regular reports are provided to the Sutton CCG Board detailing actual and forecast expenditure and activity for each contract.

14.3 The Chief Finance Officer will maintain a system of financial monitoring to ensure the effective accounting of expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality.

15. RISK MANAGEMENT AND INSURANCE


POLICY – the CCG will put arrangements in place for evaluation and management of its risks.

15.1 The Audit Committee is responsible for providing assurance to the Board that an effective system of internal control for all risks is maintained within the organisation.

15.2 The Accountable Officer has overall executive responsibility for risk management.

16. PAYROLL

POLICY – the CCG will put arrangements in place for an effective payroll service.

16.1 The Chief Finance Officer will ensure that the payroll service selected:

(a) is supported by appropriate (i.e. contracted) terms and conditions;

(b) has adequate internal controls and audit review processes; and

(c) has suitable arrangements for the collection of payroll deductions and payment of these to appropriate bodies.

16.2 In addition the Chief Finance Office shall set out comprehensive procedures for the effective processing of payroll.

17. NON-PAY EXPENDITURE

POLICY – the CCG will seek to obtain the best value for money goods and services received.

17.1 The Sutton CCG Board Audit Committee will approve the level of non-pay expenditure on an annual basis and the Accountable Officer will determine the level of delegation to budget managers.

17.2 The Accountable Officer shall set out procedures on the seeking of professional advice regarding the supply of goods and services.


(a) advise the Sutton CCG Board Audit Committee on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the Scheme of Reservation and Delegation;

(b) be responsible for the prompt payment of all properly authorised accounts and claims;

(c) be responsible for designing and maintaining a system of verification, recording and payment of all amounts payable.

18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF ASSETS


POLICY – the CCG will put arrangements in place to manage capital investment, maintain an asset register recording fixed assets and put in place polices to secure the safe storage of the CCG’s fixed assets.

18.1 The Accountable Officer will

(a) ensure that there is an adequate appraisal and approval process in place for determining capital expenditure priorities and the effect of each proposal upon plans;

(b) be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

(c) shall ensure that the capital investment is not undertaken without confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges; and

(d) be responsible for the maintenance of registers of assets, taking account of the advice of the Chief Finance Officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year.

18.2 The Chief Finance Officer will prepare detailed procedures for the disposals of assets.

19. RETENTION OF RECORDS

POLICY – the CCG will put arrangements in place to retain all records in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance.

19.1 The Accountable Officer shall:

(a) be responsible for maintaining all records required to be retained in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance;

(b) ensure that arrangements are in place for effective responses to Freedom of Information requests; and

(c) publish and maintain a Freedom of Information Publication Scheme.

20. TRUST FUNDS AND TRUSTEES

POLICY – the CCG will put arrangements in place to provide for the appointment of trustees if the CCG holds property on trust.

20.1 The Chief Finance Officer shall ensure that each trust fund which the CCG is responsible for managing is managed appropriately with regard to its purpose and to its requirements.


APPENDIX G NOLAN PRINCIPLES

1. The ‘Nolan Principles’ set out the ways in which holders of public office should behave in discharging their duties. The seven principles are:

(a) Selflessness – Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

(b) Integrity – Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

(c) Objectivity – In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

(d) Accountability – Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

(e) Openness – Holders of public office should be as open as possible about all the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

(f) Honesty – Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

(g) Leadership – Holders of public office should promote and support these principles by leadership and example.

Source: The First Report of the Committee on Standards in Public Life (1995)


APPENDIX H NHS CONSTITUTION

1. The NHS Constitution sets out seven key principles that guide the NHS in all it does:

1.1 the NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to diagnose, treat and improve both physical and mental health. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.

1.2 access to NHS services is based on clinical need, not an individual’s ability to pay. NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

1.3 the NHS aspires to the highest standards of excellence and professionalism – in the provision of high quality care that is safe effective and focused on patient experience; in the people it employs, and in the support, education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion, conduct and use of research to improve the current and future health and care of the population. Respect, dignity, compassion and care should be at the core of how patients and staff are treated not only because that is the right thing to do but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported.

1.4 the NHS aspires to put patients at the heart of everything it does. It should support individuals to promote and manage their own health. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. The NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve its services.

1.5 the NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is an integrated system of organisations and services bound together by the principles and values reflected in the Constitution. The NHS is committed to working jointly with other local authority services, other public sector organisations and a wide range of private and voluntary sector organisations to provide and deliver improvements in health and wellbeing.

1.6 the NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.

1.7 the NHS is accountable to the public, communities and patients that it serves. The NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose.

Source: The NHS Constitution: The NHS belongs to us all (March 2012)6

6 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961


APPENDIX I DISPUTE RESOLUTION PROCEDURE

CCG Management of Disputes Protocol

INTRODUCTION

This protocol is to enable the Members of the CCG ("Members" for the purposes of this protocol) to resolve any disputes that may arise between them promptly, efficiently and in line with the relevant regulatory frameworks.

16.3 The parties in dispute shall continue to comply with, observe and perform all their obligations under the Constitution and to the CCG regardless of the nature of the dispute and notwithstanding the referral of the dispute for resolution under this protocol and shall give effect forthwith to every decision delivered under this protocol.

16.4 Prior to the resolution of any disputes the affected Members will still be required to comply with any relevant obligations to the CCG.

• PRINCIPLES

o In seeking to resolve any dispute that arises, the relevant Members will undertake to adopt the principles of:

▪ Transparency - including clear communication, engagement of relevant stakeholders, enforcing declarations of interest;

▪ Objectivity – including analysis and decision making on objective information and criteria and the maintenance of an audit trail and clear accountability;

▪ Proportionality – only using the formal disputes process on matters of material importance to the CCG and only requesting resources proportionate to the significance of the dispute; and

▪ Non discriminatory – adopting a fair and respectful approach throughout.

o Before considering whether it is appropriate to refer to the disputes escalation procedure set out at paragraph 3 below, the Members should make every reasonable effort to communicate and cooperate with each other in good faith to attempt to come to an agreement in relation to the disputed matter without the need for formal intervention.

• DISPUTE ESCALATION PROCEDURE

o Step 1 – Senior Officer Level

▪ The disputed issue is clearly identified and formally raised to be discussed with the appropriate senior officer of the CCG (which will be the Chair of the CCG in the first instance unless conflicted) who has responsibility for the


area which is related to the disputed issue. Every effort is made to resolve the issue in good faith.

▪ Timescale for resolution: five (5) Business Days.

o Step 2 – Accountable Officer level

▪ If the issue is not resolved at step 1, a joint statement of the disputed issue and the precise matter(s) of dispute should be prepared and signed by both Members (and the officer reviewing the dispute at Step 1) and sent jointly to the Accountable Officer within five (5) working days. If the Accountable Officer is able to find a way to resolve the dispute with the parties through discussion which is agreed by the parties in dispute then their decision will be communicated to the Sutton CCG Board and where appropriate implemented.


o Step 3 – NHSCB

▪ If the issue is not resolved at Step 2, a joint statement of the disputed issue and the precise matter(s) of dispute should be prepared and signed by both Members (and the officer reviewing the dispute at Step 2) and sent jointly to the lead officer at the local office of the NHS England within five (5) working days. If the lead officer of the local office of the NHSCB is able to find a way to resolve the dispute with the parties through discussion which is agreed by the parties in dispute then their decision will be communicated to the Sutton CCG Board and where appropriate implemented.


• CONCLUSION

16.5 A summary report outlining the nature of the dispute, the steps followed to reach resolution and the final outcome should be prepared by the CCG and reported to the next meeting of the Sutton CCG Board. Any key learning points should be identified in this report.


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