CCG Management - Understanding CCG governance

In the second in our management series, Ross Clark explains CCGs' governance requirements.

Governance arrangements should address quality of care, finance and use of information, among other issues (Photographs: JH Lancy, SPL, Istock)
Governance arrangements should address quality of care, finance and use of information, among other issues (Photographs: JH Lancy, SPL, Istock)

There are a number of requirements clinical commissioning groups (CCGs) must consider when establishing their governance arrangements.

In its present form, the Health Bill says the governing body of the CCG must 'make appropriate arrangements to ensure it complies with ... generally accepted principles of good governance'.

The Bill requires governing bodies to have audit and remuneration committees and sets out the required constitution of a CCG but, beyond this, it does not specify what is meant by 'good governance'.

Towards Authorisation
The DH document Towards Authorisation sets out current thinking on the authorisation process. A further update to this is planned for spring 2012.

Two technical appendices provide some clarification on governance issues. One includes a list of the principal corporate governance arrangements (see box below) and the other makes reference to the publication of a governance framework for CCGs that will consider:

  • Why good governance is critical.
  • Developing a model constitution.
  • The accountable officer and other lead roles.
  • Engaging the constituent members.
  • Appointing lay and non-GP clinical members.
  • Managing conflicts of interest.

This framework was scheduled for publication in autumn 2011 but has yet to be produced. Instead, the Towards Establishment guidance focuses heavily on creating responsive and accountable CCGs. It is very likely that this will form the basis of the governance framework.

  • A clinically led infrastructure, with highly competent management support.
  • A clear organisational form, with effective business systems and processes, and a sound financial footing.
  • Governance arrangements that show clear and effective bonds across member practices and demonstrate clear and transparent processes for discharge of functions.
  • Robust systems and processes in place for effective decision-making and to manage conflicts of interest.
  • Decision-making structures clearly set out in the constitution, to include an independently chaired audit committee.
  • A constitution that is appropriate and complies with requirements of the Health Bill.
  • A scheme of delegation with underpinning processes to delegate decision-making to an appropriate level.
  • Information and quality systems in place that focus on delivering high-quality outcomes with adequate arrangements for information and data management.
  • Systems in place to manage knowledge and undertake regular joint strategic needs assessments that create a full understanding of current and future local health needs.
  • Financial and business leadership with robust systems for the management of financial control, performance and risk, ensuring value for money.
  • Securing the right expertise to ensure compliance with best procurement practice.
  • Ownership of the budget through to practice level.
  • Ensuring efficiency and effectiveness of spend.

Source: Technical Appendix 3, Towards Authorisation.

Towards Establishment
The Towards Establishment guidance reiterates that CCGs 'will need to demonstrate probity and governance commensurate with their considerable responsibilities for their patients' healthcare and taxpayers' money'. To do this, they will have to be 'effective and safe public bodies that embody Nolan principles'.

However, within these parameters, CCGs have flexibility to determine the arrangements that they judge will enable them to be effective organisations.

CCGs should reflect the values and rights enshrined in the NHS Constitution and incorporate the Good Governance Standard for Public Services principles and the seven Nolan principles (selflessness, integrity, objectivity, accountability, openness, honesty and leadership).

There is a lot of detail in this guidance but, in summary, CCGs will be expected to act transparently, manage conflicts of interest and have proper checks and balances in place to provide assurance that decisions are taken in a way that protects patients' best interests, promotes continuous improvements in quality and provides assurance that public money is well managed.

To deliver this, CCGs will have to put in place governance arrangements that include, as a minimum:

  • Corporate governance: to ensure that the CCG achieves its objectives and meets the necessary standards of accountability and probity.
  • Clinical governance: to ensure quality of service and safeguarding high standards of care.
  • Finance governance: to ensure effective stewardship of public funds through robust financial procedures, appropriate and effective management structures and financial systems.
  • Information governance: to ensure the effective and appropriate use of information and maintain comprehensive and accurate records that are kept confidential and secure.
  • Research governance: to enable CCGs to understand, develop and implement research and development in their organisations.

The CCG constitution
The constitution of a CCG therefore needs to define how all of this will be drawn together and will be overseen at corporate level by the governing body on behalf of the member practices.

The constitution is therefore a fundamental document for governance purposes and, while the proposed governance framework promises a model constitution, this has yet to be produced.

Hempsons worked closely with NHS North East to produce a constitution containing interim governance arrangements for pathfinder CCGs, which has been made available by the DH

The hope is that these arrangements can easily be fine tuned to form a model constitution under the Bill.

  • Ross Clark is a partner at GP specialist lawyers Hempsons

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