NHS North West Surrey
Clinical Commissioning Group
Annual Report and Accounts
2014/15
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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Contents
1.
Introduction from the CCG’s Council of Members
4
1.1
History and background
6
1.2
A clinically-led organisation
7
2.
Strategic Report
13
2.1
Introduction
13
2.2
Overview of NHS North West Surrey CCG
15
Health needs in North West Surrey
16
Our Strategic Commissioning Plan
16
Delivering our plan
16
Our providers
18
2.3
20
Improving quality and patient experience
Introduction
20
Improving the urgent care patient experience
21
An alternative to Accident & Emergency
22
Improving community health services
23
Improving mental health services
23
Supporting Primary Care Development
25
Caring for people in later life
26
Medicines Management
27
Musculoskeletal Services (MSK)
28
Collaborative hypoglycaemia project
29
2.4
Listening to feedback and improving patient safety
30
2.5
Improving Performance and Delivery
34
Introduction
34
Meeting key performance targets
34
Out of hours primary medical services procurement
35
Children and Young Peoples’ Services
36
Measuring delivery of services
38
Commissioning for Quality Innovation, Productivity and Performance
42
2.6
43
Listening to our community and working in partnership
Introduction
43
Engaging patients and the public
43
Partnership working
46
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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2.7
3.
Our priorities for 2015/16
Members’ Report
52
55
3.1
Introduction
55
3.2
The CCG Members and Leadership Team
56
3.3
Our Staff
62
3.4
Our premises and sustainability
65
3.5
Policy development
65
3.6
Equality and diversity report
66
3.7
Helping patients give feedback
67
3.8
Dealing with emergencies
69
3.9
Managing risks
70
4.
Annual Governance Statement 2014/15
72
4.1
Introduction & context
72
4.2
Operational Leadership Team
78
4.3
The CCG Governance Framework
79
4.4
The CCG Risk Management Framework
81
5.
Statement of Accountable Officer’s Responsibilities
93
6.
Independent Auditor’s Report to the Members of NHS North West Surrey CCG
95
7.
Financial Overview
99
8.
Financial Statements
103
9.
Remuneration Report
145
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1. Introduction from the CCG‟s Council of
Members
Welcome to the NHS North West Surrey Clinical Commissioning Group‟s (CCG‟s)
Annual Report and Accounts 2014/15.
Our Annual Report and Accounts provides us with the opportunity to review how well
we delivered our strategic aims - as set out in the CCG‟s Strategic Commissioning
Plan - during the previous year and to outline the key challenges facing the CCG
next year.
This year has been interesting, challenging and productive. We have made excellent
progress in driving the provision of safe, effective and responsive health services for
the people of North West Surrey.
One of this year‟s major achievements in our Integrated Care programme was the
further development and design of our Locality Hubs programme.
GP-led multi-disciplinary health and social care teams will use Locality Hubs to
significantly improve the quality of care in the community. This includes a particular
focus on early diagnosis and intervention for patients with a wide range of potentially
serious conditions, which will reduce complications and help them stay out of acute
care.
Locality Hubs will also ensure more effective management of the growing number of
frail elderly patients in our communities, helping them to stay as healthy and
independent as possible. We will focus on implementing the Locality Hubs
programme in 2015/16 and aim to have three Hubs fully operational by the end of
the year.
During 2014/15 we also launched a new hypoglycaemia pathway to reduce the
impact of hypoglycaemia amongst patients with diabetes. This is an excellent
example of how partnership working benefits our patients. This project was
presented as an example of innovation in the management of diabetes care at the
Kent, Surrey and Sussex Academic Health Science Network Expo on 15 January
2015. Further details can be found at page 29.
This year we also launched our pilot MSK Referral Support Service (a single point of
access to receive all GP MSK referrals excluding Rheumatology and chronic pain).
Early indications show that 95% of GPs are using the service with over 1200
referrals being made each month.
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We have defined our commissioning intentions for 2015/16 and are working more
collaboratively with Surrey County Council and other partners on the Better Care
Fund and other programmes, which mean our patients will benefit from these newly
integrated services.
We will also continue to target specific communities in areas of deprivation where the
health of the population is significantly worse than in other parts of North West
Surrey in order to improve their health outcomes.
Our priorities for 2015/16 remain the same and we will continue to focus on delivery,
implementation and practical integration of care. We look forward to working with our
patients and partner organisations in 2015/16 to ensure North West Surrey people
enjoy the best possible health.
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1.1 History and background
NHS North West Surrey Clinical Commissioning Group (NHS North West Surrey
CCG) was formally established without conditions on 1 April 2013, in line with
changes to the commissioning structure of the NHS introduced by the Health and
Social Care Act 2012.
The CCG is responsible for commissioning healthcare services for a population of
350,000 across the boroughs of Elmbridge (West), Runnymede, Spelthorne and
Woking, as well as the very small number of our population who live in Guildford and
Surrey Heath.
The CCG is a membership organisation, comprised of practices that provide primary
medical services to the population within the geographic boundaries of the CCG. The
CCG has 42 Member Practices working across three localities:
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Thames Medical (Runnymede and West of Elmbridge)
Stanwell, Ashford, Staines, Shepperton and Egham (SASSE)
Woking
This structure allows us to commission the services that our patients need at a local
level, develop services that are tailored to the specific needs of each of our diverse
communities and provides a rich understanding of how our initiatives improve
patients‟ experiences of health services.
The CCG‟s localities are aligned with the borough councils shown in purple on the
map, below.
Geography of NHS North West Surrey CCG
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1.2 A clinically-led organisation
Clinical leadership is central to our strong leadership of the local health system,
ensuring that commissioning plans and decisions are patient-centred and clinically
focused.
The Governing Body is chaired by Dr Elizabeth Lawn, a clinician with 30 years‟
experience as a GP, the last 20 of which have been in North West Surrey. As a
result, Elizabeth provides in-depth knowledge of local healthcare issues.
The CCG has nine elected GP Locality Leads (three from each locality) with
responsibility for leading clinical engagement in each area. These nine elected GPs
sit on the CCG‟s Governing Body, with one lead from each locality acting as Locality
Clinical Director.
To ensure an effective partnership between clinicians and managers, the Governing
Body has three Clinical Chiefs, each of whom leads on a different area within the
CCG‟s corporate structure. The nine clinical leaders are:
Dr Diljit Bhatia
SASSE Locality Lead
Dr Jagjit Rai
SASSE Locality Clinical Director
Clinical Executive Chair
Vacant
SASSE Locality Lead
Dr Richard Barnett
Thames Medical Locality Lead
Clinical Chief of Innovation and Quality and
Medicines Management
Dr Elizabeth Lawn
CCG Clinical Chair
Thames Medical Locality Lead
Dr Asha Pillai
Thames Medical Locality Clinical Director
Dr Linda Roberts
Woking Locality Lead
Clinical Chief of Leadership & Development
Dr Deborah Shiel
Woking Locality Clinical Director
Clinical Chief of Contracts and Performance
Dr Sundeep Soin
Woking Locality Lead
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In addition to the nine locality leads, the CCG has seven GPs who provide
leadership to our core clinical programmes, and many others who lead on and
contribute to projects.
Our Clinical Programme Leads are:
Dr Charlotte Canniff
Children & Young People
Dr Yvonne Collins
Mental Health
Dr Beth Coward
Planned Care
Dr Layth Delaimy and Dr Philippa
Woodward
Urgent Care
Dr Elizabeth Lawn and Dr Niki Kirby
Integrated Care
Dr Munira Mohammed
Targeted Communities
Council of Members
The CCG‟s Council of Members is comprised of a lead GP from each of the CCG‟s
42 Member Practices and meets twice annually. The Council of Members holds the
Governing Body to account, approves the CCG‟s strategic plans and votes on other
matters as required.
The CCG‟s Constitution sets out which decisions rest with the Group and which are
delegated to the Governing Body, as well as to other committees and subcommittees in its Scheme of Reservation and Delegation. A copy of the Constitution
can be found on the CCG‟s website: http://www.nwsurreyccg.nhs.uk/aboutus/Documents/Constitution.pdf.
Governing Body
The Governing Body is the main strategic decision-making body, providing
leadership and direction to the Clinical Commissioning Group. The Governing Body
includes the nine GP locality leads, the Chief Executive and Director of Finance and
four independent members (two clinical and two lay), ensuring objective scrutiny of
decision-making.
A patient representative, the remaining CCG directors and Chief Nurse sit as nonvoting members on the Governing Body.
Each individual who is a Member of the Governing Body at the time the Members‟
Report is approved confirms:
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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
So far as the Member is aware, that there is no relevant audit information of
which the Clinical Commissioning Group‟s external auditor is unaware; and,
That the Member has taken all the steps that they ought to have taken as a
Member in order to make themselves aware of any relevant audit information
and to establish that the Clinical Commissioning Group‟s auditor is aware of
that information
Clinical Executive
Chaired by Dr Jagjit Rai, the Clinical Executive is the main source of clinical advice
to the Governing Body. All GP Locality Leads and Clinical Programme Leads are
members of the Committee, together with the Senior Management Support Team
and representatives from public health and social care. This ensures that a wide
range of clinical and social care views inform the CCG‟s work.
Localities
As outlined above, the CCG is comprised of three localities, each with leads who are
Members of the CCG‟s Governing Body.
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Locality meetings
In line with the CCG‟s Constitution, each locality holds ten meetings a year to
ensure that all Member Practices are fully aware of the CCG‟s work and have the
opportunity to contribute. The core membership includes:
 A designated clinical lead from each practice
 At least two lead practice managers
 A locality practice nurse elected by the Practice Nurses‟ Forum
Locality Interface Managers
Each Locality also has a Locality Interface Manager who is the key link between
the CCG‟s Management Support Team and each locality. Our Locality Interface
Managers enable change by supporting the localities to deliver the CCG‟s
strategy and objectives at a local level.
Locality Engagement
The CCG is committed to engaging with and listening to its patients and partners
at every level in order to increase our understanding of patient experience and
health needs.
Patient Participation Groups
Patient Participation Groups are made up of practice patients and are an invaluable
interface between patients, GP practices and the CCG. These Groups focus on
service improvement.
Each of our three localities holds quarterly meetings where Patient Participation
Group representatives, local government, public health and voluntary sector
organisations discuss local health service issues and input into service redesign.
This year‟s topics included shared healthcare records, Locality Hubs and the pilot
Musculoskeletal Referral Support Service.
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Locality Patient Reference Groups
Locality Patient Reference Groups (LPRGs) provide an informal discussion forum
between the CCG and local residents. Under the system, nominated patient
representatives from each practice‟s Patient Participation Group share thoughts
about their experiences of local healthcare and discuss issues raised in their PPGs.
Locality engagement structure
Patient and Public Engagement Forum
The Patient and Public Engagement Forum (PPEF) is part of the CCG‟s formal
structure. Each Locality Patient Reference Group is represented on the PPEF and
the PPEF members‟ views are represented on the CCG‟s Governing Body via the
Lay Member for Patient and Public Involvement (PPI).
The PPEF engages patients, monitors the CCG‟s engagement work and acts on
patient experience information in order to help shape commissioning decisions, as
well as making recommendations to the Governing Body.
The diagram below shows how the patient engagement groups at all levels of the
CCG support each other and the Governing Body.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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NHS North West Surrey CCG patient engagement structure
Clinical Commissioning Network
The CCG holds a Clinical Commissioning Network every six weeks and actively
encourages participation from all North West Surrey Member Practices, supporting
the Continuing Professional Development of individual GPs to encourage
attendance. The agenda is developed to ensure clinical leadership of and
engagement in the CCG‟s vision, commissioning plans and decision-making.
Practice Managers‟ Forum and Operations Group
All practice managers are members of the CCG‟s Practice Managers‟ Forum.
Meetings are held bi-monthly and give practice managers the opportunity to share
knowledge, processes and best practice. This helps to encourage the continuity of
service improvement across Member Practices.
In order to support the development of primary care staff, we recently introduced a
bi-annual educational away day for current and aspiring practice managers. The
inaugural event was very well received and included speakers from the Local
Medical Committee, an employment law barrister and CCG Directors.
Two elected representatives from each locality form a Practice Managers‟
Operations Group, which regularly meets with the CCG‟s Head of Locality
Development. Members of the Operations Group also join monthly CCG Senior
Management Team meetings to ensure joined-up working at an operational level on
key issues affecting the CCG and its practices.
Member communication
Effective communication between the CCG and its Members is vital for a thriving
partnership and achieving a shared vision. The groups and forums, above, are
supported by the following channels:
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Members‟ Bulletin
Monthly Members‟ news update, highlighting major CCG programme
developments, policy changes and national awareness days.
„Spotlight‟ Clinical Update
Email to Member Practices with operational information such as clinical good
practice, medicine management updates and service changes.
“Talk to us”
A desktop tool in all Member Practices which allows GPs to provide feedback
and raise issues with the CCG quickly and directly.
CCG website
The main public-facing source of information and news about the CCG, at
www.nwsurreyccg.nhs.uk.
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2. Strategic Report
2.1 Introduction
Dr Elizabeth Lawn, Chair, and Julia Ross, Chief Executive
Ensuring patients receive high quality, safe services is at the heart of everything we
do.
Our 2014/15 Annual Report and Accounts sets out our achievements over the past
year. It also outlines what we will do in 2015/16 to strengthen systems and services
and how we will work innovatively to deliver better patient outcomes. Our approach
has been developed through active patient and public engagement and we continue
to work closely with local stakeholders and partners as we evolve our operating plan.
This ensures that we deliver significant positive change in healthcare services for
local people.
We successfully manage a wide range of challenges and issues within the health
and social care system. However, 2015/16 will bring fresh challenges, including
continued financial pressures, changes in national policy and the demographic
pressures of an ageing population.
Overcoming these challenges will require a strategic shift in how we commission
services and the genuine integration of health and social care resources.
This year has tested our resilience and emergency planning capability as well as
how we work with our wide range of provider organisations.
The local healthcare system works collaboratively for the benefit for our residents.
During winter 2014 when Ashford & St Peter‟s Hospital Trust declared a Major
Incident, the system responded well. In our role as commissioner we ensured that all
agencies, including social care and community health services, worked together to
resolve the immediate issues as quickly as possible and to agree a detailed recovery
plan.
This year the CCG has delivered an outstanding result for our dementia diagnosis
rate, identifying 63.5% of the estimated number of people in North West Surrey with
dementia based on current national prevalence data. This makes us the best
performing CCG in the Surrey and Sussex area by a margin of more than 4%. This
result shows that we are providing services that meet the needs of local people, as
well as demonstrating a good understanding of the number of local residents
requiring our support. We will continue to work towards achieving and then
surpassing the target of 67%.
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Another one of this year‟s highlights has been the introduction of the Musculoskeletal
(MSK) referral support service, which is helping to improve patient experience and
outcomes. More information about this can be found on page 28.
The Better Care Fund, whilst challenging, has enabled us to prepare and plan for the
real and practical integration of health and social care services. During 2015/16 we
will see this come to fruition through the implementation of our Locality Hubs
Programme and the on-going development of our Urgent Care Programme.
We welcome the shift towards proactive care which keeps people healthy at home
for as long as possible and prevents avoidable hospital admissions. We are
determined to focus on high impact opportunities to enable a long term, sustainable
model of care for our ageing local population.
Our Out of Hospital Strategy, which focuses on Locality Hubs, is exciting and
innovative and has been developed as part of our Integrated Care programme.
We encourage anyone who is interested in getting involved with the CCG to join their
GP practice‟s Patient Participation Group, or to look on our website at
www.nwsurreyccg.nhs.uk to discover other ways to contribute.
We certify that NHS North West Surrey CCG has complied with the statutory duties
laid down in the NHS Act 2006 (as amended).
Dr Elizabeth Lawn
Chair
Date:
Julia Ross
Chief Executive Officer
28 May 2015
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2.2 Overview of NHS North West Surrey CCG
Our vision & purpose
Our vision is to enable all people in North West Surrey to enjoy the best possible
health. To achieve this, we listen to our communities in order to plan and improve
healthcare services in line with people‟s needs. We award contracts for the delivery
of healthcare services and make sure that all services meet the required standards.
With clinical leaders and managers working in partnership, we empower Member
Practices, GPs and our residents to shape healthcare expenditure by:

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Considering the needs of patients and the local population
Deciding on how and where to invest in order to ensure effective services and
treatments
Leading the local health economy to make sure health and other care
providers work effectively together to deliver safe, seamless, high quality
services in the best interests of patients
Our operating ethos
We aim to deliver patient-centred, clinically-led commissioning of healthcare
services. We do this by operating as one Group with one vision and by supporting
our Member Practices to work as one entity through our localities.
By combining strong clinical leadership with excellent management and by working
with partners across health and social care, we now have a significant presence in
the local health economy. This gives us the foundation to achieve essential
transformational change.
The CCG promotes good governance and proper stewardship of public resources in
the pursuit of its goals and in meeting its statutory duties.
Our values
The values at the heart of the CCG are:
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Being accountable to our local population and our members
Being open and transparent in our decision making
Keeping patient experience and quality central to delivery
Having strong clinical leadership and engaging clinicians from all parts of the
system
Valuing engagement with our patients, providers and stakeholders, and using
their feedback to support the CCG‟s delivery
Ensuring good corporate governance is embedded within the CCG‟s operating
model
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Health needs in North West Surrey
We are fortunate to enjoy better health than much of Britain. People in North West
Surrey live longer than the national average and our healthcare services achieve
better results across a wide range of conditions than in many other parts of the
country.
However, we serve an ageing population, which has important implications for our
healthcare planning. Conditions such as cancer and dementia are becoming more
widespread as people live longer, leading to a greater demand for long-term care.
Strokes are more common and require urgent treatment to minimise lasting brain
damage. Also an increase in people living with serious health conditions is placing
pressure on services that were designed to deliver urgent care in a crisis, rather than
managing people‟s care over the longer term.
While North West Surrey is largely an affluent area, there are pockets of deprivation
in all of our boroughs, particularly Maybury and Sheerwater in Woking and Stanwell
in Spelthorne. North Walton in Elmbridge and parts of Chertsey and Addlestone in
Runnymede are other areas where life expectancy can be up to six years less than
in the more prosperous parts of North West Surrey.
While the NHS budget has been protected from cuts, the rising cost of medicines
and our ageing population mean that any growth in funding will be out-stripped by
growth in demand, leading to a perennial funding shortfall. Our CCG therefore needs
to continue to find innovative new ways to meet the healthcare needs of North West
Surrey residents within the available resource.
Our Strategic Commissioning Plan
Our Strategic Commissioning Plan (SCP) was developed in 2013/14 and sets out
our ambitious vision and programmes to transform local health services over the
next five years, including improving patient outcomes, quality of care, patient
experience and value for money.
We are now focusing on delivering our plan.
Delivering our plan
The four enablers set out below will ensure successful delivery of our SCP and our
vision for local health services:
Engaging and consulting with local people
Building on our strong foundation of patient and public engagement, we will continue
to engage with patients, the public and community representatives and consult them
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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as we develop our plans. This will ensure that our commissioning decisions meet
local peoples‟ needs. Please see page 43 for more information on community
engagement.
Whole system governance with key partners
The CCG has developed a governance structure featuring Strategic Change Boards
for our six main change programmes. We also have a Clinical Reference Group to
advise and make recommendations to these Boards and have implemented a robust
system of reporting across the whole organisation.
The North West Surrey Transformation Board, which includes the Chief Executive
and a senior clinician from each organisation in North West Surrey, oversees this.
We also give regular updates on progress to the Surrey Health and Wellbeing Board
and the Surrey Transformation Board.
CCG leadership and management
Our Members‟ Introduction and the Report on our Organisation describe how we
continue to improve our high-performing organisation. This is based on a true
partnership of clinicians and managers who have the skills, resources and structures
to work together to deliver our transformation programme.
Programme Management Office
The CCG‟s Programme Management Office is a dedicated resource that coordinates
delivery across our six major change programmes. It also communicates across the
system and reports to the North West Surrey Transformation Board and the CCG‟s
Clinical Executive and Governing Body. The diagram below outlines the structures:
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Our providers
Acute hospital services
Ashford and St. Peter‟s Hospitals NHS Foundation Trust provides services across
two hospitals: St Peter‟s, which delivers urgent care, including A&E, maternity,
intensive care and other specialist services; and Ashford, which focuses on
outpatient, elective services and planned care.
The CCG also commissions acute hospital services from other providers, including:
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The Royal Surrey County Hospital NHS Foundation Trust
Frimley Park NHS Foundation Trust
St. George‟s Healthcare NHS Trust
Local independent sector hospitals
Community health services
Virgin Care Services Limited (VCSL) is our main provider of community health
services. VCSL services across Surrey include community hospitals, community
nursing, children‟s services and prison healthcare. VCSL is also responsible for two
of the NHS Walk-in Centres at Woking and Weybridge.
Since April 2013, under collaborative commissioning arrangements (see page 50 for
details), NHS North West Surrey CCG has taken the lead commissioner role for the
VCSL community contract. Associate commissioners include all other Surrey CCGs
(Surrey Downs, East Surrey, Guildford & Waverley, Surrey Heath and North East
Hampshire & Farnham) two NHS England Area Teams (Surrey & Sussex and Kent &
Medway) and Surrey County Council for Children‟s Services and Public Health.
Mental Health Services
Under Surrey‟s collaborative commissioning arrangements (see page 50 for details),
Surrey and Borders Partnership NHS Foundation Trust (SABP) is commissioned on
our behalf by North East Hampshire and Farnham CCG to provide mental health
services to our local population.
SABP also provide Improved Access to Psychological Therapies services (IAPT) on
our behalf. IAPT provides help and support for people who are suffering with mild to
moderate mental health conditions such as stress, anxiety and low mood.
SABP was authorised as an NHS Foundation Trust in May 2008 and as a health and
social care Partnership Trust from April 2005. The Trust is the leading provider of
specialist mental health and learning disability services for people of all ages in
Surrey and North East Hampshire. It also provides psychiatric liaison at Ashford and
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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St. Peter‟s Hospitals and community mental health input to the Virtual Ward teams
staffed by VCSL.
Ambulance and patient transport services
South East Coast Ambulance Service (SECAmb) provides 999 emergency services,
the NHS 111 Service and patient transport services.
From 1 April 2014, NHS North West Surrey CCG has been the lead commissioner
for ambulance, patient transport and NHS 111 contracts on behalf of all Surrey
CCGs. The CCG is working with colleagues across Surrey in order to understand the
issues facing these services in all areas and to ensure the consistency of services
across the County.
From 1 April 2015, changes to the 999 contract mean that there will be separate
contracts for Kent, Surrey and Sussex. This change will provide a stronger focus on
local requirements and enable us to improve services for Surrey residents.
The current patient transport service contract expires on 30 September 2015. An
extension to the contract is currently being negotiated with the provider (SECAmb) to
ensure continuity of services whilst procurement takes place.
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2.3 Improving quality and patient experience
Introduction
Dr Richard Barnett, Clinical Chief, Innovation and Quality
Ensuring safe, high quality services for the people of North West Surrey is at the
heart of what we do.
One of our priorities is improving the quality of commissioned services and this
means making sure that the services we commission result in better outcomes for
the population of North West Surrey as a whole, as well as for the individuals using
commissioned services. We have a clear focus on quality within all contracts with our
providers, with an expectation that this drives improvement on behalf of our
residents. Our 2014/15 Quality Strategy ensures that quality is built into all the
CCG‟s work streams and service developments. A copy can be found on the CCG‟s
website.
We continue to focus on patient safety across the whole organisation. In November
2014 we held an event for all CCG staff across Surrey who are involved in the
handling of serious incidents. The purpose was to use the learning from serious
incidents to improve the quality of care for our population. As a result we have been
working with St. Peter‟s hospital to collect data on falls and subdural haemorrhage to
help us clarify the best way of identifying the risks and benefits of prescribing
anticoagulation to the frail elderly.
The CQUIN payment framework enables commissioners to reward excellence by
linking a proportion of healthcare providers' income to the achievement of local
quality improvement goals. Working with colleagues, we reviewed the Sepsis
pathway in accident and emergency as a CQUIN. This work highlighted problems
with the diagnosis and usage of broad-spectrum antibiotics and resulted in an update
of the guidelines used by the microbiology team.
During 2014/15 I was pleased to have been able to take a more active role in adult
safeguarding, in particular at some of our nursing homes. Feedback from social
services has been very positive that there has been clinical input.
We are delighted that, following an inspection in December 2014, The Care Quality
Commission rated Ashford and St Peter‟s Hospitals NHS Foundation Trust as
„Good‟. This was the first time the Hospitals had been inspected under the new
regime, which involved a much more rigorous approach than previous inspections.
Over the last year the team has built on the successes of our first year by taking a
robust approach to commissioning, consolidating our systems and processes and
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continuing to have a close relationship with each of our providers to improve the
quality of services for our residents.
Improving the urgent care patient experience
Our Urgent Care Team supported all of our provider organisations during a very
difficult year for urgent care services in North West Surrey and the UK. This work
particularly focused on improving urgent care services at times of significant
pressure, especially during very high temperatures last summer and the pressures
last winter.
During 2014/15 we received just over £3m to help the local urgent care system
better manage urgent care demand.
A team of clinicians and managers developed innovative proposals for 16 initiatives
to improve the patient experience and alleviate system pressure. All were approved
by the North West Surrey System Resilience Group (NHS North West Surrey CCG,
Ashford & St Peter‟s Hospitals NHS Foundation Trust [ASPHFT], VCSL, South East
Coast Ambulance Service [SECAmb], Surrey County Council, Surrey & Borders
Partnership NHS Foundation Trust, NHS111 and Care UK), which works together to
give leadership to urgent care services and manage system pressure. These
initiatives included:
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Greater coverage of mental health services in A&E department and other
provider services. Psychiatric liaison services hours were extended to seven
days a week from 8.00am to 03.00am, ensuring that patients attending A&E
who required psychiatric services had quicker access to assessment and
treatment. As a result, over 509 patients were assessed by the psychiatric
liaison service during these extended hours, achieving an average response
time of 40 minutes
The time during which social workers were based at ASPHFT was increased
to seven days a week, including an extended early evening service. As a
result, 220 patients were discharged more quickly, reducing their risk of
contracting a hospital acquired infection
Additional cover from our out of hours provider to make GPs available in the
Weybridge and Woking Walk-in-Centres at weekends supported by extended
x-ray provision to offer patients a fast, comprehensive alternative to A&E. As
a result, an average of over 20 patients per weekend did not require onward
referral to A&E for x-ray
VCSL‟s rapid response service, which supports people in their homes, had the
hours of its service extended to include weekends and early evenings. As a
result, over 120 patients were supported in their homes rather than being kept
in hospital
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While winter 2014/15 was relatively mild, the North West Surrey urgent care system,
in line with the rest of the country, saw unprecedented levels of demand, particularly
during Christmas and New Year, when the system was placed under exceptional
strain.
Our provider organisations worked in partnership to maintain safe, effective services
during this time. Care Quality Commission (CQC) representatives who were at St
Peter‟s Hospital for its review during the peak period endorsed this, stating in their
report that: “There was evidence of good multidisciplinary working across the trust; of
note was the competent specialist palliative care team who worked successfully
throughout the hospital. They were accessible, visible and well utilised. The clinical
effectiveness of the services was good. Care and treatment was delivered by trained
and experienced medical staff and committed nurses.”
The CQC also acknowledged that the CCG, as commissioner, provides good system
wide leadership.
The ability of the system to pull together in this way was helped by the learning
gained from responding to the floods in 2013/14 and was a testament to the
commitment and dedication of frontline staff across the local healthcare system.
An alternative to Accident & Emergency
Last year over 76,500 people attended Accident & Emergency (A&E) at St Peter‟s
Hospital, at a cost of £9.3 million. Many of those who attended A&E could have been
treated elsewhere.
To reduce A&E pressures and drive NHS 111 traffic, the CCG ran an extensive
public awareness campaign on alternative local services, in partnership with provider
organisations.
During the summer of 2014 integrated advertising, communications and public
engagement activity was undertaken, including:
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Posters at bus stops, phone boxes and train stations
Washroom advertising and beer mats in local pubs
Local newspaper wraps in each North West Surrey locality
Installing improved road signage directing people to the Weybridge, Woking
and Ashford Walk-in-Centres
Three public engagement events were held at shopping centres across North West
Surrey featuring the larger than life „Yellow Men‟. Promotional materials and
information leaflets were given to the public, while staff from the CCG, VCSL and the
SECAmb talked to shoppers.
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As a result, the number of calls to NHS 111 has steadily increased month on month,
rising from 4,463 calls in October 2014 to 5,156 in January 2015. There has been an
increase in monthly attendances at the Weybridge and Woking Walk-in-Centres,
rising from 5,361 attendances in October 2014 to 5,712 in February 2015.
A local survey of 200 people revealed that the majority found the „Yellow Men‟
campaign material eye-catching and easy to understand. We learnt through the
evaluation that using a broader range of digital and social media channels would
also be helpful in future. The impact of the „Yellow Men‟ campaign is currently being
evaluated and our findings will inform our 2015/16 campaigns.
Improving community health services
As the lead commissioner for the Virgin Care Services Ltd (VCSL) community
contract, we continued to work with VCSL to gain greater visibility of their activity and
outcomes in 2014/15, and to support the planning and redesign work required to
secure appropriate services when the block contract arrangements expire at the end
of 2016/17.
We have continued to improve partner relationships across the whole system, which
is evidenced by the integrated way in which all organisations work together. For
example, during times of significant pressure on the urgent care system, there has
been a positive response to delivering alternative care services and interventions
through working flexibly and cohesively across health and social care.
Our aspirations for care closer to home, delivered at the right place and at the right
time, are innovative. We recognise that responsive, flexible, quality community
services will be integral in achieving this.
Community nursing services for children
The Strategic Clinical Network (SCN) is undertaking a review of children‟s
community nursing services across Kent, Surrey and Sussex, which will lead to the
development of recommended guidelines and service specifications.
At present, community nursing services for children in North West Surrey are
commissioned from two providers: Ashford and St. Peter‟s and VCSL. It is our
intention to review these services and define a single service model and specification
based on outputs from the SCN. This work may lead to re-procurement of the
service.
Improving mental health services
People with mental health conditions or learning disabilities are best supported
through integrated care pathways and regular health checks to improve their quality
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and length of life. We are introducing Personal Health Budgets for people receiving
continuing healthcare to provide more choice over the care they receive.
Improving Access to Psychological Therapies (IAPT)
This year, local capacity for primary psychological therapy services continued to
improve through contracts with new providers. This resulted in a considerable
improvement in waiting times for assessment and treatment.
The CCG will ensure that patients receive the services they need by using our
Referral Support Service to co-ordinate referrals to the most appropriate provider, in
line with patient choice.
To increase patient uptake, psychiatric liaison services and perinatal services will
also be able to refer directly into IAPT services.
Behavioural services for children and young people
One of the priorities identified in our strategic planning was the lack of clear, NICEcompliant pathways for children and young people with behavioural difficulties,
including attention deficit hyperactivity disorder and autistic spectrum disorder.
During 2014/15, the CCG led a multi-professional, multi-agency review of current
service provision with our partners and stakeholders, which included parents and
carers.
During the latter part of 2014/15, we began work with Surrey County Council and
other CCGs to begin the process of commissioning a clearer pathway and improved
service model for children and young people as part of the re-procurement of Child
and Adolescent Mental Health Services in Surrey. The planned start date for the new
service is April 2016.
Identification of people with dementia
Utilising funding from NHS England and the Strategic Clinical Network, our
Medicines Management Team and one of our GPs undertook searches of GP
records to ensure that all patients with a diagnosis of dementia are included on the
dementia register. This has the added benefit of identifying patients who may not
have a formal diagnosis, enabling GPs to refer as appropriate and improve patient
care.
Dementia-friendly GP practice
GPs and primary healthcare teams are often the key contacts for people worried
about potential memory loss.
The GP Practice at Goldsworth Park Health Centre in Woking has been highlighted
as a Dementia Friendly Practice due to its outstanding service provision. Admiral
Nurse Vincent Goodorally has worked with a number of practices in Woking over the
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last eight months and has offered training to other GP practices across North West
Surrey.
Dementia Crisis Respite Service
Using funding from the Prime Minister‟s Dementia Challenge, the CCG continued to
pilot the Dementia Crisis Respite Service. The service provides respite care for
people with dementia, in their own homes, if there is a crisis or a breakdown in care
arrangements that would normally lead to hospital admission. The service has so far
provided care for over a hundred North West Surrey residents, enabling them to be
cared for at home rather than in hospital. We have secured funding to continue this
service in 2015/16.
Crisis Concordat and cafés
During 2014 the CCG participated in various stakeholder workshops to identify local
priorities to improve care for those experiencing a mental health crisis. We are part
of the countywide Crisis Concordat, which has awarded in excess of £1million to
improve crisis care in Surrey. We will work with the voluntary sector, Surrey County
Council and Surrey & Borders Partnership to implement a safe haven/crisis café
model for North West Surrey residents.
Psychiatric Liaison
As noted previously, this year the CCG has invested additional funding into the
much-valued Psychiatric Liaison service at Ashford & St Peter's Hospitals provided
by Surrey & Borders Partnership Trust (SABP). Through this investment we have
provided twilight service for working age adults and extending the older adult‟s
service to seven days.
Integrated crisis and rapid response services
Much work has been done through the partnership funding to bring elements of care
across health and social services closer together. Partnership funding has been
used to enhance the community rapid response service and to fund social care posts
in acute hospital care as part of the Older Peoples Advice and Liaison service.
These services are vital in ensuring timely, safe and effective discharge after a spell
in hospital
Supporting Primary Care Development
In 2013, the CCG commissioned the Primary Care Foundation to undertake an audit
at GP practice level to understand how access and urgent care is managed within
practices. Another aim of the audit was to provide comparative data, analysing GP
practice performance on a number of factors, including: managing access and urgent
care; ease of access by phone; consultation rate; patient experience; balance of
same day and book ahead appointments; use of telephone consultations; home
visits; workload by staff group; and variation in response by reception team. The goal
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of the data collection is to enable the sharing of best practice across the local area
and to improve services for patients.
Extra resources have been made available to the CCG locality team to support
practices via a series of practice visits. In addition, the CCG gave practical support
and guidance on how to improve patient access to appointments, opening hours and
telephony. This has helped to give staff confidence to manage urgent cases at
reception.
The 2014/15 practice performance analysis involved nearly half of the North West
Surrey GP practices. Below are examples of how practices have benefitted:
Wey Family Practice
Following audit and analysis, the practice changed the way it does some home visits.
Parishes Bridge Medical Practice
Recommendations for changes to the appointment system were made and changes
will be phased in gradually. The practice has five to six staff answering calls.
All three practices have the option for a telephone consultation appointment.
Patients can also book appointments online using Vision Online Services. Patients
must register for this service with their practice reception by bringing a photo
identification document. Through Vision Online Services, patients can also access
their medication and allergies records. Eventually, this service will be expanded to
provide test results.
Primary Care Workforce Tutor
The CCG has recently appointed a Primary Care Work Force Tutor who has been
working with our primary care based practice nurses. She has proactively supported
a forum for practice nurses and has recently organised a study day event attended
by 70 practice nurses.
She has also been involved in setting up a mentoring scheme for potential practice
nurses and has identified five mentors in three practices, one in each locality, with
nine more practices expressing an interest.
Caring for people in later life
Care Homes
This year the CCG has developed a number of initiatives focused on targeted clinical
support to nursing and residential homes across North West Surrey. These projects
include the provision of additional, structured GP and Community Matron support to
a number of homes; a new community pharmacist dedicated to carrying out
medications reviews with care home residents; and piloting of remote access to
consultant level clinical advice through a video link. This has resulted in significant
reductions in admissions to acute hospitals from care homes, as monitored through
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our System Resilience Group. These initiatives will continue to be implemented in
2015/16.
End of life strategy
End of life care is a priority for the CCG. Building on the work already carried out as
part of our Strategic Commissioning Plan, we are developing an end of life care
strategy by reviewing public health data and consulting with a range of groups to
understand what is important to people at the end of life.
Co-ordinated, Safe, Integrated Service
In June 2014 the CCG began a pilot of CoSI (Co-ordinated, Safe, Integrated), a
community service for people in the last six to eight weeks of life. CoSI helps people
to be discharged more quickly from hospital and to receive care in their preferred
place before their deaths. A review of the pilot showed that over 80% of people
received care in their preferred place and over 85% of people died in their preferred
place of death, compared to a national average of around 50%.
Following approval from the CCG Clinical Executive, the programme will be rolled
out in full across North West Surrey.
Medicines Management
The Medicines Management Team supports Member Practices to improve quality
and efficiency through the effective use of medicines. The focus of this work remains
on quality, outcomes and patient benefits.
This year the Medicines Management Team employed a new Primary Care
Pharmacist whose role is to improve the quality of prescribing in care homes and to
improve the administration and storage of medications.
The Primary Care Pharmacist has helped to optimise prescribing in several of our
care homes, leading to more effective prescribing, particularly in end of life
situations. This has reduced the numbers of medicines being taken by individuals,
thus reducing the potential for serious interactions between medications which can
result in serious and chronic disease, for example, renal impairment.
We have also introduced a programme to review polypharmacy and ensure
medicines optimisation across the entire health economy, using a CQUIN for our
local acute provider and the frailty pathway in general practice. We anticipate that
this will lead to more effective prescribing, with the potential for increased safety and
less harm to patients ultimately leading to fewer admissions to hospital.
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Prescribing Clinical Network
Our Head of Medicines Management, Linda Honey, chairs the Surrey-wide
Prescribing Clinical Network (PCN), which leads the development of medicines
management guidelines.
We work collaboratively through the PCN with the five other Surrey CCGs and
Crawley and Mid Sussex & Horsham to ensure equitable access to medicines across
our communities. The PCN also includes membership from local hospital Trusts to
enable better joint working to address medication issues. Recommendations from
the PCN are taken to the CCG‟s Clinical Executive for ratification and are
implemented via our three localities.
Many of our successes have been achieved through effective clinical engagement
and decision making across the wider health economy, with the Prescribing Clinical
Network (PCN) being the focal point of these activities.
The work of the PCN includes:
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Horizon scanning:
o Managed entry of new drugs
o Managed exit of drugs following loss of patent exclusivity
o Interpretation and implementation of all new National Institute of Clinical
Excellence Technology Appraisals (NICE TA) in relation to medicines are
discussed at the PCN
Ensuring a consistent approach to value for money and opportunities for
investment and disinvestment
Ensuring governance systems are in place to support the safe and
appropriate prescribing of drugs across the system whilst considering funding
allocations and financial flows
Promoting equity of access to medicines across Surrey by collaborative
working across all participating PCN organisations
Implementation of National Patient Safety Agency alerts and other directives
in relation to drug / patient safety issues
Musculoskeletal Services (MSK)
To address issues such as poor coordination between services, limited access to
conservative treatments and a confusing pathway for patients and professionals, the
Governing Body decided that patients with MSK conditions would be best served
through a prime provider delivery model. As a result, we agreed support for a oneyear MSK pilot project to start to improve patient experience and outcomes.
Following extensive patient and public engagement and clinical input from our GP
practices, the pilot service launched on 1 October 2014 and featured the following
changes:
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A single point of access to receive all GP MSK referrals (excluding
Rheumatology and chronic pain) via the CCG‟s Referral Support Service
(RSS)
A system of clinical triage using experienced MSK clinicians to view referrals
and signpost patients to the most appropriate service
A new extended scope practitioner service to assess referrals face to face
A direct access route to Magnetic Resonance Imaging/Computerised
Tomography and other diagnostic tests
A coordinating role for the whole MSK pathway, including integrating
physiotherapy and the local injection service
The new MSK referral pathway has been highly successful, with over 1,200 MSK
patient referrals per month. Our analysis shows that:
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MSK referrals to secondary care are down by 23%
95% of North West Surrey GPs are using the RSS for MSK referrals
A high number of patients surveyed said that they were very satisfied with the
speed of contact by the RSS and the choices they were offered
The MSK pathway redesign is saving circa £60k per month
Figures for the first four months of the service (1 October 2014 to 31 January 2015)
are detailed above.
Collaborative hypoglycaemia project
The CCG‟s Diabetes Team worked with South East Coast Ambulance Service NHS
Foundation Trust (SECAmb), pharmacy provider Merck Sharp & Dohme and
colleagues at Surrey Downs CCG on a collaborative project to reduce the impact of
hypoglycaemia amongst patients with diabetes. The Strategic Clinical Network for
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Kent, Surrey and Sussex also supported the project, providing quality assurance for
the education element.
The CCG‟s Clinical Nurse in Diabetes, Mary Braddock, has been leading part of the
project with Dr Asha Pillai; together they have provided a structured education
programme for SECAmb staff which highlights best practice in the acute
management of hypoglycaemia and includes information on the common causes of
the condition to help paramedics identify diabetic patients when responding to callout (in order). This helps reduce patient conveyances to hospital, providing the
correct treatment closer to home and supporting patients to manage their own
conditions. SECAmb staff relay this information back to primary and community care
providers so that patient care can be optimised to reduce the incidence of
hypoglycaemia.
Mary Braddock said: “Hypoglycaemia can be a serious and frightening experience
for patients with diabetes, and may be confused with a wide range of other
conditions, particularly in a medical emergency. We know that rapid treatment for a
severe attack can help prevent any long-term damage and that raising awareness of
the signs, symptoms and appropriate treatment amongst emergency response staff
can lead to significantly better patient outcomes.”
Since launching in January 2015, SECAmb has treated seven patients in North West
Surrey for a hypoglycaemic attack and the information shared with primary and
community carers has improved patient management.
The new Hypoglycaemia pathway was presented as an example of innovation in the
management of diabetes care at the Kent, Surrey and Sussex Academic Health
Science Network Expo on 15 January 2015.
2.4 Listening to feedback and improving patient safety
“Talk to Us” clinical alert system
Dr Richard Barnett, Clinical Chief of Innovation and Quality, introduced the “Talk to
Us” feedback system in 2014 so that our member GPs could let us know of any
concerns around the quality and safety of patient care. Use of this facility has grown
since then. For 2014/15 a total of 224 alerts were received covering Ashford and St.
Peter‟s and other providers. Feedback is received across three areas: prescribing,
clinical and administration. The chart below gives an overview of the alerts received.
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Through this we have been able to identify key issues for system improvements, all
of which are followed up with our providers.
Child Safeguarding
Child safeguarding is a critical priority shared with health and care providers across
our community. A clear line of accountability for safeguarding is reflected in the
CCG‟s governance arrangements from the Accountable Officer through Executive
and Clinical Leads. The Safeguarding Children Team is hosted by NHS Guildford
and Waverley CCG and provides a service across the County. The County-wide
Safeguarding Team leads safeguarding children work through an agreed action plan
and monitors compliance of agreed safeguarding standards through a performance
framework.
North West Surrey CCG is committed to safeguarding children and we execute our
responsibilities through, for example:
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The CCG‟s Quality Strategy, which underpins the Children and Young People
Strategic Workstream
Monthly safeguarding children reports to the Quality and Performance
Committee
An annual safeguarding children report to the Quality and Performance
Committee in May 2015
A programme of safeguarding training aligned and complementary to the
Surrey Safeguarding Children Boards
A consistent approach to commissioning arrangements for safeguarding
children has been developed and agreed standards for children have been
included in all provider contracts for 2015/16
The CQC and Ofsted carried out a Surrey-wide inspection in November 2014. Early
feedback on the health aspect of safeguarding has been positive. The CCG is
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awaiting the final report and a feedback workshop is scheduled for May 2015 to take
forward the learning from the review.
With Guildford and Waverly, the CCG undertakes a bi-annual audit of safeguarding
standards through the Section 11 Audit (Children Act 2004) and supports an annual
health economy wide deep dive. This process allows the CCG to monitor progress
against defined standards, which the CCG is able to demonstrate its current position
against.
The CCG is a key contributor to the work of the Surrey Safeguarding Children Board
and its sub-groups and has, over the past year, contributed to a number of serious
case reviews. Learning has been shared with relevant staff groups and is being used
to improve service commissioning and delivery.
The CCG continues to work closely with provider and commissioning colleagues,
including specialist leads, to assure the Surrey Safeguarding Children Board that
systems for governance and discharging our responsibilities are in place to ensure
that whole system learning from Serious Case Reviews is embedded in practice.
Additionally, all General Practices have an identified lead for safeguarding children.
Francis Report recommendations
The CCG is committed to commissioning care that is at all times safe, high quality
and effective, and to monitor the quality standards and performance of our providers.
As part of contract performance management we hold monthly Clinical Quality
Review Meetings (CQRM) with our providers. These meetings monitor all aspects of
the quality elements of contracts, including patient safety, patient and carer
experience and clinical effectiveness. At the meetings we also monitor assurance on
compliance. Any unresolved quality challenges that arise from CQRM are escalated
to the relevant contract management board and to the CCG Senior Management
Team.
We also understand how important organisational culture is to providing good patient
care. Quality is the central issue for everyone working in the CCG. All employees are
responsible for ensuring that clinical quality and patient safety requirements are
embedded in everything they do. Positive cultural change happens when colleagues
provide clear instructions, allow autonomy, extend genuine trust and act fairly. To
achieve sustainable cultural change, these behaviours must be demonstrated at all
levels from each individual and across professions and multidisciplinary teams.
These behaviours must also be modeled from the top of every health care
organisation, with Boards demonstrating the behaviors they want staff to emulate.
The CCG has embraced the opportunity to build on the forces for change released
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by Francis, Keogh and Berwick and developed a plan outlining our commitment to
addressing the recommendations in the Frances Report. The goals are to nurture a
culture where:
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Quality and safety are the top priority
There are clear goals for improvement at every level
Patient engagement and voice are truly enabled
Staff are engaged in developing their organisation
Staff are supported, respected, valued and developed
Team-working is not undermined by status and professional subcultures
There is integrity of purpose across the organisation
Every CCG member of staff takes responsibility for helping to bring about the
transformational change as part of the broad NHS culture that the service requires
and our communities deserve.
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2.5 Improving Performance and Delivery
Introduction
Dr Deborah Shiel, Clinical Chief for Contracts & Performance
This has been a challenging and successful second year for the CCG, as we
continue to address issues across our local health system.
In this section we look at the work the CCG has undertaken to embed structures and
processes to improve performance and delivery and how we have worked with our
providers to ensure they are delivering the best possible care for our patients.
We continue to develop a robust approach to commissioning. This includes
establishing new models that promote integration and innovation and incentivising a
move towards more care out of hospital and into the community. In turn, this will help
to reduce total spend, an essential driver for change given the financial pressures
facing the NHS locally and nationally.
Meeting key performance targets
Accident & Emergency
Along with other hospital trusts across the country, ASPHFT experienced a high
level of demand on its A&E unit during 2014/15. This was particularly acute during
Christmas and New Year, when the Trust recorded higher than average attendances
on a number of given days (see chart below).
The pressure escalated and, as with a number of other hospitals across the country,
the Trust – in agreement with NHS North West Surrey CCG colleagues – decided to
declare a Major Incident on 3 January 2015. Declaring a Major Incident facilitated a
targeted approach to mobilising additional staff and services, including doctors,
nurses and volunteers, to ensure safe care for patients within existing wards,
escalation areas and A&E. It also meant that some outpatient clinics and planned
surgery could be cancelled to reduce demand and free doctor and nurse capacity
and capacity on other sites could be commandeered.
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* Data source: SUS
The analysis shows that high monthly attendance volumes were particularly evident
for Quarter 3 (October – December 2014). Attendance volumes reached a peak in
December, which was comparable to peaks experienced in May and July. These
months all showed increases compared to 2013/14, with variances ranging from
+5.5% to +8.5%.
During December the Trust experienced an increase of 7.1%, or 554 patients, in
A&E attendances, compared to the same time last year, with a 15.7% increase in
admissions, or 286 patients, compared to 2013. There was a 26.8% increase in
admissions for the 75+ age group, many of whom are the frail elderly with multiple
conditions. These patients are more complex in terms of treatment and care and
often require complex discharge packages. This had a significant impact on patient
flow within the hospital, leading to a drop in compliance for the A&E four hour
standard, particularly during the months of October to December 2014.
A detailed recovery plan is in place to address immediate improvement priorities
such as front door configuration, patient flow, discharge planning and system
change. This will achieve immediate breach reductions through specific initiatives
within each of these priorities, including re-location of Ambulatory Emergency Care
Unit, clinical pathway re-design, improved protocols and additional step down
provision.
A trajectory for improvement has been agreed, which will deliver compliance at St
Peter‟s Hospital site from Quarter 1 2015.
Out of hours primary medical services procurement
Following a number of market engagement events, a small consortium of CCGs,
including NHS North West Surrey, NHS Guildford and Waverley and NHS Surrey
Downs, went to formal procurement for a GP Out of Hours (OOH) service on 27
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January 2014. The consortium published a Pre-Qualification Questionnaire (PQQ)
on the BRAVO Solutions e-tendering portal, offering bidders the opportunity to
express their interest in providing OOH GP services to the populations of one or
more of participating CCGs.
The procurement was advertised as a series of seven lots with one lot for core
service provision to each CCG and one for each prison facility. Providers could
choose to bid for one or more lots in any combination.
Following the Pre-Qualification Questionnaire (PQQ) shortlisting, Invitation to Tender
(ITT) documentation was published on 7 March 2014. Seven organisations were
invited to participate, with 30 April 2014 the final closing date for the submission of
ITT responses.
The tenders received were reviewed and bidder presentations took place during May
2014. A contract for the delivery of GP OOH services was awarded to Care UK,
commencing on 1 October 2014 for a period of three years.
Care UK has identified specific strategic changes likely to impact service delivery in
the local area and has undertaken an initial exploration of compensatory actions. In
addition it has recognised the need to improve performance beyond the National
Quality Requirements by developing and implementing a more robust performance
monitoring programme that will reflect changes in the strategic context.
As well as securing value for money and economic benefits, Care UK‟s high level of
demonstrable performance should deliver greater patient benefits.
Children and Young Peoples‟ Services
Working in partnership
We have worked with all Surrey CCGs via the hosted Children‟s Commissioning
Team at Guildford and Waverley CCG and with Surrey County Council on a number
of shared priorities and achievements in 2014/15.
Ensuring compliance with the Children and Families Act (2014) regarding
children with special educational needs and disabilities (SEND)
Families and stakeholders helped us review speech and language therapy (SLT),
occupational therapy (OT) and wheelchair and continence services for children.
Based on this work, we plan to integrate health and education commissioning of SLT
and OT in 2015/16, improving both access and accountability. We have also
introduced Personal Health Budgets and a „local offer‟ of services for children with
SEND. Additionally, we have clarified commissioning responsibilities for short
breaks; reviewed access to continuing healthcare; and supported the development of
partnership frameworks to ensure successful compliance with the Act.
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Improving healthcare for children who are looked after
We highlighted this as a key area for improvement in 2014/15. We will continue to
work with Surrey County Council during 2015/16 on service redesign and monitoring
until we are satisfied that the new service arrangements show improved outcomes.
Patient education
NHS North West Surrey CCG produced and distributed a „Managing your child‟s
health‟ booklet during November and December 2014 to help parents of babies and
young children manage their child‟s health. The booklet included information on
minor ailments as well as when to seek help for potentially serious conditions and
also offered guidelines on the appropriate use of health services. Health Visitors and
Practice Nurses gave copies of this booklet to new parents and thousands were
distributed via Children‟s Centres, nurseries and other early years settings. We have
had such excellent uptake and positive feedback on this booklet that a further edition
was printed in March 2015.
Working with Surrey County Council, we also provided material – including an
interactive quiz – for parents of older children, via Parents Pages and the Council‟s
e-newsletter.
Innovation
We piloted an innovative approach in secondary schools this year. The goal was to
raise awareness among young people about local NHS providers and when to use
them. This included learning about GP surgeries, Walk in Centres and Accident and
Emergency. The CCG will continue to engage with local young people in Years 7 to
10 to help them understand the services that the NHS offers in these three key
areas. We will then ask these young people to deliver the NHS message to their
peers via a variety of creative outlets, including presentations, drama, apps, videos,
etc. By engaging and informing tomorrow‟s adults about the NHS and how to
effectively use it, we hope to influence their future behaviour when they become
parents and / or responsible for elderly relatives.
Improvements to behavioural services
During 2013/14 we undertook a wide stakeholder engagement programme to set the
five year strategic plan for our CCG. As a result of this, we identified the need for
improvements to behavioural services for children and young people and adopted
this as one of our local priorities.
Today, children and young people with mental health or behavioural problems often
fall through the gaps between services. The planned re-procurement of Surrey Child
and Adolescent Mental Health Services provides us with an opportunity to specify a
more joined-up model of service provision. This will help to address gaps in the care
and management of children and young people with behavioural problems across
health, education and schools‟ social care.
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There was further consultation with parents, carers, young people, GPs, local
providers and the public during summer and autumn 2014, which led to the
development of a set of options for service improvement. We expect to commence a
procurement process in 2015.
We also successfully secured partnership funding to rapidly support young people at
times of crisis through an extension to the HOPE service (a multi-agency service for
young people aged 11-18 who have complex mental health, emotional, social and
educational needs which cannot be met by one agency alone), jointly commissioned
with SCC.
Measuring delivery of services
Maximum 18 week wait from referral to treatment (RTT)1
Our performance against this standard is demonstrated by tracking the percentage
of patients who started consultant-led treatment within 18 weeks of being referred.
Targets depend on the type of pathway the patient has followed, such as admitted,
non-admitted or incomplete.
a. Admitted Pathway: (target 90%)
Our performance on this national standard currently stands at 88.9%.
Achieving the 18 week RTT standard for the admitted pathway was a top
priority in 2014/15, which is reflected in the number of patients treated outside
of the 18 week threshold during the first two quarters. A Joint Service
Investigation was held in June 2014 to understand the underlying reasons for
the backlog and to agree a plan to sustainably achieve the 90% target. Most
of these actions were completed by the end of 2014/15.
b. Non-admitted Pathway: (target 95%)
Our performance against this national standard is currently 95.1%.
Despite a drop in Q2, when actions to address the backlog peaked, the nonadmitted pathway was not a concern in 2014/15. The CCG is confident that
improvement work across all 18 week RTT pathways will ensure our good
performance is maintained through 2015/16.
1
Data Source: UNIFY Consultant-led Referral to Treatment Waiting Times 14/05/2015
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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c. Incomplete Pathway: (target 92%)
Our performance against this national standard is currently 94.2%.
Incomplete pathways were not a concern during 2014/15. The CCG is confident
that improvement actions across all 18 week RTT pathways will ensure our good
performance is maintained through 2015/16.
Maximum 4 hour wait in A&E departments2: (target 95%)
Our performance against this standard is demonstrated by tracking the percentage
of patients who are assessed within four hours of attending A&E. A&E departments
are defined as different types:


A Type 1 A&E department is defined as a consultant-led 24 hour emergency
department which receives accident and emergency patients
A Type 3 A&E department may be doctor or nurse-led and largely receives
accident and emergency patients. It may be co-located with a major A&E or
based in the community. A Type 3 A&E treats at least minor injuries and
illnesses and can be routinely accessed without appointment
Compliance against the four hour standard is measured in two ways, depending on
whether ASPHFT or Ashford Health Centre is being considered. Each of the key
measures is reported below.
a. Type 1 and Type 3 A&E attendances at ASPHFT and Ashford Health
Centre: (target 95%)
Our current contractual measure includes all Type 1 & Type 3 attendances at
both ASPHFT and Ashford Health Centre. Historically this information has
been reported to Monitor.
Compliance was achieved for the first two quarters against the four hour A&E
target, largely through high compliance at Ashford Health Centre, which deals
with Type 3 attendances only. The drop in performance in Q3 and Q4 was
part of a larger national problem. A detailed recovery plan was put in place, as
described below.
2
Data Source: UNIFY A&E 4 hour Waiting Time Compliance
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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b. Type 1 and Type 3 A&E attendances at ASPHFT only: (target 95%)
To focus on improving the emergency responsiveness of the acute Trust, the
contractual measure will change in 2015/16 to consider Type 1 and Type 3
attendances at ASPHFT only. This includes Type 3 Genito-Urinary Medicine and
Early Pregnancy Unit attendances, because patients are able to attend these
clinics without an appointment.
To prepare for this becoming a contractual requirement in 2015/16, we have
carefully monitored this measure over the past year. The standard has not been
met for these attendances (89.9%) and has not been achieved during any quarter
of 2014/15.
Together with ASPHFT we have developed a detailed recovery plan. The plan
focuses on the following four priorities:

Front door configuration: physical estate changes that will enable the directing
of patients through a „single‟ front door
 Patient flow throughout the hospital: ensuring the most efficient flow of
patients through A&E
 Early integrated discharge planning: ensuring discharge planning is aligned
with all stakeholders in the urgent care pathway
 Whole system change: improving the ways in which the whole system works
together to create a smooth, seamless system
The CCG and ASPHFT are working together on the recovery plan and
associated trajectory, with progress monitored weekly at an executive level.
Maximum 62 day wait for urgent cancer treatment3
Our performance against this standard is monitored by measuring the percentage of
patients receiving first definitive treatment for cancer within 62 days of an urgent
referral from a GP.
The national standard for 2014/15 year to date has not been met in any quarter, with
our full year result at 78.3%. The reasons behind non-compliance with the target are
varied and include increases in demand as a result of national awareness
campaigns as well as patients choosing to have their appointments at a later date. A
recovery plan was provided by the Trust, which focused on improving governance
3
Data Source: OPEN EXETER Cancer Waiting Times 18/05/15
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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and data collection, as well as the more efficient management of patients on the
cancer pathway. The Trust was compliant in December 2014, but this was not
sustained and the recovery plan is being refreshed for 2015/16.
Maximum 8 minute response for ambulance calls
Our performance against this standard is tracked by measuring the percentage of
Category A (Red 1) ambulance calls responded to within 8 minutes. South East
Coast Ambulance (SECAmb) is the main provider in North West Surrey and also
provides ambulance services across the South East Coast.
a. Service provided across South East Coast: (target 75%)4
Official data relates to performance across the South East Coast. To date the
national standard has been met in 2014/15 (75.3%), but was not met in
Quarter 3.
Category A (R1 calls) SECamb Ambulance
Total Activity
Performance against standard
Target
Variance
Q1
3,169
75.5%
75%
+0.5%
Q2
3,036
75.7%
75%
+0.7%
Q3
3,411
74.1%
75%
-0.9%
Q4
3,503
75.8%
75%
+0.8%
YTD
13,119
75.3%
75%
+0.3%
b. Service provided within North West Surrey: (target 75%)5
Un-validated data for NHS North West Surrey CCG has been provided by
SECAmb. To date, the national standard has been met in 2014/15 (75.5%),
but not met in Quarters 3 and 4.
4
5
Data Source: UNIFY Ambulance Quality Indicators 08/05/15
Data Source: SECamb Performance Report M12
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NHS Outcomes Framework
Indicators in the NHS Outcomes Framework focus on five domains, which set out the
high level national outcomes that the NHS should aim to improve. There are a small
number of overarching indicators for each domain. These are followed by a number
of improvement areas, which focus on improving health and reducing health
inequalities.





Domain 1: Preventing people from dying prematurely
Domain 2: Enhancing quality of life for people with long term conditions
Domain 3: Helping people to recover from episodes of ill health or following
injury
Domain 4: Ensuring that people have a positive experience of care
Domain 5: Treating and caring for people in a safe environment and
protecting them from avoidable harm
Performance against the framework is improving in the majority of domains, as
evidenced by the NHS Outcomes Tool, which supports effective „commissioning for
value‟. These outcome indicators show that NHS North West Surrey CCG achieves
many good outcomes, in some cases in the top 25% nationally.
Commissioning for Quality Innovation, Productivity and
Performance
The CCG launched a number of schemes in 2014/15 to improve quality, strengthen
productivity and use innovation to make efficiency savings. This year prescribing
schemes have been particularly successful and exceeded expectation.
More information on QIPP and the CCG‟s 2014/15 financial performance may be
found in the Operating and Financial Review on page 99.
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42
2.6 Listening to our community and working in
partnership
Introduction
William McKee, CCG Lay Member for Patient and Public Involvement
and Steve McCarthy, patient representative and founder member of the
Patient and Public Engagement Forum
We have a strong record of working in partnership in North West Surrey, believing
that the health of our residents can only be improved by working closely with local
stakeholders.
We have established the CCG as a listening organisation and we continue to work
closely with local partners, clinicians and the management team to ensure that the
voices of patients and the public are heard at all levels.
The CCG has embedded our engagement structure across the organisation and we
are being open and transparent in our day to day business. One example is by
holding Governing Body meetings in public.
We continue to make good progress in building the right relationships and networks
in our local communities and will increase this activity during 2015/16 to ensure that
we are engaging in a way that is truly representative of our local population.
We want to work in partnership with local people as we improve local health
services. We also want to work closely with our health and social care partners to
ensure better, more integrated services that help support people to stay as healthy
as possible in the community.
Engaging patients and the public
The CCG has embedded a number of structures that empower local people and get
them involved in shaping our plans.
Over the last year we hosted a number of stakeholder engagement events. We
reached out to our diverse communities to help patients, local residents and
colleagues „have their say‟ on their experiences of receiving local health services.
Our engagement programme included:

Hosting a series of deliberative events across North West Surrey to enable
patients and the public to feedback on and input into our plans for the MSK
Referral Support Service
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





Holding an interactive quality workshop for all members of PPGs and
voluntary sector organisations
Holding a Surrey-wide event on our plans for Shared Healthcare Records, this
was well attended. Patient views will subsequently inform our plans
Continuing to hold our regular quarterly stakeholder meetings during 2014/15
Supporting the Diabetes Expert Patient Programme, which helps diabetic
patients better manage their conditions
Working with the Domestic Abuse Forum to encourage closer working
relationships and to raise awareness within primary care of the issues faced
by victims of domestic abuse
Being a member of the Stakeholder Engagement Panel for the proposed
merger between Ashford & St Peter‟s Hospital Foundation Trust and the
Royal Surrey County Hospital
Practice Patient Participation Groups
With the support of the CCG‟s management team, most of our 42 Member Practices
have set up Patient Participation Groups (PPGs). The purpose of PPGs is to
encourage feedback from patients about their individual GP practices and local
health services in general, and to inform commissioning via locality representatives
(see below).
Membership of PPGs varies from five or six to around sixty people, with the groups
undertaking business both virtually and through face to face meetings.
The CCG continues to work with practices to ensure that all PPGs are supported to
undertake meaningful engagement activity that will benefit their practice and feed
into the broader system via localities.
In 2014/15, all PPG members were invited to an interactive workshop led by our
Quality Directorate, to give their feedback on local services and make suggestions
about how to improve quality in local healthcare services.
Update on the „Friends of Pirbright Surgery‟, Charles Stewart, Chair
Shortly after the formation of the Patient Participation Group (PPG) linked to The Old
Vicarage in Pirbright, the Group adopted the title ‘Friends of Pirbright Surgery’. Since
that time the Group, comprising 12 members, including the lead GP from the
Practice, has continued to meet every six to eight weeks. A guidance note for PPG‟s,
produced by North West Surrey CCG and NHS England, has been used to good
advantage and the group is affiliated to the National Association for Patient
Participation.
The ‘Friends of Pirbright Surgery’ have consistently endeavoured to address local
issues that are important to patients, carers and the wider community. The Practice
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
44
continues to enjoy top ratings for the service it provides and the PPG is keen to do
all it can to support the Practice Team in maintaining this performance.
The Patient Survey undertaken by the ‘Friends of Pirbright Surgery’’ in March 2014
revealed some subjects, away from the Surgery, where there were elements of
uncertainty and concern amongst the community. The group chose to address these
issues at an Open Meeting in September 2014, which was attended by over 80
people. As noted above, the ‘Friends of Pirbright Surgery’ were particularly pleased
that Julia Ross, Chief Executive of NHS North West Surrey CCG, accepted an
invitation to be the opening speaker, with a presentation entitled „Working with you –
Improving local health services‟. We were also fortunate to have speakers from NHS
England discussing care data and „Patient online‟, whilst our closing speaker
addressed the Surrey Out of Hours GP Service.
During the year the ‘Friends of Pirbright Surgery’’ have provided a dedicated notice
board in the waiting area of the Surgery. This carries background details about the
‘Friends of Pirbright Surgery’ together with the names of the group members and
contact details, with space for other topical notices to be displayed.
Representatives of the group attend appropriate CCG meetings and quarterly
stakeholder meetings for the Woking area are always attended. In addition to the
information gained from agenda items, these gatherings provide an excellent
opportunity for informal networking with members of the CCG team and
representatives of other PPG‟s. The lines of communication between NHS North
West Surrey CCG and the community are now well established and the PPGs have
a key role to play in promoting the opportunities that exist for passing ideas and
information in both directions and, ultimately, influencing the provision of healthcare
services in our locality.
Update from the Staines Health Group, Heather Lovatt, Practice Manager
Our initiative to collect additional email addresses and mobile numbers was very
successful, with around 60% of patients now having either their email or mobile
number on file, representing an increase of approximately 30% on 2013/14.
This supports improved communication and enables us to email clinic reminder
letters, invitations and our popular newsletter to more patients. We can also use text
appointment reminders, campaigns and surveys. We feel that we have really moved
into the 21st Century and thank our Patient Reference Group for urging us to move
forward with this.
Wider engagement
While face to face dialogue remains at the heart of the CCG‟s engagement
programme, in 2015/16 we plan to build a virtual network of patients and public. This
will involve recruiting via PPGs and our partners in the community, as well as a
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
45
variety of communications channels. This will help us to have direct access to a
wider network of people than those that choose to take part in the CCG‟s formal
engagement structures and meetings. Setting up the network will be enabled by an
interactive mechanism on our website. Social media will also be used, including our
Twitter feed, and we will also develop a quarterly stakeholder newsletter to inform
people about how their involvement has made a difference.
We will continue to work with Healthwatch and with colleagues in County and
borough councils, allowing us to tap into the wider networks they have developed
within our communities.
As we work with our communities on our Strategic Change Programmes, we also
plan to use market research to ensure feedback from representative samples of our
local population underpins our engagement activity.
Partnership working
NHS North West Surrey CCG has a strong history of partnership working to benefit
the health of local residents.
Surrey Health and Wellbeing Board
The Surrey Health and Wellbeing Board includes representatives from the NHS,
public health, adult and children‟s social care, local councillors, Surrey Police,
borough and district councils and Healthwatch Surrey. These organisations work
together to improve the health and wellbeing of the people of Surrey. NHS North
West Surrey CCG‟s clinical chair, Dr Elizabeth Lawn, is a member of the Board,
along with all other Surrey CCG chairs.
The Surrey Health and Wellbeing Board developed the Surrey Joint Health and
Wellbeing Strategy in collaboration with Surrey residents, partner organisations and
key stakeholders. They agreed the following priority areas where the Board will work
together and a set of principles that will underpin its work on each priority. These
priorities are reflected in the CCG‟s work programme.
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46
Better Care Fund
The CCG has worked closely with Surrey County Council Adult Social Services to
develop proposals to improve the integration of health and social care services
through the Better Care Fund (BCF). This is a national initiative designed to deliver
real improvements in outcomes for local people by redirecting funds to ensure closer
integration between health and social care.
A Local Joint Commissioning Group (LJCG) has been established to monitor the
delivery of the BCF. The LJCG is responsible for monitoring performance against the
BCF metrics. The LJCG also agrees BCF investment decisions; ensuring financial
governance arrangements are in place and are followed regarding the pooled BCF
health and social care budget.
Joanne Alner our Director of Quality and Innovation, and Michelle Head, the Surrey
County Council North West Surrey Area Director of Social Care, jointly chair the
North West Surrey LJCG. Membership includes the CCG Director of Finance and
Surrey County Council North West Surrey Finance lead. Our LJCG draws
membership from the wider CCG and Adult Social Care and other local
stakeholders, such as our four local boroughs and district councils.
The CCG reports into the North West Surrey Transformation Board to ensure
initiatives are fully embedded in the strategic transformation of the whole system.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
47
The Surrey Better Care Fund Board provides strategic leadership across the Surrey
health and social care system and holds LJCGs to account for how they invest the
Better Care Fund, and the progress and outcomes they deliver.
There is close alignment between the Better Care Fund plan and our Strategic
Commissioning Programme. Working with our social care partners, we have agreed
three interlinked priority programmes, which together will transform services for local
people:



Integrated Urgent Care Pathway: ensuring an effective, timely response
when people need urgent or emergency care, so that people progress through
the system and are returned to their normal place of residence as quickly as
possible, with support when needed
Integrated Frailty Pathway: focused on ensuring older and vulnerable
people receive proactive support to keep them independent in the community.
This also includes responsive care when needed to avoid urgent or
emergency care, as well as support for people at the end of life
Integrated Prevention Programme: led through the Targeted Communities
Strategic Change Board. This programme will support our ambition to help
people stay well and independent for as long as possible, Mission 90
Surrey County Council
Telecare
The CCG and Surrey County Council have pooled resources to support the provision
of important telecare aids to often frail elderly or vulnerable residents across North
West Surrey. These aids include mobility sensors, alarms that can be triggered in the
event of a fall or worsening of a chronic condition and audio/visual aids to help
people to answer the door or the telephone. These aids play an important role in
keeping local people living independently for as long as possible.
Community Equipment and Adaptations
The CCG has invested jointly with Surrey County Council in additional community
equipment to ensure local residents have prompt access to different types of
equipment and adaptations through the health and social care system. These can
include wheelchairs, crutches, stair-lifts, handrails, beds, etc.
Targeted Communities Prevention Plan
During the past year we worked with the Surrey County Council Public Health team
and colleagues from our four local Districts (Spelthorne, Runnymede, West
Elmbridge and Woking) to develop the Targeted Communities Prevention Plan,
which aims to improve health and reduce health inequalities in people living in North
West Surrey.
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Some of the actions taken include:



Improving the uptake of smoking cessation of North West Surrey patients
Implementing an alcohol risk reduction programme in ASPHFT
Increasing the number of children referred to cook and eat sessions. In these
sessions commissioned by Surrey County Council, children and their families
learn how to eat healthily and prevent obesity
From April 2015 we will launch an ambitious programme to identify undiagnosed
patients with COPD and provide them with appropriate treatment to manage their
symptoms, thus helping them to avoid unnecessary hospital admissions.
Working with Public Health
The CCG works closely with the Public Health Team at Surrey County Council on
our Strategic Change Programmes to target specific communities where the health
of the population is significantly below our expected levels. As well as working
together on Children‟s and Young Peoples‟ programmes, we have supported public
health to reduce teenage pregnancy and obesity.
The Public Health Team also provides technical expertise to support the CCG‟s
commissioning, including developing the Joint Strategic Needs Assessment and
delivering public health intelligence, research and stakeholder engagement. The
CCG works jointly with the Public Health Team to deliver health improvement, health
protection and healthcare quality and evaluation. A consultant in public health sits on
the CCG‟s Clinical Executive.
Kent, Surrey and Sussex Academic Health Sciences Network and Age UK
We have entered into a partnership with the Kent Surrey and Sussex Academic
Health Science Network and Age UK to support a pioneering project which aims to
change the way that older people are cared for locally.
The number of North West Surrey residents over 85 is expected to rise to 3.5% by
2020. With the extra pressure that this will place on the local healthcare system,
finding better ways to look after people with multiple, long-term health conditions is
critical.
Under the new partnership, older people with at least two long-term conditions – for
example diabetes and dementia – will work with trained volunteers who will provide a
link between health and social care services. It will also invite the general public to
develop solutions that support the further integration of local health and social care
services.
Other partnership initiatives
 Telehealth: innovative use of new technology to provide remote monitoring
and assistance to patients with chronic obstructive pulmonary disease and
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
49
heart failure. This has allowed over 100 people with these conditions to
manage them safely and independently in their own homes with access to
specialist clinical support

Psychiatric Liaison: as previously noted, the psychiatric liaison service has
been expanded and developed as part of the whole systems partnership
funding.
Collaborative commissioning arrangements with Surrey CCGs
The CCG works in a collaborative commissioning arrangement with the five other
Surrey CCGs: East Surrey, Surrey Downs, North East Hampshire and Farnham,
Guildford and Waverley and Surrey Heath CCG. The six CCGs have agreed a
Framework for Collaboration that sets out the scope, governance; risks and
obligations of the six CCGs. Additionally, there are eight Surrey-wide collaborative
agreements, where one CCG leads the commissioning of services on behalf of the
others:
Host or lead commissioner
Service description
NHS North West Surrey CCG




VCSL (Community Services)
999, emergency ambulance services
NHS 111 services
Patient transport services
Guildford and Waverley CCG


Children‟s services
Safeguarding children
Surrey Downs CCG

NHS continuing health care and NHS
funded nursing care
Safeguarding adults

North East Hampshire and
Farnham CCG

Mental health and learning disabilities
services
Surrey Heath CCG

Managing the contract with Health
Education Kent Surrey and Sussex for the
accreditation and annual Appraisal of GPs
with a Special Interest
Working with NHS England
The CCG works in partnership with NHS England‟s Surrey and Sussex Area Team,
which commissions a number of services for the wider population, including Primary
Care, Specialised Services, Offender Health and Military Health. We are increasingly
collaborating more closely regarding primary care commissioning, given the
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
50
importance of enhancing capacity in primary care and delivering more care out of
hospital in our five year vision.
Working with local community representatives
The CCG has invested considerable time and energy in building relationships with
individuals who represent the interests of our community, including:

Healthwatch Surrey
Healthwatch Surrey has attended a number of the CCG‟s engagement
events. Jane Shipp, Lead for Community Engagement, is a member of our
Patient and Public Engagement Forum.

North West Surrey MPs
The CCG‟s Clinical Chair Dr Elizabeth Lawn and Chief Executive Julia Ross
have regular meetings with the four Members of Parliament (as at 31 March
2014) representing North West Surrey constituents: Jonathan Lord MP
(Woking), Phillip Hammond, Secretary of State for Foreign and
Commonwealth (Runnymede and Weybridge), Dominic Raab MP (Esher and
Walton) and Kwasi Kwarteng MP (Spelthorne).

Surrey Health Scrutiny Committee
The CCG‟s Clinical Chair and Chief Executive regularly meet with the Chair of
the Health Scrutiny Committee. During 2014/15 we provided the Committee
with update reports on Locality Hubs, winter pressures, MSK and
Rehabilitation and Re-ablement. We have also answered individual Member
questions on our plans.

Borough and District Councils
We continue to build strong relationships with our borough councils in
Spelthorne, Elmbridge, Runnymede and Woking by engaging with colleagues
at locality level and through our Patient and Public Engagement Forum.
This year, we provided reports to Elmbridge, Spelthorne, Working and Runnymede
Local Area Committees to update Members on our plans. Sue Robertson, the CCG‟s
Head of Locality Commissioning and Partnership, chairs the Spelthorne Local
Strategic Partnership (Spelthorne Together) and the Spelthorne Health and
Wellbeing Group. Spelthorne and Runnymede‟s Health and Wellbeing Groups
continue to meet individually and as a combined group, working to a joint action plan,
aligned to the Surrey Joint Strategic Needs Assessment, the Surrey Health and
Wellbeing Strategy, Borough plans and the CCG‟s strategic priorities.
During the past year, Woking Borough Council established its Health and Wellbeing
sub-committee, attended by Joanne Alner, the CCG‟s Director of Quality and
Innovation.
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Voluntary Sector
We continued to improve our working relationship with the voluntary sector through a
series of engagement events and we have strong representation from the voluntary
sector on our Patient and Public Engagement Forum.
In 2014/15 the CCG attended the Voluntary Action in Spelthorne (VAIS) Annual
General Meeting and other local events. Over the course of the year our Stakeholder
Engagement Manager also worked with Arthritis UK, Action for Carers, the British
Heart Foundation, the Richmond Fellowship, the Surrey Coalition for Disabled
People and other local organisations to ensure the voluntary sector has the
opportunity to contribute to our planning and commissioning decisions.
2.7 Our priorities for 2015/16
Moving into the second year of our five-year Strategic Commissioning Plan, we are
focusing on five priority areas to deliver the vision we committed to in wide
consultation with the public, patients, partners and other key stakeholders. These
areas are:





Integrated Care
Urgent and Emergency Care
CAMHS and Behavioural Services
Integrated MSK Services
Primary Care Development
Key priority: Implementing Integrated Care
 Investing to deliver more proactive care and support to help keep people,
particularly the frail elderly and their carers, as healthy as possible, ensuring
that they don‟t reach crisis levels requiring emergency hospital admission
 Developing a model of care based on Locality Hubs (see page 4 for more
details)
 Changing the model of care for Rehabilitation and Re-ablement from a
primarily acute hospital bed-based model to a more flexible mix of acute and
community beds. This will involve a wide range of home based services to
better meet the needs of our patients and deliver better patient outcomes
 To ensure the robust evaluation and sharing of learning, we will work closely
with the Academic Heath Science Network (AHSN)
Key priority: Urgent and Emergency Care
 System wide focus to ensure the consistent, sustainable delivery of the four
hour A&E access standard
 Ensuring people get access to the right high quality Urgent and Emergency
Care services 24/7
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



Enabling people to get the right treatment to meet their needs first time by
making the most appropriate use of all urgent care services, including 111,
A&E, primary care, pharmacies and self-care
Improving acute triage, crisis response and assessment
Ensuring robust and adequately resourced psychiatric liaison services
Surrey-wide review and development of provider improvement plans to ensure
provision of excellent stroke services to deliver best outcomes for patients
Key priority: Child and adolescent mental health services and behavioural
services
 We developed proposals for improving child and adolescent mental health
services (CAMHS) after listening and responding to feedback from young
people, parents and other stakeholders during our 2014 consultation
 We are working with other commissioners in CCGs, Surrey County Council
and NHS England to create:
o A service which better meets the mental and emotional health and
wellbeing needs of children and young people
o A clearer, integrated pathway and improved service model for children
and young people with emotional and behavioural difficulties, including
attention deficit hyperactivity disorder and autistic spectrum disorder, in
line with NICE guidance
o Better co-ordination between all tiers of Child and Adolescent Mental
Health services
o We expect to follow a procurement process in 2015 to ensure people get
good access to the best possible services to meet their needs
Key priority: Procurement of future Integrated Musculoskeletal (MSK) Service
We are piloting an integrated MSK service with joint GP/Extended Scope Practitioner
(ESP) Physiotherapy Triage with ESP assessment (see page 28 for more details).
Key priority: Primary Care Development
Building on the work undertaken during 2013/14, we are now developing our primary
care strategy. This includes our work with practices and the Primary Care
Foundation, where we are supporting our practices to manage pressures on their
capacity and their increasing workload. It also includes an estates strategy, linked to
the National Premises and Infrastructure Fund.
Our new strategy will include:




The creation of practice or locality-based primary care extended hours
services
Enabling access to shared practice records – an essential enabler for localitybased extended hours primary care services and our Locality Hubs
Ensuring practice pathways for managing urgent/on the day appointments are
clearly communicated to our residents
Working with the urgent care programme in creating locality based urgent
care centres and developing federated locality models, which provide
improved access for patients and extended hours GP services
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
53




Ensuring that patients will have online access to their GP records from April
2015
Increasing the use of electronic transfer of prescriptions to pharmacies to at
least 60% of practices by March 2016
Increasing the use of electronic referrals between GPs and other services to
80% by March 2016
Our Primary Care Workforce Tutor will support practices to develop the
primary care workforce through education, training and succession planning
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
54
3. Members‟ Report
3.1 Introduction
Dr Linda Roberts, Clinical Chief of Leadership and Development and Yvonne
Parish, Director of Corporate Development and Assurance
Before the CCG was formed, a strategy was in place to help shape and develop the
organisation. In the first year of the CCG, this strategy was refined and steps were
implemented to support its early evolution. This was a time when there was much to
be done to create an organisation befitting of its statutory responsibilities, yet was
flexible enough to be owned and steered by the GPs within its membership. As the
CCG moved through its second year we sought to understand what had been
achieved and what needed to change to sustain the CCG‟s exceptional performance
over time.
We recognised that, as a young and growing organisation, the centralised control
and direction that was required in the beginning needed to make way for more
delegation and autonomy. Light processes and systems are now needed to support
collaborative working and solutions thinking. We want to ensure our organisational
values act as the thread to engage people and influence behaviours and decisions
going forward.
The Governing Body and senior staff engaged in this process of review and used
feedback from both within and outside the CCG to build a new Organisation
Development Strategy which will guide our initiatives for the next three years. Our
strategy is formed of five strategic goals with initiatives embedded under each:





Goal 1: the creation of commissioning decisions is informed and influenced by
active stakeholder engagement. The CCG‟s reputation for receiving and
addressing feedback is well known and we want to build further on this
Goal 2: strong internal governance mechanisms and engaged members with
the confidence to challenge decisions and processes are essential. This
results in quality decisions and assurance
Goal 3: leaders that provide vision, drive performance, demonstrate positive
behaviours and inspire action in others to deliver successful outcomes
Goal 4: people must feel empowered, valued, stretched and energised so
discretionary effort is released and planned outcomes are achieved
Goal 5: to recruit and retain talented high performers and to grow our own
expertise
Progress against the strategy will be reported quarterly to the Governing Body.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
55
3.2 The CCG Members and Leadership Team
Council of Members
The Council of Members is comprised of a lead GP from every member practice and
meets twice a year. This body has the highest level of authority within the CCG and
holds the Governing Body to account both for adherence to the CCG‟s Constitution
and for progress against objectives.
Practice
Knowle Green Medical
Shepperton Medical Practice
Staines Health Group
Stanwell Road Surgery
Staines & Thameside Medical
Orchard Surgery
Studholme Medical Practice
The Grove Medical Centre
Hythe Medical Centre
St David's Health Centre
Fordbridge Medical Practice
Upper Halliford Medical Centre
St John‟s Health Centre
Dr Lynch & Partners
Goldsworth Medical Centre
Parishes Bridge Practice
Hillview Medical Practice
Pirbright Surgery
Heathcot Medical Practice
Maybury Surgery
College Road Surgery
Southview Surgery
Greenfields Surgery
Wey Family Practice
Chobham & West End Practice
Sunny Meed Surgery
Sheerwater Health Centre
Dr J Sillick & Partners (Red
Practice)
Hersham Surgery
Church Street Practice
The Bridge Practice
Ashford Health Centre
Sunbury Health Centre
Representative
Dr Zoe Griffiths
Dr Diljit Bhatia
Dr Seda Boghossian-Tighe
Dr Andeep Kaur
Dr Gillian McFarlane
Dr Peter Warwicker
Dr Mobin Salahuddin
Dr Jagjit Rai
Dr Pardeep Dhillon
Dr George Kamil
Dr Chris Richards
Dr Sundeep Soin
Dr Chrissie Clayton
Dr Joanne Horgan
Dr Deborah Shiel
Dr Alexandra Henderson
Dr Linda Roberts
Dr Shada Parveen
Dr Ash Kapoor
Dr David Hindley
Dr Richard Pool
Dr Sara Coe
Dr Sanj Sekhon
Dr Michael Bourke
Dr Munira Mohamed
Dr Jenny Sillick
M
F
F
M
F
F
F
M
M
M
F
M
M
M
F
F
F
M
F
F
M
M
M
F
M
M
F
F
Dr Asha Pillai
Dr Graeme Wilding
Dr David North-Coombes
Dr Ghadeer Faour
Dr Sanjay Varma
F
M
M
F
M
Dr Vineet Thapar
Dr Joanne Turvey
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
56
The Abbey Practice
Dr De Sousa & Partners
Ottershaw Surgery
Yellow Practice
Packers
Fort House Practice
Crouch Oak Practice
Ashley Medical Practice
White Practice
Dr Khalid Wyne
Dr Emile de Sousa
Dr Andrew Harris
Dr Dzung Nguyen
Dr John Harley
Dr Timothy Bates
Dr Mohan Kanagasundaram
Dr Layth Delaimy
Dr Samy Morcos
M
M
M
M
M
M
M
M
M
Governing Body
The Governing Body is the main strategic decision making body of the CCG. The
members delegate authority to the CGG to provide leadership and direction for the
organisation. As well as the nine Locality Clinical Leads, it includes management
support team leaders and four lay members, of which two are independent.
Organisation/Role
Member
Clinical Members
SASSE Locality Lead
Dr Diljit Bhatia
SASSE Locality Clinical Director
Dr Jagjit Rai
Chair of Clinical Executive
Thames Medical Locality Lead
Dr Richard Barnett
Clinical Chief of Innovation & Quality
Thames Medical Locality Lead
Dr Elizabeth Lawn
Clinical Chair
Thames Medical Locality Clinical Director
Dr Asha Pillai
Woking Locality Lead
Dr Linda Roberts
Clinical Chief of Leadership & Development
Woking Locality Clinical Director
Dr Deborah Shiel
Clinical Chief of Contracts & Performance
Woking Locality Lead
Dr Sundeep Soin
SASSE Locality Lead
Vacant
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
57
Executive Members
Chief Executive
Julia Ross
Director of Finance
Neil Ferrelly
Independent Members
Independent Member (Governance)
Michael Brooks
Independent Member (Patient and Public
Involvement)
William McKee
Registered Nurse (Clinical Member)
Sally Bassett
Secondary Care Specialist Doctor (Clinical
Member)
Dr Naila Kamal
Non-Voting Members
PPE Forum Representative
Steve McCarthy
Deputy Chief Executive
Andrew Demetriades (until
August 2014)
Director of Commissioning & Strategy (Interim)
Alison Alsbury (from
September 2014)
Director of Quality and Innovation
Joanne Alner
Director of Corporate Development and Assurance
Yvonne Parish
Director of Clinical Transformation
Dr Henriette Coetzer (from
October 2014)
Please see the Remuneration Report from page 145 for profiles of the CCG‟s
Governing Body.
Governing Body Committees and Membership
1. Clinical Executive
Organisation / Role
CCG Clinical Executive Chair
CCG Clinical Chair
Chief Executive
Clinical Chief of Quality & Innovation
Clinical Chief of Leadership & Development
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
Member
Dr Jagjit Rai (Chair)
Dr Elizabeth Lawn
Julia Ross
Dr Richard Barnett
Dr Linda Roberts
58
Clinical Chief of Contracts & Performance
SASSE Locality Lead
Clinical Director/Locality Lead Thames Medical
Planned Care Clinical Programme Lead
Children and Young People Clinical Programme Lead
Locality Lead Woking
Urgent Care Clinical Programme Lead
Dr Deborah Shiel
Dr Diljit Bhatia
Dr Asha Pillai
Dr Beth Coward
Dr Charlotte Caniff
Dr Sundeep Soin
Targeted Communities Clinical Programme Lead
Dr Munira Mohammed
Head of Medicines Management
Deputy Chief Executive
Linda Honey
Andrew Demetriades
(to August 2014)
Clare Stone
Joanne Alner
Dr Henriette Coetzer
(from October 2014)
Alison Alsbury (from
September 2014)
Neil Ferrelly
Chief Nurse/Head of Quality
Director of Quality & Innovation
Director of Clinical Transformation
Director of Commissioning & Strategy (Interim)
Director of Finance
In attendance
Assistant Director (Commissioning) Adult Social Care
Adult Social Care
Public Health Consultant
Head of Strategy & Planned Care
Head of Unplanned Care
Head of Performance & Delivery
Head of Locality Commissioning & Partnerships
Dr Layth Delaimy
Anne Butler (until
December 2014)
Michelle Head
Ruth Hutchinson
Ellen Pirie (until 27
November 2014)
James Thomas
Julia Jones
Sue Robertson
2. Remuneration and Nominations Committee
Organisation / Role
Independent Member (Governance) (Chair)*
Independent Member (PPE)
Independent Member (Secondary Care Doctor)
Independent Member (Registered Nurse)
In attendance
Chief Executive
Director of Corporate Development & Assurance
Head of Human Resources & Organisational
Development (Interim)
Member
Michael Brooks
William McKee
Dr Naila Kamal
Sally Bassett
Julia Ross
Yvonne Parish
Rhian Cadvan-Jones
* From April 15 William McKee was appointed as the Chair
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59
3. Quality and Performance Committee (revised Terms of Reference from
October 2014)
Organisation / Role
Member
Independent Secondary Care Doctor (Co-Chair)
Independent Registered Nurse (Co-Chair)
Dr Naila Kamal
Sally Bassett
William McKee [to
October 2014]
Wendy Stone [to
March 2015]
Ruth Hutchinson
Dr Deborah Shiel
Dr Richard Barnett
Joanne Alner
Andrew Demetriades
(to August 2014)
Alison Alsbury (from
September 2014)
Sue Robertson
Clare Stone
Independent Member (PPE)
Patient Representative
Public Health Consultant
Clinical Chief of Contracts & Performance
Clinical Chief of Innovation & Quality
Director of Quality & Innovation
Deputy Chief Executive
Director of Commissioning & Strategy (Interim)
Head of Locality Commissioning & Partnership
Head of Quality/Chief Nurse
In Attendance
Head of Performance & Delivery
Julia Jones
4. Audit and Risk Committee
Organisation / Role
Lay Member Governance (Chair)
Independent Secondary Care Doctor
Independent Registered Nurse
Lay Member PPE
In Attendance
Director of Finance
Director of Corporate Development & Assurance
Internal Auditor Representative, South Coast Audit
(TIAA)
Internal Auditor Representative (KPMG)
Internal Auditor Representative (KPMG)
Local Counter Fraud Service Representative (TIAA)
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
Member
Michael Brooks
Dr Naila Kamal
Sally Bassett
William McKee
Neil Ferrelly
Yvonne Parish
Clarence Mpofu to 31
May 2014
Andrew Chappell
from 1 June 2014
Neil Hewitson From 1
June 2014
Andy Morley to 31 May
2014
60
Mike Clarkson
from 1 June 2014
Richard Lawson
Iain Murray
Claire Fuller
Martyn Parnham from
March 2015
Elaine Stevens
Lauren Taylor
Elizabeth Lawn
Julia Ross
Local Counter Fraud Service Representative (Mazars)
External Auditor Representative, Grant Thornton
External Auditor Representative, Grant Thornton
Deputy Director of Finance
Financial Controller
Head of Corporate Services & Risk Management
Office Manager & Committee Administrator
CCG Clinical Chair (As Required)
Chief Executive (As Required)
5. Contract and Finance Committee (From July 2014)
Independent Member (PPE) (Chair)
William McKee
Independent Member (Governance)
Michael Brooks
Director of Finance
Neil Ferrelly
Director of Strategy & Commissioning (Interim)
Alison Alsbury
Woking Locality Lead & Clinical Chief of Contracts &
Performance
Deborah Shiel
Deputy Director of Finance
Claire Fuller
Associate Director of Contracts
Sumona
Chatterjee
Head of Performance and Delivery
Julia Jones
Gender distribution
The gender distribution for NHS North West Surrey CCG is as follows:
Body
Females
Males
Council of Members
16
26
Governing Body
10
7
Very Senior Managers
(not on Governing Body)
1
0
Employees
60
15
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61
3.3 Our Staff
The CCG currently employs 97 staff (64.95 whole time equivalent). In addition, the
CCG purchases a range of services from the South London Commissioning Support
Unit (SLCSU) in areas where the SLCSU‟s scale can add the most value. A number
of CSU staff work directly with, and in, the CCG. These services include:






Primary Care ICT
Corporate ICT
Communications and engagement
Corporate support, including information governance
HR and Workforce Assurance
Business intelligence (data warehousing)
Staff engagement
The fact that the CCG is a relatively new organisation that is still in development
allows us to design ways of working that encourage the best contributions of all
employees and members. In this respect, NHS North West Surrey CCG aspires to
become an excellent place to work, cultivating a high performance culture and
generating great patient outcomes in partnership with our other stakeholders.
We continue to work with our representative Staff Forum to encourage regular
engagement with our people. We use this to inform our decision making processes
regarding staff and to help determine how to best implement and embed decisions
made at an executive level. The Forum has been particularly helpful in planning the
move from temporary accommodation to a permanent headquarters, which is
expected to take place in spring 2015.
The process for employee consultation is covered by the CCG‟s Organisational
Change policy and discussions take place within the Staff Forum. This year no
formal staff consultations have been required.
In addition to the Staff Forum, the CCG‟s leadership team communicates with staff
on a regular basis through the following channels:





Weekly update from the Chief Executive
Monthly informal stand up briefing from the Chief Executive and other senior
managers
Monthly „whole team‟ meetings, allowing face to face communication and
engagement with the whole Management Support Team
Distribution of the monthly Members‟ Bulletin
Directorate and service team meetings
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62
Provision for disabled employees
It matters to us that everyone in the CCG is able to give their best. This includes staff
with any declared disability. We recognise and abide by our responsibilities to staff
with disabilities under the terms of the Disability Discrimination Act. Where
necessary, we make reasonable adjustments to enable an employee to continue
working if any form of disability arises whilst in our employment. For example, this
could involve providing an ergonomic chair or a power assisted piece of
equipment. This enables the CCG to ensure that the individual is not disadvantaged
because of his or her disability.
The CCG‟s Equality, Diversity and Human Rights Policy covers all employees within
NHS North West Surrey CCG and confirms that we aim to be an employer of choice,
ensuring that no job applicants or employees are unfairly disadvantaged due to any
of the protected characteristics, including disability. Vacancies are advertised
through NHS Jobs and job applicants that are disabled and meet the minimum
criteria for the post are invited for interview, with adjustments made for the interview
if required.
Employees who become disabled in the course of their employment will have a
regular review with their manager. The CCG will make any reasonable adjustments
to their employment or working conditions that would help them to perform their
duties. Promotion to all posts is based on the ability of the candidate to undertake
the role as specified in the job description and person specification.
Equality, diversity and human rights training is available for all staff as part of their
induction programme and training updates are mandatory for staff every three
years. Reports are shared with the CCG‟s Governing Body, providing a breakdown
of staff for equality purposes. This breakdown includes disability.
Managing staff sickness
The CCG grew significantly in headcount during 2014/15 and working in our current
crowded office has made it difficult to ensure all staff members remain healthy. The
organisation lost 573 days of work due to staff sickness for the twelve months to 31
December 2014, which represents an average sickness absence rate of 5.1%. A
considerable proportion of absence days were due to long-term sickness, which are
issues for a small number of staff.
The CCG is moving into new offices in Weybridge during spring 2015. This means
that staff will work in a more spacious, custom built environment with suitable
facilities.
Basic sickness absence data is presented in the form of an anonymised workforce
report to the Governing Body. Line managers record sickness absence data for each
employee on an online system, Workforce Online, to enable effective
monitoring. Where appropriate, Occupational Health gives staff with longer-term
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
63
health problems the support they need, enabling them to return to work on a phased
basis as appropriate. Sickness data is monitored through the Health and Safety
Group. Figures for staff sickness are available in the Annual Accounts below.
Health and Safety Group
The CCG Health and Safety Group ensures compliance with health and safety
legislation and national standards for all staff, visitors and the general public, by
ensuring appropriate policies are in place. The Group reviews any incidents affecting
any of the CCG‟s staff or contractors to ensure that appropriate lessons are learnt
and risks minimised. The Health and Safety Group‟s minutes are presented to the
Audit and Risk Committee on a bi-monthly basis to provide assurance in this
important area to the Governing Body.
Staff training and development
We are fully committed to the development of the relevant skills and knowledge of
our staff and our clinical leads, to ensure we are able to deliver on our vision.
A range of learning and development activities and tools have been put in place over
the last year, including leadership toolkits, a coaching register, self-assessment
needs, analysis templates, technical face-to-face training and individual performance
development plans that are linked to our strategic objectives. We have also
established Action Learning Sets for our clinical leads.
We aim to use our resources effectively and efficiently through CCG wide training
initiatives. This includes e-learning and knowledge sharing from internal expertise.
The result is a learning and development plan that can be delivered through a variety
of different approaches. This enables us to be flexible and offers value for money.
We consistently monitor and report on compliance with statutory and mandatory
training to our Executive Team on a monthly basis and quarterly to our Governing
Body.
We have also introduced a new induction starter pack and face to face induction
programme to welcome new colleagues into the organisation and to support them so
they can make a positive contribution from their first day. Our people are our
greatest asset and we will continue to cultivate a learning organisation to ensure they
are empowered to deliver on our promises to North West Surrey‟s population.
The CCG‟s Equality, Diversity and Human Rights Policy ensures that no employee
receives less favourable treatment on the protected characteristics of their age,
disability, sex (gender), gender reassignment, sexual orientation, marriage and civil
partnership, race, religion or belief, pregnancy and maternity.
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64
3.4 Our premises and sustainability
During the period under review the CCG continued to occupy temporary
accommodation on the second floor of Weybridge Primary Care Centre, in Church
Street, Weybridge.
The CCG has worked with NHS Property Services to find appropriate
accommodation for a permanent headquarters, which should be ready in spring
2015.
As landlord and managers of the CCG‟s estate, NHS Property Services will in future
years provide data to enable the CCG to produce a Sustainability Report. However,
due to the nature of the CCG‟s temporary accommodation, this has not been
possible in 2014/15.
3.5 Policy development
NHS North West Surrey CCG formally adopted a number of policies from NHS
Surrey (Surrey Primary Care Trust) at start up.
Significant work has taken place over the past year to review these and ensure all
NHS North West Surrey CCG policies are fit for purpose.
A gap analysis of policies was completed in August 2014 and an action plan
produced to ensure all relevant policies are in place by the end of 2015.
Because Human Resource policies are the most frequently used across all staff
groups, these were prioritised as urgent. We are committed to having the right policy
guidelines in place and over the next few months we plan to implement a number of
non-statutory policies such as a working from home policy and a transgender policy.
As a result of changes to legislation we have also reviewed the parental leave and
carers leave policies. The Equality Impact Assessment policy has been simplified
and relevant. Staff have been trained on carrying out an Equalities Impact
Assessment.
The CCG has a policy review group, reporting directly to the CCG Governing Body,
which meets monthly to review and monitor the progress of policy development and
to ensure consistency in format and style.
Policies are also discussed at the Quality and Performance Committee, Clinical
Executive Committee, Audit and Risk Committee and/or Staff Forum to ensure
robust governance and consultation processes are in place.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
65
The CCG Policy sub group maintains a complete list of policies approved and also
those that need to be written or reviewed as the organisation grows. All policies are
available on the website www.nwsurreyccg.nhs.uk and paper copies are available to
all staff in the CCG reference library and on the corporate drive.
All new staff, as part of induction, are expected to familiarise themselves with the
CCG‟s policies. Any policies that directly affect staff, primarily Human Resource
policies, are sent to staff-side reps as part of the consultation process. New or
revised policies are advertised on the staff notice board and highlighted at the Staff
Side Forum.
3.6 Equality and diversity report
Equality, diversity and human rights are key to the way we commission services and
support our staff.
We are committed to meeting our duties under the Equality Act 2010 by embedding
equality in the contracts for the services that we commission and in the recruitment
and development of our people.
Our aim is to reduce inequalities in health for local people by meeting the diverse
needs of our population and workforce. We want to ensure that no one is placed at a
disadvantage due to their protected characteristics. We are committed to providing a
consistently high standard of commissioning and recognise that the establishment of
a supportive, open culture which ensures equality and values diversity and human
rights is essential to achieving this goal.
In 2014 we carried out a baseline assessment using the Equality Delivery System
and agreed three Equality Objectives for our organisation:

Objective 1: To understand the health needs of our local people and ensure
that services commissioned reference the Joint Strategic Needs Assessment
and reduce health inequalities

Objective 2: To ensure that equality is at the heart of the commissioning
process, ensuring services are commissioned, procured, designed and
delivered to meet the health needs of local communities

Objective 3: To provide a working environment where staff feel valued and
are supported in their training and development needs
To help us achieve our equality objectives, we invited people from our communities
to talk to us and our public health colleagues to help us learn and understand more
about our communities.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
66
Workshops on Carers, Gypsies and Travellers and the Lesbian, Gay, Bisexual and
Transgender Community were held. Attendees told us that these events were highly
informative and helped to increase their understanding of these communities and
their health needs, as well as the challenges people in these communities may face
when accessing healthcare services.
Equality analysis training workshops have been held to help our staff understand the
importance of this and how it supports good decision making.
Equality analysis has been completed on:




The Strategic Commissioning Plan
The Quality Strategy
The Communications and Engagement Strategy
The End of Life Care Strategy
We have also updated our Equality and Diversity Policy and the Management and
Review Policy and our governance arrangements to ensure that an Equality Analysis
is completed where needed. In turn, this can provide evidence that the equality
impact on the protected characteristic groups has been considered as part of the
decision making process.
The equality and diversity information on our website has been updated and we will
continue to add to it. We are also developing an equality intranet page for staff,
which will include information about our different communities and how to access
census data. This also has links to the Joint Strategic Needs Assessment where
available.
3.7 Helping patients give feedback
The CCG‟s objectives are to listen, respond and improve services for the local
population. We actively seek feedback about the services we commission and
recognise the rights of our local residents to comment on these services and the
actions of the CCG.
We are committed to making it easy for all service users to seek advice, make
comments, raise concerns, make formal complaints or compliment any of the
services we commission. We are committed to listening, responding and using
feedback to improve local health services.
The CCG Customer Care Policy outlines the importance of encouraging and learning
from feedback from service users and carers. It also outlines the procedure to follow
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
67
when a complaint, comment, enquiry or compliment is received. The policy aims to
support and encourage service users and their representatives to make their voice
heard. This helps us to remedy poor service delivery and to inform service
improvement.
The Customer Care Team aims to ensure that everyone can access the complaints
process, that they are treated fairly and without discrimination and that information is
provided in a format that meets people's needs. The service has proved extremely
successful at signposting the local population to other areas of health and social care
when required.
It is recognised that in the majority of cases, queries or concerns can be resolved by
talking with healthcare providers. It is therefore encouraged, wherever possible, that
the person wishing to raise an issue speak with the service direct. Where this is not
possible the Customer Service Advisor will assist in trying to resolve any problems;
however, if this is not possible, the Customer Service Advisor makes sure that it is
easy for patients to make a complaint and give feedback about how services can be
improved.
The CCG ensures that all of our providers are aware of their obligation to have a
complaints procedure in place which reflects the NHS Complaints Procedures.
Service users and their representatives need to feel confident that making a
complaint will not have a negative impact on their access to the service they require.
Complaints should be treated positively and, wherever possible, leave service users
and carers feeling satisfied with the way in which their complaint has been handled,
as well as confident that the organisation has learnt from the experience.
The CCG follows national guidance and legislation surrounding NHS complaint
management. We aim to meet the principles of good complaint handling (known as
the “Principles of Remedy”) laid down by the Parliamentary and Health Service
Ombudsman (PHSO), which are included in our Customer Care Policy.
These principles are:






Getting it right
Being customer focused
Being open and accountable
Acting fairly and proportionately
Putting things right
Seeking continuous improvement
The “Talk to Us” tool on all GP desktops is available so that GPs can report any
issues or concerns regarding services from our provider contracts. This has been an
extremely useful mechanism to communicate quickly between GPs and the CCG
(see page 30 for more information).
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68
The CCG has been piloting the use of the independent Patient Opinion website
(www.patientopinion.org.uk), which enables patients and carers to anonymously
report their positive or negative experiences of UK health services. This has proven
useful in collecting soft intelligence about commissioned services.
The CCG will be promoting Patient Opinion from April 2015 and encouraging all our
major providers to use this site for additional feedback on their services.
We have been in discussion with The Health Service Ombudsman‟s Office regarding
an outstanding complaint which was originally dealt with by Surrey Primary Care
Trust. This has now been concluded with the complaint not being upheld.
The Quality and Performance Committee reviews all activity within the customer care
function on a bi-monthly basis. It triangulates information from various avenues
within the CCG, to monitor any trends or lessons learnt and make sure that they are
used to improve services.
The CCG‟s Governing Body has responsibility for ensuring that there are robust
systems and processes in place that allow service users, relatives and carers to
raise concerns and complaints. It also has responsibility for making sure that issues
are investigated and responded to in a timely manner, with lessons learnt and acted
upon. The Governing Body reviews complaints on a quarterly basis and may request
additional reports on themes, trends and learning from complaints.
Contacting the Customer Care Team
You can write to us at:
Customer Service Team
NHS North West Surrey Clinical Commissioning Group
Weybridge Hospital, Church Street, Weybridge, KT13 8DY
Phone: 01372 201802
Email: Contactus2@nwsurreyccg.nhs.uk
Or go to our website www.nwsurreyccg.nhs.uk
3.8 Dealing with emergencies
We certify that NHS North West Surrey CCG has incident response plans in place
which are fully compliant with the NHS Commissioning Board Emergency
Preparedness Framework 2013. The CCG regularly reviews and makes
improvements to its major incident plan and has a programme for regularly testing
this plan, the results of which are reported to the Governing Body.
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The CCG Business Continuity Plan has been updated for the organisation as well as
individual directorate plans to ensure the organisation is able to function during any
emergency.
3.9 Managing risks
The CCG Risk Management Policy and Strategy ensures a robust system is in place
to manage risks throughout the CCG by:







Ensuring robust governance and risk arrangements to support the delivery of
the organisation‟s strategic and operational objectives
Ensuring commissioning of high quality and safe patient care and maximising
the resources available for patient services
Developing a proactive approach to identifying and understanding risks within
and external to the organisation
Minimising the CCG‟s financial risks
Maintaining an effective system of internal control across the organisation
Minimising risks to the health, safety and welfare of patients, staff and all
those who might be affected by the CCG‟s activities
Identifying resources required to identify, manage, control and evaluate risk in
the most cost effective manner
The CCG internal auditors, KPMG, completed a Governance and Risk Management
Audit in March 2015, reporting significant assurance with minor improvement
opportunities. The CCG was assured that the corporate governance structure and
risk register were in line with other CCGs and NHS national guidance.
Each Directorate has a lead for risks within their team, who works closely with the
Head of Corporate Services and Risk to collate and if necessary highlight risks to
specific committees. All risks with a score of 15 or above or an impact of 5 are
included on the CCG‟s Board Assurance Framework (BAF).
The risk register is presented to the Executive Team on a monthly basis and they are
accountable for approving new risk scores and closures. The Risk Register and BAF
are then presented to the Audit and Risk Committee for endorsement and the BAF is
presented to the Governing Body with a summary of all new risks and risk closures.
This ensures a robust approach to management of and responsibility for risks across
the whole organisation.
Risk Management training has been received by senior managers and the
Programme Management Office Team to ensure all staff are aware of their
obligations and know how to use the risk register to score risks appropriately.
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Dr Elizabeth Lawn
Chair
Date:
Julia Ross
Chief Executive Officer
28 May 2015
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4. Annual Governance Statement 2014/15
4.1 Introduction & context
NHS North West Surrey CCG (CCG) was licensed from 1 April 2013 under
provisions enacted in the Health & Social Care Act 2012, which amended the
National Health Service Act 2006. The licence was granted by NHS England. The
CCG received its formal Authorisation (without any restrictions or covenants) on 23
January 2013 from NHS England and on 1 April 2013, the CCG was licensed without
conditions.
NHS North West Surrey CCG is a membership organisation of GP practices who
from 1 April 2013 inherited a range of functions, duties and responsibilities from the
former NHS Surrey Primary Care Trust.
During 2014/15 the CCG has operated as a legal entity under the terms of its licence
and legal and regulatory framework and continued exercising its statutory duties and
ensure that key internal controls were in place.
The CCG commissions services for the population in North West Surrey. Services
commissioned include acute services from acute NHS Trusts, mental health
services, children‟s services from a range of NHS providers and other providers.
Services commissioned include:





Acute services
Ambulance services
Community services
Mental Health services
Children and Adolescent Mental Health Services
These services are commissioned from NHS Foundation Trusts and other NHS
Trusts and other providers. The CCG also works in collaboration with the other
CCGs in Surrey and nearby counties.
The CCG works closely with Surrey County Council in the commissioning of some
services.
The CCG is clinically led with a GP majority membership on the Governing Body.
Scope of responsibility
As Accountable Officer, I have responsibility for maintaining a sound system of
internal control that supports the achievement of the CCG‟s policies, aims and
objectives, whilst safeguarding the public funds and assets for which I am personally
responsible, in accordance with the responsibilities assigned to me in Managing
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Public Money. I also acknowledge my responsibilities as set out in my Clinical
Commissioning Group Accountable Officer Appointment Letter.
I am responsible for ensuring that the CCG is administered prudently and
economically and that resources are applied efficiently and effectively, safeguarding
financial propriety and regularity.
Compliance with the UK Corporate Governance Code
Whilst the detailed provisions of the UK Corporate Governance Code are not
mandatory for public sector bodies, compliance is considered to be good practice.
This Governance Statement is intended to demonstrate the CCG‟s compliance with
the principles set out in Code.
For the financial year ended 31 March 2015, and up to the date of signing this
statement, we complied with the provisions set out in the Code, and applied the
principles of the Code except as follows:


The requirement for re-election of Directors at regular intervals; and
For executive Directors‟ pay to be aligned to underlying CCG performance.
The CCG Governance Framework
The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states:
The main function of the governing body is to ensure that the group has made
appropriate arrangements for ensuring that it complies with such generally accepted
principles of good governance as are relevant to it.
The function of the Council of Members, Governing Body and Committees are set
out below:
Council of Members
The Council of Members approved the CCG‟s governance model. It also approved
the overall strategic direction of the Group, its Constitution and mission.
These are enacted on behalf of the Governing Body and its five committees. The
Governing Body provides assurance to the Council of Members that the CCG‟s
objectives are being achieved and that it meets its statutory and legal obligations.
The Council of Members holds the Governing Body to account via the Clinical Chair
for delivery and for ensuring the CCG is clinically led and effectively engages with its
members. It also receives an annual report of the Governing Body‟s effectiveness.
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The Governing Body
The Governing Body has responsibility for:
The Governing Body consists of:

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The Clinical Chair (who is always a local GP)
Nine Locality Leads (who are GPs or other Healthcare Professionals), one of
whom is the Chair, as detailed on page 7
Two independent lay members (one who leads on audit, remuneration and
conflict of interest matters, and one who leads on patient and public
participation matters)
An independent registered nurse
An independent secondary care specialist doctor
The Chief Executive
The Director of Finance
The Governing Body makes a continual assessment of its own performance to
ensure that it discharges its functions effectively. The Governing Body delegates
responsibility for some of its functions to formal sub-committees. These are:



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

Audit and Risk Committee
Clinical Executive
Contracts and Finance Committee
Operational Leadership Team
Remuneration and Nominations Committee
Quality and Performance Committee
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The ultimate responsibility for the delivery of these roles and functions remains with
the Governing Body. The Governing Body assesses the performance of the
Committees through: a review of minutes received; on-going discussions and
assessment at every Governing Body meeting; and an annual report of each
Committee‟s effectiveness based on a Self-Assessment of their performance.
The terms of reference and membership of these Committees are available on the
CCG‟s website. Their main activities through the year and frequency of meetings are
as follows:
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Audit and Risk Committee
Remuneration and
Nominations Committee
Clinical Executive
Quality and Performance
Committee
Contract and Finance
Committee (Formed July
2014)
During the year the
committee:
During the year the
Committee:
During the year the
Committee:
During the year the
Committee:
During the year the
committee:


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






Monitored the CCG‟s
financial year end
process during 2014/15,
including reviewing key
documents, such as the
annual report, annual
accounts and
governance statement;
Reviewed and monitored
all risks and escalated to
the Governing Body the
Board Assurance
Framework for their
review
Received an assessment
of risks and assurance of
delivery of the CCG‟s
delivery programmes;
Monitored the delivery of
the internal audit plan for
the year;
Received the Head of
Internal Audit Opinion
covering the system of
internal control within the
CCG ;
Received and
considered the Internal
and External Audit



Received and approved
a proposal to create a
new post of Director of
Clinical Transformation;
Approved the policy for
GP remuneration;
Approved remuneration
packages for the Chief
Executive and CCG
Directors;
Received appraisal and
performance reports for
the Clinical Chair and
Chief Executive.
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


Provided strategic
oversight of the CCG‟s
long-term plans and of
the delivery
programmes, which are
required to achieve
them;
Reviewed the Strategic
Commissioning Plan,
Commissioning
Intentions, Programme
Delivery, and the
Prescribing Strategy;
Approved and monitored
delivery of QIPP
programmes;
Approved and monitored
delivery of key
procurements including
GP Out of Hours and
MSK.





76
Reviewed clinical risks in
the care commissioned
for the population and
embedded a robust
reporting and monitoring
framework;
Continued to lead on the
CCG‟s response to the
Francis Report
recommendations;
Set our key providers‟
challenging quality
targets for the year, and
proactively monitored
progress (the CQUIN
targets);
Approved the CCG ‟s
Serious Incident
Management Policy and
ensured the CCG
understood and reacted
to lessons learned from
all serious incidents.
Monitored Safeguarding
issues
Reviewed the work of
the Committee and its
inter-relationship with
other governance


Reviewed contract and
finance performance and
gave assurance to the
Governing Body;
Reviewed the delivery of
the finance and contract
programme and QIPP;
Reviewed provider
contract performance,
QIPP plans and overall
use of resources.
Audit and Risk Committee
Remuneration and
Nominations Committee
Clinical Executive
Quality and Performance
Committee
Report
Quorate meetings were held
on the following dates:




14 April 2014
2 June 2014
13 October 2014
2 February 2015
Contract and Finance
Committee (Formed July
2014)
committees.
Quorate meetings were held
on the following dates:

29 August 2014
[Tele conference]
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
Quorate meetings were held
on the following dates:





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9 April 2014
14 May 2014
11 June 2014
9 July 2014
13 August 2014
10 September 2014
8 October 2014
12 November 2014
10 December 2014
21 January 2015
25 February 2015
18 March 2015
77
Quorate meetings were held
on the following dates:






7 April 2014
27 May 2014
1 September 2014
6 October 2014Workshop
19 November 2014
4
March
2015Workshop
Quorate meetings were held
on the following dates:







14 July 2014
18 August 2014
27 October 2014
17 November 2014
23 January 2015
23 February 2015
23 March 2015
4.2 Operational Leadership Team
The Operational Leadership Team, which is accountable to the Governing Body, supports the
Governing Body and provides the day to day operational delivery and management of agreed
strategy for the CCG. Its membership consists of:

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Chief Executive (Chair)
Director of Finance
Clinical Chair
Chair of Clinical Executive
3 Locality Clinical Directors
Clinical Chief of Innovation & Quality
Clinical Chief of Contracts
Clinical Chief of Leadership & Development
Director of Quality and Innovation
Director of Corporate Development and Assurance
Director of Strategy and Commissioning
Director of Clinical Transformation
Collaborative arrangements
The CCG has entered into Collaborative Arrangements with CCGs across Surrey and Surrey County
Council.
Significant collaborative arrangements include:
Area
Joint Arrangement Lead Body
Adult Safeguarding
Children‟s Commissioning
Children‟s Safeguarding
Continuing Healthcare
Mental Health Commissioning
Urgent Care Commissioning
Virgin Care
Community Equipment
Surrey Downs CCG
Guildford & Waverley CCG
Guildford & Waverley CCG
Surrey Downs CCG
North East Hampshire & Farnham CCG
North West Surrey CCG
North West Surrey CCG
Surrey County Council
In addition, the CCG acts as the lead commissioner for the management of a number of acute and
private provider contracts across Surrey the most significant being Ashford & St Peters NHS
Foundation Trust.
Service organisations and the outsourcing of processes
For the whole year the CCG has utilised the services of NHS Prescription Services to pay for drug
prescriptions issued to its population.
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The CCG receives internal audit assurance over the operational service controls in place and has
robust contract management procedures in place to understand and manage risk.
4.3 The CCG Governance Framework
The National Health Service Act 2006 (as amended by the 2012 Act), at paragraph 14L(2)(b) states
that the main function of the Governing Body is to ensure that the Group has made appropriate
arrangements for ensuring that it complies with such generally accepted principles of good
governance as are relevant to it. The governance framework of the CCG is illustrated below:
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4.4 The CCG Risk Management Framework
The Risk Management strategy sets out the risk management approach of the CCG.
The purpose of this policy and strategy is to:







Ensure robust governance and risk arrangements to support the delivery of the organisation‟s
strategic and operational objectives.
Ensure commissioning of high quality and safe patient care and maximise the resources
available for patient services.
Develop a proactive approach to identification and understanding of risks inherent in and
external to the organisation.
Minimise North West Surrey CCG‟s financial risks.
Maintain an effective system of internal control across the organisation.
Reduce risks to the health, safety and welfare of patients, staff and all those who might be
affected by its activities, to the lowest level it is reasonably practicable to achieve.
Identify resources required to identify, manage, control and evaluate risk in the most cost
effective manner.
Risk management is embedded in the activities of the CCG through:




The wide dissemination of the CCG‟s Risk Management Policy and Strategy and supporting
policies and procedures.
The Committee structures described above and the risk identification and oversight that take
place within these Committees.
The process used to create the Governing Body‟s Assurance Framework (GBAF), and the
Corporate and Information Governance Risk Registers which underpin the risks reflected in the
GBAF.
Risk management skills training, including clinical risk assessments, mandatory and statutory
training programmes and the construction of a robust and high level counter fraud culture.
The key elements of the CCG‟s control framework are designed to identify and respond to risks
whether strategic, financial, reputational or relating to compliance, health and safety or clinical safety.
The original Risk Management Strategy was reviewed and refreshed in November 2013 and again in
2014; the CCG spent a considerable time this year refining the Corporate Risk Register.
The key document for setting out the CCG‟s major risks and mitigation is the Governing Body
Assurance Framework (GBAF), which identifies the main risks to the delivery of the CCG‟s strategic
objectives. It sets out the controls that have been put in place to manage risks, the assurances that
show the controls are having the desired impact, and a risk score to quantify the impact on the CCG‟s
ability to deliver its objectives if the risk was to crystallise (and the probability of this crystallisation). It
includes an action plan to further reduce the risks and an assessment of how well our current
mitigation is performing.
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The CCG Internal Control Framework
A system of internal control is the set of processes and procedures in place in the CCG to ensure it
delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate
the likelihood of those risks being realised and the impact should they be realised, and to manage
them efficiently, effectively and economically.
The system of internal control allows risk to be managed to a reasonable level rather than eliminating
all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness.
The CCG‟s control framework has four sections:
(1) Committees and officers of the CCG charged with delivery of the CCG‟s aims and objectives
(legal, clinical, and financial, as set out below). These Committees and officers understand
their objectives, the risks to their achievement, and put in place appropriate actions to mitigate
the risks and ensure the achievement of corporate objectives. To effectively assess their
performance, the Committees require timely, accurate, and complete information. This
information can be both quantitative such as financial or clinical performance, or information on
the existence or otherwise of crystallised risks (for example, losses through fraud or the
existence of Information Governance breaches).
(2) A series of controls needed to ensure that the Committees and officers of the CCG receive
timely, accurate, and complete information. These are:



Access Controls: only the approved staff of the CCG can access data.
Approval Controls: only approved staff can commit the CCG to a course of action or
change our data.
Policies and procedures: designed to ensure that CCG staff understand and adhere to
what is required of them.
When these controls are designed properly and operated correctly, the Committees and
officers know about current performance can take corrective action when required.
(3) Policies and procedures issued by Committees and officers of the CCG to address risks.
These include physical controls such as ensuring that our IT equipment cannot be stolen,
information governance policies, and policies setting expected standards of ethical behaviour.
(4) Oversight of the control environment, ensuring that the other three layers work as they should.
This oversight is undertaken by the Audit and Risk Committee and Internal Audit on behalf of
the Council of Members.
Information governance
The Governing Body is aware of the importance of maintaining high standards of information
governance and securing the confidentiality of patient information. The Senior Information Risk
Officer ensures delivery of this objective and chairs the Information Governance Steering Group.
The Senior Information Risk Officer is supported by an Information Governance Lead, and the CCG
has a range of policies, procedures and training material to make sure that information governance
principles are understood by all staff and embedded into everyday practice across the Group. The
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Governing Body has appointed the Clinical Chief of Quality and Innovation, Dr Richard Barnett, as its
Caldicott Guardian.
The NHS Information Governance Framework sets the processes and procedures by which the NHS
handles information about patients and employees, in particular personal identifiable information.
The NHS Information Governance Framework is supported by an information governance toolkit and
the annual submission process provides assurances to the CCG, other organisations and to
individuals that personal information is dealt with legally, securely, efficiently and effectively.
We place high importance on ensuring there are robust information governance systems and
processes in place to help protect patient and corporate information. We have established an
information governance management framework and are developing information governance
processes and procedures in line with the information governance toolkit. We have ensured all staff
undertake annual information governance training and have implemented a staff information
governance handbook to ensure staff are aware of their information governance roles and
responsibilities.
There are processes in place for incident reporting and investigation of serious incident breaches.
We have introduced an information asset management software programme to ensure information
flow, to and from, the CCG is managed safely. Information risk assessment and management
procedures have been fully embedded throughout the organisation. Examples of this include IG
awareness training session for all staff at a team meeting, face to face IG training with a success rate
of 98% and IG included as part of the induction programme. The CCG achieved Level 2 in the IG
toolkit in 2014/15 and are set to achieve level 3 for 2015/16.
Risk assessment in relation to governance, risk management & internal control
The CCG‟s internal risk assessment has three levels:



The first being the need to identity risks to the CCG‟s ability to operate legally. This includes
the need to operate within our license, and meet information governance and statutory
functions as set out in the CCG‟s legal and regulatory framework and illustrated above.
Secondly, once these risks are identified and suitable mitigating actions put in place the CCG
will identify risks to the achievement of its key clinical objectives, set both internally and
externally.
Thirdly, mitigation plans will then be drafted, and the impact of these mitigations on our third
level of internal assessment, our need to achieve financial balance, will be assessed. If the
level of risk on financial balance caused by our mitigation of clinical objectives risk is deemed
too high, this mitigation is reconsidered until the risk is deemed to be acceptable – and
objectives will be met – in both the clinical and financial areas.
The risk appetite statement for the CCG states “We recognise that decisions about our level of
exposure to risk must be taken in context. We are committed, however, to a proactive approach and
will take risks where we are persuaded that there is potential for benefit to patient
outcomes/experience, service quality and/or value for money. We will not compromise patient safety;
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
83
where we engage in risk strategies we will ensure they are actively monitored and managed. We will
not hesitate to withdraw our exposure if benefits fail to materialise”.
In February 2015 the CCG was reviewed by KPMG, whose report concluded Significant Assurance
regarding the processes and systems that have been put in place by the CCG in ensuring that the
design, adequacy and effectiveness of the CCG‟s Assurance Framework and Risk Management
processes are robust and continue to develop
The Executive Team reviews all risks and considers:





The need to re-score the current risks following an assessment of the controls in place.
The setting and monitoring of target risk scores going forward.
The validity of the risk scores in relationship to the risk target and changes over time.
The Corporate Risk Register is then endorsed by the Audit and Risk Committee.
High level risks are escalated to the Governing Body Assurance Framework and reviewed by
the Governing Body at every formal meeting.
One of the recommendations from the KPMG Audit was to consider the role of the Executive
Team/Operational Leadership Team in identifying and monitoring risks, checking actions; and
deciding the course of action for each significant risk e.g. treat, transfer, tolerate, terminate or take.
This is now fully implemented with the Executive Team monitoring, reviewing and approving risks on
a monthly basis, including the identification of new risks and closure where appropriate of expired
risks.
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These processes, and our core objectives, are as follows:
NHS Outcomes Framework Objectives
Indicators in the NHS Outcomes Framework focus on
five domains, which set out the high level national
outcomes that the NHS should aim to improve. There
are a small number of overarching indicators for each
domain. These are followed by a number of
improvement areas, which focus on improving health
and reducing health inequalities.





Domain 1: Preventing people from dying
prematurely.
Domain 2: Enhancing quality of life for people
with long term conditions.
Domain 3: Helping people to recover from
episodes of ill health or following injury
Domain 4:Ensuring that people have a positive
experience of care
Domain 5:Treating and caring for people in a
safe environment and protecting them from
avoidable harm
Performance against the framework is improving in the
majority of domains, as evidenced by the NHS
Outcomes Tool, which supports effective
„commissioning for value‟. These outcome indicators
show that NHS North West Surrey CCG achieves many
good outcomes, in some cases in the top 25%
nationally.
Following discussions at the Audit and Risk Committee on 14th April 2014 work has
been completed to support the reporting process of risks. Two risk management
sessions provided by TIAA were organised in May 2014. As a consequence of this
training the risk register template has been redesigned to ensure the Governing
Body and Audit and Risk Committee receive a clearer report on progress of risks.
Key risks
The key risks identified by the Governing Body in the Assurance framework were:


Failure to secure affordable office premises with the space required
Sustained failure to meet A&E 4 hour target (95% of patients admitted within 4
hours)
Review of economy, efficiency & effectiveness of the use of resources
The CCG has successfully ensured that resources are used economically, efficiently
and effectively during the year.
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Economically
The CCG ensures economy in the use of its resources through the application of its
Prime Financial Policies which require the obtaining of quotations or tendering for
significant levels of spend; this helps the CCG obtain the best possible price for
money spent. The CCG has a call off arrangement with external procurement
experts to ensure that best practice is followed when spending public money. Their
skills are supplemented by the use of external consultants when required.
Efficiently
The Governing Body continually reviews how productively the CCG uses public
money. It does this through benchmarking the services it receives against rival
providers whilst at all times ensuring that the services remain of the highest quality.
Effectively
The CCG‟s performance against its key objectives for the year shows that resources
are being used effectively to improve the health and wellbeing of the population.
As part of their work programme, the CCG‟s Internal Auditors were also able to
provide me with assurance that the three „use of resources‟ objectives were met
during the year.
In the Annual Report submitted to the Audit and Risk Committee on 22 May 2015,
our Internal Auditors provided the following:







Core Financial Systems – significant assurance with improvements required
Acute Contract Management – significant assurance
QIPP Delivery – significant assurance with minor improvements
Scheme of Delegation – significant assurance with minor improvement
opportunities
Information Governance – significant assurance
Governance and Risk Management – significant assurance with minor
development opportunities
Collaborative and Partnership Governance – partial assurance with
improvement opportunities
I can confirm that in the year 2014-15 all but one of the Internal Audit Reports have
been awarded a conclusion of significant assurance.
Review of the effectiveness of governance, risk management & internal control
As Accountable Officer I have responsibility for reviewing the effectiveness of the
system of internal control within the CCG.
Capacity to handle risk
The CCG is committed to providing high quality services in a safe and secure
environment.
The Chief Executive has overall responsibility for risk. Day to day responsibility for
risk management processes is delegated to the Director of Corporate Development
and Assurance with Directors taking responsibility for specific risk areas as follows:
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


Financial Targets and Governance: Director of Finance
Clinical, Quality and Performance: Director of Quality and Innovation
Human Resources and Health and Safety: Director of Corporate Development
and Assurance
The CCG employs a range of specialists to lead on the implementation of risk
management strategies. These include Health and Safety, security, information
governance, business continuity and emergency planning.
The responsibility for risk management is identified across all levels in the CCG; from
Governing Body members, through to all managers and staff. As indicated above,
named directors have specific responsibilities and accountability for risk, and these
are laid out in the Risk Management policy and strategy. Staff and management
responsibilities for risk are clearly identified within the Risk Management Strategy,
covering both clinical and non-clinical risks. Staff are trained appropriately within that
framework, the key elements being the use of root cause analysis techniques for the
investigation of serious incidents and the identification, preparation and evaluation of
risks for the risk register.
Training and education of staff in managing risks is provided both in house, elearning and through external advisors, such as fire safety. The CCG is committed to
learning from good practice, and works closely with its internal auditors and external
specialist bodies.
Review of effectiveness
My review of the effectiveness of the system of internal control is informed by the
work of the internal auditors and the executive directors and senior managers and
clinical leads within the CCG who have responsibility for the development and
maintenance of the internal control framework. I have drawn on performance
information available to me. My review is also informed by comments made by the
external auditors in their annual audit letter and other reports.
The Board Assurance Framework itself provides me with evidence that the
effectiveness of controls that manage risks to the CCG achieving its principal or
strategic objectives have been reviewed.
I have been advised on the implications of the result of my review of the
effectiveness of the system of internal control by the Governing Body, the Audit and
Risk Committee and Quality and Performance Committee, and a plan to address
weaknesses and ensure continuous improvement of the system is in place.
The following information highlights some of the key methods that I use to be
assured that the system of internal control is effective:
The Governing body
The Governing Body has reviewed the governance framework to ensure it is fit for
purpose post April 2014, and approved a new framework, new Committee and sub-
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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committee structures and refreshed and enhanced Standing Orders, Prime Financial
Policies and the Scheme of Reservation and Delegation.
The Audit and Risk committee
The Annual Internal Audit Plan, as approved by the Audit and Risk Committee,
enables the Governing Body to be reassured that key internal financial controls and
other matters relating to risk are regularly reviewed. The Committee has reviewed
internal and external audit reports.
Quality and Performance Committee
The Quality and Performance Committee provides assurance to the Governing Body
that there are adequate controls in place to ensure the CCG is delivering its statutory
and non-statutory clinical duties and responsibilities.
Internal Audit
Our internal auditors Head of Internal Audit Opinion is detailed in full below;
“Basis of opinion for the period 1 April 2014 to 31 March 2015
Our internal audit service has been performed in accordance with KPMG's internal
audit methodology which conforms to Public Sector Internal Audit Standards
(PSIAS). As a result, our work and deliverables are not designed or intended to
comply with the International Auditing and Assurance Standards Board (IAASB),
International Framework for Assurance Engagements (IFAE) or International
Standard on Assurance Engagements (ISAE) 3000. PSIAS require that we comply
with applicable ethical requirements, including independence requirements, and that
we plan and perform our work to obtain sufficient, appropriate evidence on which to
base our conclusion.
Roles and responsibilities
The Governing Body is collectively accountable for maintaining a sound system of
internal control and is responsible for putting in place arrangements for gaining
assurance about the effectiveness of that overall system.
The Annual Governance Statement (AGS) is an annual statement by the
Accountable Officer, on behalf of the Governing Body, setting out:



how the individual responsibilities of the Accountable Officer are discharged with
regard to maintaining a sound system of internal control that supports the
achievement of policies, aims and objectives;
the purpose of the system of internal control as evidenced by a description of the risk
management and review processes, including the Assurance Framework process;
and
the conduct and results of the review of the effectiveness of the system of internal
control including any disclosures of significant control failures together with
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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assurances that actions are or will be taken where appropriate to address issues
arising.
The Assurance Framework should bring together all of the evidence required to
support the AGS.
The Head of Internal Audit (HoIA) is required to provide an annual opinion in
accordance with PSIAS, based upon and limited to the work performed, on the
overall adequacy and effectiveness of the organisation’s risk management, control
and governance processes (i.e. the system of internal control). This is achieved
through a risk-based programme of work, agreed with Management and approved by
the Audit and Risk Committee, which can provide assurance, subject to the inherent
limitations described below.
The purpose of our HoIA opinion is to contribute to the assurances available to the
Accountable Officer and the Governing Body which underpin the Governing Body’s
own assessment of the effectiveness of the system of internal control. This opinion
will in turn assist the Governing Body in the completion of the AGS, and may also be
taken into account by other regulators to inform their own conclusions.
The opinion does not imply that the HoIA has covered all risks and assurances
relating to the organisation. The opinion is substantially derived from the conduct of
risk-based plans generated from a robust and Management-led Assurance
Framework. As such it is one component that the Governing Body takes into
account in making its AGS.
A further component will be the assurances provided on the operation of the systems
of internal control the service organisations which provide financial services on
behalf of the CCG during 2014/15 as follows:



NHS South London Commissioning Support Unit;
NHS Shared Business Service; and
McKesson: NHS Electronic Staff Records.
Assurances on the operation of these systems will be provided by ISAE3402 Service
Auditor Reports issued by the internal auditors of these organisations.
Opinion
Our opinion is set out as follows: basis for the opinion; overall opinion; and
commentary.
The basis for forming our opinion is as follows:

An assessment of the design and operation of the underpinning Assurance
Framework and supporting processes; and

An assessment of the range of individual assurances arising from our riskbased internal audit assignments that have been reported throughout the
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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period. This assessment has taken account of the relative materiality of these
areas.
Our opinion based for the period 1 April 2014 to 31 March 2015 is that:
‘Significant with minor improvement opportunities’ assurance can be given on
the overall adequacy and effectiveness of the organisation’s framework of
governance, risk management and control.
Commentary
The commentary below provides the context for our opinion and together with the
opinion should be read in its entirety.
Our opinion covers the period 1 April 2014 to 31 March 2015 inclusive, and is based
on the 7 audits that we completed in 2014/15.
The design and operation of the Assurance Framework and associated
processes
Overall our review found that the Assurance Framework in place is founded on a
systematic risk management process and provides appropriate assurance to the
Governing Body.
The Assurance Framework reflects the organisation’s key objectives and risks and is
reviewed on a regular basis by the Governing Body.
The range of individual opinions arising from risk-based audit assignments,
contained within our risk-based plan that have been reported throughout the
year
We issued two ‘significant assurance’ and four ‘significant assurance with minor
improvement opportunities’ ratings in 2014/15. We issued one report with a ‘partial
assurance with improvement opportunities’ rating. Considering the collective position
of all assurance ratings provided and the specific improvement opportunities
identified on the reviews completed, our annual opinion is that of ‘significant with
minor improvements’ assurance opinion can be given in respect of the overall
adequacy and effectiveness of the organisation’s framework of governance, risk
management and control. Management has either implemented or is implementing
the recommendations raised our reports. We are satisfied that these do not
materially adversely effect the CCG’s control environment to impact on our ability to
provide a Head of Internal Audit Opinion.
KPMG LLP
Chartered Accountants
London
22 May 2015”
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Data quality
A risk for all CCGs is the quality of information received from providers. The CCG
has robust policies and procedures in place to ensure that our commissioning teams
can rely on the data they receive and take timely and decisive action to address any
under or over performance issues with confidence.
Business critical models
An appropriate framework is in place to provide quality assurance of business critical
models which the CCG uses. This is done on a case by case basis, with the lead
Director taken ownership of each model, and scrutiny of quality assurance being
provide by the most appropriate Committee of the five listed in page 76 above.
All business critical models have been identified and information about quality
assurance processes for those models has been provided to the Analytical Oversight
Committee, chaired by the Chief Analyst in the Department of Health.
“The Chief Officer confirms that there is an appropriate framework and environment
in place to provide quality assurance of business critical models, in line with the
recommendations from the MacPherson report.”
Security
There has been no material or reportable lapses of data security during the year.
The legal status of the CCG concerning the receipt, storage, and use of personal
confidential data (PCD) relating to our patients is complex. The CCG cannot
currently legally receive PCD from our commissioners. Data validation is therefore
undertaken on our behalf by local Commissioning Support Units (CSUs).
We have submitted a satisfactory level of compliance with the information
governance toolkit assessment.
Discharge of statutory functions
During establishment, the arrangements put in place by the CCG and explained
within the Corporate Governance Framework were developed with extensive
external expert legal input, to ensure compliance with all relevant legislation. That
legal advice also informed the matters reserved for Membership (Council of
Members) and Governing Body and responsibilities and functions delegated to
Committees and personnel as outlined in the Scheme of Reservation and
Delegation.
In light of the Harris Review, the CCG has reviewed all of the statutory duties and
powers conferred on it by the National Health Service Act 2006 (as amended by the
2012 Act) and other associated legislative and regulations. As a result, I can confirm
that the CCG is clear about the legislative requirements associated with each of the
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
91
statutory functions for which it is responsible, including any restrictions on delegation
of those functions.
Responsibility for each duty and power has been clearly allocated to a lead Director.
Directorates have confirmed that their structures provide the necessary capability
and capacity to undertake all of the CCG‟s statutory duties.
Conclusion
I can confirm that no significant internal control issues have been identified during
the year. I am satisfied that the CCG operates within an efficient and effective control
environment.
Signed:
Julia Ross
Chief Executive
Date:
28 May 2015
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5. Statement of Accountable Officer‟s
Responsibilities
The National Health Service Act 2006 (as amended) states that each Clinical
Commissioning Group shall have an Accountable Officer and that Officer shall be
appointed by the NHS Commissioning Board (NHS England). NHS England has
appointed the Chief Executive to be the Accountable Officer of the Clinical
Commissioning Group.
The responsibilities of an Accountable Officer, include responsibilities for the
propriety and regularity of the public finances for which the Accountable Officer is
answerable, keeping proper accounting records (which disclose with reasonable
accuracy at any time the financial position of the Clinical Commissioning Group and
enable them to ensure that the accounts comply with the requirements of the
Accounts Direction) and safeguarding the Clinical Commissioning Group‟s assets
(and hence for taking reasonable steps for the prevention and detection of fraud and
other irregularities). These responsibilities are set out in the Clinical Commissioning
Group Accountable Officer Appointment Letter.
Under the National Health Service Act 2006 (as amended), NHS England has
directed each Clinical Commissioning Group to prepare for each financial year
financial statements in the form and on the basis set out in the Accounts Direction.
The financial statements are prepared on an accruals basis and must give a true and
fair view of the state of affairs of the Clinical Commissioning Group and of its net
expenditure, changes in taxpayers‟ equity and cash flows for the financial year.
In preparing the financial statements, the Accountable Officer is required to comply
with the requirements of the Manual for Accounts issued by the Department of
Health and in particular to:




Observe the Accounts Direction issued by NHS England, including the
relevant accounting and disclosure requirements, and apply suitable
accounting policies on a consistent basis
Make judgements and estimates on a reasonable basis
State whether applicable accounting standards, as set out in the Manual for
Accounts, issued by the Department of Health have been followed, and
disclose and explain any material departures in the financial statements
Prepare the financial statements on a going concern basis
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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To the best of my knowledge and belief, I have properly discharged the
responsibilities set out in my Clinical Commissioning Group Accountable Officer
Appointment Letter.
Signed:
Julia Ross
Chief Executive
Date:
28 May 2015
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
94
6. Independent Auditor‟s Report to the
Members of NHS North West Surrey
CCG
We have audited the financial statements of NHS North West Surrey Clinical
Commissioning Group for the year ended 31 March 2015 under the Audit
Commission Act 1998. The financial statements comprise the Statement of
Comprehensive Net Expenditure, the Statement of Financial Position, the Statement
of Changes in Taxpayers‟ Equity, the Statement of Cash Flows and the related
notes. The financial reporting framework that has been applied in their preparation is
applicable law and the accounting policies directed by the NHS Commissioning
Board with the consent of the Secretary of State as relevant to the National Health
Service in England.
We have also audited the information in the Remuneration Report that is subject to
audit, being:

The table of salaries and allowances of senior managers and related narrative
notes on pages 156 and 157 of the annual report

The table of pension benefits of senior managers and related narrative notes
on pages 157 and 158 of the annual report

The pay multiples and related narrative notes on page 146 to 147 of the
annual report.
This report is made solely to the members of NHS North West Surrey Clinical
Commissioning Group in accordance with Part II of the Audit Commission Act 1998
and for no other purpose, as set out in paragraph 44 of the Statement of
Responsibilities of Auditors and Audited Bodies published by the Audit Commission
in March 2014. To the fullest extent permitted by law, we do not accept or assume
responsibility to anyone other than the Clinical Commissioning Group (CCG)'s
members and the CCG as a body, for our audit work, for this report, or for the
opinions we have formed.
Respective responsibilities of the Accountable Officer and auditor
As explained more fully in the Statement of Accountable Officer‟s Responsibilities,
the Accountable Officer is responsible for the preparation of the financial statements
and for being satisfied that they give a true and fair view. Our responsibility is to audit
and express an opinion on the financial statements in accordance with applicable
law and International Standards on Auditing (UK and Ireland). Those standards also
require us to comply with the Auditing Practices Board‟s Ethical Standards for
Auditors.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
95
Scope of the audit of the financial statements
An audit involves obtaining evidence about the amounts and disclosures in the
financial statements sufficient to give reasonable assurance that the financial
statements are free from material misstatement, whether caused by fraud or error.
This includes an assessment of: whether the accounting policies are appropriate to
the CCG‟s circumstances and have been consistently applied and adequately
disclosed; the reasonableness of significant accounting estimates made by the
Accountable Officer; and the overall presentation of the financial statements.
In addition, we read all the financial and non-financial information in the annual
report which comprises the introduction from the CCG‟s Council of Members,
Strategic Report, Members' Report, Annual Governance Statement and areas of the
Remuneration Report not subject to audit, to identify material inconsistencies with
the audited financial statements and to identify any information that is apparently
materially incorrect based on, or materially inconsistent with, the knowledge acquired
by us in the course of performing the audit. If we become aware of any apparent
material misstatements or inconsistencies we consider the implications for our
report.
In addition, we are required to obtain evidence sufficient to give reasonable
assurance that the expenditure and income reported in the financial statements have
been applied to the purposes intended by Parliament and the financial transactions
conform to the authorities which govern them.
Opinion on regularity
In our opinion, in all material respects the expenditure and income reported in the
financial statements have been applied to the purposes intended by Parliament and
the financial transactions conform to the authorities which govern them.
Opinion on financial statements
In our opinion the financial statements:

Give a true and fair view of the financial position of NHS North West Surrey
Clinical Commissioning Group as at 31 March 2015 and of its net operating
costs for the year then ended; and

Have been prepared properly in accordance with the accounting policies
directed by the NHS Commissioning Board with the consent of the Secretary
of State as relevant to the National Health Service in England.
Opinion on other matters
In our opinion:

The part of the Remuneration Report subject to audit has been prepared
properly in accordance with the requirements directed by the NHS
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
96
Commissioning Board with the consent of the Secretary of State as relevant
to the National Health Service in England; and

The information given in the annual report for the financial year for which the
financial statements are prepared is consistent with the financial statements.
Matters on which we report by exception
We report to you if:
1. In our opinion the governance statement does not reflect compliance with
NHS England‟s Guidance;
2. We refer a matter to the Secretary of State under section 19 of the Audit
Commission Act 1998 because we have reason to believe that the CCG, or
an officer of the CCG, is about to make, or has made, a decision involving
unlawful expenditure, or is about to take, or has taken, unlawful action likely to
cause a loss or deficiency; or
3. We issue a report in the public interest under section 8 of the Audit
Commission Act 1998.
We have nothing to report in these respects.
Conclusion on the CCG‟s arrangements for securing economy, efficiency and
effectiveness in the use of resources
Respective responsibilities of the CCG and auditor
The CCG is responsible for putting in place proper arrangements to secure
economy, efficiency and effectiveness in its use of resources, to ensure proper
stewardship and governance, and to review regularly the adequacy and
effectiveness of these arrangements.
We are required under Section 5 of the Audit Commission Act 1998 to satisfy
ourselves that the CCG has made proper arrangements for securing economy,
efficiency and effectiveness in its use of resources. The Code of Audit Practice
issued by the Audit Commission requires us to report to you our conclusion relating
to proper arrangements having regard to relevant criteria specified by the Audit
Commission in October 2014.
We report if significant matters have come to our attention which prevent us from
concluding that the CCG has put in place proper arrangements for securing
economy, efficiency and effectiveness in its use of resources. We are not required to
consider, nor have we considered, whether all aspects of the CCG‟s arrangements
for securing economy, efficiency and effectiveness in its use of resources and
operating effectively.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
97
Scope of the review of arrangements for securing economy, efficiency and
effectiveness in the use of resources
We have undertaken our review in accordance with the Code of Audit Practice,
having regard to the guidance on the specified criteria, published by the Audit
Commission in October 2014, as to whether the CCG has proper arrangements for;

Securing financial resilience

Challenging how it secures economy, efficiency and effectiveness.
The Audit Commission has determined these two criteria as those necessary for us
to consider under the Code of Audit Practice in satisfying ourselves whether the
CCG put in place proper arrangements for securing economy, efficiency and
effectiveness in its use of resources for the year ended 31 March 2015.
We planned our work in accordance with the Code of Audit Practice. Based on our
risk assessment, we undertook such work as we considered necessary to form a
view on whether, in all significant respects, the CCG had put in place proper
arrangements to secure economy, efficiency and effectiveness in its use of
resources.
Conclusion
On the basis of our work, having regard to the guidance on the specified criteria
published by the Audit Commission in October 2014, we are satisfied that, in all
significant respects, NHS North West Surrey Clinical Commissioning Group put in
place proper arrangements to secure economy, efficiency and effectiveness in its
use of resources for the year ending 31 March 2015.
Certificate
We certify that we have completed the audit of the accounts of NHS North West
Surrey Clinical Commissioning Group in accordance with the requirements of the
Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit
Commission.
Iain Murray
For and on behalf of Grant Thornton UK LLP, Appointed Auditor
Grant Thornton House
Melton Street
Euston Square
London
NW1 2EP
28 May 2015
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
98
7. Financial Overview
Operating and financial review
Financial Duties and Performance 2014/15
North West Surrey CCG in common with all other CCG‟s are required to meet a
number of financial duties. The main duty is to remain within the allotted revenue
allocation, further duties on remaining within the allocated cash limit and the Running
Costs Allowance.
A summary of the CCG financial performance is detailed below:
Summary of Financial Performance
Target
Actual
£‟000
£‟000
Remain within the resource limit
407,960 402,986
Remain within the cash limit
400,916 401,202
Remain within the running costs allocation
9,154
Rating
7,273
Resource Limit
The CCG as part of its financial planning for 2014/15 was required to plan for the
delivery of a surplus of £4.026m (1% of allocation). We set a very prudent plan to
ensure delivery of this, even with this cautious financial planning; we encountered a
number of cost pressures in year, most notably in our acute contract with Ashford &
St Peter‟s Hospital‟s NHS Foundation Trust.
The CCG has delivered a surplus of £4.974m made up as follows;
2014/15
£‟000
2013/14
Total Spend
402,986
391,893
Revenue Resource Limit
407,960
393,885
Over (Under) spend
(4,974)
(1,992)
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
£‟000
99
Cash
In 2014/15 the CCG had a requirement to ensure that its cash balance at the end of
the financial year was less than £437k. The CCG‟s performance is detailed below;
2014/15
£‟000
2013/14
Total Cash Expenditure
401,202
367,405
Cash Allocation
400,916
367,420
286
(15)
Over (Under) spend
£‟000
Running Costs Allowance
The CCG received an allocation for running costs of £25 per head of population,
£8.514m, in year the CCG received its quality premium of £0.64m, making a total
£9.154m. The CCG is not permitted to overspend against this. The CCG has
restructured in year to ensure that it can meet the planned 10% reduction in its
management costs in 2015/16. Although the CCG has had to use a number of
interim and agency staff, it has managed to not only remain within the allocation but
to generate an underspend of £1.881m (2013/14 £0.235m), made up as follows;
2014/15
2013/14
£‟000
£‟000
Running Costs Expenditure
7,273
8,295
Running Costs Allocation
9,154
8,530
(1,881)
(235)
Over (Under) spend
Better Payments Practice Code
CCGs are expected to meet the requirements of the Better Payments Practice Code,
CCGs are expected to achieve the target of payment of invoices within 30 days of
receipt of goods or a valid invoice. The target is 95% of invoices paid within creditor
terms. The CCG paid 69.77% (2013/14 70.59%) of all valid invoices by the due date
or within 30 days of a receipt of a valid invoice in 2014/15. The performance is
affected due to the verification process for a significant number of relatively low value
invoices for non-contracted activity.
QIPP
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
100
In 2014/15 North West Surrey CCG QIPP challenge totalled £12.627m (2013/14
£10.857m). By the end of the financial year the CCG had met its QIPP target through
delivery of schemes. The QIPP schemes have focussed on reducing demand in
acute hospitals and reduction in medicines management.
Expenditure
The chart below shows a breakdown of the key areas of expenditure for the financial
year April 2014 to March 2015.
Main Areas of Expenditure 2014/15 - £403m
Primary
Care - £6m
(2%)
Other Contracts £6m (1%)
Running Costs £7m (2%)
Prescribing £46m (12%)
Mental Health
Commissioning £33m (8%)
Continuing
Healthcare - £25m
(6%)
General & Acute
Commissioning £241m (60%)
Community Services
Commissioning £37m (9%)
Pension Liabilities
The remuneration report provides details of pensions in respect of the Governing
Body members and note 4.5 of the Annual Accounts sets out the details of pension
costs and how the CCG accounts for its membership of the NHS defined benefit
pension scheme.
The attached accounts have been subject to audit by Grant Thornton UK LLP, Grant
Thornton House, Melton Street, Euston Square, London, NW1 2EP and an
unqualified audit opinion has been received. Details of the audit fees relating to the
financial year can be found in note 5 to the accounts. Our internal audit services
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
101
were provided by TIAA Ltd till 31 May 2014, KPMG LLP was awarded the contract
from the 1 June 2014.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
102
8. Financial Statements
Foreword to the Financial Statements
These financial statements for the 12 months ended 31 March 2015 have been
prepared under the National Health Service Act 2006 (as amended) in the form and
basis set out by NHS England in the Accounts Direction.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
103
Statement of Comprehensive Net Expenditure
For the Year Ended 31 March 2015
2014/15
2013/14
Note
£‟000
£‟000
Other Operating Revenue
2
(806)
(173)
Gross Employee Benefits
4
4,933
3,418
Other Costs
5
3,147
5,050
Other Operating Revenue
2
(2,622)
(840)
Gross Employee Benefits
4
1,052
217
Other Costs
5
397,283
384,221
402,986
391,893
Investment Revenue
0
0
Other Gains & Losses
0
0
Finance Costs
0
0
402,986
391,893
0
0
402,986
391,893
0
0
402,986
391,893
Administrative Costs
Programme Costs
Net Operating Costs before Financing
Financing
Net Operating Costs for the Financial Year
Net Gain (Loss) on Transfer by Absorption
Retained Net Operating Costs for the Financial Year
Other Comprehensive Net Expenditure
Total Comprehensive Net Expenditure for the Financial
Year
The notes on pages 107 to 143 form part of this statement.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
104
Statement of Financial Position as at 31 March 2015
Note
2014/15
£‟000
2013/14
£‟000
£
Non-current Assets
Property, Plant & Equipment
9
315
0
Intangible Assets
9
0
0
315
0
0
0
Total Non-current Assets
Current Assets
Inventories
Trade & Other Receivables
10
5,060
5,872
Cash & Cash Equivalents
14
0
15
Total Current Assets
5,060
5,887
Total Assets
5,375
5,887
Current Liabilities
Trade & Other Payables
17
(31,370)
(29,998)
Borrowings
Provisions
20
24
(286)
(168)
0
(289)
Total Current Liabilities
(31,824)
(30,287)
Total Assets less Current Liabilities
(26,449)
(24,400)
Non-current Liabilities
Trade & Other Payables
17
0
0
Provisions
24
(109)
(73)
(109)
(73)
(26,558)
(24,473)
General Fund
(26,558)
(24,473)
Total Taxpayers‟ Equity
(26,558)
(24,473)
Total Non-current Liabilities
Total Assets Employed
Financed by Taxpayers‟ Equity
The notes on pages 107 to 143 form part of this statement.
The financial statements on pages 102 to 143 were approved by the Council of
Members on 28 May 2015 and signed on its behalf by:
Signed:
Date:
Dr Elizabeth Lawn
Chair
Julia Ross
Chief Executive
28 May 2015
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
105
Statement of Changes in Taxpayers‟ Equity for the Year Ended 31 March 2015
Changes in taxpayers‟ equity for 2014/15
Clinical Commissioning Group Balance at 1 April 2014
General Fund
Total
£‟000
£‟000
(24,473)
(24,473)
Changes in Clinical Commissioning Group Taxpayers‟ Equity for 2014/15
Net operating costs for the financial year
(402,986) (402,986)
Release of reserves to the Statement of Comprehensive Net Expenditure
0
0
Transfers by absorption to (from) other bodies
0
0
Re-measurement of the defined benefit liability
0
0
Net Recognised Clinical Commissioning Group Expenditure for the Financial
Year
(402,986) (402,986)
Net funding
400,901
400,901
Clinical Commissioning Group Balance at 31 March 2015
(26,558)
(26,558)
Changes in taxpayers‟ equity for 2013/14
General Fund
Total
£‟000
£‟000
0
0
(391,893)
(391,893)
Release of reserves to the Statement of Comprehensive Net Expenditure
0
0
Transfers by absorption to (from) other bodies
0
0
Re-measurement of the defined benefit liability
0
0
(391,893)
(391,893)
Net funding
367,420
367,420
Clinical Commissioning Group Balance at 31 March 2014
(24,473)
(24,473)
Clinical Commissioning Group Balance at 1 April 2013
Changes in Clinical Commissioning Group Taxpayers‟ Equity for
2013/14
Net operating costs for the financial year
Net Recognised Clinical Commissioning Group Expenditure for the Financial
Year
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Statement of Cash Flows for the Year Ended 31 March 2015
2014/15
2013/14
£‟000
£‟000
(402,986)
(391,893)
812
(5,872)
1,111
29,998
Provisions utilised
(24)
0
Increase (decrease) in provisions
(61)
362
(401,148)
(367,405)
Cash Flows from Investing Activities
(Payments) for property, plant and equipment
(54)
0
Net Cash Inflow (Outflow) from Investing Activities
(54)
0
(401,202)
(367,405)
Net parliamentary funding received
400,901
367,420
Net Cash Inflow (Outflow) from Financing Activities
400,901
367,420
(301)
15
Note
Cash Flows from Operating Activities
Net operating costs for the financial year
Increase (decrease) in trade & other receivables
Increase (decrease) in trade & other payables
Net Cash Inflow (Outflow) from Operating Activities
Net Cash Inflow (Outflow) before Financing
Cash Flows from Financing Activities
Net Increase (Decrease) in Cash & Cash Equivalents
Cash & Cash Equivalents at the Beginning of the Financial
Year
Cash & Cash Equivalents (including bank overdrafts) at the
End of the Financial Year
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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0
14
(286)
15
107
Notes to the Financial Statements
1.
Accounting Policies
NHS England has directed that the financial statements of Clinical Commissioning
Groups shall meet the accounting requirements of the Manual for Accounts issued
by the Department of Health. Consequently, the following financial statements have
been prepared in accordance with the Manual for Accounts 2014-15 issued by the
Department of Health. The accounting policies contained in the Manual for Accounts
follow International Financial Reporting Standards to the extent that they are
meaningful and appropriate to Clinical Commissioning Groups, as determined by HM
Treasury, which is advised by the Financial Reporting Advisory Board. Where the
Manual for Accounts permits a choice of accounting policy, the accounting policy
which is judged to be most appropriate to the particular circumstances of the Clinical
Commissioning Group for the purpose of giving a true and fair view has been
selected. The particular policies adopted by the Clinical Commissioning Group are
described below. They have been applied consistently in dealing with items
considered material in relation to the accounts.
1.1
Going Concern
These accounts have been prepared on the going concern basis.
Public sector bodies are assumed to be going concerns where the continuation of
the provision of a service in the future is anticipated, as evidenced by inclusion of
financial provision for that service in published documents.
Where a Clinical Commissioning Group ceases to exist, it considers whether or not
its services will continue to be provided (using the same assets, by another public
sector entity) in determining whether to use the concept of going concern for the final
set of Financial Statements. If services will continue to be provided the Financial
Statements are prepared on the going concern basis.
1.2
Accounting Convention
These accounts have been prepared under the historical cost convention modified to
account for the revaluation of property, plant and equipment, intangible assets,
inventories and certain financial assets and financial liabilities.
1.3
Acquisitions & Discontinued Operations
Activities are considered to be „acquired‟ only if they are taken on from outside the
public sector. Activities are considered to be „discontinued‟ only if they cease
entirely. They are not considered to be „discontinued‟ if they transfer from one public
sector body to another.
1.4
Movement of Assets within the Department of Health Group
Transfers as part of reorganisation fall to be accounted for by use of absorption
accounting in line with the Government Financial Reporting Manual, issued by HM
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108
Treasury. The Government Financial Reporting Manual does not require
retrospective adoption, so prior year transactions (which have been accounted for
under merger accounting) have not been restated. Absorption accounting requires
that entities account for their transactions in the period in which they took place, with
no restatement of performance required when functions transfer within the public
sector. Where assets and liabilities transfer, the gain or loss resulting is recognised
in the Statement of Comprehensive Net Expenditure, and is disclosed separately
from operating costs.
Other transfers of assets and liabilities within the Department of Health Group are
accounted for in line with IAS 20 and similarly give rise to income and expenditure
entries.
For transfers of assets and liabilities from those NHS bodies that closed on 1 April
2013, HM Treasury has agreed that a modified absorption approach should be
applied. For these transactions only, gains and losses are recognised in reserves
rather than the Statement of Comprehensive Net Expenditure.
1.5
Pooled Budgets
Where the clinical commissioning group has entered into a pooled budget
arrangement under Section 75 of the National Health Service Act 2006 the Clinical
Commissioning Group accounts for its share of the assets, liabilities, income and
expenditure arising from the activities of the pooled budget, identified in accordance
with the pooled budget agreement.
If the Clinical Commissioning Group is in a “jointly controlled operation”, the clinical
commissioning group recognises:

The assets the Clinical Commissioning Group controls;

The liabilities the Clinical Commissioning Group incurs;

The expenses the Clinical Commissioning Group incurs; and,

The Clinical Commissioning Group‟s share of the income from the pooled
budget activities.
If the Clinical Commissioning Group is involved in a “jointly controlled assets”
arrangement, in addition to the above, the Clinical Commissioning Group recognises:

The Clinical Commissioning Group‟s share of the jointly controlled assets
(classified according to the nature of the assets);

The Clinical Commissioning Group‟s share of any liabilities incurred jointly;
and,

The Clinical Commissioning Group‟s share of the expenses jointly incurred.
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1.6
Critical Accounting Judgements & Key Sources of Estimation
Uncertainty
In the application of the Clinical Commissioning Group‟s accounting policies,
management is required to make judgements, estimates and assumptions about the
carrying amounts of assets and liabilities that are not readily apparent from other
sources. The estimates and associated assumptions are based on historical
experience and other factors that are considered to be relevant. Actual results may
differ from those estimates and the estimates and underlying assumptions are
continually reviewed. Revisions to accounting estimates are recognised in the period
in which the estimate is revised if the revision affects only that period or in the period
of the revision and future periods if the revision affects both current and future
periods.
1.6.1 Critical Judgements in Applying Accounting Policies
The following are the critical judgements, apart from those involving estimations (see
below) that management has made in the process of applying the Clinical
Commissioning Group‟s accounting policies that have the most significant effect on
the amounts recognised in the financial statements:
Provisions. The Clinical Commissioning Group has no provisions at the balance
sheet date for the costs of our populations retrospective continuing health care
claims at 31 March 2013. Some of these claims were known about by our legacy
Primary Care Trust and provided for; some were known but not provided for;
some were unknown. The formal transfer order of the Primary Care Trust‟s
assets liabilities and transactions (including contingencies) has transferred these
liabilities to the Clinical Commissioning Group. However, the legally binding
Accounts Direction – under which these financial statements are prepared – state
that retrospective continuing health care claims are to be accounted for by NHS
England and that the Clinical Commissioning Group should account for all claims
that were incurred from 1 April 2013. This conclusion was challenged by the
accounting guidance (which has no statutory basis) issued by NHS England
which states that they will solely account for those 31 March 2013 cases known
about and provided for at that date. This does not include those known about but
not provided for. The Governing Body has concluded that the Accounting
Direction takes precedence over the guidance issued by NHS England and will
therefore recognise in these financial statements only those cases for which the
required social and healthcare package started after 1 April 2013. Continuing
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Healthcare claims continue to be an area of on-going financial risk and
uncertainty for the Clinical Commissioning Group.
1.6.2 Key Sources of Estimation Uncertainty
The following are the key estimations that management has made in the process of
applying the Clinical Commissioning Group‟s accounting policies that have the most
significant effect on the amounts recognised in the financial statements:

Partially Completed Spells. The Clinical Commissioning Group
recognises expenditure relating to spells of care started by our
providers at the balance sheet date but not yet completed. This
recognition is limited to cost and volume contracts where the activity
will incur extra costs for the Clinical Commissioning Group. The Clinical
Commissioning Group works with its providers to ensure that the
Partially Completed Spells accrual is accurate at the balance sheet
date but it relies on the estimates of management concerning the
eventual cost of the treatment. At the balance sheet date the Clinical
Commissioning Group was recognising a Partially Completed Spells
liability of £2,404k.

Prescribing accrual. There is a time lag between when the Clinical
Commissioning Group‟s patients receive drugs and certain other
medical consumables prescribed by our GPs and when the Group pays
the NHS Prescription Services for their issue. At the balance sheet date
the Clinical Commissioning Group has estimated the value of this lag –
drugs and goods issued but not paid for – to be £7,498k.
1.7
Offsetting income and expenditures
The Clinical Commissioning Group has acted as host for a Surrey based healthcare
contract during the year, Virgin Community Care. The hosting arrangement means
that the Clinical Commissioning Group paid the cost of this contract for all NHS
patients who used these services and then recharged the patient‟s Clinical
Commissioning Group – or NHS England if the service is commissioned by this body
- their element. The Clinical Commissioning Group is acting as an agent in these
arrangements (as defined by IAS 18 and the NHS Manual of Accounts) and
therefore net off the recharged amounts against the underlying spend.
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1.8
Revenue
Revenue in respect of services provided is recognised when, and to the extent that,
performance occurs, and is measured at the fair value of the consideration
receivable.
Where income is received for a specific activity that is to be delivered in the following
year, that income is deferred.
1.9
Employee Benefits
1.9.1 Short-term Employee Benefits
Salaries, wages and employment-related payments are recognised in the period in
which the service is received from employees, including bonuses earned but not yet
taken.
The cost of leave earned but not taken by employees at the end of the period is
recognised in the financial statements to the extent that employees are permitted to
carry forward leave into the following period.
1.9.2 Retirement Benefit Costs
Past and present employees are covered by the provisions of the NHS Pensions
Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS
employers, General Practices and other bodies, allowed under the direction of the
Secretary of State, in England and Wales. The scheme is not designed to be run in a
way that would enable NHS bodies to identify their share of the underlying scheme
assets and liabilities. Therefore, the scheme is accounted for as if it were a defined
contribution scheme: the cost to the Clinical Commissioning Group of participating in
the scheme is taken as equal to the contributions payable to the scheme for the
accounting period.
For early retirements other than those due to ill health the additional pension
liabilities are not funded by the scheme. The full amount of the liability for the
additional costs is charged to expenditure at the time the Clinical Commissioning
Group commits itself to the retirement, regardless of the method of payment.
1.10
Other Expenses
Other operating expenses are recognised when, and to the extent that, the goods or
services have been received. They are measured at the fair value of the
consideration payable.
Expenses and liabilities in respect of grants are recognised when the Clinical
Commissioning Group has a present legal or constructive obligation, which occurs
when all of the conditions attached to the payment have been met.
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1.11
Government Grants
The value of assets received by means of a government grant are credited directly to
income. Deferred income is recognised only where conditions attached to the grant
preclude immediate recognition of the gain.
1.12
Leases
Leases are classified as finance leases when substantially all the risks and rewards
of ownership are transferred to the lessee. All other leases are classified as
operating leases.
1.12.1 The Clinical Commissioning Group as Lessee
Property, plant and equipment held under finance leases are initially recognised, at
the inception of the lease, at fair value or, if lower, at the present value of the
minimum lease payments, with a matching liability for the lease obligation to the
lessor. Lease payments are apportioned between finance charges and reduction of
the lease obligation so as to achieve a constant rate on interest on the remaining
balance of the liability. Finance charges are recognised in calculating the Clinical
Commissioning Group‟s surplus/deficit.
Operating lease payments are recognised as an expense on a straight-line basis
over the lease term. Lease incentives are recognised initially as a liability and
subsequently as a reduction of rentals on a straight-line basis over the lease term.
Contingent rentals are recognised as an expense in the period in which they are
incurred.
Where a lease is for land and buildings, the land and building components are
separated and individually assessed as to whether they are operating or finance
leases.
1.12.2 The Clinical Commissioning Group as Lessor
Amounts due from lessees under finance leases are recorded as receivables at the
amount of the Clinical Commissioning Group‟s net investment in the leases. Finance
lease income is allocated to accounting periods so as to reflect a constant periodic
rate of return on the Clinical Commissioning Group‟ net investment outstanding in
respect of the leases.
Rental income from operating leases is recognised on a straight-line basis over the
term of the lease. Initial direct costs incurred in negotiating and arranging an
operating lease are added to the carrying amount of the leased asset and
recognised on a straight-line basis over the lease term.
1.13
Cash & Cash Equivalents
Cash is cash in hand and deposits with any financial institution repayable without
penalty on notice of not more than 24 hours. Cash equivalents are investments that
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113
mature in 3 months or less from the date of acquisition and that are readily
convertible to known amounts of cash with insignificant risk of change in value.
In the Statement of Cash Flows, cash and cash equivalents are shown net of bank
overdrafts that are repayable on demand and that form an integral part of the Clinical
Commissioning Group‟s cash management.
1.14
Provisions
Provisions are recognised when the Clinical Commissioning Group has a present
legal or constructive obligation as a result of a past event, it is probable that the
Clinical Commissioning Group will be required to settle the obligation, and a reliable
estimate can be made of the amount of the obligation. The amount recognised as a
provision is the best estimate of the expenditure required to settle the obligation at
the end of the reporting period, taking into account the risks and uncertainties.
Where a provision is measured using the cash flows estimated to settle the
obligation, its carrying amount is the present value of those cash flows using HM
Treasury‟s discount rate as follows:

Timing of cash flows (0 to 5 years inclusive): Minus 1.50%

Timing of cash flows (6 to 10 years inclusive): Minus 1.055%

Timing of cash flows (over 10 years): Plus 2.20%

All employee early departures: 1.30%
When some or all of the economic benefits required to settle a provision are
expected to be recovered from a third party, the receivable is recognised as an asset
if it is virtually certain that reimbursements will be received and the amount of the
receivable can be measured reliably.
A restructuring provision is recognised when the Clinical Commissioning Group has
developed a detailed formal plan for the restructuring and has raised a valid
expectation in those affected that it will carry out the restructuring by starting to
implement the plan or announcing its main features to those affected by it. The
measurement of a restructuring provision includes only the direct expenditures
arising from the restructuring, which are those amounts that are both necessarily
entailed by the restructuring and not associated with on-going activities of the entity.
1.15
Clinical Negligence Costs
The NHS Litigation Authority operates a risk pooling scheme under which the Clinical
Commissioning Group pays an annual contribution to the NHS Litigation Authority
which in return settles all clinical negligence claims. The contribution is charged to
expenditure. Although the NHS Litigation Authority is administratively responsible for
all clinical negligence cases the legal liability remains with the Clinical
Commissioning Group.
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1.16
Non-clinical Risk Pooling
The Clinical Commissioning Group participates in the Property Expenses Scheme
and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under
which the Clinical Commissioning Group pays an annual contribution to the NHS
Litigation Authority and, in return, receives assistance with the costs of claims
arising. The annual membership contributions, and any excesses payable in respect
of particular claims are charged to operating expenses as and when they become
due.
1.17
Carbon Reduction Commitment Scheme
Carbon Reduction Commitment and similar allowances are accounted for as
government grant funded intangible assets if they are not expected to be realised
within twelve months, and otherwise as other current assets. They are valued at
open market value. As the Clinical Commissioning Group makes emissions, a
provision is recognised with an offsetting transfer from deferred income. The
provision is settled on surrender of the allowances. The asset, provision and
deferred income amounts are valued at fair value at the end of the reporting period.
1.18
Contingencies
A contingent liability is a possible obligation that arises from past events and whose
existence will be confirmed only by the occurrence or non-occurrence of one or more
uncertain future events not wholly within the control of the Clinical Commissioning
Group, or a present obligation that is not recognised because it is not probable that a
payment will be required to settle the obligation or the amount of the obligation
cannot be measured sufficiently reliably. A contingent liability is disclosed unless the
possibility of a payment is remote.
A contingent asset is a possible asset that arises from past events and whose
existence will be confirmed by the occurrence or non-occurrence of one or more
uncertain future events not wholly within the control of the Clinical Commissioning
Group. A contingent asset is disclosed where an inflow of economic benefits is
probable.
Where the time value of money is material, contingencies are disclosed at their
present value.
1.19
Financial Assets
Financial assets are recognised when the Clinical Commissioning Group becomes
party to the financial instrument contract or, in the case of trade receivables, when
the goods or services have been delivered. Financial assets are derecognised when
the contractual rights have expired or the asset has been transferred.
Financial assets are classified into the following categories:

Financial assets at fair value through profit and loss;
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
Held to maturity investments;

Available for sale financial assets; and,

Loans and receivables.
The classification depends on the nature and purpose of the financial assets and is
determined at the time of initial recognition. At the balance sheet date the Clinical
Commissioning Group holds only loans and receivables. It has no plans to hold
financial assets other than loans and receivables in the foreseeable future.
1.19.1 Loans & Receivables
Loans and receivables are non-derivative financial assets with fixed or determinable
payments which are not quoted in an active market. After initial recognition, where
the impact of the time value of money is material, loans and receivables are
measured at amortised cost using the effective interest method, less any impairment.
Interest is recognised using the effective interest method. Due to all loans and
receivables being receivable within significantly less than 12 months at the balance
sheet date the Clinical Commissioning Group has no loans and receivables where
the impact of the time value of money is material: all loans and receivables are
therefore recognised at their original transaction value.
At the end of the reporting period, the Clinical Commissioning Group assesses
whether any financial assets, other than those held at „fair value through profit and
loss‟ are impaired. Financial assets are impaired and impairment losses recognised
if there is objective evidence of impairment as a result of one or more events which
occurred after the initial recognition of the asset and which has an impact on the
estimated future cash flows of the asset.
If, in a subsequent period, the amount of the impairment loss decreases and the
decrease can be related objectively to an event occurring after the impairment was
recognised, the previously recognised impairment loss is reversed through
expenditure to the extent that the carrying amount of the receivable at the date of the
impairment is reversed does not exceed what the amortised cost would have been
had the impairment not been recognised.
1.20
Financial Liabilities
Financial liabilities are recognised on the statement of financial position when the
Clinical Commissioning Group becomes party to the contractual provisions of the
financial instrument or, in the case of trade payables, when the goods or services
have been received. Financial liabilities are de-recognised when the liability has
been discharged, that is, the liability has been paid or has expired.
Loans from the Department of Health are recognised at historical cost. Otherwise,
financial liabilities are initially recognised at fair value.
Financial liabilities are classified into the following categories:
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
Financial Guarantee Contract Liabilities;

Financial Liabilities at Fair Value Through Profit & Loss;

Other Financial Liabilities.
At the balance sheet date the Clinical Commissioning Group holds only other
financial liabilities. It has no plans to hold financial liabilities other than other financial
liabilities in the foreseeable future.
1.20.1 Other Financial Liabilities
After initial recognition, all other financial liabilities are measured at amortised cost
using the effective interest method, except for loans from Department of Health,
which are carried at historic cost. The effective interest rate is the rate that exactly
discounts estimated future cash payments through the life of the asset, to the net
carrying amount of the financial liability. Interest is recognised using the effective
interest method. Due to all other financial liabilities being payable within significantly
less than 12 months at the balance sheet date the Clinical Commissioning Group
has other financial liabilities where the impact of the time value of money is material:
all other financial liabilities are therefore recognised at their original transaction
value
1.21
Value Added Tax
Most of the activities of the Clinical Commissioning Group are outside the scope of
VAT and, in general, output tax does not apply and input tax on purchases is not
recoverable. Irrecoverable VAT is charged to the relevant expenditure category or
included in the capitalised purchase cost of fixed assets. Where output tax is
charged or input VAT is recoverable, the amounts are stated net of VAT.
1.22
Foreign Currencies
The Clinical Commissioning Group‟s functional currency and presentational currency
is sterling. Transactions denominated in a foreign currency are translated into
sterling at the exchange rate ruling on the dates of the transactions. At the end of the
reporting period, monetary items denominated in foreign currencies are retranslated
at the spot exchange rate on 31 March. Resulting exchange gains and losses for
either of these are recognised in the Clinical Commissioning Group‟s surplus/deficit
in the period in which they arise.
1.23
Third Party Assets
Assets belonging to third parties (such as money held on behalf of patients) are not
recognised in the accounts since the Clinical Commissioning Group has no
beneficial interest in them.
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1.24
Losses & Special Payments
Losses and special payments are items that Parliament would not have
contemplated when it agreed funds for the health service or passed legislation. By
their nature they are items that ideally should not arise. They are therefore subject to
special control procedures compared with the generality of payments. They are
divided into different categories, which govern the way that individual cases are
handled.
Losses and special payments are charged to the relevant functional headings in
expenditure on an accruals basis, including losses which would have been made
good through insurance cover had the Clinical Commissioning Group not been
bearing its own risks (with insurance premiums then being included as normal
revenue expenditure).
1.25
Joint Operations
Joint operations are activities undertaken by the Clinical Commissioning Group in
conjunction with one or more other parties but which are not performed through a
separate entity. The Clinical Commissioning Group records its share of the income
and expenditure; gains and losses; assets and liabilities; and cash flows.
1.26
Research & Development
Research and development expenditure is charged in the year in which it is incurred,
except insofar as development expenditure relates to a clearly defined project and
the benefits of it can reasonably be regarded as assured. Expenditure so deferred is
limited to the value of future benefits expected and is amortised through the
Statement of Comprehensive Net Expenditure on a systematic basis over the period
expected to benefit from the project. It should be re-valued on the basis of current
cost. The amortisation is calculated on the same basis as depreciation.
1.27
Accounting Standards that have been Issued but have not yet been
Adopted
The Government Financial Reporting Manual does not require the following
Standards and Interpretations to be applied in 2014/15, all of which are subject to
consultation:

IFRS 9: Financial Instruments;

IFRS 13: Fair Value Measurement;

IFRS 14: Regulatory Deferral Accounts; and

IFRS 15 Revenue for Contract with Customers.
The application of the Standards as revised would not have a material impact on the
accounts for 2014/15, were they applied in that year.
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2.
Other Operating Revenue
Recoveries in respect
of employee benefits
Education, training
and research
Charitable and other
contributions to
revenue expenditure:
non-NHS
Non-patient care
services to other
bodies
2014/15
2013/14
£‟000
£‟000
0
0
45
15
19
16
2,981
731
0
0
384
251
3,429
1,013
Income generation
Other revenue
Total
3.
Revenue
Revenue is totally from the supply of services. The Clinical Commissioning Group
receives no revenue from the sale of goods.
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119
4.
Employee Benefits & Staff Numbers
4.1
Employee benefits
4.1.1 Employee benefits expenditure
2014/15
Permanent Employees
Other
Total
£‟000
£‟000
£‟000
3,010
2,310
5,320
Social security costs
275
0
275
Employer contributions to the NHS Pension
Scheme
390
0
390
Other employment benefits
0
0
0
Termination benefits
0
0
0
3,675
2,310
5,985
Permanent Employees
Other
Total
£‟000
£‟000
£‟000
1,928
1,302
3,230
Social security costs
170
0
170
Employer contributions to the NHS Pension
Scheme
235
0
235
Other employment benefits
0
0
0
Termination benefits
0
0
0
2,333
1,302
3,635
Clinical Commissioning Group
Salaries and wages
Gross Clinical Commissioning Group
employee benefits expenditure
2013/14
Clinical Commissioning Group
Salaries and wages
Gross Clinical Commissioning Group
employee benefits expenditure
There have been no recoveries in respect of employee benefits during the year
(2013/14 £nil).
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4.2
Average number of people employed
2014/15
2013/14
Permanent Employees
Other
Total
Total
Number
Number
Number
Number
Administration and estates
57
16
73
48
Total Clinical Commissioning
Group
57
16
73
48
4.3
Staff sickness absence and ill health retirements
2014/15
2013/14
Number
Number
573
63
Total staff years
50
33
Average working days
lost
11
2
Total days lost
These values are calendar years. As the Clinical Commissioning Group was licensed
to operate from 1 April 2013 the 2013/14 disclosure only relates to the final nine
months of the year.
Number of persons retiring on ill health
grounds
2014/15
2013/14
Number
Number
0
0
There were no Ill-health retirements; costs are met by the NHS Pension Scheme,
during the year.
Total additional pensions liability accrued in the year
2014/15
2013/14
£‟000
£‟000
0
0
Where the Clinical Commissioning Group has agreed early retirements, the
additional costs are met by the Clinical Commissioning Group and not by the NHS
Pension Scheme. There were no agreed early retirements during the year.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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4.4
Exit packages and severance payments agreed in the financial year
Exit package cost band (including
any special payment element)
Compulsory Redundancies
Other Agreed Departures
Total
Departures where Special
Payments have been made
Number
£‟000
Number
£‟000
Number
£‟000
Number
£‟000
Less than £10,000
0
0
0
0
0
0
0
0
£10,001 to £25,000
0
0
0
0
0
0
0
0
£25,001 to £50,000
0
0
0
0
0
0
0
0
£50,001 to £100,000
0
0
0
0
0
0
0
0
£100,001 to £150,000
0
0
0
0
0
0
0
0
£150,001 to £200,000
0
0
0
0
0
0
0
0
Over £200,001
0
0
0
0
0
0
0
0
Total
0
0
0
0
0
0
0
0
Voluntary redundancies including early retirement contractual
costs
0
0
Mutually agreed resignations (MARS) contractual costs
0
0
Early retirements in the efficiency of the service contractual costs
0
0
Contractual payments in lieu of notice
0
0
Exit payments following employment tribunals or court orders
0
0
Non-contractual payments requiring HM Treasury approval
0
0
Total
0
0
Analysis of Other Agreed Departures
There were no exit or severance payments agreed during 2013/14.
NHS NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
122
These tables report the number and value of exit packages agreed in the financial year.
Exit costs are accounted for in accordance with relevant accounting standards and at the latest
in full in the year of departure.
Where the Clinical Commissioning Group has agreed early retirements, the additional costs
are met by the Clinical Commissioning Group and not by the NHS Pension Scheme, and are
included in the tables. Ill-health retirement costs are met by the NHS Pension Scheme and are
not included in the tables.
4.5
Pension costs
4.5.1 Pension costs
Past and present employees are covered by the provisions of the NHS Pensions Scheme.
Details of the benefits payable under these provisions can be found on the NHS Pensions
website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme
that covers NHS employers, GP practices and other bodies, allowed under the direction of the
Secretary of State, in England and Wales. The scheme is not designed to be run in a way that
would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.
Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to
the NHS Body of participating in the scheme is taken as equal to the contributions payable to
the scheme for the accounting period.
In order that the defined benefit obligations recognised in the financial statements do not differ
materially from those that would be determined at the reporting date by a formal actuarial
valuation, the FReM requires that “the period between formal valuations shall be four years,
with approximate assessments in intervening years”. An outline of these follows:
4.5.2 Accounting valuation
A valuation of the scheme liability is carried out annually by the scheme actuary as at the end
of the reporting period. This utilises an actuarial assessment for the previous accounting period
in conjunction with updated membership and financial data for the current reporting period, and
are accepted as providing suitably robust figures for financial reporting purposes. The valuation
of the scheme liability as at 31 March 2015, is based on valuation data as 31 March 2014,
updated to 31 March 2015 with summary global member and accounting data. In undertaking
this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM
interpretations, and the discount rate prescribed by HM Treasury have also been used.
The latest assessment of the liabilities of the scheme is contained in the scheme actuary
report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension
Accounts, published annually. These accounts can be viewed on the NHS Pensions website.
Copies can also be obtained from The Stationery Office.
4.5.3 Full actuarial (funding) valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due
under the scheme (taking into account its recent demographic experience), and to recommend
the contribution rates.
The last published actuarial valuation undertaken for the NHS Pension Scheme was completed
for the year ending 31 March 2004. Consequently, a formal actuarial valuation would have
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
123
been due for the year ending 31 March 2008. However, formal actuarial valuations for
unfunded public service schemes were suspended by HM Treasury on value for money
grounds while consideration is given to recent changes to public service pensions, and while
future scheme terms are developed as part of the reforms to public service pension provision
due in 2015.
The Scheme Regulations were changed to allow contribution rates to be set by the Secretary
of State for Health, with the consent of HM Treasury, and consideration of the advice of the
Scheme Actuary and appropriate employee and employer representatives as deemed
appropriate.
The next formal valuation to be used for funding purposes will be carried out as at March 2012
and will be used to inform the contribution rates to be used from 1 April 2015.
4.5.4 Scheme provisions
The NHS Pension Scheme provided defined benefits, which are summarised below. This list is
an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme
or the specific conditions that must be met before these benefits can be obtained:
The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the
1995 section and of the best of the last three years pensionable pay for each year of service,
and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are
practitioners as defined by the Scheme Regulations have their annual pensions based upon
total pensionable earnings over the relevant pensionable service.
With effect from 1 April 2008 members can choose to give up some of their annual pension for
an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This
new provision is known as “pension commutation”.
Annual increases are applied to pension payments at rates defined by the Pensions (Increase)
Act 1971, and are based on changes in retail prices in the twelve months ending 30 September
in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) has been used
and replaced the Retail Prices Index (RPI).
Early payment of a pension, with enhancement, is available to members of the scheme who
are permanently incapable of fulfilling their duties effectively through illness or infirmity. A death
gratuity of twice final year‟s pensionable pay for death in service, and five times their annual
pension for death after retirement is payable.
For early retirements other than those due to ill health the additional pension liabilities are not
funded by the scheme. The full amount of the liability for the additional costs is charged to the
employer.
Members can purchase additional service in the NHS Scheme and contribute to money
purchase AVC‟s run by the Scheme‟s approved providers or by other Free Standing Additional
Voluntary Contributions (FSAVC) providers.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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5.
Operating Expenses
2014/15
2013/14
£‟000
£‟000
5,159
2,843
826
792
5,985
3,635
4,469
4,310
252,244
237,583
10,299
13,688
0
0
78,038
79,697
147
139
Supplies and services – clinical
55
61
Supplies and services – general
841
445
1,356
711
462
1,264
Transport
1
0
Premises
1,425
1,372
Impairments and reversals of receivables
202
0
Audit fees
105
115
Other auditor‟s remuneration
0
0
Internal audit services provided by external audit
0
0
General dental services and personal dental services
0
0
44,161
44,515
0
0
17
17
2,323
2,162
754
365
2,857
2,407
Clinical negligence
0
0
Research and development (excluding staff costs)
0
0
Education and training
160
58
Provisions
(61)
362
CHC Risk Pool Contributions
575
0
Total other costs
400,430
389,271
Total operating expenses
406,415
392,906
Gross Employee Benefits
Employee benefits excluding governing body members
Executive governing body members
Total gross employee benefits
Other Costs
Services from other Clinical Commissioning Groups and NHS England
Services from Foundation Trusts
Services from other NHS trusts
Services from other NHS bodies
Purchase of healthcare from non-NHS bodies
Chair and Lay Membership Body and Governing Body Members
Consultancy services
Establishment
Prescribing costs
Pharmaceutical costs
General ophthalmic costs
GPMS/APMS and PCTMA
Other professional fees (excluding audit)
Grants to other public bodies
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
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6.
Better Payment Practice Code
6.1
Measure of compliance
2014/15
2013/14
Number
£‟000
Number
£‟000
Total Non-NHS trade invoices paid in the year
4,538
121,242
2,904
74,873
Total Non-NHS trade invoices paid within target
3,166
115,509
2,050
69,977
69.77%
95.27%
70.59%
93.46%
Total NHS trade invoices paid in the year
3,094
298,010
1,806
315,593
Total NHS trade invoices paid within target
1,960
267,206
1,090
267,436
63.35%
89.66%
60.35%
84.74%
Non-NHS Payables: Clinical Commissioning Group
Percentage of non-NHS trade invoices paid within target
NHS Payables: Clinical Commissioning Group
Percentage of NHS trade invoices paid within target
The Better Payment Practice Code requires the Clinical Commissioning Group to aim to pay all
valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.
6.2
The late payment of commercial debts (interest) act 1998
2014/15
2013/14
£‟000
£‟000
Amounts included in finance costs from claims made under this legislation
0
0
Compensation paid to cover debt recovery costs under this legislation
0
0
Total
0
0
7.
Other Gains & Losses
The Clinical Commissioning Group has no Other Gains and losses for the year to 31 March
2015 (2013/14 nil).
8.
Operating Leases
8.1
As lessee
The Clinical Commissioning Group occupies space at Weybridge Hospital which acts as the
Clinical Commissioning Group‟s Headquarters and registered office. Weybridge Hospital is
owned by NHS Property Services. The Clinical Commissioning Group is charged for
occupation of Weybridge Hospital and other properties in North West Surrey that are not
occupied by another body. The total charge received from NHS Property Services for 2014/15
was £1,306k (2013/14 £1,306k).
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
126
8.1.1 Payments recognised as an expense
2013/14
2014/15
Land
Buildings
Other
Total
Total
£‟000
£‟000
£‟000
£‟000
£‟000
Minimum lease payments
0
1,373
7
1,380
1,330
Total Clinical Commissioning Group
0
1,373
7
1,380
1,330
8.1.2 Future minimum lease payments
The Clinical Commissioning Group does not have a formal lease for the occupation of
Weybridge Hospital but it is occupied under an arrangement with the characteristics of a lease
under IFRIC 4, a value of £56,344 is payable to NHS Property Services.
2014/15
2013/14
Land
Buildings
Other
Total
Total
£‟000
£‟000
£‟000
£‟000
£‟000
Not later than one year
0
0
0
0
0
Between one and five years
0
0
0
0
0
After five years
0
0
0
0
0
Total Clinical Commissioning Group
0
0
0
0
0
Clinical Commissioning Group
Payable:
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
127
9.
Property, plant, and equipment and intangible fixed assets
9.1
Property plant and equipment
Land
Buildings
Furniture &
Fittings
Total
£‟000
£‟000
£‟000
£‟000
Cost or Valuation at 1 April 2014:
0
0
0
0
Additions Purchased
0
0
315
315
Cost/Valuation at 31 March 2015
0
0
315
315
Depreciation 1 April 2014:
0
0
0
0
Charged during the year
0
0
0
0
Depreciation at 31 March 2015
0
0
0
0
Net Book Value 31 March 2015
0
0
315
315
Owned
0
0
315
315
Total Clinical Commissioning Group
0
0
315
315
Clinical Commissioning Group
Asset financing:
9.2
Economic Lives
Minimum Maximum
Life (years) Life (years)
Plant and machinery
5
5
Transport equipment
5
5
Information technology
3
3
Furniture and fittings
5
5
In 2013/14 the Clinical Commissioning Group had no property, plant and equipment.
The Clinical Commissioning Group has no intangible fixed assets at the balance sheet date
and has no plans in the foreseeable future to purchase such assets.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
128
10.
Trade & Other Receivables
Current
Non-current
Current Non-current
2014/15
2014/15
2013/14
2013/14
£‟000
£‟000
£‟000
£‟000
1,972
0
1,659
0
85
0
391
0
3,064
0
3,743
0
66
0
51
0
(202)
0
0
0
8
0
7
0
67
0
21
0
Total Clinical Commissioning Group
5,060
0
5,872
0
Total Clinical Commissioning Group
Current and Non-current
5,060
Clinical Commissioning Group
NHS receivables: Revenue
NHS prepayments and accrued income
Non-NHS receivables: Revenue
Non-NHS prepayments and accrued income
Provision for the impairment of receivables
VAT
Other receivables
5,872
There are no pre-paid pension contributions included within other receivables.
The great majority of trade is with NHS England. As NHS England is funded by
Government to provide funding to Clinical Commissioning Groups to commission
services, no credit scoring of them is considered necessary.
11.
Receivables past their due date but not impaired
2014/15
2013/14
£‟000
£‟000
By up to three months
1,807
1,811
By three to six months
20
1,706
By more than six months
74
0
1,901
3,517
Total
The Clinical Commissioning Group did not hold any collateral against receivables outstanding
at 31 March 2015.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
129
11.1
Provision for impairment of receivables
2014/15
£‟000
Balance at 1 April 2014
0
Amounts written off during the year
0
Amounts recovered during the year
0
(Increase) decrease in receivables impaired
(202)
Transfer (to) from other public sector body
0
Balance at 31 March 2015
12.
(202)
Other Financial Assets
The Clinical Commissioning Group had no other financial assets as at 31 March 2015
(2013/14 £nil).
13.
Other Current Assets
The Clinical Commissioning Group had no other current assets as at 31 March 2015
(2013/14 £nil).
14.
Cash & Cash Equivalents
2014/15
2013/14
£‟000
£‟000
Balance at 1 April
15
0
Net change in year
(301)
15
Balance at 31 March
(286)
15
Cash with the Government Banking Service
0
15
Cash with Commercial banks
0
0
Cash in hand
0
0
Current investments
0
0
Cash and cash equivalents as in Statement of Financial Position
0
15
(286)
0
0
0
(286)
15
0
0
Made up of:
Bank overdraft: Government Banking Service
Bank overdraft: Commercial banks
Balance at 31 March
Patients‟ money held by the Clinical Commissioning Group, not
included above
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
130
15.
Non-current Assets Held for Sale
The Clinical Commissioning Group had no non-current assets held for sale as at 31 March
2015 (2013/14 £nil).
16.
Analysis of Impairments & Reversals
The Clinical Commissioning Group had no impairments or reversals of impairments recognised
in expenditure during 2014/15 (2013/14 £nil).
17.
Trade & Other Payables
2014/15
2013/14
Noncurrent
Current
Current
Noncurrent
£‟000
£‟000
£‟000
£‟000
NHS payables: Revenue
3,860
0
4,991
0
NHS accruals and deferred income
4,539
0
3,996
0
Non-NHS payables: Revenue
3,377
0
3,163
0
261
0
0
0
19,113
0
17,745
0
Social security costs
45
0
46
0
Tax
51
0
54
0
124
0
3
0
Total Clinical Commissioning Group
31,370
0
29,998
0
Total Clinical Commissioning Group Current and Noncurrent
31,370
Clinical Commissioning Group
Non-NHS payables: Capital
Non-NHS accruals and deferred income
Other payables
29,998
Included above are liabilities of £0 due in future years under arrangements to buy out the
liability for early retirement.
Included within Non-NHS accruals and deferred income is £7,498k of accruals relating to drugs
issued to the Clinical Commissioning Group‟s population but for which we have yet to be
charged by NHS Prescription Services (2013/14 £7,400k).
18.
Other Financial Liabilities
The Clinical Commissioning Group had no other financial liabilities as at 31 March 2015
(2013/14 £nil).
19.
Other Liabilities
The Clinical Commissioning Group had no other liabilities as at 31 March 2015 (2013/14 £nil).
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
131
20.
Borrowings
2014/15
2013/14
Noncurrent
Current
Current
Noncurrent
£‟000
£‟000
£‟000
£‟000
Bank overdrafts:
Government banking service
286
0
0
0
Total borrowings
286
0
0
0
Total Clinical Commissioning Group Current and Noncurrent
286
Clinical Commissioning Group
21.
0
Private Finance Initiative, LIFT & Other Service Concession Arrangements
The Clinical Commissioning Group had no private finance initiative, LIFT or other service
concession arrangements that were included or excluded from the Statement of Financial
Position as at 31 March 2015 (2013/14 £nil).
22.
Finance Lease Obligations
The Clinical Commissioning Group had no finance lease obligations as at 31 March 2015
(2013/14 £nil).
23.
Finance Lease Receivables
The Clinical Commissioning Group had no finance lease receivables as at 31 March 2015
(2013/14 £nil).
23.1
Finance leases as lessor
The Clinical Commissioning Group had no unguaranteed residual value accruing as at 31
March 2015 (2013/14 £nil).
The Clinical Commissioning Group had no accumulated allowance for non-collectable lease
receivables as at 31 March 2015 (2013/14 £nil).
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
132
24.
Provisions
2014/15
2014/15
2013/14
Current Non-current
2013/14
Current Non-current
£‟000
£‟000
£‟000
£‟000
0
0
158
0
Continuing care
168
109
131
73
Total Clinical Commissioning Group
168
109
289
73
Total Clinical Commissioning Group Current and Noncurrent
277
Clinical Commissioning Group
Restructuring
362
Legal claims are calculated from the number of claims currently lodged with the NHS Litigation
Authority and the probabilities provided by them.
£0 is included in the provisions of the NHS Litigation Authority as at 31 March 2015 in respect
of clinical negligence liabilities of the Clinical Commissioning Group.
Restructuring
Continuing
Care
Total
£‟000
£‟000
£‟000
158
204
362
Arising during the year
0
97
97
Utilised during the year
0
(24)
(24)
(158)
0
(158)
0
277
277
Clinical Commissioning Group Balance at 1 April 2014
Reversed unused
Clinical Commissioning Group Balance at 31 March 2015
Expected timing of cash flows:
Within one year
0
168
168
Between one and five years
0
109
109
After five years
0
0
0
The provision relates to a provision for the reimbursement of continuing healthcare costs to
patients or their families where, upon review, these costs should have been borne by the NHS
and not the patients or their families. This provision only relates to cases which for which the
required social and healthcare package started after 1 April 2013. For details of cases before
this date please see the disclosure in Note 25, Contingent Liabilities.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
133
25.
Contingencies
Continuing Healthcare: liabilities incurred prior to 1 April 2013.
Nursing home care provided to the Clinical Commissioning Group‟s elderly population can be a
combination of social care, paid for by the individual‟s Council, healthcare, provided by the
Clinical Commissioning Group, and living costs, which are either borne by the individual or by
their Council. The split between these three elements, or whether they exist, is decided by a
panel of health and social care experts. The criteria by which the split is decided has changed
over time. This means that where amounts paid by individuals in the past should have been
paid by the Clinical Commissioning Group„s predecessor bodies: the patient or their
beneficiaries are entitled to have these costs reimbursed.
The legal transfer order of NHS Surrey Primary Care Trust‟s assets, liabilities, and transactions
(including contingencies) has transferred the cost of these reimbursements to the Clinical
Commissioning Group but under the Accounts Direction issued by NHS England on 12
February 2014, NHS England is responsible for accounting for liabilities relating to NHS
Continuing Healthcare claims relating to periods of care before establishment of the Clinical
Commissioning Group.
We do not know the value of the reimbursements being recognised by NHS England or if in
future they will become the liability of the Clinical Commissioning Group.
26.
Commitments
26.1
Capital commitments
The Clinical Commissioning Group had no contracted capital commitments not otherwise
included in these financial statements as at 31 March 2015 (2013/14 £nil).
26.2
Other financial commitments
The Clinical Commissioning Group had no non-cancellable contracts as at 31 March 2015
(21013/14 £nil).
27.
Financial Instruments
27.1
Financial risk management
International Financial Reporting Standard 7: Financial Instrument: Disclosure requires
disclosure of the role that financial instruments have had during the period in creating or
changing the risks a body faces in undertaking its activities.
Because the Clinical Commissioning Group is financed through parliamentary funding, it is not
exposed to the degree of financial risk faced by business entities. Also, financial instruments
play a much more limited role in creating or changing risk than would be typical of listed
companies, to which the financial reporting standards mainly apply. The Clinical
Commissioning Group has limited powers to borrow or invest surplus funds and financial
assets and liabilities are generated by day-to-day operational activities rather than being held
to change the risks facing the Clinical Commissioning Group in undertaking its activities.
Treasury management operations are carried out by the finance department, within parameters
defined formally within the Clinical Commissioning Group‟s Prime Financial Policies and
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
134
policies agreed by the Governing Body. Treasury activity is subject to review by the Clinical
Commissioning Group‟s internal auditors.
27.1.1 Currency risk
The Clinical Commissioning Group is principally a domestic organisation with all transactions,
assets and liabilities being in the UK and sterling based. The Clinical Commissioning Group
has no overseas operations. The Clinical Commissioning Group therefore has low exposure to
currency rate fluctuations.
27.1.2 Interest rate risk
The Clinical Commissioning Group has no loans and therefore has low exposure to interest
rate fluctuations.
27.1.3 Credit risk
Because the majority of the Clinical Commissioning Group‟s revenue comes from
parliamentary funding, the Clinical Commissioning Group has low exposure to credit risk. The
maximum exposures as at the end of the financial year are in receivables from customers, as
disclosed in the trade and other receivables note.
27.1.4 Liquidity risk
The Clinical Commissioning Group is required to operate within revenue and capital resource
limits agreed with NHS England, which are financed from resources voted annually by
Parliament.
The Clinical Commissioning Group draws down cash to cover expenditure, from NHS England,
as the need arises, unrelated to its performance against resource limits. The Clinical
Commissioning Group is not, therefore, exposed to significant liquidity risks.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
135
27.2
Financial assets
2014/15
At „fair value
through
profit and Loans and Available
loss‟ Receivables for Sale
Total
£‟000
£‟000
£‟000
£‟000
NHS
0
1,972
0
1,972
Non-NHS
0
3,064
Cash at bank and in hand
0
0
0
0
Other financial assets
0
66
0
66
Total Clinical Commissioning Group at 31 March
2015
0
5,102
0
5,102
At „fair value
through
profit and Loans and Available
loss‟ Receivables for Sale
Total
Clinical Commissioning Group
Receivables:
3,064
All assets are held at fair value and are receivable within one year.
2013/14
£‟000
£‟000
£‟000
£‟000
NHS
0
1,659
0
1,659
Non-NHS
0
3,743
Cash at bank and in hand
0
15
0
15
Other financial assets
0
22
0
22
Total Clinical Commissioning Group at 31 March
2014
0
5,439
0
5,439
Clinical Commissioning Group
Receivables:
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
3,743
136
27.3
Financial liabilities
At „fair value
through
profit and
loss‟
Other
Total
£‟000
£‟000
£‟000
NHS
0
8,399
8,399
Non-NHS
0
22,875
22,875
Private finance initiative, LIFT and finance lease obligations
0
0
0
Other borrowings
0
286
286
Other financial liabilities
0
0
0
Total Clinical Commissioning Group at 31 March 2015
0
31,560
31,560
At „fair value
through
profit and
loss‟
Other
Total
£‟000
£‟000
£‟000
NHS
0
8,988
8,988
Non-NHS
0
20,908
20,908
Private finance initiative, LIFT and finance lease obligations
0
0
0
Other borrowings
0
0
0
Other financial liabilities
0
0
0
Total Clinical Commissioning Group at 31 March 2014
0
29,896
29,896
2014/15
Clinical Commissioning Group
Payables:
All liabilities are held at fair value and are payable within one year.
2013/14
Clinical Commissioning Group
Payables:
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
137
28.
Operating Segments
Gross
expenditure
Income
Net
expenditure
£‟000
£‟000
£‟000
£‟000
£‟000
£‟000
242,116
(649)
241,467
846
(9,277)
(8,431)
Mental Health
33,486
(21)
33,465
19
(782)
(763)
Community Services
36,851
0
36,851
1,946
(3,738)
(1,792)
Continuing Healthcare
25,440
0
25,440
0
(1,070)
(1,070)
Prescribing & Primary Care
52,728
(119)
52,609
123
(9,402)
(9,279)
Running Costs
8,080
(806)
7,274
446
(1,854)
(1,408)
Other Contracting & Reserves
7,714
(1,834)
5,880
1,995
(5,810)
(3,815)
406,415
(3,429)
402,986
5,375
(31,933)
(26,558)
Total assets Total liabilities
Net assets
Clinical Commissioning Group
General & Acute Commissioning
Total Clinical Commissioning Group
These segments have been determined by the information presented to Clinical Commissioning Group‟s chief decision making body so that it
can assess the financial performance of the Group. The Clinical Commissioning Group‟s chief decision making body is the Governing Body.
The Governing Body is the chief decision making body as it is responsible for decisions concerning the allocation of the Group‟s resources
and how these are used to address the Clinical Commissioning Group‟s objectives.
With the exception of inter-group transactions there are no transactions with a single external customer or supplier amount that exceed 10%
of the total disclosed above. As all material transactions are within Surrey and nearby counties and such information is not presented to the
Governing Body no geographical segments are presented.
28.1
Reconciliation to the final month 12 position reported to chief decision making body
The Clinical Commissioning Group‟s management reported to the Governing Body, the chief decision making body, an aggregate surplus of
£4,974k which was the final position disclosed above (2013/14 £1,992k).
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
138
29.
Pooled Budgets
The Clinical Commissioning Group is a party to two pooled budgets, Community
Equipment and Child and Adolescent Mental Health Services.
The six Surrey Clinical Commissioning Groups– as set our below - collectively purchase
Community Equipment from a pooled budget under Section 75 of the National Health
Service Act 2006 jointly run by three Surrey Community providers (Virgin Community
Healthcare, First Community Healthcare, and Central Surrey Health, who operate on
behalf of the Clinical Commissioning Groups) and Surrey County Council. The legal
parties to the pooled budget are NHS North West Surrey Clinical Commissioning Group
(who inherited the contract from its predecessor body NHS Surrey Primary Care Trust)
and Surrey County Council but all Surrey Clinical Commissioning Groups make their
payments into the pooled budget. We have therefore recognised in these financial
statements only North West Surrey CCG‟s expenditure to the pooled budget.
The six Surrey Clinical Commissioning Groups are:

NHS North West Surrey Clinical Commissioning Group;

NHS East Surrey Clinical Commissioning Group;

NHS North East Hampshire and Farnham Clinical Commissioning Group;

NHS Guildford and Waverley Clinical Commissioning Group;

NHS Surrey Downs Clinical Commissioning Group; and

NHS Surrey Heath Clinical Commissioning Group.
The Child and Adolescent Mental Health Services Pooled Budget is hosted on behalf of
the Surrey Clinical Commissioning Groups by NHS Guildford and Waverley Clinical
Commissioning Group. The legal parties to the pooled budget are NHS Guildford and
Waverley Clinical Commissioning Group (who inherited the contract from its
predecessor body NHS Surrey Primary Care Trust) and Surrey County Council. We
have recognised in these financial statements only NHS North West Surrey‟s
expenditure to the pooled budget.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
139
30.
Intra-Government & Other Balances
2014/15
Current
Receivables
Non-current
Current Non-current
Receivables Payables
Payables
£‟000
£‟000
£‟000
£‟000
1
0
971
0
Local Authorities
2,371
0
111
0
NHS bodies outside the Departmental Group
1,641
0
2,176
0
417
0
6,223
0
0
0
0
0
630
0
21,889
0
5,060
0
31,370
0
Clinical Commissioning Group
Balances with:
Other Central Government bodies
NHS Trusts and Foundation Trusts
Public Corporations and Trading Funds
Bodies external to Government
Total Clinical Commissioning Group at 31
March 2015
2013/14
Current
Receivables
Non-current
Current Non-current
Receivables Payables
Payables
£‟000
£‟000
£‟000
£‟000
27
0
123
0
3,430
0
212
0
1,324
0
2,073
726
0
6,915
0
0
0
0
0
365
0
20,675
0
5,872
0
29,998
0
Clinical Commissioning Group
Balances with:
Other Central Government bodies
Local Authorities
NHS bodies outside the Departmental Group
NHS Trusts and Foundation Trusts
Public Corporations and Trading Funds
Bodies external to Government
Total Clinical Commissioning Group at 31
March 2014
31.
0
Related Party Transactions
The majority of the Clinical Commissioning Group‟s Governing Body are GPs who either
work or are partners at North West Surrey GP Partnerships. During the year the Clinical
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
140
Commissioning Group has undertaken a number of transactions with these
partnerships. All transactions are carried out at a fair value: for clinical work this value is
set by a nationally agreed tariff; for reimbursement of time spent at the Clinical
Commissioning Group this has been set at a value commensurate with the GPs clinical
earnings forgone.
Details of related party transactions with these GP Partnerships are as follows:
Receipts
Payments to from Related
Related Party
Party
Amounts
owed to Amounts due
Related from Related
Party
Party
£‟000
£‟000
£‟000
£‟000
69
0
0
0
Hillview Medical Centre
163
0
6
0
Heathcote Medical Centre
192
0
5
0
St David‟s Family Practice
177
0
6
0
99
0
0
0
126
0
1
0
Dr Lynch and Partners
96
0
0
0
Hersham Surgery
46
0
4
0
Bridge Practice
Stanwell Road Surgery
Sunbury Health Centre Group Practice
Amounts paid to these GP Partnerships includes both payment for work done for the
Clinical Commissioning Group – such as compensating payments made to the
Partnership of our Governing Body members – and clinical services provided.
Amounts payable and owed to these GP Partnerships are not secured and are subject
to normal commercial credit terms. There is no provision against amounts receivable
from these GP Partnerships and there has been no bad or doubtful debt expense
incurred during the year.
In addition to the GP arrangements, one member of the Governing Body also sits on the
audit committee of NHS Guildford and Waverley CCG. A further member acts as a
Public Governor for Ashford and St Peters NHS Foundation Trust.
The Department of Health is regarded as a related party and the parent department of
the Clinical Commissioning Group. During the year the Clinical Commissioning Group
has had a significant number of material transactions with entities for which the
Department is regarded as the parent Department. For example:

NHS England (including commissioning support units);

NHS Foundation Trusts;
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
141

NHS Trusts;

NHS Litigation Authority; and,

NHS Business Services Authority.
In addition, the Clinical Commissioning Group has had a number of material
transactions with other government departments and other central and local
government bodies. Most of these transactions have been with Surrey County Council.
32.
Events After the Reporting Period
There are no post balance sheet events which will have a material effect on the financial
statements of the Clinical Commissioning Group or consolidated group.
33.
Losses & Special Payments
2014/15
Total
Number of
Cases
2013/14 2013/14
2014/15
Total Total
Total Value Number Value
of Cases of Cases of Case
£‟000
£‟000
Clinical Commissioning Group
Administrative write-offs
2
202
0
0
Fruitless Payments
0
0
0
0
Store Losses
0
0
0
0
Book Keeping Losses
0
0
0
0
Constructive Loss
0
0
0
0
0
0
0
0
Claims Abandoned
0
0
0
0
Total Clinical Commissioning Group at 31 March
2
202
0
0
Cash Losses
The Clinical Commissioning Group had no special payments cases during 2014/15
(2013/14 £nil).
34.
Third Party Assets
The Clinical Commissioning Group held no third party assets as at 31 March 2014
(2013/14 £nil).
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
142
35.
Financial Performance Duties
Clinical Commissioning Groups have a number of financial duties under the National
Health Service Act 2006 (as amended).
The Clinical Commissioning Group‟s performance against those duties was as follows:
2014/15
National
Health
Service Act Duty
Section
MaximumPerformance
£‟000
£‟000
Duty
Achieved?
411,389
406,415
Yes
350
315
Yes
223H(1)
Expenditure not to exceed income
223I(2)
Capital resource use does not exceed the
amount specified in Directions
223I(3)
Revenue resource use does not exceed the
amount specified in Directions
407,960
402,986
223J(1)
Capital resource use on specified matter(s)
does not exceed the amount specified in
Directions
0
0
223J(2)
Revenue resource use on specified matter(s)
does not exceed the amount specified in
Directions
0
0
223J(3)
Revenue administration resource use does not
exceed the amount specified in Directions
9,154
7,273
Yes
Yes
Yes
Yes
2013/14
National
Health
Service Act Duty
Section
MaximumPerformance
£‟000
£‟000
Duty
Achieved?
394,898
392,906
Yes
n/a
n/a
n/a
223H(1)
Expenditure not to exceed income
223I(2)
Capital resource use does not exceed the
amount specified in Directions
223I(3)
Revenue resource use does not exceed the
amount specified in Directions
393,885
391,893
223J(1)
Capital resource use on specified matter(s)
does not exceed the amount specified in
Directions
n/a
n/a
223J(2)
Revenue resource use on specified matter(s)
does not exceed the amount specified in
Directions
0
0
223J(3)
Revenue administration resource use does not
8,530
8,294
Yes
n/a
Yes
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
Yes
143
2013/14
National
Health
Service Act Duty
Section
MaximumPerformance
£‟000
£‟000
Duty
Achieved?
exceed the amount specified in Directions
Note: For the purposes of 223H(1); expenditure is defined as the aggregate of gross
expenditure on revenue and capital in the financial year; and, income is defined as the
aggregate of the notified maximum revenue resource, notified capital resource and all
other amounts accounted as received in the financial year (whether under provisions of
the Act or from other sources, and included here on a gross basis).
The Clinical Commissioning Group was given a target by NHS England of resource
exceeding expenditure by £4,974k, this has been achieved.
The Clinical Commissioning Group‟s total income for the year (as disclosed in 223H(1))
is its notified maximum revenue resource of £407,960k ( 2013/14 £393,885k) and its
other income of £3,429k (2013/14 £1,013k). Other income is disclosed in Note 2 above.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
144
9. Remuneration Report
This report is made by the Group on the recommendation of the Remuneration and Nominations
Committee in accordance with Schedule 7a of the Companies Act 1985. The first part of the
report provides details of remuneration policy; the second part provides details of the
remuneration and pensions of our senior managers for the year ended 31st March 2015.
The report is in respect of the senior managers of the CCG, who are defined as ‘those persons
in senior positions having authority or responsibility for directing or controlling the major
activities of the NHS body’. This means those who influence the decisions of the entity as a
whole rather than the decisions of individual directorates or departments. The senior managers
of the CCG are the executive, clinical, and lay members of the Governing Body. In addition the
in-year appointment of the Director of Clinical Transformation, who is not a member of the
Governing Body, has been included.
Remuneration and Nominations Committee
The Remuneration Committee is made up of a Lay Member who will chair the Committee and
the other Lay and Independent Members. A quorum is two Lay Members. During the year the
members of the Committee and the Chair have been:




Mr William McKee (Chair);
Mr Michael Brooks;
Mrs Sally Bassett;
Dr Naila Kamal.
The Committee met on 29th August 2014 with all members in attendance with the exception of
Dr Naila Kamal. The proposal to create a new post of Director of Clinical Transformation was
agreed.
The Committee meets as necessary to advise the Board on the appropriate remuneration and
terms of service for the Chief Executive, Directors and other Very Senior Managers.
Remuneration Policy
The Committee‟s deliberations are carried out within the context of national pay and
remuneration guidelines, local comparability and taking account of independent advice
regarding pay structures.
The main components of the Chief Executive‟s, Executives‟ and senior officers‟ remuneration
are set out below.
Basic Salary
Directors and senior managers‟ with remuneration set by the Very Senior Managers Pay
Framework
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
145
The Chief Executive, Director of Finance, Director of Corporate Development and Assurance,
Director of Clinical Transformation and Deputy Chief Executive (until 31st August 2014)
remuneration is set by the Very Senior Managers Pay Framework.
The reward package set by the Very Senior Managers‟ Pay Framework is as follows:
1. Basic pay is a spot rate for the post, determined by the role and an organisation specific
weighing factor. This is uplifted annually;
2. Additional payments are made where such payments are appropriate and within the
limits described in the Frameworks; and
3. An annual performance bonus scheme under Incentive Arrangements. A performance
related pay award for excellent performance of up to 5% as one off, non-consolidated
payment can be paid the following year. As at 31st March 2015 entitlement to this
payment is yet to be determined.
Directors and senior managers with remuneration paid via an agency
During 2014/15 the positions of Director of Finance (1 April 2014 to 2nd May 2014) and Director
of Strategy and Commissioning (21st July 2014 to 18th March 2015) were held by interims.
Directors and senior managers with remuneration set by Agenda for Change, the national
pay and terms and conditions framework for the NHS.
As at 31 March 2015, with the exception of the Director of Quality and Innovation, all other
Directors remuneration is set by local pay arrangements and not through Agenda for Change.
The Agenda for Change Handbook and the Very Senior Managers Framework are available to
the general public on the Department of Health website.
NHS Pension Entitlement
All staff including senior managers are eligible to join the NHS Pensions Scheme. The Scheme
has fixed the employer‟s contribution at 14% (2013/14: 14%) of the individual‟s salary as per the
NHS Pension Agency Regulations. Employee contribution rates for Trust officers and practice
staff are as follows:
Tier
Annual Pensionable Pay (full time equivalent)
1
2
3
4
5
6
7
Up to £15,431.99
£15,432.00 to £21,387.99
£21,388.00 to £26,823.99
£26,824.00 to £49,472.99
£49,473.00 to £70,630.99
£70,631.00 to £111,376.99
£111,377.00 and over
Contribution
Rate
2014/15
5.0%
5.6%
7.1%
9.3%
12.5%
13.5%
14.5%
Scheme benefits are set by the NHS Pensions Agency and are applicable to all members
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
146
Service Contracts
Each of the Directors and Very Senior Managers listed below has or has had a substantive
contract. Each Director‟s contract became effective on the following dates:
Director
Role
Ms Julia Ross
Mr Andrew Demetriades
Mr Neil Ferrelly
Ms Joanne Alner
Mrs Henriette Coetzer
Chief Executive
Deputy Chief Executive
Director of Finance
Director of Quality and Innovation
Director of Clinical Transformation
Director of Corporate Development and
Assurance
Mrs Yvonne Parish
Contract
Date
01/04/2013
09/09/2013
30/04/2014
01/04/2013
20/10/2014
01/04/2013
Leave
Date
31/08/2014
-
None of the contracts for Directors or senior managers make any provision for compensation
outside of the national pay and remuneration guidelines or NHS Pension Scheme Regulations.
The following Directors worked on a rolling contract during the year with a notice period,
exercisable by either party, of one month:
Director
Role
Ms Alison Alsbury
Mr John Leslie
Director of Strategy and Commissioning
Director of Finance
Contract
Date
21/07/2014
01/04/2013
Leave
Date
18/03/2015
02/05/2014
Termination Arrangements
Termination arrangements are applied in accordance with statutory regulations as modified by
national NHS conditions of service agreements (specified in Whitley Council/Agenda for
Change), and the NHS pension scheme. Specific termination arrangements will vary according
to age, length of service and salary levels. The Remuneration Committee will agree any
severance arrangements. Her Majesty‟s Treasury approval will be sought where appropriate.
Pay Multiples
Reporting bodies are required to disclose the relationship between the remuneration of the
highest-paid director in their organisation and the median remuneration of the organisation‟s
workforce.
The banded remuneration of the highest paid member of the Governing Body in North West
Surrey Clinical Commissioning Group in the financial year 2014/15 was £130,000 to £135,000
(£125,000 to £130,000 2013/14). This was 3 times (3 times 2013/14) the median remuneration
of the workforce, which was £43,000 (£42,000 2013/14).
The Clinical Commissioning Group‟s highest paid member of the Governing Body was Julia
Ross, Chief Executive (£130,000 to £135,000).
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
147
In 2014/15, one employee (none in 2013/14) received remuneration in excess of the highestpaid member of the Governing Body. This was the Director of Clinical Transformation whose
remuneration was banded as £155,000 to £160,000. Remuneration ranged from £20,000 to
£25,000 (£0 to £5,000 2013/14) to £155,000 to £160,000 (£125,000 to £130,000 2013/14).
Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind,
but not severance payments. It does not include employer pension contributions and the cash
equivalent transfer value of pensions.
Clinical and Lay Members of the Governing Body
The Clinical Commissioning Group has three groups of Governing Body members who are not
Executive Directors of the Clinical Commissioning Group: GP leads who are elected by their
peer GPs in the Clinical Commissioning Group Council of Members; Lay Members, appointed
by the Clinical Commissioning Group Governing Body to bring commercial experience and skills
to Governing Body; and two other independent members who are also clinicians (a registered
nurse and a secondary care Doctor).
All of these members of the Governing Body have been appointed for a renewable period of
three years.
The remuneration of the GP locality leads has been set at a level evidently in line with the
individual„s current earnings as a clinician and commensurate with the average rate for their
current employment or the specific role. The remuneration of the two lay members has been
benchmarked and is in line with non-executive director payments in other NHS organisations.
The appointments became effective on the following dates:
Governing Body
Members
GP leads
Dr Elizabeth Lawn
Dr Jagit Rai
Dr Richard Barnett
Role
Contract
Date
Leave
date
1/4/2013
1/4/2013
1/4/2013
-
Dr Sundeep Soin
Dr Asha Pillai
Dr Diljit Bhatia
CCG Clinical Chair & Thames Medical Locality Lead
Chair of Clinical Executive & SASSE Locality Lead
Clinical Chief of Innovation & Quality & Thames Medical
Locality Lead
Clinical Chief of Contracts & Performance / Woking
Locality Lead
Clinical Chief of Leadership & Development / Woking
Locality Lead
Woking Locality Lead
Thames Medical Locality Lead
SASSE Locality Lead
Independent
members
Dr Naila Kamal
Mrs Sally Bassett
Independent Secondary Care Specialist Doctor
Independent Registered Nurse
Lay Members
Mr Michael Brooks
Mr William McKee
Lay Member Governance
Lay Member PPE
Dr Deborah Shiel
Dr Linda Roberts
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
1/4/2013
1/4/2013
1/4/2013
1/4/2013
1/4/2013
-
1/4/2013
22/7/2013
-
1/4/2013
1/4/2013
-
148
Profiles of the CCG‟s Governing Body Members
Clinical Members
Dr Elizabeth Lawn Clinical Commissioning Group Clinical Chair & Thames
Medical Locality Lead
Dr Elizabeth Lawn has been a practicing GP for thirty years, for the last 20 years in
Chertsey, Surrey. She has been involved in clinical leadership roles in commissioning
for the last thirteen years. She was a board member of Surrey Thames Primary Care
Group from 1999 to 2001 and was Chair of the PCG for the last year. She was
Professional Executive Committee (PEC) Chair for North Surrey PCT from 2002 to 2006
and then interim PEC Chair for Surrey PCT from 2006 to 2007.
Elizabeth took various lead roles in practice based commissioning in North West Surrey
from 2007, and was elected Clinical Chair of North West Surrey CCG. Elizabeth was a
GP trainer for thirteen years and her particular clinical interests are in long-term
conditions and care of older adults.
Dr Deborah Shiel Clinical Chief of Contracts & Performance / Woking Locality
Lead
Dr Deborah Shiel is a GP at the Hillview Medical Centre in Woking, Surrey. She
graduated from University College Galway in 1986 and has a clinical interest in
maternity, gynaecology, paediatrics, diabetes and general practitioner training.
Dr Linda Roberts Clinical Chief of Leadership & Development / Woking Locality
Lead
Dr Linda Roberts is a GP at the Heathcot Medical Practice in Woking, Surrey. She has
a clinical interest in women‟s health and mental health.
Dr Richard Barnett Clinical Chief of Innovation & Quality & Thames Medical
Locality Lead
Dr Richard Barnett has been a GP at Sunbury Health Centre Group Practice for 25
years. Before that he studied for a masters degree in public health at Hadassah
Hospital, Jerusalem, for while working in the research practice allied to the hospital‟s
department of social medicine. He has been involved in clinical commissioning from an
early stage.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
149
Dr Jagjit Rai Chair of Clinical Executive & SASSE Locality Lead
Jagjit Rai has been a partner at St David‟s Family Practice in Stanwell since 1998. He
has an interest in education and teaches medical students, foundation year doctors and
GP trainees as well as being a GP appraiser in the Surrey area. He previously worked
for both North Surrey and Hounslow PCT in clinical management roles. He recently
completed his Masters in medical Law.
Dr Diljit Bhatia SASSE Locality Lead
Dr Diljit Singh Bhatia qualified as a GP in 2010. Since then he has been a practising GP
at Stanwell Road Surgery in Ashford. From day one he took on the role of practice lead
within the SASSE locality, and has been a commissioning locality lead since early 2012.
Diljit is looking forward to being involved in working with patients, healthcare
professionals and in partnership with local communities and local authorities in
improving and designing new healthcare services within North West Surrey.
Dr Asha Pillai Thames Medical Locality Lead
Dr Asha Pillai completed her GP training in 2010 and started working as a GP Assistant
in Staines, Surrey. She then moved to her current practice in Hersham, Surrey, and
took on the role of GP Partner. Although she is a fairly young GP, she has been known
to take on various projects with enthusiasm. She became actively involved in practice
development and then took on role of practice lead in her locality and subsequently the
role of locality lead. Asha enjoys keeping up to date and has seven postgraduate
diplomas to her name, but her particular interest lies in dermatology and family
planning.
Dr Sundeep Soin Woking Locality Lead
Dr Sundeep Soin is a GP Partner at West Byfleet Health Centre. He has strong links to
the area, having completed his GP training in North West Surrey in 2005. He offers
extensive clinical and management experience and previously worked at Medical
Director level at East Riding of Yorkshire PCT. Dr Soin is an elected member of the
BMA's committee for medical managers and is now a GP appraisal lead with
responsibility for over 500 GPs in Surrey.
In addition to his GP work, Dr Soin has extensive experience of working in A&E and for
the out-of-hours service. Dr Soin has a keen interest in dermatology and is an
accredited Botulinum toxin and filler provider.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
150
Executive Director Members
Ms Julia Ross Chief Executive
Julia Ross has over 25 years‟ experience in the NHS, working at Board level for the last
17 years. A teacher by background, she started her NHS career in organisation and
workforce development at Strategic Health Authority level and also in the acute sector.
She helped set up one of the first NHS Trusts in England in the early 1990‟s. From there
Julia extended her expertise into large scale change management and service
improvement in many different areas of the health sector and in 2002 joined the NHS
Modernisation Agency to support the establishment of the first Primary Care Trusts in
the south east.
In 2006, Julia was appointed Director of Strategy and Communications for NHS West
Kent, where as an Executive Board Director she led strategic planning, service
reconfiguration, marketing, communications as well as engagement and organisational
development. After one year on secondment to NHS South of England to lead
commissioner development in Kent, Surrey and Sussex, Julia was appointed Chief
Officer Designate of NHS North West Surrey CCG in August 2012 and became
substantive Chief Executive on 1st April 2013.
Mr Neil Ferrelly Director of Finance
Neil was previously PCT Director of Finance in Harrow, West Sussex & Kingston and
has recently been the Joint Chief Finance Officer of Both Richmond CCG and Kingston
CCG. He has worked in NHS Finance for more than 35 years and has experience from
both Acute Trusts and NHS Commissioning roles.
Neil was appointed as Director of Finance on 30th April 2014.
Ms Joanne Alner Director of Quality and Innovation
Joanne Alner has worked for the NHS for the last twenty years, after beginning her
career at Lloyds bank. Joanne‟s first job in the health sector was in a nursing home for
elderly people with dementia, followed by a successful application to start her mental
health nursing career in an old Victorian asylum in Chichester. This was the start of her
NHS career. Since then she has worked clinically as a nurse and practice development
facilitator, focusing on leadership and acute mental health nursing. She joined the
Professional Standards directorate of a community and mental health trust in West
Sussex, and has led and/or studied many of the pillars of clinical governance in her
roles ever since.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
151
In 2005, Joanne was offered a place on the London Deanery Public Health Consultant
training programme, where she spent time working in a number of different healthcare
organisations. After qualifying in 2009, she worked as Consultant in Public Health in
Surrey and more recently in Berkshire. She joined as Director of Quality and Innovation
in December 2012.
Mrs Yvonne Parish Director of Corporate Development and Assurance
Yvonne Parish has eleven years of experience of strategic and high level management
in the public sector as well as over ten years‟ experience as a generalist management
consultant and project manager in the public and voluntary sector. This has included
designing and implementing service improvement programmes, conducting reviews
leading to recommendations for change, preparing business cases to confirm rationale
for new initiatives. She has also been involved with passing on skills, knowledge and
expertise to managers and employees.
Before joining the CCG Yvonne‟s work included designing and implementing a
performance management framework at a children‟s hospice, implementing a shared
service centre for a wide range of public and voluntary sector service providers,
introducing a borough-wide, collaborative customer care training programme and
conducting an organisational review of a voluntary agency, together with the preparation
and submission of its core funding application.
Yvonne was appointed Director of Corporate Development and Assurance on 1 st
February 2013.
Lay Members
Mr Michael Brooks Lay Member (Governance)
Michael Brooks is a qualified accountant who spent most of his professional career in
the international oil and gas industry, including twenty years with Royal Dutch Shell. He
has managed a variety of finance activities in the UK and overseas in both head office
and operational environments. From 2001 to 2004 he was Finance Director of Trinity
Energy, an independent UK-based oil and gas company established to develop a
number of oil and gas projects in Uzbekistan and Russia.
Since retiring from full-time employment, Michael has developed a portfolio of business
and other activities. He was a member of the Medical Research Council from 2005 to
2009, where he also chaired the Audit Committee and remains a director of MRC
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
152
Technology, its knowledge transfer arm. He has been is a Governor of the University of
Portsmouth since 2005 and is a Non-Executive Board Member and the chair of the
Audit Committee at the Driver and Vehicle Licensing Agency in Swansea.
Mr William McKee Lay Member (Patient and Public Involvement)
William McKee is Chairman of property company Tilfen Land and Chair of the Mayor of
London‟s Outer London Commission. He sits on the Higher Education Funding Council,
Architecture, Built Environment and Planning Sub-panel of the 2014 Research
Excellence Framework. Until 2011, he was Chairman of the Advisory Committee of
Surrey University School of Management and is now a member of the Faculty Advisory
Board of Southampton University Business School. From 1993 until 2002, William was
Director General of the British Property Federation and Chairman of the European
Property Federation from 1996 until 2002. From 1999 to 2002, he was Chairman of the
CBI Trade Association Council and a member of the CBI President‟s committee. He has
been a member of numerous Government review bodies.
William was Chief Executive of the London Borough of Merton from 1981 to 1992. For
ten years he was visiting lecturer in town planning and transport planning at Imperial
College London and between 2001 and 2004 visiting Fellow in Property at Reading
University. He has written widely in books, journals and newspapers and appeared on
television and radio.
William McKee received the CBE in the 2002 Queen‟s Birthday Honours List for
services to the property industry. He is a Governor and Trustee of the Rambert Dance
Company and was a Governor of Basildon & Thurrock University Hospital from 2008 to
2010.
Mrs Sally Bassett Independent Registered Nurse
Sally Bassett has been working with the professional services firm PwC since 2008.
Sally is a registered nurse with a clinical background in ITU and general medicine. Sally
has worked in the acute, community, and independent sectors and has worked at the
Department of Health as a Nurse Advisor, the former Modernisation Agency, the East of
England Strategic Health Authority as Deputy Chief Nurse and in a PCT as Director of
Nursing and Therapies. Sally has experience in using clinical information to drive
professional and service improvements and undertakes quality governance reviews and
investigations.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
153
Dr Naila Kamal Independent Secondary Care Specialist Doctor
Dr Kamal sits on the Governing Body of North West Surrey CCG and chairs the Quality
and Performance Committee. She has over 20 years of experience working within the
NHS. She brings an in-depth understanding of the workings within the secondary care
setting allowing her to assist the operational team in quality commissioning of services,
as well as the creation of innovative pathways to meet local and national objectives.
Dr Kamal has a strong academic background at undergraduate as well as postgraduate
level. Until recently, she led the London Deanery‟s Frontier Project as its Associate
Dean. Naila has been closely affiliated with work streams that have an underpinning
focus on patient safety and quality of care. She is currently an honorary lecturer and a
clinical tutor at Imperial College School of Medicine and Chair of the ASAS committee at
the Academy of Royal Colleges. Dr Kamal has a keen interest in promoting better
understanding of quality and safety indicators and assurance measures to clinicians and
wider healthcare workers.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
154
Declared interests and conflicts
Name
Dr Elizabeth Lawn
Dr Sundeep Soin
Dr Asha Pillai
Position
CCG Clinical Chair & Thames
Medical Locality Lead
Clinical Chief of Contracts &
Performance / Woking Locality
Lead
Clinical Chief of Leadership &
Development / Woking Locality
Lead
Chair of Clinical Executive &
SASSE Locality Lead
SASSE Locality Lead
Clinical Chief of Innovation &
Quality & Thames Medical
Locality Lead
Woking Locality Lead
Thames Medical Locality Lead
Mr Michael Brooks
Lay Member Governance
Medical
Council
Mr William McKee
Lay Member PPE
Tilfen Land
Mrs Sally Bassett
Dr Naila Kamal
Independent Registered Nurse
Independent Secondary Care
Specialist Doctor
Chief Executive
Director of Finance
Director of Strategy and
Commissioning
Director
of
Quality
and
Innovation
Director
of
Corporate
Development and Assurance
PwC
NHS London Deanery
Dr Deborah Shiel
Dr Linda Roberts
Dr Jagjit Rai
Dr Diljit Bhatia
Dr Richard Barnett
Ms Julia Ross
Mr Neil Ferrelly
Ms Alison Alsbury
Ms Joanne Alner
Mrs Yvonne Parish
(a) Declared 24th November 2014
Interests
The Bridge Practice
Hillview
Centre
Medical
Heathcot
Practice
Medical
St
David's
Health
Centre
Stanwell Road Surgery
Sunbury Health Centre
Group
Dr Lynch & Partners
Hersham Surgery
Research
Energise Ltd (b)
Soin Dental Ltd
Maxwell
Medical
DVLA
Medica4u Ltd
Accessible
Retail
LAPAR
Consultancy
University
Portsmouth
Acemedix Ltd
of
Institute
Directors
of
St
Omer
Consulting Ltd
Guildford
&
Waverley
CCG
Audit
Committee(a)
MRC
Technology
(a)
Outer
London
Commission
Phoenix
Interims (b)
(b) As at 26th February 2015
With the exception of those noted above, all declarations have been made for the whole of the financial year and for the period up to the signing of this report.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
155
Committee Membership
In addition to their membership of the Governing Body the Clinical Commissioning Group‟s senior managers have also been members and Chair of the
following Governing Body Committees:
Audit and Risk
Committee
Dr Elizabeth Lawn
Dr Deborah Shiel
Dr Linda Roberts
Dr Jags Rai
Dr Diljit Bhatia
Dr Richard Barnett
Dr Sundeep Soin
Dr Asha Pillai
Mr Michael Brooks
Mr William McKee
Mrs Sally Bassett
Dr Naila Kamal
Ms Julia Ross
Mr Neil Ferrelly
Ms Alison Alsbury
Ms Joanne Alner
Mrs Yvonne Parish
Remuneration and
Nominations
Committee
Quality and
Performance
Committee
Member
Contracts and
Finance Committee
Member
Member
Chair
Member
Member
Member
Chair
Member
Member
Member
Member
Member
Chair
Member
Member
Member
Clinical Executive
Member
Member
Member
Chair
Member
Member
Member
Member
Member
Chair
Member
Member
Member
Member
Member
Member
The Contracts and Finance Committee held its first meeting on 14th July 2014. In all other cases, with the exception of Ms Alison Alsbury who joined the
Committees of which she is a member during her period of engagement with the Clinical Commissioning Group (21 st July 2014 to 18th March 2015), all other
senior managers have been members and Chair of the Committees they are assigned to for the whole of the year and up to the signing of this report.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
156
Directors‟ and Senior Managers‟ Salaries and allowances – Audited
2014/15
Salary (bands Expense Performance
Long term All pensionTotal
of £5,000)
Payments
pay and
performance
related
(bands of
(taxable) to
bonuses
pay and
benefits
£5,000)
nearest
(bands of
bonuses
(bands of
£100
£5,000)
(bands of
£2,500)
£5,000)
Name
Title
Ms Julia Ross
Mr Andrew Demetriades
Mr Andrew Demetriades
Ms Alison Alsbury (*)
Mr Neil Ferrelly
Mr John Leslie (*)
Ms Joanne Alner
Mrs Henriette Coetzer
Yvonne Parish
Dr Elizabeth Lawn
Dr Jagit Rai (**)
Dr Richard Barnett (***)
Dr Deborah Shiel (**)
Dr Linda Roberts (**)
Dr Sundeep Soin
Dr Asha Pillai (**)
Dr Zoe Griffiths
Dr Diljit Bhatia
Dr Naila Kamal
Mrs Sally Bassett
Ms Julie Hunt
Mr Michael Brooks
Mr William McKee
£000
Chief Executive
130-135
Deputy Chief Executive
40-45
Director of Planning & Performance (Interim)
NA
Director of Strategy and Commissioning
225-230
Director of Finance
95-100
Director of Finance (Interim)
20-25
Director of Quality and Innovation
90-95
Director of Clinical Transformation
70-75
Director of Corporate Development and Assurance
75-80
CCG Clinical Chair & Thames Medical Locality Lead
65-70
Chair of Clinical Executive & SASSE Locality Lead
45-50
Clinical Chief of Innovation & Quality & Thames Medical Locality
60-65
Lead
Clinical Chief of Contracts & Performance / Woking Locality Lead
45-50
Clinical Chief of Leadership & Development / Woking Locality45-50
Lead
Woking Locality Lead
10-15
Thames Medical Locality Lead
45-50
SASSE Locality Lead
NA
SASSE Locality Lead
10-15
Independent Secondary Care Specialist Doctor
15-20
Independent Registered Nurse
15-20
Independent Registered Nurse
NA
Lay Member Governance
5-10
Lay Member PPE
5-10
£00
£000
2
0
NA
0
0
0
1
0
0
2
0
1
0
0
0
0
NA
1
1
0
NA
1
1
£000
0
0
NA
0
0
0
0
0
0
0
0
0
0
0
0
0
NA
0
0
0
NA
0
0
0
0
NA
0
0
0
0
0
0
0
0
0
0
0
0
0
NA
0
0
0
NA
0
0
£000
10-12.5
5-7.5
NA
0
85-87.5
0
27.5-30
22.5-25
25-27.5
0
0
0
0
0
0
0
NA
0
0
0
NA
0
0
£000
140-145
45-50
NA
225-230
185-190
20-25
120-125
90-95
105-110
65-70
45-50
60-65
45-50
45-50
10-15
45-50
NA
10-15
15-20
15-20
NA
5-10
5-10
2013/14
Salary (bands Expense Performance Long term
All
Total
of £5,000) Payments
pay and
performance pension- (bands of
(taxable)
bonuses
pay and
related
£5,000)
to nearest (bands of
bonuses
benefits
£100
£5,000)
(bands of (bands of
£5,000)
£2,500)
£000
125-130
60-65
95-100
NA
NA
230-235
90-95
NA
70-75
65-70
45-50
65-70
35-40
35-40
10-15
45-50
30-35
10-15
15-20
10-15
0-5
5-10
5-10
£00
£000
2
0
0
NA
NA
0
4
NA
1
0
0
1
0
0
0
0
0
2
2
0
0
1
2
£000
0
0
0
NA
NA
0
0
NA
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
£000
0 255-257.5
0
5-7.5
0
0
NA
NA
NA
NA
0
0
0
42.5-45
NA
NA
0
10-12.5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
£000
385-390
65-70
95-100
NA
NA
230-235
135-140
NA
80-85
65-70
45-50
65-70
35-40
35-40
10-15
45-50
30-35
10-15
20-25
10-15
0-5
5-10
5-10
* The positions of Director of Finance and Director of Strategy and Commissioning were performed through interim arrangements. Amounts paid to these
individuals for whole or part of the year were via external arrangements and therefore the disclosure also includes an element of agency administration
expenses, together with amounts in respect of unrecovered VAT due on the services provided. The sums paid were as follows:


Director of Finance £21,000 (from 1st April 2014 to 2nd May 2014);
Director of Strategy and Commissioning £228,000 (21st July 2014 to 18th March 2015).
** Remuneration paid to these clinical members of the Governing Body in 2014/15 was made via an invoice received from their Practice and not via the CCG‟s
payroll and therefore the disclosure includes employer‟s contributions. In 2013/14 Dr Deborah Shiel and Dr Linda Roberts were paid via the CCGs payroll.
*** Dr Richard Barnett worked a reduced number of sessions during the period 14th July 2014 to 14th August 2014.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
157
During the year Ms Joanne Alner, Mr Andrew Demetriades, Ms Alison Alsbury and Mrs Yvonne Parish were co-opted Directors of the CCG, participating fully
in discussions but without voting rights.
Taxable benefits relate to the reimbursement of mileage costs incurred by senior managers in the course of discharging their duty at a rate in excess of that
which HMRC has set as non-taxable.
Directors‟ and Senior Managers‟ Pension Benefits – Audited
Name
Title
Ms Julia Ross
Mr Andrew Demetriades
Mr Neil Ferrelly
Ms Joanne Alner
Mrs Henriette Coetzer
Mrs Yvonne Parish
Chief Executive
Deputy Chief Executive
Director of Finance
Director of Quality and Innovation
Director of Clinical Transformation
Director of Corporate Development and Assurance
Real
increase
in
pension
at age 60
(bands of
£2,500)
Real
increase in
lump sum
at age 60
(bands of
£2,500)
Total
accrued
pension
at age 60
at 31
March
2015
(bands of
£5,000)
£000
£00
0 - 2.5
0 - 2.5
2.5 - 5
0 - 2.5
0 - 2.5
0 - 2.5
0 - 2.5
0 - (2.5)
10 - 12.5
2.5 - 5
0 - 2.5
0 - 2.5
Cash
Equivalent
Transfer
Value at 1
April 2014
Cash
Equivalent
Transfer
Value at 31
March
2015
Real
increase in
Cash
Equivalent
Transfer
Value
Employer's
contribution
to
stakeholder
pension
£000
Lump
sum at
age 60
related to
accrued
pension
at 31
March
2015
(bands of
£5,000)
£000
£000
£000
£000
£000
40 - 45
15 - 20
45 - 50
20 - 25
0-5
0-5
120 - 125
40 - 45
135 - 140
70 - 75
0-5
0-5
741
309
766
359
0
17
793
335
884
398
15
35
32
11
90
30
15
18
0
0
0
0
0
0
Notes
a) The lay members of our Governing Body do not receive pensionable remuneration.
The clinical members – including the Independent Registered Nurse and Independent Secondary Care Specialist Doctor – are eligible through their
substantive employment to join the NHS Pension Scheme. The remuneration paid to our clinical members is pensionable for the purposes of
calculating the individuals accrued NHS Pension scheme benefits but the CCG does not make an employer‟s pension contribution. As we are unable
to accurately separate the rights accrued to the clinical member through their role in the CCG and their substantive clinical role we have not disclosed
these entitlements in the table above.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
158
b) Cash Equivalent Transfer Values. A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits
accrued by a member at a particular point in time. The benefits valued are the member‟s accrued benefits and any contingent spouse‟s pension
payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or
arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown
relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a
senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another
scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to
the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the
guidelines and framework prescribed by the Institute and Faculty of Actuaries.
Reporting of other compensation schemes - exit packages
Exit /package cost
band (including any
special payment
element)
Less than £10,000
£10,001 - £25,000
£25,001 - £50,000
£50,001 - £100,000
£100,001 - £150,000
£150,001 - £200,000
>£200,000
Total
Number of
compulsory
redundancies,
Number
0
0
0
0
0
0
0
0
Cost of compulsory
redundancies, £‟000
Number of other
departures agreed,
Number
Cost of other
departures agreed,
£‟000
Total number of exit
packages by cost
band, Number
Total cost of exit
packages by cost
band, £‟000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total number of special payments (and total cost of special payment element)
There were no compensation or exit packages during 2014/15.
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
159
Off payroll transactions
Off-payroll engagements as of 31st March 2015, for more than £220 per day and that last longer than six months are as follows:
Number
Number of existing engagements as of 31st March 2015
21
Of which, the number that have existed:
for less than one year at the time of reporting
7
for between one and two years at the time of reporting
14
for between 2 and 3 years at the time of reporting
0
for between 3 and 4 years at the time of reporting
0
for 4 or more years at the time of reporting
0
All existing off-payroll engagements, outlined above, have at some point been subject to a risk based assessment as to whether assurance is required that the individual is
paying the right amount of tax and, where necessary, that assurance has been sought:
Number
Number of new engagements, or those that reached six months in duration, between 1 April 2014 and March 2015
10
Number of new engagements which include contractual clauses giving NHS North West Surrey CCG the right to request assurance in
relation to income tax and National Insurance obligations
10
Number for whom assurance has been requested
10
Of which:
assurance has been received
10
assurance has not been received
0
engagements terminated as a result of assurance not being received
0
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
160
Number of off-payroll engagements of board members, and/or senior officers with significant financial responsibility, during the year
Number of individuals that have been deemed "board members, and/or senior officers with significant responsibility" during the financial year.
This figure includes both off-payroll and on-payroll engagements
Signed
Date
28 May 2015
Dr Elizabeth Lawn
Chair
Julia Ross
Chief Executive
(On behalf of the Council of Members)
NORTH WEST SURREY CCG ANNUAL REPORT AND ACCOUNTS 2014/15
161
4
17