Annual Report and Accounts - Dorset Clinical Commissioning Group

Transcription

Annual Report and Accounts
2013/14
Supporting people in Dorset to lead healthier lives
Front cover - thanks to Enid, Delta and their families
CONTENTS
Welcome from our Chair and Chief Officer
Member Practices’ Introduction
List of practices
Governing Body / Members’ Report
How we work and our Governing Body
Pages
Pages
Pages
Pages
Pages
2-3
4-5
6-7
8 - 39
8 - 12
Progress against targets
Pages
14 - 15
Our localities
Pages
23 - 24
Highlights of our first year
Our Clinical Commissioning Programmes
Strategic Report
Pages
Pages
Pages
16 - 22
25 - 39
40 - 66
Financial Overview
Page
42
Outlook for 2014/15 and beyond - Chief Finance Officer
Page
46
Progress against national Quality Standards
Business Review including:
Equality and Diversity
Improving Quality
Engagement
Caring for Carers
Governing Body and Senior Managers’ Profiles
Remuneration Report
Financial Performance
Glossary of Terms
Annual Accounts Addendum
Pages
Pages
Pages
Pages
Pages
Pages
Pages
Pages
Pages
Page
Pages
43 - 45
47 - 67
51 - 53
55 - 59
61 - 62
63 - 64
67 - 77
78 - 85
86 - 89
90
91 onwards
1
WELCOME
Welcome to the NHS Dorset Clinical Commissioning
Group Annual Report and Accounts for the year
1 April 2013 to 31 March 2014.
This is the first annual report produced by
NHS Dorset Clinical Commissioning Group
(CCG) and it marks a year since we – as a
clinically led organisation – took on the role of
planning and funding local healthcare across
the county.
In doing so, we have built on the solid
foundation left by our predecessors,
Bournemouth & Poole and Dorset Primary
Care Trusts.
The following pages demonstrate our
commitment to ensuring that people get the
healthcare they need and it remains
accessible and appropriate.
Looking Ahead
The NHS in Dorset faces significant
challenges in terms of meeting the health
needs of the increasing population, ensuring
clinical and financial sustainability of NHS
services whilst responding to new national
policy and guidance (e.g. 7 day working,
quality standards).
These challenges are no different to those set
out nationally within NHS England’s document
‘A Call to Action’.
In addition to financial constraints our
providers of health care are facing
2
Tim Goodson, Chief Officer (left) and Chair
Dr Forbes Watson
pressures in terms of the profile and
deployment of their existing workforce, which
if we don’t work together to make realistic and
sustainable commissioning decisions to
re-design some services, will deepen and
lead to a financial crisis for the NHS in Dorset
within the next two years.
Therefore in Dorset, with our providers and
partners, we will undertake a clinical services
review to tell us what services need to
change, and how we should change them to
ensure that the NHS in Dorset provides high
quality, safe, and clinically and financially
sustainable services for future generations.
Further information on the outlook for 2014/15
and beyond can be found as part of the
Strategic Report on page 46.
With this in mind, we also took the opportunity
to reflect upon these challenges by discussing
our strategy through a series of engagement
events with our stakeholders.
As a result of this exercise, our current
strategy has been refreshed to reflect their
feedback. Our revised strategy 2014/19
outlines how the CCG will support three pan
Dorset transformational programmes:
Better Together, an integrated health and
social care model where the NHS and
local authorities will work together to plan
and deliver seamless services.
Clinical Services Review, which will
review clinical services across the health
and social care system within Dorset with
the aim of creating clinical and financial
sustainability.
Urgent Care Review, that aims to
transform urgent care services across
Dorset by aligning and integrating them
where possible, simplifying pathways and
using technologies to improve patient
experiences.
These three transformational programmes
complement our clinical priorities in our
delivery plan for the next two years.
They will enable us to drive the changes
required to ensure the NHS in Dorset is
sustainable, innovative and responsive to the
needs of local people.
You can read more about these programmes
on page 50.
We would like to take this opportunity to thank
all those people working both for us and with
us for their continued support since April 2013.
This has helped us develop and grow from a
fledgling organisation into one which delivers
improvements to healthcare across the county
and will continue to do so.
As a membership organisation, we are
grateful for the support of our 100 GP
practices. Our members offer their reflections
of our first year on pages 4 and 5.
As with everything we do, your voice is vital
and we actively encourage you to get
involved. Information on how to have your say
is available on our website
www.dorsetccg.nhs.uk/involve or email us at
[email protected].
You can also join our Health Involvement
Network and get more involved with our work
(see the back page of this report for more
information).
We hope you find the report informative and
interesting.
3
MEMBER PRACTICES’ INTRODUCTION
Introduction to the NHS Dorset CCG
Annual Report on behalf of Member
Practices
comprises 100 member practices across the
county of Dorset. With a registered population
of around 766,000, this makes us the third
largest CCG in England in terms of population
and with a commissioning budget of £947M,
the second largest in financial terms.
All GP practices belong to a locality which is a
geographic area, and each locality has a lead
GP who is a member of the CCG Governing
Body. You can read more about the Governing
Body’s role on page 8.
This, our member practices introduction,
represents all practices registered in Dorset
(see pages 6 and 7 for a full list of member
practices). It reflects our collective thoughts on
the CCG’s governance, progress,
performance and impact at the end of its
first year.
Reflections
Reflecting on the CCG’s first year, we have
made a solid start in addressing the health
priorities of our local communities. We have
captured this in our “highlights of our first
year” from page 16 to 22. There is still much
to do to face the significant challenges ahead
and to this end we have refreshed our
strategy to reflect this. You can read more on
page 14 to 15 about our progress and
performance as measured against annual
delivery plan targets.
Impact
The Membership Body came together, during
the year, at a series of events, focusing on the
challenges of the CCG including its first year
priorities and how, as members, we saw the
development and their engagement with our
planned Clinical Services Review.
4
The Governing Body has also added impact to
the CCG’s ambitions in embracing their new
clinical leadership roles and shaping the
strategy and engagement of the CCG with
local stakeholders.
Please read the case studies on pages
25 to 39 which feature each of our Clinical
Commissioning Programmes introduced by
the respective Clinical Chair.
Evaluation
The Governing Body and its Clinical
Commissioning Committee participated,
during November 2013, in an independent
board observation exercise with NHS
England, as part of the CCG’s development
process.
This evaluation exercise focused on
governance, challenge, individual
contributions, level of discussion, forward
focus and decision making.
This provided helpful and insightful feedback
from which the CCG can further enhance its
clinical leadership and informed the CCG
organisational development planning.
The CCG Governing Body is assessed
quarterly by NHS England’s Local Area Team.
Most recent reviews assessed us as ‘Assured’
and ‘Assured with support’ for all our domain
areas.
Members’ engagement
The CCG has developed robust engagement
mechanisms to ensure we can all participate
in clinical decision making. As each of our
practices belongs to a locality (a geographic
area) our Locality Lead GP represents us and
our patients in their role as a member of the
CCG Governing Body. You can read more
about these key people on pages 9 to 10.
A regular cycle of engagement activity has
taken place during the year to involve us in
the organisation and the development
MEMBER PRACTICES’ INTRODUCTION
of the strategy and priorities, including:
four membership events (all GP practices
invited including practice managers). The
CCG held four events throughout the year
with a cumulative attendance of 500. Video
summaries of these events were made
available via the CCG intranet for GPs who
could not attend
six workshop and development events for
the Governing Body, comprising clinical
Board Members, Lay Members, Locality
Chairs and Directors with a cumulative
attendance of 216 throughout the year
monthly locality meetings
CCG Update – a weekly e-newsletter
sent to each practice every Friday with
commissioning information and links to
the GP intranet.
The CCG’s approach to clinical engagement
formed part of our nomination for The
Guardian’s inaugural Healthcare Innovation
awards, which you can read more about on
page 21.
The member practices are supportive of the
efforts of the CCG to drive engagement,
however, all parties recognise the need to use
technology to enable virtual collaborative
discussion, given the size of the county and
the demands upon local practices.
Summary
We are assured that any matters of concern
will be flagged by the various governance
arrangements that are in place to ensure our
statutory obligations as leaders of healthcare
services for the county of Dorset are fulfilled.
As this Annual Report outlines, we recognise
the difficult challenges ahead both for the NHS
nationally and how that translates in Dorset.
We realise we have a strong role to play in
helping the healthcare system overcome
these challenges by our continuing
involvement and participation in the
development and delivery of NHS Dorset
CCG’s Strategy.
Dr Forbes Watson
CCG Chair
and on behalf of member practices
5
OUR MEMBER PRACTICES
North Dorset
Abbey View Surgery, Shaftesbury
Apples Medical Centre, Sherborne
Bute House Surgery, Sherborne
Eagle House Surgery, Blandford
Royal Crescent Surgery, Weymouth
Royal Manor Surgery, Portland
The Practice Plc, Weymouth
Wyke Regis Surgery, Weymouth
Gillingham Medical Centre, Gillingham
Purbeck
Stalbridge Surgery, Stalbridge
Corfe Castle Surgery, Corfe Castle
Newland Surgery, Sherborne
Bere Regis Surgery, Bere Regis
Sturminster Newton Medical Centre,
Sandford Surgery, Wareham
Whitecliff Surgery, Blandford
The Wellbridge Surgery, Wool
Sturminster Newton
Swanage Medical Centre, Swanage
Yetminster Surgery, Yetminster
Wareham Surgery, Wareham
Bridport Medical Centre, Bridport
Adam Practice, Poole
West Dorset
Lyme Regis Medical Centre, Lyme Regis
Lyme Bay Medical Centre, Lyme Regis
Charmouth Medical Practice, Charmouth
Portesham Practice, Portesham
Barton House Surgery, Beaminster
Poole Central
Carlisle House Surgery, Poole
Dr Newman's Surgery, Poole
Evergreen Oak Surgery, Poole
Longfleet House Surgery, Poole
Poole Town Surgery, Poole
Tollerford Practice, Maiden Newton
Rosemary Medical Centre, Poole
Prince of Wales Surgery, Dorchester
Birchwood Medical Centre, Poole
Mid Dorset
Cornwall Rd Medical Practice, Dorchester
Fordington Surgery, Dorchester
Poole North
Canford Heath Group Practice, Poole
Hadleigh Practice, Poole
Queens Avenue, Dorchester
Harvey Practice, Poole
Broadmayne Surgery, Broadmayne
Heatherview Medical Centre, Poole
The Atrium Health Centre, Dorchester
Puddletown Surgery, Puddletown
Milton Abbas Practice, Milton Abbas
Cerne Abbas Surgery, Cerne Abbas
Weymouth and Portland
Abbotsbury Road Surgery, Weymouth
Bridges Medical Centre, Weymouth
Cross Road Surgery, Weymouth
Dorchester Road Surgery, Weymouth
6
Lanehouse Surgery, Weymouth
Poole Bay
Herbert Avenue, Poole
Lilliput Surgery, Poole
Madeira Medical Centre, Poole
Parkstone Health Centre, Poole
Poole Road Medical Centre, Poole
Wessex Road Surgery,Poole
Westbourne Medical Centre, Poole
OUR MEMBER PRACTICES
North Bournemouth
Marine & Oakridge Partnership, Bournemouth
Banks & Bearwood Medical Centre
Bournemouth
Shelley Manor Medical Centre, Bournemouth
Alma Partnership, Bournemouth
Durdells Avenue Surgery, Bournemouth
Kinson Road Medical Centre, Bournemouth
Leybourne Surgery, Bournemouth
Northbourne Surgery, Bournemouth
Talbot Medical Centre, Bournemouth
Village Surgery, Bournemouth
Central Bournemouth
Denmark Road Medical Centre, Bournemouth
Holdenhurst Road Surgery, Bournemouth
Providence Surgery, Bournemouth
Southbourne Surgery, Bournemouth
Christchurch
Barn Surgery, Christchurch
Burton Medical Centre, Christchurch
Farmhouse Surgery, Christchurch
Grove Surgery, Christchurch
Highcliffe Medical Centre, Christchurch
Orchard Surgery, Christchurch
Stour Surgery, Christchurch
James Fisher Medical Centre, Bournemouth
East Dorset
Panton Practice, Bournemouth
Old Dispensary, Wimborne
Moordown Medical Centre, Bournemouth
Cranborne Surgery, Wimborne
St Albans Medical Centre, Bournemouth
Orchid House Surgery, Ferndown
East Bournemouth
Quarter Jack Surgery, Wimborne
Woodlea House Surgery, Bournemouth
Beaufort Road Surgery, Bournemouth
Boscombe Manor Medical Centre
Bournemouth
Crescent Surgery, Bournemouth
Littledown Surgery, Bournemouth
Penny's Hill Surgery, Ferndown
Trickett's Cross Surgery, Ferndown
Verwood Surgery, Verwood
Village Surgery, Poole
Walford Mill Surgery, Wimborne
West Moors Group Practice, West Moors
7
GOVERNING BODY / MEMBERS’ REPORT
NHS Dorset Clinical Commissioning Group (CCG)
was created and fully authorised without conditions
on 1 April 2013.
Introduction
NHS Dorset CCG is the third largest clinical
commissioning group in England, in terms of
population and, with a commissioning budget
of £947M, the second largest in financial
terms.
We have a Governing Body and our own
constitution which sets out how the
organisation will work.
Whilst we do not directly provide any health
services, we have responsibility for
commissioning (planning and funding) a
number of them for local people. These
include:
planned hospital care at local hospitals
urgent and emergency care e.g. A&E,
ambulance services, out of hours care and
the NHS 111 service
community health services
mental health and learning disability
services
rehabilitation care
maternity, children’s and family services
NHS continuing healthcare.
Our mission
Our mission, aims and strategic principles
have been developed through wide
consultation and engagement with
stakeholders and partners across Dorset.
8
Supporting people in Dorset to
lead healthier lives
As leaders we will use our clinical
understanding to drive forward continuous
improvements in services throughout Dorset
that support people to lead healthier lives for
longer.
Our aims
We aim to be an organisation that:
is trusted and builds confidence in our
public, patients and stakeholders
challenges and encourages its partners,
members and staff to drive improvements
in services and performance
values its staff and membership and is a
great place to work
uses resources effectively and efficiently
has a local focus but doesn’t lose sight of
the bigger picture.
Our values
We have six values which underpin everything
we do. These are:
Caring
Collaborative
Courageous
Honest
Responsive
Responsible.
Our Governing Body is made up of 13 GP Locality Chairs,
a Chair, a Chief Officer, a Chief Finance Officer, two Lay
Members, one Nurse Lead and one Doctor Lead.
Who we are: our Governing Body
Our Governing Body is made up of 13 GP Locality Chairs, a chair, a Chief Officer, a Chief
Finance Officer, two Lay Members, one nurse
lead and one hospital (secondary care) doctor
lead. The Chair is Dr Forbes Watson and the
Chief Officer is Tim Goodson.
The Governing Body has a responsibility to
ensure there are appropriate healthcare
services for the people of Dorset. All GP
practices belong to a locality which is a
geographic area, and each locality has a lead
GP who is a member of the CCG Governing
Body. The members of our Governing Body are:
Dr Forbes Watson, Chair
Tim Goodson, CCG Chief Officer
Dr Peter Blick, Locality Chair for Central
Bournemouth
Dr Jenny Bubb, Locality Chair for Mid
Dorset
Dr Rob Childs, Locality Chair for North
Dorset
Dr Colin Davidson, Locality Chair for East
Dorset
Dr Paul French, Locality Chair for East
Bournemouth
Dr Richard Jenkinson, Locality Chair for
Christchurch
Dr Tom Knight, Locality Chair for North
Bournemouth
Dr Chris McCall, Locality Chair for Poole
North
Dr Blair Millar, Locality Chair for West
Dorset
Dr Andy Rutland, Locality Chair for Poole
Bay
Dr Patrick Seal, Locality Chair for Poole
Central
Dr Karen Kirkham, Locality Chair for
Dr David Haines, Locality Chair for Purbeck
Paul Vater, Chief Finance Officer
David Jenkins, Lay Member Lead for
Patient and Public Involvement and Deputy
CCG Chair
Teresa Hensman, Lay Member Lead for
Governance
Mary Monnington, Registered Nurse Member
Dr Chris Burton, Secondary Care Member.
Each GP liaises between the Governing Body
and practices in the locality to ensure
decisions reflect local issues and needs.
The Governing Body has three committees
which report to it: a clinical commissioning
committee, a remuneration committee and an
audit and quality committee.
The Audit and Quality Committee provides the
Governing Body with an independent and
objective view of the CCG’s financial systems,
financial information and compliance with
finance-related laws, regulations and
directions.
It gives assurance on the quality of services
commissioned and promotes a culture of
continuous improvement and innovation with
respect to safety of services, clinical
effectiveness and patient experience.
9
The Audit and Quality Committee is chaired by
Governance. The further members are:
Charles Buckle, Non-governing Body Lay
Member
Dr Paul French, Governing Body
representative
David Jenkins, Lay Member Lead
for Patient and Public Involvement and
Deputy CCG Chair
Mary Monnington, Registered Nurse Member
Tina Thompson, Non-governing Body Lay
Member.
The Clinical Commissioning Committee
The Clinical Commissioning Committee is
responsible for developing and recommending
clinical priorities; promoting patient and public
involvement and engagement; supporting the
delivery of clinical effectiveness and ensuring
a clinical perspective in the business of the
CCG.
It is made up of the chairs of the seven
Clinical Commissioning Programmes,
executive and Lay Members. The CCC is
chaired by Dr Forbes Watson. Other members
are:
10
Tim Goodson, Chief Officer
David Jenkins, Lay Member Lead
Deputy CCG Chair
Dr Chris Burton, Governing Body, Secondary
Care Member
Dr Lionel Cartwright, Chair, Cancer and End
of Life Clinical Commissioning Programme
(CCP)
Dr Paul French, Chair, Mental Health and
Learning Disabilities CCP
Dr Karen Kirkham, Chair, Maternity,
Reproductive and Family Health CCP
Dr Chris McCall, Chair, General Medical
and Surgical CCP
Dr Christian Verrinder, Chair,
Musculoskeletal and Trauma CCP
Dr Andy Rutland, Mid Locality
Representative
Dr Craig Wakeham, Chair, Cardiovascular
Disease, Stroke and Diabetes CCP
Dr Simon Watkins, Chair, Pan Dorset CCP
Dr Peter Blick, East Locality
Representative
Dr Rob Childs, West Locality
Representative
Jane Pike, Director of Service Delivery
Suzanne Rastrick, Director of Quality.
Profiles of members of the Governing Body
and the register of their interests can be found
on pages 68 to 77.
The Remuneration Committee
The Remuneration Committee makes
recommendations to the Governing Body
about the remuneration, fees and allowances
for senior employees and people who are
appointed or who provide services to the
CCG. The Remuneration Committee is
chaired by David Jenkins, Lay Member Lead
Deputy CCG Chair. Other members are:
Dr Chris McCall Governing Body,
Locality Lead, Assistant Clinical Chair
Dr Forbes Watson, CCG Chair
Governance / Chair of Audit & Quality
Committee
Mary Monnington, Registered Nurse
Member
Engagement: how we work with
our partners
Engagement is at the heart of everything we
do and we are committed to meaningful
external and internal engagement to help
shape services and improve health outcomes
for the population of Dorset.
Please turn to page 61 for details of how we
do this.
Our future plans and priorities
We have spent time with a number of our
partners outlining our priorities for the coming
years.
Based on the Department of Health’s Quality,
Innovation, Productivity and Prevention
Programme (QIPP), we have integrated this
approach into all our plans to make sure we
are able to reinvest savings required of the
NHS over the coming years.
These high-level priorities are consistent with
the priorities identified by both our local Health
and Wellbeing Boards and are:
improving health and reducing health
inequalities
a better quality of life for people with
long-term conditions
better recovery from episodes of ill health
or injury
a positive experience in a safe environment
and protection from avoidable harm.
Our strategy
We have published our five-year strategy
which outlines what our ambitions and
priorities are over the coming years. This
strategy also addresses issues and comments
raised by our members, providers, partners
and patients. It focuses on our four strategic
principles of:
services designed around people
preventing ill health and reducing
inequalities
sustainable healthcare services
care closer to home.
Our initial priorities for the year 2013/14 were:
improving dementia diagnosis and
services
reducing avoidable emergency admissions
integrating and improving services for
children, young people and their families
improving mental health services
Environmental, social and community issues
integrating and improving community care
for adults and older people
improving end of life care services
reshaping acute services, whilst
maintaining access.
These priorities aim to deliver:
fewer premature deaths
reducing preventable deaths.
You can read about our progress against
these priority areas on pages 14 to 15.
You can read more about our commitment to
the environment, community and society in
our Sustainability Report on page 52.
Pension liabilities
For more information regarding pension
benefits and costs please see page 83 in the
11
Financial Performance section (1.8.2
Retirement Benefit Costs and Note 4.5:
Pension Costs).
External audit and disclosure
To read the external audit report, please turn
to page 4 of 53 in the Accounts Addendum.
Our Governing Body members’ disclosure to
auditors is outlined on page 77.
Information governance, complaints and
compliance
For information regarding data loss or
confidentiality, complaint handling and other
matters relating to Principles for Remedy,
please see pages 50 to 59 within our Quality
section. Our Annual Governance Statement
on page 6 of 53 (sections 5.5 and 18) in the
Accounts Addendum discloses our assurance
process regarding these matters.
12
Equality, diversity and workforce
Policy information regarding our commitment
to equality and diversity, including disabilities
and gender, is available on pages 51 to 53
within the Strategic Report section. This
section also contains information regarding
our approach to employee consultation, which
you can read under Commissioning Support
Development on page 52.
Emergency preparedness, resilience and
response (EPRR)
Detailed information on EPRR and how we
work with our partners to support the Dorset
community should an incident occur can be
found on page 60 to 61.
Progress against targets
Please see the delivery plan progress report
on 14 and 15.
Members of Dorset Ladies County Golf Association keep active at Canford Magna Golf Club
13
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15
HIGHLIGHTS OF OUR FIRST YEAR
We had some notable successes during our first year in
operation and have launched a range of innovative services
to improve healthcare in Dorset
Call 111 for medical help
Telehealth referrals reach 300
The new NHS 111 service was
implemented successfully across Dorset
in April with few of the problems reported
elsewhere in the press and media.
The NHS Dorset CCG Telehealth project
team received their 300th patient referral
for a Homepod Telehealth system in May.
April 2013
NHS 111 call handling and triage services
are provided by the South Western
Ambulance Service NHS Foundation
Trust.
The aim of the service is to make it easier
for people to access local NHS healthcare
services.
People can call 111 when they need
medical help fast and when it’s not a 999
emergency.
111 is a fast and easy way to get the right
help, whatever the time, day or night,
seven days a week.
In excess of 200,000 calls were made to
the service in the first year.
16
May 2013
A Homepod is a specialist piece of
equipment that is provided in the patient’s
home and is able to take readings and
upload results directly to a central
computer held at a surgery or hospital.
The Homepod reads blood pressure,
weight, pulse, temperature and oxygen
levels.
Once installed, the Telehealth equipment
is extremely easy to use. Feedback so far
from patients and healthcare
professionals has been very positive.
Telehealth saves time and travel for the
patient as they do not have to attend
routine appointments as regularly as they
normally would. The value of the scheme
was recognised by being shortlisted for a
national award.
Personal health budgets pilot
rolls out for national success
Care and Compassion
Conference a success
The Government has committed the NHS
to the national roll-out of personal health
budgets (PHBs) which were successfully
piloted in Dorset.
Compassionate care is as important as
the quality of care and we work with
hospitals and services to ensure that
patients and their families are treated with
compassion.
May 2013
From 1 April 2014, CCGs can offer PHBs
to people receiving NHS continuing
healthcare. By March 2015 everyone who
could benefit will have the option of a
PHB.
Dorset is one of nine ‘Going further, faster’
sites which are already offering PHBs. A
national Patient Outcome Evaluation Tool
survey showed that 92% of Dorset
patients receiving a PHB reported an
improvement in their physical health
compared to 69% nationally.
Eighty per cent reported an improvement
in their mental health against a national
average of 64%.
It also showed that all carers involved in
the pilot felt their views were fully included
in the care planning process.
The Personal Health Budget project in
Dorset was winner of the Health Service
Journal Efficiency in Financial Services
award in 2012.
June 2013
We brought together health partners and
members of the public at a conference to
learn how care and compassion is
everyone’s responsibility.
Around 100 delegates represented
hospitals, local authorities, service
providers and voluntary groups.
Presentations were received from
National Patient Champion Ashley Brooks,
who told of his experiences whilst being
treated for leukaemia and MRSA, Dorset
County Council and Dorset Healthcare
University NHS Foundation Trust along
with local hospitals.
London-based Guys’ and St Thomas NHS
Foundation Trust showed their awardwinning film ‘Barbara’s Story’, which tells
of the experiences of an elderly patient
during a hospital visit and is part of an
innovative dementia training programme.
17
The Big Ask tests temperature
of local health services
June 2013
Working with local partners, we launched
an ambitious project to get an in-depth
insight into people’s views of Dorset
health services.
The Big Ask sought views on a range of
NHS services, from local GP and out-ofhours services to community, mental
health and hospital services. We wanted
to find out how well informed people were
about the services available locally, how
they choose healthcare and what services
they used the most.
We also asked how people think the NHS
could provide information in the most
effective way. Most importantly, we asked
for individual opinions on the NHS in
Dorset – what people valued most and
what could be improved.
This is the first time Dorset NHS
organisations have worked together in this
way on an exercise of this scale. The
project involved Dorset County Hospital
NHS Foundation Trust, The Royal
Bournemouth and Christchurch Hospitals
NHS Foundation Trust and Poole Hospital
NHS Foundation Trust and Dorset
Healthcare University NHS Foundation Trust.
The Big Ask was carried out by
Bournemouth University’s Market
Research Group to ensure its
independence. More than 12,000 people
were sent the survey directly but anyone
could take part and more than 6,000
responses were received.
This information will be invaluable when
we are reviewing and improving services,
for example the transformational
programmes highlighted on page 50.
18
Dorset CCG looks to improve
services for those affected by
headaches
August 2013
Headaches can take many forms and
have a number of causes including stress
and lack of sleep.
With around 14% of Dorset residents –
over 108,000 people – affected by
migraine or cluster headaches alone, we
gathered views on how to improve
services for local sufferers.
As a result of the events, draft proposals
for new services along with a draft service
specification have been sent to those
people who have registered an interest in
headaches for comment.
More than 10 million people in the UK get
headaches, making them one of the most
common health complaints.
Whilst most are not serious and can be
treated with some basic remedies or
lifestyle changes, some people have
headaches that are so severe they need
to consult medical help.
Drinkheads: health bodies warn
about mixing alcohol with
parenting
September 2013
We joined forces with Bournemouth &
Poole Local Safeguarding Children Board,
Dorset Safeguarding Children Board and
Public Health Dorset to highlight the
dangers to parents.
A hard-hitting campaign from local health
partners was launched in Dorset to alert
parents to the dangers of drinking alcohol
when they are looking after young children.
While thankfully rare in Dorset, there have
been cases of children coming to harm
while being under the care of adults who
have had too much to drink.
As part of the campaign, posters have been
displayed at selected sites in Weymouth,
Poole and Bournemouth with radio
advertising running in parallel.
An advertisement also ran in Primary Times
magazine - 50,000 copies of which was
distributed to parents through primary
schools across Dorset.
19
A new patient transport service
October 2013
A new non-emergency patient transport
service for Dorset residents was
introduced in October. The county-wide
service was designed in consultation with
NHS treatment centres and patient groups
to provide an adaptable and reliable
service to the local community.
Study to reduce hip arthritis
pain launches in Bournemouth
and Christchurch
September 2013
A pioneering study to assess the link
between regular cycling activity and
reduced hip pain or need for hip surgery
was launched in Bournemouth and
Christchurch, with local residents being
invited to sign up and get involved.
Cycling Against Hip Pain (CHAIN) is a
concept proposed by Mr Robert
Middleton, consultant orthopaedic
surgeon and hip specialist at the Royal
Bournemouth Hospital, which is a leading
centre in hip replacement surgery.
The study is based on evidence that
indicates that regular cycling activity and
education could reduce symptoms for
people with hip pain, stiffness and arthritis
and reduce the need for surgery.
20
The service ensures patients with a
medical need receive transport suitable for
their particular health circumstances.
Bookings are processed by the Dorset
Patient Transport Bureau located in
Bournemouth.
A separate 24-hour booking line is
available for NHS personnel booking
transport on a patient’s behalf.
To ensure all mobility requirements and
weather conditions are catered for, a
comprehensive fleet of vehicles ranging
from 4-wheel drive ambulance cars to
Patient Transport Service (PTS)
ambulances are available.
The new service is run by E-zec Medical,
a family-run company set up by former
NHS personnel in 1998.
E-zec Medical operates a number of NHS
contracts, including a PTS service in
Hampshire.
There were some initial teething problems
because of heavy demand, but with the
mobilisation of additional crews, E-zec
Medical is now providing a reliable patient
transport service.
NHS Dorset CCG shortlisted
for leadership programme
Christchurch Health Network
wins national award
We were delighted to have been
shortlisted for the inaugural Guardian
Healthcare Innovation Awards.
Our Christchurch locality won a
prestigious award for Making a Difference
at the NHS Alliance Acorn Awards in
November for their community health and
wellbeing project.
October 2013
We were one of three nominees in the
category of Leadership Innovation for
Great Leaders for our Leadership
Development Programme.
This was built into transition arrangements
as we moved from our previous primary
care trust status into our first year as NHS
Dorset CCG.
The aim of Great Leaders was to develop
clinical leadership and commissioning
skills across the NHS.
This is important given the new role GPs
have in managing budgets and planning
how NHS funding is spent.
We developed a high-level training and
learning programme for clinicians.
It was designed to enable them to become
confident leaders so they can fulfil their
role as commissioners, lead local health
priorities and make the best use of
resources as part of the Government’s
recent NHS reforms.
December 2013
The project, led by Jan Childs, practice
manager of Stour Surgery at the time, was
a winner in the best example of a ‘practice
working with its community to improve
health’ category.
The aim of the project was to establish a
Christchurch Health Network, which would
strengthen links with Christchurch
Borough Council, Christchurch
Community Partnership and the voluntary
sector.
Feedback to the locality CCG group then
helps them to improve the health and
wellbeing of local people.
Membership of the health network has
now reached over 175 and includes local
government councillors, representatives
from the health and wellbeing board, third
sector agencies, police, patients and
carers.
21
Getting active in North
and East Dorset
May 2013 / January 2014
Two new schemes aimed at helping
people to get fit and active have been
pioneered in our North and East localities.
New exercise equipment that is free to
use for people living in and around
Blandford Forum was installed in May,
funded by the Blandford Forum Town
Council and our North Dorset locality.
There is a slightly higher than average
rate of obesity amongst adults in North
Dorset so we hope to encourage them to
lead a healthier and more physically
active life.
The locality group is working with other
North Dorset towns and hopes to be able
to provide similar facilities.
In January 2014, our East Dorset locality
worked with Christchurch and East Dorset
Partnership (Moors Valley Country Park)
and Dorset Partnership for Older People
Programme (POPP) to encourage local
people to get active.
The initiative Activate East Dorset offers a
range of free activities to people who are
registered with local GPs. These include:
wellness walks, chair-based exercise
classes and a green referral scheme.
22
Video highlights our work
with new mums
March 2014
The work of the Maternity, Reproductive
and Family Health commissioning team
has been highlighted in a video.
Produced by NHS England to mark them
being a finalist in the NHS England
Excellence in Participation Awards, the
video features interviews with members of
the team along with local mums (see page
35 for more details).
The team was highly commended for their
work in seeking feedback from local
people to inform the commissioning of
maternity services.
The awards were celebrated at the Health
Innovation EXPO 2014 which took place
in Manchester.
You can see the video on our website at
www.dorsetccg.nhs.uk
OUR LOCALITIES
We work to ensure our services meet the different local
needs across Dorset through 13 localities
NHS Dorset CCG serves a population of
around 766,000 people who live in a
combination of widespread rural areas along
with the urban conurbations of Bournemouth,
Poole, Dorchester and Weymouth.
All GP practices in Dorset belong to a locality
which is a geographic area. Each of our 13
localities make up the CCG and each has a
lead GP who also is a member of the CCG
Governing Body.
The Governing Body is responsible for
ensuring that there are appropriate health
care services for the people of Dorset.
Localities can help inform and influence
commissioning decisions both within their
specific area and by working collaboratively
with other localities to improve services across
Dorset.
Each locality is also represented on the local
authorities Health and Wellbeing Boards
where they work alongside elected council
members.
Whilst there are common health needs across
the county, the localities ensure that local
populations have a voice in planning and
prioritising health services.
The localities are grouped into three clusters
across Dorset.
The three CCG clusters are:
West Dorset
Mid Dorset
North Dorset
West Dorset
East Dorset
Christchurch
Central Bournemouth
East Bournemouth
North Bournemouth
Mid Dorset
East Dorset
Poole Bay
Poole Central
Poole North
Purbeck
You can read more about the lead GP for
each locality on page 68. Locality managers
from the CCG work alongside the lead GPs,
prescribing leads and local clinicians and
stakeholders within each of the localities
ensuring that the work of clinical
commissioners for Dorset and localities is
aligned.
23
OUR LOCALITIES
Key achievements of the locality teams
during the year 2013 / 2014 include:
Patient Participation Week took place in early
June when members of the engagement team
visited venues in North Dorset, inviting
members of the public to come and find out
how they could get involved in shaping local
healthcare in the future.
As part of the implementation of a locallybased 24-hour electrocardiogram (ECG)
service, practices in the Mid Dorset locality
have received the equipment and training
ready to start delivery, once the provider is
appointed.
This will improve the local cardiology pathway,
giving rapid, specialist interpretation of
readings and a subsequent reduction in
cardiology referrals and emergency
admissions for undiagnosed arrhythmia
problems
During the summer of 2013 members of the
Weymouth and Portland locality team helped
educate local people of the dangers of staying
out in the sun without protection.
Working in partnership with a number of
stakeholders the team extended a positive,
preventative message through information,
awareness, non-clinical advice and a range of
free merchandise including 9,000 sachets of
24
sun screen and 5,000 UV wristbands.
The Safer Sun Initiative worked in partnership
with a number of stakeholders, including
Dorset Cancer Network, Beach Control, RNLI
Lifeguards, beach traders, Weymouth
Community Volunteers, Weymouth College
and local pharmacies.
An initiative to get people active was launched
in Christchurch locality during early 2014 in
conjunction with Christchurch and East Dorset
Partnership (Moors Valley Country Park) and
Dorset Partnership for Older People
Programme (POPP).
Activate East Dorset offers a range of free
activities to people who are registered with
local GPs.
Dermatoscopes have been purchased for
practices across Purbeck. These will support
local dermoscopy services. This is a
diagnostic technique used for mole screening
and skin cancer diagnosis. We are sure they
will be of great benefit to local people.
The funding of new exercise equipment that is
free to use for people living in and around
Blandford Forum.
The equipment has been funded by the
Blandford Forum Town Council and NHS
Dorset CCG’s North Dorset locality.
CLINICAL COMMISSIONING PROGRAMMES
We have a number of Clinical Commissioning Programmes
(CCPs) working across Dorset to consider how healthcare
services can be improved. CCPs are led by local GPs.
The Cardiovascular Disease, Stroke and
Diabetes Clinical Commissioning Programme
is working to:
develop a balanced approach to all aspects
of care for people with heart disease
ensure that people who are having a stroke
or have had a TIA (mini stroke) can access
specialist services 24 hours a day, seven
days a week
further develop community-based services
for people with diabetes, helping to prevent
complications of the disease and enabling
them to receive care closer to home.
While the CCP is working towards providing
the best possible service to stroke patients,
steps were also taken during the year to help
prevent people having a stroke in the first place.
In Weymouth and Portland, most GP practices
in the area joined a pilot project to offer people
a pulse check when they attended flu jab
sessions.
One practice carried out a one-month inhouse campaign. The aim was to identify
people with atrial fibrillation (AF), an
abnormally fast or irregular heartbeat that can
lead to stroke in the future.
If one was detected, an electrocardiogram
(ECG) was offered to check electrical activity
in the heart and, if that confirmed atrial
fibrillation, the patient could be started on
medication.
A total of 6,086 patients were screened and
256 found to have an irregular pulse. Some
people declined to go on for an ECG, but 165
patients did have the examination and 22
were diagnosed with AF.
Mrs Peggy
Hansford (86)
guessed that
something was
wrong when she
was not able to
walk as far as the
bus stop she had
always used and
was rather
breathless.
‘I was not really
able to do the things I used to do,’ said
Mrs Hansford. But she was caring for her
husband John and didn’t go to the doctors.
Then she had her pulse checked when
she went for her flu jab in the autumn and
that gave her the reason why.
A follow-up ECG confirmed that she had
atrial fibrillation and she is now relieved
that she is on medication to help her avoid
having a stroke. She has regular checks at
Lanehouse Surgery in Weymouth.
‘I have been coming to the doctor’s at
Lanehouse since 1950 when the GP then
held his surgeries at his home,’ said Mrs
Hansford. ‘They are very good – and they
were always good to my husband too. I
feel very supported. They are almost like a
part of my family.’
The project was not only potentially of great
benefit to patients with AF who could have
gone on to have a stroke, but was cost
effective too. It was calculated that by avoiding
potential strokes, every £1 invested in the
project could lead to a saving of £220 to the
NHS.
25
Cardiovascular, Stroke and Diabetes CCP
‘
Clinical Chair of the CCP is
GP Dr Craig Wakeham. He says,
Another successful project launched during the
year was the self-care My Health My Way
service aimed at improving the lives of
people with long-term conditions, including
diabetes.
My Health My Way offers information and
support, giving patients more control and
confidence over their lives and helping them
overcome some of the challenges they face.
They are helped to build and maintain the
confidence to self-manage problems like pain
or fatigue, exercise or dietary changes, anxiety
or depression.
That help could be delivered through one-toone coaching, telephone support, group work,
online tools or structured support groups.
People can be referred by their doctor,
pharmacist or other health professional or refer
themselves.
The service has a dedicated telephone
number, email address and website
www.myhealthdorset.org.uk.
Patients with long-term conditions were
involved in every stage of the development of
the project, including during the procurement
process when it was decided who should
provide the service.
26
Despite significant
improvements, coronary heart
disease is the biggest single
cause of deaths in the UK. Every year there
are approximately 152,000 strokes in the
country, which can lead to severe disability.
There is a considerable rise in the number
of people diagnosed with type 2 diabetes
which can lead to serious health problems in
the long term. Many more people are
thought to have diabetes without knowing it.
This CCP team is working in many different
ways to help people lower their risk of
becoming ill with these diseases.
Eating healthily and taking more exercise
can lower the risk of all three, so we shall
look for ways of helping them to do that.
We shall ensure that if they do become ill,
they receive the right treatment, promptly.
For example, the speed with which people
who have strokes are treated can make a
huge difference to the severity of any
disability they may suffer.
Prevention is better than cure, so we shall
try to identify people at risk of developing ill
health. The atrial fibrillation pilot project (see
page 25) is an example of early intervention.
Helping people to live healthier lives is really
a joint project between them and the NHS
and our partners who provide care for them.
’
We shall work to ensure that people have
the information and support they need to
make the healthy choices that can be of
benefit to individuals and their families.
Mental Health and Learnng Disabilities CCP
The priorities for the Mental Health and
Learning Disabilities Clinical Commissioning
Programme (CCP) are to:
review and improve the pathway for
people who have acute mental health
conditions
review and improve older peoples’ mental
health services and increase early
diagnosis of dementia in our prevalent
population
using learning from the Confidential Inquiry
into Premature Deaths of People with
Learning Disabilities (CIPOLD) and the
Winterbourne View report, further improve
learning disability services that are
provided jointly by the NHS and our local
authorities
improve primary care mental health
services including access to psychological
therapies.
The CCP team is working to ensure that
mental health is valued equally with physical
health to achieve ‘Parity of Esteem’. It is also
working to provide services that are of a
consistently high quality across Dorset for
people with learning disabilities, dementia and
mental health conditions.
Existing services are being reviewed,
redesigned if necessary and commissioned in
three main areas:
Mental Health, which includes:
services for people who are acutely ill
rehabilitation services for people who are
recovering
Steps to Wellbeing, a free, confidential
service for people aged 18 and over
offering a range of different types of
treatment for low mood or depression,
anxiety or stress
assisting people to gain employment
when able
specialised services for people with
conditions such as adult eating disorders
and Asperger’s assessment and diagnosis.
During this year we have commissioned a
Community Asperger’s Assessment Service
across Dorset, which will go live in early 2014/15.
We have also implemented the mental health
urgent care service in the west of Dorset,
including the launch of a recovery house in
Weymouth. This led to an increase in crisis
response home treatment staff, who work to
keep people in their own homes, preventing
hospital admissions.
The recovery house run by Rethink Mental
Illness was a first for Dorset CCG. It opened in
April 2013 with seven beds for people
recovering from acute mental health crisis.
Dementia
The CCG commissions services, often in
partnership, for people living with dementia
and their carers. This includes inpatient
services, the memory assessment service and
memory support and advice services.
We are working with our three local authorities
to commission a pan Dorset memory support
and advisory service for people living with
dementia and their carers.
We have significantly improved dementia
diagnosis rates in Dorset and piloted an
innovative service to help people to gain
support and advice: the Dorset Memory
Gateway.
Learning Disabilities
The White Paper Valuing People defines
learning disability as meaning the presence of:
a significantly reduced ability to understand
new or complex information, to learn new
skills (impaired intelligence) with a reduced
ability to cope independently (impaired social
functioning) which started before adulthood,
with a lasting effect on development.
27
Mental Health and Learning Disabilities CCP
We commission health services specifically for
people who have a learning disability. These
include the community learning disability
teams, which are jointly staffed by local
authorities and the NHS, and an intensive
support team.
A key focus is to ensure that learning from the
Winterbourne View Hospital in Bristol, where
there was criminal abuse of patients by staff,
is taken into consideration and, where
clinically appropriate, as few people as
possible are placed in units outside of their
home area.
We also work with providers to improve how
people with a learning disability access
services and how providers make reasonable
adjustments.
28
Forum values opportunity to
have a say in future services
Chief executive of the West Dorset Mental
Health Forum is Becky Aldridge (pictured
above). She says,
The Dorset Mental Health Forum is an
independent local charity run and led by
people with lived experience of mental health
problems and access to services.
We employ people with their own experiences
Mental Health and Learning Disabilities CCP
of mental health problems and we have a
broad constituency of people across Dorset
who are interested and engaged in our work.
Being able to represent the experiences and
views of people with mental health problems
and advocating for services that promote
wellbeing and enable recovery is a vital part of
our work in Dorset.
Being part of the CCP team and having a
voice within commissioning projects gives us
the opportunity to act as a critical friend and to
bring the customer and patient experience to
the heart of the CCP’s business.
We believe that this perspective brings a
necessary and sometimes challenging
dimension to the CCP’s work in a way that can
influence and shape services.
We particularly support the CCP’s
commitment to ensuring that mental health
has equal priority with physical health.
As No Health without Mental Health states,
‘good mental health and resilience are
fundamental to our physical health, our
relationships, our education, our training, our
work and to achieving our potential.’
We also welcome the CCP’s review of existing
services, ensuring that providers are
delivering ‘recovery-oriented services that aim
to support people to build lives for themselves
outside of mental health services with an
emphasis on hope, control and opportunity.’
We believe that these principles and
aspirations sit firmly with ensuring that people
with mental health problems have choice and
access to the right services at the right time,
including early intervention and availability of
services as soon as they are needed, in the
least disruptive, least restrictive and least
stigmatising way.
GP Dr Paul French. He says,
‘
One of the principal aims of this CCP
team is to ensure that people with a mental
illness or condition are assessed and
treated by services that are on a par with
those available for people with physical ill
health. This is called Parity of Esteem.
One significant illness which is going to
become more common as the population
ages is dementia. This is a devastating
illness for them, their families and carers.
Before we can help to improve their lives,
we need to know who they are, so prompt
diagnosis is really important.
We are working hard with the Dorset
Dementia Partnership to identify dementia
patients early and improve services overall,
for them and their carers.
Dementia is a progressive illness but there
is much we can do to help people maintain
as good a quality of life for as long as
possible.
For other mental illnesses, the emphasis is
on recovery.
To help patients we offer treatment and
support, exploring ways in which they can
gain employment if they are well enough,
and play a positive role in their families and
local communities.
People with learning disabilities are at
higher risk of developing certain health
problems.
’
We want to ensure they have good access
to health checks so that any problems
can be disagnosed early and treated
effectively.
29
Priorities for the Musculoskeletal and Trauma
Clinical Commissioning Programme are to:
develop a comprehensive community-based
musculoskeletal service
embed the new approach to the
management of chronic persisting pain and
extend to other areas
ensure we maximise patient outcomes from
elective surgery.
During the year we have been developing a
new care pathway for people suffering from
spinal pain. A project group has been
established to agree a service specification,
consider the impact this will have on current
services and engage with patients.
We have also commissioned a new Dorset
Community Persistent Pain Service from Dorset
Healthcare University NHS Foundation Trust.
Roll-out of the pain service began in East
Dorset in 2013/14 and consultants will be in
post in Bridport Hospital in West Dorset in June
2014. See next page for examples of how this
service is working in action.
We are ensuring that patients of the orthotics
service receive the same standard of care
across Dorset by drawing up a pan Dorset
service specification.
The orthotics service provides patients with
external devices on weak or injured joints that
need support, for example elbows and wrists.
Oxford Score templates have been provided to
GPs to help them assess whether people with
hip and knee problems should be referred to a
specialist. Patients are asked to ‘score’ their
pain and mobility difficulties in several activities,
for example washing or kneeling. This enables
the GP to reach an overall assessment of their
problems and to decide the best course of
action for them.
Use of the scoring system has led to improved
referrals, a reduction in waiting times and
30
improved outcomes for patients. A review of
physiotherapy services is under way. All
practice managers, GPs and patients using
services at our providers are being surveyed.
Clinical guidelines and service specifications will
then be agreed with clinicians and
communication and training materials
developed for primary care. The public will be
consulted as the service develops.
One of the most significant advances in the
treatment of rheumatoid arthritis in recent years
has been the development of a group of drugs
called biologics.
Following discussions with rheumatology
specialists, a service specification has now
been drawn up for the use of these drugs to
treat psoriatic arthritis and ankylosing
spondylitis as well.
The musculoskeletal five-year vision and
strategy project team has been formed to
oversee the development and implementation of
services from 2014/2019.
Patients, carers and the general public will be at
the heart of this work and their views and input
will drive it forward. Their interest was
demonstrated by an excellent turn-out for our
first public and patient event in February.
Patients feel the benefit
thanks to new pain service
For more years than she can remember,
Judith Watson has been in pain.
She has scoliosis, an abnormal curvature of
the spine, and multi-level spondylosis that
includes age-related wear and tear in her
neck.
‘Everything I do is difficult and painful and that
can lead to all sorts of things, including
depression,’ she said.
Over the years, Mrs Watson (pictured with her
husband Peter, above right) has had X-rayguided injections, that helped for a time but
always wore off before the next one was
given. ‘Medication helps too but makes me
very tired and I am fighting my eyelids by
teatime,’ she said.
But now, she is benefiting from the new
Dorset Community Pain Service that came
into operation during the year and aims to set
a world-class standard.
Mrs Watson now receives injections at more
regular intervals that she finds beneficial.
The pain service team includes, Dr Naeem
Ahmed and Dr Mohamed El Toukhy, the Pain
Consultants, GPs, counsellors, occupational
therapists, specialist pain physiotherapists,
nurses, and psychology and therapy
assistants. The service includes a holistic
approach to pain and Meherzin Das is the
lead for this aspect of the service.
It has a ‘Soaring Above Pain’ website for
service users and professionals. The site
features a virtual ‘patient platform’ specifically
for people who can set and monitor
personalised goals, obtain information about
self-management of pain and generally benefit
from contact with an online community that
understands how they feel.
Discussions are taking place with Dorset
County Council to set up free bespoke classes
for pain patients and free Tai Chi courses are
already on offer in Poole, Bournemouth and
Blandford. Coffee mornings are organised and
there is a quarterly newsletter.
A Pain Chain peer support system trains
people who have already been through
the pain service to mentor others who
are struggling with their condition.
31
Mrs Watson has found the pain management
programme particularly effective. ‘It’s very
helpful to understand how pain works to try
and adjust your attitude to it and “shut the pain
gates” before it takes over,’ she said.
On one session, Mrs Watson and her fellow
participants were asked to visualise their pain
and then think of something that would be an
antidote to it. She visualised red hot metal and
then poured cold water on it.
‘It was very, very helpful. At the end almost all
of us had reduced our estimation of our pain,’
she recalled. ‘They are teaching us the tricks
of the trade.’
Mrs Di Smith, who has had severe arthritis
since 1976, agreed on the value of the
service.
‘I believe that if I had been referred to a pain
management service all those years ago, I
wouldn’t be as bad as I am now,’ she said.
‘I would have been taught exercises and how
to sit and stand properly to help my joints last
longer.’
Her husband suffers from arthritis in his neck
and spine. Both need regular X-ray-guided
injections.
Both couples played an important role in the
consultations that took place before the new
service was commissioned through focus
groups and discussions, including helping to
write the service specification, in which better
communication was a key requirement.
‘When you ring the pain service now you
nearly always get to talk to someone instead
of an answerphone. If you have to leave a
message they will phone you back.
32
Clinical Chair of this CCP
is Dr Christian Verrinder.
He says,
‘
The CCP has achieved a lot
in the last year.
The implementation of the new persistent
pain service was always going to be a
challenge but has been successfully
embedded now into the Dorset Healthcare
system.
We have taken on some ambitious areas to
review this year including physiotherapy
services, a five-year vision and developing
the service specification of an exciting new
back pain service.
’
The engagement from patients,
stakeholders and clinicians alike has
been really encouraging.
‘That’s important because a lot of the time
when you make that phone call you are
at the end of your tether.’
Both couples welcomed the more timely
guided X-ray service and hoped that when all
the patients who need treatment for pain are
identified the correct timetable for each patient
can be maintained.
They also hoped that once the service is fully
up and running it will be a real ‘community’
service and available as close as possible to
their homes.
These are some of the challenges faced by
CCGs when they are planning local
healthcare and it’s why involving patients
when reviewing services is so important and
valuable.
Maternity, Family Services and Reproductive Health CCP
The Maternity, Reproductive and Family
Health Clinical Commissioning Programme
team is working to improve the health of the
family in several different areas. These are
listed with their individual objectives below:
Maternity
We will work to provide a maternity service
that is of an equally high standard across
Dorset and that meets the identified needs of
local mothers-to-be and their families.
We have worked closely with local women and
families to seek their views on key priorities
for development of maternity services in
Dorset.
This work led to us being finalists in the NHS
England Excellence in Participation Awards.
The results of this feedback, as well as the
work we have done with our wider
stakeholders, has now led to the development
of a pan Dorset strategy for maternity services
for the next five years.
Our vision is that maternity services in Dorset
work proactively with partners to support
women and families to give their children the
best possible start in life.
We want high quality, safe and personalised
services that can meet the needs of all
women and families and are delivered in a
sustainable, evidence based, responsive
and compassionate way.
Reproductive and gynaecological services
We will work to ensure that all aspects of
gynaecological care are of a high quality.
During the year we re-commissioned fertility
services and introduced changes that widen
the age limits that women living in Dorset can
qualify for in vitro fertilisation (IVF) from April 1
2014.
We plan to consult widely on further changes
during the coming year.
We have also carried out a local review of
termination of pregnancy services and will be
implementing its recommendations during the
coming year.
Children with additional needs/disabilities
Children and young people with additional
needs/disabilities will have their healthcare
needs met in the local community wherever
possible.
To help us do this we have commissioned
additional occupational and physiotherapy
33
children in Dorset have access to nursing
care in the community when they need it.
By supporting families and carers, making
sure they are well informed about the health
condition their child has, and by providing
training for healthcare professionals in primary
care, we aim to reduce inappropriate A&E
attendances and hospital admissions.
Health outcomes of vulnerable children
support for children with complex needs and
also improved services available for children
needing palliative care.
A review of services for children with Attention
Deficit Hyperactivity Disorder and Autistic
Spectrum Disorders has been carried out and
the findings will be implemented in the coming
year, for example developing pan Dorset joint
care pathways.
Working with partners, we plan to fully
implement the health elements of the Special
Educational Needs and Disabilities Bill, which
will simplify the assessment process for
children with special educational needs and
disabilities who require support from various
agencies.
They will receive a single education, health
and care plan and every provider of services
will be required to publish an offer of services
to this group of children and young people.
Children with chronic disease or who are in
need of urgent care
We will work to provide high-quality care for
children and young people with chronic
diseases across Dorset.
For example, we have increased the provision
of insulin pumps for children with diabetes.
We have also reviewed community
paediatric services and will be introducing a
pan Dorset model of care to ensure all
34
The health outcomes of vulnerable and hardto-reach children, young people and families
will be improved.
During the year we enhanced services for
children who are Looked After (in the care of
the local authority) to ensure that each child
had a timely assessment of their health needs
and a plan of how these should be met.
We also improved medical services for
children who have been abused, ensuring
they have access to health assessments.
Improvements will continue to be made during
the coming year. The effectiveness and quality
of the services we provide will be monitored
and a designated nurse appointed specifically
for children who are Looked After.
Comprehensive Child and Adolescent Mental
Health Services (CAMHS)
We will work to provide a comprehensive
CAMHS to meet the identified needs of
children and young people
Work has continued with our partners
throughout the year to implement the pan
Dorset CAMHS Strategy.
We have also reviewed services for children
with learning disabilities and additional mental
health needs and will implement the findings
of this review in 2014.
These include development of a pan Dorset
pathway of care.
Clinical Chair of the
Maternity, Reproductive and
Family Health is Dr Karen
Kirkham. She says,
‘
The CCP team has had a busy year
completing the work that was prioritised in
2013, including the increased provision of
insulin pumps for children, more speech and
language therapy services and development
of a pan Dorset palliative care service for
children.
Mum Hannah Baker (centre) with Natalie
Bain (left) and Frances Aviss of the CCG.
Mums project wins praise
When it comes to understanding pregnancy,
childbirth and those first days and weeks of a
baby’s life, there is no-one more qualified to
help than new mums.
So when we were deciding our priorities for
the development of maternity services, we
asked for their views.
We made use of the social network Facebook,
which has links to opinion polls and online
surveys. That gave us very useful objective
feedback which we could use in staff training.
A young mum gave a powerful and moving
account of her struggle with anxiety and
depression after her baby was born which was
anonymised and shared with midwives, health
visitors and other members of staff developing
our commissioning strategy.
Another mum Hannah Baker said that at first
she did not see how anything she said could
contribute to future services.
‘I have been amazed that so much had been
Alongside this we have been taking forward
the development of the Maternity Strategy
and review of community paediatric services
We have built strong links with acute and
community providers, and developed a
strong and collaborative commissioning
relationship with our local authority
colleagues across Dorset, which will lead to
improved commissioning of services for
children.
We will continue working to improve
communication with our GP colleagues
regarding new guidelines and improvements
in services with a focus on quality and
equity of access to services.
’
taken into account and there’s a huge amount
of outcomes as a direct result of being part of
the parents’ feedback,’ she said. An online poll
also sought the views of other families to
gather a range of opinions and suggestions.
Mums highlighted the importance of
breastfeeding support. As a result short
soundbites of women talking about their
experiences are now on our website and
available for staff.
Mum Lucinda Holman added: ‘Someone
asking how it was for you and what can we do
to improve services was really amazing.’
35
General Medical and Surgical CCP
The General Medical and Surgical Clinical
Commissioning Programme is working to:
develop comprehensive community
services for common conditions so that
patients can receive their care closer to
home
review, design and deliver new models of
care across a number of priority areas to
improve patient outcomes
ensure that patients receive the right care
in the right place.
The new Dorset Adult Integrated Respiratory
Service is one example of how the
programme is meeting these priorities. This
service will mainly help people with:
moderate to severe chronic obstructive
pulmonary disease (COPD), a collection of
lung diseases including chronic bronchitis,
emphysema and chronic obstructive
airways disease
bronchiectasis where the airways of the
lungs become abnormally widened, leading
to a build-up of excess mucus that can
make them more vulnerable to infection
pulmonary fibrosis, a rare and
poorly-understood condition that causes
scarring of the lungs.
People who have one of these diseases are
more likely to have frequent emergency
admissions to hospital.
To help avoid these admissions, the new
service will enable them to have specialist
respiratory care in the community, closer to
home.
The service extends existing best practice,
including early discharge from hospital
when admission is unavoidable.
Specialist respiratory nurses working partly in
the community and partly in hospitals to
36
support patients can enable them to go home
earlier than otherwise might have been the
case.
They can also signpost patients to a range of
additional services to help them live with and
manage their conditions.
GPs can contact the service for advice and
guidance and refer to the specialist respiratory
team in the first instance, which may avoid the
necessity to admit a patient to hospital.
The new service will be based in the three
acute hospitals in Dorset which will act as
hubs to serve the local population.
The Royal Bournemouth Hospital, Dorset
County Hospital and Poole Hospital are
currently developing their plans to deliver this
new service.
There has been wide consultation with
clinicians and GPs and a patient reference
group has met regularly to comment on all
stages of the process as the service
specification has been drawn up.
Michel Hooper-Immins, a member of the
group and chairman of the Weymouth Locality
General Medical and Surgical CCP
‘
Network and governor of Dorset County
Hospital, said,
’
I enjoyed the patient respiratory reference
group today. I hope it is the start of a useful
exercise in patients influencing the scope and
course of their future treatment.
As the new service is phased in, the group will
continue to provide regular feedback, which
will be taken into account as it develops.
In addition, a patient-reported experience
measure will be used to ensure a genuine
understanding of the patient’s experience.
This new service will be implemented in
phases from April 2014 and will include
education and training for primary care staff.
Events to promote the new service with
primary care will continue until the new
service is fully phased in.
One of the more common ailments that can
seriously affect people’s lives is the headache.
Dr Chris McCall, who says of
the new respiratory service,
‘
This project not only delivers equitable
care across Dorset, it helps to meet the
wishes of those patients who told us they
wanted a proactive, supportive and
integrated healthcare system that
responds to their needs 24 hours a day,
seven days a week.
’
The links between the specialist respiratory
team and the team providing ongoing care
will be an important development for
implementation across other clinical areas.
With around 14% of Dorset residents – more
than 108,000 people – affected by migraine or
cluster headaches alone, we gathered views
on how to improve services for local sufferers.
One way we did this was to hold a headache
discussion forum at Sturminster Newton.
‘
One participant said,
’
It’s great that at last people’s opinions are
being listened to – it’s people living with
conditions who know!
37
Cancer and End of Life CCP
The Cancer and End of Life Clinical
Commissioning Programme team is working to:
reduce cancer deaths through early
diagnosis
improve the experience of patients
recognise and support their needs
throughout treatment and afterwards
improve end-of-life care for all patients,
whatever disease they have and wherever
they spend their last weeks and days
provide an effective and cost efficient
service.
Improvements in treatment means more people
are surviving cancer but survival rates in the UK
are not as high as the best in Europe and vary
across the country.
By diagnosing cancer at an earlier stage, and
ensuring access to the best treatment, it is
hoped that significant improvements in survival
rates can be made. This year for example we
have:
supported the Be Clear on Cancer
Campaign, raising awareness of the
symptoms of cancer
refreshed the cancer two-week wait referral
guidance to make sure anybody with cancer
symptoms is referred at the right time to the
right place
appointed two Macmillan GPs to promote
best practice in cancer and end-of-life care.
Most patients would prefer to receive their care
and treatment closer to home, reducing the
number of follow-up hospital visits and the
amount of travelling they have to do.
We support this where possible, with the focus
initially on suitable patients with breast cancer,
prostate cancer and colorectal cancer.
Patients living with cancer in the long term and
those who are clear of the disease after
38
treatment may still need some support, which
need not necessarily be clinical.
We work with partners to provide this in the
community and one example is the creation of a
community choir (see next page) which can
have a very beneficial effect on its members.
End of Life
Since the launch of the national End of Life
Care Strategy, we have maintained our focus on
providing the best care possible for people
whose lives are coming to an end.
The publication Planning For Your Future guide
encourages patients to ensure their last wishes
are written down and can be acted upon when
they die.
An End of Life Care website has been launched
and education and training programmes put in
place to promote best practice to those involved
in the care of the dying. This has included:
a conference for more than 300 participants
the roll-out of the national Gold Standard
Framework (GSF) programme across care
homes, primary care, acute and community
hospitals
the selection of Dorset as one of three GSF
Integrated Cross Boundary Care
demonstrator sites
the launch of end-of-life care accredited
training for people working in patients’ homes
and care homes.
In drawing up our priorities, we have consulted
widely and made significant progress in
developing joint working with patients and local,
regional and national partners such as NHS
England, Macmillan, Cancer Research UK and
the Dorset Cancer Alliance.
An independent review of all health services
provided to end-of-life patients has been carried
out. There is widespread consultation on the
options recommended which may become part
of the CCP during 2014/15.
Cancer and End of Life CCP
Singing the blues away . . .
Rising Voices Wessex is a community choir
for local people living with and beyond cancer.
It was set up after the Living Well With And
Beyond Cancer In Dorset conference, by
Verena Cooper, lead nurse for Dorset Cancer
Network, and Dr Alastair Smith, clinical
adviser to the National Cancer Survivorship
Initiative.
The project rationale was that singing is fun,
and good for you. It can help with breathing,
combat fatigue and restore confidence.
It doesn’t need to be complicated or
expensive, you do not even need to be able to
read music or sing, but it will help to regain a
sense of wellbeing.
‘
You can sing for fun - everyone can! As one
member commented,
I want to say how much I enjoyed choir last
evening! What a lovely friendly, cheerful
crowd of people. I will definitely be back next
week!
I got home last night and couldn’t remember
any of the tunes to the words I had, but woke
up this morning with the melody of ‘Sing’ in my
head – how amazing was that!
’
The project is a co-operative venture between
the CCG, Dorset Cancer Network, Lewis
Manning Hospice, Macmillan Cancer Support,
Dorset Cancer Network Patient Partnership
Panel and Lighthouse in Poole.
Picture courtesy of Lewis Manning Hospice
Clinical Chair of the CCP
is Dr Lionel Cartwright,
who says,
‘
Despite the relatively high
incidence and prevalence of
cancers in the CCG area, Dorset cancer
patients experience outcomes, survivorship and
life expectancy on a par with the best in the
country. This is a tribute to the skills of our
clinicians, the tenacity of our patients and the
support of their families and friends. We are not
complacent and we aspire to achieve health
outcomes that match the best in the world.
We are working to raise cancer awareness as
many cancers can be treated successfully if
diagnosed early. The Be Clear on Cancer
campaign has led to an extra 300 cases of lung
cancer being identified and treated nationally.
We urge people to seek a diagnosis at the first
signs of a problem.
Non-clinical activities can help maintain a good
sense of wellbeing, even while receiving
treatment. Such projects as ‘Rising Voices
Wessex’ provide a chance to have fun which,
with healthy eating and regular exercise, can
make a real difference to how people cope.
For people nearing the end of their lives, we are
working with specialist and community-based
services to provide sensitive and personalised
care, designed around the individual and
provided closer to home. The patient will always
be at the forefront of services in the future.
’
39
STRATEGIC REPORT
Our business model
NHS Dorset CCG was created on 1 April
2013. Our mission is to support people in
Dorset to lead healthier lives.
To read more about our role as commissioners
of healthcare for the county of Dorset, and our
aims and values, please turn to pages 8 and 9
within our Governing Body / Members Report
section. To understand how we work, please
turn to pages 48 to 50 in this section.
Our licence conditions
NHS Dorset CCG was created and fully
authorised without conditions.
Our strategy
You can read more about our strategy and
priorities including the three pan Dorset
transformational programmes on page 11 of
our Governing Body / Members’ Report as
well as within our Business Review on page
50 in this section.
You can read more about how our strategy will
support these challenges, including the three
pan Dorset transformational programmes on
page 46.
CCG Assurance Framework
Our assurance framework section outlines
how the CCG has discharged its duties under
the amended NHS Act 2006.
A range of examples within this annual report
evidences how we have applied the required
assurance frameworks to our business.
We have ensured health services are provided
in line with the NHS Constitution targets –
more information is available on page 44.
We are committed to supporting the NHS
Constitution among patients, public and staff –
more information is available on page 46
onwards. We also ran a media campaign on
local radio throughout Dorset from January-
40
March 2014. The aim of this campaign was to
help people understand what the NHS
Constitution means to them and we developed
website information for them to download and
comment upon.
NHS Dorset CCG has supported NHS
England in ensuring high quality primary
medical services have been maintained.
The CCG has indicated that it would want
to further enhance its role to include
developing primary care and is discussing
with NHS England
We actively encourages patient choice and
the member practices promote and encourage
the use of Choose and Book services, with
very high levels of usage across the whole of
Dorset.
We promoted the involvement of patients,
carers and their representatives in decisionmaking.
Page 22 in our Highlights of the Year section
cites an example from our work with maternity
services, which was highly commended by
NHS England.
We have also been commended for our work
in innovation, leadership, education and
training in the Guardian’s Healthcare
Innovation awards (see page 21).
We consulted widely when drawing up our
commissioning plans. From a range of
engagement events with our stakeholders
(see page 2) to a large-scale public survey
called the Big Ask developed with our other
NHS partners (see page 18).
We have also developed a wide range of
engagement and feedback channels to ensure
people can get involved in our work. Read
more on pages 61 to 62 and on our back
cover.
Through our dedicated emergency
preparedness and resilience team, we have
taken appropriate steps to ensure the CCG
STRATEGIC REPORT
and its providers are properly prepared for any
incidents. More information on these plans is
available on pages 60 to 61.
We have cooperated with our Health and
Wellbeing boards to align our strategy (see
pages 11 and 62). We have also worked with
our local authorities to prepare Joint Strategic
Needs Assessments (page 48).
Our Quality team takes responsibility for child
safeguarding. Read more about their work on
page 55. We also have a dedicated clinical
lead – Dr Peter Blick – for child and adult
safeguarding (please see page 70).
NHS Dorset Clinical Commission Group
certifies that it has complied with the statutory
duties laid down in the NHS Act 2006 (as
amended).
Financial Key Performance Indicators (KPIs)
More information regarding our KPIs can be
found on pages 14 to 15 within our Governing
Body / Members Report section.
Additional information on KPIs can be found in
our financial tables. Specific areas to highlight
are: revenue surplus (see next page), staff
costs and average persons employed (see
page 87), running costs (see page 86) and
Better Payments Practice Code (see
page 88).
41
STRATEGIC REPORT
Financial Overview
We achieved our financial duties for 2013/14 and delivered a surplus of £12.6 million, which
included a surplus of £2 million on the CCG running cost allowance, which is set nationally at £25
per head of population. This was delivered against the revenue resource limit of £928.4 million and
a running cost allowance of £18.7 million, respectively. By spending less on our running costs, we
are able to spend more on direct patient care.
There have been a number of challenges for the CCG in the 2013/14 financial year, not least of
which was ensuring that the baseline funding from the legacy PCTs was with the right
commissioner. The biggest challenge in this context was in respect of specialist commissioning.
Transfer adjustments were agreed in September 2013 with NHS England.
The CCGs annual revenue performance is set out in Table 1.
Table 1: Summary of 2013/14 Revenue Performance
2013/14
2013/14
2013/14
Programme
Running Costs
Total
10,614
2,000
£'000
Revenue Resource Limit
Under spend against
Percentage under spend
928,367
1.1%
£'000
£'000
18,730
947,097
10.7%
1.3%
12,614
Although the CCG was only required to deliver a 1% surplus, the decision was taken to maintain
the legacy Dorset PCT and Bournemouth and Poole Teaching PCT levels going forward.
Analysis of Net Operating Costs 2013/14
Performance
£m
The final performance against the 2013/14 indicators will not be available until later in the year, the
results will be published on the CCG's website. The CCG continues to monitor performance
against national quality standards and performance against QP (Quality Premium) indicators. The
following position is based on the latest performance.
42
STRATEGIC REPORT
National Quality Standards
Indicator definition
Admitted patients to start treatment within a maximum of 18 weeks from referral
(specialty level)
Non-admitted patients to start treatment within a maximum of 18 weeks from referral
Referral to Treatment
waiting times for non-urgent (specialty level)
consultant-led treatment
Patients on incomplete non-emergency pathways (yet to start treatment) should have
been waiting no more than 18 weeks from referral (specialty level)
Zero tolerance of over 52 week waiters
Cancer waits - 2-week waits
Cancer waits - 31 days
Cancer waits - 62 days
Maximum two-week wait for first outpatient appointment for patients referred urgently with
suspected cancer by a GP)
Maximum two-week wait for first outpatient appointment for patients referred urgently with
breast symptoms (where cancer was not initially suspected)
Maximum one month (31 day) wait from diagnosis to first definitive treatment for all
cancers
Maximum 31 day wait for subsequent treatment where that treatment is surgery
Maximum 31 day wait for subsequent treatment where that treatment is an anticancer drug regime
Maximum 31 day wait for subsequent treatment where the treatment is a course of
radiotherapy
Maximum two month (62 day) wait from urgent GP referral to first definitive treatment
for cancer
Maximum 62 day wait from referral from an NHS screening service to first definitive
treatment for all cancers
Maximum 62 day wait for first definitive treatment following a consultant's decision to
upgrade the priority of the patient (all cancers)
Category A Red 1 calls resulting in an emergency response arriving within 8 minutes
Category A ambulance calls Category A Red 2 calls resulting in an emergency response arriving within 8 minutes
Diagnostic test waiting times
Category A calls resulting in an ambulance arriving at the scene within 19 minutes
Patients should be admitted, transferred or discharged within 4 hours of their arrival
at an A&E department
Mixed Sex Accommodation
Sleeping accommodation breach
Mental Health
Infection Control
Rating
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Patients waiting for a diagnostic test should have been waiting no more than 6 weeks
Not Achieved
from referral
A & E waits
Cancelled operations
2013/14
No waits from decision to admit to admission (trolley waits) over 12 hours
Achieved
Not Achieved
Achieved
All patients who have operations cancelled, on or after the day of admission
(including the day of surgery), for non-clinical reasons to be offered another binding
Not Achieved
date within 28 days, or the patient's treatment to be funded at the time and hospital of
the patient's choice.
No urgent operation to be cancelled for a 2nd time
Care Programme Approach (CPA): The proportion of people under adult mental
illness specialties on CPA who were followed up within 7 days of discharge from
psychiatric in-patient care during the period
Zero tolerance of MRSA
Rates of Clostridium Difficile
Achieved
Achieved
Not Achieved
Achieved
43
STRATEGIC REPORT
Although NHS Dorset CCG did not achieve in 2013/14 six of the national quality standards shown
on page 43, we continue to make progress against them through regular contract review meetings
with providers.
Some further details are provided below:
MRSA – 7 cases haved been reported in 2013/14 compared to 13 cases in 2012/13 for the two
former PCTs
a total of 21 operations cancelled were not rebooked with 28 days. However these patients
were treated within a short period of time after the 28 days
only 15 cases of mixed sex accommodation breaches were recorded in 2013/14, all of which
related to Salisbury NHS Foundation Trust
a total of 7 trolley waits over 12 hours from decision to admit were recorded in 2013/14, of which
two were agreed as being clinically appropriate
a total of 6 patients (to the end of January 2014) were waiting over 52 weeks for treatment,
across all our commissioned providers in England.
Quality Premiums
The Quality Premium is intended to reward the CCG for improvements in the quality of the services
that we commission and for associated improvements in health outcomes and reducing
inequalities.
Payment will be up to £5 per patient in the CCG as an additional fund, receivable in 2014/15. The
Quality Premium is reduced if the commissioned providers do not meet the NHS Constitution
requirements.
2013/14
NHS Constitution requirements for the following patient rights pledges
90% of patients during the year should wait no more than 18 weeks from referral
to consultant-led treatment
95% of patients during the year should be admitted, transferred or discharged
within four hours of their arrival at an A&E department
85% of patients during the year should have a maximum wait of 62 days from
urgent GP referral to first definitive treatment for cancer
75% 8 minute response for Cat A (RED 1) ambulance calls (based on South
West Ambulance full service)
Expected Adjustment (based on Forecast Rating)
Actual
Expected Rating
95%
Achieved
96%
87%
71%
Achieved
Achieved
Not Achieved
25%
Although South Western Ambulance Service NHS Foundation Trust has been unable to achieve
the 8 minute response rate in 2013/14, continual progress is being made to improve the
performance, taking the South West as a whole into account.
It should also be noted that the performance for the population of Dorset continues to see
response rates above the 75% target and it is the areas outside of Dorset in which South
West Ambulance NHS Foundation Trust operates that are causing us not to achieve this
target.
44
STRATEGIC REPORT
Domain
Domain Definition
Preventing people from dying
prematurely
Reducing the potential years of life lost from causes
considered amenable to healthcare: adults, children
and young people by at least 3.2%
Long-term conditions
Reducing emergency admissions combined across
the following areas
1) Unplanned hospitalisation for Chronic
Ambulatory care sensitive conditions
2) Unplanned hospitalisation for Asthma, Diabetes
and Epilepsy in under 19s
3) Emergency admissions for acute conditions that
should not usually require admission
4) Emergency admissions for children with lower
respiratory tract infections (LRTI)
Rating
Achieved
Achieved
Recovery from episodes of ill health or injury
Ensuring that people have a positive
experience of care
1) Roll out of Friends and Family Test
2) An improvement in average FFT scores for acute
inpatient care and A&E services between Q1
2013/14 and Q1 2014/15 for acute hospitals that
serve a CCG's population
Treating and caring for people in a safe
environment and protecting them from
avoidable harm
1) No cases of MRSA and
2) Clostridium Difficile are at or below defined
thresholds for CCG
Local Priority Quality Premium
Domain
Domain Definition
Achieved
Not Achieved
2013/14
Expected Rating
Knee replacements
Total health gain assessed by patients by difference between the
pre-operative score and post-operative score as completed by the
patient
Dementia
Number of people diagnosed / prevalence of dementia
Achieved
Under-75 mortality rate
Under 75 mortality rate respiratory disease - 21.5 per 100,000
population
Achieved
Achieved
45
STRATEGIC REPORT
Outlook for 2014/15 and beyond
The level of growth over the next two years for
clinical commissioning groups has already
been published nationally and NHS Dorset
CCG will receive 2.14% (2014/15) and 1.7%
(2015/16) respectively, although national
planning commitments against the growth
made available is not fully known.
The current planning assumption for 2014/15
and 2015/16 is that we will continue to
maintain surplus levels at £12 million by not
utilising any of the brought forward surplus in
either year.
This is in line with NHS England planning
guidelines and represents 1.3% of our total
budget.
The NHS is facing significant and enduring
financial pressures over the forthcoming
periods and our CCG and Dorset health
economy is no exception. Within 2013/14
significant non-recurrent financial support had
to be provided to some of our hospitals, and
this has continued into 2014/15.
There is recognition by the
CCG that people's needs for
services continue to grow.
This means that we have to
transform the way services
are delivered to continue to
deliver high quality services within the
resources available.
In addition to the challenges facing the local
health economy, the CCG also recognises the
need to continue to work with local
government to develop strong plans to secure
continuity of sustainable services for the
future.
The recognition of these challenges in the
local health and care system has resulted in
strong partnership working across providers
and local government, including plans
submitted under the Better Care Fund national
initiative, to provide more integrated health
and social care services, with a particular
emphasis on services for the frail elderly.
As part of the recognition and commitment of
the CCG to provide sustainable and high
quality services for the future, we will be
commissioning a Clinical Services Review in
2014/15 to begin to address the challenges of
financial sustainability, an increasingly ageing
population, complex delivery systems and
long term conditions.
It is recognised that we need to be bold and
innovative and have no predetermined
solutions or options going into the Review,
whilst extensively engaging with patients, the
public, provider organisations and partner
stakeholders to ensure that the 'blueprint' for
services is fit for Dorset.
Paul Vater
Chief Finance Officer
46
STRATEGIC REPORT
Business review
NHS Dorset CCG is overseen by NHS
England and in common with all other CCGs,
we have a constitution which sets out our
business processes.
NHS Dorset CCG began from a strong
platform of success with sound finances and
strong clinical leadership left by the two
organisations it replaced – Bournemouth &
Poole and Dorset Primary Care Trusts.
One of the major changes in the healthcare
system has been the development of GPs as
leaders of healthcare commissioning, as each
practice became members of the CCG.
To prepare them for this new role, we
organised four engagement and development
events with more than 545 GPs and practice
managers attending.
We recorded some milestone achievements
during our first full year of operation, such as
successful commissioning of the new NHS
111 non-emergency phone service which went
live in Dorset during April.
Despite negative media attention in other
parts of the country, the 111 service for
Dorset, delivered by South Western
Ambulance Service Foundation Trust, is
performing well and improving week by week.
The commissioning teams continue to lead
major programmes including the review of
Urgent Care and Making Purbeck ‘Fit for the
Future’ 2013 which focuses on making local
healthcare sustainable.
There are more details about these and other
successes in Highlights of the Year on pages
16 to 22.
Recent NHS reforms not only place clinicians
in charge of the budgets but also put patients
central to the agreement of our health
priorities.
We began this work in earnest by launching
our strategy and public prospectus. GPs have
facilitated events where more than 300
members of the public, patients and health
partners fed back their views to inform our
strategy.
As part of our KPIs we committed to delivering
three priorities by April 2014 – as detailed on
page 11.
The NHS has a challenging time ahead and
we have to be confident about where we need
to spend our budget and be creative in how
we spend it – such as ensuring we join up with
other healthcare and voluntary organisations
to get the best out of the services on offer.
We start from a robust financial position, clear
clinical leadership with a commitment to make
a difference to health provision and a firm
foundation of working with partners and
stakeholders across health and social care.
We will ensure that we continue to listen to our
patients and gather their feedback to make
this difference felt in Dorset.
Risks and uncertainties
We will face an increasingly challenging
financial year in 2014/15 as the NHS
continues to operate within a tight financial
framework during a period of further change
and movement towards greater integration
with social care.
This should be viewed against a background
of a rising number of older people in the local
population, health inequalities and a
significant number of people living with
disability and long-term conditions.
The emphasis will need to be one of
continued financial control to support the CCG
to commission sustainable health services
and deliver the outcomes to meet our strategic
objectives.
This will include providing non-recurrent
funding to support a full clinical services
review.
47
STRATEGIC REPORT
Although NHS Dorset CCG ended its first year
of operation with a planned underspend of
£12 million, financial risks emerged towards
the end of the year, particularly in the area of
continuing healthcare funding.
The increase on emergency pressures
experienced in all acute hospitals required the
CCG to fund non-recurrent schemes to
address the winter pressures.
GP referrals grew by 4.5 percent in 2013/14
and this trend is causing pressures on hospital
and community services.
This increase will require changes to planned
activity within the secondary care provider
contracts for 2014/15.
Our finance and performance teams will
continue to work very closely with the
localities to develop referral management and
financial monitoring systems.
These systems look at referral patterns and
the associated financial impact. A Dorset
Information Dashboard has been developed in
partnership with Somerset CCG and has been
offered to every practice in Dorset. Uptake for
this commissioning intelligence tool has
been high.
The area we serve
Dorset GP practices serve a population of
around 766,000 living in sparsely distributed
rural areas and the urban conurbations of
Bournemouth, Poole and Weymouth.
Overall the population of Dorset enjoys
relatively good health with a higher life
expectancy than the English average.
The challenges are:
48
a high and rising proportion of older people
– which is predicted to grow by six per cent
between 2013 and 2020. This poses a
significant challenge for the health and
social care system
inequalities in life expectancy across
Dorset – although there have been
reductions, gaps of 4.4 years among men
and 3.5 among women still exist in certain
areas
cardiovascular disease (CVD) and cancer
are the major causes of death which
together accounted for 29 per cent of
deaths in 2011
increasing numbers of people living with
long-term conditions (LTCs). In 2011, 19
per cent of people in Dorset were living
with a LTC or disability which impacted on
their health
although most people lead healthy
lifestyles, some issues such as smoking,
smoking in pregnancy, sexual health,
alcohol consumption and obesity give
cause for concern.
In order to address the potential health needs
of the population, Joint Strategic Health
Needs Assessments (JSNAs) have been
produced in conjunction with local authorities
across Dorset.
How we work
We have two business bases: one in Poole in
the east of Dorset and the other in Dorchester
in the west of the county.
Clinical engagement and leadership is
provided via GP leads from each of the 13
localities in Dorset who sit on the Governing
Body. Their key roles are:
shaping the direction and supporting the
implementation of the CCG and health and
wellbeing strategies
representing the views of their practices
and patients on how services are designed
and provided
supporting the delivery and implementation
of services within the locality.
STRATEGIC REPORT
Our member practices are at the heart of our
communities and in a good position to
understand the needs of their populations.
Members can influence decisions and provide
feedback through the locality chair and at
locality meetings, so that local focus is not lost
amongst the national and wider Dorset
priorities. There are more details about our
localities and how they work on pages
23 - 24.
Patients and the public can influence and
provide feedback in many ways such as via
their practice, the Health Involvement
Network, or patient participation groups. Read
more about how you can get involved on the
back cover of this report.
We have internal commissioning support
services, which are provided through four
directorates:
Quality
Service Delivery
Finance and Performance
Engagement and Development.
Suzanne Rastrick, Director of Quality
Each directorate is led by an executive
director, accountable to the Chief
Officer, Tim Goodson. They are:
Jane Pike, Director of Service Delivery
Charles Summers, Director of Engagement
and Development.
You can read their biographies on pages
73 - 74.
Providers
We are able to commission services from a
range of providers to ensure we get value for
money and meet local needs.
Providers may include local health partners
e.g. community or acute hospitals, mental
health organisations, local pharmacies,
private businesses and other organisations.
Our key providers across the county include:
Dorset County Hospital NHS Foundation
Trust
Dorset HealthCare University NHS
Foundation Trust
Poole Hospital NHS Foundation Trust
Royal Bournemouth and Christchurch
Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
University Hospital Southampton NHS
Foundation Trust
Yeovil District Hospital NHS Foundation
Trust
South Western Ambulance Service NHS
Foundation Trust.
Our plans for improving care in Dorset
If we are to have sustainable health and social
care services in Dorset that are fit for the
future, we need to work with stakeholders,
partners and providers to make courageous
decisions on how local services are provided.
Over the next two years the CCG will focus on
delivering local priorities as well as national
objectives set out in the documents NHS
Mandate 2013 to 2015 and Everyone Counts:
Planning for Patients in 2014/15 to 2018/19.
This national planning guidance sets out the
challenges and priorities for NHS England.
It emphasises that CCGs will need to make
courageous decisions with partners and
providers to change how services are
delivered.
It aims to ensure that the quality of care is
raised to the best international standards,
49
STRATEGIC REPORT
whilst closing a potential funding gap of £30bn
by 2020/21.
We are committed to delivering the national
priorities and improving the health of the
population in Dorset. Through the delivery of
our three transformational programmes and
Clinical Commissioning Programmes (CCPs)
we will:
improve outcomes for patients as
measured through the five domains of the
NHS Outcomes Framework and seven
outcome ambition measures
reduce inequalities
improve mental health as well as physical
health
involve and engage stakeholders through
every stage of development and change
transform service models with our partners
focus on
access
quality (patient safety, experience
and effectiveness, including actions
from the Francis, Berwick and
Winterbourne View reports and NHS
Constitution)
innovation and research
value and the best use of resources.
To help us do this, we have a plan for 2014 to
2016 which outlines how we will deliver the
first two years of our five-year strategy.
This plan outlines how we will concentrate on
three transformational programmes:
50
Better Together – this aims to transform
health and social care across Dorset to
enable and deliver a sustainable
improvement in health and care through
person-centred, outcome-focused,
preventative, co-ordinated care
Clinical Services Review – this will review
clinical services across the health and
social care system and those that span
Dorset population boundaries to ensure
high-quality, patient-centred, sustainable
services
Urgent Care Review – the Pan Dorset
Urgent Care Programme aims to transform
urgent care services across Dorset by
aligning services and simplifying pathways,
integration and by using technologies.
These programmes are interlinked and will be
delivered in partnership with the three local
authorities and the four main NHS foundation
trusts in Dorset.
They will look for further opportunities to
integrate health and social care and ensure all
services are provided as close to home as
possible and in community settings unless it is
not appropriate to do so.
The programmes will be overseen by the
Better Together Sponsor Board, with each
partner organisation having lead responsibility
for relevant projects within them.
They will be supported by our Clinical
Commissioning Programmes (CCPs) and
through working in partnership with
stakeholders.
The plan includes how our internal
commissioning support team will work to help
deliver these transformational programmes,
support the CCPs and ensure that the CCG
continues to meet all of its legal duties.
Clinical commissioning
The commissioning of healthcare is organised
within Clinical Commissioning Programmes
(CCPs).
Each of these programmes is clinically led by
a GP and includes members from a range of
disciplines and professions.
These multidisciplinary members bring
together their knowledge and expertise to
prioritise what needs to be done to redesign
and implement improvements to services.
STRATEGIC REPORT
Each of these programmes involves other
clinicians, patients and providers to consider
and deliver improvements to services.
The programmes support the delivery of three
transformation programmes as well as specific
priorities. The CCPs and their GP Leads are:
General Medical
Dr Chris McCall
Maternity, Reproductive and Family Health
Dr Karen Kirkham
Cardiovascular Disease, Stroke and Diabetes
Dr Craig Wakeham
Musculoskeletal and Trauma
Dr Christian Verrinder
Mental Health and Learning Disabilities
Dr Paul French
Cancer and End of Life
Dr Lionel Cartwright
The Pan Dorset Programme for Urgent Care,
Clinical Services Review and the Better
Together Programme will go into operation
during 2014/15
Dr Simon Watkins.
Read more about how the CCPs are
delivering real benefits for real people on
pages 25 to 39.
Equality and Diversity
The CCG is committed to ensuring as an
employer it provides an open and supportive
environment to staff, recognising that all
employees have the right to be treated with
consideration, dignity and respect. The CCG
ensures it meets this commitment by:
its mission, aims, strategy and supporting
objectives
supporting employees in their professional
development
ensuring employees have access to
statutory and mandatory training including
development around equality and diversity
providing a happy and fulfilling environment
in which to work, where staff are engaged
and involved in matters which affect their
working lives
attracting and retaining high calibre staff
through an open and transparent
recruitment and selection programme
which is responsive to the diverse needs of
the applicants
creating an environment where staff are
able to raise any concerns they may have
with supporting policies in place which are
open and transparent and consistently
applied
providing development to managers to
ensure they support their members of staff
supporting staff in their health and
wellbeing, through manager involvement,
HR intervention and through an
occupational health programme as well
as an employee assistance programme
offering a completely confidential
counselling, support and mediation service
for all staff and their immediate families.
The CCG recognises its obligations under the
Equality Act 2010 and the supporting
employment legislation, which is reflected in
the CCG Dignity at Work Policy.
The CCG is committed to ensuring the
principles of this policy are embedded into the
organisation and actively monitors its
performance through the production and
analysis of internal workforce data relating to
each of the nine protected characteristics.
Workforce and HR support
Our workforce team supports the organisation
with HR advice and guidance and played an
important role in helping our clinicians and
commissioning staff successfully manage the
transition from PCTs to CCG.
We have amended our HR policies to reflect
the new organisation and during 2014/15 we
51
STRATEGIC REPORT
will be strengthening the workforce function
further by moving all HR transactional services
in-house.
Male
Female
26.19%
73.81%
Bands 1-7
16.75%
Governing Body
76.92%
Senior Managers
Staff gender analysis
83.25%
23.08%
Organisational development
Clinical development
During 2013/14 we introduced initiatives to
support the development of clinicians as leaders
of the CCG, ensuring they can fulfil their role as
clinical commissioners, leading local health
priorities and making the right resource choices.
As a membership organisation comprising 100
practices in Dorset, we run regular GP
membership events and Governing Body
development workshops supporting our clinical
leads to fulfil their role. Over 400 GPs attended
these activities during 2013/14.
We offer communications and public relations
training and advice to equip the Governing Body
and GPs with this new aspect to their role, so
they can respond to the media and provide the
authentic clinical voice of the CCG.
We organised commissioning skills
development for clinical leaders linked to each
of our six Clinical Commissioning Programmes.
GPs also work closely with our engagement and
communications team at local events, by talking
to patients and the general public about their
healthcare needs and experience.
Commissioning support development
Throughout the year, nearly 300 people
attended induction sessions aimed at helping
our support teams develop a clear
52
understanding of the CCG’s role, purpose,
mission and aim.
Each of our four directorates run regular
development days to ensure commissioning
support teams are fully briefed on the CCG
strategy, the challenges ahead and the changes
to our business.
The Chief Officer holds regular briefings where
staff have the opportunity to discuss concerns
and hear ‘from the top’. Staff can access inhouse and external training for their
professional development, including places on
the NHS leadership academy programmes.
Sustainability
The NHS aims to reduce its carbon footprint by
10% between 2009 and 2015. In support of this
target, NHS Dorset CCG is committed to
promoting sustainability and has included a
requirement in the NHS contract relating to the
Carbon Reduction Strategy, which includes the
following elements:
saving Carbon, Improving Health – this
requires provider organisations to report on
progress on climate change adaptation,
mitigation and sustainable development
including performance against carbon
reduction management plans. The
providers are required to incorporate the
outcome in their respective annual reports
Sustainable Development Strategy –
provider boards are required to approve a
strategy
Carbon Management & Climate Change
Adaptation Action Plan – providers should
agree a plan and provide the performance
against the agreed standards
Initial/annual reassessment – providers
are required to continually monitor and
provide a report on progress.
Clinical Commissioning Group position
The CCG has a Sustainability Strategy which it
STRATEGIC REPORT
has adopted from the former Primary Care
Trusts, which runs from 2010-2014. The
strategy recognises the CCG’s responsibility
and has aligned delivery work streams with
the Good Corporate Citizenship model. The
CCG is currently in the process of writing the
new strategy for the 2014/15 – 2018/19 period.
Good Corporate Citizenship model
The key areas for action are energy, water
and carbon management, sustainable
procurement and food, low carbon travel,
transport and access, waste reduction and
recycling, green spaces, staff engagement
and communication, buildings and site design,
organisational and workforce development,
partnership and networks, governance, IT and
finance.
Energy, water and carbon management
The CCG is aware of its own responsibilities in
supporting sustainability and has already
greatly reduced the office space footprint in
2013/14 at the Canford House site from 1,899
to 941sqm and is continuing to review
accommodation requirements. In order to
further facilitate moves to a smaller footprint
the CCG has introduced smaller desks to both
maximise the space in its corporate office and
also to create a paperless environment.
It should be noted that the CCG does not
directly pay for energy and water as the
responsibility for properties within the
commissioning architecture sits with NHS
Property Services Ltd.
Sustainable procurement
The CCG is committed to reducing indirect
environmental and social impacts associated
with the procurement of goods and services.
Purchasing procedures are constantly being
refined to help minimise waste, which includes
ensuring that we incorporate a sustainability
section on any procurement.
Waste reduction and recycling
Across all sites used by the CCG, we have
incorporated a paper recycling collection
service. In addition the CCG has also
implemented recycling of computers and
related items in partnership with wider
community groups.
Low carbon travel, transport and access
In recognising the benefits of supporting low
carbon travel the CCG has removed all lease
cars for staff and have introduced low
emission pool cars in their place. In addition
the CCG has dedicated car parking spaces for
car sharers. In 2014/15 the CCG is looking to
re-introduce a cycle to work scheme, (see
table below).
Partnership and networks
The CCG as part of its wider stakeholder
involvement has signed up to the
In 2013/14 Dorset CCG have had the following costs and performance in relation to travel:
Classification
Miles Travelled
Pool Car Usage
59,620
Mileage Claims
416,722
Cost £
tCO2e
20,684
44
217,975
154
(tCO2e stands for “Tonnes of CO2 equivalent”, which is a measure that allows you to compare
the emissions of other greenhouse gases).
53
STRATEGIC REPORT
Bournemouth Borough Council sustainable
city plans.
As part of the wider communications with staff
regarding restricted parking at CCG sites, the
CCG has actively promoted the use of car
sharing and park and ride options operated by
local authorities.
Staff engagement and communications
Included within the job specifications for all
new members of staff there is a requirement
to promote and embrace the principles of
sustainable development in their daily duties
and to ensure that they use energy and other
natural resources as efficiently as possible to
minimise their carbon footprint.
In addition we have participated in the NHS
Sustainability Day by encouraging a paperless
day by staff which was also promoted on
Twitter and internal communications.
Governance, IT and finance
In order to support lower waste the CCG is
committed to using technologies where
possible, which has resulted in the
introduction of video-conferencing and mobile
devices to reduce the need for travelling and
waste paper.
Key Provider Snapshot
Royal Bournemouth & Christchurch Hospitals
NHS Foundation Trust (RBCHFT)
The Trust has continued to make significant
progress in improvements on sustainability
and have chosen to purchase electricity from
100% combined heat & power (CHP)
guaranteed sources during 2013/14.
In addition it is worth noting that the Trust
generates approximately 15% of its energy
onsite, through solar panels and low pressure
water.
54
Poole Hospital NHS Foundation Trust (PHFT)
The Trust has undertaken an investment
grade audit as part of an Energy Performance
Contract (EPC), working with British Gas &
Breathe Energy.
This contract identifies measures to reduce
energy consumption by 25% to support
delivery towards the 2015 target.
In addition schemes that have been put in
place include LED lighting, cardboard
compactor to support recycling and active
promotion of a dedicated car share scheme.
Dorset Healthcare University NHS
Foundation Trust (DHUFT)
The Trust is continuing to make progress on
reducing carbon emissions of 10% by 2015,
which has included a significant reduction in
floor space (m2) since 2007/08, although at
the same time staff numbers have increased.
A resulting factor of this reduction is the drop
in gas and electricity usage.
The Trust has implemented a number of
improvements including replacement of
boilers, upgrading lighting to LED and
installation of combined heat & power (CHP)
at St Ann’s Hospital.
Dorset County Hospital NHS
Foundation Trust (DCHFT)
The Trust has developed a Sustainable
Development Management Plan where it is
actively monitoring progress on the key
themes identified in the Good Corporate
Citizenship model, including detailed actions,
which are regularly monitored.
The key performance areas will be reported
as part of the Trust annual report.
STRATEGIC REPORT
Improving quality
Putting quality at the heart of all we do
The quality team is responsible for patient safety,
quality improvement, corporate governance and
medicines management. The team is committed to
ensuring compassionate care is equally as important
as the quality of treatment. We work closely with
providers of care to ensure that our patients, their
families and carers are treated with compassion,
respect and dignity, in safe environments and are
protected from harm. Our outcomes for 2013/14
include:
Infection control
We continue to work in partnership with all our providers and have made progress in reducing the
number of healthcare-acquired infections. These results have been achieved by the provision of
training, information and advice with infection prevention and control teams across Dorset to share
best practice and monitor and learn from incidents.
During 2013/14 cases of MRSA in Dorset reduced from 2012/13 figures to a total of seven per
year. Incidences of C-difficile are also declining, as shown overleaf.
55
STRATEGIC REPORT
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NB Dorset data in this table includes care homes, community hospitals and individuals at home
We have a number of contracts with care
home providers delivering nursing care to
residents.
To ensure that the type of care being both
commissioned and provided is meeting the
needs of residents, our Care Home Quality
Assurance Team have undertaken joint visits
with three local authorities to review current
arrangements and provide guidance and
support to care home staff in relation to
nursing care.
A key objective of the team is to ensure that
all homes now receive regular reviews of their
standards of nursing care in line with the
recommendations highlighted in the
Winterbourne View Report.
The investment we have made by developing
the Quality Assurance Team builds on our
existing foundations and confirms our
commitment to ensuring that all residents
within Dorset care homes receive high-quality,
safe care.
Since April 2013 the team have completed
125 monitoring visits, with a further six carried
56
out by May 2014 – bringing our visits to 100%
completion.
The team publish a quarterly newsletter which
is circulated to care homes and have recently
established a successful annual care home
managers’ event.
The team also work closely with both internal
and external partners including the Continuing
Healthcare Team and the Care Quality
Commission.
Safeguarding children
In partnership with the Dorset Safeguarding
Children Board, Bournemouth & Poole
Safeguarding Children Board and Public
Health Dorset we launched Drinkheads – a
campaign to highlight the dangers of drinking
while looking after young children. Drinkheads
advertisements featured in local print media
and interviews with CCG experts appeared on
BBC News.
Safeguarding adults
Adult Safeguarding within the CCG includes
monthly engagement with all NHS provider
safeguarding leads, three local authority
STRATEGIC REPORT
safeguarding teams and NHS England. Public engagement has been undertaken through the pan
Dorset Adult Safeguarding Boards.
The CCG receives regular quality reports from data analysis highlighting any areas of concern,
repeated issues or significant failures in care. The safeguarding function has ensured the CCG has
met its obligations and responsibilities in relation to local and national policy. The CCG is an active
partner in the development of Pan Dorset strategies to improve hydration and nutrition and the
reduction of pressure ulcers.
Improving the patient experience - Friends and Family Test
Launched in April 2013, the national Friends and Family Test asks patients who have recently
visited A & E or had an overnight stay in their local hospital if they would recommend their care. It
aims to improve the hospital experience and raise standards of NHS care. The results for your
local hospitals – in Bournemouth, Poole or Dorchester – are available at NHS Choices website at
www.nhs.uk. The test is set to be introduced into GP practices during 2014/15.
Our quality team uses this ‘real-time’ feedback from our patients and carers to reduce poor
experiences as we regularly monitor local results and work with providers to improve scores.
Medicines management
The medicines team implemented a new prescribing dataset to inform discussions on prescribing
at General Practice visits.
A team of CCG locality pharmacists now work closely with prescribing lead GPs in each locality.
Family and Family Test Response Rates
Resonse Rate (%)
25
20
15
10
5
0
July
August
September
October
DCHFT
10.1
8.2
12
17.4
20
23.1
PHFT
7.6
12.3
13.4
15.6
15.1
14.1
RBCHFT
13.5
17
17.2
19.4
21.9
21.6
DHUFT
14
20
19
22
18
16
England
16.1
17.1
18.6
19.6
20.9
19.9
57
STRATEGIC REPORT
Information governance and compliance
NHS Information Governance (IG) is a
framework for handling personal information
about patients and employees in a confidential
and secure manner to appropriate ethical and
quality standards in a modern health service.
They advise prescribers and implement audits
to ensure prescribing is evidence-based and
meets national quality standards.
In October, collaboration between us and our
NHS providers saw the launch of the pan
Dorset formulary on our website and a
medicines advisory group which provides
recommendations on the prescribing and
commissioning of medicines.
It is important that the public recognise the
role they can play in managing their
medicines. During the year, we launched an
education campaign to remind patients to
order repeat prescriptions in plenty of time
and to encourage them to go to the local
pharmacy when they run out of medicines,
rather than call 111. (One third of calls to the
111 service at the weekend were due to
people running out of medicines.)
A series of videos on repeat prescriptions,
self-managed care, flu vaccinations and
general GP advice was published in our digital
media channels to offer practical advice in
managing healthcare needs.
Learning and development
Throughout the year we held a conference
and events with providers and other
stakeholders to share findings of the Francis
Inquiry and discussed recommendations of
the report.
Over 100 delegates attended and agreed to
share good practice in future, and to work
towards improving dignity and compassion in
care across the local health and social care
community.
58
It provides consistent standards enabling
employees to deal with the many different
information handling requirements.
The submission of the annual Information
Governance Toolkit (IGT) to the Health and
Social Care Information Centre gives
assurances to the CCG, other organisations
and to individuals that personal information is
dealt with legally, securely, efficiently and
effectively. (Submissions are awarded either a
satisfactory or unsatisfactory status.)
Successful submission of version 11 of the
IGT was achieved and we were awarded
satisfactory status in 31 October 2013.
Information governance training is mandatory
for staff within the CCG regardless of
designation. Twenty IG training sessions were
undertaken during the year and 96% of staff
attended.
We certify that NHS Dorset Clinical
Commissioning Group has complied with HM
Treasury’s guidance on cost allocation and the
setting of charges for information.
Complaints
We handle complaints sympathetically. We
follow the guidance provided by the NHS
Complaints Procedure and the more recently
published Department of Health reports
relating to NHS complaints handling.
Our approach is a personal one, and we
endeavour to ensure concerns and questions
are answered with a written response.
We aim to help all those who contact us, if
necessary by redirecting them to the relevant
organisation, and will forward complaints
onwards if required.
STRATEGIC REPORT
During the year from 1 April 2013
we have handled 198 complaints:
85 related to the CCG and have been
responded to
10 are awaiting a response (as at
31/03/2014)
103 did not relate to the CCG and, with the
agreement of the complainant, have been
forwarded to providers who will provide a
direct response.
There has been one request for information
for a Parliamentary Health Service
Ombudsman investigation into the handling of
a complaint relating to the CCG.
Data management and confidentiality
There have been no data / confidentiality
breaches.
Challenges
The Care Quality Commission (CQC) has
undertaken a series of inspections, new and
follow up, to providers from which NHS Dorset
CCG commissions services.
This included one of the ‘new style’ large CQC
hospital inspections to the Royal
Bournemouth and Christchurch Hospitals
NHS Foundation Trust in October 2013. The
findings showed that standards were not
being met in two areas of the hospitals and
that staffing and skill mix were an issue across
medical and nursing staff.
An action plan is in place and the Trust is
being supported by the CCG to ensure action
is taken and standards maintained.
Dorset Healthcare University NHS Foundation
Trust consists of multiple sites and the CQC
have undertaken visits to 11 individual sites
throughout 2013.
Five sites were completely compliant. Four
sites had issues with staffing levels and
management and two sites were not
compliant across a number of the standards.
There are robust action plans in place to
ensure the areas that require action have
taken the necessary steps to improve care so
that standards are compliant.
This is being closely monitored by the CCG in
conjunction with Monitor and the CQC, and
improvements have been made.
Poole Hospital and Dorset County Hospital
also had visits from the CQC during the year,
and were found not to be meeting some of the
required standards.
Actions have been taken to address these
issues and the CCG is working with all of
these providers to ensure standards are met
in the future.
Future priorities for the quality team
In addition to the areas outlined above, our
priorities for 2014/15 include:
ensuring full implementation of the ‘6Cs’
and Compassion in Practice (see diagram
and link for more information http://www.england.nhs.uk/nursingvision/)
roll out of seven day services across health
providers
improving quality of care for people as we
move towards integration of services
across the health and social care system
reduction in the number of pressure ulcers.
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STRATEGIC REPORT
Emergency preparedness and resilience
Under the Health and Social Care Act 2012,
clinical commissioning groups were classified
as Category 2 responders as defined under
the Civil Contingencies Act (2004).
This means we have a legal duty to cooperate with other Category 1 and 2
responders (blue light services, healthcare
providers, local authorities, the Environment
Agency, the Met Office, utility companies) to
plan for, respond to, and recover from
incidents in Dorset.
In addition we have signed a Memorandum of
Understanding (MoU) with NHS England
Wessex Area Team which outlines how we will
assist them in discharging aspects of their
Category 1 duties locally.
Key sections include incident notification,
command and control arrangements during
the different levels of incident response and
recovery in order to clarify how the new
Emergency Preparedness, Resilience and
Response (EPRR) arrangements would work
locally.
How this work is organised
Dorset CCG is a key member of the Dorset
Local Health Resilience Partnership (LHRP)
which brings together the directors
accountable for EPRR from all health
organisations including local authority public
health departments.
This group meet quarterly to discuss the
direction of work and to ensure that health
partners are working together to meet shared
goals, actions/targets and milestone
achievements during the year.
In June we launched on-call packs for senior
managers which means all key information is
now accessible from tablets, phones and any
computers with an internet connection.
The CCG is required to conduct a live
60
exercise every three years, a tabletop
exercise every year, and two communications
exercises a year. A tabletop exercise in which
senior managers from the CCG and NHS
England Wessex Area Team talked through an
‘incident’ was held in October, followed by a
similar exercise involving the wider health
community. As this is our first year, we are
aiming to take part in a live exercise between
2014 and 2016.
There was a real test of the emergency
arrangements during the prolonged severe
weather during the winter. Lessons have been
learned and have led to some refinements in
our emergency planning.
During the period of severe weather, the CCG
was actively involved in regular emergency
planning calls with other agencies across
Dorset.
We helped with the identification of vulnerable
patients living in the Winterbourne Abbas and
Sixpenny Handley areas of Dorset who were
in need of evacuation assistance.
Our revised major incident plan has been
developed.
Work will now begin on developing an elearning package to teach all key response
staff about the major incident plan and this will
be complemented with practical major incident
room training.
Business continuity plans have been finalised
outlining how the CCG’s critical functions
would continue in the event of an interruption.
We certify that the NHS Dorset Clinical
Commissioning Group has incident response
plans in place, which are fully compliant with
the NHS Commissioning Board Emergency
Preparedness Framework 2013.
The NHS Dorset Clinical Commissioning
Group regularly reviews and makes
improvements to its major incident plans and
has a programme for regularly testing this
STRATEGIC REPORT
plan, the results of which are reported to the
Governing Body.
How we have worked with other
stakeholders / partners
We work regularly with other partners to meet
our legal obligation to share information and
co-operate with other agencies.
There are a number of multi-agency local
resilience forum groups which meet regularly
to develop emergency plans.
Following a pilot phase in 2013/14, a civil
contingencies unit (CCU) for Dorset is being
launched, supported by Dorset's Local
Resilience Forum, comprised of membership
from Category 1 organisations. The CCG, and
NHS England Wessex Area Team are
supporting the development of the CCU in
mutual areas of training, exercising and multiagency planning.
Future plans
Over the next year the EPRR team will be
working with the wider health community, local
resilience forums and the civil contingencies
unit to develop and update the existing
pandemic, mass casualty, severe weather and
fuel plans.
Within NHS Dorset CCG, the focus will be on
distributing the e-learning packages and the
development of modules for all relevant staff,
in addition to practical training sessions.
The final sections of the Business Continuity
Plan will be completed and we will be
ensuring that all of our plans will be reviewed
and updated as part of an annual programme.
Engagement and communications
The CCG has both internal and external
stakeholders. By definition our stakeholders
are taken to be any person, group or
organisation that affects, or can be affected by
our actions.
Our stakeholders include the people of
Dorset, all those within the new involvement
and engagement networks, localities, the
CCPs, HealthWatch Dorset, health and
wellbeing boards, health overview and
scrutiny committees, local authorities,
providers (both NHS and private), voluntary
organisations, NHS England and MPs.
We are always keen to involve people in our
work to help us make better informed
decisions about our local NHS services and
work continues to develop our enabling
networks.
We recognise that everyone is a patient at
some point in their lives and that we all have
experiences, views and concerns that can be
shared to help shape the future.
Gathering views, listening to people and
feeding back this information to our
commissioning teams is a really important part
of our work.
We encourage people to get involved and
comment on local services. This can be by
contacting us by telephone, letter, email or
social media.
We proactively seek opinions by attending
meetings, distributing surveys and running
focus group discussions to canvass a wide
range of views and voices to ensure we
understand about specific issues in Dorset.
Over the past year we have actively
developed our Health Involvement Network.
This is an opportunity for local people to hear
more about the work we do and get involved
in projects, as well as working collaboratively
with other local organisations and bodies.
People can get involved with the work of the
CCG through:
our website - www.dorsetccg.nhs.uk
social media such as Facebook, Twitter
and YouTube
information in our newsletters
61
STRATEGIC REPORT
information shared via our health and
council partners and network
local media
face-to-face meetings and events
by contacting Lay Members
local GP practices.
We know it is important to feed back the
outcomes of engagement. We do this in the
following ways:
contacting all those involved in specific
work to thank them and let them know how
their views have been used
publicising reports and outcomes in
newsletters, bulletins and on the website
producing an annual report of engagement
activity
reporting engagement and communications
activities to our Governing Body.
During 2013 we conducted a county-wide
health survey – The Big Ask – along with other
NHS partners. More than 6,000 people
responded with views on local services and
how we could improve them for the future.
Through a number of events, including the
Health Involvement Network, we have
gathered views from the voluntary and
community sector, other health professionals,
partners, community representatives, carers,
patients and the general public.
In addition, our Clinical Commissioning
Programmes have been engaging and
involving providers, partners and patients to
develop strategic plans for each clinical area
of work. Key areas of engagement worked on
during 2013/14 were:
62
developing the new NHS Dorset CCG
Health Involvement Network
supporting localities and their constituent
GPs to undertake involvement and
engagement work with local stakeholders
supporting Clinical Commissioning
Programmes to achieve meaningful
involvement and engagement work to
inform changes to health services
continuing to build stakeholder
relationships
promoting engagement opportunities to
ensure wide awareness of our engagement
work and advertising opportunities for
involvement
continuing to develop our partnerships with
local people to gather insight into their
views and experiences to help shape
services
monitoring the effectiveness of our work
and to let stakeholders know how the views
of local people have informed change.
Alignment with health and wellbeing strategies
We work with two health and wellbeing
boards, one covering Dorset County Council
and one covering the Boroughs of
Bournemouth and Poole.
These boards are responsible for producing
health and wellbeing strategies for their
populations.
The strategies have been developed in
partnership with Dorset CCG and other
stakeholders. Our principles and priorities
reflect those set out in the health and
wellbeing strategies.
STRATEGIC REPORT
We recognise the invaluable contribution that carers make
to society by supporting them in their caring role
This year our funding to support carers in our
area increased to £1 million from £850,000 in
2012/13.
This money has helped to provide them with
what they often tell us they need the most – a
break from their caring responsibilities. Our
spending plans are in line with the national
Carers Strategy and our local plans.
We know that many people do not identify
themselves as carers, regarding themselves
as just a relative or friend helping someone
who could not manage without their support.
But we do know that 82,500 identified carers
are receiving services commissioned by our
partner local authorities - Dorset County
Council, Bournemouth Borough Council and
the Borough of Poole.
We are also helping them through the
Carers Individual Support Scheme (CISS)
commissioned by Dorset County Council and
administered by the charity Help and Care.
This makes small grants to carers which can
make all the difference to their lives. The
scheme is much appreciated and comments
have included:
‘
I am extremely appreciative and it was
used to purchase a computer … it’s never too
late to learn they say. I hope I become
competent one day. With renewed thanks to
you and your team.
A much needed break for me and my
husband, I am really grateful for the help. I
was able to visit my 90 year old mother and
pay for someone to stay with my disabled
husband while I was away.
’
Around 800 carers have benefited since the
grant opened in June 2012.
Dorset Carers Support Project Fund
Since the fund began 15 carers projects in
Dorset have been awarded a share of around
£45,000. The projects have been diverse and
well spread geographically. Combined they
have reached over 3,500 carers across the
county. Some examples of the types of
projects funded are:
information, advice and befriending
creative projects
support for young carers in transition
funding for carers groups, peer led training
for carers of people with dementia and
professional counselling for carers.
The fund has just been modified to broaden
the funding levels available and continues to
attract lots of interest from potential projects
that could benefit carers in Dorset.
Dorset Carers Activity Service
The carers activity service has proved to be
very popular and has been busy since its
inception.
A regular bulletin is produced and circulated
widely around the county and includes details
of all the service’s activities which have been
arranged including:
the complementary therapy voucher
scheme and day trips
pre-planned activity sessions
special events to mark occasions such as
Carers Week and Carers Rights Day
‘Your Choice’ activity grant scheme.
It also has full details of carers’ support groups
that operate around the county and other
opportunities of interest, such as other free
activities available locally.
63
STRATEGIC REPORT
The number of carers who access the service
has consistently grown since its launch and
we will continue to work hard to ensure it
continues to do so.
Our local authority partners in Bournemouth
and Poole have started the Carers Carefree
Choir and received very positive feedback
from members, including a comment
describing the choir as ‘one big happy family’.
Our magazine Caring Matters has received a
makeover and is now compact and proving
very popular as a
source of information
and articles for all
carers.
Our first edition of
the new format
featured Tim
Goodson, CCG
Chief Officer,
answering
questions from
carers, showing
our commitment to
them and
acknowledging the
vital role they play.
David Jenkins, Deputy CCG Chair, is the Lay
Member with specific responsibility for
engagement. He is passionate about his role,
making sure the voice of the public is heard
when new services are planned or existing
ones redesigned.
So the views of carers are certainly being
sought as we work to ensure they have
access to the same standard of services
wherever they live in Dorset, Bournemouth or
Poole. These plans are set out in the
document ‘Better Together – The pioneer
partnership: improving health and social care
with people in Bournemouth, Dorset and
Poole’.
64
There is more information about the
programme on the Dorset For You web site
https://www.dorsetforyou.com/better-together
This approach will help us to meet the needs
of an ageing population by providing highquality services in difficult financial times.
Dorset residents can be assured that we are
all committed to rising to these challenges.
Young carers
receive support
from the CCG
and our local
authority
partners.
Many have to put
their childhoods
on hold to care
for a parent or
sibling, foregoing
some of the
carefree activities of their peers. As one
nine-year-old said at a recent Dorset
Carers Partnership meeting,
‘
’
I don't get to do some of the things
my friends do but I don’t mind because
I love my mum and dad.
Giving them a break from their caring
responsibilities is one way they are
supported.
Raising awareness of what they do is
another and in October Val Mitchell,
(pictured) the CCG’s carers engagement
facilitator, appeared on local television in a
video about a Dorset young carer who was
promoting awareness about the role of
young carers.
The video was made by Fixers, young
people using their life’s experience to fix
the future, and the project comes under the
umbrella of the Public Service
Broadcasting Trust.
STRATEGIC REPORT
We have already discussed some of the risks
and challenges that lie ahead for us. This
section considers the challenges and
opportunities in more detail.
Future Trends: Local challenges and
opportunities
As well as the demographic challenges we face
in Dorset, there are other challenges and
opportunities which must be addressed if we
are to maximise health gain and transform and
improve local health and social care services.
Economic
Challenges:
deliver Quality, Innovation, Productivity
and Prevention (QIPP) within budgets
deliver continuous service improvements
and efficiency savings
reduce the amount of money spent on
avoidable admissions and re-admissions
to hospital
shifting the spend across different sectors
of healthcare to reflect the need to provide
care closer to home.
doing things once across Dorset where
appropriate
in-house commissioning support, enabling
resilience, succession planning and skill mix,
learning and influence.
Quality
meeting the rights of our public and patients
as set out in the NHS Constitution
commissioning organised around healthcare
pathways, services improvements and
outcomes
strong relationships with providers and
partners and forums for feeding back quality
concerns
working with nursing and care homes.
Challenges:
promote, support and participate in
collaborative working with other
commissioners of health and social care
services and ensure that the complexities of
the system do not detract from the ability to
work effectively together
consider innovative solutions to encourage
integrated patient centred services.
Opportunities:
Challenges:
implementation of the findings from the NHS
reports into the Francis, Berwick and
Winterbourne View inquiries
Collaboration and integration
healthy financial position
large CCG therefore have economies of
scale
ensuring that the providers of healthcare
services understand and deliver services that
meet and exceed the standards and quality
of care required.
Opportunities:
Opportunities:
delivering improved outcomes for people as
set out in the NHS Mandate and NHS
Outcomes Framework
GP-led Clinical Commissioning Programmes
coterminosity with the county of Dorset
local authority boundaries
public health single service across Dorset
with support integrated into clinical
commissioning programmes
established Better Care Fund enabling
health and social care integration
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STRATEGIC REPORT
strong relationships with partners across
the health and care system
history of collaborative
commissioning arrangements.
Patient choice / insight and engagement
Challenges:
66
promote, support and participate in
collaborative working with other
commissioners of health and social care
services and ensure that the complexities
of the system do not detract from the ability
to work effectively together
consider innovative solutions to encourage
integration.
Opportunities:
clinical engagement and leadership
strong legacy of public and patient
involvement and engagement
responsive to local needs
locality development into patient insight
and feedback
development of the CCG Health
Involvement Network
enhance engagement work of clinical
commissioning programmes to inform and
develop clinical services.
GOVERNING BODY & SENIOR MANAGER PROFILES
We have a Governing Body with a
membership comprising:
13 GP Locality Chairs
a Nurse Lead and
a secondary care Doctor Lead.
Biographies, joining dates and committee
membership for each of the Governing Body
members are set out in this section of the
annual report.
a Chair
Chief Officer
The 13 GP localities, the GP Chairs for the
period 1 April 2013 to 31 March 2014 and their
appointment dates are set out below:
two Lay Members
Locality
GP Chair
Date appointed
Central Bournemouth
Dr Piers Wilde
Dr Peter Blick
1 April 2013
1 August 2013
East Bournemouth
Dr Paul French
1 April 2013
Christchurch
East Dorset
Mid Dorset
North Bournemouth
North Dorset
Poole Bay
Poole Central
Poole North
Dr Richard Jenkinson
Dr Colin Davidson
Dr Jenny Bubb
Dr Carol Linnard
Dr Tom Knight
Dr Rob Childs
Dr Andy Rutland
Dr Patrick Seal
Dr Chris McCall
Purbeck
Dr David Haines
Dr Karen Kirkham
West Dorset
Dr Blair Millar
1 April 2013
Date stood down
31 July 2013
1 April 2013
1 April 2013
1 April 2013
1 September 2013
31 August 2013
1 April 2013
1 April 2013
1 April 2013
1 April 2013
1 April 2013
1 October 2013
1 April 2013
30 September 2013
1 April 2013
67
Dr Forbes Watson
Dorset CCG Chair
Dorset Health and Wellbeing
Board Vice Chair
Dr Forbes Watson is a GP
principal in Lyme Regis. Trained at the
University of Glasgow, he has worked in
Glasgow, Cornwall and Australia before
moving to Lyme Regis, where he has been
since 1997.
Forbes is the Chair of the clinical
commissioning group for Dorset. He is
married with children and his interests include
rugby union and boating - he is the honorary
medical advisor and chairman of the Lyme
Regis Royal National Lifeboat Institution.
Tim Goodson
Chief Officer (performs the
function of accountable officer for
NHS Dorset CCG)
(Appointed 1 April 2013)
Tim originally joined the NHS in 1995 as an
internal auditor following his initial
accountancy training with chartered
accountancy practices in the private sector.
Tim later moved into more mainstream finance
functions with Dorset Community NHS Trust
and North Dorset PCT.
Prior to his current role, Tim was the Director
of Finance for Dorset Primary Care Trust,
Bournemouth and Poole Teaching PCT, and
South West Dorset Primary Care Trust.
During Tim's career in the NHS he has had a
broad range of executive lead responsibilities
including: Deputy Chief Executive, finance,
performance, information, commissioning,
primary care, sustainability, support services,
information management and technology, risk
management, estates and capital planning.
He is a Fellow of the Association of Chartered
Certified Accountants (ACCA).
68
Tim enjoys making the most of the outdoors
and enjoys cycling, walking, skiing and
kayaking and is a keen follower of rugby and
football, although his playing days are now
behind him.
Paul Vater
Paul Vater has worked in both the
private sector and the NHS in a
wide range of financial roles including internal
and external audit. He is a Fellow of the
Association of Chartered Certified
Accountants (ACCA).
Paul is the executive lead on finance,
procurement, and performance, including
contracting, and is also the CCG lead for
information management and technology.
As a member of the South West Healthcare
Financial Management Association, he has
strategic interest in the training and
development of NHS finance professionals
across the South West. Prior to his role with
NHS Dorset CCG, he was the Deputy Director
of Finance for Dorset PCT.
GP Locality Lead members
Dr Jenny Bubb
Clinical Chair,
Mid Dorset Locality
Dr Jenny Bubb is a GP partner at
Cerne Abbas surgery and is
currently the Mid Dorset Locality
Lead. She qualified from medical school in
Southampton in 2001 before moving to
Dorchester to complete GP training. She has
worked at Cerne Abbas surgery since 2008.
She lives in the Piddle Valley with her
husband and son. Her interests include hiking
in the beautiful Dorset countryside and playing
tennis.
Dr Rob Childs
Clinical Chair
North Dorset Locality
Dr Rob Childs has been a GP
partner at Bute House Surgery
Sherborne since 1993. He qualified from
Southampton University in 1987 and has
worked in the UK, Australia and the Channel
Islands.
He trained as a GP in Bath. He has been
locality lead for North Dorset since 2008 and
also represents his local GPs on the Dorset
Local Medical Committee. Rob is married with
two teenage sons and likes to play golf when
time allows.
Dr Colin Davidson
Clinical Chair
East Dorset Locality
Dr Colin Davidson has been a
principal GP working in Cranborne Dorset
since 1988. He qualified at the Middlesex
Hospital in London and worked there and
subsequently in Brighton and Bournemouth
before following the sunshine again to
Australia.
He followed a physician training programme
to become a Fellow of the Royal College of
Physicians, but finds general practice the only
place to practice true general medicine.
He is married to a doctor and has three
children. He is a rugby referee, sails, skis and
has been seen on a golf course when not at
meetings; despite his body profile he has run
three London Marathons.
Dr Paul French
Clinical Chair
East Bournemouth Locality
Dr Paul French is a senior partner
at The Marine and Oakridge
Surgery in Southbourne, Bournemouth, where
he has been working since 1984.
He trained at The Royal London Hospital in
Whitechapel. He has been working for
primary care organisations continuously since
their inception.
During this time he was the Professional
Executive Committee (PEC) Chair of
Bournemouth PCT for four years and then the
interim PEC chair of Bournemouth and Poole
PCT for one year. His main areas of work are
care of the elderly, including stroke and
dementia.
He is married with one son and enjoys
walking and skiing. Paul is the chair for the
Mental Health and Learning Disabilities
Clinical Commissioning Programme.
Clinical Chair
Christchurch Locality
Dr Richard Jenkinson has been
a partner at Burton Medical
Centre, Christchurch since 1995.
He qualified in London and worked there and
later in Devon to complete his postgraduate
training. As well as being a GP he has a
special interest in ears, nose and throat.
He is married with five children and enjoys
walking and is a silver leader for the Duke of
Edinburgh's award scheme.
Dr Carol Linnard
Clinical Chair
North Bournemouth Locality
(until 31 August 2013)
Dr Carol Linnard is the senior
partner of the Alma Medical
Centre and has worked there for
almost three decades.
Throughout that time she has been involved
in the education of the next generation of
doctors and holds posts at Southampton
Medical School, Winchester University and
Wessex Deanery. Over the years she has
been part of the changing structures of
management affecting NHS primary care and
69
is now committed to locality commissioning.
Carol is married with three adult children and
along with the usual leisure activities she
enjoys ‘mending things’.
Dr Tom Knight
Clinical Chair
North Bournemouth Locality
(From 1 September 2013)
Dr Tom Knight is a GP principal at
Northbourne Surgery in Bournemouth where
he has been a partner since 2009. He
qualified from Charing Cross and Westminster
University in 1997, and did his vocational
training for General Practice in Dorset. Tom is
married with three young children and his
interests are in aviation and watersports.
Dr Chris McCall
Clinical Chair
Poole North Locality
Having joined The Hadleigh
Practice in Broadstone and Corfe
Mullen in 1982 after training in London and
Devon / Cornwall but retiring from clinical
practice in 2002.
Dr Chris McCall is now experiencing the third
iteration of GP / primary care-led
commissioning but his enthusiasm remains
undaunted and he has been locality lead for
Poole North since its inception.
He is married with a grown-up family that
continues to arrive on the doorstep at frequent
intervals. He is still trying to catch that elusive
30lb+ salmon. Chris is the chair for the
General Medical and Surgical Clinical
Commissioning Programme and assistant
Clinical Chair for the CCG.
Dr Blair Millar
Clinical Chair
West Dorset Locality
Dr Alan Blair Millar is a GP
principal at The Bridport Medical
Centre where he has been since
70
1994. He trained at King’s College Hospital
School of Medicine and he has worked in
London, Poole and Exeter, which is where he
did his GP training.
Blair has been involved in practice-based
commissioning since its inception and is now
the clinical lead for the Dorset West Locality.
He is married with three children and his
interests include sailing and skiing.
Dr Piers Wilde
Clinical Chair
Central Bournemouth
Bournemouth
(until 31 July 2013)
Dr Piers Wilde has been a GP partner at
Moordown Medical Centre in Bournemouth for
nine years.
He qualified from London’s Kings College
Hospital in 1993 and completed his GP
training working in London, Peterborough,
Australia and Dorchester.
He has been involved in commissioning for 5
years and is married, living in Poole. His
interests include music, mountain biking and
food.
Dr Peter Blick
Clinical Chair
Bournemouth Central Locality
From 1 August 2013)
Dr Peter Blick completed his training as a GP
in 1981 and was appointed as a partner in The
Holdenhurst Road Surgery where he worked
for 30 years. He was chairman of Dorset Local
Medical Committee for eight years and has
trained 20 GPs. He currently works clinical
sessions in Blandford and is the GP tutor in
Bournemouth. He is a GP lead in adult and
children's safeguarding.
Apart from his medical interests he is a keen
yachtsman and skier and enjoys mountain
walking with his wife. He is an active member
of his local church in Sway.
Dr Andrew Rutland
Clinical Chair
Poole Bay & Parkstone Locality
Dr Andrew Rutland is senior
partner at The Lilliput Surgery in
Poole. Having gained an initial degree at
Oxford University, he qualified at Charing
Cross and Westminster Medical School. He
worked in Australia and locally in Dorset,
before joining his current practice permanently
in 1996.
He is married to a GP and has two rapidly
growing boys. He keeps fit running regularly,
dog walking and occasional hockey, and tries
to spend as much summer time as possible
on the water. Professionally he is a GP trainer
and appraiser, and enjoys life in a proactive
practice.
Dr Patrick Seal
Clinical Chair
Poole Central Locality
Dr Patrick Seal is a GP principal
at The Adam Practice in Poole
where he has been a partner since 1991. He
qualified from Cambridge University and
University College Hospital in 1985, and did
his vocational training for general practice in
Dorset.
Married with four children all aged over 20, he
was on the Local Medical Committee for eight
years and has been locality lead for Central
Poole for seven years. He has been a GP
trainer for the past 12 years, and is excited
about opportunities for closer working with
colleagues in voluntary sector organisations
and with the local authority and public health.
Occasional Alpine air is his favoured form of
relaxation, and real coffee!
Dr Karen Kirkham
Clinical Chair
Weymouth and Portland Locality
Dr Karen Kirkham qualified in
1988 from the Middlesex Hospital
Medical School, trained in general practice in
Dorset and has been a partner at The Bridges
Medical Centre in Weymouth since 1994.
Alongside working in a busy general practice,
she has developed an interest in women’s
health and in particular the fields of maternity,
fertility, contraception and sexual health.
She is also a speciality doctor in genitourinary
medicine. She is chair of the Maternity,
Reproductive and Family Health Clinical
Commissioning Programme.
Clinical Chair
Purbeck Locality
(until 30 September 2013)
Dr Christian Verrinder is a GP
principal at The Wellbridge
Practice, Wool.
He trained in Nottingham and worked there
after qualification as well as in Derby,
Warwick, Cheltenham and Australia before
moving to Poole in 2002.
He is married with children. His professional
interests include GP training, sports and
exercise medicine as well as orthopaedic
medicine.
Dr David Haines
Clinical Chair
Purbeck Locality
Dr David Haines has been
practising in Swanage for 24
years.
After training at King’s College Hospital,
London, he completed his training in general
practice in Shaftesbury. Following this he
worked as a single-handed locum in Bluff,
New Zealand, for a year.
He led fundholding for his practice in Dorset in
the 1990s. He chaired the Purbeck and
Blandford PCG and then the Purbeck locality
of the South and East Dorset PCT.
71
When the Dorset PCT formed, he chaired the
Medicines Management Committee. He is an
elected member of the Dorset Local Medical
Committee.
David has interests in ornithology and sport.
He still plays cricket and coaches the game in
Swanage. He is married with three children.
Dr Ros Maycock
Chair, Mental Health and
Learning Disability Clinical
Commissioning Programme
(until October 2013)
Dr Ros Maycock was a GP for
nearly 30 years in a practice in Poole and,
until October 2013, was chair of the Mental
Health and Learning Disabilities CCP.
Prior to appointment with the CCG, Ros was
Chair of the Professional Executive
Committee and a member of the
Bournemouth and Poole NHS Primary Care
Trust Board.
Dr Chris Burton
Secondary Care Member
Chris qualified in 1987 and was
awarded PhD for work on pathophysiology of kidney tubular cells in 1997. He
was appointed to the post of Consultant
Nephrologist at North Bristol NHS Trust (NBT)
in 2000.
Chris has a long-standing interest in improving
the quality of patient care, including patient
experience. He set up the first kidney patient
forum in Bristol to discuss services with patients
in 2006. He was made clinical director of renal
and transplantation services at NBT in 2006
and established systems of clinical governance
and improved infection control in this role.
Chris was made Medical Director of NBT in
2009. His focus is improving the quality of
care for patients. This includes responding to
individual patient concerns as well as working
with colleagues within the Bristol health
72
system to improve services. He worked with
Bristol PCT PEC in 2010/12. His Medical
Director portfolio includes improving quality
and safety, Caldicott Guardian, cancer
services quality and the role of Director of
Infection Prevention and Control.
Mary Monnington
Registered Nurse Member
Mary qualified as a Registered
Nurse in 1972 at St Thomas
Hospital, London. She has over
40 years’ experience in the National Health
Service as both a clinical nurse and director of
nursing in both acute and community provider
and clinical commissioning organisations.
Mary is also a registered lecturer practitioner
with experienced of delivering and
commissioning clinical professional education
for nurses and associated health
professionals. She has a special interest in
professional conduct and competence
encompassing all health professional groups.
Mary is married with two daughters and lives
in Wiltshire.
Teresa Hensman
Lay Member Lead for
Governance
Teresa is a Fellow of the
Chartered Association of Certified
Accountants and a member of the Association
of Fraud Examiners.Teresa qualified as an
accountant in 1996 while working for the
Hammersmith Hospitals NHS Trust.
She has more than 13 years' senior
management experience within housing
associations and local government with
revenue budgets in excess of £250 million.
Outside of the CCG, Teresa is an independent
Mental Health Act hospital manager for Dorset
HealthCare, and a member of the Local Food
Links parent forum.
David Jenkins
Lay Member Lead for Patient and
Public Involvement and Deputy
CCG Chair
After beginning his working life
as a teacher, David qualified as a solicitor,
practising mainly in the public service.
He worked with Oxfordshire and Hampshire
County Councils, and with the Local
Government Ombudsman service, before
joining Dorset County Council in 1989. He
became their chief executive in 1999, a post
he held until 2012.
David has extensive experience of the public
service, having chaired the Dorset
Connexions company, the Dorset Youth
Offending Team Board, the Total Place Board
for Bournemouth, Dorset and Poole, and the
steering group that put in place the
arrangements for the 2012 Olympic and
Paralympic sailing events. He currently chairs
a committee on waste management for
Gloucestershire County Council.
David is a trustee of a number of local
charities, mainly involved with the arts and
musical education, and is a Fellow of the
Royal Society of Arts.
He is president of the Dorset Association of
Parish and Town Councils, and a Deputy
Lieutenant of Dorset.
Executive Directors
The Governing Body is supported by an
internal commissioning structure with services
provided through four directorates:
quality
service development
finance and performance
engagement and development.
Each directorate is led by an executive
director, accountable to the Chief Officer. The
Chief Finance Officer sits on the Governing
Body. Details of the other Executive Directors
are as follows:
Suzanne Rastrick
Director of Quality
Suzanne qualified as an
occupational therapist (OT) and
began her career in the acute hospital sector,
moving to practise in community and primary
care where she then gained her first general
management role.
She was one of the first allied health
professionals (AHPs) to hold a substantive
Director of Nursing post and has since held
these roles in both providing and
commissioning organisations. She has also
been chief executive of a primary care trust
cluster.
She has a non-executive portfolio in the
commercial and not-for-profit housing sector
and sits on a number of national groups
including NHS Employers Policy Board and
Health Education England AHP Advisory
Group.
Jane Pike
Director of Service Delivery
Jane spent the first 16 years of
her career as a clinical
microbiologist both in the NHS and veterinary
fields.
In 1997 she was successful in gaining a place
on the NHS accelerated management training
scheme, graduating in 2000.
Since that time she has held a variety of
senior management positions at local,
regional and national level, spanning
operational and strategic commissioning
responsibilities.
Jane joined NHS Dorset PCT from NHS
73
Hampshire PCT, where she had been the
Programme Director - Service Redesign since
2007. Prior to this she held the role of head of
adult services at East Hampshire, Fareham and
Gosport Primary Care Trust, managing all adult
community services, including four community
hospitals.
Jane was appointed as director of acute and
primary care service improvement for NHS
Dorset and NHS Bournemouth and Poole in
July 2011, and to the Director of Service
Delivery (designate) for the CCG in October 2012.
Charles Summers
Director of Engagement and
Development
Charles was formerly Director of
Workforce for NHS Dorset and NHS
Bournemouth and Poole from July 2011.
He joined the NHS in 1993 and has worked in
various health settings, developing and
improving people management. He is a Fellow
of the Chartered institute of Personnel and
Development and a qualified executive coach.
Charles provided professional advice on all
aspects of workforce and organisational
development practice to both local PCT boards
and to the leadership of the shadow Clinical
Commissioning Group for Dorset.
Charles has worked at executive level with a
number of NHS boards since 2005 and leads
our equality and diversity, public engagement,
organisational development, strategic planning
and emergency planning responsibilities.
Charles Buckle
Non-governing Lay member
Charles Buckle was appointed a non Governing
Body Lay Member of Dorset CCG in April 2013
having earlier been a volunteer Lay Member of
the clinical governance working group of the
Dorset PCT for two and a half years. Charles
had previously spent six years as a member of
the senior staff and bursar of a large Dorset
comprehensive upper school after his principal
career in the Royal Navy from which he retired
in the rank of Captain in 1993.
Swanage has been home for most of his life
during which he has variously been involved
with the community hospital and the lifeboat.
Charles is married with two children. His
principal interest is sailing.
Tina Thompson
Non-governing Lay member
Tina Thompson was appointed a non-Governing
Body Lay Member of Dorset CCG in April 2013
Tina Thompson is a freelance management
consultant working with voluntary and
community sector organisations since 2007.
She undertook a joint honours degree in
economics and politics as a mature student,
graduating in 1992, following which she had a
career in the voluntary sector working in
advocacy and advice agencies including
Citizens Advice.
Tina lives in Bournemouth, was a member of
the Bournemouth LINK Stewardship Group and
is a trustee of Friends of Boscombe Chine
Gardens. She currently works with
Bournemouth 2026 Trust – a community land
and development trust which she helped to set
up; is a lay advisor at Health Education Wessex
and undertakes occasional freelance work with
other voluntary and community sector
organisations.
Interests outside work include steam trains and
she has volunteered on the Swanage Railway
as a Ticket Inspector.
Declaration of interests Pursuant to our values of openness and honesty, it is a requirement that
all member practices of the Dorset Clinical Commissioning Group (CCG), Governing Body
members, GPs who are paid to provide services to the CCG and all staff declare any interests
that they have that may conflict with the interests of the CCG itself. Please see pages 75 to 77.
74
Name and CCG Role
Dr Peter Blick
GP
Locality Chair for Central
Bourmemouth
Governing Body
Committee,
CCP or Staff
Governing Body,
CCC
Dr Jenny Bubb
Governing Body
GP
Locality Chair for Mid Dorset
Dr Chris Burton
Governing Body,
Secondary Care Member
CCC
Dr Lionel Cartwright
GP
Governing Body
CCC
CCP Lead
Dr Rob Childs,
GP
Locality Chair for North
Dorset
Governing Body,
CCC
Dr Colin Davidson,
Governing Body,
GP
Locality Chair for East Dorset
Dr Paul French
GP
Locality Chair for East
Bournemouth
Tim Goodson
Chief Officer
Governing Body
CCC
Audit & Quality
Committee
CCP Lead
Governing Body,
CCC
Interests
Date
Declared
Adult Safeguarding Lead,
GP Tutor, Bournemouth,
Out of Hours Contract for New Wave Care UK,
Salaried GP – Whitecliff Surgery, Blandford
Partner, Cerne Abbas GP Surgery,
Co-opted member of DCC for HWB purposes
17/03/2014
Member of the Trust Board of North Bristol NHS Trust which provides a small number
of specialist services (not commissioned by the CCG) to the population of Dorset,
Wife is a GPSI in dermatology in the Bristol region
Partner, Harvey Practice,
Shareholder, Solutions for Health,
Medical Advisor, Magna Care Centre, Bed Fund Victoria Hospital Wimborne,
Wife is a Community Matron employed by Bournemouth and Poole Community Health
Services
GP Partner, Bute House Surgery Sherborne,
LMC Representative for North Dorset,
Clinical Assistant in Endoscopy, Yeovil District Hospital,
Dorset PCT Representative on Yeovil District Hospital Board of Governors,
Member of Yeatman Hospital Management Group
Senior Partner, The Cranborne Practice (PMS Dispensing and Training),
Director, Dorset Diagnostics Ltd.,
Wife is a Director of Dorset Diagnostics Ltd.,
Community Endoscopy Lead for DHUFT,
Trustee, Boveridge House School,
Wife is a GP at Eagle House Surgery, Whitecliff Mill Street, Blandford Forum, Dorset
DT11 7DQ,
DDL hold an AQP contract for Community Endoscopy,
Co-opted members of the B&P HWB Board
17/02/2013
HFMA Member,
HFMA South West Executive Branch Committee Member,
Co-opted member of DCC for HWB purposes,
Partner works for Bournemouth Borough Council
Prior 30/09/2009
13/04/2013
13/04/2013
16/11/2011
04/02/2014
Prior 14/11/2011
14/11/2011
12/05/2010,
19/03/2014,
19/03/2014
17/01/2012
15/01/2013
04/02/2014
05/02/2014
Dr David Haines,
GP,
Locality Chair for Purbeck
Teresa Hensman, Lay
Member Lead for
Governance
Chair of the Audit and Quality
Committee
Governing Body
Governing Body,
Audit & Quality
Committee,
Remuneration
Committee
Mental Health Act Hospital Manager, DHUFT
08/10/2012
Governing Body
GP Partner, Northbourne Surgery,
FTSE 100 index linked savings
15/01/2014
Dr Carol Linnard
GP,
Locality Chair for
North Bournemouth
Governing Body
(Until 31 August 2013)
Partner, Alma Partnership
Programme Director for Winchester University/Wessex Deanery
Practice holds PMS and Contract for providing a GU and Family Planning Service
Governor, Royal Bournemouth Hospital
Prior 17/11/2011
Dr Tom Knight
GP
Locality Chair for
North Bournemouth
04/02/2014
20/01/2013
75
Name and CCG Role
Dr Ros Maycock
GP
GP Transition Lead
Governing Body
Committee,
CCP or Staff
CCP
(Until October
2013)
Date
Declared
Partner, Evergreen Oak Surgery (Training Practice)
Practice is a member of the Poole Central Locality Commissioning Group
Member of Poole Children Trust Board
Member of Bournemouth Children Trust Board
Husband employed by Purbeck CAB
Prior 17/11/2011
Prior 17/11/2011
09/01/2013
09/01/2013
09/01/2013
Dr Blair Millar
Governing Body
GP,
Locality Chair for West Dorset
Mary Monnington
Governing Body,
Registered Nurse Member
Audit & Quality
Committee
Remuneration
Committee
Dr Piers Wilde
Governing Body
GP,
(Until 31 July 2013)
Locality Chair Central
Bournemouth Locality
GP Partner, Bridport Medical Centre Skellern Practice,
Wife (Dr Joanna Cotton) is a member of the Cancer Support Group “The Living Tree”
Council member [UKCCG] United Kingdom Council of Caldicott Guardians, Panel
Member Professional Performance Committees Nursing and Midwifery Council [NMC]
Nurse Member Wiltshire CCG
Husband JET Monnington, Senior Solicitor Moore Blatch Resolve LLP Southampton
08/06/2010,
09/01/2013,
04/02/2014
05/2009
02/2013
04/2013
06/03/2013
Jane Pike
Dorset CCG
Suzanne Rastrick
Director of Quality, Dorset
CCG
05/02/2014
Allied Health Professional/Healthcare Scientist
Member, Policy Board, NHS Employers
Member, Health Education England Advisory Group
Group Board Member and Chair, Audit and Risk Committee, Spectrum Housing Group
Limited which involves oversight of the following companies: Spectrum Housing Group
Limited, Spectrum Property Care Limited, Signpost Homes Limited, Spectrum Premier
Homes Limited
Member, Council of the College of Occupational Therapists
Chair of the English Board of the College of Occupational Therapists
Prior to
30/04/2009
01/09/2009
01/12/2010
20/06/2012
20/06/2012
Dr Chris McCall
Governing Body,
GP,
CCC,
Locality Chair for Poole North, Remuneration
Committee
CCP Lead
Nothing to declare
Senior Partner Moordown Medical Center, Bournemouth
Medical Cosmetic Medical Doctor Hyperbaric Doctor for Atlantic Enterprise
Circle. Solutions For Health
Governing Body,
CCC
Governing Body
CCC
Trustee of Healthcare Financial Management Association (HFMA) – South West Branch 02/04/2013
GP
CCC
CCP Lead
(Until 30 September
2013)
CCC
CCP Lead
GP Partner, Wellbridge Practice Wool (dispensing practice also holds contract to provide 02/03/2011
medical inpatient care for Wareham and Blandford Hospitals),
Employed by Orthopaedic Medical Service (OMS) former Bournemouth & Poole PCT,
01/04/2011
DHUFT from April 2011
Charles Buckle
Lay Member,
Member Audit and
Quality Committee
GP, Lilliput Surgery,
Shareholder, Solutions for Health,
Wife is a Partner at The Harvey Practice
Nothing to declare
13/02/2012
Dr Andy Rutland
GP
Locality Chair for Poole Bay
Charles Summers
Director of Engagement and
Development, Dorset CCG
Paul Vater
Dr Simon Watkins
GP
76
Interests
Partner at Evergreen Oak Surgery,
Deputy Chair, Poole Central Locality,
Work Out of Hours shift for provider SWAST,
Member of DHCUFT (Not on Governing Body, but to keep in touch with priorities)
Member of Purbeck Health Network
Prior to
17/11/2011
13/01/2013
15/03/2011
22/02/2014
22/02/2014
22/02/2014
05/02/2014
14/05/13
Name and CCG Role
Ms Tina Thompson
Governing Body
Committee,
CCP or Staff
Lay Member,
Audit & Quality
Committee
David Jenkins
Lay Member Lead for Patient
and Public Engagement,
Deputy Chairman of the
Governing Body,
Chairman of the
Remuneration Committee
Governing Body,
Audit & Quality
Committee,
CCC,
Remuneration
Committee
GP
Locality Chair for
Christchurch
Governing Body
Dr Patrick Seal, GP
Locality Chair for Poole
Central
Dr Craig Wakeham
GP,
CCP Lead
Dr Forbes Watson
GP,
CCG Chair,
CCC Chair
Governing Body
Dr Karen Kirkham
Governing Body,
GP,
CCC,
Locality Chair for Weymouth CCP Lead
and Portland
CCC
Governing Body,
CCC
Remuneration
Committee
Interests
Employee of Bournemouth Borough Council working for Bournemouth 2026 Trust
Lay Advisor, Health Education Wessex/Wessex Deanery
Freelance Management Consultant, Third Sector Management Solutions
Site Assessor, Quality Performance Mark, Action for Advocacy
Secretary, Friends of Boscombe Chine Gardens
Date
Declared
14/11/2011
Chair of Gloucestershire County Council's Waste Working Group (2 to 3 days a
month)
Deputy Lieutenant, Dorset,
Trustee, Bournemouth Symphony Orchestra Endowment Fund,
Trustee, Richard Ely Trust for Young Musicians.
Trustee, Burton Bradstock Festival,
Patron, Bridport Arts Centre,
President of the Dorset Association of Parish and Town Councils.
GP Partner, Burton Medical Centre,
GPwSI in ENT, employed by DHUFT,
Director, Wessex Aviation Medical Services Ltd,
GP Partner, the Bridges Medical Centre Weymouth,
Specialty Doctor in Sexual Health, employed by DCHFT,
Board Member, Sexual Health South West Regional Office,
Member of Children’s Trust Board, Dorset,
Governor at Sunninghill Preparatory School,
Husband is a GP Partner at Abbotsbury Road Surgery Weymouth,
GP, The Adam Practice,
Quay Medical Care Limited, the Adam Practice’s provider vehicle for PCOS and
Paediatric service
Senior Partner, Cerne Abbas Surgery (PMS dispensing practice), Dorset LM
21/11/2012,
04/11/2013
Principal, GP Practice (PMS)
in Lyme Regis
Contract with VH Doctors Ltd for medical care.
Spouse clinical employee for DHUFT.
Honorary Medical Advisor and Chairman of RNLI Lyme Regis
Prior to
30/04/2009
15/05/2013
15/05/2013
15/05/2013
04/02/2014
10/05/2010
07/01/2013
10/05/2010
04/02/2014
Prior 14/11/2011
04/02/2014
Prior to
17/11/2011,
16/02/2012
26/04/2012
Each declaration is considered individually. In the main, the acts of declaring, recording and
publishing declared interests are sufficient to deal with the interest declared. Where after
consideration, and having regard to the Nolan principles, a member’s personal or private interests
are such as to prejudice his/her ability to remain disinterested in any particular issue, they will be
advised to withdraw from participating in decision making in that particular issue.
Each individual who is a member of the Governing Body at the time the Members' Report is
approved confirms: 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 them aware of any
relevant audit information and to establish that the clinical commissioning group's auditor is aware
of that information.
77
REMUNERATION REPORT
CCG’s business and management thereon
Board and Executive Committee Members
Full details of the remuneration paid to the
Governing Body members and senior
employees are provided within the
Remuneration Report included herein,
together with their pension entitlements and
declaration of interest.
As part of the governance structure, the CCG
has in place an Audit & Quality Committee
which is responsible for providing the Board
with assurance across the range of CCG
activities, whilst retaining a particular financial
focus.
The Audit & Quality Committee is chaired by
Governance, who has relevant and recent
financial experience. Other Lay Members of
the Committee during 2013/14 were Tina
Thompson, Charles Buckle, and David
Jenkins.
The Committee reviews its terms of reference
and its effectiveness annually and
recommends to the Governing Body any
changes required as a result of the review.
In 2013/14, the Audit & Quality Committee
discharged its responsibilities by:
78
reviewing and recommending the CCG’s
draft financial statements and the external
auditors detailed reports thereon
reviewing the effectiveness of the external
audit process
reviewing and monitoring the external
auditors’ independence and objectivity and
the effectiveness of the audit process,
taking into account relevant UK
professional and regulatory requirements
reviewing the external auditors’ annual
work plan, including its non-audit services
and fees
reviewing the risks associated with the
reviewing the policies and procedures for
all work related to fraud and corruption
reviewing investigations as a result of the
instigation of the CCGs whistle blowing
policy
reviewing the CCGs system of internal
control and its effectiveness, reporting to
the Governing Body on the results of the
review and receiving regular updates on
key processes for management of the risks
facing the CCG
reviewing the effectiveness of the internal
audit function
reviewing the internal audit work
programme, internal audit reports and
periodic progress reports on its work during
the year; and
reviewing governance and risk
management arrangements to ensure
appropriate processes
are in place.
The Audit & Quality Committee has wide
powers to establish special investigations in
the event that any wrongdoing is brought to its
notice, in particular, in the case of
defalcations, fraud or theft.
External Audit
Grant Thornton is the appointed external
auditor for the CCG. The total fee paid to
Grant Thornton was £122,000 including VAT
and was paid to cover the cost of the statutory
audit and associated services.
Senior Managers Remuneration Report
For the purpose of this report, senior
managers are defined as being ‘those persons
in senior positions having authority or
responsibility for directing or controlling the
major activities of the Clinical Commissioning
Group’.
REMUNERATION REPORT
This means those who influence the decisions
of the organisation as a whole rather than the
decisions of individual directorates or
departments. Such persons will include
advisory and Lay Members.
The CCG’s Remuneration Committee is
chaired by David Jenkins, Deputy Chair of the
CCG Governing Body. The Committee met on
five occasions in 2013/14.
It is the Remuneration Committee that
determines the reward packages of Executive
Directors.
The policy on remuneration of senior
managers has been determined reflecting a
Dorset based public sector benchmarking
exercise, national CCG remuneration
guidance and principles established by the
Department of Health within a very senior
managers pay framework.
In the coming year, the committee will review
its policy with wider CCG benchmarking
(following the publication of other CCG annual
accounts) together with any further
development of national remuneration
guidance for CCGs.
Senior CCG officers are eligible for
consideration of a performance related pay
award.
Determination of any award is at the
discretionary recommendation of the
committee, determined by reference to the
achievement of business objectives. Awards
range from 0-5% of individual basic salary.
Senior officer appointments to the CCG are
offered under substantive employment terms
and subject to 6 months’ notice of termination.
Other appointments to the Governing body
(excluding Chief Officer and Chief Finance
Officer) are determined for periods of three
years, renewable under terms provided for by
the constitution. (Please see pages 68 to 77
for Governing Body and Senior Managers’
Profiles).
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 mid-point banded remuneration of the
highest paid director in the financial year
2013/14 was £132,500. This was 3.6 times the
median remuneration of the workforce, which
was £36,666.
In 2013/14, no employee’s full time equivalent
salary was in excess of the highest paid
director. Remuneration ranged from £5,000 to
£132,500.
Total remuneration includes salary, nonconsolidated performance-related pay,
benefits-in-kind as well as severance
payments.
It does not include employer pension
contributions and the cash equivalent transfer
value of pensions.
Exit Packages
In 2013/14 there were two exit packages, at a
cost of £11,033.
79
REMUNERATION REPORT
Salaries & Allowances (subject to audit)
Name and Title
Salary and
Fees
Taxable
Benefits
Annual
PerformanceRelated
Bonuses
Long Term
Performance
Related
Bonuses
All Pensionrelated
Benefits
(Bands of
£5,000)
Rounded
to the
nearest
£’000
Bands of
£2,500)
Bands of
£5,000)
£’000
£’000
£’000
£’000
£’000
70 – 75
0
0
0
10 – 12.5
85 –- 90
100 – 105
0
0
0
12.5 – 15
£”000
Dr Forbes Watson, Chair
Mr Tim Goodson, Chief Officer
130 – 135
Mrs Suzanne Rastrick,
Director of Quality
100 – 105
Mr Paul Vater, Chief Finance Officer
Ms Jane Pike,
Mr Charles Summers, Director of
Engagement and Development
Dr Paul French, GP Locality Chair for
East Bournemouth and GP Clinical
Commissioning Programme (Mental
Health and Learning Disabilities) Lead
Dr Jenny Bubb, GP Locality Chair for
Mid Dorset
Dr Robert Childs, GP Locality Chair
for North Dorset
Dr Colin Davidson, GP Locality Chair
for East Dorset
Dr David Haines, GP Locality Chair for
Purbeck (from 1st October 2013)
Dr Chris McCall, GP Locality Chair for
Poole North and GP Clinical
Commissioning Programme (General
Medical and Surgical) Lead
Dr Blair Millar, GP Locality Chair for
West Dorset
Dr Andy Rutland, GP Locality Chair
for Poole Bay
Dr Patrick Seal, GP Locality Chair for
Poole Central
Dr Tom Knight, GP Locality Chair for
North Bournemouth (from 1st
September 2013)
80
90 – 95
90 – 95
0
0
0
1
(Bands of
£5,000)
0
0
0
0
Bands of
£5,000)
0
0
0
0
Total
17.5 – 20
150 – 155
12.5 – 15
115 – 120
12.5 – 15
12.5 – 15
115 – 120
105 – 110
105 – 110
55 – 60
0
0
0
0 – 2.5
55 – 60
25 – 30
0
0
0
2.5 – 5
30 – 35
25 – 30
0
0
0
0
25 – 30
25 – 30
20 – 25
0
0
0
0
0
2.5 – 5
0
2.5 – 5
30 – 35
25 – 30
65 – 70
0
0
0
0
65 – 70
25 – 30
0
0
0
0
25 – 30
25 – 30
0
0
0
2.5 – 5
30 – 35
25 – 30
25 – 30
0
0
0
0
0
2.5 – 5
0
2.5 – 5
30 – 35
30 – 35
REMUNERATION REPORT
Salary
and Fees
Taxable
Benefits
(Bands of
£5,000)
Rounded to
the nearest
£’000
Dr Karen Kirkham, GP Locality Chair
for Weymouth and Portland and GP
Clinical Commissioning Programme
(Maternity, Reproductive and Family
Health) Lead
55 – 60
Dr Peter Blick, GP Locality Chair for
Central Bournemouth (from 1st August
2013)
Name and Title
Dr Richard Jenkinson, GP Locality
Chair for Christchurch
Dr Chris Burton, Secondary Care
Member
Ms Mary Monnington, Registered
Nurse Member
Dr Piers Wilde, Former GP Locality
Chair for Central Bournemouth (1st April
2013 – 31st July 2013)
Dr Carol Linnard, Former GP Locality
Chair for North Bournemouth (1st April
2013 – 31 August 2013)
All Pensionrelated
Benefits
Total
Bands of
£2,500)
Bands of
£5,000)
0
7.5 – 10
65 – 70
0
0
2.5 – 5
30 – 35
0
0
0
0
20 – 25
20 – 25
0
0
0
0
20 – 25
20 – 25
0
0
0
0 – 2.5
20 – 25
10 – 15
0
0
0
0
10 – 15
0
0
0
2.5 – 5
30 – 35
(Bands of
£5,000)
Bands of
£5,000)
0
0
25 – 30
0
20 – 25
£’000
15 – 20
Dr Christian Verrinder, Former GP
Locality Chair for Purbeck (1st April 2013
– 30 September 2013) and GP Clinical
25 – 30
(Musculoskeletal and Trauma) Lead
Lay Members
Annual
Long Term
Performance- PerformanceRelated
Related
Bonuses
Bonuses
£’000
0
£’000
0
£’000
0
£’000
0
£’000
15 – 20
Mrs Teresa Hensman, Lay Member
Lead for Governance, Chair of the Audit
& Quality Committee
15 – 20
0
0
0
0
15 – 20
Mr David Jenkins, Lay Member Lead
for Public Engagement, Deputy Chair of
the Governing Body and Chair of the
0–5
0
0
0
0
0–5
15 – 20
0
0
0
0
15 – 20
0–5
0
0
0
0
0–5
Ms Tina Thompson, Lay Member,
Member Audit & Quality Committee
Mr Charles Buckle, Lay Member,
Member Audit & Quality Committee
81
REMUNERATION REPORT
Name and Title
Salary and
Fees
Taxable
Benefits
(Bands of
£5,000)
Rounded to
the nearest
£’000
£’000
£’000
Annual
Long Term
Performance- PerformanceRelated
Related
Bonuses
Bonuses
(Bands of
£5,000)
£’000
Bands of
£5,000)
£’000
All Pensionrelated
Benefits
Total
Bands of
£2,500)
Bands of
£5,000)
£’000
£’000
Clinical Commissioning Programme Chairs (not members of Governing Body)
Dr Lionel Cartwright, GP Clinical
(Cancer and End of Life) Lead
Dr Craig Wakeham, GP Clinical
(Cardiovascular Disease, Stroke,
Renal and Diabetes) Lead
Dr Simon Watkins, GP Clinical
Commissioning Programme (Pan
– Urgent Care, Clinical Services
Review and Better Together) Lead
Dr Ros Maycock, Former GP
Clinical Commissioning
Programme (Mental Health and
Learning Disabilities) Lead until
31 October 2013
Notes 1.
2.
3.
4.
5.
82
25 – 30
0
0
0
0 - 2.5
30 - 35
25 – 30
0
0
0
2.5 - 5
30 – 35
25 – 30
0
0
0
0
25 – 30
30 – 35
0
0
0
2.5 - 5
35 – 40
No directors waived any allowances or remuneration during the period 1 April 2013
to 31 March 2014.
Other remuneration and benefits in kind relate to on-call and mileage above taxable
threshold.
No payments have been made to past senior managers by the CCG in 2013/14.
No payments have been made to a senior manager for loss of office in 2013/14
No member of staff formally identified as a senior manager in the CCG has been
given additional payments outside of payroll or give in assets in 2013/14.
REMUNERATION REPORT
Senior Manager Pension Benefits (subject to audit)
Real
Real
Total
increase in increase in
accrued
pension at
pension
pension at
age 60
lump sum at age 60 at
age 60
31 March
2014
(bands of
£2,500)
(bands of
£2,500
(bands of
£5,000)
5 – 7.5
17.5 – 20
5 – 7.5
Ms Jane Pike,
Director of
Service Delivery
Mr Charles
Summers,
Director of
Engagement
and
Development
Dr Chris
Burton,
Secondary Care
Member
(bands of
£5,000)
Cash
Cash
Real
Employers
Equivalent Equivalent increase in contribution
Transfer
Transfer
Cash
to
Value at 31 Value at 31 Equivalent partnership
March 2013 March 2014 Transfer
pension
Value
£’000
£’000
£’000
£’000
£’000
30 – 35
90 – 95
366
476
102
0
15 – 17.5
25 – 30
80 – 85
370
491
114
0
(2.5) - (0)
(7.5) - (5)
30 - 35
100 - 105
605
594
(25)
0
0 – 2.5
5 – 7.5
35 – 40
105 – 110
619
693
60
0
2.5 – 5
7.5 – 10
20 – 25
65 – 70
318
392
67
0
0 – 2.5
5 - 7.5
45 - 50
135 - 140
721
846
109
0
£’000
Mr Tim
Goodson, Chief
Officer
Mr Paul Vater,
Chief Finance
Officer
Mrs Suzanne
Rastrick,
Director of
Quality
£’000
Lump sum
at age 60
related to
accrued
pension at
31 March
2014
£’000
Notes
1. Lay Members do not receive pensionable remuneration.
2. Full details of the accounting policy regarding pension costs can be found within Note 4 of the
full set of audited financial statements.
3. As it is not possible to apportion the CETV across organisations, the full value for each senior
manager is reported above.
4. Mrs Suzanne Rastrick has a decrease in Pension benefits, due to a change in role; last year’s
role was Interim Chief Executive.
5. Dr Chris Burton is recharged to the clinical commissioning group by North Bristol NHS Trust
which includes pension costs. In accordance with the Manual of Accounts, 100% of Dr Burton’s
NHS pension entitlements are shown above, however, only 12% of the pension entitlements
relate to his clinical commissioning group engagement.
6. GPs who serve on the Governing Body for the CCG are recognised as being under a ‘contract
for service’ and therefore according to the NHS Pension Agency do not fall within the definition
of a senior manager for disclosure under Greenbury.
83
REMUNERATION REPORT
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 members 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.
Real Increase in CETV
This reflects the increase in CETV effectively funded by the employer. It takes account of the
increase in accrued pension due to inflation, contributions paid by the employee (including the
value of any benefits transferred from another scheme or arrangement) and uses common market
valuation factors for the start and end of the period.
Off-payroll Engagements
Following the review of Tax arrangements of public sector appointees published by the Chief
Secretary to the Treasury, clinical commissioning groups are required to publish information on
their highly paid and/or senior off-payroll engagements.
Off-payroll engagements as of 31 March 2014, for more than £220 per day and that last longer
than 6 months are as follows:
The number that have existed:
For less than one year at the time of reporting
Total number of existing engagements as of 31 March 2014
Number
NIl
Nil
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.
84
REMUNERATION REPORT
Number of new engagements or those that reached six months in duration, between 1 April 2013
and 31 March 2014
Number of the above which include contractual clauses giving the clinical commissioning group the right to request
assurance in relation to Income Tax and National Insurance obligations.
Number for whom assurance has been requested.
Of which, the number:
For whom assurance has been received
For whom assurance has not been received
That have been terminated as a result of assurance not being received.
Number
Nil
Nil
Nil
Nil
Nil
Nil
Nil
85
FINANCIAL PERFORMANCE
SUMMARY FINANCIAL STATEMENTS
The statements below summarise the information contained within the full audited accounts.
Statement of Comprehensive Net Expenditure
Administration Costs and Programme Expenditure
Gross Employee Benefits
Other Costs
Less: Miscellaneous Income
Net Operating Costs before Financing
Investment Revenue
Other (Gains) & Losses
Finance Costs
NET OPERATING COST FOR THE FINANCIAL YEAR
Other Comprehensive Net Expenditure
Impairments and reversals put to the Revaluation Reserve
Net (gain)/loss on revaluation of property, plant and equipment
Release of reserves to Statement of Comprehensive Net Expenditure
TOTAL COMPREHENSIVE NET EXPENDITURE FOR THE YEAR
13,496
926,659
(5,672)
934,483
0
0
0
934,483
0
0
0
934,483
The purpose of this statement is to summarise, on an accruals basis, the net operating costs of
the CCG. The statement identifies gross operating costs, less miscellaneous income, to arrive
at the net operating costs of the CCG.
86
Overview
The audited accounts show that during the year ended 31 March 2014, the CCG achieved all of its
financial duties.
The CCG has a statutory duty to maintain expenditure within the resource limits set for revenue,
including managing programme and running costs allocations separately.
Revenue expenditure covers the general day to day costs involved in the commissioning of
healthcare. The CCG met its statutory duty to operate within its revenue resource limit and in
addition is significantly under the £25 per head running cost allowance.
Total net operating costs for the financial year
REVENUE SURPLUS
2013/14
£’000
TOTAL
934,483
2013/14
£’000
Programme
917,753
2013/14
£’000
Running Costs
16,730
12,614
10,614
2,000
947,097
928,367
18,730
This note measures the CCG’s performance against its statutory duty to operate within the
revenue resource limit set by the Department of Health and NHS England.
The revenue resource limit is the maximum the CCG can spend on commissioning healthcare for
its resident population.
Staff Costs
Salaries and wages
Employer contributions to NHS Pensions Agency
Social Security Costs
2013/14
£’000
11,396
1,235
854
Termination Benefits
Other Employment Benefits
TOTAL STAFF COSTS
11
0
13,496
This note includes permanently (those directly emloyed by the CCG) and other employed staff
(those on secondment or loan from other organisations, bank / agency / temporary staff and
contract staff).
87
Average Number of Persons Employed
Average Number of Persons Employed (Other Staff)
Sickness & Absence Data
Total Days Lost
Total Average Number of Staff (FTE)
Average Working Days Lost
2013/14
295
2013/14
Number
1,220
234
5.21
The employee absence level within the CCG is above the national target of 3% and also
above the target we have set for ourselves of 2%. In light of this the CCG introduced a new
Managing Absence policy in April 2014 as part of a wider re-launch of HR polices.
This has been supported by a series of briefings across CCG sites for managers and
employees. One of the key objectives in the Workforce Plan for 2014/15 is a review of the
current managing attendance system from recording through to monitoring and
engagement with managers as well as development. We will then develop a new managing
attendance system with the appropriate communication, engagement and development
strategy to roll out to the organisation.
This note has been prepared consistently with total staff costs above.
The above 2013/14 figures relate to commissioning staff only and following national
guidance, the calculation of sickness absence in a financial year is calculated using working
days only. The calculation of sickness absence in a financial year is calculated using only
working days.
Running Costs
Running costs (£’000s)
Weighted population (number in units)
Running costs per weighted population (£ per head)
88
2013/14
16,730
749,179
£22.33
Better Payments Practice Code
In accordance with the Better Payments Practice Code, valid invoices should be paid by their
due date or within 30 days of receipt, whichever is later. CCG performance is presented below,
measured in terms of both the number and value of invoices received, against an NHS
administrative target to pay over 95% of non-NHS trade creditors in accordance with the code.
Non-NHS Payables
Number
2013/14
£’000
Total bills paid in the year
27,290
130,783
Percentage of bills paid within target
96.9%
98.7%
Total bills paid within target
26,441
NHS Payables
Number
2013/14
129,063
£’000
Total bills paid in the year
3,601
682,215
Percentage of bills paid within target
98.1%
101.0%
Total bills paid within target
3,534
688,789
The 101.0% is caused by a large credit note. If the credit note could be removed from the
figures, the per centage of NHS invoices paid within target would fall to 99.7%
This note shows the CCG’s performance against its administrative duty to pay all
creditors within 30 calendar days of receipt of goods or valid invoice, whichever is later,
unless other payment terms have been agreed.
Losses and Special Payments
The CCG had no losses or special payments during 2013/14.
During 2013/14 the CCG had no lapses of data security.
Losses or special payments are payments that Parliament would not have envisaged healthcare
funds being spent on when it originally provided the funds.
89
GLOSSARY
A&E
AF
Atrial Fibrillation
B&P
Bournemouth and Poole
AHPs
CAAS
CAMHS
CCC
CCG
CCP
CCU
CETV
CHC
CIPOLD
COPD
CQC
CVD
Allied health professionals
Community Adult Asperger
Service
Child and Adolescent Mental
Health Services
Civil Contingencies Unit
Cash Equivalent Transfer Value
Continuing Health Care
Confidential Inquiry into
Premature Deaths of People with
Learning Disabilities
Chronic Obstructive Pulmonary
Disease
Care Quality Commission
EPRR
FFT
GSF
HR
Health and Wellbeing Board
Information Governance
Information Governance Toolkit
IV
Intravenous
JSNA
Joint Strategic Health Needs
Assessments
IVF
KPI
LRTI
LHRP
LSCB
LTC
MRSA
MSK
NBT
OT
In Vitro Fertilisation
Key Performance Indicator
Local Area Team
Local Health Resilience
Partnership
Lower Respiratory Tract Infection
Bournemouth and Poole Local
Safeguarding Children Board
Long Term Condition
Meticillin-resistant
Staphylococcus Aureus, a type of
bacterial infection
Musculoskeletal
North Bristol NHS Trust
Occupational therapist
Cardiovascular disease
PCT
Primary Care Trust
Dorset County Hospital NHS
Foundation Trust
PHFT
Poole Hospital NHS Foundation
Trust
Dorset Safeguarding Children
Board
EPC
IGT
Programme
Clinical Commissioning Group
DSCB
ECG
IG
LAT
Dorset County Council
DHUFT
HWB
Committee
DCC
DCHFT
90
Accident and Emergency
Dorset Healthcare University
NHS Foundation Trust
PEC
PHB
POPP
Electrocardiogram
PROM
Emergency preparedness,
resilience and response
RBCHFT
Energy Performance Contract
Friends and Family Test
Gold Standard Framework
Human Resources
PTS
TIA
Professional Executive
Committee
Personal Health Budget
Dorset Partnership for Older
People Programme
Patient Reported Outcome
Measures
Patient Transport Services
Royal Bournemouth and
Christchurch Hospitals NHS
Foundation Trust
Transient Ischaemic Attack
(mini-stroke)
NHS DORSET CLINICAL COMMISSIONING GROUP
FINANCIAL STATEMENTS
FOR THE YEAR ENDED
31 MARCH 2014
NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14
CONTENTS
Foreword to the Accounts
3
Independent Auditor's Report
4
Statement of the Signing Officer Responsibilities
5
Annual Governance Report
6-19
Head of Internal Audit Opinion
20-24
The Primary Statements:
25
Statement of Financial Position
Statement of Changes in Taxpayers' Equity
Statement of Cash Flows
Notes to the Accounts:
Note 1
Note 2
Note 3
Note 4
Note 5
Note 6
Note 7
Note 8
Note 9
Note 10
Note 11
Note 12
Note 13
Note 14
Note 15
Note 16
Note 17
Note 18
Note 19
Note 20
Note 21
Note 22
Note 23
Note 24
Note 25
Note 26
Note 27
Note 28
Note 29
Note 30
Note 31
Note 32
Note 33
Note 34
Note 35
Note 36
Note 37
Note 38
Note 39
Note 40
Note 41
Note 42
Note 43
Note 44
26
27
28
29
30
Accounting policies
Miscellaneous Revenue
Revenue
Employee benefits and staff numbers
Operating Expenses
Better payments practice code
Income Generation Activity
Investment Income
Other gains and losses
Finance costs
Net Gain (Loss) by Absorption
Operating Leases
Property, Plant and Equipment
Intangible Non-Current Assets
Investment Property
Inventories
Trade and other receivables
Other financial assets
Other current assets
Cash and cash equivalents
Non-current assets held for sale
Analysis of Impairments and Reversals
Trade and other payables
Deferred revenue
Other financial liabilities
Other liabilities
Borrowings
PFI and NHS LIFT contracts
Finance lease obligations
Provisions
Contingencies
Commitments
Financial instruments
Operating segments
Pooled budget
NHS LIFT investment
Intra Government and other balances
Related Party transactions
Events after the reporting period
Losses and special payments
Third Party Assets
Financial performance targets
Impact of IFRS treatment
Analysis of Charitable reserves
31-36
37
37
38-39
40
41
41
41
41
41
42
42
43-44
45
45
45
46
46
46
46
46
47
47
48
48
48
48
48
48
48
49
49
49
50
50
50
50
51
52
52
52
52
52
52
Glossary of financial terms
53
Contents
Page 2 of 53
FOREWORD TO THE ACCOUNTS
ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2014
These accounts for the year ended 31 March 2014 have been prepared by the NHS Dorset
Clinical Commissioning Group under section 17 of the National Health Service Act 2006 (as
amended) in the form which the Secretary of State has, with the approval of the Treasury,
directed.
Forward
Page 3 of 53
Independents Auditor's Report
Page 4i to 4iii of 53
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 Timothy Goodson to be the
Chief Officer of the Clinical Commissioning Group.
The responsibilities of an Accountable Officer, including responsibilities for the propriety and
regularity of the public finances for which the Accountable Officer is answerable, for 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 for safeguarding the Clinical
Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and
detection of fraud and other irregularities), 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; and,

Prepare the financial statements on a going concern basis.
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.
Tim Goodson
Chief Officer / Accountable Officer
4 June 2014
Page 5 of 53
Signing Officer Responsilbities
GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING
GROUP
Governance Statement by Tim Goodson as the Chief Officer of NHS Dorset Clinical
Commissioning Group.
1
Introduction
1.1
The NHS Dorset Clinical Commissioning Group (CCG) was licenced from 1
April 2013 under provisions enacted in the Health & Social Care Act 2012,
which amended the NHS Act 2006.
1.2
The CCG operated in shadow form prior to 1 April 2013, to allow for the
completion of the licencing process and the establishment of function,
systems and processes prior to the CCG taking on its full statutory duties on 1
April 2013.
1.3
As at 1 April 2013, the CCG was licensed without conditions.
2
Scope of Responsibility
2.1
The Chief Officer has responsibility for maintaining a sound system of internal
control that supports the achievement of the CCG’s policies, aims and
objectives, whilst safeguarding public funds and departmental assets for
which he is personally responsible, in accordance with the responsibilities
assigned to him in Managing Public Money. He is also responsible for
ensuring that the CCG is administered prudently and economically and that
resources are applied efficiently and effectively. The Chief Officer also
acknowledges his responsibilities as set out in his Clinical Commissioning
Group Accountable Officer Appointment letter.
3
Compliance with the UK Corporate Governance Code
3.1
Whilst the detailed provisions of the UK Corporate Governance Code (the
Code) are not mandatory for public sector bodies, compliance is considered to
be good practice. The NHS Clinical Commissioning Groups Code of
Governance has been created by extracting from the Code, parts relevant to
CCG’s. This Governance Statement is intended to demonstrate the CCG’s
compliance with the principles set out in the NHS Clinical Commissioning
Group’s Code of Governance.
3.2
For the financial year ended 31 March 2014 and up to the date of signing this
statement, the CCG complied with the provisions set out in the NHS Clinical
Commissioning Groups Code of Governance and applied the principles of the
Code except as follows:
Annual Governance Statement
Page 6 of 53
GROUP

Principle 5: The CCG has just initiated plans to publish learning from
Governanceand
Statement
by Tim
Goodson asfollowing
the Chiefrecommendations
Officer of NHS Dorset
Clinical
responses
to complaints
in the
Francis
Group.
report. This will beCommissioning
implemented immediately;
1
1.1
4
Introduction

Principle 6: The Governing Body has not received an annual summary
of information that is available to the public. This will be addressed
The NHS
Clinical
Commissioning
Group May
(CCG)
was licenced from 1
andDorset
presented
at the
Governing Body’s
meeting.
which
amended
the NHSFramework
Act 2006.
The
CCG
Governance
1.2
4.1.
TheNational
CCG operated
shadowAct
form
prior( as
to 1amended)
April 2013,attoparagraph
allow for the
The
HealthinService
2006
14L(2)(b)
completion
of
the
licencing
process
and
the
establishment
of
states: the main function of the governing body is to ensure function,
the group has
systems
and processes
prior to the
takingit on
its full statutory
duties
on 1
made
appropriate
arrangements
forCCG
ensuring
complies
with such
generally
April 2013.
accepted
principles of good governance as are relevant to it.
1.3
4.2
As at
1 April
the CCGorganisation
was licensedcomprising
without conditions.
The
CCG
is a2013,
membership
of 100 GP practices
throughout Dorset.
2
4.3
2.1
4.4
4.5
3
3.1
4.6
The CCG Governing Body is committed to providing the resources and
The Chief
Officernecessary
has responsibility
for maintaining
a sound system
of internal
support
systems
to support
the Risk Management
Framework
and
control
that
supports
the
achievement
of
the
CCG’s
policies,
aims
and
will ensure that action is taken to address all risks that are identified and
objectives,aswhilst
safeguarding public funds and departmental assets for
assessed
unacceptable.
assigned
him in Managing
Public the
Money.
He is also
responsible for
The
CCG to
Governing
Body reviews
Assurance
Framework/Corporate
Risk
ensuringas
that
the CCG
administered
prudentlythe
and
economically
and that
Register
a whole;
sixismonthly,
and through
Audit
and Quality
resources are
applied
efficiently
andFramework/Corporate
effectively. The Chief Officer
also
Committee,
reviews
the
Assurance
Risk Register
as a
acknowledges
his
responsibilities
as
set
out
in
his
Clinical
Commissioning
whole, every quarter.
The CCG Governing Body is made up of 13 Locality Chairs who are GP’s or
Compliance
with
theChair,
UK Corporate
Governance
Code the Chief Finance
retired
GP’s, the
GP
the Accountable
Chief Officer,
Officer, two lay members, the Lead Nurse and the Lead Consultant. The CCG
Whilst the detailed
provisions
of the UK Corporate Governance Code (the
Governing
Body meets
bi-monthly.
be good
The NHS Executive
Code
of
There
arepractice.
three non-voting
Directors, theGroups
Director
of Quality,
the
Governance
has
been
created
by
extracting
from
the
Code,
parts
relevant
to
Director of Service Delivery and the Director of Engagement and
CCG’s.
This
Governance
Statement
is
intended
to
demonstrate
the
CCG’s
Development that support the CCG Chief Officer. The Governing Body is
compliance
principles
in the NHS
Clinical
Commissioning
supported
bywith
thethe
Chief
Officer set
andout
Governing
Body
Secretary.
4.7
3.2
The first standing agenda item for CCG Governing Body meetings is to
For thecompliance
financial year
ended
31 March
2014
and
to states
the date
of no
signing
this
ensure
with
Standing
Order
3.11
(I) up
that
that
business
statement,
the
CCG
complied
with
the
provisions
set
out
in
the
NHS
Clinical
shall be transacted at a meeting unless at least 1/3 of the whole number of
Commissioning
Groups
Code
Governance
and
appliedquoracy
the principles
of the
the
Chairman and
members
isof
present.
During
2013-14
has been
Code except
maintained
forasallfollows:
CCG Governing Body meetings.
4.8
The CCG Governing Body has three committees that report to it. These are
the Remuneration Committee, Clinical Commissioning Committee and the
Audit and Quality Committee.
Page 7 of 53
GROUP
Audit and Quality Committee
4.9 The Audit and Quality Committee
is the
committee which has delegated
Commissioning
Group.
responsibility from the CCG Governing Body for the monitoring and oversight
of risk and governance.
1
Introduction
4.10
1.1
1.2
4.11
1.3
2
2.1
4.12
4.13
3
3.1
4.14
3.2
The
and Quality
monitors
and
provides
overall assurance
to
The Audit
NHS Dorset
ClinicalCommittee
Commissioning
Group
(CCG)
was licenced
from 1
the
Governing
Body
that
the
CCG
is
delivering
quality
care
that
meets
the
standards
laid out
statute
and that the CCG is aligning strategic direction
which amended
thein
NHS
Act 2006.
with local assurance mechanisms by monitoring the Assurance
Framework/Corporate
Risk Register
ontobehalf
the Governing
Body. As part
The CCG operated in shadow
form prior
1 Aprilof
2013,
to allow for the
of
this
committee’s
remit
the
Audit
and
Quality
Committee
will
review
internal
audit
reports
on the systems
place
risk management.
systems
and processes
prior tointhe
CCGfor
taking
on its full statutory duties on 1
April 2013.
The Audit and Quality Committee membership consists of two lay members
from
Governing
Body
whom
one is
the Chair
of the committee, two nonAs atthe
1 April
2013, the
CCGofwas
licensed
without
conditions.
Governing Body lay members, one GP Governing Body member and the
Lead
Nurse
Governing Body member. The Director of Quality and the Chief
Scope
of Responsibility
Finance Officer also attend the meetings and support the committee.
The
Audit
Quality
meet
quarterly.
During aims
2013-14
control
thatand
supports
theCommittee
achievement
of the
CCG’s policies,
and quoracy has
been
maintained
for all Audit and
Quality
meetings
objectives,
whilst safeguarding
public
funds and
departmental assets for
The
Quality
Group
is a working
group
reporting
to the
Audit andforQuality
assigned
to him
in Managing
Public
Money.
He is also
responsible
Committee.
The
Quality
Group
has
delegated
responsibility
for and
the that
ensuring that the CCG is administered prudently and economically
management,
monitoring
and
reporting
of
clinical
governance,
governance,
risk,
patient safety
and quality. There
a in
Quality
Framework
in place which
acknowledges
his responsibilities
as set is
out
his Clinical
Commissioning
details
the
structures
and
processes
to
ensure
quality
is
embedded
throughout the commissioning cycle.
Clinical Commissioning Committee
The
Clinical
Committee
supportcompliance
the Governing
Body with
Code)
are notCommissioning
mandatory for public
sector bodies,
is considered
to
delivery
of
clinical
effectiveness
and
governance
through:
CCG’s.support
of the Audit
and Quality
Committee
in discharging
the CCG’s
This Governance
Statement
is intended
to demonstrate
the CCG’s
responsibility
for
clinical
governance
for
commissioned
services
including
monitoring and enforcement of National Service
Group’s
Code of the
Governance.
Frameworks, National Institute of Clinical Excellence guidance and
Quality
standards
or up
other
agreed
standards;
For theCare
financial
yearCommission
ended 31 March
2014 and
to the
date of
signing this
Commissioning
providingGroups
clinical Code
oversight
to contractand
management
on specific
Clinical
of Governance
applied the principles
of the
Commissioning
Code except
as follows: Programme areas;

providing clinical scrutiny of service quality, effectiveness and safety
and advising the Governing Body;

providing clinical assessment of commissioning outcomes;
Page 8 of 53
GROUP
4.15 The Clinical Commissioning Committee also support communication with
partners and stakeholders through:
Commissioning
Group.

supporting and promoting
effective
partnership working, including joint
planning and commissioning, with other NHS organisations, local
1
Introduction
authorities and the voluntary and independent sectors;
1.1
1.2
1.3
4.16
2
2.1
4.17
4.18
3
3.1
3.2
Dorset Clinical
Group
(CCG) was through
licenced CCPs;
from 1
The NHS
encouraging
andCommissioning
facilitating locality
engagement
NHS Act
2006. perspective, conflict with providers of
which amended
resolving,the
through
a clinical
service;
of the licencing
process
and the establishment
of function,
completion
maintaining
effective
communications
and engagement
with front-line
systems
and
processes
prior
to
the
CCG
taking
on
its
full
statutory
duties on 1
healthcare professionals.
April 2013.
The Remuneration Committee is constituted as a standing committee of the
Scope
of Responsibility
CCG
Governing
Body. The Committee is a non-executive committee and has
no executive powers other than those specifically delegated in these Terms of
Reference.
objectives,
whilst safeguarding
and departmental
for
The
Remuneration
Committeepublic
shallfunds
comprise
of the Chair,assets
the Deputy
Chair,
which
he isofpersonally
accordanceand
withtwo
the other
responsibilities
the
Chair
the Audit responsible,
and Quality in
Committee,
individuals who
assigned
to him
Managing
Public
Money. He is also responsible for
are
members
ofinthe
Governing
Body.
resources
are applied
efficiently and
effectively. The Chief Officer also
The
Remuneration
Committee
shall:
Accountable
Officer Appointment
letter.
Group review
the appraisal
of the performance
of the Chief Officer, directors
and other appropriate members of the senior team;

recommend to the Governing Body the remuneration and terms of
service of the Chief Officer, directors and other appropriate members of
the senior team and annual salary awards;

recommend to the Governing Body special severance payments of the
Chief Officer, directors and all other staff, subject to receiving HM
Treasury (if necessary) approval in accordance with any current
guidance;

determine a matter where the Governing Body is unable to determine
the matter because of an inability to form a quorum and has specifically
delegated to the committee a matter or matters to be determined by the
committee on behalf of the Governing Body.

4.19
determine any matter delegated to it by the Governing Body.
The CCG Governing Body’s agenda covers all areas of financial accountability
and governance including the following reports made to every meeting:
•
Chair’s report;
•
Chief Officers update;
Page 9 of 53
delegated to the committee a matter or matters to be determined by the
committee on behalf of the Governing Body.

determine any matter delegated to it by the Governing Body.
4.19 The CCG Governing Body’s agenda covers all areas of financial accountability
and governance
including
theNHS
following
reports
made to
every meeting:
GOVERNANCE
STATEMENT
FOR
DORSET
CLINICAL
COMMISSIONING
GROUP
•
Chair’s report;
•
Chief
Officers
Governance
Statement
by update;
Tim Goodson as the Chief Officer of NHS Dorset Clinical
•
Finance and Performance reports;
1
Introduction
•
Board Assurance Framework and Risk Register;
1.1
under
provisions
enacted the
in the
HealthReport
& Social
Care Act 2012,
April 2013
Quality
Report
incorporating
Francis
Recommendations.
1.2
4.20
The CCG
operated
in shadow
formtoprior
to 1 April
2013,that
to allow
the received
Other
significant
reports
relating
internal
controls
havefor
been
completion
the licencing
process
and
the establishment
by
the CCGofGoverning
Body
during
2013-14
include: of function,
•April 2013.
Annual update for safeguarding Adults and Children;
1.3
1 April 2013,
the CCG
was licensed without conditions.
•As at Annual
Complaints
report;
2
of Responsibility
•Scope
Annual
review of the Governance documents.
2.1
Officer
has responsibility
for maintaining
a soundand
system
of internal
•The Chief
Standing
Financial
Instructions,
Standing Orders
scheme
of
control
that supports
achievement
of the CCG’s policies, aims and
delegation
andthe
committee
structures.
which
he isand
personally
in accordance
with
responsibilities
The
Audit
Qualityresponsible,
committee agenda
covers
all the
areas
of financial
assigned to himand
in Managing
Public
Money.the
He following
is also responsible
for to every
accountability
governance
including
reports made
meeting:
responsibilities
as set out in his Clinical Commissioning
acknowledges
Customerhis
Care
report;

changes to Assurance Framework/Corporate Risk Register;

investigations following instigation of the Employee Whistle Blowing
WhilstPolicy;
the detailed provisions of the UK Corporate Governance Code (the
practice.
The NHS Clinical
Commissioning
Groups Code
be good
updates
on Litigation,
Medical
Negligence, Inquests
and of
enquiries;
Thisdive
Governance
Statement
is intended to demonstrate the CCG’s
CCG’s.
deep
on significant
risk issues;
Code
Governance.
Group’s
review
ofofSignificant
Providers Contracts report;
4.21
3
3.1
3.2

Safeguarding Adults report;

Safeguarding Children report;

Information Governance report;

Dorset Medicines Advisory Group report;

Internal Audit reports;
Page 10 of 53
GROUP

External Audit reports;
Governance
Statement
by reports.
Tim Goodson as the Chief Officer of NHS Dorset Clinical
 Counter
Fraud
1
Introduction
4.22
In relation to Risk Management, the Quality Group seeks to provide assurance
to the Audit and Quality Committee by:
1.1
2013 under that
provisions
enacted
in the
Health & Social
Care Act 2012,
April confirming
appropriate
Risk
Management
arrangements
are in place;
1.2
1.3
2
2.1
4.23
5
5.1
3
3.1
5.2
3.2
5.3
 monitoring all significant risks which may impact on the CCG business
The planning
CCG operated
in shadow form prior to 1 April 2013, to allow for the
process;
 ensuring action to improve risk management processes and systems, to
April 2013.
address all known and previously unidentified risks;
 ensuring that patient safety is central to all services commissioned by the
CCG including safeguarding of adults and children, via contract and
quality monitoring of secondary and tertiary providers;
 monitoring the CCG Assurance Framework/Corporate Risk Register.
objectives,
whilst safeguarding
public
funds and departmental
assets
for
The
CCG Governing
Body has
arrangements
in place via its
Governance
which he is personally
responsible,
in accordance
with the its
responsibilities
Framework
and structures
to ensure
that it discharges
statutory functions
assigned
to
him
in
Managing
Public
Money.
He
is
also
responsible
forThe
and the Chief Officer can confirm that they are legally compliant.
ensuring that
the CCG
is completing
administeredaprudently
and economically
that
Governing
Body
will be
self -assessment
later on and
in the
year.
acknowledges
his
responsibilities
as set out in his Clinical Commissioning
The
CCG Risk
Management
Framework
The CCG is committed to minimising risks to which it is exposed, strategically
Compliance
with the
Corporate
and corporately.
TheUK
overriding
aimGovernance
is to reduceCode
the potential for loss of
services due to adverse events, financial management or performance and
Whilst
detailed provisions
of the UK Corporate
Code (thebe of
qualitythe
management
of commissioned
services Governance
that could ultimately
Code)
are
not
mandatory
for
public
sector
bodies,
compliance
is
considered to
detriment to the population the CCG serves.
Governance
has been
created
by extracting
from the
parts
relevant
In order to achieve
this
aim, risk
management
hasCode,
become
part
of theto
culture
CCG’s.
This
Governance
Statement
is
intended
to
demonstrate
the
CCG’s
of the organisation, and become a primary concern of all staff and
compliance
withThe
the principles
set out in the
NHS Clinical
Commissioning
stakeholders.
Risk Management
Strategy
was approved
and endorsed
Group’s
Code
of
Governance.
by the Governing Body in December 2012 ready for use in April 2013 to
reflect the CCG’s risk management requirements.
statement,
the CCG complied
with the provisions set out in the NHS Clinical
The Risk Management
Strategy:
 sets out the organisation’s objective to identify, treat and mitigate risk;

defines the role and objectives of the CCG’s committees and groups. It
describes the supporting strategies, policies and procedures that
determine the management and ownership of risk and the management of
situations in which control failure leads to material realisation of risks;
Page 11 of 53
GROUP

specifies the way in which risk issues are to be considered at each level of
planning,
ranging
from
the corporate
objectives
setNHS
out Dorset
in the CCG’s
Governance
Statement
by Tim
Goodson
as the Chief
Officer of
Clinical
Delivery Plan to theCommissioning
individual objectives
within
Directorates;
Group.
1
1.1
1.2
1.3
2
5.4
2.1
5.5
3
5.6
3.1
5.7
3.2
 specifies risk assessment and identification processes for new and
Introduction
existing activities and the resultant risk action plans and how these are
within
the Corporate
RiskGroup
Register
for the
The captured
NHS Dorset
Clinical
Commissioning
(CCG)
wasorganisation;
licenced from 1

standardises
and
clarifies
the terminology of risk management and
which
amended the
NHS
Act 2006.
establishes clear, consistent and effective risk scoring systems;

explains
Frameworks
assesses of
the
risk and the impact
completion
of the
the Assurance
licencing process
and the and
establishment
function,
of failure,
identifiesprior
the control
mechanisms
these
objectives
systems
and processes
to the CCG
taking on to
its monitor
full statutory
duties
on 1
and
clarifies
the
assurances
that
are
present
to
review
and
monitor
the
April 2013.
implementation of objectives;
 explains the risk scoring system that enables the organisation to
impartially
assess risk and identify high risk areas.
Scope
of Responsibility
The Chief
CCG Officer
identifies
requirements
for completing
equality
impact
hasthe
responsibility
for maintaining
a sound
system
of internal
assessments
when
commissioning
services,
changes
to
services,
control that supports the achievement of the CCG’s policies, aims and use of
information
withinsafeguarding
services and
within
the and
policies
that are used.
objectives, whilst
public
funds
departmental
assets for
Incident
reporting
is openly
ensuring and
that Serious
the CCGIncident
is administered
prudently
andencouraged
economicallyfrom
and its
thatstaff, GP
practices
the provider
organisations
that itThe
commissions.
resources and
are applied
efficiently
and effectively.
Chief OfficerThis
also information
is
analysed
and
used
to
identify
risks
which
may
impact
on
the
business of the
CCG.
The Quality Group and the Audit and Quality Committee have patient
representatives as that attend the meetings regularly to ensure there is a voice
for patients and public. They are integral to scrutinising the risks identified and
understanding what actions are taken to mitigate and reduce these risks.
Governance
created
by extracting
from of
theitsCode,
parts
relevant to
The
CCG is has
ablebeen
to assure
itself
of the validity
Annual
Governance
CCG’s.
This
Governance
Statement
is
intended
to
demonstrate
the
CCG’s
Statement in a number of ways. These are:
 adherence to the Risk Management Strategy;
the CCG complied
withand
thereporting
provisionsmechanisms
set out in thein
NHS
Clinical
statement,
the governance
framework
place
for
Commissioning
Groups
Code
of
Governance
and
applied
the
principles
of the
provision of assurance;

scrutiny of the draft Governance Statement by members of the Audit and
Quality Committee prior to submission and sign off at the special meeting
for closure of finances in June 2014;
Page 12 of 53
GROUP
5.8
The cumulative contribution of the above mechanisms assists in the
assurance of commissioning services that ensure patient safety is high profile.
Commissioning
Group.
6
The CCG Internal Control
Framework
1
6.1
1.1
1.2
6.2
6.3
1.3
2
7
2.1
7.1
7.2
3
3.1
7.3
7.4
3.2
Introduction
A system of internal control is the set of processes and procedures in place in
a clinical commissioning group to ensure that it delivers it policies, aims and
The NHS Dorset
(CCG)
licenced
from 1the
objectives.
It is designed
to identify andGroup
prioritise
thewas
risks,
to evaluate
April 2013 of
under
provisions
enacted
in the
Health
& Socialshould
Care Act
2012,
likelihood
those
risks being
realised
and
the impact
they
be realised
which
amended
the
NHS
Act
2006.
and to manage them efficiently, effectively and economically.
The CCG
operated
in shadow
priorrisk
to 1toApril
2013, to allow
the
The
system
of internal
controlform
allows
be managed
to a for
reasonable
level
completion
the licencing
andtherefore
the establishment
of function,
rather
than of
eliminating
all process
risk; it can
only provide
reasonable and not
systems and
processes
prior to the CCG taking on its full statutory duties on 1
absolute
assurance
of effectiveness.
April 2013.
The Assurance Framework/Corporate Risk Register has controls described for
every
entry.
are
reviewed
on aconditions.
monthly basis along with
As at 1risk
April
2013,The
the controls
CCG was
licensed
without
progress for reducing risk to ensure they are still effective.
Information Governance
The
CCG
particular
importance
on CCG’s
risks for
data security
and to this
control
thatplaces
supports
the achievement
of the
policies,
aims and
end
there iswhilst
an Information
Governance
which meets
quarterly.
objectives,
safeguarding
public fundsGroup
and departmental
assets
for This
group
manages
risks
pertaining
to
data
security
as
part
of
its
remit.
This group
reports
quarterly
the AuditPublic
and Quality
assigned
to him into
Managing
Money. Committee.
He is also responsible for
The
NHS Information
Governance
FrameworkThe
sets
the Officer
processes
resources
are applied efficiently
and effectively.
Chief
also and
procedures
byhis
which
the NHS handles
information
about
patients and
acknowledges
responsibilities
as set out
in his Clinical
Commissioning
employees,
in
particular
personal
identifiable
information.
The NHS
Information Governance Framework is supported by an information
governance
and
the
annual submission
process
Compliance toolkit
with the
UK
Corporate
Governance
Code provides assurances to
the clinical commissioning group, other organisations and to individuals that
personal
is dealtof
with
securely,
efficientlyCode
and effectively.
Whilst theinformation
detailed provisions
thelegally,
UK Corporate
Governance
(the
The
CCG has
completed
the Information
Toolkit
is to
an
Governance
has
been created
by extractingGovernance
from the Code,
parts which
relevant
annual
requirement
and
has
achieved
level
2
in
all
standards
of
the
toolkit.
The CCG has ensured all staff under take annual information governance
training
face to face
have
implemented
a staff
governance
For the financial
year and
ended
31 March
2014 and
up to information
the date of signing
this
handbook
staff arewith
aware
the information
roles and
statement, to
theensure
CCG complied
the of
provisions
set out ingovernance
the NHS Clinical
responsibilities.
7.5
There are processes in place for incident reporting and investigation of serious
incidents pertaining to information governance.
Page 13 of 53
GROUP
8
Pension Obligations
Governance
by Tim
Goodson
Chief Officer
NHS
Dorset
Clinical
8.1
As an Statement
employer with
staff
entitledas
tothe
membership
ofof
the
NHS
Pension
Commissioning
Group.
Scheme, control measures
are in place
to ensure all employer obligations
contained within the Scheme regulations are complied with. This includes
1
Introduction
ensuring that deductions from salary, employer’s contributions and payments
into the Scheme are in accordance with the Scheme rules, and that member
1.1
The
NHS Scheme
Dorset Clinical
Commissioning
Group
(CCG)
licenced from
1
Pension
records
are accurately
updated
in was
accordance
with the
April
2013 under
provisions
enacted in the Health & Social Care Act 2012,
timescales
detailed
in the regulations.
9
Equality Diversity and Human Rights Obligations
1.2
of the licencing
process
the that
establishment
function,with the
9.1 completion
Control measures
are in place
to and
ensure
the CCG of
complies
systems
and
processes
prior
to
the
CCG
taking
on
its
full
statutory
duties on 1
required public sector equality duty set out in the Equality Act 2010.
April 2013.
10
Sustainable Development Obligations
1.3
10.1 The CCG is required to report its progress in delivering against sustainable
2
Scope
of Responsibility
development
indicators.
2.1
10.2
10.3
3
11
3.1
11.1
11.2
3.2
11.3
The
has responsibility
maintaining
sound system
of internal and
The Chief
CCG Officer
are developing
plans tofor
assess
risks, a
enhance
our performance
control
the achievement
of the CCG’s
aims andadaption
reducethat
our supports
impact against
carbon reduction
and policies,
climate change
objectives,
safeguarding
public funds
and departmental
assets
for and
objectives.whilst
This includes
establishing
mechanisms
to embed
social
which
he is personally
responsible,
in accordance
with the responsibilities
environmental
sustainability
across
policy development,
business planning
assigned
to him in Managing Public Money. He is also responsible for
and in commissioning.
resources
and effectively.
The Chief Officer
The CCG are
will applied
ensureefficiently
that it complies
with its obligations
underalso
the Climate
acknowledges
as set out Reporting
in his Clinical
Commissioning
Change Act 2008
including the Adaption
power
and the Public
Group
Accountable
OfficerAct
Appointment
Services
(Social Value)
2012. We letter.
are also setting out our commitments
as a socially responsible employer.
Risk Assessment in Relation to Governance, Risk Management and
Whilst
theControl
detailed provisions of the UK Corporate Governance Code (the
Internal
be
good
practice.
TheaNHS
Clinical of
Commissioning
Groups
The
CCG
operates
declaration
Interest register
andCode
this isofchecked
Governance
has
been created
by extracting
the Code,
relevant
to
regularly and
potential
conflicts
of interestfrom
are taken
in toparts
account
in all
CCG’s.
Governance
Statement is intended to demonstrate the CCG’s
aspectsThis
of the
CCG’s business.
The CCG
operates
a Governing Body Assurance Framework/Corporate Risk
Group’s
Code
of Governance.
Register which identifies the systems of internal control in place to efficiently,
effectively,
and year
economically
these
assurance
For
the financial
ended 31 manage
March 2014
andrisks
up toand
the provide
date of signing
this to
the CCG and
the organisation’s
these
systems
are present.
statement,
the CCG
complied with stakeholders
the provisions that
set out
in the
NHS Clinical
All risks
identified
in the Assurance Framework/Corporate Risk Register
Code
except
as follows:
require the formulation of an action plan. A member of the Patient Safety
Team meets with risk leads on a monthly basis to record progress against
action plans and documents the effect these are having on the residual risk
score. All action plans are formally reported via the Board Assurance
Framework/Risk Register. The document includes all risks that may impact on
the achievement of the Corporate Objectives.
Page 14 of 53
GROUP
11.4 The Governing Body receives regular assurance on the management of
internal risks and assurance both directly via six monthly reports including the
Governance
Statement
by Tim
GoodsonFramework/Corporate
as the Chief Officer of NHS
Clinical
full Governing
Body
Assurance
Risk Dorset
Register
and via
Commissioning
Group.
assurance from the Audit
and Quality Committee.
1
Introduction
11.5
The Audit and Quality Committee reviews the full Governing Body Assurance
Framework/Corporate Risk Register on a quarterly basis.
1.1
April 2013
under
enacted
in the basis
Healthby
& Directors
Social Care
Act 2012, the
11.6 Reports
are
alsoprovisions
received on
a monthly
summarising
which
amended
the NHS Act 2006.
top
risks
to the organisation
(those scoring over twelve), new risks, closed risk
and any key risk issues. Directors also review the full Governing Body
Framework/Corporate
Risk to
Register
everytoquarter.
1.2 Assurance
The CCG operated
in shadow form prior
1 April 2013,
allow for the
11.7 There
have
29 new
risks
identified
for 2013/2014.
These duties
are ason
follows:
systems
andbeen
processes
prior
to the
CCG taking
on its full statutory
1
April 2013.
 3 related to concerns regarding providers which Monitor and CQC have
investigated;
1.3
As at
1 April 2013, the CCG was licensed without conditions.
2
of Responsibility
Scope
8 related
to contracts and procurement;
2.1
Officer
has responsibility
for maintaining
a sound system of internal
The2Chief
related
to finance
being identified
or adjusted;
whilst
safeguarding
public
funds and departmental assets for
objectives,
2 for staff
training
related to
induction;
to him
Managing
Money. He is also responsible for
assigned
2 related
to in
targets
and Public
objectives;
are to
applied
efficiently and effectively. The Chief Officer also
resources
2 related
performance;
Accountable
Officer
Appointment
letter.of the CCG remit;
Group
3 related
to clarity
of functions
outside
3
the UK Corporate
Compliance
3 related with
to Business
Continuity;Governance Code
3.1
the detailed
Whilst
4 related
to IT.provisions of the UK Corporate Governance Code (the
be good
practice.
Therisks
NHSrelated
ClinicaltoCommissioning
Code
of it was set up
Many
of the
in year
the start of theGroups
CCG to
ensure
Governance
has
been
created
by
extracting
from
the
Code,
parts
relevant
to be able to operate effectively and fulfil its new functions. These riskstohave
CCG’s.
This Governance
Statement
is intended
to demonstrate the CCG’s
been
mitigated
over the year
and are
all now closed.
Group’s
Code of Governance.
The
outstanding
risks that are in place on 31 March 2014 will be carried over
in to the new financial year and will continue to be managed within the
For the financial
year ended
March
2014 and up to the date of signing this
framework
described
within31
this
statement.
Code except
as follows:Efficiency and Effectiveness of the Use of
Review
of Economy,
resources
11.8
11.9
3.2
12.
12.1
There are procurement processes which the CCG adheres to. There is a
scheme of delegation which ensures that financial controls are in place across
the organisation. An audit programme is followed to ensure that resources are
used economically, efficiently and effectively.
Page 15 of 53
GROUP
13.
Governance, Risk Management and Internal Control
Governance
Statement
Tim
Goodson
as the Chief
Officer ofthe
NHS
Dorset Clinical
13.1
The Chief
Officerby
has
the
responsibility
for reviewing
effectiveness
of the
Commissioning
Group.
system of internal control
within the CCG.
1
14.
Introduction
Capacity to handle risk
1.1
14.1
The NHS Dorset
Clinical for
Commissioning
Group (CCG)
was licenced
from
1 via
Leadership
is provided
the risk management
process
within the
CCG
AprilGoverning
2013 underBody.
provisions
enacted in the Health
& Social
Care established
Act 2012, in
the
The organisational
structure
has been
which to
amended
the NHS
Act 2006.and is described in the following paragraphs.
order
assist with
this process
1.2
14.2
operated
in shadow
form nominated
prior to 1 April
to allow
for the
The CCG
Director
of Quality
has been
as 2013,
the lead
Director
for Risk
completion of the
licencing
process
establishment
of function,
Management
activity
falling
withinand
the the
remit
of the CCG.
April
2013. are responsible for compliance with the Risk Management
All
Directors
Strategy to ensure that remedial actions are identified and taken wherever
As atrisks
1 April
the CCG
wastheir
licensed
conditions.
key
are2013,
identified
within
area without
of responsibility.
14.3
1.3
2
14.4
2.1
14.5
3
3.1
14.6
15
3.2
15.1
Scope
of Responsibility
All
Deputy
Directors, managers and staff are responsible for compliance with
the Risk Management Strategy for ensuring that remedial actions are
The Chief and
Officer
has wherever
responsibility
maintaining
a sound
system
ofarea
internal
identified
taken
keyfor
risks
are identified
within
their
of
responsibility.
whichPatient
he is personally
responsible,
in accordance
with the
the consistent
responsibilities
The
Safety Team
within the
CCG supports
identification
assigned
to him inand
Managing
Public Money.
is also
responsible
for and is
and
assessment
management
of riskHe
across
the
organisation
ensuringtothat
CCG is administered
prudently The
and economically
and that
central
thethe
dissemination
of best practice.
Team administer
the key
resources act
are as
applied
efficiently
and effectively.
Thefunction,
Chief Officer
alsoupon and
systems,
a central
resource
and advisory
advise
acknowledges
as programmes
set out in his Clinical
Commissioning
deliver
key training
and education
to ensure
staff learn through
Grouppractice,
Accountable
Officer
Appointment
good
ensure
compliance
withletter.
policies, procedures and management
of risk and support lead officers, groups and committees in undertaking the
Compliance with
the UK
Corporate Governance Code
requirements
of their
roles.
Whilst
the detailed
provisions
of the UK Corporate
Governance
(the
The
Head
of Patient
Safety supported
by the Patient
SafetyCode
and Risk
Code)
are
not
mandatory
for
public
sector
bodies,
compliance
is
considered
to
Manager has been appointed to monitor risk management and patient safety
be good
practice. The NHS
Groups
Code
of involves
within
commissioned
and corporate
services for the
CCG,
which
Governance has
been
by and
extracting
from the
Code,
parts
relevant to
engagement
with
the created
Directors
Directorate
risk
leads
to maintain
the
CCG’s.
This
Governance
Statement
is
intended
to
demonstrate
the
CCG’s
CCG’s Assurance Framework/Corporate Risk Register.
Group’s Code
of Governance.
Review
of Effectiveness
For the
financial
year
ended 31 March
2014
and up
to the date
of signing
this
The
review
of the
effectiveness
of the
system
of internal
control
is informed
by
statement,
complied
withand
the provisions
set out
in the NHS
Clinical
the
work ofthe
theCCG
internal
auditors
the executive
managers
and
clinical
Commissioning
Code
of Governance
andfor
applied
the principlesand
of the
leads
within theGroups
CCG who
have
responsibility
the development
Code except as
maintenance
offollows:
the internal control framework. The Chief Officer has drawn
on performance information available to him. His review is also informed by
comments made by the external auditors in their management letter and other
reports.
Page 16 of 53
GROUP
15.2 The Board Assurance Framework itself provides the Chief Officer with the
evidence that the effectiveness of controls that manage risks to the CCG
Governance
Statement
by Tim
Goodsonhave
as thebeen
Chiefreviewed.
Officer of NHS Dorset Clinical
achieving
its principal
objectives
15.3 The Chief Officer has been advised on the implications of the result of his
1
Introduction
review of the effectiveness of the systems of internal control including the
Governing Body, the Audit and Quality Committee, Quality Group and
1.1 Information
The NHS Dorset
Group
(CCG) was
licenced from
Governance
Group and a plan
to address
weaknesses
and1 ensure
April 2013 under
provisionsofenacted
in theisHealth
& Social Care Act 2012,
continuous
improvement
the system
in place.
15.4 Executive Directors within the CCG who have responsibility for the
1.2 development
The CCG operated
in shadow form
to 1 April
to allow
forprovide
the
and maintenance
of prior
the system
of 2013,
internal
control
the
completion
of with
the licencing
process and the establishment of function,
Chief
Officer
assurance.
AprilGoverning
2013.
15.5 The
Body Assurance Framework/Corporate Risk Register itself
provides the Chief Officer with evidence that the effectiveness of controls that
1.3 manage
As at 1 April
thethe
CCG
was licensed
without its
conditions.
the 2013,
risks to
organisation
achieving
principal objectives have
been reviewed.
2
15.6 The Head of Internal Audit provides the Audit and Quality Committee with an
2.1 annual
The Chief
Officer
has responsibility
for maintaining
sound
system
of internal
report
detailing
the audit coverage
for theayear
and
assessment
of the
control thatofsupports
the achievement
the CCG’s
aims and significant
adequacy
the control
environmentofthrough
her policies,
annual statement:
objectives, whilst
publicisfunds
and system
departmental
assets
for
assurance
can besafeguarding
given that there
a sound
of internal
control,
which he istopersonally
in accordance
with the
designed
meet the responsible,
organisation’s
objectives, and
thatresponsibilities
controls are generally
assigned
to him
in Managing Public Money. He is also responsible for
being
applied
consistently.
resources completion
are applied efficiently
and effectively.
The
Officer also
15.7 Following
of the planned
audit work
forChief
the financial
year for the
acknowledges
his
responsibilities
as
set
out
in
his
Clinical
Commissioning
CCG, the Head of Internal Audit issued an independent and objective opinion
Group
Officer
Appointment
letter.
on
the Accountable
adequacy and
effectiveness
of the
CCG’s system of risk management,
governance and internal control. The Head of Internal Audit concluded that:
3

Significant assurance can be given that there is a generally sound system
3.1
Whilstofthe
detailed
provisions
of theto
UK
Corporate
Governance Code
(the and
internal
control,
designed
meet
the organisation’s
objectives,
Code)that
arecontrols
not mandatory
for
public
sector
bodies,
compliance
is
considered
to
are generally being applied consistently. However, some
be good
practice.inThe
Clinical
Commissioning
Groups Code
weakness
theNHS
design
and/or
inconsistent application
ofof
controls put the
Governance
has
been
created
by
extracting
from
the
Code,
parts
relevant
to
achievement of particular objectives at risk.
Group’sthe
Code
of the
Governance.
15.8 During
year
Internal Audit issued the following audit reports with a
conclusion of limited assurance:
3.2
statement,
the CCG
complied
with the provisions
set out inHealthcare
the NHS Clinical
 Contract
Monitoring
Arrangements
for Continuing
and Section
Commissioning
Groups
Code
of
Governance
and
applied
the
principles
of the
117 Providers. A follow up audit in this area during April
2014 confirmed
Codethat
except
as progress
follows: is being made on implementing the agreed actions
good
arising from the internal audit in September 2013. The key findings
related to contract monitoring, contract conditions and inter-agency
communications for joint contracts for the provision of care with the Local
Authorities.

PC Environment. A review took place in July 2013 which identified the
existence of sensitive information on some office computer hard-drives.
Page 17 of 53
A follow up audit during March 2014 confirmed that there has been good
progress in implementing agreed actions from the initial review.
GROUP

PC Environment. A review took place in July 2013 which identified the
existence of sensitive information on some office computer hard-drives.
A Statement
follow up audit
March
2014
confirmed
there
hasClinical
been good
Governance
by Timduring
Goodson
as the
Chief
Officer ofthat
NHS
Dorset
progress in implementing
agreed
actions
from
the
initial
review.
However, an additional high priority finding was identified which is being
addressed with an associated action plan.
1
Introduction
1.1
1.2
15.9
The NHS
Clinical
Commissioning
Programmes.
number
recommendations
Dorset
GroupA(CCG)
wasoflicenced
from 1
with
associated
action
plans
have
been
agreed
for
implementation
to
the
whichaddress
amended
thefindings.
NHS Act These
2006. included the systems and processes
around project management, declaration of interest and links with other
areas
in the organisation
in respect
reporting
and
engagement
The CCG
operated
in shadow form
prior to 1ofApril
2013, to
allow
for the
During
year
Internalprior
Audit
not issue
a conclusion
systemsthe
and
processes
to did
the CCG
takingany
on audit
its fullreports
statutorywith
duties
on 1
of
no
assurance.
April 2013.
16
1.3
Data
As at Quality
1 April 2013, the CCG was licensed without conditions.
16.1
2
The
data
by the Governing Body is obtained from various sources of
Scope
of used
Responsibility
which all are national systems. The Provider data is quality assured through
contract
performance
monitoring
and against
the Secondary
The Chiefand
Officer
has responsibility
for maintaining
a sound
system of Uses
internal
Service
(SUS)
quality
dashboard.
Business
Models
which he isCritical
personally
responsible, in accordance with the responsibilities
The
Chiefthat
Officer
confirms
that thereprudently
is an appropriate
framework
ensuring
the CCG
is administered
and economically
andand
that
environment
in
place
to
provide
quality
assurance
of
business
critical
models,
in line with the recommendations from the MacPherson report.
The Chief Officer confirms that all business critical models have been
identified and that the information about quality assurance processes for
those models is currently being worked through. Once this has been
completed, it will be shared with all partners including the area team within
NHS England.
Data Security
CCG’s.
This
Governance
is intended
to demonstrate
the
CCG’s
The
CCG
has
completedStatement
the Information
Governance
Toolkit
which
is an
compliance
with the principles
set out in the
NHS
Clinical
Commissioning
annual
requirement
and has achieved
level
2 in
all standards
of the toolkit.
Group’s
Code of Governance.
This
is considered
a satisfactory level of compliance
2.1
17
17.1
17.2
3
3.1
18
18.1
3.2
18.2
For thewere
financial
year ended
31 March
2014 to
and
up to
the date
of2013-2014
signing this that
There
no Serious
Incidents
relating
data
security
for
statement,
the
CCG
complied
with
the
provisions
set
out
in
the
NHS
Clinical
required reporting to the Information Commissioner.
19
Discharge of Statutory Functions
19.1
The Chief Officer confirms that correct arrangements are in place for the
discharge of statutory functions, have been checked for any irregularities and
that they are legally compliant in line with the recommendations in the Harris
Review.
Page 18 of 53
GROUP
19.2 During establishment, the arrangements put in place by the CCG and
Governance
Statement
GoodsonGovernance
as the Chief Framework
Officer of NHS
Dorset
Clinical with
explained
within by
theTim
Corporate
were
developed
Commissioning
Group.
extensive expert external
legal input, to
ensure compliance with all the
relevant legislation. The legal advice also informed the matters reserved for
1
Introduction
the Governing Body and the scheme of delegation.
1.1
19.3
The
NHS
Clinical
Commissioning
Group
(CCG) was
licenced
from 1 duties
In
light
of Dorset
the Harris
Review,
the CCG has
reviewed
all of
the statutory
April the
2013
under provisions
Health &
SocialService
Care ActAct
2012,
and
powers
conferred enacted
on it by in
thethe
National
Health
2006 (as
which
amended
the
NHS
Act
2006.
amended) and other associated legislative and regulations. As a result, the
Chief Officer can confirm that the CCG is clear about the legislative
1.2
The CCG operated
in shadow
prior
to 1 statutory
April 2013,
to allow for
requirements
associated
withform
each
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and
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responsible, including any restrictions on delegation of those functions.
April 2013.
19.4 Responsibility
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director. Directorates have confirmed that their structures provide the
1.3
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was licensed
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duties.
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Tim Goodson
with the UK Corporate Governance Code
43June Compliance
2014
3.1
3.2
Page 19 of 53
Head of Internal Audit Opionion
Page 20 of 53
Page 21 of 53
Page 22 of 53
Page 23 of 53
Page 24 of 53
THE PRIMARY STATEMENTS
Statement of Financial Position
Statement of Changes in Taxpayers' Equity
Statement of Cash Flows
Primary Statements
Page 25 of 53
Statement of Comprehensive Net Expenditure for year ended
31 March 2014
NOTE
2013-14
Admin
£000
2013-14
Programme
£000
2013-14
Total
£000
Commissioning
Other operating revenue
Gross employee benefits
Other Costs
Net operating costs before financing
2
4
5
(40)
10,682
6,087
16,730
(5,632)
2,814
920,571
917,753
(5,672)
13,496
926,659
934,483
Financing
Investment revenue
Other (gains) & losses
Finance costs
Net operating costs for the financial year
8
9
10
0
0
0
16,730
0
0
0
917,753
0
0
0
934,483
16,730
917,753
0
934,483
£000
0
0
0
0
0
0
0
0
£000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16,730
0
917,753
0
934,483
Net Gain (Loss) on transfer by absorption
Retained Net Operating Costs for the Financial Year
11
Other Comprehensive Net Expenditure
Impairments & reversals
Net gain (loss) on revaluation of property, plant & equipment
Net gain (loss) on revaluation of intangibles
Net gain (loss) on revaluation of financial assets
Movements in other reserves
Net gain (loss) on available for sale financial assets
Net gain (loss) on assets held for sale
Re-measurement of the defined benefit liability
Reclassification Adjustments:
On disposal of available for sale financial assets
Total comprehensive net expenditure for the financial year
The notes on pages 31 to 52 form part of this statement.
NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and
because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future
years. This also applies to the notes associated with the statement.
The purpose of this statement is to summarise, on an accruals basis, the net operating costs of the CCG. The statement
identifies gross operating costs, less miscellaneous income, to arrive at the net operating costs of the CCG.
SOCNE
Page 26 of 53
Statement of Financial Position at
31 March 2014
31 March 2014
NOTE
£000
Non-current assets
Property, plant and equipment
Intangible assets
Investment property
Trade and other receivables
Total non-current assets
13
14
15
17
18
0
0
0
0
0
0
Current assets
Inventories
Trade & other receivables
Other current assets
Cash & cash equivalents
Total current assets
16
17
18
19
20
576
7,279
0
0
5
7,860
21
0
7,860
7,860
23
25
26
27
30
(42,242)
0
0
0
(2,567)
(44,809)
(36,949)
23
25
26
27
30
0
0
0
0
(956)
(956)
(37,905)
Non-current assets held for sale
Total current assets
Total assets
Current liabilities
Trade & other payables
Other liabilities
Borrowings
Provisions
Total current liabilities
Total Assets Less Current Liabilities
Non-current liabilities
Trade and other payables
Other liabilities
Borrowings
Provisions
Total non-current liabilities
Total Assets Employed
Financed by taxpayers' equity
General fund
Revaluation reserve
Other reserves
Charitable Reserves
Total taxpayers' equity
(37,905)
0
0
0
(37,905)
The notes on pages 31 to 52 form part of this statement.
NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and
because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future
years. This also applies to the notes associated with the statement.
The financial statements on pages 26 to 29 were approved by the Governing Body on 4 June 2014 and signed on its
behalf by:
4 June 2014
SOFP
Page 27 of 53
Statement of Changes In Taxpayers Equity for the year ended
31 March 2014
General fund
Revaluation
reserve
Other
reserves
Total
£000
£000
£000
£000
0
0
0
0
865
0
0
865
0
865
0
0
0
0
0
865
(934,483)
0
0
(934,483)
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
0
0
0
(933,618)
0
0
0
0
0
0
0
0
0
0
0
(933,618)
895,713
(37,905)
0
0
895,713
(37,905)
CCG Balance at 1 April 2013
Transfer of assets and liabilities from closed NHS bodies as a
result of the 1 April 2013 transition
Transfer between reserves in respect of assets transferred from
closed NHS bodies
Adjusted CCG Balance at 1 April 2013
Changes in taxpayers’ equity for 2013-14
Net operating costs for the financial year
Net gain (loss) on revaluation of property, plant and equipment
Net gain (loss) on revaluation of intangible assets
Net gain (loss) on revaluation of financial assets
Net gain (loss) on revaluation of assets held for sale
Impairments and reversals
Movements in other reserves
Transfers between reserves
Release of reserves to the Statement of Comprehensive Net
Expenditure
Reclassification adjustment on disposal of available for sale
financial assets
Transfers by absorption to (from) other bodies
Transfer between reserves in respect of assets transferred
under absorption
Reserves eliminated on dissolution
Re-measurement of the defined benefit liability
Net Recognised CCG Expenditure for the Financial Year
Net funding
CCG Balance at 31 March 2014
Changes in an entity's equity between the beginning and the end of the reporting period reflect the increase or decrease in its net
assets during the period.
The Statement has been interpreted to include figures for net operating costs for the year and funding for the year.
NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of
this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years.
SOCITE
Page 28 of 53
Statement of Cash Flows for the year ended
31 March 2014
NOTE
Cash Flows from Operating Activities
Net operating expenses for the financial year
Depreciation and amortisation
Impairments and reversals
Other gains (losses) on foreign exchange
Donated assets received credited to revenue but non-cash
Government granted assets received credited to revenue but non-cash
Interest paid
Release of PFI deferred credit
(Increase) decrease in inventories
(Increase) decrease in trade & other receivables
(Increase) decrease in other current assets
Increase (decrease) in trade & other payables
Increase (decrease) in other current liabilities
Provisions utilised
Increase (decrease) in provisions
Net Cash Inflow (Outflow) from Operating Activities
2&5
13
16
17
23
30
Cash flows from Investing Activities
Interest received
(Payments) for property, plant and equipment
(Payments) for intangible assets
(Payments) for investments with the Department of Health
(Payments) for other financial assets
(Payments) for financial assets (LIFT)
Proceeds from disposal of assets held for sale: property, plant and equipment
Proceeds from disposal of assets held for sale: intangible assets
Proceeds from disposal of investments with the Department of Health
Proceeds from Disposal of other financial assets
Proceeds from the disposal of financial assets (LIFT)
Loans made in respect of LIFT
Loans repaid in respect of LIFT
Rental revenue
Net Cash Inflow (Outflow) from Investing Activities
Net cash inflow (outflow) before Financing
2013-14
£000
(934,483)
0
575
0
0
0
0
0
(286)
(7,279)
0
42,242
0
0
3,523
(895,708)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(895,708)
Cash flows from Financing Activities
Net funding received
Other loans received
Other loans repaid
Capital element of payments in respect of finance leases and on Statement of Financial Position
PFI and LIFT
Capital grants and other capital receipts
Capital receipts surrender
Net Cash Inflow (Outflow) from Financing Activities
895,713
0
0
0
0
0
895,713
Net increase (decrease) in cash & cash equivalents
5
Cash & Cash Equivalents at the Beginning of the Financial Year
Effect of exchange rate changes in the balance of cash held in foreign currencies
Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year
0
0
5
20
Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of
this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years. This also
applies to the note associated with this statement.
The Statement of Cash Flows provides information on CCG liquidity, viability and financial adaptability.
SCF
Page 29 of 53
NOTES TO THE ACCOUNTS
The notes to the accounts provide additional details on the entries on the primary statements as well as
additional disclosures, such as the accounting policies that the organisation follows when preparing its
accounts.
Cover Notes
Page 30 of 53
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 2013-14 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.
The accounting arrangements for balances transferred from predecessor PCTs ("legacy" balances) are determined by the
Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to
be accounted for by the CCG are in respect of property, plant and equipment (and related liabilities) and inventories. All other
legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted
for by NHS England. The impact of the legacy balances accounted for by the CCG is disclosed in note 11 to these financial
statements. The CCG's arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in note 30,
Provisions, to these financial statements.
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 Department of Health Group
Transfers as part of reorganisation are required to be accounted for by use of absorption accounting in line with the Government
Financial Reporting Manual, issued by HM 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
Charitable Funds
The clinical commissioning group has no Charitable Funds.
1.6
Pooled Budgets
Where the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the NHS 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.
Note 1
Page 31 of 53
1.7
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.
1.7.1
Critical Judgements in Applying Accounting Policies
No critical judgements with a significant effect on the amounts recognised on the financial statements were required.
1.7.2
Key Sources of Estimation Uncertainty
Key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies are
detailed within the relevant disclosure notes to these financial statements, most notably Note 30 Provisions.
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. The clinical commissioning group allows a
maximum of five days to be carried forward, and only in exceptional circumstances.
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.
1.11
Property, Plant & Equipment
1.11.1 Recognition
Property, plant and equipment is capitalised if:
• It is held for use in delivering services or for administrative purposes;
• It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;
• It is expected to be used for more than one financial year;
• The cost of the item can be measured reliably; and,
• The item has a cost of at least £5,000; or,
• Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets
are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal
dates and are under single managerial control; or,
• Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or
collective cost.
Where a large asset, for example a building, includes a number of components with significantly different asset lives, the
components are treated as separate assets and depreciated over their own useful economic lives.
1.11.2 Valuation
All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or
constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner
intended by management. All assets are measured subsequently at fair value.
Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement
of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment.
Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that
would be determined at the end of the reporting period. Fair values are determined as follows:
• Land and non-specialised buildings – market value for existing use; and,
• Specialised buildings – depreciated replacement cost.
Note 1
Page 32 of 53
HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets
and, where it would meet the location requirements of the service being provided, an alternative site can be valued.
Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost
includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for
assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use.
Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.
An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset
previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged
there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an
impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to
expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and
losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net
Expenditure.
1.11.3 Subsequent Expenditure
Where subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised.
Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing
carrying value of the item replaced is written-out and charged to operating expenses.
1.12
Intangible Assets
1.12.1 Recognition
Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the
clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only:
• When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning
group;
• Where the cost of the asset can be measured reliably; and,
• Where the cost is at least £5,000.
Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for
example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not
integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on
research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated
assets are recognised if, and only if, all of the following have been demonstrated:
• The technical feasibility of completing the intangible asset so that it will be available for use;
• The intention to complete the intangible asset and use it;
• The ability to sell or use the intangible asset;
• How the intangible asset will generate probable future economic benefits or service potential;
• The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and,
• The ability to measure reliably the expenditure attributable to the intangible asset during its development.
1.12.2 Measurement
The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date
when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is
recognised in the period in which it is incurred.
Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market
exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair
value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and
technological advances.
1.13
Depreciation, Amortisation & Impairments
Freehold land, properties under construction, and assets held for sale are not depreciated.
Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and
intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption
of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical
commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical
commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are
reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are
depreciated over their estimated useful lives.
At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or
intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable
amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet
available for use are tested for impairment annually.
A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment
charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure.
Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss
subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but
capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment
loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.
Note 1
Page 33 of 53
1.14
Donated Assets
Donated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued,
depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are
as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude
immediate recognition of the gain.
1.15
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.
1.16
Non Current Assets Held for Sale
Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction
rather than through continuing use. This condition is regarded as met when:
• The sale is highly probable;
• The asset is available for immediate sale in its present condition; and,
• Management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the
date of classification.
Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair
value is open market value including alternative uses.
The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is
recognised in the Statement of Comprehensive Net Expenditure. On disposal, the balance for the asset on the revaluation reserve
is transferred to the general reserve.
Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is
retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.
1.17
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.
1.17.1 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.
1.17.2 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’s 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 straightline basis over the lease term.
1.18
Private Finance Initiative Transactions
The clinical commissioning group has no PFI schemes.
1.19
Inventories
Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be
a reasonable approximation to fair value due to the high turnover of stocks.
1.20
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 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.
1.21
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 1.9%
• Timing of cash flows (6 to 10 years inclusive): Minus 0.65%
• Timing of cash flows (over 10 years): Plus 2.2%
Note 1
Page 34 of 53
• All employee early departures: 1.8%
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.
1.22
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.
1.23
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.
1.24
Carbon Reduction Commitment Scheme
The clinical commissioning group is not party to a Carbon Reduction Scheme.
1.25
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.
1.26
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;
• 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.
1.26.1 Financial Assets at Fair Value Through Profit and Loss
The clinical commissioning group holds no Financial Assets with embedded derivatives.
1.26.2 Held to Maturity Assets
The clinical commissioning group holds no Held to Maturity Assets.
1.26.3 Available for Sale Financial Assets
The clinical commissioning group holds no Available for Sale Financial Assets.
1.26.4 Loans & Receivables
The clinical commissioning group holds no Loans and Receivables.
1.27
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.
1.27.1 Financial Guarantee Contract Liabilities
Financial guarantee contract liabilities are subsequently measured at the higher of:
• The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and,
• The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and
Contingent Assets.
1.27.2 Financial Liabilities at Fair Value Through Profit and Loss
The clinical commissioning group holds no Financial Liabilities with embedded derivatives.
Note 1
Page 35 of 53
1.27.3 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.
1.28
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.
1.29
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.
1.30
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.
1.31
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).
1.32
Subsidiaries
The clinical commissioning group has no Subsidiaries.
1.33
Associates
The clinical commissioning group has no Associates, where it has the power to influence decisions.
1.34
Joint Ventures
The clinical commissioning group is not party to any Joint Ventures.
1.35
Joint Operations
The clinical commissioning group is not party to any Joint Operations.
1.36
Research & Development
The clinical commissioning group does not undertake any Research and Development.
1.37
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 201314, all of which are subject to consultation:
• IAS 27: Separate Financial Statements
• IAS 28: Investments in Associates & Joint Ventures
• IAS 32: Financial Instruments – Presentation (amendment)
• IFRS 9: Financial Instruments
• IFRS 10: Consolidated Financial Statements
• IFRS 11: Joint Arrangements
• IFRS 12: Disclosure of Interests in Other Entities
• IFRS 13: Fair Value Measurement
The application of the Standards as revised would not have a material impact on the accounts for 2013-14, were they applied in
that year.
Note 1
Page 36 of 53
2. Miscellaneous Revenue
Recoveries in respect of employee benefits
Patient transport services
Prescription fees and charges
Dental fees and charges
Education, training and research
Charitable and other contributions to expenditure: NHS
Charitable and other contributions to expenditure: non-NHS
Receipt of donations for capital acquisitions: NHS Charity
Receipt of government grants for capital acquisitions
Non-patient care services to other bodies
Income generation
Rental revenue from finance leases
Rental revenue from operating leases
Other revenue
Total
Admin
Programme
2013-14
Total
£000
£000
£000
0
0
0
0
(19)
0
0
0
0
(1)
0
0
0
(20)
(40)
0
0
0
0
(175)
0
0
0
0
(5,413)
0
0
0
(44)
(5,632)
0
0
0
0
(194)
0
0
0
0
(5,414)
0
0
0
(64)
(5,672)
This note discloses the income that relates directly to the operating activities of the CCG. It excludes cash received
from NHS England by the CCG, which is credited directly to the General Fund.
3. Revenue
2013-14
Total
£000
From rendering of services
From sale of goods
Total
(5,672)
0
(5,672)
Revenue received is totally from the supply of services. The clinical commissioning group receives no revenue from
the sale of goods.
Note 2-3
Page 37 of 53
4. Employee Benefits and Staff Numbers
4.1 Employee Benefits
Salaries and wages
Social security costs
Employer contributions to the NHS Pension Scheme
Termination benefits
Gross CCG employee benefits expenditure
Less: Recoveries in respect of employee benefits (note 4.1.2)
Net CCG employee benefits expenditure including capitalised costs
Less: Employee costs capitalised
Net CCG employee benefits expenditure excluding capitalised costs
4.1.2 Recoveries in respect of employee benefits
Salaries and wages
Total CCG recoveries in respect of employee benefits
2013-14
Permanently
employed
£000
9,689
854
1,235
11
11,788
0
11,788
Other
£000
1,707
0
0
0
1,707
0
1,707
Total
£000
11,396
854
1,235
11
13,496
0
13,496
11,788
1,707
13,496
0
0
0
0
0
0
9,689
854
1,235
11
11,788
0
11,788
1,707
0
0
0
1,707
0
1,707
11,396
854
1,235
11
13,496
0
13,496
4.1.3 Net employee benefits expenditure
Salaries and wages
Employer contributions to the NHS Pension Scheme
Termination benefits
Net CCG employee benefits expenditure including capitalised costs
Less: Employee costs capitalised
Net CCG employee benefits expenditure excluding capitalised costs
The average salary is approximately £38,000 excluding on costs. The clinical commissioning groups average costs are higher than other NHS Bodies due to the higher skill mix required in delivering its core
functions.
Permanently employed staff are directly employed by the CCG and include those on outward secondment or on loan to other organisations (although the recovery of the cost of these staff is netted off). Other
staff relates to those on inward secondment, on loan from other organisations, bank, agency, temporary staff or contract staff.
4.2 Staff Numbers
Average Staff Numbers
Other
TOTAL
Of the above - staff engaged on capital projects
2013-14
Permanently
employed
Number
266
266
Other
Number
35
35
0
Total
Number
301
301
0
0
This note is analysed over the same column heading as staff costs included within Note 4.1 above. The same definitions apply.
4.3 Staff Sickness Absence and Ill Health Retirements
2013-14
Number
1,220
234
5.21
Total days lost
Total average number of staff (full time equivalent)
Average working days lost
The above figures are provided by the Health and Social Care Information Centre (HSCIC) and must be used. Please note the HSCIC figures are for the calendar year for the 9 months to December 2013,
and not for the Financial Year of 2013/14.
The figures the clinical commissioning group have calculated based on the Financial Year 2013/14, are shown below.
Total days lost
Total average number of staff (full time equivalent)
Average working days lost
2013-14
Number
2,149
266
8.08
Number of persons retired early on ill health grounds
2013-14
Number
0
£000s
0
Total additional pensions liabilities accrued in the year
The first part of this note identifies the days lost due to both long term and short term sickness. The second part discloses the number and average additional pension liabilities of individuals who retired early
on ill health grounds during the year (this information is supplied by NHS Pensions).
4.4 Exit packages agreed in the financial year
2013-14
Other agreed departures
Compulsory redundancies
Less than £10,000
Total
Number
2
2
£
11,033
11,033
Number
0
0
Total
£
0
0
Number
2
2
£
11,033
11,033
Departures where special
payments have been made
Total
Number
0
£
0
4.6 Severance payments
Other agreed departures
Number
0
0
0
0
0
0
0
Voluntary redundancies including early retirement contractual costs
Mutually agreed resignations (MARS) contractual costs
Early retirements in the efficiency of the service contractual costs
Contractual payments in lieu of notice
Exit payments following Employment Tribunals or court orders
Non-contractual payments requiring HMT approval*
Total
£
0
0
0
0
0
0
0
Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the CCG has
agreed early retirements, the additional costs are met by the CCG and not by the NHS pensions scheme. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table.
The two individuals transferred into the CCG on old PCT contracts, which should have been reviewed as part of the close down of the PCT. The roles were critically reviewed and as such it was identified that
the work they covered was being picked up by Clinicians who had been appointed into roles with the CCG. The individuals were fully consulted with and suitable opportunities for employment were explored.
This disclosure reports the number and value of exit packages taken by staff leaving in the year.
* As a single exit package can be made up of several components each of which will be counted separately in this table, the total number will not necessarily match the total number in the table above, which
will be the number of individuals.
These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been recognised in part or in full in a previous period.
Redundancy and other departure costs have been paid in accordance with the individuals contract of employment.
Exit costs are accounted for in accordance with relevant accounting standards and, at the latest, in full in the year of departure.
Note 4.1-4 & 6
Page 38 of 53
4. Employee Benefits and Staff Numbers
4.5 Pension Costs
Past and present employees are covered by the provisions of the NHS Pension 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 clinical commissioning group
of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.
The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation
every year. An outline of these follows:
4.5.1 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 to be paid by employers and scheme
members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered
the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the Scheme had accumulated a
notional deficit of £3.3 billion against the notional assets as at 31 March 2004.
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 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.
In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and most employees had up to
April 2008 paid 6%, with manual staff paying 5%.
Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of
changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer
contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of
employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings.
On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s
liabilities.
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 by updating
the results of the full actuarial valuation.
Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme
actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme
liability to be valued.
The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest
midpoint) updated to 31 March 2011 with summary global member and accounting data.
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) Resource Account, published annually. These accounts can be viewed on the NHS
Pensions website. Copies can also be obtained from The Stationery Office.
4.5.3 Scheme provisions
The NHS Pension Scheme provides 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 HM Revenue & Customs 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;
• 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 statement of comprehensive net expenditure at the time the
clinical commissioning group commits itself to the retirement, regardless of the method of payment; and,
• Members can purchase additional service in the 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.
Note 4.5
Page 39 of 53
5. Operating Expenses
Gross Employee Benefits
Employee benefits excluding governing body members
Executive governing body members
Total gross employee benefits
Other Costs
Services from other CCGs 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
Supplies and services – clinical
Supplies and services – general
Consultancy services
Establishment
Transport
Premises
Impairments and reversals of receivables
Inventories written down
Depreciation
Amortisation
Impairments and reversals of property, plant and equipment
Impairments and reversals of intangible assets
Impairments and reversals of financial assets
• Assets carried at amortised cost
• Assets carried at cost
• Available for sale financial assets
Impairments and reversals of non-current assets held for sale
Impairments and reversals of investment properties
Audit fees
Other auditor’s remuneration
• Internal audit services
• Other services
General dental services and personal dental services
Prescribing costs
Pharmaceutical services
General opthalmic services
GPMS/APMS and PCTMA
Other professional fees (excluding audit)
Grants to other public bodies
Clinical negligence
Research and development (excluding staff costs)
Education and training
Change in discount rate
Other expenditure
Total Other Costs
Total Operating Expenses
Admin
Programme
2013-14
£000
£000
Total
£000
10,387
295
10,682
2,814
0
2,814
13,201
295
13,496
167
1
4
0
281
650
0
205
11
2,605
46
1,628
0
0
0
0
0
0
748
674,739
6,147
0
119,921
0
264
303
0
1,083
2
2,632
0
0
0
0
575
0
915
674,740
6,151
0
120,202
650
264
508
11
3,688
48
4,259
0
0
0
0
575
0
0
0
0
0
0
122
0
0
0
0
0
0
0
0
0
0
0
122
76
0
0
0
0
0
0
85
0
18
0
144
0
46
6,087
16,770
0
0
0
107,928
0
574
5,273
211
71
0
20
35
0
44
920,571
923,385
76
0
0
107,928
0
574
5,273
296
71
18
20
179
0
90
926,659
940,155
Premises - The costs of premises is high in 2013/14 due to additional charges received from NHS Property Services
following national guidance from NHS England, these costs will reduce in future years.
GPMS/APMS and PCTMA - The costs are for enhanced services which deliver a range of primary care based enhanced
services locally.
Note 5
Page 40 of 53
6. Better Payment Practice Code
6.1 Measure of Compliance
2013-14
Number
2013-14
£000
Non-NHS Payables
Total Non-NHS trade invoices paid in the year
Total Non-NHS trade invoices paid within target
Percentage of Non-NHS trade invoices paid within target
27,290
26,441
96.89%
130,783
129,063
98.68%
NHS Payables
Total NHS trade invoices paid in the year
Total NHS trade invoices paid within target
Percentage of NHS trade invoices paid within target
3,601
3,534
98.14%
682,215
688,789
100.96%
The 100.96% is caused by a large credit note, if the credit note could be removed from the figures, the percentage of NHS
Invoices paid within target would fall to 99.7%.
This note shows the CCG's performance against its administrative duty to pay all creditors within 30 calendar days of receipt
of goods or valid invoice, whichever is later, unless other payment terms have been agreed. There is a performance target
of 95% for each measure.
6.2 The Late Payment of Commercial Debts (Interest) Act 1998
2013-14
£000
Amounts included in finance costs from claims made under this legislation
Compensation paid to cover debt recovery costs under this legislation
Total
0
0
0
This note relates to the prompt payment code legislation which allows entities to claim interest from other entities on debts
incurred under contracts.
7. Income Generation Activities
The clinical commissioning group does not undertake any Income Generation Activities.
8. Investment Income
The clinical commissioning group does not have any Investment Income.
This note discloses the interest earned on investments.
9. Other Gains and Losses
The clinical commissioning group does not have any Other Gains and Losses.
The total in this note equals the amounted figure (charged)/ credited to the Statement of Comprehensive Net Expenditure.
10. Finance Costs
2013-14
Total
£000
0
0
Other finance costs
Total Finance Costs
This note identifies the CCGs interest costs, including the unwinding of discounts on provisions, and corresponds with the
amount shown on the Statement of Comprehensive Net Expenditure.
Note 6-10
Page 41 of 53
11. Net Gain (Loss) on Transfer by Absorption
The clinical commissioning group does not have any Net Gains or Losses on Transfer by Absorption.
12. Operating Leases
The clinical commissioning group currently is lessee in respect of property leases and equipment rental.
The most significant rents are for Trust Headquarters and related buildings across the county. The clinical
commissioning group does not have any contractual option to buy these properties.
12.1 CCG as Lessee
Payments recognised as an Expense
Minimum lease payments
Contingent rents
Sub-lease payments
Total
Payable:
No later than one year
Between one and five years
After five years
Total
Land
£000
Buildings
£000
Other
£000
2013-14
Total
£000
0
0
0
0
3,179
0
0
3,179
0
0
0
0
3,179
0
0
3,179
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
The clinical commissioning group occupies property owned and managed by NHS Property Services Ltd.
For 2013-14, a transitional occupancy rent based on annual property costs allocations was agreed.
While our arrangements with NHS Property Services Ltd fall within the definition of operating leases, the
rental charge for future years has not been agreed. Consequently, this note does not include future
minimum lease payments for these arrangements.
This note identifies the amount included in operating expenses in respect of operating lease agreements.
It also highlights the amounts the CCG is liable for under non-cancellable leases over the next five years.
All operating leases relating to items with a purchase cost above the capitalisation limit are regarded as
non-cancellable.
12.2 CCG as Lessor
This relates to sub leases, mainly to healthcare contractors, with medium term leases. The clinical
commissioning group does not act as a lessor.
This note identifies the amount included in operating expenses in respect of operating lease agreements.
It also highlights the amounts the CCG expects to receive under non-cancellable leases over the next five
years.
All operating leases relating to items with a purchase cost above the capitalisation limit are regarded as
non-cancellable.
Note 11-12
Page 42 of 53
13. Property, Plant and Equipment
Information
technology
£000
0
Total
575
575
575
575
575
575
0
(575)
(575)
0
0
(575)
(575)
0
Purchased
Donated
Government Granted
CCG Total at 31 March 2014
0
0
0
0
0
0
0
0
Asset financing:
Owned
Held on finance lease
On-Statement of Financial Position private finance initiative & LIFT contracts
Private finance initiative residual interests
0
0
0
0
0
0
0
0
0
0
2013-14
CCG Cost or Valuation at 1 April 2013
Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition
Adjusted CCG Cost or Valuation at 1 April 2013
CCG Cost or Valuation at 31 March 2014
CCG Depreciation at 1 April 2013
Impairments charged to operating expenses
CCG Depreciation at 31 March 2014
CCG Net Book Value at 31 March 2014
£000
0
At the 1 April 2013, NHS Dorset CCG received a transfer of Information Technology Assets from NHS Dorset PCT for the
assets held in the PCT's HQ and other offices. Once these assets were transferred, a decision was taken to impair the
assets due to their age/obsolescence.
Revaluation Reserve Balance for Property, Plant & Equipment
CCG Cost or Valuation at 1 April 2013
Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition
Adjusted CCG Cost or Valuation at 1 April 2013
Information
technology
Total
£000's
0
£000's
0
0
0
0
0
0
0
13.1 Additions to Assets Under Construction in 2013-14
The clinical commissioning group had no Additions to AUC as at 31 March 2014.
Note 13-13.1
Page 43 of 53
13.2 Donated Assets
The clinical commissioning group had no Donated Assets as at 31 March 2014.
13.3 Government Granted Assets
The clinical commissioning group had no government Granted Assets as at 31 March 2014.
13.4 Property Revaluation
The clinical commissioning group has no Land and Buildings and therefore there is no Property Revaluation.
Any properties that are occupied by the CCG are either owned by Private Landlords or are recorded by the
Secretary of State via NHS Property Services Ltd, for which the CCG are liable to incur a charge as part of the
service agreement.
13.5 Compensation from Third Parties
The clinical commissioning group had no Compensation from Third Parties as at 31 March 2014.
13.6 Write Downs to Recoverable Amount
The clinical commissioning group had no Write Downs to Recoverable Amount as at 31 March 2014.
13.7 Temporarily Idle Assets
The clinical commissioning group had no Temporarily Idle Assets as at 31 March 2014.
13.8 Cost or Valuation of Fully Depreciated Assets
The clinical commissioning group had no Fully Depreciated Assets still in use as at 31 March 2014.
13.9 Economic Lives of Property, Plant and Equipment
Minimum Life
(Years)
0
0
0
0
0
0
Buildings exc Dwellings
Dwellings
Plant & Machinery
Transport Equipment
Information Technology
Furniture and Fittings
Maximum Life
(Years)
0
0
0
0
0
0
The clinical commissioning group has no Property Plant and Equipment that is depreciating in the financial year
2013/14.
This note records the range of remaining useful economic lives of property, plant and equipment employed by
the CCG.
Note 13.2-13.9
Page 44 of 53
14. Intangible Non-Current Assets
The clinical commissioning group had no Intangible Non-Current Assets as at 31 March 2014.
14.1 Donated Assets
The clinical commissioning group had no Donated Assets as at 31 March 2014.
14.2 Government Granted Assets
The clinical commissioning group had no Government Granted Assets as at 31 March 2014.
14.3 Revaluation
As the clinical commissioning group had no Intangible Non- Current assets, no Revaluation has been
considered.
14.4 Compensation from Third Parties
The clinical commissioning group had no compensation from Third Parties as at 31 March 2014.
14.5 Write Downs to Recoverable Amount
The clinical commissioning group had no Write Downs to Recoverable Amount as at 31 March 2014.
14.6 Non-capitalised Assets
The clinical commissioning group had no Non-capitalised Assets as at 31 March 2014.
14.7 Temporarily Idle Assets
The clinical commissioning group had no Temporarily Idle assets as at 31 March 2014.
14.8 Cost or Valuation of Fully Depreciated Assets
The clinical commissioning group had no fully Depreciated Assets still in use as at 31 March 2014.
14.9 Economic Lives of Intangibles
As the clinical commissioning group had no intangible non-current assets, no Economic Lives have been
considered.
15. Investment Property
The clinical commissioning group had no Investment Property as at 31 March 2014.
16. Inventories
Transfer of assets from closed NHS bodies as a result of the
1 April 2013 transition
Restated Opening Balance
Additions
Inventories recognised as an expense in the period
Other
£000
0
Total
£000
0
290
290
2,650
(2,364)
576
290
290
2,650
(2,364)
576
The Inventories held by the clinical commissioning group relate to the proportion of the items held on its behalf
by two Pooled Budgets. The transfer represents the closing balance held by Bournemouth and Poole PCT
which on the 1st April 2013 was transferred to the CCG.
Note 14-16
Page 45 of 53
17. Trade and Other Receivables
Current
Non-current
31 March 2014
£000
31 March 2014
£000
1,523
0
2,376
1,486
1,734
160
7,279
7,279
0
0
0
0
0
0
0
CCG
NHS receivables: Revenue
NHS receivables: Capital
NHS prepayments and accrued income
Non-NHS receivables: Revenue
Non-NHS prepayments and accrued income
VAT
Total CCG
Total CCG Current and Non-current
Included in CCG NHS receivables are pre-paid pension contributions
0
The great majority of trade is with NHS England. As NHS England is funded by Government to buy NHS patient care services, no
credit scoring of them is considered necessary.
The level of trade with non-NHS organisations is immaterial and is covered by contractual terms, therefore no credit scoring of
them is considered necessary.
This note analyses the amounts owing to the CCG at the Statement of Financial Position date.
17.1 Receivables Past Their Due Date But Not Impaired
By up to three months
By three to six months
By more than six months
Total
31 March 2014
£000
721
25
52
798
This note analyses the length of time beyond their due date the amounts owing to the CCG at the Statement of Financial Position
date have been outstanding.
17.2 Provision For Impairment of Receivables
The clinical commissioning group has no Provision for the Impairment of Receivables.
A provision for the impairment of receivables is where there is a risk of debt not being collected.
18. Other Financial Assets
The clinical commissioning group had no Other Financial Assets as at 31 March 2014.
19. Other Current Assets
The clinical commissioning group had no other Current Assets as at 31 March 2014.
20. Cash and Cash Equivalents
Opening balance
Net change in year
Closing balance
Made up of
Cash with Government Banking Service
Cash in hand
Current investments
Cash and cash equivalents as in statement of financial position
Bank overdraft - Government Banking Service
Cash and cash equivalents as in statement of cash flows
Patients' money held by the CCG, not included above
31 March 2014
£000
0
5
5
4
1
0
5
0
5
0
21. Non-Current Assets Held for Sale
The clinical commissioning group had no Non-Current Assets Held for Sale as at 31 March 2014.
Notes 17-21
Page 46 of 53
22. Analysis of Impairments and Reversals Recognised in 2013-14
22.1 Analysis of Impairments & Reversals: Property, plant & equipment
31 March 2014
£000
Impairments and Reversals charged to SoCNE
Total charged to Departmental Expenditure Limit
Unforeseen Obsolescence
Total charged to Annually Managed expenditure
Total impairments and reversals charged to the Statement of Comprehensive Net Expenditure
0
575
575
575
Impairments and Reversals charged to the Revaluation Reserve
Total Impairments and Reversals charged to the Revaluation Reserve
Total Impairments and Reversals of Property, Plant & Equipment
0
575
22.2 Analysis of Impairments & Reversals: Intangible assets
The clinical commissioning group had no Impairments or Reversals of Impairments recognised in expenditure during 2013-14.
22.3 Analysis of Impairments & Reversals: Investment property
22.4 Analysis of Impairments & Reversals: Inventories
The clinical commissioning group had no Impairments or Reversals of Impairments Recognised in expenditure during 2013-14.
22.5 Analysis of Impairments & Reversals: Financial assets
22.6 Analysis of Impairments & Reversals: Non-current assets held for sale
22.7 Analysis of Impairments & Reversals: Totals
31 March 2014
£000
Total Impairments and Reversals charged to the Statement of Comprehensive Net Expenditure
Departmental Expenditure Limit
Annually Managed Expenditure
Total Impairments and Reversals charged to the Statement of Comprehensive Net Expenditure
Total Impairments charged to Revaluation Reserve
Total Impairments
0
575
575
0
575
Of the above none related to Impairment on revaluation to “modern equivalent asset” basis.
Of the above none related to Total impairments and reversals of Donated and Government Granted Assets charged to the
Statement of Comprehensive Net Expenditure.
23. Trade and Other Payables
Current
31 March 2014
£000
Non-current
31 March 2014
£000
CCG
Interest payable
NHS payables: revenue
NHS accruals and deferred income
Non-NHS payables: revenue
Non-NHS accruals and deferred income
Tax
Other payables
Total CCG
0
(7,502)
(2,805)
(5,935)
(25,074)
(144)
(149)
(634)
(42,242)
0
0
0
0
0
0
0
0
0
(42,242)
The clinical commissioning group have not included any liabilities for people, due in future years under arrangements to buy out
the liability for early retirement over 5 years.
Other payables include £177,146.27 in respect of outstanding pensions contributions at 31 March 2014, and £400,000 of
accruals for invoices registered on the finance ledger, but not approved at 1 April 2014.
This note analyses the amounts owed by the CCG at the Statement of Financial Position date.
Note 22-23
Page 47 of 53
24. Deferred Revenue
The clinical commissioning group had no Deferred Revenue as at 31 March 2014.
25. Other Financial liabilities
The clinical commissioning group had no Other Financial Liabilities as at 31 March 2014.
26. Other Liabilities
The clinical commissioning group had no Other Liabilities as at 31 March 2014.
27. Borrowings
The clinical commissioning group had no Borrowings as at 31 March 2014.
28. PFI & LIFT Contracts
The clinical commissioning group had no Private Finance Initiative, LIFT or other service concession arrangements that were
excluded from the Statement of Financial Position as at 31 March 2014.
29. Finance Lease Obligations
The clinical commissioning group had no Finance Lease Obligations or receivables as at 31 March 2014.
30. Provisions
Current
31 March 2014
£000s
(2,567)
0
Non Current
31 March 2014
£000s
(910)
(46)
Total CCG
(2,567)
(956)
(3,523)
Continuing care
Other
Comprising:
Transfer of assets from closed NHS bodies as a result of the 1 April 2013
transition
Adjusted CCG Balance at 01 April 2013
Arising during the year
Expected Timing of Cash Flows:
No Later than One Year
Later than One Year and not later than Five Years
Continuing
Care
£000s
0
Other
£000s
0
Total
£000s
0
0
0
(3,477)
(3,477)
0
0
(46)
(46)
0
0
(3,523)
(3,523)
(2,567)
(910)
(3,477)
0
(46)
(46)
(2,567)
(956)
(3,523)
Amount Included in the Provisions of the NHS Litigation Authority in Respect of Clinical Negligence Liabilities:
£000s
0
As at 31 March 2014
Critical accounting judgments and key sources of estimation uncertainty:
The provisions shown under the heading 'Other' relate to dilapidation costs associated with leases for Mey House, and the costs
are uncertain.
A provision has been made against applications for continuing healthcare support where a panel has not yet met to determine
whether the application is approved. The provision is calculated on a named basis for the period that continuing healthcare
may be eligible, at the probability rate of the application being awarded, which was 30% for Appeals and 15% for Retrospective
Appeals in 2013/14. The provision is calculated at £1,657,350 for Appeals and £1,820,106 for Retrospective Appeals.
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. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare
provisions accounted for by NHS England on behalf of this CCG at 31 March 2014 is £12,708,000.
This note analyses the amounts recorded as provisions by the CCG at the Statement of Financial Position date.
Note 24-30
Page 48 of 53
31. Contingencies
31 March 2014
£000
Contingent liabilities
Other - Continuing Healthcare
Net Value of Contingent Liabilities
14,226
14,226
There are no contingent Assets
The contingent liability above relates to retrospective continuing care claims, and is directly linked with the continuing care provision included in Note 30. An
estimation has been made of the value based upon the amounts claimed. The uncertainties relate to the eligibility of the claims. Whilst possible, it has been deemed
unlikely that these amounts will be reimbursed. It is not practicable to provide an estimate of the financial effect.
This contingent liability is for the remainder of the risk of 70% for Appeals and 85% for Retrospective Appeals, for those applications not included as a provision
within Note 30 to these accounts. The contingent liability is calculated at £3,912,398 for Appeals and £10,313,932 for Retrospective Appeals.
The purpose of this note is to disclose material contingent liabilities or assets, if there is more than a remote possibility that there will be a transfer of ‘economic
benefit’ as a result of events that existed before the Statement of Financial Position date.
32. Commitments
The clinical commissioning group had no contracted capital commitments not otherwise included in these financial statements as at 31 March 2014.
33. Financial Instruments
33.1 Financial Risk Management
Financial reporting standard IFRS 7 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 standing
financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the clinical commissioning group’s internal auditors.
Only where the CCG is exposed to material risk should the appropriate IFRS 7 disclosures be made. The headings in IFRS 7 should be used to the extent that they
are relevant.
33.1.1 Currency Risk
The clinical commissioning group is principally a domestic organisation with the great majority of 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.
33.1.2 Interest Rate Risk
The clinical commissioning group borrows from government for capital expenditure, subject to affordability as confirmed by NHS England. The borrowings are for 1
to 25 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The clinical
commissioning group therefore has low exposure to interest rate fluctuations.
33.1.3 Credit Risk
Because the majority of the clinical commissioning group’s revenue comes 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.
33.1.4 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.
33.2 Financial Assets
Receivables - NHS
Receivables - non-NHS
Cash at bank and in hand
Total at 31 March 2014
33.3 Financial Liabilities
NHS payables
Non-NHS payables
Total at 31 March 2014
At ‘fair value
through profit
and loss’
£000
0
0
0
0
Loans and
receivables
Total
£000
1,523
1,486
5
3,014
£000
1,523
1,486
5
3,014
At ‘fair value
through profit
and loss’
£000
0
0
0
0
Other
Total
£000
(10,306)
(31,009)
0
(41,315)
£000
(10,306)
(31,009)
0
(41,315)
Due to the short-term nature of these transactions, the fair value of these financial assets and liabilities approximate the carrying amounts at the balance sheet date.
Financial instruments are a broad range of assets and liabilities that arise from contracts and result in a financial asset being created in one entity and a financial
liability in another. This note discloses the interest rate risks arising from the CCG's financial assets and liabilities, which largely comprise items due after more than
one year, such as long-term debtors and creditors, and provisions made under contract.
Note 31-33
Page 49 of 53
34. Operating Segments
The clinical commissioning group has only one operating segment, that of commissioning healthcare services for the population of Dorset.
An operating segment is a component of an entity:
* that engages in business activities from which it may earn revenues and incur expenses;
* whose operating results are regularly reviewed by the entity's chief operating decision maker to make decisions about resources to be allocated to
the segment and assess its performance; and
* for which discrete financial information is available.
35. Pooled Budget
The clinical commissioning group has entered into two pooled budget arrangements, hosted by Dorset County Council and Bournemouth Borough
Council. Under the arrangement, funds are pooled under Section 75 of the National Health Service Act 2006 for the provision of Bournemouth and
Poole's Integrated Community Equipment Service and Dorset IESD. The arrangement with Bournemouth Borough Council transferred from
Bournemouth and Poole PCT which is now closed.
As a commissioner of health care services, Dorset CCG makes contributions to the pool, which are used to purchase health care services. At 31
March 2014, the clinical commissioning group had a total payables balance with Dorset County Council of £97,147 made up of £97,147 trade
payables and no cash, which related to the trading transactions within the pooled budget arrangements. Within these arrangements the CCG's
contribution to income for the pool for 2013/14 was £925,652, being £925,652 partner contribution and no other funding.
The Integrated Equipment Services for Dorset (IESD) Memorandum Account for the pooled budget is
reproduced below.
2013-14
£000
Revenue
Dorset County Council
Dorset Healthcare University NHS Foundation Trust
Dorset CCG
Dorset County Hospital NHS Foundation Trust
Re-ablement Board
Total contributions to revenue
1,419
1,891
379
233
200
4,122
Expenditure
Integrated Community Equipment Service
4,122
Under/ (over) spend
0
As a commissioner of health care services, Dorset CCG makes contributions to the pool, which are used to purchase health care services. At 31
March 2014, the clinical commissioning group had a total payables balance with Bournemouth Borough Council of £50,150 made up of £50,150
trade payables and no cash, which related to the trading transactions within the pooled budget arrangements. Within these arrangements the CCG's
contribution to income for the pool for 2013/14 was £1,364,090, being £1,364,090 partner contribution and no other funding.
The Bournemouth & Poole ICES Memorandum Account for the pooled budget is reproduced below.
2013-14
£000
Revenue
Bournemouth Borough Council
Borough of Poole
Dorset CCG
Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
Poole Hopsital NHS Foundation Trust
Risk Share
Total contributions to revenue
517
479
1,364
346
175
61
2,942
Expenditure
Integrated Community Equipment Service
2,942
Under/ (over) spend
0
A pooled budget is the term used to describe a project financed by several mutually interested organisations. By definition, pooled funds are flexible,
intended to meet local needs and priorities. A pooled budget, such as the Integrated Community Equipment Service, is not an entity in its own right.
36. NHS LIFT Investments
The clinical commissioning group had no NHS LIFT Investments as at 31 March 2014.
37. Intra-Government and Other Balances
Other central government bodies
Local authorities
NHS bodies outside the departmental group
NHS trusts & foundation trusts
Bodies external to government
Total balances at 31 March 2014
Current
Receivables
£000s
160
1,485
1
3,898
1,735
7,279
Non-current
receivables
£000s
0
0
0
0
0
0
Current
Payables
£000s
(554)
(1,708)
(2,614)
(7,692)
(29,674)
(42,242)
Non-current
payables
£000s
0
0
0
0
0
0
Intra-Government balances are defined as balances between the reporting entity and other bodies within the boundary set for the Whole of
Government Accounts.
Note 34-37
Page 50 of 53
38. Related Party Transactions
The Department of Health is regarded as a related party. 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;
• 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 [e.g. Dorset County Council, Bournemouth Borough Council and Borough of Poole Council Local Authorities in respect of joint enterprises].
The clinical commissioning group has received no revenue or capital payments from charitable funds.
Dorset Clinical Commissioning Group is a body corporate established by order of the Secretary of State for Health.
1
2
3
4
Dr Forbes Watson, CCG Chair. Principal GP Practice in Lyme Bay Medical Centre, Bidder for the Lyme Regis
Contract (20/6/2012), Spouse clinical employee for Dorset Healthcare University NHS FT (DHUFT), Honorary
Medical Advisor and Chairman of RNLI Lyme Regis, Co-opted member of DCC for Health and Wellbeing Board
purposes. Lyme Bay Medical Centre.
Dr Jenny Bubb, Locality Chair - Mid Dorset . GP and Partner at Cerne Abbas Surgery, Co-opted member of Dorset
County Council (DCC) for Health and Wellbeing Board purposes. Cerne Abbas Surgery.
Dr Rob Childs, Locality Chair - North Dorset . GP and Partner at Bute House Practice, LMC Representative North
Dorset, Clinical Assistant in Endoscopy at Yeovil District Hospital, NHS Dorset CCG Representative on Yeovil
District Hospital Board of Governors, Member of Yeatman Hospital Management Group. Bute House Practice.
Dr Colin Davidson, Locality Chair - East Dorset . GP and Partner at Cranborne Practice - PMS Dispensing and
Training, Clinical Lead for East Dorset Locality, Director and wife a director at Dorset Diagnostics Ltd (DDL), Clinical
Lead for Endoscopy - Victoria Hospital in Wimborne, Trustee at Boveridge House School, wife is a GP at Eagle
House Surgery. DDL hold an AQP contract for Community Endoscopy. Co-opted member of DCC for Health and
Wellbeing Board Purposes. Cranborne Practice.
5
Dr Colin Davidson a Director and his wife is a director at Dorset Diagnostics Ltd.
6
Tim Goodson, Chief Officer. Member of Healthcare Financial Management Association (HfMA), South West Branch
HfMA Committee Member, Co-Member of Dorset Health and Wellbeing Board. Partner works in Finance
Department for Bournemouth Borough Council. HfMA.
Dr Richard Jenkinson, Locality Chair - Christchurch. GP Partner of Burton Medical Centre, GPSI in ENT employed
by DHUFT, Director of Wessex Aviation Medical Services Ltd, Co-opted member of DCC for Health and Wellbeing
Board purposes. Burton Medical Centre.
Dr Tom Knight, Locality Chair - North Bournemouth . GP partner Northbourne Surgery, FTSE 100 index linked
savings. Northbourne Surgery.
Dr Blair Millar, Locality Chair - Dorset West. GP Partner of Bridport Medical Centre Skellern Practice, Wife (Dr
Joanna Cotton) is a member of the Cancer Support Group “The Living Tree”, Co-opted member of Dorset County
Council for Health and Wellbeing Board purposes. Bridport Medical Centre Skellern Practice.
7
8
9
10 Dr Andy Rutland, Locality Chair - Poole Bay & Parkstone . GP partner Lilliput Surgery, shareholder of solutions for
health, wife is a partner at the Harvey Practice. Lilliput Surgery.
11 Dr Patrick Seal, Locality Chair - Poole Central. GP partner Adam Practice, Quay Medical Care Limited, the Adam
Practice's provider vehicle for PCOS and Paediatric service. Adam Practice.
12 Dr Karen Kirkham, Locality Chair - Weymouth & Portland . GP Partner of the Bridges Medical Centre Weymouth,
Specialty Doctor in Sexual Health employed by Dorset County Hospital NHS Foundation Trust, Board Member of
Sexual Health South West Regional Office, Member of Children’s Trust Board Dorset, Governor at Sunninghill
Preparatory School, Husband is a GP Partner at Abbotsbury Road Surgery Weymouth , Co-opted member of DCC
for Health and Wellbeing Board purposes. Bridges Medical Centre.
13 Paul Vater, Chief Finance Officer. Member and Trustee of the South West Healthcare Financial Management
Association (HfMA), FCCA Membership. SW HfMA.
14 David Jenkins, Lay Member - Board. Chair of Gloucestershire County Councils Waste Working Group (2 to 3 days
a month), Deputy Lieutenant of Dorset, Trustee of Bournemouth Symphony Orchestra Endowment Fund, Trustee of
Richard Ely Trust for Young Musicians, Trustee of Burton Bradstock Festival, Patron of Bridport Arts Centre,
President of the Dorset Association of Parish and Town Councils. Gloucestershire County Council.
15 Teresa Hensman, Lay Member - Board (and Chair of Audit Committee). Mental Health Act Manager Associate,
DHUFT. DHUFT.
16 Mary Monnington, Nurse Member. Council member [UKCCG] United Kingdom Council of Caldicott Guardians,
Panel Member Professional Performance Committees Nursing and Midwifery Council [NMC], Nurse Member
Wiltshire CCG, Husband JET Monnington, Senior Solicitor Moore Blatch Resolve LLP Southampton. Moore Blatch
Resolve LLP.
17 Chris Burton, Secondary Care Member. Member of the Trust Board of North Bristol NHS Trust which provide
specialist commissioning services for Dorset population commissioned by NHS England. Partner is a GPSI in
dermatology in the Bristol region. North Bristol NHS Trust.
18 Suzanne Rastrick, Director of Quality. Allied Health Professional/Healthcare Scientist Member, Policy Board for
NHS Employers. Member of Health Education England Advisory Group. Group Board Member and Chair, Audit
and Risk Committee. Spectrum Housing Group Limited which involves oversight of the following companies:
Spectrum Housing Group Limited, Spectrum Property Care Limited, Signpost Homes Limited, Spectrum Premier
Homes Limited. Member of Council of the College of Occupational Therapists, Chair of the English Board of the
College of Occupational Therapists. Spectrum Housing Group Limited.
19 Suzanne Rastrick, Director of Quality. Signpost Homes Limited.
20 Suzanne Rastrick, Director of Quality. Spectrum Premier Homes Limited.
21 Charles Buckle, Non Governing Body Lay Members. Member of DHUFT (Not on governing body, but to keep in
touch with their priorities), Member of Purbeck Health Network, anticipate being a member of Health Watch.
DHUFT.
22 Tina Thompson, Non Governing Body Lay Members. Employee of Bournemouth Borough Council working for
Bournemouth 2026 Trust, Lay Advisor, Health Education Wessex/Wessex Deanery, Freelance Management
Consultant for Third Sector Management Solutions, Site Assessor for Quality Performance Mark, Action for
Advocacy Secretary, Friends of Boscombe Chine Gardens. Wessex Deanery.
23 Dr Ros Maycock, GP Transition Lead (Left 31 October 2013). Partner at Evergreen Oak Surgery (Training
Practice), Member of Poole Children Trust Board, Member of Bournemouth Children Trust Board. Evergreen Oak
Surgery.
24 Dr Piers Wilde, Locality Chair - Central Bournemouth (Left 31 July 2013). GP Moordown Medical Centre,
Shareholder of Circle & Solutions for Health. Moordown Medical Centre.
25 Dr Carole Linnard, Locality Chair - North Bournemouth (Left 31 August 2013). Partner GP Alma Partnership,
Programme Director for Winchester University/Wessex Deanery, Governor at Royal Bournemouth & Christchurch
Hospital NHS Foundation Trust. Alma Partnership.
25 Dr Carole Linnard, Locality Chair - North Bournemouth (Left 31 August 2013). Partner GP Alma Partnership,
Programme Director for Winchester University/Wessex Deanery, Governor at Royal Bournemouth & Christchurch
Hospital NHS Foundation Trust. Royal Bournemouth & Christchurch Hospital NHS Foundation Trust.
Payments to
Related Party
£’000
262
Receipts from
Related Party
£’000
0
Amounts owed
to Related
Party
£’000
9
Amounts due
from Related
Party
£’000
0
120
0
10
0
677
0
20
0
1,149
0
22
0
0
0
0
0
10
0
0
0
1,289
0
19
0
655
0
0
0
2,483
0
55
0
938
0
19
0
3,326
0
0
0
1,947
0
27
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
658
0
567
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
519
0
14
0
760
0
19
0
711
0
0
0
161,772
0
1,333
877
177,286
0
2,114
877
The CCG has detailed in this note all declarations of interest for Governing Body Members, however only related party transactions have been disclosed where they meet the criteria of having (i)
control or joint control over the reporting entity, (ii) have significant influence over the reporting entity or (iii) are a member of the key management personnel.
Note 38
Page 51 of 53
39. Events after the end of the Reporting Period
The clinical commisioning group has no Events after the end of the Reporting Period.
This note discloses the financial consequences of events (both favourable or unfavourable) that occur between the Statement of Financial Position
date and the date on which the financial statements are approved by the Board, if appropriate.
Two types of events can be identified:
* those that provide evidence of conditions that existed at the end of the reporting period (adjusting events); and
* those that are indicative of conditions that arose after the reporting period (non-adjusting events).
40. Losses and Special Payments
The total number of losses cases in 2013-14 and their total value was as follows:
Total Value Total Number
of Cases
of Cases
£s
0
0
0
0
0
0
Losses
Special payments
Total losses and special payments
Details of
cases
individually
over
£250,000
There were no cases over £250,000.
Losses or special payments are payments that Parliament would not have envisaged healthcare funds being spent on when it originally provided the
funds.
The total costs included in this note are on a cash basis and will not reconcile to the amounts shown elsewhere within the accounts which are
prepared on an accruals basis.
41. Third Party Assets
31 March 2014
£000
0
0
Third party assets held by the clinical commissioning group
Third party assets are held by the CCG on behalf of a third party, for instance as money held on behalf of patients. As these assets do not belong to
the CCG they are not included in the Statement of Financial Position or the trade payables note.
42. Financial Performance Targets
Clinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended).
The clinical commissioning group’s performance against those duties was as follows:
2013-14
National
Health
Service Act
Section
Duty
223J(2)
Expenditure not to exceed income
Capital resource use does not exceed the amount specified in Directions
Revenue resource use does not exceed the amount specified in Directions
Capital resource use on specified matter(s) does not exceed the amount specified
in Directions
Revenue resource use on specified matter(s) does not exceed the amount
specified in Directions
223J(3)
Revenue administration resource use does not exceed the amount specified in
Directions
223H(1)
223I(2)
223I(3)
223J(1)
Duty
Achieved?
Maximum
Performance
£’000
£’000
(12,614)
0
947,097
(12,614)
0
934,483
Yes
Yes
Yes
0
0
Yes
0
0
Yes
18,730
16,730
Yes
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 purpose of this note is to disclose the Financial Performance of the CCG. Where a clinical commissioning group breaches, or plans to breach,
one of the statutory financial provisions, even if this is agreed with NHS England (e.g. setting a deficit budget) local auditors are under a duty to make
a report to the Secretary of State for Health under Section 28 of the Audit Commission Act 1998.
43. Impact of IFRS Treatment
There was no significant impact due to IFRS Accounting Treatment.
44. Analysis of Charitable Reserves
The clinical commissioning group has no Charitable Reserves.
Note 39-44
Page 52 of 53
GLOSSARY OF FINANCIAL TERMS
Accruals
An accounting concept. In addition to payments and receipts of cash,
adjustment is made for outstanding payments, debts to be collected and stock.
This means that the accounts show all of the income and expenditure that
related to the financial year.
Assets
An item that has a value in the future. For example, a debtor (someone who
owes money) is an asset, as they will in future pay. A building is an asset,
because it houses activity that will provide a future income stream.
Audit
The process of validation of the accuracy, completeness and adequacy of
disclosure of financial records.
Capital
Land, buildings, equipment and other non-current assets owned by the CCG,
the cost of which exceeds £5,000 and has an expected life of more than one
year.
Cash limit
A limit set by the NHS England which restricts the amount of cash drawings
that the CCG can make in the financial year. There is a combined cash limit
for both revenue and capital.
Commissioning
Purchase of healthcare from external service providers (NHS, other public
sector, private and voluntary) to meet the needs of the population.
Current assets
Trade receivables (debtors), inventories (stocks), cash or similar, whose value
is, or can be converted into, cash within the next twelve months.
Governance
Governance is the system by which organisations are directed and controlled .
It is concerned with how the organisation is run, how it is structured and how it
is led. Corporate governance should underpin all that an organisation does. In
the NHS, this means it must encompass clinical, financial and organisational
aspects.
Gross operating costs
This is the total revenue expenditure, including accruals and provisions,
incurred in the course of performing all aspects of the CCG’s functions during
the year.
Intangible assets
Brand value or some other right (for example, a software licence), which
although invisible is likely to derive financial benefit for its owner in the future,
and for which you might be willing to pay.
Miscellaneous revenue
Income that relates directly to the operating activities of the CCG. This
excludes cash from NHS England, which is credited to the general fund.
Non-current assets
Land, buildings, equipment and other long term assets that are expected to
have a life of more than one year.
Resource limit
Expenditure limits are determined for each NHS organisation by NHS England
for both revenue and capital, which limit the amount that may be expended on
revenue purchases, as assessed on an accruals basis (that is, after adjusting
for debtors and creditors).
Glossary
Page 53 of 53
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how the views of local people are helping to shape the NHS for the future.
Current members of the HIN comprise our Locality Involvement Networks,
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© Dorset Clinical Commissioning Group 2014

Annual Report and Accounts - Dorset Clinical Commissioning Group

Transcription

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