Primary Care Commissioning Next Steps to Delegated Commissioning September Board Paper. 2.0 Delegated Opportunities, Benefits and Risks

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1 Primary Care Commissioning Next Steps to Delegated Commissioning September Board Paper 1.0 Introduction This paper provides a briefing to the Wandsworth CCG Board on our progress in developing a Primary Care Commissioning Programme in Wandsworth as part of the wider transforming primary care programme. Previous papers to the Board have provided detail on our progress to date and addressed the potential opportunities and risks associated with taking on fully delegated primary care functions in the future. This paper should be read in conjunction with the Delegated Commissioning paper submitted by South West London Collaborative Commissioning (SWLCC) which provides an update on matters relating to delegated commissioning for each of the South West London CCG Governing Bodies to support the decision making process. This paper details our local progress to date updating on the developments of the work programme and how the CCG is ensuring that we will be in a position to take on fully delegated commissioning responsibilities in the future whilst addressing some of the previous concerns raised by the Board. 2.0 Delegated Opportunities, Benefits and Risks Delegated Commissioning arrangements give CCGs full responsibility for commissioning general practice services. Legally NHSE will retain the residual liability for the performance of primary medical care commissioning and as such NHSE will require assurance that its statutory functions are being discharged effectively by the CCG. The formal liability for primary care commissioning for legal reasons will remain with NHS England although individual CCGs will remain accountable for meeting their statutory duties for instance in relation to quality, financial resources and public participation. Delegated responsibilities will include: Contractual GP performance management Budget management Complaints management Design of local incentive schemes as an alternative to QOF and DES contracts Delegated commissioning arrangements will exclude any individual GP performance management. NHSE will also be responsible for the administration of payments and list management Legally NHSE will retain the residual liability for the performance of primary medical care commissioning. Therefore will require robust assurances that its statutory functions are being discharges effectively Delegated commissioning excludes functions reserved to NHS England but CCGS will be expected to work collaboratively with NHS England and will assist and support NHS England to carry out these 1

2 Reserved Functions. These Reserved Functions include individual GP performance management, administration of payments and performers list management, Section 7A (Public Health) functions and funds, capital expenditure functions and funds, complaints management and decisions in relation to the Prime Ministers Challenge Fund. Fully Delegated Commissioning offers an opportunity for CCGs to assume full responsibility for commissioning general practice services. Opportunities and benefits that exist within full delegation arrangements include: GPs in CCGs to have direct leadership to influence the development of investment in general practice CCGs will be best place to commissioning primary, community and secondary care in holistic and integrated manner Ability to design local schemes to replace QOF and DESs based on local knowledge CCGs will have more power to drive forward the five year forward agenda Greater freedom for how primary care finances are used Local decisions closer to patients needs Ability to use innovative commissioning to implement local priorities Better care for patients via joined up working Tailored services to meet the local needs of the patient population Local patients have greater opportunities to input and influence Creates the ability to develop and commission end to end care Adopting fully delegated arrangements for Primary Care Commissioning Services will benefit patients as it will provide a greater opportunity for them to influence local service delivery as CCGs take a more active role in commissioning primary care services. This will mean the provision of local services that are better suited to address local needs and priorities. The increased control over locally commissioned services will enable us to develop more seamless, joined up patient pathways and end to end patient care. By delivering these services we can ensure a better patient experience e.g. if we want to have better access to care over the weekend or out of hours, this can be achieved as a result of GPs working closely together. The more GPs that work together to address this issue, the greater the likelihood that we will be able to make it a reality. The choice on whether we wish to move towards a fully delegated approach in 2016/17 is not without its risks and it is proposed that the CCG Primary Care Commissioning Implementation Group work through identifying these risks and establish systems and/or processes to mitigate against these. Risks associated with adopting the fully delegated approach include: CCG has full accountability if it goes wrong Limited access to resources to perform well Performance management places tension between the CCG and its Members Increase in expectation from NHSE in contract management and complaints handling Failure to deliver effective commissioning plans will undermine the whole primary care transformation plan 2

3 Reliant on IT and practice data sources being shared outside of Primary care Reputational risk if failure occurs Under delegated arrangements there are additional risks in terms of the increased responsibilities associated with this option and there is lack of clarity from NHSE of the exact resources to be allocated and the impact of undertaking additional functions at an individual CCG level. 3.0 Primary Care Commissioning Update 3.1 Progress to date In July the Board agreed in principle that they were confident that a move to delegated commissioning would be the most suitable option for Wandsworth, although further assurances would be required in order to make the formal decision in September. The Board asked for more detail on the governance arrangements in place to support Primary Care Commissioning as well as more information on the due diligence associated with potentially taking on these new responsibilities. Much of the progress taken place over the last two months has been to ensure that we can provide further assurances to the Board in order to make a final decision our future approach to primary care commissioning. 3.2 High Level Work Programme The work programme for the Primary Care Commissioning Implementation Group (PCCIG) can be split into two; in terms of a local implementation programme for Wandsworth and then to ensure the delivery of the requirements of the Joint Committee and meeting any associated programme timeframes. Below details the high level priorities for the Wandsworth PCCIG, which will ensure that we successfully deliver Primary Care Commissioning in Wandsworth and meet the requirements associated our current responsibilites under the Joint Commissioning arrangements in 2015/16. Working through the specific requirements for a move to full delegation from 2016/17 Submission and application process to NHS England Development of the 'Primary Care Committee' as part of the requirements for delegated commissioning Financial Development - managing the risk within the framework of moving to delegated commissioning Development of the governance arrangements to support fully delegated commissioning Reviewing capacity and resources to ensure that there is sufficient capacity, resources and skills to take on delegated commissioning including contract management, payment authorisation etc. Support the PMS Review Programme in conjunction with NHS England Area Team Development of a comprehensive Communication and Engagement Plan To provide a forum for Wandsworth specific discussion/decisions that are required by NHS England Area Team i.e practice closures, GP retirements Developing the future Quality performance indicators for Primary Care 3

4 The delivery of this workplan is fundamental in ensuring that Wandsworth will be in a position to take on the functions assocaited with delegated arrangements aiming to locally address some of the risks associated with delegated commissioning. 3.3 Governance Arrangements The Primary Care Commissioning Implementation Group (PCCIG) has been established the aim of which is to operationalise the vision and strategy for Primary Care Commissioning more specifically to enable to the CCG to move forward with taking on fully delegated primary care commissioning functions from April This group will act as the formal Wandsworth CCG Working Group as required by the South West London Joint Committee and as such will support the Committee requirements and associated work programme until Wandsworth is in a position to take on the fully delegated primary care functions. The membership of this group includes the three Wandsworth representatives on the Joint Committee, with the purpose of ensuring effective lines of communication between the Joint Committee and the CCG. The Terms of Reference (TORs) for the group are currently being finalised but it s important to note that these stipulate that this group will be established on an interim basis with the sole purpose of supporting the work programme to establish delegated commissioning arrangements. These TORs also make reference to the wider context of our overarching Primary Care Transformation Strategy; consequently it is important to recognise that there will be additional groups that will have interdependencies with the work programme of the group; namely the Estates Working Group, the Primary Care Transformation Steering Group, GP Resources Committee and the Contract and Procurement Management Group. As part of the future requirements to move to fully delegated commissioning arrangements the CCG need to ensure that we have a Primary Care Committee in place in order for NHS England to effectively discharge the functions associated with primary care commissioning. As part of the governance structure in development it is proposed that the current GP Resources Committee take the place of the Primary Care Committee in the future, with the Primary Care Implementation Group charged with supporting this process in order to ensure that we meet the requirements as stipulated by NHS England. Guidance has been released from NHS England in the form of Draft TORs (Appendix A) which detail the requirements of this Committee. 3.4 Engaging with our Members, Patients and the Public Engagements activities have been part of an ongoing programme of work to ensure that Members, Patients and the Public are kept informed on our programme of work associated with Primary Care Commissioning in Wandsworth and have an opportunity to comment on and influence the decisions being made. Our Wandsworth Membership have been kept constantly updated and involved in the decision making throughout this process via focussed Joint Locality Members Forums, and presentations and discussions at all Locality Member Forums to consider the option of moving to delegated commissioning in In addition, to ensure that the Board can confidently make a decision in full 4

5 knowledge of the views of our Members all GPs and Practice Mangers have been asked to feedback via an online survey, any concerns or raise any queries in light of the decisions being made. Of the 270 members surveyed, nineteen (7%) ) responses were received from our Membership, with 8 (3%) individuals either requesting further information or raising concerns; the key themes of which are detailed below Key Themes from our Member s Survey 1. Would you like more information about what Full Delegation may mean for Member Practices, and if so what? Practical Details and Examples Provide a concise summary of what it actually means specifics of the changes and the implications of these changes Contracting KPIs PMS Review process Contracting routes for the future Withdrawing of contracts Process Timescales for the changes When will the CCG be managing the contracts 2. Do you have any concerns about a move to taking on Fully Delegated Commissioning that you would like to raise? Are systems in place to take on delegated short time frame for establishing new structure and processes Does the CCG have the staff, and capacity to do the work Impact of the additional responsibilities on the organisation Do we have systems in place to mange Conflicts of Interest Consequences of taking on delegated commissioning Creating uncertainty What will with impact be on Primary Care staff and their workload Destabilise Primary Care Contracting Process Will there be changes in the funding of contracts How will they be funded Will it create inequalities/inequity in funding for practices Will contract values be reduced In response to the survey a report will be sent back to our Members which will look to address these questions and concerns and provide the additional information as required. Additionally a frequently asked questions (FAQ) leaflet will be developed that will be regularly updated in order to provide a forum for Members to raise any questions and ensure that any additional queries can be answered. A structured programme of patient and public engagement has taken place over the last 11 months which has included regular attendance and presentations at a number of Locality Patient Group meetings, Locality Member Forums and the PPI Reference Group. The general response following these engagement activities is that there is consistent support for a move towards taking on fully delegated commissioning responsibilities from 2016/17 with each group recognising the benefits and opportunities associated with taking on these arrangements. Targeted engagement work is ongoing with the Wandsworth PPI Reference Group to look at how we can continue to meaningfully engage with patients and the public on the subject of Primary Care Commissioning. As part of this work the Group have begun to look at developing our key messages 5

6 on delegated commissioning to ensure that we provide suitable information for the public that explains the subject and reflects our decision processes and outcomes of implementing our work programme. A Communications and Engagement Plan will be developed by the PCCIG which will further outline our plans to continue to effectively engage with members, patients, Public and stakeholders. 3.5 PMS Review Process for As part of the Joint Commissioning work programme for 2015/16 it is understood that the CCG will need to support the PMS review process that is being undertaken by NHS England which is part of a National directive which required a review of all local PMS contracts and to complete this review process by March 2016 at the latest. The purpose of the review is to secure best value from future investment of the premium element of PMS funding. NHS England London Area Team colleagues have stated that they will be providing additional non recurrent resource within the London Team to support the baseline review process, although it has been noted that the time frames associated are exceptionally challenging; with CCGs formally feeding back these concerns. NHS England Area Teams are looking at the data within the contracts and reviewing the KPIs; with the aim of developing a London principle for the premiums for PMS practices. It is clear that any newly developed KPIs should be lined to the 17 specifications including the Strategic Commissioning Framework for London, with the potential for a picking list developed for London which will detail the possible premium options for London CCGs enabling individual organisations to pick those that were are the most appropriate for their area enabling better use of the funding. The Primary Care Implementation Group discussed some of these principles with the NHS England Area Team as there was a concern that it was not sensible to conduct a large scale review until the development of the Multispecialty Community Providers (MCP) model is better established (in 2018) also noting that Wandsworth had previously undertaken a review within the least 3 years and we have some practices who are still in transition as a result. With this is mind it was agreed that a light-touch desktop based review would be the most appropriate approach for Wandsworth looking towards implementing a more robust review process over the next few years in order to ensure that this is completed in conjunction with the wider primary care transformation agenda. 3.6 Delegated Application Process Initial deadlines for our submission to NHS England of our application for delegated commissioning were set at the 2nd October; however these have now been extended to the 6th November to allow CCGs time to complete the application process. This will not change the need to make a formal decision on the direction for Wandsworth at the September Board meeting, however it will provide additional time for us to ensure that we have the information and assurances in place to complete our application. NHS England has recently released a revised application form (Appendix B), and it will be expected that this is completed by the CCG rather than at South West London level as previously with Joint Commissioning. The PCCIG will be responsible for ensuring that information is available to complete the application process and will ensure that the submission timelines are met. 6

7 As such the Board will be asked to delegate the responsibility for completing and submitting the application to the PCCIG in order to meet the timescales involved. As with the 2014/15 process, regional panels will meet to review the proposals and make recommendations to a national panel on which proposals to take forward. It is anticipated that NHS England will compete this process by the end of Next steps due diligence It has been noted that for those CCGs that have taken on delegated commissioning in the first wave there have been a considerable number of legacy issues to manage. As such it has been proposed by the South West London Chief Officers and Chairs that an additional commissioned due diligence exercise is undertaken between September and November to identify any possible areas of risk. The scope of the detailed due diligence exercise will include finance, legal and governance and regulatory issues, the findings of which will be shared with CCGs in December. 5.0 Recommendations The Board are asked to note: The progress to date in developing our local approach to delivering our Primary Care Commissioning Programme and establishing our Primary Care Commissioning Implementation Group. The details included in the South West London Paper and the request to decide whether to proceed with a submission to NHS England on 6th November 2015 to move to delegated commissioning, as of the 1st April 2016, subject to the outcome of the due diligence exercise. The Board are also asked: To delegate the responsibility to the Primary Care Commissioning Implementation Group for the completion and submission of Wandsworth CCG s application to ensure that the correct due diligence is in place as required to complete submission by the 6 th November. 7

8 Appendix A Next steps towards primary care cocommissioning: Annex F Delegated commissioning model-draft terms of reference November

9 Draft terms of reference [insert name] CCG Primary Care Commissioning Committee Introduction 1. Simon Stevens, the Chief Executive of NHS England, announced on 1 May 2014 that NHS England was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG. 2. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to [insert name] CCG. The delegation is set out in Schedule The CCG has established the [insert name] CCG Primary Care Commissioning Committee ( Committee ). The Committee will function as a corporate decisionmaking body for the management of the delegated functions and the exercise of the delegated powers. 4. It is a committee comprising representatives of the following organisations: [insert name] CCG [NHS England]; [insert others as relevant]. Statutory Framework 5. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act. 6. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the Board and the CCG. [insert details as relevant] 9

10 7. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2). 8. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below: Duty to have regard to impact on services in certain areas (section 13O); Duty as respects variation in provision of health services (section 13P). 9. The Committee is established as a committee of the [Governing Body] of each named CCG [Individual agreements should include appropriate provisions consistent with overriding governance arrangements] in accordance with Schedule 1A of the NHS Act. 10. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State. 10

11 Role of the Committee 11. The Committee has been established in accordance with the above statutory provisions to enable the members to [for example] make collective decisions on the review, planning and procurement of primary care services in [insert name of area], under delegated authority from NHS England. 12. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and [insert name] CCG, which will sit alongside the delegation and terms of reference. 13. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. 14. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. 15. This includes the following: GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract); Newly designed enhanced services ( Local Enhanced Services and Directed Enhanced Services ); Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF); Decision making on whether to establish new GP practices in an area; Approving practice mergers; and Making decisions on discretionary payment (e.g., returner/retainer schemes). 16. The CCG will also carry out the following activities: a) [to be completed examples listed below] 11

12 b) To plan, including needs assessment, primary [medical] care services in [insert area]; c) To undertake reviews of primary [medical] care services in [insert area]; d) To co-ordinate a common approach to the commissioning of primary care services generally; e) To manage the budget for commissioning of primary [medical] care services in [insert area]. Geographical Coverage 17. The Committee will comprise the [insert name] CCG [and, if relevant, other named CCGs]. Membership 18. The Committee shall consist of: [insert make-up of committee list of members included as Schedule 3] 19. The Chair of the Committee shall be [insert process for identification/appointment] 20. The Vice Chair of the Committee shall be [insert process for identification/appointment]. 21. [Consider whether others will be non-voting attendees. This should include a standing invite to a HealthWatch representative and a Health and Wellbeing Board representative.] Meetings and Voting 22. The Committee will operate in accordance with the CCG s Standing Orders. The Secretary [amend as relevant to individual CCG arrangements] to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member 12

13 representative no later than [x] days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify. 23. Each member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible. [Reconsider voting procedures following a decision on the make-up of the committee]. Quorum [Insert provisions for quorum. This will need to be consistent with the CCG s Standing Orders and as agreed between the parties. Quoracy will also need to reflect conflicts of interest guidance] Frequency of meetings 24. [Insert provisions for frequency of meetings. The suggested frequency is weekly for the first month and then as agreed after that]. 25. Meetings of the Committee shall: a) be held in public, subject to the application of 23(b); b) the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time. 26. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view. 13

14 27. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions. 29. Members of the Committee shall respect confidentiality requirements as set out in the CCG s [Constitution or Standing Orders, amend as relevant]. 30. The Committee will present its minutes to [insert name of relevant area team] of NHS England and the governing body of [insert name] CCG each month [could be longer] for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 27 above. 31. The CCG will also comply with any reporting requirements set out in its constitution. 32. [It is envisaged that these Terms of Reference will be reviewed from time to time, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.] Accountability of the Committee [Budget and resource accountability arrangements and the decision-making scope of the Committee to be included within this section as agreed] [The CCG will need to review its Standing Financial Instructions and Standing Orders to ensure that are sufficient in the context of delegated commissioning.] [For the avoidance of doubt, in the event of any conflict between the terms of this Scheme of Delegation and Terms of Reference and the Standing Orders of Standing Financial Instructions of any of the members, the latter will prevail.] [Allowance for consultation with members of CCGs / public] 14

15 Procurement of Agreed Services [The detailed arrangements regarding procurement will be set out in the delegation agreement. Please refer to the Next Steps in primary care cocommissioning document for further guidance on this.] Decisions 33. The Committee will make decisions within the bounds of its remit. 34. The decisions of the Committee shall be binding on NHS England and [insert name] CCG. 35. The Committee will produce an executive summary report which will be presented to [insert name of area team] of NHS England and the governing body of [insert name] of the CCG each month [could be longer period] for information. [Signature provisions] [Schedule 1 Delegation-to be added when final arrangements confirmed] [Schedule 2 Delegated functions-to be added when final arrangements confirmed] [Schedule 3 - List of Members-to be added when confirmed] 15

16 Appendix B Delegated Commissioning: Submission pro forma and checklist to apply to commence on 1st April CCGs who do not currently have delegated arrangements for the commissioning of primary medical services are invited to apply for delegated responsibility between now and 6 November To apply, the pro forma communication below should be jointly completed and signed by CCGs and the relevant NHS England Director of Commissioning Operations (DCO), and be sent to the two addresses set out below before midday Friday 6 November 2015 as specified below. It is strongly recommended that CCGs begin working with the corresponding NHS England DCO at least 6-8 weeks in advance of submission to ensure that all the necessary internal processes, information and documentation is updated and approved in advance. NHS England will provide the offer of support to all CCGs to take forward the cocommissioning arrangement of their choice except in cases where the assurance process has raised significant concerns in respect of current capacity and/or capability to enter into a delegated commissioning arrangement. As with the 2014/15 process, regional panels will meet to review the proposals and make recommendations to a national panel on which proposals should be taken forward. CCGs will be notified of the outcome of their application by the end of the year. Further information on the application and approvals process can be found here. Begin communication From: <CCG Name> and <NHS England DCO title> To: and NHS England Regional Primary Care Co-Commissioning contact Subject: Application for <CCG Name> to begin delegated commissioning arrangements on 1 April Dear colleagues, This is to confirm that <CCG Name> is applying to begin delegated commissioning of primary medical services with NHS England on 1 April NHS England is requested to progress the application to the regional panels for consideration. 16

17 We are pleased to confirm that the CCG has met the following requirements and that satisfactory evidence of this has been provided to the NHS England DCO: Delegated Commissioning Checklist <CCG Name> has set out clearly defined objectives and benefits of the arrangement CCG Constitution or proposed constitutional amendment has been updated in line with the guidance (and this has also been approved by the NHS England regional office and sent to prior to this submission). Governance documentation has been updated in line with the NHS England guidance (delegated terms of reference) CCG has reviewed its conflicts of interest policy in line with NHS England s managing conflicts of interest statutory guidance. The DCO confirms the CCG meets the required conflicts of interest management thresholds. CCG IG Toolkit meets level 2 criteria as a minimum Y / N Y / N Y / N Y / N Y / N The CCG s current assurance level (as at Q2 of 2015/16 or equivalent) for each of the five assurance components: (Key: Outstanding, Good, Limited Assurance, Not Assured) Well led organisation Delegated Functions, if previously engaged in joint commissioning Finance Performance Planning Additional Comments: O/G/LA/NA O/G/LA/NA O/G/LA/NA O/G/LA/NA O/G/LA/NA Finance template for delegated budgets completed in full (include completed table below): Y / N Notes for completing the finance template: 1. Double click into the table to complete the excel template. 2. Please enter the notified numbers for your CCG and how the primary care allocation is split between GP Services and other primary care functions for 2015/16 (below) 3. This will be reconciled back to the area team allocation for primary care and subsequent in year adjustments. Where possible M6 2015/16 figures should be used. 4. It is recognised that uplift for 2016/17 cannot be notified until the completion of the spending review, and allocation process which is expected to be available from late December

18 PART II Finance Template for delegated budgets Notified delegated Budget (1) Movement out of GP Services (2) Movement Into GP Services (3) Total '000 '000 '000 '000 GP Services /- General Practice - GMS 0 General Practice - PMS 0 Other list based services (APMS) 0 Premises cost reimbursements 0 Other premises costs 0 Enhanced services 0 QOF 0 Other GP services 0 Primary care NHS property services - GP 0 Sub Total GP services N/A + - +/- Acute services 0 Mental health services 0 Community health services 0 Primary care services 0 Continuing care services 0 Other care services 0 Sub total CCG programme costs Total Please provide a description in the change in spend detailed above The DCO confirms the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements. The DCO confirms the CCG is capable of taking on delegated functions Y / N Y / N Four scanned / electronic signatures provided at the foot of this . Typed names unfortunately cannot be used. Y / N I hereby confirm that <CCG Name> membership and governing body have seen and agreed to all proposed arrangements in support of taking on delegated commissioning arrangements for primary medical services on behalf of NHS England for 2016/17. NHS England is requested to progress the application to the regional panels for consideration. 18

19 Signed by <CCG Name> Accountable Officer Signature (scan/electronic version required): Print Name: Position: Date: Signed on behalf of <CCG Name> Audit Committee Chair Signature (scan/electronic version required): Print Name: Position: Date: Signed by NHS England Director of Commissioning Operations Signature (scan/electronic version required): Print Name: Position: Date: End communication 19

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