NHS Merton CCG. Proposed Changes to the NHS Merton CCG Constitution October 2015

Transcription

1 NHS Merton CCG Proposed Changes to the NHS Merton CCG Constitution October 2015 SPONSOR: Dr Andrew Murray, Chair of Merton Clinical Commissioning Group AUTHOR: Adam Doyle, Chief Officer, Merton Clinical Commissioning Group TO BE CONSIDERED B: NHS Merton CCG Membership 1. SUMMAR The National Health Service Act 2006 (the Act ), as amended by the Health and Social Care Act 2012 requires that a Clinical Commissioning Group adopts a constitution. The NHS Merton Clinical Commissioning Group Constitution sets out the terms on which NHS Merton Clinical Commissioning Group (the CCG ) will exercise its statutory function of commissioning services for the purposes of the health service in England. The current Constitution has been in effect from 1 April 2013, being the date on which NHS England established the CCG. The last updates to the Constitution were made on 14 November Further changes relating to the joint commissioning of primary care services were agreed by the CCG Governing Body on 26 February 2015 and need to be enacted in the Constitution. For sake of completeness this report restates those changes, which were agreed in preparation for the Joint Commissioning of Primary Care Services that commenced on 1 April The Constitution has been reviewed in partnership with the South East Commissioning Support Unit (SECSU), in particular with the SECSU Corporate Affairs Team. A number of updates have been identified which are detailed in this report. The main changes are summarised as follows: The Chair and Chief Officer recognise that clinical engagement and leadership need to be further strengthened in the CCG. In line with this the current governance structure has been reviewed and a new governance structure is

2 proposed. This new structure will strengthen clinical engagement and leadership, particularly through the creation of a Clinical Transformation Committee as a formal Committee of the CCG Governing Body. Parts of the Constitution have been substantially rewritten by Capsticks Solicitors to incorporate the power to enter into Joint Commissioning arrangements for Primary Care Services with NHSE and other CCGs. The changes were approved by the SW London Joint Committee for Commissioning Primary Care Services. NHSE are a member of this Committee and the changes were formally approved by NHSE as part of the Joint Commissioning Submission process. Three appendixes are attached to this report: Appendix 1lists all proposed changes identified since the Constitution was last submitted to NHS England in November Appendix 2 shows the current and proposed governance structure for the CCG. Appendix 3 comprises the NHS England Checklist for submitting changes. With the exception of Joint Commissioning for Primary Care Services, none of the proposed changes alter the functions, roles or responsibilities of Merton CCG or the population and geographical area it is responsible for. The Chair and Chief Officer request the support of the Membership to update the CCG Constitution to: Strengthen clinical leadership Increase clinical engagement Update matters of fact Add clarity to existing statements and remove redundant statements Reflect changes in local and national policy Once support has been given by the Membership and, following this, the Governing Body all changes to the Constitution must be submitted to NHS England for final approval. This is one of the conditions governing every CCGs relationship with NHSE. MEMBERSHIP INVOLVEMENT: This paper seeks the support of the Membership. SELF CERTIFICATION for NHSE: Please see Appendix 3 PUBLIC AND USER INVOLVEMENT: Please see Appendix 3, Application Checklist

3 IMPACT ASSEESMENT: The proposed changes are considered to have either positive or neutral impact. Further detail on the impact of each proposed change can be found in Appendix 1. RECOMMENDATIONS: The Membership is asked to:- 1. SUPPORT the changes to the Constitution listed in Appendixes 1 and 2. ACRONMS: Not applicable SPONSOR CONTACT: Name: Dr Andrew Murray Andrew.murray@mertonccg.nhs.uk AUTHOR CONTACT: Name: Adam Doyle adam.doyle@mertonccg.nhs.uk Telephone:

4 APPENDIX 1 Appendix 1: Merton CCG Constitution Requested Changes October 2015 Ref ORIGINAL Page Reference Amendments actioned in draft since the changes to the Constitution approved in November 2013 NEW Page Reference Reason For Change Impact 1. Throughout document Minor stylistic, accuracy and grammatical changes. Document numbering system simplified where appropriate. Throughout document To improve the clarity and consistency of the Constitution None 2. Page 2 Chairs Statement: Rewritten 3. Page 6 Paragraph 1.1 Updated to make statements current Page 2 The CCG has a new Chair and the Chair s Statement been updated accordingly. Page 7 Statements in paragraph out of date None Positive Impact Restatement of CCG values by new Chair/ relaunch of Constitution. 4. Page 6 Paragraph 1.1 Page 7 Bullet point added for the Conflict of Interests Policy Positive reminds reader that Conflicts of Interest Policy is a key document. 5. Page 7 Paragraph References to Crown Immunity removed. Page 9 The rationale for deleting these sentences is that Crown Immunity was removed from the NHS approximately 25 years ago and as such this statement is redundant. None 6. Page 7 Paragraph 2.5 Text changed to The Governing Body shall oversee the executive functions of the CCG as undertaken by its appointed officers. Page 9 To confirm that the CCGs appointed officers carry out the executive functions of the CCG None 7. Page 7 Paragraph Reference to unincorporated association removed and replaced with descriptive sentence. Page 9 To add clarity and improve understanding of the status of the association. None 8. Page 7 Paragraph Reference to a clinical leadership team removed 9. Page 8 Paragraph 2.6 Vision and Strategic Goals Updated to reflect current thinking and priorities Page 9 To avoid misinterpretation of the term. None Page 10 Out of date last reviewed in November 2013 Positive Impact - Constitution will reflect the agreed vision and strategic goals for 2015/16 and moving forward. 10. Page 8 Bullet point added for preventative care Page 10 To stress the importance of taking a preventative approach to commissioning Positive - Stresses the importance of taking a preventative approach to commissioning 11. Page 8 Bullet point added for preventative care Page 11 To stress the importance of taking a preventative approach to commissioning Positive - Stresses the importance of taking a preventative approach to commissioning

5 12. Page 11 Paragraph 3.3 Title changed from Register of Members to Register of Practice Leads Page 14 To accurately reflect the purpose and content of the paragraph None 13. Page 20 Paragraph 5.6 Updated to clarify the arrangements for the joint Charitable Funds Committee with Sutton CCG. Page 23 To clarify the arrangements for the joint Charitable Funds Committee with Sutton CCG. None 14. Page 20 Add paragraph 5.7 and 5.8 detailing the functions of the new CCG Clinical Transformation Committee and the SWL Joint Commissioning Group for Primary Care. Page 24 Inserting summary statements of the Committee/ Group in accordance with CCG / PLF decision making Positive: Reflects arrangements of the CCG accurately 15. Page 24 Part 7 Annual Report Updated to make statements current Page 28 Current statement is out of date None 16. Page Part 9: Third Party Engagement/Collaborative Working Page Substantially rewritten by Capsticks Solicitors to incorporate the power to enter into Joint Commissioning arrangements for Primary Care Services with NHSE and other CCGs. Approved by the CCG Governing Body on 26 February 2015 and the SW London Joint Committee for Commissioning Primary Care Services. NHSE is a member of this Committee and the changes were formally approved by NHSE as part of the Joint Commissioning Submission process. Positive Impact - Allows Merton CCG to jointly commission primary care services on behalf of the residents of Merton. 17. Page 30 Part 10: Conflicts of Interest text substantially reduced and section cross referenced to a standalone and detailed Conflicts of Interest Policy. Detailed policy removed from Constitution. Page 37 As advised by Capsticks solicitors as part of the preparations for Joint Commissioning of Primary Care Services None. Please note: the standalone policy has been updated to comply with Managing conflicts of interest: statutory guidance for CCGs, December This was also in preparation for Joint Commissioning of Primary Care Services 18. Page 33 Paragraph 11.1 Updated by Human Resources to clarify that the CCG can pay its remuneration and travelling or other allowances as determined either by NHS Terms and Conditions or for Very Senior Managers by the Governing Body Page 40 Original wording was more general resulting in an unintentionally incorrect power being inferred. Positive Impact corrects unintentional but potentially misleading statement.

6 19. Page 43 Schedule BP4 Change 4 th NHS Guiding Principle to The patient will be at the heart of everything the NHS does. Page 51 To reflect the updated NHS Constitution July 2015 Positive Impact changes the aspiration to a requirement. 20. Page 50 Schedule 4 Removal of reference to Sutton and Merton PCTs Page 58 Reflecting the current commissioning environment and that established by the Health and Social Care Act. Positive updates the Constitution to reflect accurately the commissioning landscape 21. Page 57 Schedule 8 Removal of statement 1.1 which added no value due to duplication 22. Page Appendix 1 and 2: Updated to reflect reduction in number of localities from 3 to 2. Please note: List of Practice Members is not affected by this change. Page 64 Reducing duplication None Page Agreed by the Membership as a better way of working Positive Impact - improved clinical engagement and internal management 23. Pages 64 to 93 (Appendix 3-9) Appendix 3 to 10: Terms of Reference for Governing Body Committees reviewed and updated to reflect current arrangements, including Practice Leads Forum Page To ensure all terms of reference are up to date None 24. Original Page 67 Original Appendix 4, Governing Body Terms of Reference removed and main provisions incorporated into standing orders. Text Removed As advised by Capsticks solicitors as part of the preparations for Joint Commissioning of Primary Care Services and on the grounds that the Governing Body is not a Committee None - the functioning of the Governing Body remains unchanged 25. New Text Appendix 9: Terms of Reference for Clinical Transformation Committee written, approved and inserted into Constitution. Page 100 The Clinical Transformation Committee will be a formal Governing Body Committee. This will significantly strengthen clinical leadership and engagement. Positive Impact strengthened clinical leadership and engagement. 26. New Text Appendix 10: Terms of Reference for Joint Committee for Primary Care Commissioning inserted into Constitution. Page 104 As advised by Capsticks solicitors as part of the preparations for Joint Commissioning of Primary Care Services Positive Impact - Allows Merton CCG to jointly commission primary care services on behalf of the residents of Merton. 27. Page 94 (Appendix 10) Appendix 11 Standing Orders Job Titles updated and consistency achieved in the use of job titles: Chair (of the Governing Body) Vice Chair (Lay Member) Deputy Clinical Chair (GP) Page 110 onwards To add clarity and consistency to roles and processes Positive Impact adds clarity to roles and processes.

7 28. Page 94 Appendix 11 Section 2: Chair and Deputy Chair Appointment: Composition of membership, key roles and appointment process separated to make the process for electing a Chair consistent with local process and precedent and provide a clear process for nomination of a Deputy Chair Clinical). Page 111 To ensure the Constitution reflects local agreed process and the need for and occurrence of elections is clearly set out. Positive Impact clarifies the process and ensures consistency. 29. Page 94 Appendix 11 Section 2: Chair and Deputy Chair Appointment: Composition of membership, key roles and appointment notice period for Chair brought into line with requirements of the Chief Officer Page 111 To maximise CCG opportunity for continuity. Positive Impact clarifies the process and ensures consistency. 30. Page 96 Old Paragraph Process for selecting GP practice representatives rebadged as a selection process rather than a selection and election process. Page 113 Section 3 To more accurately describe the process involved. None the actual process remains unchanged. 31. Pages 98 to 99 Paragraph 2.5 The wording for the terms of office of the Lay Members (x2), Independent Nurse Member and Secondary Care Specialist Doctor strengthened Page 114 and 115 paragraphs 3.3 to 3.5 To clarify that while appointments will last between 2 and 3 years to meet the needs of the CCG, that a start date, term of office and end date will be agreed with each post holder on appointment. Positive Impact clarifies position. 32. Pages 98 Paragraph 2.5 The wording of the roles of the Lay Member clarified to include the governance position of Vice Chair Page 114 paragraph 3.3 To clarify roles and functions within the CCG and ensure consistency of descriptions within the Constitution. Positive Impact clarifies position. 33. Pages 98 to 99 Paragraph 2.5 The wording of the eligibility criteria for the Independent Nurse Member and Secondary Care Specialist Doctor strengthened Page 114 & 115 paragraphs 3.4 and 3.5 To clarify CCG compliance with national guidance. Positive Impact clarifies position. 34. Pages 99 Paragraph The wording for the notice period for the Chief Officer amended to 6 months Page 116 paragraph 3.6 The wording for the notice period of the Chief Officer amended to reflect current NHSE practice Positive Impact clarifies position. 35. New Text Appendix 11 paragraph 3.8 added to clarify the appointment process for GP representatives on the Governing Body Page 116 Clarifies the appointment process for GP representatives on the Governing Body Positive Impact - clarifies the appointment process for GP representatives on the Governing Body

8 36. Pages Section 4.6 impose consistency in use of term s Chair, Vice Chair, and Deputy Clinical Chair Page 117 Section 4 To more accurately describe the process involved. None the actual process remains unchanged. 37. New Text Appendix A added to Standing Orders to incorporate the main provisions for the functioning of the Governing Body. Page 127 As advised by Capsticks solicitors as part of the preparations for Joint Commissioning of Primary Care Services None the functioning of the Governing Body remains unchanged 38. New Text Appendix A Substantive Provisions (GB) confirmed that one of the Lay Members will act as Vice Chair in circumstances specified by the Constitution. Page 127 Wording updated to clarify existing arrangements. None the functioning of the Governing Body remains unchanged 39. Page 108 Standards Of Business Conduct And Managing Conflicts Of Interest Detailed Conflicts of Interest Policy removed and section cross referenced to detailed standalone Policy. Text Removed page 132 As advised by Capsticks solicitors as part of the preparations for Joint Commissioning of Primary Care Services None. Please note: the standalone policy has been updated to comply with Managing conflicts of interest: statutory guidance for CCGs, December This was in preparation for Joint Commissioning of Primary Care Services 40. Page 117 Appendix 12 Financial Policies Reviewed and updated as necessary and instructed by the Audit and Governance Committee March 2015 Page 133 Appendix 13 To reflect current national policies and guidance Positive Impact Ensures financial policies are up to date 41. Page 163 onwards Appendix 13 Scheme of Delegation and Reservation: Page 182 Appendix 14 To clarify arrangements Positive clarifies arrangements Reviewed and updated as necessary and instructed by the Audit and Governance Committee March Page 163 onwards Appendix 13 Scheme of Delegation and Reservation: Page 182 Appendix 14 To clarify arrangements Positive clarifies arrangements Specifying GB delegations to specific Committees the GB has delegated responsibilities to.

9 Current Governance Structure Appendix 2

10 Proposed Governance Structure Appendix 2

11 CCG Constitution Update October Application to NHSE (Checklist) CCG name: Merton CCG Type and brief description of Constitution Change (mark all that apply) Variations to CCG Constitution (excluding CCG mergers or dissolutions): CCG Merger: N/A APPENDIX 3 Merton CCG requests permission to update its CCG Constitution for matters of fact, to add clarity to existing statements or because national or local policy has been updated. For sake of completeness this document incorporates the changes agreed by NHS England in preparation for the Joint Commissioning of Primary Care Services that commenced on 1 April Dissolution of CCG: N/A APPLICATION CHECKLIST Criteria The reason why a variation is being sought Contained in application (/N)? The proposed varied constitution with the amended clauses clearly signposted Assurance that member practices have agreed to the proposed change(s) Assurance that stakeholders have been consulted if required A self-certification by the Chair or Accountable Officer, on behalf of the CCG, that the revised constitution continues to meet the requirements of the Act. Assurance that the CCG has considered the need for legal advice on the implications of the proposed changes, including whether advice has been sought.

12 Appendix 3 A completed impact assessment of the changes, which should cover as a minimum the factors required to be considered by NHS England set out below. Factors for NHSE to consider Considerations Does the constitution meet the requirements of legislation and is otherwise appropriate? Is each of the members a provider of primary medical services? Is the area appropriate (i.e. that there are no overlapping CCGs and no gaps)? Is the proposed Accountable Officer appropriate? Has the CCG has made appropriate arrangements to ensure it is able to discharge its functions? Has the CCG made arrangements to ensure that its governing body is correctly constituted and otherwise appropriate? The likely impact of the requested variation on the persons for whom the CCG has responsibility the registered and resident population of the CCG been considered? (What is the likely impact?) Will there be an impact on financial allocations for the financial year in which the variation would take effect? (if yes please provide further details) CCG Response: es. es. es. es. es. es. No alterations to the functions of the CCG other than: No. To establish the ability of the CCG to enter into Joint Commissioning arrangements for Primary Care Services (positive impact) To increase clinical leadership and engagement in the CCG (positive impact). Will the change impact on NHS England s function? (if yes please provide further details) es. Establishes the ability of the CCG to enter into Joint

13 Appendix 3 Commissioning arrangements for Primary Care Services with NHSE. Has the CCG sought and taken into account the views of the following; any local authority whose area covers the whole or any part of the CCG s area; any other CCG which would be affected; and any other person or body which in the CCG s view might be affected by the variation requested, es as part of the Joint Committee arrangements for Joint Commissioning in South West London. Also partners have been made aware, as appropriate, and participate in meetings of the CCG where this work has been discussed Has the CCG(s) suitably sought and taken into account the views of patients and the public? The public participate in meetings of the Governing Body where this work has been discussed. The CCG and the Membership have taken a considered and proportionate view as to the scale and impact of these changes and communicated accordingly. How often has the CCG applied for variation(s) of this kind before? This is the first occasion since a submission in November The detailed variations in the current submission have not been applied for before. Self-certification by the Chair and Chief Officer of Merton CCG, on behalf of the CCG, that the revised constitution continues to meet the requirements of the Act We the undersigned certify that the revised constitution will continue to meet the requirements of the NHS Act 2006 as amended by the Health and Social Care Act 2012 and is otherwise appropriate. Signature: Date: 12 October 2015 Dr Andrew Murray, Chair of Merton Clinical Commissioning Group Signature: Date: 12 October 2015 Adam Doyle, Chief Officer, Merton Clinical Commissioning Group