Item Number: 14
Name of Presenter: Dr Shaun O’Connell
Meeting of the Governing Body
4 June 2015
Delegated authority for approval of clinical policies
Purpose of Report
For Decision
1. Rationale
The CCG established the Referral Support Service (RSS) in 2013, a key element of the
Referral Support Service is the development of clinical guidelines to triage referrals into
secondary care. These guidelines have been developed by clinicians on behalf of the CCG
working closely with secondary care specialists on each pathway. As the RSS has embedded
and grown, there are a significant number of guidelines produced on behalf of the CCG, and
although are not formally clinical ‘policy’ of the CCG, they are expected to be followed.
The CCG has also now established the Clinical Effectiveness and Research sub-Committee
under the Quality and Finance Committee to make recommendations on clinical policy
including in relation to RSS and Individual Funding Request thresholds (Appendix – Draft
Terms of Reference).
Currently all clinical policy decisions are approved at Governing Body in line with the scheme
of delegation within the constitution. It is anticipated that as RSS guidelines are reviewed and
the scheme expanded that these will operate as clinical policies for the CCG. It is proposed
that any new or amended guidelines or changes to clinical thresholds are reported to the
Clinical Effective and Research Committee for review and recommendation to Quality and
Finance.
To reduce the impact on reporting to Governing Body, it is proposed that clinical policy
approval is delegated to the Quality and Finance Committee in line with the financial impact on
any clinical policy change as detailed in the detailed scheme of delegation, with exceptions of
clinical policy changes that are of significant reputational importance.
2. Strategic Initiative
Integration of care
Person centred care
Primary care reform
Urgent care reform
Planned care
Transforming MH and LD services
Children and maternity
Cancer, palliative care and end of life care
System resilience
3. Actions / Recommendations
That the Governing Body approves delegation of approval for clinical guidelines relating to
RSS or changes in clinical policy to the Quality and Finance Committee where the financial
impact would be up to £500k and there is no significant reputational risk or identified impact.
4. Engagement with groups or committees
N/a
5. Significant issues for consideration
The establishment of the Clinical Effectiveness and Research sub-Committee provides an
enhanced level of assurance around the development of clinical thresholds and policies for the
CCG.
6. Implementation
Implementation will be led by the GP Lead for Prescribing and Planned Care and the Chief
Nurse.
7. Monitoring
The Governing Body will receive updates from the Quality and Finance Committee at each
meeting, in which would include any clinical guideline or policy approval from Quality and
Finance.
8. Responsible Chief Officer and Title
Mark Hayes
Chief Clinical Officer
9. Report Author and Title
Dr Shaun O’Connell
GP Lead for Prescribing and Planned Care
10. Annexes
The Clinical Research and Effectiveness Committee draft terms of reference are attached.
Draft 18.05.15
Draft Terms of Reference for the Clinical Research and
Effectiveness Committee
1.
Title
The Committee shall be known as the Clinical Research and Effectiveness
Committee of the NHS Vale of York Clinical Commissioning Group (CCG).
2.
Accountable To
2.1
The Committee shall be accountable to the NHS Vale of York CCG Quality
and Finance Committee.
2.2
The Committee will support the Governing Body to discharge its
responsibilities around the promotion and use of research, clinical review and
policy formulation and compliance with NICE requirements.
3.
Reporting Arrangements
3.1
The Committee’s Terms of Reference shall be agreed by the NHS Vale of
York CCG Quality and Finance Committee, as a sub-committee supporting
the functions of the Quality and Finance Committee.
3.2
The minutes of the Committee shall be formally recorded and these can be
presented to the Governing Body on request. The Committee will operate in
line with the CCG Standing Orders.
3.3
The Chair of the Committee will provide a summary report to each Quality and
Finance Committee.
3.4
The Committee will, by exception, escalate matters it considers should be
brought to the attention at the full Governing Body.
4.
Duties
4.1
Authority
4.1.1 The Committee is to investigate any activity within its terms of reference. It
may seek any information it requires from any employee and all employees
are directed to co-operate with any request made by the Committee.
4.1.2 The Committee has authority to review clinical thresholds for the CCG; to
inform clinical policy and to support the development of the Referral Support
Service (RSS) and Individual Funding Request process. This will include
consideration of cost effectiveness, alignment to commissioning strategy and
evidence-based patient outcomes. The Committee will make
recommendations on clinical policy to the Quality and Finance Committee
and/or Governing Body as required.
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Draft 18.05.15
4.1.3 The Committee will horizon scan, gather and review evidence, such as best
practice clinical guidance, national and local research outcomes, NICE
guidance and technical appraisals, clinical case studies, to inform
commissioning for the CCG.
4.1.4 The Committee will lead on the processes and structures relevant to the
promotion and use of research and provide scrutiny on application for
research projects and/ or clinical studies, including the management of
research allocation for the CCG, review and decision of Extra Treatment
Costs, dissemination of research findings across the CCG.
4.1.5 The Committee will oversee any delegated activity of the CCG, such as CCG
representation on national, local and other relevant fora relating to clinical
effectiveness and research.
4.1.6 Review clinical recommendations to help inform of SMT, Quality and Finance
Committee and Governing Body decisions on medicines management,
prescribing and formulary as required.
4.1.7 The Committee will formulate the CCG responses to clinical effective and
research requirements, including responses to NICE guidance and technical
appraisals.
4.2
Risk Management
The Committee shall consider the development of clinical effectiveness and
research assurance framework to inform the corporate assurance framework
of emerging risks to the CCG in relation to the activity of the Committee,
including financial, reputational and compliance issues.
4.3
Conflicts of Interest
The Committee will comply with the CCG Conflicts of Interest policy and
management requirements.
4.3
Training and Briefing
4.3.1 The Committee shall promote the open and honest sharing of clinical
effectiveness and research outcomes to inform commissioning through-out
the organisation.
4.3.2 The Committee shall promote regular and open dialogue with other
organisations, both NHS and non-NHS regarding clinical effectiveness and
research.
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5.
Membership
5.1
The core Committee shall comprise:
GP Clinical Lead (Co-Chair)
Chief Nurse (Co-Chair)
Lay Member of the Governing Body
Deputy Chief Finance Officer
Deputy Chief Operating Officer
GP Representation
Nursing Representation
Research and Development Manager
Head of Corporate Assurance and Strategy
Public Health Representative
Individual Funding Request Service Senior Delivery Manager
RSS Manager
Additional members will be invited in accordance with the agenda
6.
Quorum
No business shall be transacted unless there are at least five members
present, of which one shall be a Co-Chair, one a Clinician and the Individual
Funding Request Service Senior Delivery Manager or representative.
Decision Making
When a vote is required, each core member of the Committee has a single
vote. A simple majority is necessary to confirm a decision. In the event of an
equality of votes, the Chair of the meeting shall have the second and casting
vote.
Conflicts of Interest shall be managed in line with NHS Vale of York CCG
Conflicts of Interest policy.
7.
Attendance
7.1
Regular attendance at Committee meetings leads to improved engagement
and governance. In the event that an attendee is unable to attend a meeting
it is their responsibility to ensure that a nominated deputy is properly briefed
and empowered to act on their behalf.
7.2
Frequency of attendance by members and attendees will be reviewed by the
Committee Chair at least annually.
8.
Frequency
8.1
The Committee will meet initially on a monthly basis but may adjust frequency
if agreed at the Committee.
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9.
Links to other Committees and Groups
9.1
The Committee reports to the Quality and Finance Committee. The Audit
Committee may request information or reports from the Clinical Effectiveness
and Research Committee at any point.
9.2
The Committee will inform and make recommendations to Senior
Management Team and the Governing Body as required.
10.
Review of Terms of Reference
The Committee shall review its Terms of Reference at least annually.
11.
Review of Committee Effectiveness
11.1
The Committee shall undertake a review of its effectiveness at least annually.
11.2
The Committee shall be subject to any review of CCG committees as
required.
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