Constitution Constitution of NHS Wyre Forest Clinical Commissioning Group January 2015

Constitution Constitution of NHS Wyre Forest Clinical Commissioning Group January 2015

CONTENTS 1. FOREWORD... 4 2. INTRODUCTION AND COMMENCEMENT... 6 2.1. Name... 6 2.2. Statutory Framework... 6 2.3. Status of this Constitution... 6 2.4. Amendment and Variation of this Constitution... 6 3. AREA COVERED... 7 4. MEMBERSHIP... 9 4.1. Membership of the Clinical Commissioning Group... 9 4.2. Eligibility... 10 5. VISION, MISSION, VALUES AND AIMS... 11 5.1. Vision and Mission... 11 5.2. Values... 11 5.3. Aims... 11 5.4. Principles of Good Governance... 12 5.5. Accountability... 12 6. FUNCTIONS AND GENERAL DUTIES... 14 6.1. Functions... 14 6.2. General Duties... 15 6.3. General Financial Duties... 17 6.4. Other Relevant Regulations, Directions and Documents... 18 7. DECISION MAKING: THE GOVERNING STRUCTURE... 19 7.1. Authority to act... 19 7.2. Scheme of Reservation and Delegation... 19 7.3. Joint Commissioning Arrangements with other Clinical Commissioning Groups... 19 7.4. Joint Commissioning Arrangements with NHS England for the Exercise of Clinical Commissioning Group Functions... 20 7.5. Joint Commissioning Arrangements with NHS England for the Exercise of NHS England s Functions... 21 7.6. General... 22 7.7. Groups working with the Clinical Commissioning Group... 23 7.8. Joint Arrangements... 23 7.9. The Governing Body... 23 8. ROLES AND RESPONSIBILITIES... 26 8.1. Practice Representatives... 26 8.2. Other GP and Primary Care Health Professionals... 26 2 of 43

8.3. All Members of the Group s Governing Body... 26 8.4. The Chair of the Governing Body... 26 8.5. The Deputy Chair of the Governing Body... 27 8.6. Role of the Accountable Officer... 27 8.7. Role of the Chief Finance Officer... 28 8.8. Joint Appointments with other Organisations... 28 9. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST... 30 9.1. Standards of Business Conduct... 30 9.2. Conflicts of Interest... 30 9.3. Declaring and Registering Interests... 31 9.4. Managing Conflicts of Interest: general... 31 9.5. Managing Conflicts of Interest: contractors and people who provide services... 33 9.6. Transparency in Procuring Services... 33 10. THE GROUP AS EMPLOYER... 35 11. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS... 36 11.1. General... 36 11.2. Standing Orders/Scheme of reservation and delegation/prime financial policies... 36 12. APPENDIX A: DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION... 37 13. APPENDIX B - LIST OF MEMBER PRACTICES... 39 14. APPENDIX C STANDING ORDERS - Separate document... 41 15. APPENDIX D SCHEME OF RESERVATION AND DELEGATION - Separate document... 41 16. APPENDIX E PRIME FINANCIAL POLICIES - Separate document... 41 17. APPENDIX F - NOLAN PRINCIPLES... 42 18. APPENDIX G NHS CONSTITUTION... 43 3 of 43

1. FOREWORD 1.1. The NHS Wyre Forest Clinical Commissioning Group (CCG) has 12 local GP Practices who work together to make sure that the best possible healthcare is available for the people of Kidderminster, Stourport, Bewdley and the surrounding villages. This is managed through Clinical Commissioning which is the Government policy to give GPs and other health professionals more say in how NHS resources are used. Local GPs and practice staff are involved with designing and commissioning (or buying) local services, as well as providing them. Our aim is to: '...bring together local people, GPs and other clinical professionals to improve the quality and experience for patients of their health care. 1.2. We will do this by harnessing expertise, working with local people and helping our patients to make full use of the services that are available, and to change the way that these are currently delivered through the use of the local knowledge. We will ensure Practices work together in a consortium arrangement to maintain the strengths of general practice, focusing on the commissioning and development of high quality, effective and accessible services for patients whilst maintaining the financial governance via delegated budgets. 1.3. The Practices in Wyre Forest have a long history of working together. All of the Practices were part of previous GP Fund Holding arrangements and worked very closely together during this period. From 1999 2001 they worked together via Wyre Forest Primary Care Group and from 2001 to 2006 as Wyre Forest Primary Care Trust. Since 2006 they have worked with NHS Worcestershire as a successful Practice Based Commissioning (PBC) Cluster. Wyre Forest has a long and well established GP Association and Executive of which all 72 Wyre Forest GPs are members. 1.4. Wyre Forest GP Commissioning Consortium was formally established and fully recognised by NHS Worcestershire on 1 st October 2010. It is currently developing itself as a high performing clinical led commissioning organisation, which will be able to take on its statutory responsibilities from April 2013. 1.5. This constitution sets out the arrangements made by NHS Wyre Forest CCG to meet its responsibilities for commissioning care for the people for whom it is responsible. It describes the governing principles, rules and procedures that the Group will establish to ensure probity and accountability in the day to day running of the Clinical Commissioning Group; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of the Group. 1.6. The constitution includes: a) the arrangements for the discharge of the Group s functions and those of its governing body, b) the procedure to be followed by the Group and its governing body in making decisions and securing transparency in its decision making c) arrangements for discharging the Group s duties in relation to registers of interests and managing conflicts of interests d) arrangements for securing the involvement of persons who are, or may be, provided with services commissioned by the Group in certain aspects of those commissioning arrangements and the principles that underpin these. 1.7. The constitution applies to the following, all of whom are required to adhere to it as a condition of their appointment: a) the Group s member practices 4 of 43

b) the Group s employees, c) individuals working on behalf of the Group and d) anyone who is a member of the Group s governing body (including the governing body s audit and remuneration committees) e) anyone who is a member of any other committee(s) or sub-committees established by the Group or its governing body 1.8. This constitution and associated documents have been developed to cover the requirements of Part 1 Schedule 1A of Health and Social Care Act 2012, complies with regulations and legislation and has taken account of guidance as published. The model constitution template as published by the NHS Commissioning Board has been used as the basis of this document. 5 of 43

2. INTRODUCTION AND COMMENCEMENT 2.1. Name 2.1.1. The name of this Clinical Commissioning Group is NHS Wyre Forest Clinical Commissioning Group. 2.2. Statutory Framework 2.2.1. Clinical commissioning groups are established under the Health and Social Care Act 2012 ( the 2012 Act ). 1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 ( the 2006 Act ). 2 The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision. 3 2.2.2. The NHS Commissioning Board is responsible for determining applications from prospective groups to be established as clinical commissioning groups 4 and undertakes an annual assessment of each established group. 5 It has powers to intervene in a clinical commissioning group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so. 6 2.2.3. Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution. 7 2.3. Status of this Constitution 2.3.1. This constitution is made between the members of NHS Wyre Forest Clinical Commissioning Group and takes effect from 18 th January 2013, the date on which the CCG was formally authorised by the NHS Commissioning Board. The constitution is published on the Group s website at www.wyreforestccg.nhs.uk 2.4. Amendment and Variation of this Constitution 2.4.1. This constitution can only be varied in two circumstances. 8 a) where the Group applies to the NHS Commissioning Board and that application is granted; b) where in the circumstances set out in legislation the NHS Commissioning Board varies the Group s constitution other than on application by the Group. 1 2 3 4 5 6 7 8 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations issued 6 of 43

3. AREA COVERED 3.1. The geographical area covered by NHS Wyre Forest Clinical Commissioning Group consists of 12 GP Practices located within North-West Worcestershire. The practices are broadly within the geographic boundary of Wyre Forest District Council, which covers the three main towns of Kidderminster, Bewdley and Stourport-on-Severn and several surrounding villages including Arley, Rock, Chaddesley Corbett, Cookley and Wolverley. The Practices have a total registered population of just over 112,000. The Clinical Commissioning Group (CCG) emerged in 2010 and its members have been working hard to develop an effective commissioning role as set out in the Government s White Paper Equity and excellence: Liberating the NHS. 3.2. Hagley Surgery is the only practice located outside the Wyre Forest District Council geographical area but has a long association with the GPs in this area and is part of the Wyre Forest Clinical Commissioning Group. In addition, a significant number of the people living in Hartlebury, although outside the main geographical area, are registered with Wyre Forest based practices. 3.2.1. Below is listed the lower layer super output areas (LSOAs) the CCG area covers, as updated by NHS Commissioning Board as of 28 th March 2013. (LSOAs are geographic areas designed to improve the reporting of small area statistics.) LSOA code 2011 LSOA name 2011 E01032431 Wyre Forest 001A E01032432 Wyre Forest 001B E01032433 Wyre Forest 001C E01032439 Wyre Forest 001D E01032440 Wyre Forest 001E E01032479 Wyre Forest 001F E01032441 Wyre Forest 002A E01032442 Wyre Forest 002B E01032443 Wyre Forest 002C E01032444 Wyre Forest 002D E01032445 Wyre Forest 002E E01032436 Wyre Forest 003A E01032438 Wyre Forest 003B E01032446 Wyre Forest 003C E01032447 Wyre Forest 003D E01032448 Wyre Forest 003E E01032434 Wyre Forest 004A E01032435 Wyre Forest 004B E01032437 Wyre Forest 004C E01032450 Wyre Forest 004D E01032430 Wyre Forest 005A E01032480 Wyre Forest 005B E01032481 Wyre Forest 005C E01032482 Wyre Forest 005D E01032451 Wyre Forest 006A E01032452 Wyre Forest 006B E01032453 Wyre Forest 006C E01032454 Wyre Forest 006D E01032449 Wyre Forest 007A E01032464 Wyre Forest 007B 7 of 43

E01032465 E01032466 E01032467 E01032468 E01032474 E01032475 E01032476 E01032477 E01032478 E01032469 E01032470 E01032471 E01032418 E01032419 E01032420 E01032421 E01032422 E01032427 E01032428 E01032429 E01032472 E01032473 E01032455 E01032456 E01032457 E01032458 E01032459 E01032460 E01032461 E01032462 E01032463 E01032423 E01032424 E01032425 E01032426 Wyre Forest 007C Wyre Forest 007D Wyre Forest 007E Wyre Forest 007F Wyre Forest 008A Wyre Forest 008B Wyre Forest 008C Wyre Forest 008D Wyre Forest 008E Wyre Forest 009A Wyre Forest 009B Wyre Forest 009C Wyre Forest 010A Wyre Forest 010B Wyre Forest 010C Wyre Forest 010D Wyre Forest 010E Wyre Forest 011A Wyre Forest 011B Wyre Forest 011C Wyre Forest 011D Wyre Forest 011E Wyre Forest 012A Wyre Forest 012B Wyre Forest 012C Wyre Forest 012D Wyre Forest 012E Wyre Forest 013A Wyre Forest 013B Wyre Forest 013C Wyre Forest 013D Wyre Forest 014A Wyre Forest 014B Wyre Forest 014C Wyre Forest 014D 8 of 43

4. MEMBERSHIP 4.1. Membership of the Clinical Commissioning Group 4.1.1. The following practices comprise the members of NHS Wyre Forest Clinical Commissioning Group. Practice Name Almer Lodge Surgery/Cookley Partnership Bewdley Medical Centre Chaddesley Surgery Church Street Surgery Forest Glades Medical Centre Hagley Surgery Kidderminster Health Centre Northumberland House Surgery Stanmore House Surgery Stourport Health Centre Medical Centre Wolverley Surgery York House Medical Centre Address Aylmer Lodge, Broomfield Road, Kidderminster, Worcestershire, DY11 5PA Cookley Surgery, 1 Lea Lane, Cookley, Kidderminster, Worcestershire, DY10 3TA Dog Lane, Bewdley, Worcestershire, DY12 2EG The Surgery, Hemming Way, Chaddesley Corbett, Worcestershire, DY10 4SF David Corbet House, Callows Lane, Kidderminster, Worcestershire, DY10 2JG Bromsgrove Street, Kidderminster, Worcestershire, DY10 1PE 1 Victoria Passage, Hagley, Stourbridge, West Midlands, DY9 0NH Bromsgrove Street, Kidderminster, Worcestershire, DY10 1PG 437 Stourport Road, Kidderminster, Worcestershire, DY11 7BL Linden Avenue, Kidderminster, Worcestershire, DY10 1PG The Health Centre, Worcester Street, Stourport-on- Severn, Worcestershire, DY13 8EH The Surgery, Wolverley, Kidderminster, Worcestershire, DY11 5TH 20-21 York Street, Stourport-on-Severn, Worcestershire, DY13 8EH 4.1.2. Appendix B of this constitution contains the list of practices, together with the signatures of the practice representatives confirming their agreement to this constitution. 9 of 43

4.2. Eligibility 4.2.1. Providers of primary medical services to a registered list of patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, will be eligible to apply for membership of this Group 9. 4.2.2. Subject to any Regulations or requirements as set by the NHS Commissioning Board pertaining CCG membership, any practice wishing to join, rejoin or leave the CCG must, in the first instance, make a request in writing to the Chair of the governing body for discussion at the next available meeting. Any such request must be supported by a quorate meeting of the governing body. 9 See section 14A(4) of the 2006 Act, inserted by section 25 of the 2012. Regulations to be made 10 of 43

5. VISION, MISSION, VALUES AND AIMS 5.1. Vision and Mission 5.1.1. The vision of NHS Wyre Forest Clinical Commissioning Group is that we will bring together local people, GPs and other clinical professionals to improve the quality and experience for patients of their health care. 5.1.2. The mission of NHS Wyre Forest Clinical Commissioning Group is to maintain the strengths of general practice, focusing on the commissioning and development of high quality, effective and accessible services for patients whilst maintaining the financial governance via delegated budgets. 5.1.3. The Group will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. 5.2. Values 5.2.1. Good corporate governance arrangements are critical to achieving the Group s objectives. 5.2.2. The values that lie at the heart of the Group s work are: 5.3. Aims a) The CCG will be a caring and listening organisation; b) The CCG will serve local people, patients and practices; c) The CCG will value clinical input in all it does; d) The CCG will aim for safe, seamless patient centred care, delivered as close to patients homes as possible; e) The CCG will value partnerships with other organisations; f) The CCG will be aware of risk and manage it, but it will not be afraid to take calculated risks if it is in the interests of local people to do so. 5.3.1. The Group s aims are to: a) Ensure collective agreement to the principles underpinning the development of clinical commissioning in the Wyre Forest; b) Ensure that required commissioning targets are met including QIPP; c) Ensure the effective management of commissioning across all practices; d) Determine and develop patient centred pathways of care; e) Feed into the coordination and planning of the Operating Plan in accordance with the commissioning cycle; f) Commission patient centred services based upon the health needs of patients at practice and locality and wide levels in line with national and local policies; g) Ensure that patient choice is maximised through the commissioning process and to involve patients and the local public; h) Ensure contestability is rigorously tested through an equitable and transparent tendering and commissioning process; i) Ensure that any conflict of interest is identified and declared and that the NHS and BMA Code of Conduct, accountability and openness is upheld by practices commissioning services; 11 of 43

j) Develop robust quality and Clinical Governance arrangements, including the preparation of proposals for the development and monitoring of clinical standards in the commissioning process and all of its constituent primary care practices. 5.4. Principles of Good Governance 5.4.1. In accordance with section 14L(2)(b) of the 2006 Act, 10 the Group will at all times observe such generally accepted principles of good governance in the way it conducts its business. These include: a) the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business; b) The Good Governance Standard for Public Services; 11 c) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles 12 d) the seven key principles of the NHS Constitution; 13 e) the Equality Act 2010. 14 f) Standards for Members of NHS Boards and Governing Bodies in England. (when published) 5.5. Accountability 5.5.1. The Group will demonstrate its accountability to its members, local people, stakeholders and the NHS Commissioning Board in a number of ways, including by: a) publishing its constitution; b) appointing independent lay members and non GP clinicians to its governing body; c) holding meetings of its governing body in public (except where the Group considers that it would not be in the public interest in relation to all or part of a meeting); d) publishing annually a commissioning plan; e) complying with local authority health overview and scrutiny requirements; f) meeting annually in public to publish and present its annual report (which must be published); g) producing annual accounts in respect of each financial year which must be externally audited; h) having a published and clear complaints process; i) complying with the Freedom of Information Act 2000; j) providing information to the NHS Commissioning Board as required. 10 11 12 13 14 Inserted by section 25 of the 2012 Act The Good Governance Standard for Public Services, The Independent Commission on Good Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004 See Appendix F See Appendix G See http://www.legislation.gov.uk/ukpga/2010/15/contents 12 of 43

5.5.2. In addition to these statutory requirements, the Group will demonstrate its accountability by: a) ensuring that its member practices are actively encouraged to participate in the Group b) promoting patient participation in decision making c) making plans and outcomes from QIPP public d) The governing body of the Group will throughout each year have an on-going role in reviewing the Group s governance arrangements to ensure that the Group continues to reflect the principles of good governance. 13 of 43

6. FUNCTIONS AND GENERAL DUTIES 6.1. Functions 6.1.1. The functions that the Group is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health s Functions of clinical commissioning groups: a working document. They relate to: a) commissioning certain health services (where the NHS Commissioning Board is not under a duty to do so) that meet the reasonable needs of: b) all people registered with member GP practices, and c) people who are usually resident within the area and are not registered with a member of any clinical commissioning group; d) commissioning emergency care for anyone present in the Group s area; e) paying its employees remuneration, fees and allowances in accordance with the determinations made by its governing body and determining any other terms and conditions of service of the Group s employees; f) determining the remuneration and travelling or other allowances of members of its governing body. 6.1.2. In discharging its functions the Group will: a) act 15, when exercising its functions to commission health services, consistently with the discharge by the Secretary of State and the NHS Commissioning Board of their duty to promote a comprehensive health service 16 and with the objectives and requirements placed on the NHS Commissioning Board through the mandate 17 published by the Secretary of State before the start of each financial year by i) requiring progress of delivery of the duty to be monitored through the Group s reporting mechanisms and delegating responsibility as reflected in standing orders and scheme of delegation and reservation b) meet the public sector equality duty 18 by : i) delegating responsibility to the Group Head of Corporate Affairs ii) iii) iv) developing a strategy setting out how the Group intends to discharge this duty monitoring progress of the duty through the Group s Governing Body publishing at least annually, sufficient information to demonstrate compliance with this general duty across all their functions v) preparing and publishing specific and measurable equality objectives, revising these at least every four years c) work in partnership with Worcestershire County Council to develop joint strategic needs assessments 19 and joint health and wellbeing strategies 20 through: 15 16 17 18 19 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by section 192 of the 2012 Act 14 of 43

6.2. General Duties i) membership of the Worcestershire Health and Wellbeing Board; the Group will nominate a member and deputy to represent the Group and provide the partnership link 6.2.1. in discharging its functions the Group will: 6.2.2. Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements 21 in line with the Group s stated aim to ensure that patient choice is maximised through the commissioning process and to involve patients and the local public. The Wyre Forest Group will support the following Statement of Principles: a) extend patient choice and where possible, will invite participation with patients and the public in decision making, and planning b) work in partnership with patients and the local community to secure the best care for them c) adapt engagement activities to meet the specific needs of the different patient groups and communities d) publish information about health services on the Group s website and through other media e) encourage and act on feedback f) support the Advisory Group to access patient views and support/input into any new service developments g) be represented at the Wyre Forest Patients Group h) Invite members of the Patient Forum to attend the Advisory Group. i) involve patients and the public in development and consideration of proposals by the Group for changes in the commissioning arrangements where the implementation of the proposals would have an impact. j) use the independent Advisory Group to monitor and report compliance against this Statement of Principles. 6.2.3. Promote awareness of, and act with a view to securing that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution 22 by: a) delegating lead responsibility to oversee its discharge to the Head of Commissioning and Service Redesign and the Executive Nurse Quality and Patient Safety b) monitoring progress of the duty through both the Group s Finance and Performance Committee and the Quality and Patient Safety Committee 6.2.4. Act effectively, efficiently and economically 23 by: 20 21 22 23 See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health Act 2009 (as amended by 2012 Act) See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 15 of 43

a) requiring progress of delivery of the duty to be monitored through the Finance and Performance Committee b) reporting through regular Governing body documents supported by the Chief Finance Officer c) ensuring that commissioning processes are open, fair and seek to ensure value for money in line with good practice and the stewardship of public monies. 6.2.5. Act with a view to securing continuous improvement to the quality of services 24 by: a) delegating responsibility to the Executive Nurse - Quality and Patient Safety supported through the Quality and Patient Safety Committee b) reporting through regular Governing body documents supported by projects specified to improve the quality of services and the patient experience 6.2.6. Assist and support the NHS Commissioning Board in relation to the Governing body s duty to improve the quality of primary medical services 25 by: a) delegating responsibility to the Accountable Officer b) requiring the progress of delivery of the duty to be monitored through the Governing body reporting mechanisms 6.2.7. Have regard to the need to reduce inequalities 26 by: a) delegating responsibility to the Executive Nurse - Quality and Patient Safety supported through the Quality and Patient Safety Committee b) reporting through regular Governing body documents c) engaging with the public health agenda in partnership with the Local Authority d) active engagement in the Worcestershire Health and Wellbeing Board 6.2.8. Promote the involvement of patients, their carers and representatives in decisions about their healthcare 27 by: a) delegating responsibility to the Chair/Clinical Leader and the Chief Officer to ensure that this is upheld as a principle throughout everything the Group does b) supporting the Advisory Group c) reporting through regular Governing body documents supported by projects specified to promote and improve involvement 6.2.9. Act with a view to enabling patients to make choices 28 by: a) delegating responsibility to the Chair/Clinical Leader and the Chief Officer to ensure that this is supported throughout all business and development plans in the long term b) monitoring and supporting progress through the Advisory Board c) reporting through regular review of Governing body documents to ensure they support choice 24 25 26 27 28 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act 16 of 43

6.2.10. Obtain appropriate advice 29 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: a) delegating responsibility to i) The CCG Governing body and all formal committees to ensure that appropriate advice and membership is secured to support decision making with reporting to the Governing body as applicable to enable review and evaluation of this function. 6.2.11. Promote innovation 30 by: a) delegating shared responsibility to i) The Quality and Patient Safety Committee through the Executive Nurse Quality and Safety ii) iii) iv) The Head of Commissioning and Service Redesign The Head of Business Development and Operations reporting to the Governing body as applicable to enable evaluation and review of this function 6.2.12. Promote research and the use of research 31 by: a) delegating responsibility to the Executive Nurse - Quality and Patient Safety to oversee its discharge in accordance with the Research Policy b) To report on progress through the Quality and Patient Safety Sub-Committee to the Governing body 6.2.13. Have regard to the need to promote education and training 32 for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty 33 by: a) delegating lead responsibility to the Chief Officer and the Head of Corporate Affairs to oversee the discharge of this duty. b) development of and implementation against the Organisational Development Plan c) report to the Governing body on progress against the Organisational Development Plan 6.2.14. Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the Group considers that this would improve the quality of services or reduce inequalities 34 by: a) delegating lead responsibility to the Head of Commissioning and Service Redesign, the Head of Business Development and Operations and the Executive Nurse - Quality and Patient Safety b) a constructive relationship between the Group and the Public Health Service. 6.3. General Financial Duties 6.3.1. the Group will perform its functions so as to: 29 30 31 32 33 34 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act 17 of 43

6.3.2. Ensure its expenditure does not exceed the aggregate of its allotments for the financial year 35 by a) delegating responsibility to the Chief Finance Officer with the lead responsibility to oversee its discharge b) monitoring progress of the duty through the Group s Governing body governance processes as set out in the Scheme of Reservation and Delegation 6.3.3. Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by the NHS Commissioning Board for the financial year 36 by a) delegating responsibility to the Chief Finance Officer with the lead responsibility to oversee its discharge b) monitoring progress of the duty through the Group s Governing body governance processes as set out in the Scheme of Reservation and Delegation and Prime Financial Policies 6.3.4. Take account of any directions issued by the NHS Commissioning Board, in respect of specified types of resource use in a financial year, to ensure the Group does not exceed an amount specified by the NHS Commissioning Board 37 by a) delegating responsibility to the Chief Officer with the lead responsibility to oversee its discharge b) monitoring progress of the duty through the Group s Governing body governance processes as set out in the Scheme of Reservation and Delegation and Prime Financial Policies 6.3.5. Publish an explanation of how the Group spent any payment in respect of quality made to it by the NHS Commissioning Board 38 by a) delegating responsibility to the Chief Finance Officer with the lead responsibility to oversee its discharge b) monitoring progress of the duty through the Group s Governing body governance processes as set out in the Scheme of Reservation and Delegation and Prime Financial Policies 6.4. Other Relevant Regulations, Directions and Documents 6.4.1. The Group will a) comply with all relevant regulations; b) comply with directions issued by the Secretary of State for Health or the NHS Commissioning Board; and c) take account, as appropriate, of documents issued by the NHS Commissioning Board. d) The Group will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant Group policies and procedures. 35 36 37 38 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act 18 of 43

7. DECISION MAKING: THE GOVERNING STRUCTURE 7.1. Authority to act 7.1.1. The Clinical Commissioning Group is accountable for exercising the statutory functions of the Group. It may grant authority to act on its behalf to: a) any of its members; b) its governing body; c) employees; d) the Management Team or sub-committee of the Group, including the Audit and Remuneration Committees. 7.1.2. The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the Group as expressed through: a) the Group s scheme of reservation and delegation; and b) for committees, their terms of reference. 7.2. Scheme of Reservation and Delegation 39 7.2.1. The Group s scheme of reservation and delegation sets out: a) those decisions that are reserved for the membership as a whole; b) those decisions that are the responsibilities of its governing body (and its committees), the Group s committees and sub-committees, individual members and employees. 7.2.2. The Clinical Commissioning Group remains accountable for all of its functions, including those that it has delegated. 7.3. Joint Commissioning Arrangements with other Clinical Commissioning Groups 7.3.1. The clinical commissioning Group may wish to work together with other clinical commissioning groups in the exercise of its commissioning functions. 7.3.2. The clinical commissioning Group may make arrangements with one or more clinical commissioning groups in respect of: a) delegating any of the Clinical Commissioning Group s functions to another clinical commissioning group; b) exercising any of the commissioning functions of another clinical commissioning group; or c) exercising jointly the commissioning functions of the Clinical Commissioning Group and another clinical commissioning group. 7.3.3. For the purposes of the arrangements described at paragraph 6.3.2, the clinical commissioning Group may: a) make payments to another clinical commissioning group; b) receive payments from another clinical commissioning group; c) make the services of its employees or any other resources available to another clinical commissioning group; or d) receive the services of the employees or the resources available to another clinical commissioning group. 39 See Appendix D 19 of 43

7.3.4. Where the clinical commissioning Group makes arrangements which involve all the clinical commissioning groups exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions. 7.3.5. For the purposes of the arrangements described at paragraph 7.3.2 above, the clinical commissioning Group may establish and maintain a pooled fund made up of contributions by any of the clinical commissioning groups working together pursuant to paragraph 7.3.2 (c) above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made. 7.3.6. Where the clinical commissioning Group makes arrangements with another clinical commissioning group as described at paragraph 7.3.2 above, the clinical commissioning Group shall develop and agree with that clinical commissioning group an agreement setting out the arrangements for joint working, including details of: a) how the parties will work together to carry out their commissioning functions; b) the duties and responsibilities of the parties; c) how risk will be managed and apportioned between the parties; d) financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; e) contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements. 7.3.7. The liability of the clinical commissioning Group to carry out its functions will not be affected where the clinical commissioning Group enters into arrangements pursuant to paragraph 7.3.2 above. 7.3.8. The clinical commissioning Group will act in accordance with any further guidance issued by NHS England on co-commissioning. 7.3.9. Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the clinical commissioning Group Governing Body. 7.3.10. The Clinical Commissioning Group Governing Body shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a written report every four months to the Clinical Commissioning Group Governing Body and at least annually review aims, objectives, strategy and progress with partners and publish an annual report on progress made against objectives. 7.3.11. Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the clinical commissioning Group Governing Body can decide to withdraw from the arrangement, but has to give notice to partners, in line with the notice periods as detailed within the respective joint committee s terms of reference. 7.4. Joint Commissioning Arrangements with NHS England for the Exercise of Clinical Commissioning Group Functions 7.4.1. The clinical commissioning Group may wish to work together with NHS England in the exercise of its commissioning functions. 7.4.2. The clinical commissioning Group and NHS England may make arrangements to exercise any of the clinical commissioning Group s commissioning functions jointly. 7.4.3. The arrangements referred to in paragraph 7.4.2 above may include other clinical commissioning groups. 20 of 43

7.4.4. Where joint commissioning arrangements pursuant to 7.4.2 above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question. 7.4.5. Arrangements made pursuant to 7.4.2 above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the clinical commissioning Group. 7.4.6. Where the clinical commissioning Group makes arrangements with NHS England (and another clinical commissioning group if relevant) as described at paragraph 7.4.2 above, the clinical commissioning Group shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of: a) how the parties will work together to carry out their commissioning functions; b) the duties and responsibilities of the parties; c) how risk will be managed and apportioned between the parties; d) financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; e) contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements. 7.4.7. The liability of the clinical commissioning Group to carry out its functions will not be affected where the clinical commissioning Group enters into arrangements pursuant to paragraph 7.4.2 above. 7.4.8. The clinical commissioning Group will act in accordance with any further guidance issued by NHS England on co-commissioning. 7.4.9. Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the clinical commissioning Group Governing Body. 7.4.10. The Clinical Commissioning Group Governing Body shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a written report every four months to the Clinical Commissioning Group Governing Body and at least annually review aims, objectives, strategy and progress with partners and publish an annual report on progress made against objectives. 7.4.11. Should a joint commissioning arrangement prove to be unsatisfactory, the Clinical Commissioning Group Governing Body can decide to withdraw from the arrangement, but has to give notice to partners, in line with the notice periods as detailed within the respective joint committee s terms of reference. 7.5. Joint Commissioning Arrangements with NHS England for the Exercise of NHS England s Functions 7.5.1. The Clinical Commissioning Group may wish to work with NHS England and, where applicable, other clinical commissioning groups, to exercise specified NHS England functions. 7.5.2. The Clinical Commissioning Group may enter into arrangements with NHS England and, where applicable, other clinical commissioning groups to: a) exercise such functions as specified by NHS England under delegated arrangements; b) jointly exercise such functions as specified with NHS England. 21 of 43

7.5.3. Where arrangements are made for the Clinical Commissioning Group and, where applicable, other clinical commissioning groups to exercise functions jointly with NHS England, a joint committee may be established to exercise the functions in question. 7.5.4. Arrangements made between NHS England and the Clinical Commissioning Group may be on such terms and conditions (including terms as to payment) as may be agreed between the parties. 7.5.5. For the purposes of the arrangements described at paragraph 7.5.2 above, NHS England and the Clinical Commissioning Group may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made. 7.5.6. Where the Clinical Commissioning Group enters into arrangements with NHS England as described at paragraph 7.5.2 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of: a) how the parties will work together to carry out their commissioning functions; b) the duties and responsibilities of the parties; c) how risk will be managed and apportioned between the parties; d) financial arrangements, including payments towards a pooled fund and management of that fund; e) contributions from the parties, including details around employees and equipment to be used under the joint arrangements. 7.5.7. The liability of NHS England to carry out its functions will not be affected where it and the Clinical Commissioning Group enter into arrangements pursuant to paragraph 7.5.2 above. 7.5.8. The Clinical Commissioning Group will act in accordance with any further guidance issued by NHS England on co-commissioning. 7.5.9. Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Clinical Commissioning Group Governing Body. 7.5.10. The Clinical Commissioning Group Governing Body shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a written report every four months to the Clinical Commissioning Group Governing Body and at least annually review aims, objectives, strategy and progress with partners and publish an annual report on progress made against objectives. 7.5.11. Should a joint commissioning arrangement prove to be unsatisfactory, the Clinical Commissioning Group Governing Body can decide to withdraw from the arrangement, but has to give notice to partners, in line with the notice periods as detailed within the respective joint committee s terms of reference. 7.6. General 7.6.1. In discharging functions of the that have been delegated to its governing body and its committees, joint committees, sub committees, all members must: a) comply with the Group s principles of good governance, 40 b) operate in accordance with the Group s scheme of reservation and delegation, 41 40 See section 4.4 on Principles of Good Governance above 22 of 43

c) comply with the Group s standing orders, 42 d) comply with the Group s arrangements for discharging its statutory duties, 43 e) where appropriate, ensure that member practices have had the opportunity to contribute to the Group s decision making process. 7.6.2. When discharging their delegated functions, committees, joint committees, sub committees must also operate in accordance with their approved terms of reference. 7.6.3. Where delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must: a) identify the roles and responsibilities of those clinical commissioning groups who are working together; b) identify any pooled budgets and how these will be managed and reported in annual accounts; c) specify under which clinical commissioning group s scheme of reservation and delegation and supporting policies the collaborative working arrangements will operate; d) specify how the risks associated with the collaborative working arrangement will be managed between the respective parties; e) identify how disputes will be resolved and the steps required to terminate the working arrangements; f) specify how decisions are communicated to the collaborative partners. 7.7. Groups working with the Clinical Commissioning Group 7.7.1. The Advisory Group 7.7.2. The Wyre Forest GP Association 7.8. Joint Arrangements 7.8.1. The Group has a joint committee with the following local authority: i) Worcestershire County Council, through the Integrated Commissioning Executive Officers Group supporting the Section 75 agreement. 7.9. The Governing Body 7.9.1. Functions - the governing body has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this constitution. 44 The governing body has responsibility for: a) ensuring that the Group has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the Groups principles of good governance 45 (its main function); b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the Group and the allowances payable under any pension 41 42 43 44 45 See appendix D See appendix C See chapter 5 above See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act See section 4.4 on Principles of Good Governance above 23 of 43

scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act; c) approving any functions of the Group that are specified in regulations; 46 d) leading the setting of vision and strategy e) approving commissioning plans f) monitoring performance against plans g) providing assurance of strategic risk 7.9.2. Composition of the Composition of the Governing Body: The governing body shall not have less than 10 members and comprises of: a) the chair, the Clinical Leader b) two other GPs (one of which is the assistant clinical chair) c) one Practice Manager representative d) two lay members: e) one to lead on matters of governance, including audit, remuneration and conflict of interest, (Deputy Chair) f) one to lead on patient and public participation matters g) one registered nurse, the Executive Nurse - Quality and Patient Safety h) one secondary care specialist doctor i) the accountable officer (Chief Officer) j) the chief finance officer 7.9.3. Co-options to the Governing Body a) Co-options to the governing body must be agreed by a majority of the governing body and will be made on the following basis: i) The purpose of the co-option must be clearly articulated and be linked to how it contributes to meeting the functions and responsibilities of the CCG; ii) iii) iv) Each co-option will require the nomination of a named individual; The term of office will be determined at the time of co-option but will be no more than two years in the first instance, with the option of extension on an annual basis, providing the purpose of this extended term can be articulated; All co-opted members will, at all times, act in line with the constitution v) Co-opted members will not count towards the quorum; vi) vii) Co-opted members will not be eligible to vote; Persistent failure to act within the requirements of the constitution will provide grounds for removal from office. viii) There will be no more than two co-opted members on the governing body at any one time. 7.9.4. Committees of the Governing Body - the governing body has appointed the following committees and sub-committees: 46 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act 24 of 43