St Helens CCG Governing Body Meeting · McCarthy, it had been confirmed that Graham Urwin and Clare...

Mission Statement:

‘Making a difference – right care, right place, right time’

St Helens Clinical Commissioning Group fully support and abide by the pledges set out within the NHS Constitution and we work to ensure we portray the values and behaviours expected of all NHS organisations

St Helens CCG Governing Body Meeting PART I

Date: Wednesday, 22nd May 2019

Time: at 8.30 am Venue: Conference Room A, St Helens Chamber,

Salisbury Street, St Helens WA10 1FY

Part 1 of this meeting will be held in public

Meeting of the NHS St Helens Clinical Commissioning Group

Governing Body (Public Meeting) Part I to be held on Wednesday, 22nd May 2019 at 8.30 am in

Conference Room A, St Helens Chamber, Salisbury Street, St Helens WA10 1FY

AGENDA

Apologies for absence: James Catania, Omar Shaikh, Val Davies Declarations of Interest:

Item Time Agenda Item

Purpose Presented by

PB19/05/01

8.30 am

Welcome and Apologies

To Note

Chair

PB19/05/02

Declarations of Interest

To Note/Action

Chair

PB19/05/03

1. Page 5

8.35 am

Minutes of the Previous Meeting and Actions held on 10th April 2019

For Ratification

Chair

PB19/05/04

Matters Arising

For Discussion

Chair

PB19/05/05 CHAIR AND CLINICAL ACCOUNTABLE OFFICER’S REPORTS

1. 8.45 am

Chairs Report

For Information

Chair

2.

Page 15

8.55 am

Clinical Accountable Officer’s Report

For Information

Deputy Accountable Officer

3.

Page 21

9.05 am

Patient Story

For Information

Chief Nurse

PB19/05/06 STRATEGY

1.

9.15 am

Annual Report Presentation

For Information

Clinical Accountable Officer

PB19/05/07 KEY ISSUES OF BOARD SUBCOMMITTEES

1.

Page 23

2. Page 27

3. Page 31

4. Page 33

5.

Page 35

6. Page 39

7.

1

9.35 am

(a) Key Issues of the Quality Committee

held on 10th April 2019 and 5th May 2019

(b) Key Issues of the Finance, and Performance Committee held on 24th April 2019

(c) Key Issues of the Primary Care

Commissioning Committee held on 1st May 2019

(d) Key Issues of GP Members Council

held on 1st May 2019 (e) Key Issues of Audit Committee held on

3rd April 2019 (f) Key Issues of the HR and OD

Committee held on 26th April 2019 (g) Key Issues of the Remuneration

Committee held on 26th April 2019

For Information For Information For Information For Information For Information For Information For Information

Chair of the Quality Committee Chair of the F&P Committee Chair of the Primary Care Commissioning Committee Chair of GP Members Council Chair of the Audit Committee Chair of the HR and OD Committee Chair of the Remuneration Committee

PB19/05/08 GOVERNANCE

1. Page 45

2.

3.

4. Page 97

9.50 am 10.00 am 10.10 am 10.20 am

Remuneration Framework Re-appointment of the CCG Lay Chair (included within the Key Issues of the Remuneration Committee report) Governing Body Assurance Framework (GBAF) (report to follow) 360° Stakeholder Feedback

For Approval For Approval For Approval To Note

Chair of the Remuneration Committee Chair of the Remuneration Committee Associate Director; Corporate Governance Associate Director; Corporate Governance

PB19/05/09 FINANCE

1. Page 123

10.30 am

Finance Update

For Information

Chief Finance Officer

PB19/05/10 PERFORMANCE

1.

Page 133

10.45 am

Performance Update

For Information

Chief Finance Officer

PB19/05/11 ANY OTHER BUSINESS

11.00 am

REFLECTION: What difference have we made to local people with the decisions we made in the meeting today?

Date and time of next meeting: The next meeting of the NHS St Helens CCG Governing Body will take place on Wednesday, 10th July 2019, Conference Room A, St Helens Chamber, Salisbury Street, St Helens WA10 1FY

NOTE: Enclosures are sent to Board Members only – copies will be available from the St Helens CCG Office: 01744 457237 or on the website: www.sthelensccg.nhs.uk “The Trust hereby resolves that the remainder of the meeting be held in private, because publicity would be prejudicial to the public interest, by reason of the confidential nature of the business to be transacted.” (Section 1 (2) 0f the Public Bodies (Admission to Meetings) Act 1960) If you are unable to attend this meeting, please send your apologies to Cathy Edge on 01744 457237 or e mail [email protected]

The Public Bodies (Admission to meetings Act 1960) permits the CCG to pass a resolution at the meeting to exclude the public and press from part of the meeting by reason of the confidential nature of the business or for other special reasons stated in the resolution. Whenever a resolution to conduct business in private is passed, the resolution itself will be made public.

http://www.sthelensccg.nhs.uk/

mailto:[email protected]

NHS St Helens CCG Governing Body

Meeting held on Wednesday, 10th April 2019 at 10.00am in Conference Room A, St Helens Chamber, Salisbury Street, St Helens WA10 1FY

Part I (Public Meeting) Minutes

Members Present Initials Role Geoffrey Appleton GA Lay Chair, St Helens CCG (Chair) Rachel Cleal RC Deputy Strategic Director/Deputy Accountable Officer Iain Stoddart IS Chief Finance Officer Sue Forster SF Director of Public Health Tony Foy TF Lay Member - Audit, Governance & Finance Lisa Ellis LE Chief Nurse Val Davies VD NED, St Helens and Knowsley Trust Dr Omar Shaikh OS GP Governing Body Member Dr David Reade DR GP Governing Body Member Mark Weights MW Lay Member, Patient and Public Involvement In Attendance Angela Delea AD Associate Director; Corporate Governance Members of the Public x 2 Minute-taker Cathy Edge CE PA to the Chair Agenda Item

Action

PB190401 INTRODUCTION & WELCOME

The Chair welcomed the attendees and members of the public to the meeting.

APOLOGIES

Apologies were received from: Sarah O’Brien, Clinical Accountable Officer Dr Sue Hyde, GP Governing Body Member Dr Hilary Flett, GP Governing Body Member Dr Mike Ejuoneatse, GP Governing Body Member James Catania, Secondary Care Consultant The Chair declared the meeting quorate.

PB190402 DECLARATIONS OF INTEREST The Chair reminded the Governing Body members of their obligation to declare any

interest they may have on any issues arising at committee meetings which might conflict with the business of the CCG. All declarations are listed in the CCG’s Register of Interests; which is available on the CCG website at the following link: http://www.sthelensccg.nhs.uk/Library/public_info/St%20Helens%20CCG%20Register%20of%20Declaration%20of%20Interest%2031%2003%2017.pdf There were no declarations of interest received.

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http://www.sthelensccg.nhs.uk/Library/public_info/St%20Helens%20CCG%20Register%20of%20Declaration%20of%20Interest%2031%2003%2017.pdf

http://www.sthelensccg.nhs.uk/Library/public_info/St%20Helens%20CCG%20Register%20of%20Declaration%20of%20Interest%2031%2003%2017.pdf

PB190403 MINUTES OF THE PREVIOUS MEETING

1.

The minutes of the previous meeting held on 13th March 2019 were agreed as a true and accurate record of proceedings with the following amendment:- PB190205(3) Social Prescribing - paragraph 2 should read: - The Chair proposed that the Lay Member, Patient and Public Involvement, and the Public Health representative arrange to meet with the Salford Team. The minutes of the Governing Body (Urgent Decision Making Committee) held on 29th March 2019 were agreed as a true and accurate record of proceedings and had been approved virtually by the members of the Committee. The NHS St Helens CCG Governing Body:

• Ratified the minutes of the previous meeting • Ratified the minutes of the Governing Body (Urgent Decision Making

Committee)

PB190404 MATTERS ARISING

Matters arising from the previous meeting held on 13th March 2019 PB180911 Quality Workforce - Recruitment Agencies had been approached regarding negotiating a reduced cost for locums with no positive outcome and the action was closed. PB190311 Quality Multi Agency Safeguarding Arrangements - The MASA had been presented at the GP Members April PLT and the action was closed. There were no further matters arising.

PB190405 CHAIR AND CLINICAL ACCOUNTABLE OFFICER’S REPORTS

1.

The Chair’s Report The Chair reported on the following:-

• Meeting with Tom Tasker, Chair of Salford CCG and Chair of the Manchester Chairs meeting. He will continue to meet with the Chair to share current information and challenges

• A day visiting VCA Services with Cllr Marlene Quinn and was very impressed. He had also met with the VCA Chair and Chief Executive to discuss opportunities for development

• A day as an interview panel member for NW Academy Graduates in Leeds reporting a high calibre of graduates

• Attendance at a Mother’s Day event hosted by the local Mosque • Attendance at the joint Chief Executive and Chairs meeting with Cheshire

West and Chester • Attendance at the Mersey Internal Audit Conference with the Lay Member,

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Audit, Governance and Finance. The Lay Member praised the speakers and agreed to share the presentation from Anita Charlesworth, Director of Research and Economics at the Health Foundation, when this is available

The Governing Body noted the Chair’s report. The Clinical Accountable Officer’s Report The Deputy Clinical Accountable Officer presented the Clinical Accountable Officer’s report. The purpose of the report was to inform and update the Governing Body on the key strategic areas of work for the CCG since the last report. She reported on the following: St Helens CCG Primary Care An LMC Learning Event was held on 28th March 2019 regarding changes to the GP contracts and new Network Contract. This was a very positive event, highlighting significant investment in Primary Care and a real opportunity for Practices to work together and address issues such as workforce and demand. The CCG will be supporting practices over the next few weeks to meet the deadlines. The Network Contract also supports the integration agenda in St Helens. Cheshire and Mersey Wide Cheshire & Mersey Health and Care Partnership A new Regional Director has now officially started and his North West Team is in place. Any decisions about the Cheshire and Mersey Health and Care Partnership are yet to be made. The Deputy Accountable Officer confirmed the development of St Helens Place Based Plan as mandated by the Cheshire and Mersey Health and Care Partnership. She reported that St Helens continues to raise concerns about the Partnership’s lack of inclusion in the development of the overall plan. The Executive Team from Halton and Warrington CCGs had met with St Helens regarding the development of future footprints with a further workshop planned to include Knowsley CCG. The Chief Finance Officer reported that as well as the new Regional Director, Bill McCarthy, it had been confirmed that Graham Urwin and Clare Duggan will be part of the North West Team with Jonathan Stevens as Director of Finance for the North West. He agreed to share the new structure with the Governing Body when this is available. The NHS St Helens CCG Governing Body:-

• Noted the reports of the Chair and the Clinical Accountable Officer Patient Story The Chief Nurse presented the patient story highlighting the benefits of multidisciplinary team assessments. The Governing Body received the patient story. The Chief Nurse reiterated that all Governing Body Members could submit a patient story and that negative stories were also welcome.

IS

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The NHS St Helens CCG Governing Body:-

• Noted the patient story

PB190406 STRATEGY

1.

2.

EU Exit Preparations The Chief Nurse presented the EU Exit Preparations update as SRO for the CCG. She noted the uncertain times with an initial 30 page plan in place. She reported that daily sit reps were now to be submitted to NHSE on any impact to the services and a weekly return on workforce. She reported no evidence of impact to date. With regard to reports of concerns regarding medicines in short supply she confirmed that the Assistant Director; Medicines Management, had noted that this was a long standing issue and it would be difficult to confirm that this was now related to Brexit. The GP Governing Body Member, DR, proposed that the issue had accelerated in his practice to a daily issue but the Chief Nurse reiterated that there was no evidence that this was related to Brexit. The Chair noted that the Pharmaceutical Council had reported that prices of drugs were rising and the Chief Finance Officer noted that the No Cheaper Stock Available list was being monitored. The NHS St Helens CCG Governing Body:-

• Noted the update Early Help Strategy The Director of Public Health presented the Early Help Strategy. The purpose of the report was to ask the Governing Body to note and approve the multi-agency Early Help Strategy for Children, Young People and Families in St Helens 2019-2022. She reported that the background for the strategy was to provide early help for children and families who made need support above and beyond universal services with considerable work undertaken on the scope and thresholds for this support. She noted that both professionals and families had been involved in creating the suite of documents attached to the strategy designed to provide information and sign posting for service users. The Director of Public Health drew the Governing Body’s attention to the Action Plan and STEPUP working together to provide Early Help. • S – stopping Stigma and building strengths • T – Working Together • E – Assessing Early and supporting the journey • P – Developing Professionals • U – Valuing Uniqueness • P – Promote Positive outcomes The Governing Body noted and approved the strategy. The Chair highlighted the excellent work being undertaken by Home Start at Peter Street working at changing the behaviours of parents and training in complementary services. The Lay Member, Audit, Governance and Finance, complemented the Director of Public Health on the ‘easy to read’ strategy and requested an update to the

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Governing Body in the future on measures of success. He also requested some indicators of “what good looks like” and timescales for improvement. He acknowledged that some indicators would be hard to provide a measure and proposed some narrative of case studies could demonstrate a measure of success. The Chair echoed this highlighting that it is a long term strategy which can be a challenge when reporting progress. The Chief Finance Officer queried the statement on page 58 of the strategy regarding the local and national context of children thriving in St Helens which will be considered further. The Deputy Accountable Officer complemented the Director of Public Health on the Report and proposed that the biggest challenge was the behavior of adults and work to be undertaken with parents to support the early help strategy. She proposed some adult workshops that are child focused be arranged which was agreed. The Chair requested an update in 6 months’ time with progress on the proposed Adult Services children’s project. The NHS St Helens CCG Governing Body:-

• Noted the report • Approved the strategy

SF/RC

PB190407 KEY ISSUES OF THE BOARD SUBCOMMITTEES

1.

2.

3.

4.

a. Key Issues of the Finance and Performance Committee held on 27th

March 2019 - The Chief Finance Officer presented the key issues as highlighted within the report.

b. Key Issues of the Integrated Finance and Performance Board held on 13th February 2019 - The Chief Finance Officer presented the key issues as highlighted within the report. He noted the clear focus on wider financial arrangements issues around health care. He reported that an integrated performance report is being development that will feed into section 75. The Lay Member, Audit, Governance and Finance, highlighted the importance of an integrated performance report on a wide range of measures to validate the progress of St Helens Cares.

c. Key Issues of the Quality Committee held on 3rd April 2019 - The key issues of the Quality Committee were deferred to the next meeting.

d. Key Issues of the People’s Board held on 13th March 2019 - The Director of Public Health presented the key issues as highlighted within the report.

The NHS St Helens CCG Governing Body:- • Noted the key issues

PB190408 GOVERNANCE

1.

Communications and Engagement 6 Month Update The Associate Director; Corporate Governance, presented the Communications and Engagement 6 Month Update. The purpose of the report was to provide a summary of communications and engagement activity in the period 1st October 2018 to 31st March 2019 and outline plans for the next six months. The Associate Director drew the Governing Body’s attention to the work undertaken

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over the last 6 months working with the integrated team and working well with Public Health colleagues on engagement. She highlighted the overview of the work planned for the next 6 months including work with Healthwatch who have been tasked with engagement on the NHS Long Term Plan and the Cheshire and Merseyside Health Care Partnership. She reported that the results of the 360° feedback had been circulated to Governing Body with analysis to be undertaken which will then be reported to a future Governing Body meeting. The Associate Director asked the Governing Body to approve the refreshed Communications and Engagement Strategy which was agreed. She noted the particular focus on integration within SHIPS and the St Helens collaborative agreement to create a stakeholder forum. The Chair noted the consultation underway on the legislative changes in the Long Term Plan and the Associate Director confirmed that a response will be submitted from the CCG by 25th April 2019. The Director of Public Health reported on a call from the LGA requesting a summary on the St Helens People’s Board and the democratic stewardship of the integrated agenda and this is expected to be published nationally. The NHS St Helens CCG Governing Body:-

• Noted the report • Approved the strategy

PB190409 FINANCE

1.

Finance Performance Update The Chief Finance Officer presented the Financial Performance update. He reported that the financial position for 2018/19 had been finalised with the CCG meeting the breakeven control total, subject of audit mitigation actions and that the QIPP slippage was delivered in line with the plans as previously reported to Governing Body and its sub committees. He noted that the risk sharing agreement with the Local Authority had been misreported in the local press as that “the CCG were not repaying a £4 million loan” to the Local Authority, however, it was noted that this was not a loan and was part of the formal risk share negotiation over the CHC pool and section 75 agreement. He reported that the best practice for timely payment of invoices within 30 days was expected to be met with credit due to the teams for timely responses. The Chief Finance Officer reported that 19/20 would be another challenging year with the new Operational Plan and Financial Plan submitted to NHSE on 3rd April. He noted that the submissions reflected the discussion held at the Urgent Decision Making Committee held on 29th March, highlighting the extent of the financial gap and how the CCG intend to achieve long term sustainability. He reported that the plan was clear that the CCG are unable to bridge the deficit in one financial year and extending that time provides sustainability of services over a number of years. The Chief Finance Officer noted the positive year for St Helens CCG for elective and non-elective care aligning to the new recovery plan aiming to be back to in year financial balance by 2021 and repaying the accumulated and historic debt. He

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noted the need to develop the wider system ownership and governance systems for the future financial recovery and that the Lead Provider Memorandum of Understanding should support this. He reported that the system wide recovery plan was to be finalised by the end of May and St Helens CCG plan will feed into the overall plans. He reminded the Governing Body of the CCG’s £7.6 million of unmitigated risk as reported on 29th March and subsequent risks with provider contracts. The planned £2 million overspend was expected to be covered by the Commissioner Sustainability Fund. He noted that clarification on the conditions for accessing this fund for next year was awaited. The Lay Member, Audit, Governance and Finance, concurred that a longer term recovery system plan was the way forward. The NHS St Helens CCG Governing Body:-

• Noted the update

PB190410 QUALITY

1.

Education and Training Update The Chief Nurse presented the Education and Training Update. The purpose of the report was to provide the Governing Body with an update on education and training for the CCG employed staff, the CCG responsibility to promote clinical education and training in primary care, and promotion of education and training within commissioned providers through contractual requirements. She noted that the Education and Training for CCG staff included membership of the North West Leadership Academy and AQuA which provide a number of learning opportunities for staff. She also highlighted the safeguarding training provided for the CCG’s commissioned services. She reported that the CCG is also a lead partner in the successful bid by Edge Hill University to become a medical school. The Chair requested some evaluation of training going forward with some brief case studies which was agreed. The Deputy Accountable Officer queried the training for integrated staff which will be considered further. The Associate Director; Corporate Governance confirmed that the CCG training budget was quite limited and was enhanced by accessing the apprentice levy and a small CPD budget from Education England. The Chief Finance Officer confirmed that there is a variety of organisations that the CCG subscribe to that are supportive in delivering training or invite more senior staff to take part in round table events with opportunities to influence the policy agenda. The Governing Body debated the mandatory training and it was noted that the CCG do try to provide a range of ways to provide this training in order to reduce the amount of e-learning. The Governing Body endorsed the report The NHS St Helens CCG Governing Body:-

• Endorsed the report

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PB190411 ANY OTHER BUSINESS

Suicide Memorial Event The Director of Public Health reminded the Governing Body of the suicide memorial event to be held at 7 pm that evening, 7th April, at the Stadium. Visit by the Chief Executive of Public Health England The Director of Public Health informed the Governing Body of the visit by Duncan Selbie to St Helens on 8th May. GP Workforce The Chief Nurse agreed to bring a report on GP nursing and non-medical workforce to a future meeting. Integration Update The Deputy Accountable Officer reported on the appointment of Paul Sanderson as Deputy Chief Executive for the Council and interim Assistance Chief Executive, Kevin Ireland who will be in place for a 4 month period. NHS St Helens and Knowsley NHS F Trust The STHKT NED informed the Governing Body that the Trust had maintained its outstanding rating following their recent CQC inspection and the Governing Body congratulated the Trust on their achievements. There was no other business.

LE

DATE OF NEXT MEETING

The next meeting of the Governing Body will be held on Wednesday, 8th May 2019 at 10 am in the Conference Room A, St Helens Chamber, Salisbury Street, St Helens WA10 1FY

Minutes Ratified as Accurate Record Name: Geoffrey Appleton

Signature:

Date:

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ACTION POINTS FROM CCG GOVERNING BODY PART I MEETING HELD ON 10.04.19

Action Number

Due From: Action Required: Required by: Completed:

62. Lisa Ellis/ Karen Edwardson

PB180911 Quality Workforce - Recruitment Agencies to be approached regarding the promotion of St Helens to their candidates

14th November 2018 Deferred to 10.04.19

Closed

72. Sarah O’Brien/ Sue Forster

PB190111 Performance Research, Innovation and Development Report The Governing Body agreed that the CCG should be more proactive in research, innovation and development and the Clinical Accountable Officer and the Director of Public Health agreed to progress this, in particular with St Helens and Knowsley NHS Trust

17th April 2019 Deferred to July 2019

73. Sue Forster

PB190205 Chair And Clinical Accountable Officer’s Reports Social Prescribing Presentation on social prescribing to be presented to the May Governing Body meeting

8th May 2019 Deferred to June 2019

74. Karen Leverett

PB190206 Strategy NHS Plan Overview A presentation on the Care Homes Project to be presented to a future Governing Body

12th June 2019

75. Rachel Cleal

PB190206 Strategy Commissioning Intentions The GP Governing Body Members requested that those intentions that require clinical support be identified in order to allocate those areas of work.

8th May 2019

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76. Iain Stoddart

PB190206 Strategy Operational Plan 2019/20 52 week waiters to be flagged to the Governing Body within the Performance reports

8th May 2019

77. Angela Delea

PB190308 Governance Governing Body Assurance Framework (GBAF) Qtr 4 A new risk associated with integrated urgent care and the current out of hours provider was identified to be included on the GBAF

8th May 2019

78. Lisa Ellis

PB190311 Quality Multi Agency Safeguarding Arrangements The MASA be presented at the GP Members April PLT

25th April 2019

Closed

79. Lisa Ellis

PB190311 Quality Safeguarding Children and Adults Update A report was requested on children in transition from LAC services

8th May 2019 Deferred to 10th July 2019

80. Iain Stoddart

PB190405 Clinical Accountable Officers Report The Chief Finance Officer agreed to provide the Governing Body with the new NHSE/NHSI Structure when this is available.

12th June 2019

81. Sue Forster/ Rachel Cleal

PB190406(2) Early Help Strategy An update to be provided for the Governing Body in 6 months’ time on the strategy and progress on the proposed Adult Services Children’s Project.

13th November 2019

82. Lisa Ellis

PB190411 Any Other Business The Chief Nurse agreed to provide a report on GP nursing and non-medical workforce.

10th July 2019

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Report to Governing Body Date of meeting:

22nd May 2019

Governing Body Member Lead:

Prof Sarah O’Brien

Accountable Director:

Clinical Accountable Officer

Report title:

Clinical Accountable Officer Report

Item for: Decision Assurance Information X (Please insert X as appropriate)

Strategic Objectives

This report supports the following CCG Strategic Objectives. Please insert ‘x’ as appropriate. 1. To deliver financial sustainability x 2. To deliver improvements through system redesign and in priority areas. x 3. To deliver improved outcomes for patients x 4. To develop primary care capacity and capability as system leaders x

Governance and Risk

Does this report provide assurance against any of the risks identified in the Assurance Framework? (please specify) N/A

Is this report required under NHS guidance or for statutory purpose? (please specify) No

Purpose of this paper The purpose of this paper is for the Clinical Accountable Officer to inform and update Governing Body on the key strategic areas of work for the CCG since the last report.

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Further explanatory information required: Does this paper link to any of the 10 key themes of the CCG’s Improvement Plan. If yes, please specify.

It provides a general update on progress with the whole improvement Plan

How will this benefit the health and wellbeing of St Helens residents or the Clinical Commissioning Group?

N/A the paper is an information update only

Please describe any possible Conflicts of Interest associated with this paper.

No conflicts of interest

Please identify any current services or roles that may be affected by issues within this paper.


What risks may arise as a result of this paper? How can they be mitigated?


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Clinical Accountable Officer Update to Governing Body (May 2019) The purpose of this report is to inform and update the Governing Body on the key areas of strategic work since the April Governing Body meeting. NHS St Helens CCG

1. Primary Care - Network bids have been received by the deadline of 15th May 2019. At the

time of writing the CCG are reviewing bids and an update will be given at the next meeting. 2. IAF Meeting - The CCG’s end of year IAF (Improvement and Assessment Framework)

meeting with NHSE is scheduled for 17th May 2019. 3. Public Health England Visit - St Helens were visited by the Chief Executive of Public

Health England on 8th May 2019. He met with the Director of Public Health, myself and leads from the Council. It was a very positive visit, he strongly endorsed integration and all the positive work we are doing across St Helens. He then mentioned us on Twitter and in his weekly update.

Cheshire and Mersey Wide

1. Cheshire & Mersey Health and Care Partnership There was a full Cheshire and Mersey Health Care Partnership meeting on 8th May with the new Regional Director, someone from the National Transformation Team and panel discussions. The key messages were:-

• Place based working and integration remain the way forward • Cheshire and Merseyside still have work to do on becoming an ICS (Integrated Care

System) within the time frame • May be a good time to take stock and prioritise what we work on • There was a discussion about developing a system wide memorandum of

understanding

2. Strategic Plan for 2019-24 The NHS Long Term Plan requires each STP/ICS to explain how this will be delivered locally. The Cheshire and Merseyside HCP will be required to produce a Strategic Plan for 2019-24 by the autumn of 2019. The C&M HCP have requested each place to produce its own Strategy to contribute to the wider STP plan. Work has begun on developing our plan and it is envisaged that a first draft will be submitted to the Governing Board in June 2019 and on to boards/committees of key partners for initial endorsement. An engagement programme will be developed and executed during the summer. Places are requested to submit their local strategies by the end the summer with the final version of the C&M Five Year Strategy to be launched at the Partnership event in October 2019. The key milestones are shown in the table below:

Milestone Date Places to submit public engagement plans to review

16 May 2019

Draft Place 5 Year Strategy Developed

31 May 2019

Draft Place 5 Year Strategy submitted to the GB for approval

12 June 2019

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Draft Place 5 Year Strategy Engagement Programme

Mid-June to Mid-August

Governing body receive final draft of Place 5 Year Strategy following engagement exercise

11 September

St Helens Place 5 Year Strategy submitted to C&M HCP

Mid-September

C&M 5 Year Strategy completed and submitted for final approval

End of September

Full Partnership event – endorsement and adoption 30 October 2019 Whilst the timescales are driven by national and regional agendas, the process does allow us to take stock and develop the next stages of our St Helens Cares Journey.

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DOCUMENT DEVELOPMENT Process Yes No Not

applicable Comments & Date (i.e. presentation, verbal, actual report)

Outcome

Public Engagement (please detail the method i.e. survey, event, consultation)

x

Clinical Engagement (please detail the method i.e. survey, event, consultation)

x

Has ‘due regard’ been given to Equality Analysis (EA) and any adverse impacts? (Please detail outcomes, including risks and how these will be managed)

x

Legal Advice Sought

x

Presented to any other groups or committees including Partnership Groups – Internal/External (please specify in comments)

x

Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.

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Patient Story

In July 2018, a former patient of the Trust presented her story to the Trust’s Board along with her husband. The patient was a happy and healthy 25 year old who was enjoying the joys of newly married life.

On the evening of 5th February 2017, the patient and her husband had attended an ice hockey game of their local team. On returning home, she started to feel cold and unwell. As the evening progressed she became worse with the development of a headache and vomiting. At 06:55 on 6th February, her husband called 999 as she had developed a widespread purple rash and was not improving.

The ambulance arrived at 07:20 to and within minutes she was administered IV antibiotics.

She was rushed to Whiston Hospital and arrived at A&E at 07:44 where the Accident and Emergency team started work on her immediately and she received further antibiotics.

The patient was transferred to ICU where she was sedated and intubated and was later diagnosed with Pneumococcal Sepsis via blood cultures. She spent just over 8 months in hospital undergoing numerous operations and unfortunately had her left leg amputated and several fingers on both hands.

She was transferred to 4D/3A where she received lifesaving operations to save her right leg and maintain the ability to work.

After being transferred to Seddon Suite, she received intensive physiotherapy to learn to feed herself with adapted equipment and with the aid of a prosthetic leg, walk again.

On 14th September 2017 she was discharged home where she continued to receive support through occupational therapy and has been able to maintain her driving licence and an adapted new car.

In December 2017, she returned back to work full time as a graphic designer.

Since her discharge, she has been able to achieve so much including holidays, attending Buckingham Palace to receive her Scout leader award and has held her first Sepsis Ball raising over £7000 for The UK Sepsis Trust in September 2018.

She is working closely with the Trust for the upcoming Sepsis Conference in November 2019 to produce a 6 minute patient experience video and to answer questions about her recovery and amazing journey.

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Quality Committee Meeting Date: 3rd April 2019 Agenda Item Ref:

Improvement or Operational Plan Theme

Key Issue Decision/ Action Corporate Risk/ GBAF Reference - Mitigation

QC190420 Provider Updates – North West Boroughs High number of referrals currently being received by the Assessment Team. These issues have been highlighted on the Risk Register.

Governing Body are asked to note the highlighted concerns, and note that these have been included on the Risk Register

2.2,2.3,3.1,3.2,3.4 4.1,4.3,5.2,5.3,5.4

QC190405 End of Life Report from NHSE Re: STHK Potential delay.

Noted report and recommendation however points of clarity raised to NHSE.

1.1,2.2,3.1,3.2,4.4

QC190408 LD Annual Health Checks Target 75% has declined since last year and is currently at 39.71 (Feb19).

Focussed visit to GP practises to improve uptake and quality is now underway.

2.1,2.2,2.3,3.2,3.3 4.4,5.2,5.3

QC190410 Community Podiatry Specification Approved

Key Issues Report Date Prepared by: Claire Holtby, PA to Chief Nurse/ Deputy Chief Nurse - Quality 11/06/19 Verified by: Lisa Ellis, Chief Nurse/ Director of Quality 12/06/19 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Audit Committee – please highlight any specific issues to be escalated. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.

KEY ISSUES REPORT

23

Quality Committee Meeting Date: 8th May 2019 Agenda Item Ref:



QC190505 Pan Mersey Recommendations Approved

QC190509 Transforming Care Agenda

Noted – 2 fully discharged, 2 partially discharged.

QC190513 IAPT Specification

Approved

QC190514 National STOMP Audit Noted assurance. LE to discuss with neighbouring CCG’s how they have reached full compliance.

QC190517 Primary Care Quality Process Approved

QC190520 Risk Register Noted and approved

Key Issues Report Date Prepared by: Claire Holtby, PA to Chief Nurse/ Deputy Chief Nurse - Quality 09/05/19 Verified by: Lisa Ellis, Chief Nurse/ Director of Quality 10/05/19 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Audit Committee – please highlight any specific issues to be escalated. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.

KEY ISSUES REPORT

25

Finance & Performance Committee – 24th April 2019 Agenda Item Ref:


Key Issue Decision/ Action Corporate Risk/ GBAF Ref - Mitigation

F&P 190405 (a)

NHS Constitutional Performance The CCG Constitutional Dashboard was presented to update members on progress against the 23 individual performance measures that the CCG report on. Of these, there are 9 failing measures YTD as detailed in the report with action plans in place to support all measures.

Committee noted the report.

F&P 190405 (b)

Performance Report The Priority area this month was Primary Care and Prescribing and updates were provided by project leads under a later agenda item. The report detailed areas where the CCG is failing performance duties and the Committee discussed actions being taken against some key areas. A routine plan is in place where operational leads present in detail to the committee and it was agreed that Urgent Care would be the next focus area.

Committee noted the current performance position.

F&P 190405 (c)

Children’s Wheelchair waiting times A report was included on actions being progressed to improve the performance of children getting wheelchairs within 18 weeks. The children’s commissioner was not available to present the report so the committee requested a few areas of clarification.

The committee noted the report

KEY ISSUES REPORT

27

F&P 190405 (d)

Operational Plan – focus areas Primary Care The primary care lead presented the action plans and a detailed discussion was held about workforce and the challenges this is presenting. This is being addressed through PCC and alternative workforce models are being reviewed and are part of the new Primary Care Network Contract. Medicines Management The Meds Management lead presented an update and noted that new clinical pharmacists were being put in place to work on key areas, e.g. care homes/stoma etc.

Committee noted the report. Committee noted the report.

F&P 190406 (a)

Finance report – Month 12 The CCG reported a breakeven in-year financial position for 2018/19, therefore achieving the control total set by NHSE. The breakeven financial position was achievable through a combination of settlement deals, non-recurrent mitigations and the receipt of external financial support from NHSE. The underlying financial position for 2018/19 is reported to be £7.5m deficit, with a cumulative deficit of £13.6m.

Committee noted the final year-end financial position.

F&P 190406 (b)

Budget Book 2019/20 The Budget Book was presented for information and is based on the Financial Plan submitted to NHSE on 4th April 2019. One change was noted to the approved version of the Financial Plan compared with the Governing Body approved plan from

Committee received and noted the Budget Book for information.

28

29th March. This relates to a reduction in the CCGs allocation as a result of Cheshire and Mersey Health Care partnership contribution and is noted in the commentary at the front of the Budget Book.

F&P 190406 (c)

Draft Financial Recovery Plan 2019/20 The draft Financial Recovery Plan was submitted to NHSE on 4th April 2019 and is consistent with the Financial Plan approved by Governing Body on 29th March 2019. The CCG has started to gather information from relevant partners to develop a ‘System-wide Recovery Plan’ by 30th June 2019.


F&P 190406 (d)

Contracts update 2019/20 A report was provided to apprise members of the latest position around sign off of contracts for the main providers - St Helens and Knowsley Trust, Bridgewater Trust, North West Boroughs, Warrington and Halton Trust, Royal Liverpool & Broadgreen and Wrightington, Wigan & Leigh. It was noted that the majority of contracts were agreed but not yet signed or awaiting agreement from associate commissioner(s).

Committee noted the progress in relation to 2019/20 provider contracts.

F&P 190406 (e)

Estates update An update was provided on key ongoing work areas for the Strategic Estates Group (SEG) which includes a review and better utilisation of void spaces in clinics. Next steps include continued development of a midwifery led unit at Lowe House and Four Acre Hub plans and continued improvements in utilisation across the borough.

Committee noted the content of the report.

29

F&P 190407 (a)

Corporate Risk Register An update was provided as at April 2019, which showed a total of 13 operational risks for the F&P Committee at the start of the new financial year.

Committee noted the current risk register position and approved the closure of 4 risks and the addition of 3 new risks.

Key Issues Report Date Prepared by: Dawn Mellan 14th May 2019 Verified by: Julie Ashurst 15th May 2019 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.

30

Primary Care Commissioning Committee Meeting Date: 1st May 2019 Agenda Item Ref:



PC190505 FINANCE REPORT The Committee received the full year Primary Care forecast outturn based on information at February 2019. The Deputy Chief Finance Officer reported that the final overspend figure for 18/19 based on March figures was £80K.

The Committee:- • Noted the report • Approved the Delegated Co-

Commissioning budgets • Requested further narrative

within future Finance Reports and a breakdown of the spend for GP Members and the public

1.1, 1.2, 1.3

PC190507 OUT OF HOURS UPDATE The Assistant Director; Primary Care reported that St Helens ROTA had given the CCG notice that they no longer wished to provide this service to the practices that had ‘opted out’ of providing their own OOH service.

The CCG are working with PC24 and ROTA in order to transition the patients.

3.1, 5.1

PC190508 PRIMARY CARE GOVERNANCE AUDIT The Committee received the results of a recent audit conducted by Mersey Internal Audit Agency in relation to Primary Medical Care Commissioning and Contracting; Governance Review.

A workshop has been planned to review effectiveness of Committee arrangements on 3rd May, 2019 with any proposal for change to the current structure to be presented to the next meeting of the Primary Care Commissioning Committee for approval, together with revised

Objective 5: To stabilise, support and sustain primary care

KEY ISSUES REPORT

31

Terms of Reference.

Key Issues Report Date Prepared by: Cathy Edge 02.05.19 Verified by: Geoffrey Appleton 07.05.19 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Audit Committee – please highlight any specific issues to be escalated. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.

32

GP Members Council Meeting Date: 1st May 2019 Agenda Item Ref:



MC190505 Out of Hospital/ Primary & Community Care

Review of “Big 6 Booklet” – Children’s Pathways

Number of GP members identified to review each section within the Big 6 Booklet and feedback comments.

2.1

MC190506 Digital Presentation by Dr Breach, Haydock Medical Centre around alternative services/ ways of working

Members Council received the presentation and discussed the different ways of working and opportunities within their own practices/ networks.

5.3

MC190507 Integration of H&S Care

Presentation by Julie Ashurst, Deputy Chief Finance Officer on Annual Report 2018/19 Key Highlights

Members Council received the Annual Report summary for 2018/19 and the challenges going forward were highlighted

ALL

MC190508 N/A Reappointment of CCG Lay Chair – Remuneration Committee Recommendation

Members Council agreement to recommend to Governing Body the reappointment of Lay Chair

4.3

Key Issues Report Date Prepared by: Hilary Southern, Governance & Corporate Services Manager 01/05/19 Verified by: Dr Mike Ejuoneatse, Chair of GP Members Council 13/05/19 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Audit Committee – please highlight any specific issues to be escalated. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.

KEY ISSUES REPORT

33

Audit Committee – 3rd April 2019 Agenda Item Ref:


AC 190406 Risk Management Strategy A refreshed version was presented to committee for approval as per annual requirements.

Committee approved the refreshed Risk Management Strategy, subject to some minor amendments.

AC 190407 GBAF Arrangements A report was presented to provide assurance around the robust Risk Management process in place to support the GBAF. Risks were discussed and a number of actions agreed.

Committee noted the update and are satisfied that the CCG has robust risk management processes in place.

AC190408 Accounting Policies The Accounting Policies for 2018/19 were presented to committee for approval. Members noted that where numbers are quoted within the policy, these can only be completed after ledger close.

Committee received assurance in relation to the new Accounting Standards and approved the Accounting Policies for inclusion in the 2018/19 Annual Accounts. Committee Chair to feed back this assurance to NHSE.

AC190409 Losses, Special Payments, Tender Waivers and Aged Debtors/Creditors No significant write-offs or special payments were reported in quarter 3, with one small loss/write off expected in quarter 4. An ongoing issue in relation to the debtor balance has been resolved and a way forward agreed. There has been little change to the aged creditors’ position but the CCG has robust evidence in place to support all items that have been formally disputed.

Committee noted the update. Narrative to be included in future reports to highlight the efforts made to control and reduce the debts.

KEY ISSUES REPORT

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AC190411 Interim Service Auditor Reporting (SAR) Letter No exceptions identified for the period 1st April 2018 and 31st December 2018. The 12 month report is due to be finalised by 26th April 2019.

Committee noted the update.

AC190412 Draft Head of Internal Audit (HOIA) Opinion ‘Substantial Assurance’ was received in relation to the CCG’s internal controls for the period 1st April 2018 and 31st March 2019.

Committee noted the Draft HOIA Opinion for 2018/19.

AC 190413 Internal Audit progress report 3 reports have been finalised since the last meeting, all of which received positive opinions as noted below: Assurance Framework – ‘Meets Requirements’ Conflicts of Interest – ‘Fully Compliant’ Primary Care Governance – ‘Substantial Assurance’


AC 190414 Follow up Audit Recommendations No concerns were raised with most recommendations completed by the CCG on time and target dates agreed for any outstanding actions.


AC 190415 Internal Audit Charter Report included for information.


AC190416 Internal Audit Plan 2019/20 Proposed plan presented for approval.

Committee approved the proposed Internal Audit Plan for 2019/20.

AC190417 Anti-Fraud briefing Report presented to clarify changes to NHSCFA Standards for Commissioners for 2019/20. Deadline for annual submission of Self-Review Tool is 30th April 2019.

CFO and Committee Chair to complete online approval in collaboration with MIAA by the noted deadline.

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AC190418 Anti-Fraud Work Plan 2019/20 Work Plan presented with proposed activity against the 4 key principles (as per NHS Standards), similar to previous years.

Committee approved the proposed Anti-Fraud Work Plan for 2019/20.

AC190419 External Audit Progress Report No significant findings reported by Grant Thornton following the interim audit carried out in February 2019 in relation to the CCG’s Financial Statements.


AC190420 External Audit Plan (year ending 31st March 2019) Grant Thornton have identified two specific issues that are recognised as being the most significant risks nationally. These are override of management control and completeness of secondary healthcare expenditure (year end contract variations). These will be the areas of focus within the accounts audit.

Committee approved the External Audit Plan for year ending 31st March 2019.

Key Issues Report Date Prepared by: Dawn Mellan 14th May 2019 Verified by: Tony Foy 15th May 2019 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. Formal Minutes, once approved, will be made available on request.

37

KEY ISSUES REPORT HUMAN RESOURCES AND ORGANISATIONAL DEVELOPMENT COMMITTEE Meeting Date: 26th April 2019

Agenda Item Ref:

Improvement / Operational Plan Theme

Key Issue Decision/ Action Corporate Risk/ GBAF

HR19/04/04 Effective Organisation

HR Performance Management Framework – The Committee reviewed the Qtr. 3 2018/19 performance report. Performance remained positive against all indicators with the exception of sickness absence rates. The CCG cumulative sickness absence rate was 2.67% for the 12 month period January 2018 to December 2018, against a target of 2.50%. This was recognised as being due to seasonal ailments. The sickness absence rate of peer groups being 3.39%. Qtr 4 workforce dashboard tabled at meeting evidenced Improvement, with a rate of 2.24% for March 19.

Committee satisfied with overall HR performance for 18/19 period, and remained assured of the evidence of continuous monitoring through ELT of the range of performance measures.

HR19/04/05 Effective Organisation

Committee reviewed the year end performance against the 2018/19 OD plan, noting excellent progress against plan. Members noted the main areas for inclusion in the 19/20 plan and the requirement to refresh the OD Strategy for 2021.

Based on evidence of CCG improvement from wide range of assessments, it was agreed a specific evaluation against OD plan was not required. ELT to monitor on-going performance against 19/20 plan

OD Plan supports delivery of all risks on the GBAF

HR19/04/ 06 Effective Organisation

Committee reviewed its two risks on the corporate register noting actions taken to mitigate both risks, and agreeing that target scores has been achieved a full assurance reached.

Committee agreed to closure of both risks

4.3 Failure to have capacity/capability

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HR 19/04/07 Effective Organisation

Committee completed effectiveness review against ToRs and its overall performance.

Committee agreed that it had fulfilled it functions and were confident that the processes are embedded to be assured of on-going monitoring through ELT Committee. It was recommended by an annual HR & OD performance report be presented to Governing Body,

Key Issues Report Date Prepared by: Angela Delea, Associate Director, Corporate Governance 08.05.19 Verified by: Geoffrey Appleton, Committee Chair 15.05.19 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Audit Committee – please highlight any specific issues to be escalated. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.

40

Date/Agenda Item Ref:

Key Issue Decision GBAF/CCG Risk

RC19/04/04

The HR Business Partner presented the Committee with the final draft version of the Clinical Leadership and Governing Body Remuneration Framework. This framework will guide the work of the Remuneration Committee, and has been developed in response to a regional MIAA audit of remuneration practice across CCGs.

The Committee recommends the new Remuneration Framework for approval by Governing Body. – See Framework Appendix 1

1.1 Failure to deliver financial control total

RC 19/04/05 The Associate Director, Corporate Governance presented the Remuneration and Staff Report, as included in the CCG Annual Report 2018/19

The Committee agreed the content for inclusion in the 2018/19 Annual Report

RC 19/04/07 The Associate Director, Corporate Governance advised that the term of office for the CCG Chair was due to expire on 31st August 2019, and presented a proposal to recommend the re-appointment of the current Chair, subject to agreement with the Members Council.

The Committee recommends the GB approve reappointment for a further 3 year period, with the same rate of pay and Terms & Conditions and that this recommendation should go to Members Council for agreement.

Key Issues Report Date Prepared by: Angela Delea, Associate Director Corporate Governance 29th April 2019 Verified by: Tony Foy, Committee Chair 30th April 2019 NOTE: A copy of any papers referenced in this Key Issues Report will be made available on request to the Committee Chair. A copy of this report will be sent to Audit Committee – please highlight any specific issues to be escalated. Formal Minutes, once approved, will be made available to the Audit Committee and Governing Body on request.

KEY ISSUES REPORT Remuneration Committee 25th January 2019

41

NHS St Helens Clinical Commissioning Group

Clinical Leadership and Governing Body Remuneration Framework In respect of the following Governing Body Roles

- Elected GP Members - Lay Chair - Lay Members - Secondary Care Doctor on the Governing Body - Registered Nurse on the Governing Body - Deputy Chair/Deputy Clinical Lead

And the following other CCG roles

- Clinical Leads - Named Safeguarding GPs

43

1. Introduction .............................................................................................................................. 5

2. Policy statement ...................................................................................................................... 5

3. Purpose and scope .................................................................................................................. 5

4. Roles and responsibilities ........................................................................................................ 5

4.1 Managers ....................................................................................................................... 5

4.2 Individuals ...................................................................................................................... 6

4.3 Human Resources .......................................................................................................... 6

4.4 Finance........................................................................................................................... 6

4.5 Governing Body .............................................................................................................. 6

4.6 Remuneration Committee ............................................................................................... 6

5. Guidance ................................................................................................................................. 7

5.1 National Guidance .......................................................................................................... 7

5.2 Senior Remuneration ...................................................................................................... 7

5.3 HMRC guidance and compliance.................................................................................... 7

6. Types of engagement .............................................................................................................. 8

6.1 Off Payroll Workers ........................................................................................................ 8

6.2 Office Holder .................................................................................................................. 8

6.3 Contract ‘of’ / ‘for’ Service ............................................................................................... 9

7. Fair pay review principles ...................................................................................................... 10

8. Approach to remuneration ..................................................................................................... 10

8.1 Elected GPs on the CCG Governing Body .................................................................... 10

8.1.1 Role Outline .................................................................................................... 10

8.1.2 Specific attributes and competencies .............................................................. 10

8.1.3 Remuneration rate .......................................................................................... 10

8.1.4 Time Commitment ........................................................................................... 11

8.1.5 Contractual status ........................................................................................... 11

8.1.6 Mechanism for payment .................................................................................. 11

8.1.7 Pension (GP SOLO) ....................................................................................... 12

8.1.8 Annual Leave, sickness and ‘allowable’ absence ............................................ 12

8.1.9 Travel expenses.............................................................................................. 13

8.2 Lay Chair of the Governing Body .................................................................................. 13

8.2.1 Role Outline .................................................................................................... 13


8.2.3 Time Commitment ........................................................................................... 14



8.2.6 Pension ........................................................................................................... 15

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8.2.7 Annual Leave, sickness .................................................................................. 15

8.2.8 Travel expenses.............................................................................................. 15

8.3 Deputy Chair/Deputy Clinical Lead ............................................................................... 15

8.3.1 Role Outline .................................................................................................... 15


8.3.3 Time Commitment ........................................................................................... 16



8.3.6 Pension ........................................................................................................... 16

8.3.7 Annual Leave, sickness .................................................................................. 17

8.3.8 Travel expenses.............................................................................................. 17

8.4 Lay members on the Governing Body ........................................................................... 17


8.4.2 Time Commitment ........................................................................................... 17



8.4.5 Pension ........................................................................................................... 18

8.4.6 Annual Leave, sickness and ‘allowable’ leave ................................................. 18

8.4.7 Travel expenses.............................................................................................. 18

8.5 Secondary care doctor on the Governing Body............................................................. 19

8.5.1 Role Outline .................................................................................................... 19


8.5.3 Further points .................................................................................................. 19


8.5.5 Time Commitment ........................................................................................... 20



8.5.8 Pension ........................................................................................................... 20

8.5.9 Annual Leave, sickness and ‘allowable’ absence ............................................ 20

8.5.10 Travel expenses.............................................................................................. 21

8.6 Registered nurse on the Governing Body ..................................................................... 21

8.6.1 Role Outline .................................................................................................... 21


8.6.3 Further points .................................................................................................. 22


8.6.5 Time Commitment ........................................................................................... 22


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8.6.8 Pension ........................................................................................................... 23

8.6.9 Annual leave, sickness and ‘allowable’ leave .................................................. 23

8.6.10 Travel expenses.............................................................................................. 23

8.7 Clinical Leads ............................................................................................................... 23

8.7.1 Role Outline .................................................................................................... 23


8.7.3 Time Commitment ........................................................................................... 25

8.7.4 Contract ‘Of’ Service Roles ............................................................................. 25

8.7.5 Contract ‘for’ Service Roles ............................................................................. 25


8.7.7 Mechanism for payment - contract ‘of’ service ................................................ 25

8.7.8 Mechanism for payment - contract ‘for’ services.............................................. 25

8.7.9 Annual leave, sickness and ‘allowable’ leave - contract ‘of’ service roles ........ 26

8.7.10 Annual leave, sickness and ‘allowable’ leave - contract ‘for’ service roles ....... 27

8.7.11 Travel expenses.............................................................................................. 27

8.8 Named Safeguarding GPs ............................................................................................ 27

8.8.1 National Guidance .......................................................................................... 28

8.8.2 Named GPs .................................................................................................... 28



8.8.5 Pension ........................................................................................................... 29

9. Equal opportunities ................................................................................................................ 29

10. Framework Review ................................................................................................................ 29

11. Associated documents ........................................................................................................... 29

12. Appendix 1 – Comparison Table ............................................................................................ 30

13. Appendix 2 – GP pensionable income ................................................................................... 31

14. Appendix 3 – GP Office Holder Agreement ............................................................................ 32

15. Appendix 4 – Lay Member Agreement ................................................................................... 44

16. Appendix 5 – Clinical Lead Agreement .................................................................................. 49

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1. Introduction NHS St Helens Clinical Commissioning Group (the CCG) is committed to ensuring a fair and transparent approach to remuneration is adopted for Governing Body members and Clinical Leads. In addition, the CCG, as an NHS organisation and a public body, is covered by the HM Treasury ‘Managing Public Money’ handbook and has a statutory requirement to exercise its functions effectively, efficiently and economically. This framework outlines the CCG’s responsibilities and its approach to fulfilling them and is based on best human resources practice, internal audit discussions and is reflective of national arrangements for the NHS pension scheme, associated employment law and HMRC guidance. The framework provides information for on the following areas:

• National guidance • HMRC compliance • Remuneration principles

2. Policy statement The CCG’s policies and guidance set out the organisation’s standards and intentions, and are written with the aim of being as clear and comprehensive as possible. However, the CCG operates in a dynamic and evolving work environment and attention should be paid to the spirit of the guidance as well as the letter. Policies or guidance documents by themselves cannot guarantee effective behaviour or the delivery of key objectives. Whilst they are designed to support the CCG, and the people working within it, our success depends on continuous, high quality effort by everyone the policy covers. Therefore, consideration must be given to good practice when applying or interpreting any of the CCG’s policies, and you should read any guidance or supporting documentation that relates to this document to help you do this. 3. Purpose and scope The aim of this framework is to set out a clear, fair and transparent approach to the remuneration of non-VSM Governing Body Members and other supporting clinical engagement roles. This Framework will be effective for the CCG from 26th April 2019. For the avoidance of doubt, this policy is not applicable to employees on a Very Senior Manager (VSM) contract or those who are covered by the national terms and conditions of service (Agenda for Change) other than for those contractual terms explicitly agreed by the Remuneration Committee, these staff are out of scope of this remuneration framework. 4. Roles and responsibilities 4.1 Managers Those responsible for or involved in the appointment of any staff outlined in this framework must familiarise themselves with the contents of this framework and raise any questions or queries

47

regarding its application to the human resources department prior to take steps to recruiting to these roles and enacting any decisions. 4.2 Individuals All individuals are responsible for providing all necessary information to the CCG as and when required to enable the CCG to make appropriate adjustments and ensure compliance with its obligations. Individual GPs are responsible for providing all necessary information to the CCG on Tiered global earnings and Additional Voluntary Contributions (AVCs) as and when required to enable the CCG to calculate the correct pensionable pay and contributions. 4.3 Human Resources The human resources team will be responsible for providing additional guidance, advice and support to managers in the application and operation of this framework. 4.4 Finance The CCG finance team are responsible for monitoring payments made in line with guidance and budgeted amounts. The team also prepare the GP SOLO form at the end of the year for GP’s to approve and work with other agencies (NHS England, Primary Care Support Services England, Capita, Payroll provider) to ensure the correct amount have been applied. The CCG finance team also prepare the remuneration report and ‘off-payroll’ engagement information for Annual Report and Accounts requirements 4.5 Governing Body In line with the CCG constitution, the Governing Body is responsible for 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. 4.6 Remuneration Committee The Remuneration Committee is a statutory committee of the CCG that is accountable to the Governing Body for making recommendations on determinations about the remuneration, fees and other allowances for:

• Very Senior Management (VSM) employees; • Governing Body Members; • Clinical leads; • for people who provide services to the CCG; and • allowances under any pension scheme that the CCG may establish as an alternative to the

NHS pension scheme. The CCG’s Remuneration Committee is responsible for ensuring the CCG adheres to this supporting framework and that any decisions that are understood to be outside this approved

48

framework are reviewed, considered and recommended for approval by the Governing Body prior to any decisions being made. 5. Guidance 5.1 National Guidance In line with the Health and Social Care Act each CCG may appoint persons to be employees or work on a contract for service basis as it considers appropriate and is able to:

• Pay its employees remuneration and travelling or other allowances in accordance with determinations made by its Governing Body; and

• Employ them on such terms and conditions as it may determine. NHS England provided initial guidance document1 to CCGs in respect of remuneration ranges and amounts for Accountable Officers and Chief Finance Officers. No further specific guidance or mandate has been published since the development of this guidance which outlines specific remuneration arrangements or approaches for any other Governing Body role of Clinical Leads engaged by a CCG, however, an additional guidance document2 from NHS England does outline some principles for reimbursement and remuneration for clinical Governing Body members that CCGs may wish to take into account. 5.2 Senior Remuneration CCGs are now subject to the same controls on senior remuneration as NHS providers. Consequently, when a CCG is seeking to appoint a Clinical Chief Officer or Chief Officer who will hold the AO role, or any other senior staff member on a Very Senior Manager (VSM) contract of employment, early consideration has to be given to the level of remuneration proposed for the post. Where the remuneration proposed is anticipated to exceed £150,000 per annum under requirements promulgated from time to time, CCGs will now require formal consent from NHS England and Ministerial approval before the role can be advertised. If the appointment does not exceed £150,000 per annum then no further approvals are required and the CCG Remuneration Committee can determine the remuneration in accordance with existing guidance. For the avoidance of doubt, all individuals who are paid under different terms such as based upon a sessional rate, or notional rate do not have a whole time equivalent value, therefore in relation to this framework it is not anticipated that any of the ‘roles’ will exceed this threshold but will be kept under review in line with remuneration guidance. 5.3 HMRC guidance and compliance CCGs are expected to ensure that HMRC are content with any arrangements put in place and that all payments are made in accordance with tax and national insurance regulations and with any guidance or advice issued by the NHS England.

1 Clinical Commissioning Groups: Remuneration guidance for Chief Officers (where the senior manager also undertakes the accountable offer role) and Chief Finance Officers 2 Clinical commissioning group governing body members: Role outlines, attributes and skills (October 2012)

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6. Types of engagement 6.1 Off Payroll Workers Particular consideration should be given to the impact of the IR35 legislation in respect of any off-payroll workers (OPW) engaged by the CCG in ensuring that appropriate tax and national insurance deductions are made in line with these regulations. Whilst the IR35 legislation is not new, since 2017 the onus of deducting tax and national insurance deductions on behalf of an OPW now rests with the public-sector body engaging the individual. The approaches to remuneration outlined in this framework have been developed in accordance with current HMRC guidance and tax legislation, however, recognising the complexities associated with this area the CCG may need to take further independent and expert advice as required to ensure continued compliance with HMRC requirements. Guidance can be found at: https://www.gov.uk/guidance/off-payroll-working-in-the-public-sector-reform-of-intermediaries-legislation The CCG has a ‘IR35’ policy and procedure in place in order to manage its OPW obligations and have been reflected as appropriate within this framework. 6.2 Office Holder The general definition of an office-holder is that

• they are neither an ‘employee’ (a worker under a contract of employment) or perform specified activities through a contract for services.

Examples of office-holders usually include, non-executive directors, company secretaries, board members of statutory bodies or trustees of an organisation

• As an ‘office holder’ these arrangements therefore result in no ‘contract of’ service or ‘contract for’ service between the post holder and the CCG but will require the CCG to establish an office holder ‘agreement’ to clarify working arrangements.

• As an ‘office holder’ is not considered to be an employee of the CCG, they would not normally attract any employment benefits such as, but not limited to, statutory or occupational sick pay, redundancy pay, maternity or adoption pay/leave, paternity pay/leave.

• Appendix Three includes details of the CCG office holder ‘agreement’ in relation to these areas.

• An office-holder does not usually receive a salary or regular remuneration for their services but are sometimes paid a fee for their services or to cover their expenses. The CCG constitution (regarding GP members) and NHS England guidance (lay members) in this area supports remuneration for CCG Governing Body Members who could be considered normally ‘office holders’ and such are remunerated based on agreed benchmarked rates.

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https://www.gov.uk/guidance/off-payroll-working-in-the-public-sector-reform-of-intermediaries-legislation

https://www.gov.uk/guidance/off-payroll-working-in-the-public-sector-reform-of-intermediaries-legislation

• ‘Office holder’ remuneration received is not normally considered to be pensionable, However, in line with guidance3 issued by NHS Pensions, where an office holder is a GP and the GP is a member of the NHS Pension scheme, all earnings are pensionable under the provisions of ‘practitioner’ pension scheme. This includes any earnings from undertaking the role of a GP on a Governing Body as an ‘office holder’.

6.3 Contract ‘of’ / ‘for’ Service A contract ‘for’ service differs to a contract ‘of’ service and has a number of distinctions with regards to the CCG’s responsibilities A contract ‘of’ service can be described as a more typical ‘employer’ to ‘employee’ agreement where the employee undertakes work as an integral part of the business. Key aspects of rights and responsibilities of status under a contract of service are

• The worker is controlled by their employer – they must perform the tasks they are instructed to by a line manager according to their job description

• The worker is expected to work at a specific place during specific hours on specific days (even flexi-time has core hours)

• The worker must present themselves for work and cannot send someone else as a substitute

• Employees have statutory rights to holiday pay, sick pay, maternity and paternity rights and redundancy payments

• Employees have statutory rights regarding how they can be asked to leave their employment A contract ‘for’ service applies where a ‘contract’ established between two parties in a ‘buyer / supplier’ basis. The creation of a contract for service does not automatically create employment rights, providing the organisation maintains the treatment of the individual engaged via a contract for service in line with the contract. The key rights, obligations and responsibilities that apply under a contract for services include:

• A requirement to supply services to the buyer according to the contract schedule’s specification

• A requirement to complete the project, and any milestones, according to the contract schedule

• A requirement to provide services to the standard required by the client as agreed in the contract

• The right to be paid the rate agreed in the contract, assuming the services have been provided according to the contract’s requirements

• The right to provide a substitute to complete the work specified in the contract • The onus on the individual to ‘make good’ any work that is not completed to a satisfactory

standard at a cost to the individual and not the organisation.

Under a Contract ‘for’ service arrangement, there is no statutory right to holiday pay, sick pay, maternity and paternity rights and redundancy payments.

3 Pension Status for CCG Earnings (05/2017) (V5)

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7. Fair pay review principles In addition to reflecting the guidance documents provided by NHS England this framework is based on the following key principles, which are informed by and consistent with the principles set out in the Hutton Fair Pay Review:

• Remuneration should fairly reward each individual’s contribution to their organisation’s success and should be sufficient to recruit, retain and motivate individuals of sufficient calibre. However, organisations should be mindful of the need to avoid paying more than is necessary in order to ensure value for money in the use of public resources;

• Remuneration must be set through a process that is based on a consistent framework and independent decision-making based on accurate assessments of the weight of roles and individuals’ performance in them;

• Remuneration should be determined through a fair and transparent process via bodies that are independent of those whose pay is being set, and who are qualified or experienced in the field of remuneration. No individual should be involved in deciding his or her own pay;

• Remuneration must be based on the principle of equal pay for work of equal value. 8. Approach to remuneration This section outlines the CCG’s approach to the remuneration, the associated terms of engagement and/or terms and conditions of employment for each specific role. A full summary of the agreed approaches can be found at Appendix 1 reflecting the principles as described above. 8.1 Elected GPs on the CCG Governing Body 8.1.1 Role Outline

As well as sharing responsibility with the other members for all aspects of the CCG governing body business, the individuals acting on behalf of member practices will bring the unique understanding of those member practices to the discussion and decision making of the governing body as their particular contribution.

8.1.2 Specific attributes and competencies

• have the confidence of the member practices in the CCG, demonstrating an understanding of all of the member practices, of the issues they face and what is important to them; be competent, confident and willing to give an unbiased strategic clinical view on all aspects of CCG business;

• be highly regarded as a clinical leader, beyond the boundaries of a single practice or profession – demonstrably able to think beyond their own professional viewpoint; have an in-depth understanding of a specific locality(ies) if the CCG has decided to operate in this way;

• be able to take a balanced view of the clinical and management agenda and draw on their specialist skills to add value; and

• be able to contribute a generic view from the perspective of a member practice in the CCG, whilst putting aside specific issues relating to their own practice circumstances.

8.1.3 Remuneration rate The CCG has agreed a total sessional cost rate of £300.00, the rate is

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inclusive of:

• Employee national insurance contributions, and employee pension (GP SOLO) contributions as applicable.

but exclusive of:

• Employer national insurance contributions and employer pension (GP SOLO) contributions as applicable.

Employee contributions for taxation, national insurance and pension requirements will be adjusted at source through normal payroll mechanisms. 8.1.4 Time Commitment The basis for time commitment is

• Variable depending on the level of contribution required for clinical input and governance To ensure consistency, all elected Governing Body Members clinical will be asked to ensure diaries are up to date and sessional logs completed to provide supporting evidence for financial probity purposes.

8.1.5 Contractual status With regards to the application of this to the CCG remuneration framework,

• the NHS Group Accounting Manual provides guidance that “HMRC typically deem services provided directly to fulfil the role of Governing Body Member as being those of an “office holder”. For payments relating to these services, the “office holder” should typically be treated as an employee, with deduction at source through the payroll for taxation and national insurance payments”4

In line with the HMRC guidance and recognising the responsibilities of assurance and oversight associated with these roles the CCG therefore considers that GPs serving on the CCG’s Governing Body are to be appointed as ‘office holders’. The CCG’s Constitution states that the GP Representative’s term of office is for three years, and may stand for re-election so long as they continue to fulfil the eligibility criteria. The notice period for both parties is three months. 8.1.6 Mechanism for payment In order to ensure that the CCG meets its obligations in respect of HMRC / Pensions requirements and that there are no inconsistencies of approach, all elected GPs are expected to be paid via the CCG’s payroll provider with the appropriate tax, national insurance and pension (GP SOLO) deductions made as applicable at source

4https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/602449/FRAB_128__09__-_Health_Manual_-_Annex_C.PDF

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The resulting ‘net’ payment can be made either to an individual or to their nominated practice but in both circumstances must be made via the CCG’s payroll following adjustment for these deductions. 8.1.7 Pension (GP SOLO) In line with guidance5 issued by NHS Pensions, where a GP is a member of the NHS Pension scheme, all earnings are pensionable under the provisions of ‘practitioner’ pension scheme. This includes any earnings from undertaking the role of a GP on a Governing Body as an ‘office holder’. In line with the ‘practitioner’ pension scheme rules any pension deductions are to be made using the GP SOLO methodology with individual GPs being responsible for providing all necessary required information to the CCG o(for example tiered global earnings and AVCs as and when required) to enable the correct calculation of pensionable pay and required GP SOLO contributions. For 2018/19 rates, please refer to Appendix 2. The CCG is responsible for a number of aspects as per below:

• making the necessary pension contribution payments to the pension’s agency on a monthly basis before the 19th of the following month. These payments are currently performed manually following the deductions being made at source.

• responsible for providing GP SOLO forms on an annual basis to GP members who are in the pension scheme, for submission in line with deadlines.

It is the individual’s responsibility to inform the CCG of their individual pension arrangements and whether they are a member of the practitioner scheme. The Pensions Agency will not inform the CCG of any changes therefore it is imperative that the GP keeps the CCG up to date with any changes to their personal circumstances. 8.1.8 Annual Leave, sickness and ‘allowable’ absence

As an office holder rather than an employee, elected GP Governing Body members would not normally receive an annual leave allowance or entitlement to statutory sickness, maternity pay as described above.

However, the CCG recognises that members may not be available at all times due to other personal and professional commitments and as such the CCG’s policy would be to continue to provide remuneration providing they meet above 90% of agreed time commitments.

The table below provides an indication of time commitments in relation to the number of sessions required to attend for full remuneration, and equivalent sessions of ‘allowable absence’ for other personal and professional commitments.

5 Pension Status for CCG Earnings (05/2017) (V5)

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Weekly Commitment Annual Equivalent

Required Time Commitment (@90%)

Allowable absence

1 Session per week 52 sessions 46 Sessions 6 sessions

2 Sessions per week (1 day) 104 sessions 93 Sessions 11 sessions

3 Sessions per week 156 sessions 140 Sessions 16 sessions

4 Sessions per week (2 days) 208 sessions 187 Sessions 21 sessions


Elected GP members shall be expected to comply with the CCG’s normal reporting procedures for scheduled meetings (in order to assess and manage quoracy issues as applicable), and also ensure that the CCG’s Chair is aware of any absences from scheduled meetings etc.

For the avoidance of doubt whilst the CCG may continue to provide remuneration to the individual, providing the necessary time commitment is met, a payment during times of absence does not constitute a payment for annual leave or sickness.

8.1.9 Travel expenses Expenses should be requested in line with the CCG’s travel expenses policy and payroll timetable (which are based on the agreed NHS ‘agenda for change’ rates in each financial year). Individuals are not entitled to receive payment of ‘home to office’ expenses 8.2 Lay Chair of the Governing Body 8.2.1 Role Outline As well as sharing responsibility with the other members for all aspects of the CCG governing body business, the Chair of the governing body will have specific responsibility for:

• The Lay Chair will be responsible for providing probity, support and leadership to the Governing Body, other Lay Members and the Clinical Accountable Officer, supporting the Clinical Accountable Officer in discharging the responsibilities of the organisation.

• To ensure that the CCG is an effective outcome focused Clinical Commissioning Group that commissions the best health care within the resources available through the redesign and implementation of innovative new care pathways.

• To provide leadership in the development of strategy. Contributing to building a shared vision of the aims, values and culture of the organisation.

• Leading the Governing Body, ensuring it remains continuously able to discharge its duties and responsibilities as set out in the Constitution. To ensure the provision of accurate, timely and clear information to the Governing Body and the senior management team to meet statutory requirements.

• Ensuring the building and development of the Group’s Governing Body and its individual members.

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• Ensuring the group has proper constitutional and governance arrangements in place. Overseeing governance and particularly ensuring that the Governing Body and wider group acts with the utmost transparency and responsiveness at all times.

• Ensuring that the group builds and maintains effective relationships, particularly with the Health & Wellbeing Board, the Local Authority and Key Partners.

• Plan and conduct Governing Body meetings with the Clinical Accountable Officer. Facilitate the effective contribution of Lay members, GPs and other members.

• Arrange the regular evaluation of the performance of the Governing Body, its committees, individual Lay members, GP members and Clinical Accountable Officer.

The Chair will also have a key role in overseeing governance and particularly ensuring that the governing body and the wider CCG behaves with the utmost transparency and responsiveness at all times. They will ensure that:

• public and patients‘ views are heard and their expectations understood and, where appropriate, met;

• that the organisation is able to account to its local patients, stakeholders and the NHS Commissioning Board; and

• the CCG builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the relevant local authority.

8.2.2 Remuneration rate The CCG has agreed an annual salary of £30,000 for 16 hours (4 sessions) per week; Employee contributions for taxation, national insurance and pension requirements will be adjusted at source through normal payroll mechanisms.

8.2.3 Time Commitment

The basis for time commitment is

• 4 sessions per week (16 hours)

8.2.4 Contractual status The CCG is responsible for the recruitment and selection process for the appointment of the Chair of the Governing Body. NHS England will play a significant role in the appointment process. The Governing Body will approve the process on the recommendation of the Remuneration Committee, including appropriate advertising, assessment centre and panel membership. For the Chair appointment the panel membership shall include representation from Members Council and Governing Body GPs. The Lay Chair is issued a contract of employment. The CCG’s Constitution states that the Chair’s term of office is for 3 years, but may stand for re-appointment after the initial term of office, providing the can still fulfil the eligibility criteria subject to serving a maximum term of office of 9 years. The notice period for both parties is 3 months.

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8.2.5 Mechanism for payment The Lay Chair is paid via the CCG’s payroll provider with the appropriate tax, national insurance and pension deductions made as applicable at source

8.2.6 Pension

The role is pensionable under the ‘Officer’ pension scheme and as such deductions will be taken at source via the ESR payroll system. Eligible employees will be auto enrolled into the NHS pension scheme, or the NEST pension scheme if they are not eligible for the NHS pension scheme, and will have to opt out if they do not wish to contribute. Further information about the NHS Pension Scheme and the current contribution rates can be found at https://www.nhsbsa.nhs.uk/member-hub. 8.2.7 Annual Leave, sickness

Annual leave and sickness is in accordance with NHS Terms and Conditions of Employment.

8.2.8 Travel expenses Expenses should be requested in line with the CCG’s travel expenses policy and payroll timetable (which are based on the agreed NHS ‘agenda for change’ rates in each financial year) Individuals are not entitled to receive payment of ‘home to office’ expenses 8.3 Deputy Chair/Deputy Clinical Lead 8.3.1 Role Outline The Deputy Chair / Deputy Clinical Lead is a leadership role within the CCG and will support the Chair and Clinical Chief Executive in leading the organisation. The Deputy Chair/Deputy Clinical Lead must ensure high standards of probity and governance prevail and that the CCG remains within its terms of authorisation. The St Helens CCG Deputy Chair/Deputy Clinical Lead will deputise for the Chair at the Governing Body, various committees and act as an external ambassador for the CCG at required times. The Deputy Chair / Clinical Lead will work alongside the Clinical Chief Executive and will provide vision, drive and clinical leadership to move forward the CCG’s Strategic Commissioning Strategy. The Deputy Chair / Deputy Clinical Lead will:

• Chair the CCG’s GP Members Council • Be responsible for planning the CCG General Practice Protected Learning Time sessions

(PLT) and their integration with CCG work plans and priorities • Chair a major Contract Committee for the CCG • Lead a major clinical area for the CCG

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https://www.nhsbsa.nhs.uk/member-hub

8.3.2 Remuneration rate The CCG has agreed a total sessional cost rate of £325.00, the rate is: inclusive of:

• Employee national insurance contributions, and employee pension contributions as applicable.

but exclusive of:

• Employer national insurance contributions and employer pension contributions as applicable. Employee contributions for taxation, national insurance and pension requirements will be adjusted at source through normal payroll mechanisms.

8.3.3 Time Commitment The basis for time commitment is

• Two leadership sessions per week (1 day) in addition to Governing Body role with regards to the ‘governance’ aspect of the role (in each of the 52.143 weeks of the financial year).

• Two sessions are allocated for clinical leadership as required by the CCG – total contractual 4 sessions

8.3.4 Contractual status The CCG is responsible for the selection process for the appointment of the Deputy Chair/Deputy Clinical Lead of the Governing Body. The Governing Body will approve the process on the recommendation of the Remuneration Committee, including appropriate advertising and assessment. The CCG’s Constitution states the Deputy Chair is eligible for reappointment subject to the agreement of the Members Council, serving a maximum term of office of 9 years. If deemed appropriate. The Deputy Chair/Deputy Clinical Chair is issued a contract of employment. 8.3.5 Mechanism for payment The Deputy Chair/Deputy Clinical Lead is paid via the CCG’s payroll provider with the appropriate tax, national insurance and pension deductions made as applicable at source

8.3.6 Pension

The role is pensionable under the ‘Officer’ pension scheme and as such deductions will be taken at source via the ESR payroll system. Eligible employees will be auto enrolled into the NHS pension scheme, or the NEST pension scheme if they are not eligible for the NHS pension scheme and will have to opt out if they do not wish to contribute.

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Further information about the NHS Pension Scheme and the current contribution rates can be found at https://www.nhsbsa.nhs.uk/member-hub. 8.3.7 Annual Leave, sickness

Annual leave and sickness is in accordance with NHS Terms and Conditions of Employment.

8.3.8 Travel expenses Expenses should be requested in line with the CCG’s travel expenses policy and payroll timetable (which are based on the agreed NHS ‘agenda for change’ rates in each financial year) Individuals are not entitled to receive payment of ‘home to office’ expenses 8.4 Lay members on the Governing Body 8.4.1 Remuneration rate The CCG’s constitution determines it is required to have three lay members on the Governing Body to support the CCG in obtaining the necessary levels of assurance. Lay member remuneration is based on an agreed remuneration of £15,000 per annum (4 days per month) Lay member’s time commitments are based on an equivalent of 30 hours per month (£312.50 per day)

8.4.2 Time Commitment

To ensure consistency, all Governing Body Members will be asked to ensure diaries are up to date.

8.4.3 Contractual status Recognising the statutory nature of these roles the CCG considers that Lay Members serving on the CCG’s Governing Body are to be appointed as ‘office holders’ thus mirroring the arrangements6 for non-executive directors in the NHS who hold a ‘statutory’ office in line with the Health and Social Care Act (2012). The CCG’s constitution states that the Lay Members term of office is for 3 years, but may be re-appointed up to a maximum term of office of 9 years. The notice period for both parties is 3 months. 8.4.4 Mechanism for payment In order to ensure that the CCG meets its obligations in respect of HMRC requirements and that there are no inconsistencies of approach, all lay members are expected to be paid via the CCG’s

6 NHS Improvement Terms and Conditions for Trust Chairs and Non-Executive Directors

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https://www.nhsbsa.nhs.uk/member-hub

payroll provider with the appropriate tax, national insurance deductions made as applicable at source. 8.4.5 Pension As an office holder any earnings under this arrangement are considered to be non-pensionable and therefore individuals are not able to enrol in the NHS Pension (or any alternative pension scheme) for this appointment. 8.4.6 Annual Leave, sickness and ‘allowable’ leave

As an office holder rather than an employee, Lay Members would not normally receive an annual leave allowance or entitlement to statutory sickness, maternity pay as described above.


The table below provides an indication of time commitments in relation to the number of sessions required to attend for full remuneration, and equivalent sessions of ‘allowable absence’ for other personal and professional commitments (to include periods of sickness)

Weekly Commitment Annual Equivalent Required Time Commitment (@90%)

Allowable absence

4 Sessions per month 48 sessions 43 Sessions 5 sessions


Lay members shall be expected to comply with the CCG’s normal reporting procedures for scheduled meetings (in order to assess and manage quoracy issues as applicable), and also ensure that the Chair is aware of any absences from scheduled meetings etc.


In exceptional circumstances, sickness issues may be considered by the CCG in line with existing policies and procedures.

8.4.7 Travel expenses Travel expenses incurred by the individual on CCG business are reflective of arrangements for non-executive directors in NHS trusts which mirror the rates set under Agenda for Change and will be amended automatically as and when the rates under Agenda for Change are amended.

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8.5 Secondary care doctor on the Governing Body 8.5.1 Role Outline Each CCG is required to have a ‘secondary care’ doctor as part of its Governing Body membership. As well as sharing responsibility with the other members for all aspects of the CCG Governing Body business, this clinical member will bring a broader view, on health and care issues to underpin the work of the CCG. In particular, they will bring to the Governing Body an understanding of patient care in the secondary care setting. 8.5.2 Specific attributes and competencies

• be a doctor who is, or has been, a secondary care specialist, who has a high level of understanding of how care is delivered in a secondary care setting;

• be competent, confident and willing to give an independent strategic clinical view on all aspects of CCG business;

• be highly regarded as a clinical leader, preferably with experience working as a leader across more than one clinical discipline and/or specialty with a track record of collaborative working;

• be able to take a balanced view of the clinical and management agenda, and draw on their in depth understanding of secondary care to add value;

• be able to contribute a generic view from the perspective of a secondary care doctor whilst putting aside specific issues relating to their own clinical practice or their employing organisation’s circumstances; and

• be able to provide an understanding of how secondary care providers work within the health system to bring appropriate insight to discussions regarding service redesign, clinical pathways and system reform.

8.5.3 Further points Whilst the individual may well no longer practise medicine, they will need to demonstrate that they still have a relevant understanding of care in the secondary setting. The secondary care specialist cannot be an employee or member (including shareholder) of, or a partner in, a provider of primary medical services, or a provider with whom the CCG has made commissioning arrangements. The exceptions are where the CCG has made an arrangement with a provider, subsequent to a patient exercising choice, and where the CCG has made an arrangement with a provider in special circumstances to meet the specific needs of a patient (for example, where there is a very limited choice of provider for a highly specialised service). 8.5.4 Remuneration rate NHS England guidance recommends that remuneration should be paid either:

• at a rate commensurate with their salary or as needed for replacement costs; or • at a rate commensurate with the average rate for their profession and level of seniority.

It is recognised given the specialised nature and experience/qualifications necessary to undertake this role the CCG may choose to ‘second’ an individual from a Trust to undertake this role and provide a fee to the Trust to ‘backfill’ the time afforded to the CCG. Where this arrangement is

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deemed suitable it is recommended that additional advice is sought from Human Resources prior to confirming any arrangements. 8.5.5 Time Commitment The basis for time commitment is approximately 2 sessions per month in each financial year To ensure consistency, all Governing Body Members will be asked to ensure diaries are up to date.

8.5.6 Contractual status The CCG considers that the secondary care doctor serving on the CCG’s Governing Body is to be appointed as an ‘office holder’. 8.5.7 Mechanism for payment Depending upon the circumstances of the individual candidate when meeting the role competencies (e.g. whether currently employed or in previous employment) this will adjust the mechanism for payment. In circumstances where a secondment arrangement is agreed the employing Trust will continue to pay the individual and a recharge arrangement will be agreed with the CCG to pay any fees incurred whilst undertaking CCG business. If the candidate is outside of existing employment (but is able to demonstrate the relevant competencies for the role) then the CCG will make arrangement for the post holder to be paid via the CCG’s payroll with the appropriate tax and national insurance deductions made at source to ensure that the CCG meets its obligations in respect of HMRC. 8.5.8 Pension As an office holder any earnings under this arrangement are considered to be non-pensionable, but in circumstances where a secondment arrangement is agreed the fees incurred by CCG will reflect charges made by the host employer. 8.5.9 Annual Leave, sickness and ‘allowable’ absence

As an office holder rather than an employee, the secondary care doctor would not normally receive an annual leave allowance or entitlement to statutory sickness, maternity pay as described above.



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Allowable absence


The Secondary care doctor will be expected to comply with the CCG’s normal reporting procedures for scheduled meetings (in order to assess and manage quoracy issues as applicable), and also ensure that the Chair is aware of any absences from scheduled meetings etc.


8.5.10 Travel expenses Travel expenses incurred by the individual on CCG business are reflective of arrangements for non-executive directors in NHS trusts which mirror the rates set under Agenda for Change and will be amended automatically as and when the rates under Agenda for Change are amended. 8.6 Registered nurse on the Governing Body 8.6.1 Role Outline Each CCG is required to have a registered nurse as part of its Governing Body membership. As well as sharing responsibility with the other members for all aspects of the CCG Governing Body business, as a registered nurse on the Governing Body, this person will bring a broader view, from their perspective as a registered nurse, on health and care issues to underpin the work of the CCG especially the contribution of nursing to patient care. 8.6.2 Specific attributes and competencies

• be a registered nurse who has developed a high level of professional expertise and knowledge;

• be competent, confident and willing to give an independent strategic clinical view on all aspects of CCG business;

• be highly regarded as a clinical leader, probably across more than one clinical discipline and/or specialty – demonstrably able to think beyond their own professional viewpoint;

• be able to take a balanced view of the clinical and management agenda and draw on their specialist skills to add value;

• be able to contribute a generic view from the perspective of a registered nurse whilst putting aside specific issues relating to their own clinical practice or employing organisation‘s circumstances; and

• be able to bring detailed insights from nursing and perspectives into discussions regarding service re-design, clinical pathways and system reform.

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8.6.3 Further points The nurse cannot be an employee or member (including shareholder) of, or a partner in, a provider of primary medical services, or a provider with whom the CCG has made commissioning arrangements. The exceptions are where the CCG has made an arrangement with a provider, subsequent to a patient exercising choice, and where the CCG has made an arrangement with a provider in special circumstances to meet the specific needs of a patient (for example, where there is a very limited choice of provider for a highly specialised service). This is especially in relation to this particular role and does not preclude practice nurses from being members of the Governing Body in other capacities. 8.6.4 Remuneration rate NHS England guidance recommends that remuneration should be paid either:

• at a rate commensurate with their salary or as needed for replacement costs; or • at a rate commensurate with the average rate for their profession and level of seniority.

It is recognised that the CCG may choose to ‘backfill’ an individual from a General Practice to undertake this role and provide a fee to reimburse time afforded to the CCG. Where this arrangement is deemed suitable it is recommended that additional advice is sought from Human Resources prior to confirming any arrangements. 8.6.5 Time Commitment The basis for time commitment is approximately two sessions per month in each financial year To ensure consistency, all Governing Body Members will be asked to ensure diaries are up to date and sessional logs completed to provide supporting evidence for financial probity purposes.

8.6.6 Contractual status The CCG considers that the registered nurse serving on the CCG’s Governing Body is to be appointed as an ‘office holder’. 8.6.7 Mechanism for payment Depending upon the circumstances of the individual candidate when meeting the role competencies (e.g. whether currently employed or in previous employment) this will adjust the mechanism for payment. In circumstances where a backfill arrangement is agreed the employing General Practice will continue to pay the individual and a recharge arrangement will be agreed with the CCG to pay any fees incurred whilst undertaking CCG business. If the candidate is outside of existing employment (but is able to demonstrate the relevant competencies for the role) then the CCG will make arrangement for the post holder to be paid via the CCG’s payroll with the appropriate tax and national insurance deductions made at source to ensure that the CCG meets its obligations in respect of HMRC.

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8.6.8 Pension As an office holder any earnings under this arrangement are considered to be non-pensionable. 8.6.9 Annual leave, sickness and ‘allowable’ leave

As an office holder rather than an employee, the ‘registered nurse’ would not normally receive an annual leave allowance or entitlement to statutory sickness, maternity pay as described above.

However, the CCG recognises that the registered nurse may not be available at all times due to other personal and professional commitments and as such the CCG’s policy would be to continue to provide remuneration providing they meet above 90% of agreed time commitments.



Allowable absence


The registered nurse will be expected to comply with the CCG’s normal reporting procedures for scheduled meetings (in order to assess and manage quoracy issues as applicable), and also ensure that the Chair is aware of any absences from scheduled meetings etc.


8.6.10 Travel expenses Travel expenses incurred by the individual on CCG business are reflective of arrangements for non-executive directors in NHS trusts which mirror the rates set under Agenda for Change and will be amended automatically as and when the rates under Agenda for Change are amended. 8.7 Clinical Leads 8.7.1 Role Outline GP Clinical Leads play a key role in the successful implementation of CCG commissioning plans, providing clinical advice and leadership to support required changes across a variety of work programmes. These roles involve collaborative working with colleagues across the health care system, focused on whole pathways of care to facilitate required changes in practice.

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CCG clinical lead roles can vary dependent upon relevant organisational need (and required delivery of operational plans) and often varying sessional commitments and ‘contractual’ durations, dependent upon the requirements of the work programme. It is anticipated that there will be a need for a number different arrangements with regards to clinical leads requirements, with a mixture of contract ‘of’ and ‘for’ agreements, dependent upon organisational needs and characteristics of the each clinical advisory roles. Some examples are provided in the table below with regards to these arrangements and the relationship to the definitions of contract ‘of’ and ‘for’ services Characteristic Contract ‘of’ Contract ‘for’ Role Nature Ongoing Support Pathway / Project Based No of Sessions ‘all year round’ ‘time limited’ Substitution Allowable No In some circumstances Relationship with Individual Individual or GP Practice Payment Mechanism CCG Payroll CCG Payroll but can be paid to

the GP Practice bank account Role Examples Named Safeguarding GP Leads Demand Management /

Neighbourhood Leads Ongoing Clinical Advice (IFR / Macmillan / MCAS)

Clinical Advisors (e.g. Cancer / Mental Health)

8.7.2 Remuneration rate NHS England guidance recommends that remuneration should be paid either:

• at a reasonable rate, in line with practice earnings; • at a rate commensurate with allowing backfill; • in line with any local sessional rate as approved.

The CCG has an agreed sessional rate of £300 per session for non-governing body clinical roles and for the avoidance of doubt is inclusive of: inclusive of:

• Employee national insurance contributions and employee pension (GP SOLO) contributions as applicable.

but exclusive of:


Employee contributions for taxation, national insurance and pension requirements will be adjusted at source through normal payroll mechanisms. If payment is made via the CCG payroll system but paid directly to the host GP Practice, then assuming the GP is eligible for the NHS Pension scheme an additional 14.38% will be added on to the payment to reflect the employers Pension contribution rate. No pension will be deducted at source and it will be the responsibility of the host GP Practice to ensure the pension deductions are made and paid on to the NHS Pensions Agency accordingly.

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8.7.3 Time Commitment All clinical lead sessions will vary number of sessions per week dependent upon organisational need. 8.7.4 Contract ‘Of’ Service Roles The basis for time commitment is 52.143 weeks in each financial year Postholders will be asked to ensure diaries are up to date in order to provide supporting evidence for financial probity purposes.

8.7.5 Contract ‘for’ Service Roles The basis for time commitment will be agreed between the CCG and the host practice, but is anticipated to be for a fixed / time limited period of time. To ensure consistency, all Clinical Leads will be asked to ensure sessional logs completed and submitted to the CCG to provide supporting evidence for financial probity purposes.

8.7.6 Contractual status As per definitions above regarding contract status (relating to ‘of’ or ‘for’ status), CCG clinical lead engagements will either be considered to be on a ‘contract of’ or ‘contract for’ service basis due to nature of support to the organisation, A Contract ‘Of’ Service agreement will result a relationship between the CCG and an individual clinical lead with result being the individual being placed upon the CCG payroll. The Contract ‘for’ Service will be between the CCG and the ‘host’ general practice with regards to requirements for services provided. The general practice will then arrange for relevant services / support to be provided from within the practice establishment and would usually be on a named basis as approved by the CCG. This principle enables a ‘substitution’ principle to apply should any individual not be available to provide the required, the general practice can either reallocate to another individual (again with CCG approval) or the CCG can alternatively arrange another ‘contract for service’ with another practice in order to fulfil its requirements. 8.7.7 Mechanism for payment - contract ‘of’ service In order to ensure that the CCG meets its obligations in respect of HMRC requirements and that there are no inconsistencies of approach, all clinical leads with a contract ‘of’ service are expected to be paid via the CCG’s payroll provider with the appropriate tax, national insurance and pensions deductions made as applicable at source. 8.7.8 Mechanism for payment - contract ‘for’ services All contract ‘for’ service ‘clinical lead’ payments are to be paid via the CCG’s payroll provider with the appropriate tax and national insurance deductions made as applicable at source. In terms of pension contributions, if the payments are to be made to the individual GP directly, and they are eligible, then pension will also be deducted at source via the GP SOLO process. If the payment is

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to be made to the host GP Practice then no pension will be deducted at source and an additional 14.38% will be added on to the payment for the employer pension contribution. It will be the responsibility of the host GP Practice to manage the appropriate deductions and payovers in line with the NHS Pension Agency guidelines. Any staff engaged to undertake clinical lead duties must have an ‘employment’ basis with a practice within the CCG’s boundary that will accept payment from the CCG for services to be provided if applicable. Occasionally, the CCG may require input from other clinicians from outside of the CCG’s boundary, for example the CCG sometimes uses the services of an ‘Out of Area’ GP Advisor (who clearly cannot be ‘employed’ via a GP Practice within the CCG boundary). These cases will be considered on an individual basis but all other aspects will remain consistent with other elements of this remuneration framework including consistent application the rate of remuneration for non-governing body roles (unless defined separately within this document) Payment will be made via the monthly Local Enhanced Service payment mechanism on a monthly basis. This process will then allow the relevant practice to pay for locum staff to back fill positions as and when required. The practice is therefore responsible for administering any necessary pension arrangements. 8.7.9 Annual leave, sickness and ‘allowable’ leave - contract ‘of’ service roles

‘Clinical Leads’ who are engaged through Contract ‘of’ Service basis, would receive an equivalent annual leave allowance and entitlement to statutory sickness, maternity pay in line with statutory requirements.

With regards to annual leave, based on an allowance of 5.6 weeks’ holiday per annum full time including bank holidays (equivalent of 28 days at 2 sessions per day equally 56 sessions), annual leave allowance is as per the below table (rounded)

1 Session per week 6 sessions (3 days)

2 Sessions per week (1 day) 11 sessions (5.5 days)

3 Sessions per week 17 sessions (8.5 days)

4 Sessions per week (2 days) 22 sessions (11 days)

5 Sessions per week 28 sessions (14 days)

Clinical Leads would be expected to comply with the CCG’s normal leave reporting procedures in place, and also ensure that the CCG is aware of any absences from scheduled meetings etc.

Contract Leads under a contract ‘of’ service would also have statutory rights to sick pay, maternity and paternity rights.

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8.7.10 Annual leave, sickness and ‘allowable’ leave - contract ‘for’ service roles

As ‘Clinical Leads’ who are engaged through ‘host’ GP Practices on a ‘Contract for Service’ basis, they would not receive an annual leave allowance or entitlement to statutory sickness, maternity pay as described above.



Weekly Commitment Annual Equivalent (based on 46 week per annum)

Required Time Commitment (@90%)

Allowable absence

1 Session per week 46 sessions 41 Sessions 5 sessions

2 Sessions per week (1 day) 92 sessions 83 Sessions 9 sessions


4 Sessions per week (2 days) 184 sessions 166 Sessions 18 sessions



8.7.11 Travel expenses Travel expenses for employed clinical leads are reimbursed in line with the nationally agreed mileage and travel rates for agenda for change staff. For the avoidance of doubt no home to office mileage shall be payable. Expenses should be requested in line with the CCG’s travel expenses policy and payroll timetable. 8.8 Named Safeguarding GPs Specific Guidance is provided below with regards to the Named Safeguarding GP roles as required by CCG’s. The guidance relates to contract ‘of’ service with specific application as per relevant sections below.

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St Helens CCG does not employ the named GP for Safeguarding on a contract ‘of’ service and incorporates these duties in the Governing Body GP role on a ‘contract ‘for’ service ‘office holder’ status. 8.8.1 National Guidance NHS England’s ‘Safeguarding Vulnerable People in the NHS – Accountability and Assurance Framework’ sets out the expectations of CCGs in this area. In this guidance it sets out that CCGs are responsible for securing the expertise of Designated Professionals on behalf of the local health system and are required to demonstrate that they have appropriate systems in place for discharging their statutory duties in terms of safeguarding. As CCGs are responsible for securing the expertise of Designated Professionals on behalf of the local health system, it is therefore expected that many Designated Professionals will be employed by CCGs but as noted above St Helens CCG does not employee the GP’s. 8.8.2 Named GPs Named GPs/Named Professionals have a key role in promoting good professional practice, providing advice and expertise for fellow professionals, and ensuring appropriate safeguarding training is in place. Broadly the role of the Named GP/Named Professional includes:

• Providing specific expertise on relevant issues; • Providing supervision, expert advice and support to GPs and other primary care staff; • Offering advice on local arrangements with provider organisations for safeguarding issues; • Promoting, influencing and developing relevant training for GPs and their teams; and • Providing input as a skilled professional to safeguarding processes, in line with the

procedures of Local Safeguarding Boards. From a statutory perspective, whilst the Named GP role only covers safeguarding of children and young people, it is recommended that CCG’s consider commissioning a cluster model of named safeguarding clinicians with a range of expertise. 8.8.3 Contractual status As per definitions above regarding contract status (relating to ‘of’ or ‘for’ status), Safeguarding GPs are considered to be on a ‘contract of’ service basis due to nature of support to the organisation, and the lack of ‘substitution’ principle that applies to these arrangements and in effect will normally be employee’s of the CCG however this is not the case for St Helens CCG. 8.8.4 Remuneration rate The CCG has agreed an equivalent sessional rate of the GP Governing Body of £300 inclusive of:

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• Employee national insurance contributions, and employee pension (GP SOLO) contributions as applicable.

but exclusive of:


Employee contributions for taxation, national insurance and pension requirements will be adjusted at source through normal payroll mechanisms.

8.8.5 Pension This would be the same as the GP Governing Body Member detailed at section 8.1.7. 9. Equal opportunities In applying this policy, the CCG will have due regard for the need to eliminate unlawful discrimination, promote equality of opportunity, and provide for good relations between people of diverse groups, in particular on the grounds of the following characteristics protected by the Equality Act (2010); age, disability, gender, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, and sexual orientation, in addition to offending background, trade union membership, or any other personal characteristic. 10. Framework Review This policy will be reviewed every twelve months unless an earlier review is required. This will be led by the CCG’s Remuneration Committee in conjunction with expert professional human resource and finance advice. 11. Associated documents

• Clinical Commissioning Groups: Remuneration guidance for Chief Officers (where the senior manager also undertakes the accountable offer role) and Chief Finance Officers.

• Clinical Commissioning Groups: HR Frequently Asked Questions (FAQs) Additional questions June 2012.

• Clinical commissioning group Governing Body members: Role outlines, attributes and skills (October 2012).

• Pension Status for CCG Earnings (05/2017) (V5). • NHS Improvement: Terms and Conditions for NHS Trust Chairs and Non-Executive

Directors.

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https://www.england.nhs.uk/wp-content/uploads/2012/03/Remuneration-guidance-final.pdf

https://www.england.nhs.uk/wp-content/uploads/2012/03/Remuneration-guidance-final.pdf

https://www.england.nhs.uk/wp-content/uploads/2012/03/Remuneration-FAQs-Final.pdf

https://www.england.nhs.uk/wp-content/uploads/2012/03/Remuneration-FAQs-Final.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/09/ccg-members-roles.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/09/ccg-members-roles.pdf

https://www.nhsbsa.nhs.uk/sites/default/files/2017-04/Pension%20Status%20for%20CCG%20Earnings%20Factsheet%20%28V4%29%2004.2016.pdf

https://improvement.nhs.uk/resources/terms-and-conditions-nhs-trust-chairs-and-non-executive-directors/

https://improvement.nhs.uk/resources/terms-and-conditions-nhs-trust-chairs-and-non-executive-directors/

12. Appendix 1 – Comparison Table Role Sessional Rate

and time commitment

Contractual status

Payment mechanism

National Insurance Employers Responsibility

Pensionable Home to office mileage

GPs on the Governing Body £300 per session (Session = 4 hours)

Office holder Payroll to individual

CCG Yes (dependent upon individual)

No

Chair of the Governing Body (GP) £30000 per annum (Session = 4 hours)

Employed/Office Holder

Payroll to individual


No

Deputy Chair/Deputy Clinical Lead

£325 per session (Session = 4 hours)

Employed/Office Holder



No

Lay Members on the Governing Body

£15000 per annum (4 days per month)

Office holder Payroll to individual

CCG No No

Secondary care doctor on the Governing Body

Equivalent Salary Office holder Payroll to individual

As applicable No No

Registered nurse on the Governing Body

Recharge from Host Employer or Equivalent Salary

Office holder Recharge from host employer or Payroll to individual

As applicable No No

Clinical Leads (for) £300 per session (Session = 4 hours)

Contract for service

Payment to individual

CCG Yes (dependent upon individual status)

No

Safeguarding GPs £300 per session (Session = 4 hours)

Contract for service


CCG Yes (dependent upon individual status)

No

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13. Appendix 2 – GP pensionable income In line with guidance found at: https://www.nhsbsa.nhs.uk/sites/default/files/2018-04/GP%20Solo%202018%20guidance-20180412-28V2%29.pdf 1995/2008 Scheme members The rate of employee (tiered) contributions must be based on the GP’s global NHS pensionable income, i.e. Practice + fee based OOHs + fee based CCG. 2015 Scheme members If the GP is a member of the 2015 Scheme the pay that is used to set the contribution tiered rate for GP (and non-GP) Providers who start after 1 April or leave before 31 March is annualised; e.g. a GP who starts at a surgery on 01/06/2018 and earns £70,000.00 up to 31/03/2019 is subject to the 13.5% rate. (£70,000.00 ÷ 304 days x 365 days = notional pay of £84,046.05). Where a GP Provider or salaried GP is a 2015 Scheme member and has no breaks in membership but also performs SOLO work, any breaks in that SOLO work are ignored for the purpose of setting the tiered rate; i.e. the rate is based on the actual surgery and SOLO income. 2018/19 Total or annualised GP pensionable

income 2018/19 contribution rate

1 Up to £15,431.99 5% 2 £15,432.00 to £21,477.99 5.6% 3 £21, 478.00 to £26,823.99 7.1% 4 £26,824.00 to £47,845.99 9.3% 5 £47,846.00 to £70,630.99 12.5% 6 £70,631.00 to £111,376.99 13.5% 7 £111,377.00 and over 14.5%

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https://www.nhsbsa.nhs.uk/sites/default/files/2018-04/GP%20Solo%202018%20guidance-20180412-28V2%29.pdf

https://www.nhsbsa.nhs.uk/sites/default/files/2018-04/GP%20Solo%202018%20guidance-20180412-28V2%29.pdf

14. Appendix 3 – GP Office Holder Agreement

CONFIDENTIAL

OFFICE HOLDER APPOINTMENT BETWEEN XXX CLINICAL COMMISSIONING GROUP (THE CCG)

AND

[NAME]

STATEMENT OF OFFICE HOLDER CONTRACT Following your election as a Governing Body Member, this contract for a term of Office confirms the arrangements for your appointment as *GP Governing Body Member/GP Director/Clinical Lead to the CCG. This contract formally confirms the terms and conditions under which your appointment has been made. These are the standard terms and conditions of the CCG for the appointment of Office Holders to the CCG. It is important that you read these carefully and contact Name, Job Title should you have any queries. Please indicate your acceptance of these terms and conditions by signing one copy and returning it to Name.

1. Appointment

1.1 Your appointment is effective from DATE and shall continue for an initial period of INSERT subject to earlier termination in accordance with Paragraph 2 of this letter.

1.2 This appointment does not create any contract of employment between you and the

CCG, and is not within the jurisdiction of the employment tribunals. Terms and conditions applicable to NHS employees do not apply to this appointment.

1.3 This appointment is governed by the terms set out in this letter, and the legislative

framework set out in the National Health Service Act 2006 (as amended from time to time) and regulations made thereunder. The appointment is also subject to the terms of the Constitution of the CCG and any Standing Orders or other rules and regulations made pursuant to the Constitution.

2. Termination of Appointment

2.1 Your appointment may be terminated by either party with 3 months’ notice with the

exception of the clauses 2.2. and 2.3

2.2 Your appointment may be terminated by the CCG forthwith upon the happening of any of the following events, where:

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2.2.1 the Governing Body of the CCG are of the view that it is no longer in the interests of the National Health Service that you continue to hold office (see paragraph 2.2);

2.2.2 you are no longer eligible to be a member of the Governing body of a

clinical commissioning group, in accordance with the Constitution, the NHS Act 2006 and the NHS (Clinical Commissioning Group) Regulations 2012 (as amended from time to time). ;

2.2.3 you have committed an act which, if you were an employee would be an

act of gross misconduct or you have committed a serious breach of these terms of appointment;

2.2.4 in the case of a request pursuant to paragraph 5.5 below:

(i) you fail to provide information in response to the request within

reasonable time, or

(ii) you provide information which is inadequate to demonstrate

either how you have complied with paragraphs 5.3 and 5.4, or why those paragraphs do not apply to you;

2.2.5 in the case of a request pursuant to paragraph 5.6 below, you fail to

provide the specified information within the specified period, or

2.2.6 the CCG receives information which demonstrates that, at any time when

paragraphs 5.3 and 5.4 apply to you, you are not complying with those paragraphs.

2.3 The following list provides examples of matters, which may indicate to the CCG that it is no longer in the interests of the National Health Service that a Member on the CCG Governing Body continues in office. The list is not intended to be exhaustive or definitive as the Governing Body will consider each case on its merits, taking account of all relevant factors:

2.3.1 if the Governing Body Member has an appraisal that is or sequence of appraisals that are unsatisfactory;

2.3.2 if the Governing Body Member no longer enjoys the confidence of the majority of the CCG and this is evidenced by a majority vote of the CCG;

2.3.3 if the Governing Body Member loses the confidence of the public or local community in a substantial way;

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2.3.4 if the Governing Body Member fails to deliver work, attend meetings or substantially comply with the roles and responsibilities as set out in Annex 1 to this letter;

2.3.5 if there is a terminal breakdown in essential relationships within the CCG, related to the Governing Body Member

2.3.6 if the Governing Body Member fails or is failing to observe and comply with the Constitution for the CCG.

2.3.7 if there is a failure to comply with the CCG’s policies notified to the Governing Body Member;

2.3.8 if the Governing Body Member commits a criminal offence;

2.3.9 In the event of the governing Body Member being on long term sick leave for a period of 6 months, the CCG reserves the right to review the contract and may take the decision to give notice due to the post holder’s inability to perform their duties due to ill health.

2.3.10 If the GP Governing Body Member is not included on the primary medical performers list held by NHS England (as well as maintaining employment as a general practitioner);

2.3.11 if the Governing Body Member fails to adhere to the CCG’s Managing

Conflicts of Interest and Gifts and Hospitality policy;

3. Roles, Responsibilities and Indemnity

3.1 Your role and responsibilities as a Governing Body Member are set out in the role description attached at Annex 1 to this letter. This also includes the skills and attributes required for the role.

3.2 As a Governing Body Member you have a responsibility to discharge the role honestly, reasonably, in good faith and without negligence.

3.3 The CCG will indemnify you against personal liability which you may incur whilst in carrying out your duties, provided that at the time of incurring the liability, you were acting honestly and in good faith.

4. Time Commitment

4.1 You will be expected to devote the time set out in Annex 2 of this letter to your role

on the CCG. Provided that (i) the time commitment is met (ii)you attend a satisfactory number of meetings (not less than 80%) and (iii) your duties are completed in a timely manner, you may organise your time in such a manner as you consider appropriate.

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4.2 The location and time of all meetings will be notified to you by the CCG and reasonable notice will be given of any variations to pre-planned dates, times or locations.

4.3 You will also be expected to devote appropriate preparation time ahead of each meeting.

5. Fees

5.1 You will be paid a fee as a Governing Body Member (office holder) at the rate of

£INSERT plus employers superannuation contribution which will be paid monthly in equal instalments after deduction of any taxes and other amounts required by law. The CCG will ensure that the appropriate Tax and National Insurance contributions are deducted at source. To ensure that the CCG can comply with HMRC requirements the payment will be administered through the PAYE systems. On termination of your appointment you shall only be entitlement to such fees as may have accrued to the date of termination.

5.2 There is no entitlement to compensation for loss of office and you will not be entitled to any pension, bonus or other benefits (e.g. paid holidays, bank holidays, sick pay etc) apart from those specifically addressed in this letter.

5.3 Where you are liable to be taxed in the UK in respect of remuneration received under this letter, you shall at all times comply with the Income Tax (Earnings and Pensions) Act 2003 (ITEPA) and all other statutes and regulations relating to income tax in respect of your remuneration.

5.4 Where you are liable to National Insurance Contributions (NICs) in respect of remuneration received under this letter, you shall at all times comply with the Social Security Contributions and Benefits Act 1992 (SSCBA) and all other statutes and regulations relating to NICs in respect of your remuneration.

5.5 The CCG may, at any time during the term of your appointment, request you to provide information which demonstrates how you have complied with paragraphs 5.3 and 5.4 above, or why those paragraphs do not apply to you.

5.6 A request under paragraph 5.5 above may specify the information which you must provide and the period within which that information must be provided.

5.7 The CCG may supply any information which it receives under paragraph 5.5 above to the Commissioners of Her Majesty’s Revenue and Customs for the purpose of the collection and management of revenue for which they are responsible.

6. Pension

6.1 As an Office Holder there is no entitlement to access to the NHS Pension Scheme as an “employee”.

6.2 Depending on the arrangement for payment of the fees and your personal circumstances, the fees may be pensionable income, If that is the case, the fees

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must be accounted for on form SOLO. For the avoidance of doubt the fees paid under paragraph 5.1 excludes any employer contribution to the pension scheme.

7. Committees, sub committees and working groups

You agree to comply with the terms of reference for the CCG and any other committees, sub committees and/or working groups of the CCG that you may be appointed to.

8. Outside Interests

8.1 It is accepted and acknowledged that you may have business interests other than those of the CCG, and that you will declare any conflict of interest that becomes apparent from time to time, and in accordance with paragraphs 8.2 and 8.3 below and the Constitution.

8.2 If you have a material interest, whether that interest is direct or indirect, in any

contract or proposed contract or other matter, and are present at a meeting of the CCG at which the contract or the other matter is the subject of consideration, you shall disclose that interest to the CCG at that meeting as soon as practicable after its commencement. You shall not take part in the consideration or discussion of the contract or other matter or vote on any question in respect of it.

8.3 Details of arrangements for the disclosure of interests are set out in the CCG Constitution

9. Public Speaking

9.1 You shall not make political speeches or engage in other political activities associated with, or in relation to, matters affecting the work or operation of the CCG.

9.2 In cases of doubt, advice from Name, Chair of the Governing Body, should be sought.

10. Confidentiality In this agreement confidential information means information not otherwise properly in the public domain which is disclosed to the office holder in their capacity as a Governing Body Member of the Clinical Commissioning Group and which falls into one of the following categories:

10.1 Patient identifiable data;

10.2 Personal information about any other person;

10.3 Commercially sensitive information including in particular

10.3.1 Information about any current procurement for services which relates to a specific bidder or was provided by them in confidence;

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10.3.2 Information the disclosure of which would materially distraught any planned procurement;

10.3.3 Information relating to matters conducted in the private session of the

governing body of the CCG and,

10.3.4 Information received expressly in confidence or marked as confidential.

10.4 The office holder may not without the consent of the governing body disclose confidential information save in the following circumstances:

10.4.1 Where required to do so by any legal or professional obligation;

10.4.2 Where the information has subsequently been lawfully published;

10.4.3 Where the matter relates to concerns about the quality or effectiveness of NHS treatment and the matter has not been satisfactorily dealt with by the clinical commissioning group.

10.5 Disclosure to the press or public should only be undertaken after internal means of trying to resolve the issues have been exhausted.

10.6 Nothing in this clause shall be taken as preventing the office holder from raising concerns about any matter relating to the NHS with the Clinical Commissioning Group, NHSE, CQC, Monitor or the provider of the services in question or any other relevant regulator . Nothing in this agreement shall prevent the office holder from using information received outside their capacity as [office holder].

11. Review Process The performance of every member of the CCG (including you) and its sub committees and/or working groups will be evaluated annually. If in the interim, there are matters which cause you concern about your role, you should discuss them with Name, Chair of the Governing Body, as soon as is appropriate.

12. Criminal Matters

You are required to declare immediately to the Chair of the Governing Body if you are ever arrested, you have any pending prosecutions or convictions (including driving offences) and/or any cautions. Failure to disclose the fact of an arrest, pending prosecution or conviction or a caution, may result in termination of your appointment by the CCG.

13. Policies and procedures

You are required to comply with the policies and procedures of the CCG that are supplied to you from time to time that are specifically for Office Holders, these will include, but not limited to Office Holders Removal and Suspension Policy.

14. Equal Opportunities

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14.1 The CCG are committed to providing equal opportunities regardless of sex, marital status, colour, race, age, religion, sexual orientation, nationality or national origins.

14.2 A copy of the CCG's Equal Opportunities Policy may be obtained from the CCG Intranet. You should be familiar with, and at all times comply, with the terms of this policy.

15. Health and Safety at Work Act You are reminded that, in accordance with the Health and Safety at Work Act 1974, you have a duty to take reasonable care to avoid injury to yourself and to others.

16. Loss of Personal Effects

The CCG will not accept liability for loss or damage to personal property on CCG premises by burglary, fire, theft or otherwise. You should make arrangements to provide your own insurance cover.

17. Removal of CCG Property

You must not remove any material or goods which belong to the CCG from its premises unless it is in the normal course of your office and the necessary authorisation has been obtained from Name, Chair of the Governing Body

If you are in agreement with the above terms and conditions please sign both copies of this statement, retain one and return the other to Name. On behalf of XXXX CCG Name Chair of the Governing Body --------------------------------------------------------------------------------------------------------------------------------

ACCEPTANCE STATEMENT

I have read and accept this office holder contract in respect of the office of the CCG Governing Body member outlined in this document and have retained a copy.

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...............................................................................................................................................

NAME POST

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Annex 1: CCG Governing Body member – Outline Role Description7 Responsibilities to include the following: Core role outline – for all CCG Governing Body members A core role outline for all CCG Governing Body members and a core set of skills competencies and attributes are described in this section. As a member of the CCG Governing Body, each individual will share responsibility as part of the team to ensure that the CCG Governing Body exercises its functions effectively, efficiently, economically, with good governance and in accordance with the terms of reference of the CCG Governing Body. Each individual is there to bring their unique perspective, informed by their expertise and experience. This will support decisions made by the CCG Governing Body as a whole and will help ensure that:

1. a new culture is developed that ensures the voice of the member practices is heard and the interests of patients and the community remain at the heart of discussions and decisions;

2. the CCG Governing Body act in the best interests with regard to the health of the local

population at all times;

3. the CCG Governing Body 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;

4. decisions are taken with regard to securing the best use of public money;

5. the CCG Governing Body, 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;

6. the CCG Governing Body is responsive to the views of local people and promotes self-care

and shared decision-making in all aspects of its business; and good governance remains central at all times.

7 Adapted from the "Governing Body Members – Roles Attributes and Skills NHS Commissioning Board Authority, April 2012"

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Core attributes and competencies Each individual needs to:

• demonstrate commitment to continuously improving outcomes, tackling health inequalities and delivering the best value for money for the taxpayer;

• embrace effective governance, accountability and stewardship of public money and

demonstrate an understanding of the principles of good scrutiny;

• demonstrate commitment to clinical commissioning, the CCG Governing Body and to the

wider interests of the health services;

• bring a sound understanding of, and a commitment to upholding, the NHS principles and

values as set out in the NHS Constitution;

• demonstrate a commitment to upholding The Nolan Principles of Public Life along with

an ability to reflect them in his/her leadership role and the culture of the CCG Governing Body;

• be committed to upholding the Standards for NHS Boards and CCG Governing Bodies in England;

• be committed to ensuring that the organisation values diversity and promotes equality

and inclusivity in all aspects of its business;

• consider social care principles and promote health and social care integration where this

is in the patients’ best interest; and

• bring to the CCG Governing Body, the following leadership qualities:

• creating the vision - effective leadership involves contributing to the creation of a

compelling vision for the future and communicating this within and across organisations;

• working with others - effective leadership requires individuals to work with others in teams and networks to commission continually improving services;

• being close to patients - this is about truly engaging and involving patients and communities;

• intellectual capacity and application - able to think conceptually in order to plan flexibly for the longer term and being continually alert to finding ways to improve;

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• demonstrating personal qualities - effective leadership requires individuals to draw upon their values, strengths and abilities to commission high standards of service; and

• leadership essence - can best be described as someone who demonstrates presence and engages people by the way they communicate, behave and interact with others.

Core understanding and skills Each individual will have:

• a general understanding of good governance and of the difference between governance and management;

• a general understanding of health and an appreciation of the broad social, political and

economic trends influencing it;

• capability to understand and analyse complex issues, drawing on the breadth of data that

needs to inform CCG deliberations and decision-making, and the wisdom to ensure that it is used ethically to balance competing priorities and make difficult decisions;

• the confidence to question information and explanations supplied by others, who may be

experts in their field;

• the ability to influence and persuade others articulating a balanced, not personal, view

and to engage in constructive debate without being adversarial or losing respect and goodwill;

• the ability to take an objective view, seeing issues from all perspectives, especially

external and user perspectives;

• the ability to recognise key influencers and the skills in engaging and involving them;

• the ability to communicate effectively, listening to others and actively sharing information;

and

• the ability to demonstrate how your skills and abilities can actively contribute to the work

of the governing body and how this will enable you to participate effectively as a team member.

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Core personal experience

• previous experience of working in a collective decision-making group such as a board or committee, or high-level awareness of ‘board-level’ working; and

• a track record in securing or supporting improvements for patients or the wider

public.

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15. Appendix 4 – Lay Member Agreement

NHS St Helens Clinical Commissioning Group (CCG) LAY MEMBER TERMS & CONDITIONS

To be used for appropriate CCG Lay Members

These are the terms and conditions under which your appointment has been made. It is important that you read these carefully and contact the CCG should you have any queries. You should notify the CCG if there is any change in your situation or connections during the period of your appointment. CORE BASIS OF GOVERNING BODY ROLE Governing body member role descriptions need to be in line with the requirements of the legislative framework and there are certain elements that are likely to be desirable for them all. A core role outline for all governing body members and a core set of skills competencies and attributes are described in this section. These are then supplemented (in the next sections), for each of the roles that will be specified in the legislation, by a set of specific attributes and competencies which may be appropriate to ensure the unique contribution of that individual member to the workings of the whole governing body. As a member of the CCG’s governing body each individual will share responsibility as part of the team to ensure that the CCG exercises its functions effectively, efficiently, economically, with good governance and in accordance with the terms of the CCG constitution as agreed by its members. Each individual is there to bring their unique perspective, informed by their expertise and experience. This will support decisions made by the governing body as a whole and will help ensure that: a new culture is developed that ensures the voice of the member practices is heard and the

interests of patients and the community remain at the heart of discussions and decisions; the governing body and the wider CCG act in the best interests with regard to the health of

the local population at all times; 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;

decisions are taken with regard to securing the best use of public money; 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;

the CCG is responsive to the views of local people and promotes self-care and shared decision-making in all aspects of its business; and

good governance remains central at all times ADDITIONAL SPECIFIC ROLE OUTLINE OF LAY MEMBERS: - 1. GOVERNANCE ROLE The role of this lay member will be to bring specific expertise and experience to the work of the governing body. Their focus will be strategic and impartial, providing an external view of the work of the CCG that is removed from the day-to-day running of the organisation. Their role will be to

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oversee key elements of governance including audit, remuneration and managing conflicts of interest. They will need to be able to chair the audit committee. As Chair of the Audit Committee, this lay member would be precluded from being the Chair of the governing body – although they could be the Deputy Chair. This person will have a lead role in ensuring that the governing body and the wider CCG behaves with the utmost probity at all times. Good practice would also suggest that this person would also have a specific role in ensuring that appropriate and effective whistle blowing and anti-fraud systems are in place. 2. PATIENT & PUBLIC INVOLVEMENT As well as sharing responsibility with the other members for all aspects of the CCG governing body business, as a lay member on the CCG’s governing body you will bring specific expertise and experience, as well as knowledge as a member of the local community, to the work of the governing body. Your focus will be strategic and impartial, providing an independent view of the work of the CCG that is external to the day-to-day running of the organisation. As one of the lay members, you may be asked to fulfil the role of Deputy Chair or Chair of the governing body, if appropriate. You will help to ensure that, in all aspects of the CCG’s business the public voice of the local population is heard and that opportunities are created and protected for patient and public empowerment in the work of the CCG. In particular, you will ensure that: public and patients’ views are heard and their expectations understood and met as

appropriate;

the CCG builds and maintains an effective relationship with Local Healthwatch and draws on existing patient and public engagement and involvement expertise; and

the CCG has appropriate arrangements in place to secure public and patient involvement

and responds in an effective and timely way to feedback and recommendations from patients, carers and the public.

3. SECONDARY CARE DOCTOR As well as sharing responsibility with the other members for all aspects of the CCG governing body business, this clinical member will bring a broader view, on health and care issues to underpin the work of the CCG. In particular, they will bring to the governing body an understanding of patient care in the secondary care setting. 4. REGISTERED NURSE As well as sharing responsibility with the other members for all aspects of the CCG governing body business, as a registered nurse on the governing body, this person will bring a broader view, from their perspective as a registered nurse, on health and care issues to underpin the work of the CCG especially the contribution of nursing to patient care.

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AGREEMENT BETWEEN NHS St Helens Clinical Commissioning Group of [address] and <<NAME>> (“the Lay Member”) of [address]. 1.0 Statutory Basis for Appointment – Lay Members on the Governing Body of CCGs hold a

statutory office under the Health & Social Care Act 2012. It does not create any contract of service or contract for services between you and the CCG.

2.0 Tenure of Appointment – The duration of the appointment is for a term of <<xxx>> years. However, the post is subject to the provisions for early termination contained at clauses 5 – 7 inclusive. It is determined by the Constitution of the CCG based on the requirements of the organisation.

3.0 Employment Law – The appointments are not within the jurisdiction of Employment Tribunals. Neither is there any entitlement for compensation for loss of office through employment law.

4.0 Reappointments – Lay members are eligible to be considered for re-appointment at the end of the term but you have no right to be reappointed. The Chair and Chief Officer of the CCG will usually consider afresh the question of who should be appointed to the Governing Body. 4.1 The challenges faced by the Governing Body can change over time and to ensure

that the Governing Body is equipped for its future role, the Chair and Chief Officer will take into account: - 4.1.1 the performance of the CCG, taking into account member practice views and

NHS England performance reports 4.1.2 the make-up of the Governing Body in terms of its skills, geographical

representation; 4.1.3 the Governing body dynamics and effectiveness of its team working.

5.0 Resignation - . You may resign at any time by giving notice in writing to the Chair of the

CCG. A three month notice period is expected. Where this is not possible, the notice period should be agreed with the Chair

6.0 Termination of appointment – The Constitution sets out the grounds on which your appointment may be terminated. The CCG may terminate your appointment if you do not properly comply with the requirements of the regulations with regard to pecuniary interests in matters under discussion at meetings of the CCG (e.g. a failure to disclose such an interest). 6.1 Furthermore, the CCG may terminate your appointment if the CCG consider that it is

no longer in the interests of the Health Service that an appointee continues in office. The following list provides examples of matters which may give an indication to the CCG that it is no longer in the interests of the health service that an appointee continues in office. The list is not intended to be exhaustive or definitive; the Governing Body will consider each case on its merits, taking account of all relevant factors.

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6.1.1 If an annual appraisal or sequence of appraisals is unsatisfactory.

6.1.2 If the appointee no longer enjoys the confidence of the board.

6.1.3 If the appointee loses the confidence of the public or local community in a substantial way.

6.1.4 If a lay member appointee fails to ensure that the Governing Body monitors

the performance of the CCG in an effective way.

6.1.5 If the appointee fails to deliver work against pre-agreed targets incorporated within their annual objectives.

6.1.6 If there is a terminal breakdown in essential relationships e.g. between

appointee and the rest of the Governing Body.

6.1.7 If the Lay Member ceases to hold the relevant qualifications or experience for which they were appointed to the role.

6.1.8 If the Lay Member is excluded or disqualified from holding post as a member

of the CCG, with the meaning of the CCG Regulations.

7.0 Suspension of Appointment – you can be suspended from performing your functions as a Lay Member while consideration is given to whether your appointment should be terminated. An initial period of suspension will not exceed 6 months although in exceptional circumstances further periods of suspension may be considered. If you are suspended you can request in writing a review of the decision.

8.0 Remuneration - As a consequence of your appointment, you are entitled to be remunerated by the CCG for so long as you continue to hold office as a Lay Member. You are entitled to receive remuneration only in relation to the period for which you hold office. There is no entitlement to compensation for loss of office. 8.1 The current remuneration is <<£XXXXXX>> per annum.

9.0 Expenses – are paid to CCG Lay Members at rates set out by the Secretary of State for Health (as per Terms and Conditions of Non Executive Directors of NHS Trusts). When claiming expenses, Lay Members are required to certify that: - 9.1 Travelling expenses were actually incurred on NHS business; and 9.2 Subsistence expenses were necessarily incurred and that the periods of absence

and details of meals taken were specified in the claim. 9.3 There is no local discretion to pay at rates other than those set out in the

“Appointments Commission Non-Executive Information Sheet 01/04. 9.4 All claims must be made through the CCG Payroll Provider 9.5 Lay Members are entitled to receive payment of “home to office” expenses.

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10.0 Tax and National Insurance - Remuneration is taxable under Schedule E, and subject to Class I National Insurance contributions. Any queries on these arrangements should be taken up with the Inspector of Taxes or the Contributions Agency respectively.

11.0 Time commitment – The time commitment is <<XXX>> days per week/per month. This may be during the working day or in the evening according to the requirements of the CCG.

12.0 Public speaking - On matters affecting the work of the CCG, lay members should not normally make political speeches or engage in other political activities.

13.0 Conflict of Interest & Declaration of Interest - CCGs are required to adopt the Codes of Conduct and Accountability, published in April 1994. The Codes require Lay Members to declare on appointment any business interests, position of authority in a charity or voluntary body in the field of health and social care, and any connection with bodies contracting for NHS services. These must be entered into a register which is available to the public.

14.0 Indemnity - The CCG is empowered to indemnify you against personal liability which you may incur in certain circumstances whilst carrying out your duties.

15.0 Constitution - This appointment will also be subject to any relevant provisions contained within the Constitution of the CCG. If there is any contradiction between the Constitution and these terms, the CCG Constitution will prevail.

SIGNED by : [insert title] On behalf of [name Clinical Commissioning Group:- DATE: SIGNED by the Lay Member: DATE:

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16. Appendix 5 – Clinical Lead Agreement

CONTRACT FOR SERVICES – CLINICAL LEAD THIS AGREEMENT is dated DATE and is made BETWEEN: NHS NAME Clinical Commissioning Group, ADDRESS ("the CCG"); and Dr NAME, ADDRESS ("the GP” or “Clinical Lead) WHEREAS the CCG wishes to benefit from the skills and abilities of the GP and the GP has agreed to provide his services to the CCG on the following terms and conditions: IT IS AGREED as follows: 1 ENGAGEMENT 1.1 The CCG shall engage the GP and the GP shall act for the CCG on the terms and conditions

set out in this Agreement. 1.2 The relationship of the GP to the CCG will be that of independent contractor and at no time

will the GP hold himself out as being an employee of the CCG. The GP shall have no right or power to contract on behalf of the CCG or bind the CCG in any way in relation to third parties unless specifically authorised to do so by the Governing Body of the CCG ("the Governing Body").

2 TERM The GP’s engagement shall commence on DATE and shall continue (subject to the terms of

this Agreement) until DATE, unless terminated by either party giving to the other not less than three months’ notice in writing.

3 DUTIES 3.1 The key duties of the GP shall be to advise the CCG on SPECIALITY. These duties shall be

carried out at the CCG’s offices or at such other location or locations as may be necessary for the proper performance of his duties.

3.2 The number of annual sessions each GP will provide will be agreed between the GP and the

Chief Executive. 3.3 The GP is free to carry out any other consultancy work with other organisations during times

not chargeable to the CCG provided that the GP will not during his engagement undertake any additional engagements which would interfere with or preclude the performance of his duties under this Agreement or which may lead to a conflict of interest between the GP and the best interests of the CCG and shall not accept any employment or engagement which is similar to or in any way competitive with any business of the CCG without the prior written consent of the Governing Body.

4 FEES AND ENTITLMENTS

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4.1 In consideration of his services, the CCG shall pay the GP a fee at the rate of £ per hour; (£ per 4 hour session) plus employer superannuation contribution. This sessional rate takes into account the SOLO form completed annually to confirm pensionable pay and payment in this regard.

4.2 The CCG shall pay the fees to the GP via payroll and tax and other statutory deductions shall be made.

4.3 The GP shall be reimbursed in full by the CCG in respect of all expenses properly and

reasonably incurred by him in connection with the performance of his duties under this Agreement, subject to the production of such receipts as the CCG may require.

5 LIABILITY 5.1 The GP shall exercise all reasonable skill, care and attention in all matters and shall indemnify

the CCG in respect of any and all costs, claims, liabilities and expenses incurred in respect of the GP’s performance (or non-performance) of his duties.

5.2 In accordance with the terms of the CCG’s Constitution, the CCG will indemnify the GP against any personal civil liability which is incurred in the performance of his duties, as long as the GP has acted honestly and in good faith and in accordance with the terms of the Constitution, save for where the GP has acted recklessly.

6 INTELLECTUAL PROPERTY RIGHTS 6.1 The GP shall communicate to the CCG full details of all information which results from the

duties (including any inventions or developments which are made or conceived by the GP ("the Results") during the term of the Consultancy or within 6 months after its end.

6.2 Upon termination of the duties the GP shall assign all rights, title and interest (including all

intellectual property rights) in the Results to the CCG with full title guarantee. The GP shall without further remuneration but at the CCG’s expense execute all documents and do all acts and things which the CCG at any time during or after the Consultancy requires to obtain or maintain any patents or other protection in respect of the Results in any part of the world or to vest the Results in the CCG.

7 TERMINATION 7.1 The CCG shall be entitled to terminate this Agreement with immediate effect and without any

payment in lieu of notice by giving notice in writing to the GP in the event of any of the following:

7.1.1 if the GP is guilty of serious misconduct or other conduct calculated or likely to affect

prejudicially the interest of the CCG; or 7.1.2 if the GP becomes insolvent or bankrupt or enters into any composition or arrangement

with or for the benefit of his creditors; or 7.1.3 if the GP commits any material or persistent breach of any of the terms or conditions of

this Agreement or shall willfully neglect or refuse to carry out any of his duties or to comply with any instruction given to him by the Governing Body; or

7.1.4 if the GP shall be convicted of any offence involving any act of fraud or dishonesty; or

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7.1.5 the GP is removed or suspended by the GMC or from any relevant Performers’ List [other than in circumstances where the GP retires and is removed from the Performers’ List]; or

7.1.6 if the Clinical Lead fails to adhere to the CCG’s Managing Conflicts of Interest and Gifts

and Hospitality policy.

7.2 Upon termination of the engagement under this Agreement the GP shall not represent himself

as being engaged by or connected with the CCG. 8 CONFIDENTIALITY 8.1 The GP shall at all times keep confidential all information relating to the CCG, its business,

finances, affairs and projects. 8.2 The GP shall, on termination of this Agreement for any reason whatever, forthwith deliver up

to the CCG all tangible materials relating to the matters specified in Clause 6.1, and shall in addition, if so requested by the CCG, disclose to and inform the CCG to the fullest extent of all information, calculations, data, technology and know-how of any description known to him in any way relating to or in connection with such matters and their current state or future proposals or development to enable the same to be continued or developed to their fullest extent.

9 NOTICES 9.1 Any notice required or permitted to be given or served under this Agreement shall be in writing

and may be served by either party by personal service or by post addressed to, in the case of the CCG, its registered office and in the case of the GP, the address stated in this Agreement, or such other address as the GP may hereafter intimate in writing to the CCG.

9.2 Any such notice shall be deemed to have been served

9.2.1 if delivered, at the time of delivery; or 9.2.2 if posted, at the expiry of 48 hours after posting.

10 WAIVERS AND REMEDIES 10.1 The rights of each party under this Agreement may be exercised as often as necessary and

are cumulative and not exclusive of its rights under the general law. 10.2 No waiver of any of the provisions of this Agreement shall be effective unless it is expressly

stated to be such in writing and signed by both parties. 10.3 Any delay in exercising or non-exercise of any right is not a waiver of that right. 10.4 Any remedy or right conferred upon the parties for breach of this Agreement shall be in

addition to and without prejudice to all other rights and remedies available to it.

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11 SEVERABILITY

11.1 If any provision of this Agreement is held invalid, illegal or unenforceable in any jurisdiction, such provision shall be severed and the remainder of the provisions of this Agreement shall continue in full force and effect as if this Agreement had been executed with the illegal or unenforceable provision eliminated.

12 REPRESENTATIONS

12.1 The GP warrants and represents to the CCG that he is under no obligation, covenant or restriction which would or might operate to prevent or restrict the GP from performing his obligations under this Agreement or which may give rise to any conflict of interest between the GP and the CCG. .

13 ENTIRE AGREEMENT

13.1 This Agreement constitutes the entire understanding and agreement between the parties relating to the subject matter of this Agreement and supersedes any previous agreement between the parties.

14 GOVERNING LAW AND JURISDICTION

14.1 This agreement shall be governed by and construed in accordance with the law of England and the parties hereby submit to the exclusive jurisdiction of the English courts.

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IN WITNESS WHEREOF the parties have signed this agreement the day and year first above written.

SIGNED for and on behalf of the CCG by

Chair

before this witness:

Witness signature:

Witness name:

Witness address:

SIGNED by the GP

before this witness:

Witness signature:

Witness name:

Witness address:

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Report to NHS St Helens CCG Governing Body

Date of meeting: 22nd May 2019

Governing Body Member Lead: Clinical Accountable Officer/ Strategic Director People’s Services

Accountable Director: Associate Director: Corporate Governance

Report title: NHS St Helens CCG 360o Stakeholder Survey 2018/19

Item for: Decision Assurance Information X (Please insert X as appropriate)

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This report supports the following CCG Strategic Objectives. Please insert ‘x’ as appropriate. 1. To deliver financial stability X 2. To integrate health within the place of St Helens through system redesign X 3. To deliver improved outcomes for people X 4. To be recognised as good system leaders X 5. To support and transform primary care to be a system leader in St Helens Cares X

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Does this report provide assurance against any of the risks identified in the Assurance Framework? (please specify) 3.2 – Lack of appropriate and/ or effective arrangements in place to secure patient and public involvement in planning, developing and delivering health & social care services. 5.3 – Without effective Primary Care engagement and support St Helens will compromise its ability to deliver the St Helens Cares strategy What level of assurance does it provide? Reasonable (List levels i.e. Limited/Reasonable/Significant) Is this report required under NHS guidance or for statutory purpose? (please specify) The information provided through the 360o Stakeholder Feedback Survey feeds in to the year-end improvement and assessment conversations with NHS England.

Purpose of this paper

To present to Governing Body the results of the 2018/19 3600 Stakeholder Feedback Survey undertaken by Ipsos Mori. 1. Executive Summary

The full report is available at Appendix A. The number and type of stakeholders included in the survey is determined nationally. For NHS St Helens CCG this included all member practices, 6 local CCGs, St Helens People’s Board (Health & Wellbeing Board), 7 NHS Providers, local authority representatives, local councillors, a range of voluntary/ community sector, Healthwatch, and patient groups. The 2018/19 report mirrored the previous year’s format with a number of key areas identified, containing 3-5 questions; however some of the areas were different themes to last years and therefore a direct comparison is not available. Overall, within the areas that are directly comparable the CCG demonstrated improvement on last year’s results.

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The overall response rate was higher, at 63% (compared to 57% the previous year, and compared to Ipsos Mori’s average response rate of 60% for the year). GP Member Practices response rate for this year was 59% (compared to 53% 2017/18), 83% Patient Group/ Voluntary Group (compared to 67% 2017/18) and 80% Local Authority Response rate (compared to 60% last year). Groups whose response rate was lower were Other CCGs (down 17%) and NHS Providers (down 18%). In terms of the feedback gathered, overall the CCG saw positive responses in the following areas: Overall Engagement – saw an increase in the number of positive responses around the

effectiveness of the working relationship with the CCG, with 83% rating the CCG as a good local system leader.

Core Functions – saw confirmed positive responses around the CCG improving health outcomes for the population of St Helens, improving the quality of local health services and delivering value for money.

Commissioning/ Decommissioning – saw an increase in the number of positive responses around CCG’s involving the right individuals and organisations when commissioning and/ or decommissioning services.

The Leadership area was expanded in the 2018/19 Survey to include “Partnership working in the local health and care system”. The CCG scored well on all three questions within this area: CCG considers the benefits to the whole health and care system when taking a decision – 69%

agree CCG actively avoids passing on problems to another system provider – 62% agreed CCG works collaboratively with other system partners on the vision to improve the future health of

the population across the whole system – 81% agreed Two areas identified as having a lower response this year are: The CCG engages effectively with patients and the public, including those groups within the local

population who are at risk of experiencing poorer health outcomes when commissioning/ decommissioning services. The response rate for this question had decreased by 8%.

The CCG demonstrates that it has considered the views of patients and the public, including those groups which experience poorer health outcomes and/ or barriers to accessing health and care, when it is commissioning/ decommissioning services. The response rate for this question had decreased by 11%.

Next Steps 1. The report will be shared with Member Practices at the July GP Members Council meeting 2. Since the Survey was completed the CCG Chair has a planned programme of visits to a number of

Third Sector organisations, to hear about the work they are undertaking across St Helens; these visits will continue throughout the year; providing the opportunity for third sector organisations to showcase their work and the impact they are having within St Helens; and to enable the CCG to listen to how it can improve two way communication

3. The CCG Communication & Engagement Strategy has been refreshed for 2019/20, and can be found on the CCG’s public website – an action plan is in place to ensure the strategy is fully implemented.

4. The CCG has a Stakeholder Map, which is used during all Engagement and Consultation work; this map has been reviewed during the Communications & Engagement Strategy refresh to ensure it accurately reflects the make-up of CCG stakeholders.

5. Stakeholder Forum being established, providing a wider network for patient/ public engagement in all aspects of St Helens Cares work.

6. The CCG will publish a copy of the full report on its website following the GP Members Council meeting in July.

2. Recommendations

Governing Body is asked to note the contents of the 2018/19 3600 Stakeholder Feedback Survey – the full report will be published on the CCG’s corporate website.

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Slide 3 Summary: headline findings

Slide 5 Background and objectives

Slide 6 Interpreting the results

Slide 7 Using the results

Slide 8 Detailed findings

Slide 21 Appendix: methodology and technical details

Slide 23 Appendix: CCG Clusters

Table of contents

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Overall engagement

Overall, how would you rate the effectiveness of your working relationship

with the CCG?

88%

Overall, how would you rate (the CCG’s) effectiveness as a local system

leader, i.e. as part of an Integrated Care System (ICS)/Sustainable

Transformation partnership (STP)?

76%

Leadership and partnership working in the local

health and care system ]

To what extent do you agree or disagree with EACH of the following

statements:

The CCG considers the benefits to the whole health and care system when

taking a decision. 69%

The CCG actively avoids passing on problems to another system partner. 62%

The CCG works collaboratively with other system partners on the vision to

improve the future health of the population across the whole system. 81%

% very good/fairly good

% very effective/fairly effective

% strongly agree/tend to agree

Summary: headline findings The following charts show the summary findings for St Helens CCG indicating the percentage of stakeholders responding positively to the key

survey questions.

St Helens CCG *Base = all stakeholders (42) 101


Core functions

How would you rate the effectiveness of the CCG at doing EACH of the

following:

Improving health outcomes for its population 69%

Reducing health inequalities 55%

Improving the quality of local health services 74%

Delivering value for money 57%

Commissioning/decommissioning services

To what extent do you agree or disagree with EACH of the following

statements about the way in which the CCG commissions/decommissions

services?

The CCG involves the right individuals and organisations when

commissioning/decommissioning services

62%

The CCG asks the right questions at the right time when


60%

The CCG engages effectively with patients and the public, including those

groups within the local population who are at risk of experiencing poorer

health outcomes when commissioning/decommissioning services

60%

The CCG demonstrates that it has considered the views of patients and the

public, including those groups which experience poorer health outcomes

and/or barriers to accessing health and care, when it is


57%

% very effective/fairly effective

% strongly agree/tend to agree

St Helens CCG *Base = all stakeholders (42) 102


Background and objectives

St Helens CCG

Clinical Commissioning Groups (CCGs) need to have strong relationships with a range of stakeholders in

order to be successful commissioners within their local health and care systems. These relationships

provide CCGs with valuable intelligence to help them make the effective commissioning decisions for their

local populations.

The CCG 360o Stakeholder Survey, which has been conducted since 2013/14, enables stakeholders to

provide feedback about their CCGs. The results of the survey serve two purposes:

1. Provide CCGs with insight into key areas for improvements in their relationships with stakeholders and

provide information on how stakeholders’ views have changed over time.

2. Contribute towards NHS England’s statutory responsibility to conduct an annual assessment of each

CCG, through the CCG Improvement and Assessment Framework.

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Interpreting the results

• For each question, the response to each answer is presented as both a percentage (%) and as a

number (n). The total number of stakeholders who answered each question (the base size) is also

stated at the bottom of each chart and in every table. For questions with fewer than 30 stakeholders

answering, we strongly recommend that you look at the number of stakeholders giving each response

rather than the percentage, as the percentage can be misleading when based on so few stakeholders.

• Throughout the report, ‘the CCG’ refers to St Helens CCG.

• Where results do not sum to 100%, or where individual responses (e.g. tend to agree; strongly agree)

do not sum to combined responses (e.g. strongly/tend to agree) this is due to rounding.

• There have been significant changes to the survey this year, such as the removal, rewording and

reordering of several questions (including the answer codes). Additionally, the online format of the

survey has changed this year and the ability for stakeholders to answer the questionnaire on behalf of

multiple CCGs at the same time is a new feature, introduced to make participation easier and less

time-consuming. These changes mean that we are unable to report on trend data. Please see slides 21

and 22 for more information on the methodology.

St Helens CCG 104


Using the results

• The following slides show the results for each question, with a breakdown also shown for each of the

core stakeholder groups where relevant, as well as regional and cluster* comparisons.

• The comparisons are included to provide an indication of differences only and should be treated with

caution due to the low numbers of respondents and differences in CCGs’ stakeholder lists.

• Any differences are not necessarily statistically significant differences; a higher score than the cluster

average does not always equate to ‘better ’ performance.

• The comparisons offer a starting point to inform wider discussions about the CCG’s ongoing

organisational development and its relationships with stakeholders. For example, they may indicate

areas in which stakeholders think the CCG is performing relatively less well, for the CCG to discuss

internally and externally to identify what improvements can be made in this area, if any.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

St Helens CCG 105


Regional and cluster comparisons

33%

55%

12% 14

23

5

Very good Fairly good Fairly poor Very poor

Stakeholder group No. of

participants

Very good/

Fairly good

Fairly poor/

Very poor

GP member practices 20 85% (17) 15% (3)

Health & wellbeing boards 1 100% (1) -

Healthwatch and voluntary/patient groups 7 86% (6) 14% (1)

NHS providers 4 100% (4) -

Other CCGs 3 67% (2) 33% (1)

Upper tier/unitary LA 4 100% (4) -

Wider stakeholders 3 100% (3) -

Q1. Overall, how would you rate the effectiveness of your working relationship with

the CCG?

By stakeholder group All stakeholders

St Helens CCG

Percentage of stakeholders saying very good/fairly

good

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.. **The DCO is the group of local CCGs that fall under the same NHS England Director of Commissioning Operations (at sub-regional level) as the CCG

Number of participants: CCG 2018/19 (42), Cluster (721), DCO (458), National (7677).

38%

37%

43%

33%

50%

53%

48%

55%

National

DCO**

Cluster*

CCG 2018/19

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33%

43%

12%

5% 7%

14

18

5

2 3

Very effective Fairly effective Not very effective Not at all effective Don't know


participants

Very effective/

Fairly effective

Not very

effective/Not at

all effective




NHS providers 4 75% (3) 25% (1)

Other CCGs 3 67% (2) 33% (1)




St Helens CCG


Q3. Overall, how would you rate the CCG’s effectiveness as a local system leader, i.e. as part

of an Integrated Care System (ICS)/Sustainable Transformation Partnership (STP)?

Percentage of stakeholders saying very

effective/fairly effective

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

22%

17%

25%

33%

52%

56%

52%

43%

National

DCO**

Cluster*

CCG 2018/19

**The DCO is the group of local CCGs that fall under the same NHS England Director of Commissioning Operations (at sub-regional level) as the CCG 107



29%

40%

19%

2% 10% 12

17

8

1

4

Strongly agree Tend to agree Tend to disagree Strongly disagree Don't know


participants

Strongly

agree/Tend to

agree

Strongly

disagree/Tend to

disagree





Other CCGs 3 67% (2) -


Wider stakeholders 3 67% (2) 33% (1)

All stakeholders By stakeholder group

St Helens CCG

Percentage of stakeholders saying strongly

agree/tend to agree


To what extent do you agree or disagree with EACH of the following statements?

Q5a. “The CCG considers the benefits to the whole health and care system when taking a

decision.”


26%

24%

30%

29%

53%

53%

51%

40%

National

DCO**

Cluster*

CCG 2018/19




24%

38%

19%

5%

14% 10

16

8

2

6



participants

Strongly

agree/Tend to

agree

Strongly

disagree/Tend to

disagree




NHS providers 4 75% (3) 25% (1)

Other CCGs 3 100% (3) -




St Helens CCG



Q5b. “The CCG actively avoids passing on problems to another system partner.”



agree/tend to agree

22%

19%

26%

24%

42%

42%

41%

38%

National

DCO**

Cluster*

CCG 2018/19





36%

45%

12% 2% 5%

15

19

5

1 2



participants

Strongly

agree/Tend to

agree

Strongly

disagree/Tend to

disagree





Other CCGs 3 67% (2) 33% (1)




St Helens CCG


agree/tend to agree


Q5c. “The CCG works collaboratively with other system partners on the vision to improve the

future health of the population across the whole system.”


34%

32%

39%

36%

48%

48%

46%

45%

National

DCO**

Cluster*

CCG 2018/19




19%

50%

19%

2% 10%

8

21

8

1

4



participants

Very effective/

Fairly effective

Not very

effective/Not at

all effective




NHS providers 4 75% (3) 25% (1)





St Helens CCG




How would you rate the effectiveness of the CCG at doing EACH of the following? How would you rate the effectiveness of the CCG at doing EACH of the following?

Q6a. “Improving health outcomes for its population.”


16%

15%

18%

19%

60%

59%

61%

50%

National

DCO**

Cluster*

CCG 2018/19




14%

40% 29%

17%

6

17

12

7



participants

Very effective/

Fairly effective

Not very

effective/Not at

all effective




NHS providers 4 50% (2) 50% (2)








How would you rate the effectiveness of the CCG at doing EACH of the following?

Q6b. “Reducing health inequalities.”


12%

10%

14%

14%

51%

49%

53%

40%

National

DCO**

Cluster*

CCG 2018/19

**The DCO is the group of local CCGs that fall under the same NHS England Director of Commissioning Operations (at sub-regional level) as the CCG

St Helens CCG

112



17%

57%

12%

5% 10%

7

24

5

2

4



participants

Very effective/

Fairly effective

Not very

effective/Not at

all effective









St Helens CCG





Q6c. “Improving the quality of the local health services.”


19%

16%

24%

17%

55%

56%

55%

57%

National

DCO**

Cluster*

CCG 2018/19




14%

43% 7%

7%

29%

6

18 3

3

12



participants

Very effective/

Fairly effective

Not very

effective/Not at

all effective









St Helens CCG





Q6d. “Delivering value for money.”


18%

16%

23%

14%

47%

47%

47%

43%

National

DCO**

Cluster*

CCG 2018/19




12%

50%

17%

10%

12%

5

21

7

4

5



participants

Strongly

agree/Tend to

agree

Strongly

disagree/Tend to

disagree


Health & wellbeing boards 1 - -





Wider stakeholders 3 67% (2) 33% (1)


St Helens CCG


agree/tend to agree


To what extent do you agree or disagree with EACH of the following statements about the way in which the

CCG commissions/decommissions services?

Q8a. “The CCG involves the right individuals and organisations when commissioning/decommissioning

services.”


18%

16%

21%

12%

48%

48%

48%

50%

National

DCO**

Cluster*

CCG 2018/19




17%

43% 12%

10%

19%

7

18

5

4

8



participants

Strongly

agree/Tend to

agree

Strongly

disagree/Tend to

disagree









St Helens CCG


agree/tend to agree




Q8b. “The CCG asks the right questions at the right time when commissioning/decommissioning

services.”


14%

15%

19%

17%

44%

45%

43%

43%

National

DCO**

Cluster*

CCG 2018/19




14%

45% 10%

5%

26%

6

19 4

2

11



participants

Strongly

agree/Tend to

agree

Strongly

disagree/Tend to

disagree










agree/tend to agree

St Helens CCG




Q8c. “The CCG engages effectively with patients and the public, including those groups within the local

population who are at risk of experiencing poorer health outcomes when commissioning/

decommissioning services.”


18%

14%

21%

14%

43%

45%

45%

45%

National

DCO**

Cluster*

CCG 2018/19




14%

43% 5%

5%

33%

6

18

2

2

14



participants

Strongly

agree/Tend to

agree

Strongly

disagree/Tend to

disagree










agree/tend to agree

St Helens CCG




Q8d. “The CCG demonstrates that it has considered the views of patients and the public, including those

groups which experience poorer health outcomes and/or barriers to accessing health and care, when it is

commissioning/decommissioning services.”


18%

16%

22%

14%

45%

45%

45%

43%

National

DCO**

Cluster*

CCG 2018/19



Appendix: methodology and technical details

• It was the responsibility of each CCG to provide the list of stakeholders to invite to take part in the CCG

360o stakeholder survey. CCGs proposing to merge in April 2019 collaborated with each other to produce

and submit a single stakeholder list across the merging CCGs.

• CCGs were provided with a specification of core stakeholder organisations to be included in their

stakeholder list. Beyond this, however, CCGs had the flexibility to determine which individual within each

organisation was the most appropriate to nominate. CCGs were also given the opportunity to add up to

ten additional stakeholders they wanted to include locally (they are referred to in this report as ‘wider

stakeholders’).

• Stakeholders who were nominated by more than one CCG or to represent more than one organisation

had the opportunity to complete the questionnaire in a ‘grid’ format. They could choose to give the same

responses for each CCG that asked them to take part and the organisations they represent, or to give

different answers for each CCG and each organisation.

• Stakeholders were sent an email inviting them to complete the survey online. Stakeholders who did not

respond to the email invitation, and stakeholders for whom an email address was not provided, were

telephoned by an Ipsos MORI interviewer who encouraged response and offered the opportunity to

complete the survey by telephone. Non-responding stakeholders were sent reminder emails and

telephone calls to encourage participation.

St Helens CCG 119


Stakeholder group Invited to take

part in survey

Completed

survey

Response

rate

GP member practices One from every member practice*

34 20 59%

Health & wellbeing boards Up to two per HWB* 2 1 50%

Local Healthwatch Up to three per local Healthwatch*

2 2 100%

Other patient groups and voluntary sector

organisations or representatives Up to eight* 6 5 83%

NHS providers Up to two from each acute, mental health and community health providers*

7 4 57%

Other CCGs Up to five* 6 3 50%

Upper tier or unitary local authorities Up to five per local authority*

5 4 80%

Wider stakeholders 5 3 60%

All stakeholders 67 42 63%

Appendix: methodology and technical details

• Within the survey, stakeholders

were asked a series of

questions about their working

relationship with the CCG.

Stakeholders were asked all

the same questions in this

year’s survey, with no bespoke

CCG questions.

• Fieldwork was conducted

between 14th January and 28th

February.

• 42 of the CCG’s stakeholders

completed the survey. The

overall response rate was 63%,

which varied across the

stakeholder groups as shown

in the table opposite.

*Specification from the core stakeholder framework St Helens CCG

Survey response rates for St Helens CCG

120


Each CCG is compared to a cluster of the other CCGs to which they are most similar. The clusters are based on the

following variables:

Barnsley CCG South Sefton CCG

Bury CCG South Tees CCG

Calderdale CCG South Tyneside CCG

Doncaster CCG Southend CCG

Halton CCG Stoke on Trent CCG

Hartlepool and Stockton-on-Tees CCG Sunderland CCG

Mansfield and Ashfield CCG Tameside and Glossop CCG

North East Lincolnshire CCG Thanet CCG

North Tyneside CCG Wigan Borough CCG

Rotherham CCG Wirral CCG

St Helens CCG

• Index of Multiple Deprivation averages

(overall and health domain)

• Population registered with practices

• Age of population • Population density

• Ethnicity

• Ratio of registered population to overall population

Based on these variables, the following CCGs form the CCG cluster for St Helens CCG

Appendix: CCG Clusters

121

24 CCG 360 Stakeholder Survey 2018/19 – CCG level report | April 2019 | Public CCG 360 Stakeholder Survey 2018/19 – CCG level report | April 2019 | Public

Version 1 | Internal Use Only

For more information

[email protected]

This work was carried out in accordance with the requirements of the international quality standard for market research, ISO 20252 and with the Ipsos MORI Terms and Conditions which can be found here 122

http://www.ipsos-mori.com/terms

Report to Governing Body Date of meeting:

22th May 2019

Governing Body Member Lead:

Iain Stoddart – Chief Finance Officer

Accountable Director:

Iain Stoddart – Chief Finance Officer

Report title:

Financial Update

Item for: Decision Assurance X Information X (Please insert X as appropriate)


This report supports the following CCG Strategic Objectives. Please insert ‘x’ as appropriate. 1. To deliver financial stability X 2. To integrate health within the place of St Helens through system redesign. 3. To deliver improved outcomes for people 4. To be recognised as good system leaders. 5. To support & transform primary care to be a system leader in St Helens

Cares.

Governance and Risk

The paper addresses issues around the following areas of the Governing Body Assurance Framework. Objective 1: To deliver financial stability 1.1 Failure to deliver to financial control total and achieve statutory financial

duties

1.2 Excessive demand not being managed

Is this report required under NHS guidance or for statutory purpose? (please specify) In discharging its constitutional duties, the CCG has a responsibility to regularly report and to determine actions that deliver to its financial control total and statutory financial duties. This also includes any specific terms as set out by NHS England through “Directions” issued by the Secretary of State for Health and Social Care. The Governing Body and its Finance and Performance Committee are clearly sighted on financial issues on a regular basis.

Purpose of this paper To inform the Governing Body of the CCG’s financial performance for the year ended 31st March 2019 and preliminary information pertaining to 2019/20 .

123

Further explanatory information required: Does this paper link to any of the 10 key themes of the CCG’s Improvement Plan. If yes, please specify.

Yes – The QIPP agenda incorporates all 10 key themes


Any potential changes to services as a result of information contained within this paper are subject to the equality impact assessment and quality impact assessment of the CCG.


None


None


None

124

1. Executive Summary An Executive Summary is included within the main paper. The CCG is reporting a breakeven in-year financial position for 2018/19 therefore achieving the control total set by NHS England. The CCG has achieved all of its statutory financial duties and adhered to the mental health investment standard, maximum cash drawdown and Better Payment Practice Code during the financial year. Delivery of the breakeven control total was made possible through a combination of settlement deals, non-recurrent mitigations to offset slippage on QIPP plans and the receipt of external financial support from NHSE. The CCG reports under-delivery of QIPP savings of £4m however this was offset through the receipt of external financial support. The 2019/20 planned position is expected to be met as at Month1 and further system wide financial recovery plans require submission by the end of June 2019.

2. Background and Update The CCG has planned for a balanced in-year financial position (cumulative deficit of £13.6m) for the 18/19 financial year. The plan required the CCG to achieve a QIPP savings target of £14.7m. Budgetary overspends and non-delivery of QIPP targeted plans resulted in an increased recovery plan savings requirement in order for the CCG to meet its financial target. Earlier in the financial year the forecast unmitigated deficit was over £9m before any mitigations were applied.

3. Next Steps (as appropriate) The draft accounts were submitted on 24th April 2019, the external audit commenced from 7th May 2019 with the final accounts to be submitted on 29th May 2019. A system wide recovery plan will be formulated based upon the CCG initial submission. This is expected to reaffirm the multi-year approach to financial recovery.

4. Recommendations The Governing Body is asked to note:

a) The 2018/19 year-end financial position in line with Control Total b) The 2019/20 expected balanced position for month 1 and the position with respect

to the requirement for a system wide Financial Recovery Plan.

125

DOCUMENT DEVELOPMENT Process Yes No Not

applicable Comments & Date (i.e. presentation, verbal, actual report)

Outcome


N/A


N/A


N/A

Legal Advice Sought

N/A


X Full reporting of the CCG 2018/19 final accounts will be made to the Audit Committee on 24th May 2019. Previous information on the M12 financial position has been presented to the Audit Committee, Finance & Performance Committee and Council Of Members.

The reports were discussed and noted.


126

FINANCIAL UPDATE

1. Executive Summary

1.1 This report largely details the financial position to the end of March 2019 (Month 12) and preliminary

information pertaining to 2019/20.

1.2 The CCG reports a breakeven financial position for 2019/20, therefore achieving the financial plan. The annual accounts are subject to audit opinion and at the time of the Governing Body meeting the audit will have commenced.

1.3 Delivery of the breakeven control total was made possible through a combination of settlement deals,

non-recurrent mitigations to offset slippage on QIPP plans and the receipt of external financial support from NHSE. This out-turn is the result of a managed strategy of recovery to improve the trajectory of spending and avoid an in-year deficit which was forecast to be in excess of £9m earlier in the year.

1.4 Month 12 was a reasonably favourable month for the CCG in terms of the final position of variable

budgets and actions completed in preceding months had effectively removed a great deal of the residual risk by locking down contracts and securing mitigations.

1.5 The CCG reports QIPP delivery of £10.7m against its target of £14.7m. £7m was delivered against the original QIPP plans with a further £3.7m contribution from the non-recurrent savings and mitigations. The remaining £4m gap was offset by the receipt of external financial support from NHSE. In achieving £10.7m in savings the CCG delivered a savings of 3.2% which is a level typically considered by NHSE to be a very high savings target.

1.6 The CCG also met all cash targets, invoice payment targets and remained within its capital resource limit during 2018/19

1.7 It is expected that the CCG will balance to plan as at Month 1 of the 2019/20 financial year and that

further work is ongoing to develop the system wide recovery plan for submission by the end of June 2019.

2. High level Financial Dashboard & Summary of Financial Performance

2.1 Table 1 summarises the CCGs performance against its statutory financial duties.

2.1 The table indicates a breakeven position on both revenue and capital budgets.

Statutory Duties 2018/9 Target £m

Actual £m

Variance £m Met?

Expenditure not to exceed income 343.7 343.7 0.0Capital resource use does not exceed the amount specified in directions 0.1 0.1 0.0Revenue resource use does not exceed the amount specified in directions 339.1 339.1 0.0Revenue administration resource use does not exceed the amount specified in directions 4.2 3.7 -0.5

127

2.2 The CCG delivered a surplus of £0.5m against its total running cost allowance, thus exceeding its original QIPP savings challenge in this area. In constraining running cost expenditure during 2018/19 the CCG is on target to manage the 20% real terms reduction in running cost allowance that will impact from 20/21.

2.3 The CCG has spent 100% of its in-year allocation. The chart below indicates the areas in which the

money was spent.

2.4 Appendix A shows the final budgetary performance of the CCG for 2019/20. The variance of some budgets may have been influenced by the enacting of mitigations in the final month of the year and the release of available reserves at year end.

3. Key Expenditure Areas to Note:

3.1 Mental Health – Pressures on out of area MH cases continued but did not worsen compared to the forecast within the final month. The CCG reports that it has achieved the mental health investment standard for 2018/19 which requires investment in mental health services to increase by at least the percentage of overall funding growth (2.8% during 2018/19).

3.2 Acute Commissioning – The CCG had reached settlement agreements with a number of key acute

providers in the approach to the month 12 accounts and over 80% of the acute budget was made certain through these discussions. The CCG finished the year with an outstanding dispute with the main acute provider over the counting and coding of zero length of stay activity. It is expected that this dispute will be resolved early in the new financial year.

3.3 Prescribing – The prescribing position improved in the final month of the year. In total the budget

was only £184k overspent despite No Cheaper Stock Obtainable (NCSO) pressures of circa £0.7m plus a further £0.7m of cost increases following NCSO drugs coming back into the drug tariff at a

Mental Health, £27.6m

Acute Commissioning, £168.8m

Other Primary Care, £6.4m

Continuing Care, £24.1m

Community Health, £27.5m

Other (inc. Better Care Fund), £17.7m

Running Costs, £3.7m

Primary Care GP contracts, £28.4m

Prescribing, £34.8m

128

premium prices. The original prescribing QIPP challenge of £2m was delivered but not the stretch challenge of a further £0.5m.

3.4 Continuing Healthcare – The CHC forecast remained reasonably stable in Month 12. The final

position of the pooled budget is based on a forecast out-turn provided by the local authority and it is not expected that there would be any significant movement upon receipt of the final pooled budget out-turn.

3.5 Running costs – The CCG delivered a surplus of £0.5m against its total running cost allowance,

thus exceeding its original QIPP savings challenge in this area. In constraining running cost expenditure the CCG is preparing well to manage the 20% real terms reduction in running cost allowance from 20/21.

3.6 Underlying position – The CCG reports an underlying financial deficit of £7.5m. This was expected

given £3.7m of the recurrent QIPP plan was delivered through non-recurrent measures and the achievement of the balanced control total was dependant on £4m non-recurrent support. Obviously this underlying position carries forward into the 19/20 plan and is a major factor in the challenging QIPP requirement for next year.

4. Cash and Better Payment Practice Policy

4.1 Appendix B shows the final Statement of Financial Position for 2018/19. It is important that the CCG manages the cash at year-end to ensure it holds as little as possible. The cash balance at the end of March-19 was £13k.

4.2 The table below shows the Better Payment Practice Code performance for the full year. The CCG adhered to the standard by paying at least 95% of all invoices by the due date or within 30 days of receipt of a valid invoice, whichever is the latter. The standard was achieved for both NHS and NON-NHS invoices by value and volume.

5. 2019/20 Financial Year

5.1 The CCG does not usually report the financial position in month 1, as there is limited information available on which to base a view. There are no known material variances to the financial plan at this stage in the financial year and it is expected that Month 1 activity and finance are in line with plans.

5.2 The CCG has submitted a Financial Recovery Plan to NHSE on 3rd April. This was based on financial information reported to Governing Body in March 2019 (inc Urgent Decision Making Committee on 29th March)

5.3 The Recovery Plan highlights the extent of the financial gap faced by the CCG and details how the CCG can achieve long term sustainability over a multi-year period. It makes it clear that the CCG are unable to bridge the underlying demand pressures and non-recurrent pressures brought forward from

2018-19 2018-19 2017-18 2017-18Number £'000 Number £'000

Non-NHS Payables: CCGTotal Non-NHS trade invoices paid in the year 6,435 86,102 5,886 81,965Total Non-NHS trade invoices paid within target 6,290 85,319 5,750 80,799Percentage of CCG non-NHS trade invoices paid within target 97.75% 99.09% 97.69% 98.58%

NHS Payables: CCGTotal NHS trade invoices paid in the year 2,347 216,581 2,333 212,765Total NHS trade invoices paid within target 2,289 216,356 2,297 212,179Percentage of CCG NHS trade invoices paid within target 97.53% 99.90% 98.46% 99.72%

2017-18 Results2018-19 to March 2019

129

2019/20 in a single year (19/20) and a multi-year approach would allow a sustainable financial recovery.

5.4 The demand trends seen in 2018/19 are positive for elective and non-elective demand, and following similar trends the Recovery Plan indicates that the CCG can achieve in year balance by 2021/22. After that time the CCG will be in a position to start to pay off its historic debt.

5.5 The detail within the plan is specific to the CCG at this stage, but systems are requested to jointly own financial recovery and highlight how they will collectively contribute to financial recovery. To this end a systems based financial recovery plan is due to be formulated by the end of June 2019. The current plan highlighted an overview of the system ownership and governance linked to the St Helens Cares MOU and governance arrangements around St Helens Cares. This is to be confirmed.

5.6 The CCG will continually monitor the financial position very closely throughout the financial year and any changes in the level of net risk will be reported to both the Governing Body and the Finance and Performance Committee as well as NHS England at the earliest opportunity.

6. Recommendations

6.1 The Governing Body is asked to note:

a) The 2018/19 year-end financial position in line with Control Total

b) The 2019/20 expected balanced position for month 1 and the position with respect to the requirement for a system wide Financial Recovery Plan.

Appendices:

Appendix A Budgetary Performance Summary

Appendix B Statement of Financial Position

130

Budgetary Performance Summary - Month 12 2018/19 Appendix A

Annual Budget £ Bud YtD £ Act YtD £ Var YtD £ Variance @ M11 In-month movement

Mental Health 27,660,362 27,660,362 27,637,841 -22,521 -108,409 85,888606001 - MENTAL HEALTH CONTRACTS 21,451,279 21,451,279 21,274,622 -176,658 -32,781 -143,877

606006 - CHILD AND ADOLESCENT MENTAL HEALTH 678,155 678,155 662,724 -15,431 -10,000 -5,431

606031 - MENTAL HEALTH SERVICES - OUT OF AREA 4,075,909 4,075,909 4,589,705 513,796 429,039 84,758

606056 - MENTAL HEALTH SERVICES - OTHER 1,455,019 1,455,019 1,110,790 -344,229 -494,667 150,438

Acute Commissioning 165,135,262 165,135,262 168,827,138 3,691,876 4,687,275 -995,399606071 - ACUTE COMMISSIONING 153,839,015 153,839,015 157,262,518 3,423,503 4,504,892 -1,081,390

606076 - ACUTE CHILDRENS SERVICES 2,673,763 2,673,763 2,609,248 -64,515 -42,230 -22,285

606086 - AMBULANCE SERVICES 7,483,928 7,483,928 7,590,996 107,068 92,776 14,292

606091 - INFECTION CONTROL 4,312 4,312 -22,247 -26,559 -24,605 -1,953

606106 - HIGH COST DRUGS -375,535 -375,535 -234,854 140,681 73,957 66,723

606116 - NCAS/OATS 1,509,778 1,509,778 1,621,477 111,699 82,485 29,214

Primary Care 70,044,213 70,044,213 69,560,937 -483,275 -218,319 -264,956606141 - CENTRAL DRUGS 1,051,888 1,051,888 1,100,635 48,747 41,802 6,945

606146 - COMMISSIONING SCHEMES 105,250 105,250 95,304 -9,946 -11,722 1,776

606151 - LOCAL ENHANCED SERVICES 1,915,804 1,915,804 1,652,359 -263,445 -74,386 -189,059

606156 - MEDICINES MANAGEMENT - CLINICAL 1,157,627 1,157,627 1,115,604 -42,024 -78,294 36,270

606161 - OUT OF HOURS 689,934 689,934 372,897 -317,037 -100,752 -216,285

606162 - GP FORWARD VIEW 871,804 871,804 871,804 0 -663 663

606166 - OXYGEN 272,935 272,935 263,112 -9,823 -7,166 -2,658

606171 - PRESCRIBING 34,600,000 34,600,000 34,784,441 184,441 314,000 -129,559

606176 - PRIMARY CARE IT 1,030,774 1,030,774 959,119 -71,655 -362,664 291,009

606177 - PRIMARY CARE INVESTMENTS -10,000 -10,000 -27,698 -17,698 -11,798 -5,900

606178 - PRC DELEGATED CO-COMMISSIONING 28,358,196 28,358,196 28,373,361 15,165 73,322 -58,158

Continuing Care 23,443,572 23,443,572 24,105,157 661,585 547,049 114,536606182 - CHC POOLED BUDGET 21,793,559 21,793,559 22,905,102 1,111,543 934,678 176,865

606186 - CONTINUING HEALTHCARE ASSESSMENT & SUPPORT 909,896 909,896 414,798 -495,097 -417,467 -77,630

606187 - Children's Continuing Care 740,117 740,117 785,257 45,139 29,838 15,302

Community Health 27,540,964 27,540,964 27,542,991 2,027 10,251 -8,225606211 - COMMUNITY SERVICES 24,068,872 24,068,872 24,018,159 -50,713 -45,439 -5,275

606216 - CARERS 169,224 169,224 135,807 -33,417 -20,164 -13,253

606221 - HOSPICES 1,079,344 1,079,344 1,112,887 33,543 40,009 -6,466

606226 - INTERMEDIATE CARE 1,565,385 1,565,385 1,571,635 6,250 3,785 2,465

606231 - LONG TERM CONDITIONS 658,139 658,139 704,503 46,364 32,060 14,304

Other 21,406,628 21,406,628 17,723,319 -3,683,309 -3,669,629 -13,679606256 - COMMISSIONING - NON ACUTE 887,247 887,247 848,822 -38,425 -7,324 -31,101

606276 - NON RECURRENT PROGRAMMES 3,731,000 3,731,000 -87,174 -3,818,174 -3,761,685 -56,489

606291 - PROGRAMME PROJECTS (BCF) 12,980,184 12,980,184 13,068,661 88,477 92,470 -3,993

606296 - REABLEMENT -78,596 -78,596 -72,469 6,127 5,623 504

606301 - RECHARGES NHS PROPERTY SERVICES LTD 2,965,000 2,965,000 3,047,326 82,326 -2,249 84,575

606308 - SAFEGUARDING 572,945 572,945 541,820 -31,125 -31,523 398

606309 - NHS 111 230,347 230,347 254,912 24,565 17,250 7,315

606312 - CLINICAL LEADS 118,500 118,500 121,419 2,919 17,808 -14,889

Programme Costs Reserves 0 0 0 0 8,011 -8,011606261 - COMMISSIONING RESERVE 0 0 0 0 0 0

606281 - NON RECURRENT RESERVE 0 0 0 0 8,011 -8,011

Programme Costs Grand Total 335,231,000 335,231,000 335,397,383 166,382 1,256,229 -1,089,846

Running Costs Grand Total 3,885,000 3,885,000 3,718,618 -166,382 -205,021 38,639

CCG CORE TOTAL 339,116,000 339,116,000 339,116,000 0 1,051,208 -1,051,208

Financial Performance - Month 12 (Mar-19)

131

Statement of Financial Position Month 12 2018/19 Appendix B

31-Mar-19 31-Mar-18

£'000 £'000Non-current AssetsProperty, Plant & Equipment 82 8

Intangible Assets 164 205Total Non-current Assets 246 213

Current AssetsTrade & Other Receivables 7,064 5,562

Cash & Cash Equivalents 13 11Total Current Assets 7,077 5,574

Total Assets 7,323 5,787

Current Liabilities

Trade & Other Payables: -14,993 -14,339Total Current Liabilities -14,993 -14,339

Total Assets less Current Liabilities -7,669 -8,553

Non-current Liabilities

Trade & Other Payables 0 0Total Non-current Liabilities 0 0

Total Assets Employed -7,669 -8,553

Financed by Taxpayers’ Equity

General Fund -7,669 -8,553

Total Taxpayers’ Equity -7,669 -8,553

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Report to NHS St Helens CCG Governing Body

Date of meeting: 22nd May 2019

Governing Body Member Lead: Clinical Accountable Officer

Accountable Director: Iain Stoddart

Report title: Performance Update

Item for: Decision Assurance X Information X (Please insert X as appropriate)


This report supports the following CCG Strategic Objectives. Please insert ‘x’ as appropriate. 1. To deliver financial sustainability 2. To deliver improvements through system redesign and in priority areas. X 3. To deliver improved outcomes for patients X 4. To develop capacity and capability as system leaders 5. To stabilise, support and sustain primary care

Governance and Risk

Does this report provide assurance against any of the risks identified in the Assurance Framework? Improved outcomes for patients What level of assurance does it provide? Reasonable

Is this report required under NHS guidance or for statutory purpose? (please specify) No

Purpose of this paper The purpose of this paper is to: • Provide an update on current performance against key priority areas including the IAF. • Provide an update on this month’s (April 2019) Priority Area: Primary Care and Prescribing. • Update the Committee on the 2018/19 Quality Premium performance.

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Further explanatory information required: Does this paper link to any of the key themes of the CCG’s Operational Plan & Improvement Plan. If yes, please specify.

Yes – the Improvement Plan themes are mapped to the Operational Plan for 2017-19 which incorporates key performance indicators/IAF metrics.


The intention of the IAF is to use national benchmarking data intelligently to drive up the performance of services commissioned by CCGs. By making progress and demonstrating improvement in performance, the quality of services to patients and service users will improve.


None identified in compiling this report


Addressing the measures reported as “underperforming” should result in an improvement in clinical services delivered to patients.


• Reputational risk should improvements not manifest

• The CCG needs to strive to demonstrate continuous

improvement in the IAF areas identified by NHSE as underperforming. The themes are the focus of on-going commissioning work to drive improvement. Those actions are summarised in a refreshed overarching Action Plan that is owned by the Quality and Performance Committee with clear officer and clinical leadership to ensure continued focus on improvement and mitigate risks.

• Risk that the Quality Premium is not achieved. There is

a financial risk in not achieving the Quality Premium income. Whilst this could be mitigated by preparing action plans to improve CCG performance in the underperforming areas, there is a limiting factor that the CCG has to achieve its overall financial plans in order to qualify to receive any Quality Premium income.

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1. Executive Summary Performance reporting to the Governing Body covers CCG performance in line with Constitutional standards, Quality Premium and a range of local metrics, some of which are used for IAF assessment by NHSE. Detailed reporting to and assurance thereof is provided by the Finance and Performance Committee, with exceptions reported to the Governing Body. Exceptions are listed below and cover performance for the 2018/19 financial year. Further information on wider NHS performance is provided by NHSE at: https://www.england.nhs.uk/statistics/statistical-work-areas/combined- performance-summary/ 1.1 - Quality Premium 2018/19 – Performance year to date (Appendix 1 refers) Quality Premium performance overlaps with certain constitutional standards and targets. Current performance is illustrated at Appendix 1. The total available is £932k which is split between demand management measures (£704k) and other measures (Domain 1-6 and constitutional measures in Appendix 1 - £228k). Based on the latest data available, St. Helens CCG could achieve £55k if performance were to continue in this manner. Areas underperforming within our Quality Premium 2018/19 measures are as follows:

• Demand Management – This area consists of Type 1 A&E attendances (A1), non-elective admissions with a zero day length of stay (A2) and non-elective admissions with a length of stay of 1 day or more (B). This section has a potential value of £704k for St Helens CCG but year to date we are failing the targets. Whilst A1 is green, both A2 and B must be green to achieve the premium.

• Out of Area Placements (Domain 4) – Year to date to month 9 18/19, this measure is reporting 280 cases against a target of 143. Performance for this area has remained static in the last 2 months.

• Inappropriate antibiotic prescribing in primary care (part of Domain 5) – This measure is

based on a rolling 12 month period and reporting in month 9 18/19 is 1.281 against a target of 0.965. Whilst this measure is still RAG rated red, performance has been improving month on month since the start of the financial year.

• High-risk atrial fibrillation patients on anti-coagulant drug therapy (Domain 6) – This

measure is a snapshot taken directly from GP systems and as at month 12 this measure is reporting 81.8% against a target of 91.6%.

1.2 – Performance measures from IAF and other key CCG frameworks reported to Finance & Performance Committee in April 2019 (Appendices 2 and 3 refer) 1.2.1 Summary of Current Performance – Red Rated Measures All red rated performance measures can be found in Appendix 2. There are 44 indicators rated red which is a decrease of 2 compared to February 2019 reporting. 1.2.2 Green and Amber Rated Measures Appendix 3 includes 55 measures within the Repository which are RAG rated as green which is 2 more compared to February 2019 reporting.

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https://www.england.nhs.uk/statistics/statistical-work-areas/combined-%20performance-summary/

There are also 4 measures that are RAG rated amber. 1.2.3 Priority Area Reporting – Primary Care & Prescribing The focus area for April was Primary Care and Prescribing. The table indicates the measures that the CCG is assessed against. The final column indicates whether this is an improving trajectory from the previous month. The action plans for all Primary Care and Prescribing measures were reviewed at the April 2019 Finance & Performance Committee in detail. Both leads attended the April 2019 meeting and additionally presented papers demonstrating progress against the operational plan. KPI No. Measure Latest

Period Latest Performance

Target Improving

107a Appropriate prescribing of antibiotics in primary care

Dec-18 (rolling 12 months)

1.281 0.965 Yes

107b Appropriate prescribing of broad spectrum antibiotics in primary care


6.72% 10% No

QP Trim A 30% reduction (or greater) in the number of trimethoprim items prescribed to patients aged 70 years or greater


3,043 4,981 Yes

128b Patient experience of GP services 2018 83.77% 83.76% No

128c Primary Care Access - Extended access to GP services on a weekend and evening

Oct-18 100% 100% Static

128d Primary care workforce - GPs and practice nurses per 1,000 population

Mar-18 0.74 1.04 No

RC CVD High-risk atrial fibrillation patients on anti-coagulant drug therapy

Mar-19 81.84% 91.61% No

128e Total investment in primary care transformation made by CCGs compared with the £3 head commitment

Q3 18/19 Green Green Static

The March meeting of the F&P Committee focussed on all red RAG IAF measures. This was a shortened meeting due to being followed by the Integrated Performance Board; however, a number of queries were posed by members and action plans shared outside of the meeting.

2. Recommendations The Governing Body is requested to:

1- Review the report noting current performance levels.

2- Note that the Finance & Performance Committee are reviewing performance as appropriate

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and will recommend remedial action for those metrics that are not operating to target.

3- Advise of any further direction to the Finance & Performance and Quality Committees in relation to areas which are performing less well or request any additional assurance actions.

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DOCUMENT DEVELOPMENT

Process Yes No N/A Comments & Date (i.e. presentation, verbal, actual report)

Outcome


X Not in production of this document - where commissioning activity is carried out in response to the requirements of the 5 YFV/Next Steps and CCG Operational Plan public engagement will continue to be carried out in line with due process


X As above


X Not in production of this document - where commissioning activity is carried out in response to the requirements of the 5 YFV/Next Steps and CCG Operational Plan Quality and Equality impact assessments will be carried out in line with due process

Legal Advice Sought

X


X Presented to F&P Committee on 24/4/19.


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Appendix 1 - Quality Premium 2018/19 Demand Management & Quality Premium 2018/19St Helens CCG

KEY: Off Trajectory YTD

Awaiting Data

On Trajectory YTD

QUALITY PREMIUM MEASURES DEMAND MANAGEMENT MEASURES

LOCALLY SELECTED MEASURES CONSTITUTIONAL MEASURES

DEMAND MANAGEMENT Financial Value Achieving Based on Month 9 Position: £0

QUALITY PREMIUM Financial Value Achieving Based on Month 9 Position: £55,237

TOTAL Financial Value Achieving Based on Month 9 Position: £55,237

Maximum 18 weeks Referral To Treatment (Incomplete Pathway-

92% Standard)

At January 2019 performance

favourably above target with 94.21%

Domain 1 - Early Cancer Diagnosis

Awaiting Data

2018 (Calendar Year) published 2020

Domain 6 - RightCare Indicator Circulation Problems (CVD)

High-risk atrial fibrilation patients on anti-coagulant drug therapy

(Target 91.61% at year end)

March 2019 performance adversely below target

at 81.84%

Domain 3 - Continuing Healthcare

(Target >85%)

At quarter 3 2018/19 90% of assessments completed within 28

days

Domain 4 - Mental Health

(Target rate of 120.21 at year end)

At December 2018 reporting a rate of

176.22 against the YTD target of 90.16

Domain 2 - GP Access and Experience

Awaiting Data

Published July 2019

Cancer - 2 month from GP referral to first

treatment(85% standard)

At January 2019 performance adversely

below target with 80.00%, but on target

YTD 85.38%

A1 - Type 1 A&E Attendances

(Target 57,445 at year endand 47,976 January YTD)

YTD January 2019 performance favourably below target

at 45,888

A2 - Non-Elective admissions with zero length of stay

(Target 11,612 at year endand 9,686 at January YTD)

YTD January 2019 performance adversely above target

at 12,124

B - Non-Elective admissions with length of stay 1 day or more

(Target 17,964 at year endand 14,978 at January YTD)

YTD January 2019 performance adversely above target

at 17,997

Domain 5 -Bloodstream

Infections Ecoli

(Target 181 cases at year end)

At February 2019 reporting 165 cases

against the YTD target of 166


Infections (Target 4,981)

Trimethoprim Nitrofurantoin - 70 yrs+

At December 2018reporting 3,043

(12 month rolling)


Infections(Target 0.965)

STAR-PU

At December 2018 reporting 1.281

(12 month rolling)

Domain 3 - Continuing Healthcare

(Target <15%)

At quarter 3 2018/19 0% of assessments completed in an

acute hospital setting

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Appendix 2 – Red Rated Measures

Area Indicator Name Latest Period

Latest Data Target

Improving on

previous period?

Infections Number of MRSA infections Feb-19 YTD 2 0 Static

Ambulance

Ambulance Response – Category 2 – Best Response Average

Feb-19 00:29:48 00:18:00 Yes

Ambulance Calls – Category 2 90th Percentile Feb-19 01:03:38 00:40:00 No



Ambulances - Proportion of incidents managed without need for transport to Accident and Emergency departments

Feb-19 32.1% 40.0% Yes

Mental Health

IAPT - Average number of treatment sessions Nov-18 7.3 8.0 Yes

IAPT Access Q2 2018/19 3.3% 4.8% Yes

Estimated diagnosis rate for people with dementia for registered patients Resident population is rated GREEN and both populations above national 77% target

Feb-19 77.3% 79.8% (local target)

No

Proportion of people with a learning disability on the GP register receiving an annual health check

2017/18 50.2% 51.4% Yes

Mental Health Acute – out of area placements per 100,000 population Reported zero in month for Dec-18

Dec-18 YTD 176.22 90.16 Yes

Proportion of people on GP severe mental illness register receiving physical health checks

Q2 2018/19 17.9% 60% Static

Cancer

62-day wait for first treatment following referral from a NHS cancer screening service YTD measure is rated GREEN

Jan-19 86.7% 90.0% Yes

All cancer two month urgent referral to first treatment wait YTD measure is rated GREEN

Jan-19 80% 85.0% No

31-day standard for subsequent cancer treatments-surgery YTD measure is rated GREEN

Jan-19 86.7% 94.0% No

104 day cancer breaches Jan-19 YTD 22 0 Static

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Cancers diagnosed at early stage 2017 54% 57% Yes

Urgent Care

Total Non-Elective Spells (Specific Acute) with a zero LOS Jan-19 1,212 1,016 No

Total Non-Elective Spells (Specific Acute) Latest month is rated GREEN

Jan-19 2,560 2,586 No

Total Non-Elective Spells (Specific Acute) with a 1+ LOS Jan-19 1,823 1,570 No

Emergency admissions for urgent care sensitive conditions per 100,000 population *Local data = 3,223 (Q3 18/19) RED

Q1 2018/19 3,345 2,371 Yes

Emergency bed days per 1,000 population *Local data = 561 (Q3 18/19) RED

Q1 2018/19 532 500 No

A&E 4 Hour Target Performance Feb-19 84.2% 95.0% Yes

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive conditions *Local data = 3,824 (Q3 18/19) RED

Q1 2018/19 3,082 2,074 Yes

Right Care Expenditure in areas with identified scope for improvement

Q2 2018/19 Red Green N/A

End of Life

% of deaths with three or more emergency admissions in the last three months of life *Local data = 12.6% vs target of 11.2% in Q3 18/19

2017 6.2% 5.4% Yes

Personal Health

Budgets

Number of personal health budgets in place per 100,000 CCG population

Q3 2018/19 58.7 80.7 Yes

Planned Care

NHS e-Referral Service (e-RS) Utilisation Coverage Dec-18 68.3% 100% No

Incomplete RTT pathways performance (52 week) *data does not include STHK

Jan-19 YTD 14 0 Static

Total Other Referrals (G&A) for a first Appointment Jan-19 2,846 2,530 Yes

Consultant Led First Outpatient Attendances (Specific Acute) Jan-19 6,123 5,533 No

Consultant Led Follow-Up Outpatient Attendances (Specific Acute)

Jan-19 14,847 13,289 Yes

Expenditure in areas with identified scope for improvement

Q1 2018/19 Red Green Static

Number of cancelled operations on or after the day of admission (STHK Only)

Dec-18 YTD 1 0 Static

Prescribing Anti-microbial resistance: Dec-18 1.281 0.965 Yes

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Appropriate prescribing of antibiotics in primary care

rolling 12 months

High-risk atrial fibrillation patients on anti-coagulant drug therapy (Snapshot). Target derived from all practices below the CCG average of 89.03% being brought up to that figure and practices above that maintaining.

Mar-19 81.8% 91.6% No

Quality Number of Mixed Sex Accommodation breaches

Jan-19 YTD 2 0 Static

Public Health Maternal smoking at delivery Q3 2018/19 12.5% 9.7% Yes

Primary Care Primary care workforce - GPs and practice nurses per 1,000 population

Mar 18 0.74 1.04 No

Corporate Progress against Workforce Race Equality Standard 2017 0.09 0.13 No

Children, Young People

& Maternity

Emergency admissions for children with lower respiratory tract infections (LRTIs)

Jan-19 YTD 505 444 Yes

Percentage of children waiting less than 18 weeks for a wheelchair

Q3 2018/19 59.9% 95.5% No

% children aged 10-11 classified as overweight or obese 2016/17 38.5% 34.2% No

Choices in maternity services 2017 54.3 60.8 No

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Appendix 3 – Green Rated Measures


Latest Data Target

Improving on

previous period?

Infections Number of C.Difficile infections Feb-19

YTD 33 70 Yes

Number of E.coli infections Feb-19 YTD 165 166 No

Urgent Care

% of 30 day Readmissions Jan-19 10.3% 11.7% Yes

Total A&E Attendances (Excluding Planned Follow-Up Attendances) Jan-19 9,136 9,788 No

% of deaths with three or more emergency admissions in the last three months of life (Proxy - Hospital Deaths only) *National data – 6.2% (2017) RED

Q2 2018/19 15.4% 16.4% Yes

Total A&E Type 1 Attends - (Excluding Planned Follow up Attendances)

Jan-19 4,801 4,974 No

Ambulance Ambulance Calls – Category 1 90th Percentile Feb-19 00:14:07 00:15:00 Yes

Cancer

Cancer two week wait for breast symptoms Jan-19 95.0% 93.0% Yes

All cancer 2 week wait YTD measure is rated RED Jan-19 94.0% 93.0% No

% of patients receiving first definitive treatment within one month of a cancer diagnosis

Jan-19 97.5% 96.0% Yes

31-day standard for subsequent cancer treatments - anti cancer drug regimens

Jan-19 100% 98.0% Yes

31-day standard for subsequent cancer treatments – radiotherapy Jan-19 95.5% 94.0% No

62-Day wait for first treatment for cancer following a consultant’s decision to upgrade the patient’s priority

Jan-19 94.1% 85.0% Yes

One-year survival from all cancers 2015 72.3% 72.3% Static Cancer patient experience 2017 8.9 8.8 Yes

Mental Health

Dementia care planning and post diagnostic support 2016/17 78.4% 78.1% Static

Delivery of the Mental Health investment standard

Q2 2018/19 Compliant N/A

The proportion of people that wait 6 weeks or less from referral to their first IAPT treatment appointment

Nov-18 96% 75.0% No

IAPT - The proportion of people that waited less than 28 days from their first treatment appointment to their second treatment

Nov-18 11.9 28 No

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appointment % of CPA inpatients discharges followed up within 7 days *Local data = 92.9% (Jan-19) RED

Q3 2018/19 97.9% 95.0% Yes

The proportion of people that wait 18 weeks or less from referral to their first IAPT treatment appointment

Nov-18 96% 95.0% No

Completeness of LD Register 2017/18 0.51% 0.49% Yes

IAPT Recovery Rate Nov-18 51.0% 50.0% Yes

Psychosis treated with a NICE approved care package within two weeks of referral

Jan-19 100% 50.0% Yes

Reliance on specialist inpatient care for people with a learning disability and/or autism

Jan-19 61 64 Yes

Children, Young People

& Maternity

The proportion of CYP with Eating Disorders (urgent cases) that wait 1 week or less from referral to start of NICE-approved treatment

Q3 2018/19

No Activity 100% Static

The proportion of CYP with Eating Disorders (routine cases) that wait 4 weeks or less from referral to start of NICE-approved treatment

Q3 2018/19 100% 100% Static

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

Jan-19 YTD 276 315 Yes

Women’s experience of maternity services 2017 83.1 83.0 Yes

Planned Care

Total Elective Spells (Specific Acute) Jan-19 2,593 2,526 No

Total Referrals made for a First Outpatient Appointment (General & Acute) YTD measure is rated RED

Jan-19 6,412 6,459 No

% of patients waiting 6 weeks or more for a diagnostic test Jan-19 0.88% <1% No

Total GP Referrals made for a First Outpatient Appointment (General & Acute)

Jan-19 3,566 3,929 No

Incomplete RTT pathways performance *Some months do not include STHK data

Jan-19 94.2% 92.0% Yes

Number of Completed Non-Admitted RTT Pathways *Some months do not include STHK data

Jan-19 19,771 45,828 No

Number of completed admitted RTT pathways *data does not include STHK

Jan-19 YTD 5,650 12,250 No

Number of new RTT pathways Nov 18 1,803 6,963 Yes

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(clock starts) *data does not include STHK Delayed transfers of care attributable to the NHS and Social Care per 100,000 population

Jan-19 6.9 10.4 No

Public Health

People with diabetes diagnosed less than a year who attend a structured education course *National Data = 9%

Feb-19 11.6% 7.3% Yes

Neonatal mortality and still births per 1,000 births 2016 3.0 4.8 No

Injuries from falls in people aged 65 and over per 100,000 population

Jan-19 1,880 2,600 Yes

Diabetes patients that have achieved all three of the NICE-recommended treatment targets

2017/18 43.6% 38.7% Yes

Prescribing

Anti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics in primary care

Dec-18 rolling

12 months

6.7% 10.0% No

A 30% reduction (or greater) in the number of trimethoprim items prescribed to patients aged 70 years or greater

Dec-18 rolling

12 months

3,043 4,981 Yes

Carers The proportion of carers with LTC who feel supported to manage their condition

2018 0.63 0.59 No

Primary Care

Primary Care Access - Extended access to GP services on a weekend and evening

Oct-18 100% 100% Yes

Completeness of the GP LD Register 2016/17 49.2% 47.3% Static

Patient experience of GP services 2018 83.8% 83.8% No Total investment in Primary Care (£3 per head)

Q3 2018/19 Fully Compliant Static

Corporate

Probity and corporate governance Q2 2018/19 Fully Compliant Static

Staff engagement index 2017 3.87 3.78 Yes Quality of CCG Leadership Q2

2018/19 Green Green Static

Continuing Health Care

Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting

Q3 2018/19 0% 12% Static

CHC Part 1:To complete a timely provision of assessment information, specialist assessments, attendance at Multidisciplinary Team (MDT) meeting, and prompt verification and eligibility decision processes within 28 days

Q3 2018/19 90% 80% Yes

CHC Part 2: Assessment of eligibility for NHS Continuing

Q3 2018/19 0% 15% Static

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Healthcare should usually be deferred until an accurate assessment of future needs can be made following post-acute recovery.

Amber Rated Measures


Latest Data Target

Improving on

previous period?

Ambulance Ambulance Response – Category 1 – Best Response Average

Feb-19 00:08:33 00:07:00 No

Finance In year financial performance Q2 2018/19 Amber Green Static

Infections Sepsis Awareness 2017 Amber Green Static

Corporate Compliance with statutory guidance on patient and public participation in commissioning health care

2017 Amber Green Static

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GLOSSARY of TERMS

AQP Any Qualified Provider

BCF Better Care Fund

CAO Clinical Accountable Officer

CCG Clinical Commissioning Group

C&B Choose and Book

CHC Continuing Health Care

CQA Clinical Quality and Approvals

CQC Care Quality Commission

CCSP Clinical Commissioning Strategic Plan

CSU Commissioning Support Unit

CQUIN Commissioning for Quality and Innovation

DH Department of Health

E&D Equality & Diversity

ESD Early Supported Discharge

FARG Finance and Activity Review Group

FIMS Financial Information Management System

FT Foundation Trust

GB Governing Body

IAPT Integrated Access Point to Treatment

IPSG Integrated Programme Strategy Group

JSNA Joint Strategic Needs Analysis

KLOE Key Line of Enquiry

KPI Key Performance Indicators

LAT Local Area Team

LSP Local Strategic Partnership

LMC Local Medical Committee

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MIAA Mersey Internal Audit Agency

MM Medicines Management

NCA Non-Contracted Activity

NCB National Commissioning Board

NEL Non Elective

NPFIT National Programme for Information Technology

PbR Payment by Results

PCT Primary Care Trust

PPA Prescription Pricing Authority

QIPP Quality, Innovation, Productivity and Prevention

RTT Referral to Treatment

SHA Strategic Health Authority

StH&KHT St Helens & Knowsley Hospitals Trust

TFA Tripartite Formal Agreement

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