NHS Coventry and Rugby Clinical Commissioning Group Annual report 2013/14

123 Pages·2014·2.02 MB·English

NHS Coventry and Rugby
Clinical Commissioning Group

Annual report 2013/14

Page 1 of 123
Foreword ................................................................................................................... 4
Table of Contents
Member Practices’ Introduction .............................................................................. 5
Strategic Report ........................................................................................................ 7
Nature, Objectives and Strategies of the CCG .................................................................. 7
Legislative Requirements ................................................................................................ 29
Development and Performance of the CCG for the Period Under Review and in the Future
........................................................................................................................................ 35
The Resources, Principle Risks, Uncertainties and Relationships that may Affect the
CCG’s Long-term Performance ....................................................................................... 39
Sustainability Report ....................................................................................................... 41
Equality Report ................................................................................................................ 41
Members’ Report .................................................................................................... 45
Member Practices ........................................................................................................... 45
Membership of the Governing Body ................................................................................ 45
Pension Liabilities ........................................................................................................... 46
Sickness Absence ........................................................................................................... 46
External Audit .................................................................................................................. 48
Disclosure of ‘Serious Untoward Incidents’ ...................................................................... 49
Cost allocation and setting of charges for information ..................................................... 49
Principles for remedy ....................................................................................................... 49
Employee consultation .................................................................................................... 50
Policy in relation to disabled employees .......................................................................... 50
Emergency preparedness, resilience and response ........................................................ 51
Statement as to Disclosure to Auditors ............................................................................ 51
Remuneration Report ............................................................................................. 52
Presumption of Disclosure............................................................................................... 52
Remuneration Committee Report .................................................................................... 52
Policy on Remuneration of Senior Managers .................................................................. 53
Senior Managers Performance Related Pay ................................................................... 53
Policy on Senior Managers contracts .............................................................................. 54
Senior Managers Service Contracts ................................................................................ 54
Payments to Past Senior Managers ................................................................................ 54
Salaries and Allowances ................................................................................................. 55
Payments for Loss of Office ............................................................................................ 55
Pension Benefits ............................................................................................................. 56
Pension Note................................................................................................................... 57
Pay Multiples ................................................................................................................... 58

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Off-payroll Engagements ................................................................................................. 58
Governing Body Profiles and Additional Information ........................................................ 58
Statements by the Accountable Officer ................................................................ 59
Statement of Accountable Officer’s responsibilities ......................................................... 59
Annual Governance Statement 2013-14.......................................................................... 61
Annual Internal Audit Report 2013/14 and Head of Internal Audit Opinion ........................ 86
Annual Accounts .................................................................................................... 94
Report by the auditors to the members of the Clinical Commissioning Group ................. 94
Financial statements ....................................................................................................... 97
Appendices ........................................................................................................... 115
Appendix 1 .................................................................................................................... 115
Appendix 2 .................................................................................................................... 120

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Welcome to the first Annual Report from NHS Coventry and Rugby Clinical
Foreword
Commissioning Group (CCG). I am delighted to introduce this report which sets out
our achievements in 2013/14. We are responsible for commissioning health services
in Coventry and Rugby which involves planning and paying for services and ensuring
the quality is of a high standard.

NHS Coventry and Rugby CCG operated in shadow form during 2012/13, initially as
three separate locality groups, Inspires and Godiva Localities in Coventry, and
Rugby Locality, before formally taking over responsibilities from NHS Coventry and
NHS Warwickshire on 1 April 2013 and becoming authorised to take on our full
statutory duties.

Since then, we have moved forward as a new organisation and this is all down to the
commitment and dedication of our members and staff. It is vital that we involve local
people in the development of high quality local services and we have been delighted
by the level of participation from our patients and members of the public. We have
shown throughout this report examples of where involvement of local people has
made a difference to our strategy and services.

Our GP members, patients, carers, and stakeholders have all worked closely with us
to shape our plans for the future, and helped us to develop commissioning intentions
that put patients at the very heart of services.

The NHS nationally is facing a number of challenges, as we all live longer, live with
more long term conditions, and our hospitals struggle to manage emergency
attendances. In addition, funding for health is not keeping pace with demand so we
all need to provide services more efficiently.

Our overriding priority is quality, and by working together with patients, hospitals,
communities and local authorities we believe we can and are making positive
changes for the future.

Dr Adrian Canale-Parola
Chair, NHS Coventry and Rugby Clinical Commissioning Group
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2013/14 has been a year of significant change for the NHS, with GPs taking
Member Practices’ Introduction
responsibility for the majority of local health services and some responsibilities for
health moving to local authorities. National financial challenges and changes to the
structure of health and social care have created a significant challenge for us as a
new organisation but one that we are committed to facing with boldness and
integrity.

Our 77 member practices have formed into three groups. Rugby as a Borough has a
natural boundary. Coventry practices have formed two locality groups known as
InSpires and Godiva. All three work together over key decisions but they have
individual ways of maintaining communication and managing change.

In order for the CCG to be truly clinically led, GPs must be at the heart of decision
making. Member GPs were involved in setting commissioning intentions in 2012/13
when the CCG existed in shadow form so right from the start of the first year of the
CCG, priorities were established from GPs. Progress against these priorities during
the first year has been shared with members on a regular basis through the
established locality structures. The CCG has built on this model in the first year with
locality workshops ensuring members were pivotal in the development of the group’s
strategy for the forthcoming financial year. Several areas identified by members as
part of the Commissioning Intentions work have since had successful business
cases developed and have already made a difference for our local population.

As Coventry and Rugby CCG has embedded within the new framework, we have
worked closely with our partners across health and social care to build excellent
working relationships with our providers, local authorities, community groups and the
voluntary sector. We have developed a thriving network of patient representatives
which brings together the views and experiences of patients from our member
practices.

As part of the authorisation process the CCG signed up to a 360 degree stakeholder
survey which included feedback from the wider membership with regard to
engagement and awareness of the work of the CCG from a member perspective.
This exercise has recently been repeated to ensure on going feedback from
members. In addition to this, the CCG has commissioned Capita to provide
development sessions for all appointed Clinical Leads across the three localities and
all other Governing Body members. Further work to strengthen the development of
the membership has continued with team sessions being held as part of the
Organisational Development programme.

Other activities from a locality perspective that have been undertaken in 2013/14
include a Training Needs Analysis across the practice nursing workforce to identify
and address any gaps, tri-annual peer review visits for all member practices and on
going monthly meetings as set out within the Constitution under the Memorandum of
Understanding for each locality.

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We are committed to commissioning services that are fair and available to all our
communities, and as part of this overall commitment the Governing Body makes
available its papers as well as meeting in public at least six times a year.

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The Strategic Report contains the following sections:
Strategic Report
• Nature, Objective and Strategies of the CCG
• Legislative Requirements
• Development and Performance of the CCG for the period under review and in
the Future
• The resources, principle risks, uncertainties and relationships that may affect
the CCG’s long term performance
• Sustainability Report
• Equality Report
Nature, Objectives and Strategies of the CCG

History and structure of the CCG
Since April 1 2013, the CCG has been responsible for planning and buying
healthcare services across Coventry and Rugby. This includes hospital services,
mental health services and community services such as district nurses and
physiotherapists.

To ensure that the handover was as smooth as possible from the Primary Care
Trusts, NHS Coventry and NHS Warwickshire, the CCG operated in shadow form
from June 2012.

On 1 April 2013, our licence status was set as ‘authorised with conditions’.

NHS England identified eight areas where they needed supplementary information in
order that the CCG could be fully authorised with no conditions:
2.3A Accountability between CCG and member practices is reflected in its
constitution and in any broader governance arrangements.
4.1A Constitution complies with requirements of Part 1 of Schedule 1A of
Health and Social Care Act.
4.2.1G CCG has appropriate risk-sharing arrangements with other CCGs in
place and clearly understood by all parties.
5.1A CCG has written agreements in place detailing the scope of the
collaboration with other CCGs, with clear lines of accountability and
decision-making processes.
5.4B Arrangements with Arden CSU need to be formalised in the SLA for
2013/14
6.1A CCG has completed OD diagnostic/ self-assessment tool or equivalent.
6.1B CCG has plans in place informed by the outcomes of a diagnostic self-
assessment tool.
6.2A Systems in place to sustain two-way accountability between members.

The CCG was invited to submit further evidence against these criteria and, at the
first post-authorisation evidence review in June 2013, seven of the conditions were
removed.
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The final condition related to our constitution. Time was taken to agree the
Constitution, with full and detailed consultation with GP practices and the Local
Medical Committee. At the request of our members, we did not adopt the standard
national Constitution. This meant that it has taken some extra time to get everything
fully agreed, but the benefit of now having such a robust document was worth the
slight delay. The final condition (4.1A) was removed in January 2014. NHS Coventry
and Rugby CCG is now fully authorised to commission healthcare services for the
people of Coventry and Rugby.

Involving local people
One of the largest changes between the CCG and its predecessor organisations will
be the on going involvement of our local patients, their families, carers,
representatives and members of the public in helping us to decide how to spend our
money and helping us to ensure that services commissioned are of a high quality.
We have ensured that we built on previous patient member groups and now have a
wide network of local people who help comment on our plans and priorities which
has led to our organisational vision and values:

Our vision
• To improve the health and wellbeing of our community
• To provide the best possible patient experience
• To ensure choice, value for money and high quality care

Our values
• We will ensure our population receives fair and timely access to a choice of
services which are safe, clinically effective and patient centred
• We will focus on health and wellbeing, preventing ill health and reducing
health inequalities
• Services should be as local as possible
• Our resources should be used effectively and efficiently by investing in
services that deliver quality and best value for money
• We will be responsive and listen and work with the community, practices and
partner organisations
• We will enable and empower our workforce and members to be the best they
can

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Box 2
Key Achievement: Involvement of our members, partners and stakeholders in
setting commissioning priorities.
In summer 2013, we held a series of workshops involving representatives from member
practices in each of the CCG’s three localities along with CCG staff and key staff from the
two local authorities and over 1000 local people through on going process of
engagement.
From these engagement activities, seven work programmes have been selected as those
likely to make the most significant contributions to improving health outcomes for our
population.
These are:
- Diabetes
- Dementia
- Urgent Care
- End of life
- Stroke
- Children, Young People and Maternity
- Elective care

The above work programmes are underpinned by a further ‘sharing information’
programme. These work programmes are further detailed within the CCG’s Operational
Plan 2014-16 and Strategic Plan to 2018-19 and will be aligned within the Arden wide 5
year strategic plan covering the whole of Coventry and Warwickshire.

We have worked with our health and social care partners to implement the Better
Care Fund locally, and to ensure that joined up plans reduce duplication and offer
local people high quality, cost effective services. We are working with Coventry and
Warwickshire Health and Wellbeing Boards to manage the challenges of an aging
population, the need to increase efficiencies and promote innovation. However, we
are clear that this must not be at the expense of maintaining acceptable levels of
safety, quality and patient experience.

We know that we will need to make bold and difficult decisions but we are committed
to ensuring that all such decisions are taken only after consideration of the impact on
quality, safety and patient experience and open discussion with our public and our
other local stakeholders.

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Local population

The geographical area of the CCG is that covered by Coventry City Council and
Rugby Borough Council.

Coventry has diverse communities with varying levels of deprivations as seen
through the inequalities ‘Number 10 bus route’ which shows the difference in life
expectancy between more and less affluent areas of the city.

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