Council of Members 26 March 2015 Minutes of last meeting: January - - PDF document

Council of Members

26 March 2015

Minutes of last meeting:

January 2015

• Dr. Richard Proctor, Council of Members Chair

Effective Co-Commissioning

• f Primary Care

Dr Jonty Heaversedge, CCG Chair and Dr Richard Proctor, CoM Chair

Working together for improved outcomes

As a CCG we have committed to clinically led and locally determined and responsive commissioning of health services in Southwark. This presents huge opportunities to make a difference for the patients we know best. But… as a membership organisation of general practices it also poses challenges – we determine commissioning intentions in the best interests of our entire population at the same time as providing services relentlessly focused on doing the best for ‘our’ registered list. We have established a great many things to assist us:

• Elected Governing Body members to provide a single leadership voice and a Council of

Members to provide practices with a direct role in commissioning planning and oversight.

• A Conflicts of Interest infrastructure to advice and help us by testing the objectivity of our

thinking.

• Management resources to assist in the planning and implementation of our strategies.
• Engagement opportunities with members, local people and stakeholders.

These support us, provide legitimacy, evidence base and focus but they require and can not replace - effective interactions, mutual understanding and team work to make effective and safe decisions

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Table work: the scenario

In developing our plans for 2016/17 we have proposed and are developing a consensus that: A nationally determined set of QOF indicators does not optimally incentive providers to improve outcomes for local people. Our proposition is that a locally determined set of indicators with disproportionate reward associated with addressing greatest local need would work better. Moreover, we believe the level of QOF associated resource does not reflect the new level of primary care delivered preventative care we would wish to describe and commission.

Questions:

Who do we engage in this commissioning discussion? What should the criteria for our decision making be? Who should make this decision and how – how would we best use our discussion? As a public body how would we best communicate our decisions?

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Table Discussion and Feedback

Arrangements for the Co-Commissioning of Primary Care

Dr Richard Proctor, CoM Chair Andrew Bland, Chief Officer and Malcolm Hines, Chief Financial Officer

Primary care co-commissioning

In February 2015 the CCG was formally notified that it had received approval to co- commission primary care services for the borough – pending changes to our constitution. Our successful application was submitted on 30 January following endorsement from the Council of Members and the decision of the Governing Body to proceed in that month. The CCG will be a Joint Commissioner (Level Two) with NHS England from 1 April 2015 as opposed to a Delegated Commissioner where full responsibility is transferred to CCG. This an arrangement for Southwark BUT it sits alongside the same approval for the

• ther five boroughs in south east London who we will work and share resources with.

Our application was approved as it demonstrated:

• That CCG involvement in commissioning of primary care would deliver enhanced
• utcomes for our population by focusing the resources and design of services across

the whole care pathway

• The required support of local people through engagement, our partners (particularly the

Health and Wellbeing Board) through their agreement and significant engagement with member practices. This alongside appropriate governance has secured this position.

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How will we co-commission services (1 of 2)

From 1 April 2015 the scope of our commissioning intentions / plans will broaden to include primary care. Whilst responding to a wider scope our commissioning intentions will still be: a) Developed with members, b) Recommended by our Governing Body and c) Approved annually by our Council of Members They will be joint with NHS England who will seek to align their requirements for commissioning to our local intentions – when combined they should provide a coherent local approach – the CCG will need to assure itself of this before any decisions are made Decision making will remain local and clinically led – We will develop our intentions in the usual way; our Conflicts of Interest Panel will advise us of their objectivity and alignment to population need and improved outcomes and impact in reducing inequalities before our Governing Body decide upon them.

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How will we co-commission services (2 of 2)

CCG-generated commissioning intentions for primary care will be subject to our usual processes before going to a Joint Committee – a committee of our Governing Body and

• f the NHS England Board where they will be agreed and progressed in public.

That committee will seek to work by consensus but where a vote is required there will be seven voting members: 1. Six from the CCG (2 Lay members, 2 GP Governing Body members, the external nurse member or secondary care member and the Chief Officer) and 2. One from NHS England (this vote will be shared by three attendees) The CCG members will have a majority say in all circumstances accept those where a decision would break NHS England statutory duties – here the NHS England vote would be weighted to equal the CCG vote and they would have a casting vote. Local and clinically led commissioning would preside in these arrangements as CCG members would be articulating the Governing Body’s view with a majority vote if needed. The committee will be chaired by a CCG lay member, the committee will be held in public and representatives from Healthwatch, the Health and Wellbeing Board (Local Authority) and the LMC in attendance

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Primary Care Joint Committee membership

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• CCG Chair
• GP member of the Governing Body (from a different

practice to the chair)

• Governing Body specialist in secondary care OR

External Governing Body nurse

Clinical Members

• Lay Member for Public and Patient Involvement or

Quality (Chair)

• Lay Member for Governance (Vice Chair)
• Chief Officer

Lay and Executive Members

• Medical Director for South London
• Director of Commissioning Operations
• Director of Primary Care

NHS England Members (1 voting member, 2 non-voting members)

Was this straight forward?

In short….No. National guidance has changed four times around governance since the 30 January 2015. As a consequence: Delegated co-commissioning arrangements are still unclear and these CCGs are being awarded budgets without the due diligence that Southwark CCG would expect. We have successfully argued for a Southwark only joint committee rather than a regional arrangement that would have allowed voting from non-local stakeholders from

• ther boroughs.

We have not agreed proposals for parity of voting between CCG and NHS England committee members for all decisions (accepting this only where statute would be broken). We have secured the primacy of our existing arrangements (Council of Members and Governing Body) making the joint committee a place for joint agreement of our locally derived commissioning intentions. We have successfully agreed that our Conflict of Interest arrangements are appropriate for co-commissioning and in doing so ensured GP members are not excluded from decision making.

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Question and Answers

Council of Members to approve: The proposed constitutional changes relating to co-commissioning

Refer to Terms of Reference for Joint Committee (in CoM papers)

Update on CCG Financial Position

Malcolm Hines, Chief Financial Officer

Duty YTD Target YTD Performance RAG Annual Target Forecast Performance RAG Achieve planned surplus (Expenditure not to exceed income) £5,474k £6,916k £5,972k £7,141k Capital resource does not exceed the allowance N/A N/A N/A N/A Revenue resource does not exceed the allowance £346,568k £339,652k £379,826k £372,685k Capital Resource use on specified matters does not exceed the allowance N/A N/A N/A N/A Revenue resource use on specified matters does not exceed the allowance N/A N/A N/A N/A Revenue administration resource use does not exceed the allowance £6,807k £6,234k £7,621k £6,915k

Financial Performance Duties

Notes: 1. The above duties correspond to those reported in Note 42 of the Annual accounts, and represent the statutory duties of the CCG.

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CCG Programme Budget Summary: M11 2014/15

Programme Budget Annual Budget (£k) Variance to Month 11 (£k) Predicted End

• f Year (£k)

Best Case (£k) Worst Case (£k) Acute 222,766

• 1,329
• 1,597
• 1,268
• 1,925

Client Groups 70,388 2,500 2,496 2,636 2,251 Community and Primary Health Services 35,271 176 200 300 100 Prescribing 31,046

• 720
• 786
• 655
• 1,055

Corporate Costs 6,227 121 150 220 100 Earmarked Budgets and Reserves 535 121 535 Planned Surplus 5,972 5,474 5,972 5,972 5,972 Total 372,205 6,343 6,435 7,205 5,978 Reserves not utilised in above position 535 535 Reserves not yet utilised in above position (Month 10 for comparison) 535 535

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CCG Programme Budget Summary: M11 2014/15

• Agreements have been reached with Guy’s & St Thomas’, King’s College Hospital and

South London and Maudsley Foundation Trusts with regard to year end positions. This has resulted in a significant reduction in risk to the CCG.

• There has been significant RTT and Winter Resilience funding made available within

Southwark in recent months.

• The running cost allocation is separate from the Programme budget and is monitored
• separately. Running costs are forecast to be underspent by £706k at year end. This

includes an underspend of £406k on Quality Premium Award budgets, for which the

• ffsetting spend is against Programme budgets.
• Programme Budgets are set to underspend by £463k at year end, due to the

prescribed treatment of the return to the CCG of £869k relating to the CCG’s contribution to the national 20145/15 Continuing Care Risk Pool, offset against the £406k Quality Premium Award spend mentioned above

• Total QIPP savings plans of £16,388k are in place for 2014/15. In order to achieve the

plans, an investment of £797k has been made. This includes £455k on Mental Health QIPP schemes and £342k on Acute schemes. This leaves the net QIPP value at £15,591k.

• The CCG is forecasting to deliver the QIPP programme in full in 2014/15.

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Question and Answers

CCG Operating Plan and CCG Budget 2015/16

Dr Jonty Heaversedge, CCG Chair and Dr Richard Proctor, CoM Chair Malcolm Hines, Chief Financial Officer

What is an Operating Plan?

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The Operating Plan is an assurance document, which sets out how through the commissioning process, the CCG plans to improve the health and wellbeing of people living in our borough. The plan also sets out how the CCG will meet mandatory requirements set by NHS England in the annual operating framework planning guidance. The document sets out our locally- defined response to these requests. The Operating Plan is a declaration of the CCG’s commitment to meet national requirements; establish the extent of our ambition for the improvement of certain performance and outcome indicators; and provide a view of the programmes of work underway and planned to ensure these targeted improvements happen. The Southwark Operating Plan 2015/16 describes the CCG’s response to the requirement included in planning guidance published in December 2014: The Forward View into Action: Planning for 2015/16 and Supplementary information for commissioner planning, 2015/16. Both the CCG Council of Members and NHS England are responsible for assuring and endorsing CCG plans and the CCG submits detailed planning templates to NHS England. The Operating Plan document incorporates these detailed submissions and supplements this information with further description of the key actions and activities the CCG plans to complete in 2015/16 to deliver an improved NHS in Southwark.

What is an Operating Plan?

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Planning guidance stipulates that the ‘fundamental elements’ of CCG operating plans must address the following:

• An approach to improving patient outcomes as set out in the NHS Outcomes Framework.
• The CCG’s approach to improving health and reducing health inequalities (linked to the local

Health and Wellbeing Strategy).

• The CCG’s approach to ensuring a ‘parity of esteem’ between physical and mental health

commissioning.

• The CCG’s approach to improving access to local services for everyone.
• Details of how the CCG will meet NHS Constitution standards and performance trajectories.
• Details of the CCG’s response to the Francis, Berwick and Winterbourne View reports and the

CCG’s approach to safeguarding.

• Approach and improvement ambitions in relation to patients safety and patient experience.
• Planned progress towards seven day working.
• To present financial plans that meet NHS business rules; deliver efficiency and clearly link to

service and activity plans.

The full CCG Operating Plan 2015/16 is been included as part of the Council of Members papers.

Delivering our Operating Plan

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The CCG has established six programme boards to support the delivery of our Operating Plan in 2015/16. The boards are multi-disciplinary forums providing assurance and leadership in key areas of CCG business. The boards are: 1. Primary Care Development 2. Integration and Neighbourhood Development 3. Mental Health and Parity of Esteem 4. Resilient Communities and Prevention 5. Quality and Safety 6. Engagement. Each board reports into a CCG Committee and indirectly to the CCG Governing Body. Regular progress reports will be shared with the Council of Members over the next year. The following slides provides for each board, a concise summary of its purpose; its the key

• bjectives; and work plan for 2015/16. Full details are included in the CCG’s Operating Plan

document in your papers.

Primary Care Development

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What remit does the programme board have and which areas does it focus on?

• This Board has recently been reviewed and now has a sole focus on Primary Care Commissioning;

supported by a Primary Care Development Group where commissioners and providers meet to discuss quality improvement and neighbourhood initiatives.

What does the programme board hope to do?

• Ensure that primary care providers deliver high quality services consistently across the whole population

in line with the objectives outlined in Southwark’s Primary and Community Care Strategy (PCCS) 2013/14 – 2015/16.

• Oversee the development of the organisational infrastructure of primary care in order to be able to

deliver on the expectations and intended outcomes of the Primary and Community Care Strategy.

• The Board will review its mandate in relation to co-commissioning and the SEL governance structure.

What is the key work started and planned for the future?

• Review of 2014/15 neighbourhood initiatives (e.g. Neighbourhood Development Plan) to inform future

commissioning decisions, and articulate the primary care ‘service offer’ in order to best meet the

• bjectives of the PCCS.
• Oversee the roll-out of the CCG’s Primary Care Workforce Plan, including the development of

Community Education Provider Networks.

• Implementation of the Primary Care Dashboard to benchmark key quality indicators.
• Ensure that the CCG is meeting its statutory responsibility to monitor and improve the quality of primary

care services.

What remit does the programme board have and which areas does it focus on?

• Oversee the development of integrated neighbourhood models and Local Care Networks.
• Develop joint commissioning across health and social care, based on outcomes.
• Work to promote integrated care to ensure that services are centred around the needs of the patient,

reduce duplication and respond to both health and social needs.

What does the programme board hope to do?

• Set up Local Care Networks for North and South Southwark. These will be the foundation of integration

and bring together all local health and social care organisations (including patient groups and the voluntary sector) to work to improve services and outcomes for their local populations.

• Identify the segments that we wish to prioritise for commissioning through Local Care Networks, and

develop the outcomes we wish to see delivered.

• Oversee market and provider development to address gaps in the current system, enabling a greater

range of health and social care services to be delivered in the community.

What is the key work started and planned for the future?

• Workshops are being held in March to bring together nominated representatives of the Local Care
• Networks. Their discussions will focus on agreeing ways of working and developing work plans for the

year ahead.

• Work is underway to align commissioning intentions between the CCG and Council, and a review is being

undertaken to scope out opportunities for broader collaboration.

Integration and Neighbourhood Development

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Mental Health and Parity of Esteem

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What remit does the programme board have and which areas does it focus on?

• The Board is responsible for providing the strategic leadership to promote parity of esteem

(approaching the care of a person in an holistic way which values their mental health and wellbeing equally with their physical health) throughout Southwark CCG and its partners.

• Ensure parity of esteem is embedded across all services.

What does the programme board hope to do?

• Ensure commissioning and strategic decision making by the CCG is in line with the vision to

achieve full parity between mental and physical health services.

• Ensure all services are outcome based with a focus on evidence based therapies, recovery that

will reduce social isolation, increase integration and promoting daily living.

• Better-integrated services, that enables smooth transitions and joint working across the whole

system to wrap care and support around individuals, networks and communities with a strong emphasis on prevention. What is the key work started and planned for the future?

• 24 hours crisis care (Crisis Concordat, Crisis Line, 24 hour home treatment, Psychiatric Liaison).
• Transformation of Adult mental Health Services (Primary Care, Community, Inpatient services).
• Development of CAMHS services (Prevention, Early intervention, Eating Disorders).
• Dementia Services (Early diagnosis and wrap around social support).
• Improving Access to Psychological Therapies tender.
• Development of a outcomes framework.

Resilient Communities and Prevention

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What remit does the programme board have and which areas does it focus on?

• Develop and agree evidence based prevention priorities – across the system.
• Lead a cohesive transformation programme to improve outcomes for people.
• Ensure the building of resilience underpins the board’s work programme.

What does the programme board hope to do?

• Strengthen the focus on prevention to enable people to enjoy longer healthier lives.
• Target activity to those who need it most in order to reduce inequality.
• Develop community resilience by enabling the voluntary sector and volunteering to support

individuals, families and communities.

• Contribute to a sustainable health and social care economy by providing more effective earlier

intervention and support. What is the key work started and planned for the future?

• Engaging with communities to inform the business case for an integrated tier two and three
• besity service.
• Reviewing the effectiveness of tobacco smoking strategy and services.
• Reviewing alcohol strategy and effectiveness of services.
• Supporting a programme of voluntary sector and volunteering development.
• Expansion of self management schemes.

Quality and Safety

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What remit does the programme board have and which areas does it focus on?

• To ensure quality is at the heart of everything the CCG does.
• To provide advice and assurance to Governing Body (and committees) on issues of clinical

effectiveness, patient experience and patient safety.

What does the programme board hope to do?

• Embed procedures for identifying, investigating and learning from poor quality.
• Provide assurance that commissioned services are safe, high quality and adequate plans are in

place to respond to any issues of poor quality.

• Receive reports from externals e.g. CQC, Monitor and support actions to address poor quality.
• Provide a platform to support outcomes based commissioning.

What is the key work started and planned for the future?

• Representing CCG at all quality and serious incident committees at providers enabling informed,

effective dialogue, actions are agreed, lessons fed back across CCG.

• Developing a framework for clinical site visits, including priority areas for action.
• Reviewing and re-launching of Quality Alerts system.
• CCG Quality Framework aligned with key priorities of programme board.
• Reviewing and critiquing of quarterly CCG Quality Report.
• Collating commissioner responses to Quality Account submissions from foundation trusts.

Engagement

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What remit does the programme board have and which areas does it focus on?

• The Board is exploring how to maximise the range of patient and public voices that we

hear.

• The Board is exploring how we better engage with CCG membership.
• The Board will support and advise on the engagement that the other programme boards

wish to undertake. What does the programme board hope to do?

• The Board is currently scoping what a digital / virtual platform might incorporate: access

to on-line services, signposting, connecting communities, engaging and use of data.

• The Board is exploring options for carrying out surveying of Southwark residents to gain

wider views of health and wellbeing to inform our commissioning.

• The Board is in discussion with the Building Resilient Communities Programme Board

about taking a co-design approach to smoking cessation services. What is the key work started and planned for the future?

• Design and launch of a ‘virtual platform’ for information and support.

Meeting NHS Constitution standards

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Performance The CCG is committed to meeting NHS Constitution and national performance standards

• ver 2015/16. However the expected performance at the end of 2014/15 at King's College

Hospital (KCH) related to RTT admitted patient care, diagnostic and A&E waits means that the Trust will to not be in a position of compliance for every reporting period or every month in 2015/16. Discussions are currently taking place between NHS Southwark CCG, the Trust's Coordinating Commissioner, other CCG and NHSE commissioners and tripartite panel members to determine system performance expectations for KCH. A number of important diagnostic work streams are being undertaken to ensure that recovery trajectories are underpinned by a shared whole system diagnostic, robust demand, capacity and action plans, a clear risk assessment and a contingency plan, thus providing start confidence and assurance in relation to agreed trajectories.

Meeting NHS Constitution standards

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It is anticipated that the outcome of this work will result in a time limited planned failure being agreed by commissioners and tripartite panel members for these targets, with recovery trajectory and action plans signed off by all parties and reflected in 2015/16 contracts with KCH though a Quarter 1 contract variation, noting final trajectories are not expected to be agreed until mid April for the KCH Denmark Hill site and early to mid-May for the KCH Princess Royal University Hospital (PRUH) site. Our current planning assumptions in relation to the expected return to compliance by target, noting these will be tested and refreshed in the light of the further work being undertaken over the next few weeks, are as follows:

• RTT admitted - recovery by end May 2015 for Denmark Hill and end Q2 for the PRUH

site and Trust wide. Full compliance with other RTT national standards for the whole of 2015/16.

• Diagnostic waits - recovery by end Quarter One 2014/15 for each of the Denmark Hill

and PRUH sites and Trust wide.

• A&E - full compliance for A&E at Denmark Hill and recovery by end Quarter Two for the

PRUH and Trust wide. The CCG's overall performance against the above standards will be impacted by the KCH performance position, with the CCG’s return to compliance mirroring that of KCH.

Budgetary Framework 2015/16

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Financial context Southwark CCG has a good history of financial achievement, having achieved all of its financial duties in 2013/14 and forecasting to achieve the same again in 2014/15, including exceeding the requirement to achieve an increased surplus of £5.97m (increased by £2m in 2014/15). Our current plans for 2015/16 include:

• maintaining a surplus of £7,141k (1.8% compared to the requirement of 1%);
• holding a contingency of £1,981k (meeting the 0.5% target); and
• holding a reserve for non-recurrent spend of £3,962k (meeting the 1% target)

Our historic record in QIPP delivery is equally robust, forecasting to deliver the full £15.5m QIPP programme for 2014/15 and having delivered over 99% of the 2013/14 programme. The strong history of financial and performance achievements have enable the CCG to be in a position where it is able to reduce the level of QIPP required to just under £8m for 2015/16. This is a reduction of over 50% of the 14/15 target.

Budgetary Framework 2015/16

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Financial planning for 2015/16 In its original 5 year plan submitted at the beginning of 2014/15, the CCG had assumed an allocation increase of 2.78%. The revised allocation calculation resulted in an actual allocation increase of 3.61%. This change resulted in the CCG receiving circa £3m more than had originally been planned, but there were additional commitments tied into this increase, such as winter resilience funding. The increase has an implication for future years as well, as it means that the CCG will be almost 0.6% above target, and so is only expected to receive national average minimum growth beyond 2015/16. We are continuing to work closely with providers in agreeing the assumptions to be included within 2015/16 contracts including baseline activity assumptions, seasonality & volume growth changes, service developments and the impact of KPI/ QIPP and transformation

• initiatives. The 2015/16 tariff decision and the resulting uncertainty is inevitably impacting on

progress in negotiations. Budgets are based on 2014/15 forecast outturn, a tariff deflator assumption, population & incidence growth and QIPP plans. 2015/16 budgets are based on realistic planning assumptions are we are working closely with providers to jointly agree and manage transformation initiatives to manage activity levels. The CCG Budgetary Framework 2015/16 has been included as part of the Council of Members papers.

Budgetary Framework 2015/16

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The CCG is using the currently agreed national assumptions with regards to uplifts and efficiencies (net tariff has reduced by 0.8%), releasing resource to commissioners, this is a combination of inflation of 1.9%, increased clinical negligence premiums of 1.1%, and net of 3.8% efficiency savings. It is important to note that the national tariff has not been agreed by providers and on that basis, providers have been given 2 options to choose from. The results of this are as yet unknown and are likely to affect the assumptions just discussed. The CCG has included these in its plans a risk, but has enough mitigations in place to cover the worst case

• scenario. This is a national issue rather than an individual CCG issue.

We have included assumptions for acute growth, for 2014-15 outturn, unwinding of non- recurrent funding, demographic growth and meeting Referral to Treatment targets (RTT), although there are still concerns about maintaining performance and of delivering sustained

• quality. Areas within mental health such as external placements continue to overspend.

Significant service change is planned for 2015-16 and the CCG needs to continue its past good performance on achieving QIPP programmes. The CCG had identified substantial risks related to the transfer of specialised services such as renal dialysis and bariatric surgery, but this risk has abated with the deferral of this transfer until 2016/17.

Budgetary Framework 2015/16

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Opening Budget Envelopes 2015-16 (£000s) 2014-15 2015-16 Acute services 207,663 209,724 Mental Health services 52,408 53,663 Community services 32,935 34,185 Primary care prescribing 31,200 32,485 Re-ablement with Local Authority 1,844 Continuing care and Free nursing care 16,944 15,650 Better Care Fund 20,478 Corporate costs and property costs 5,015 5,838 Total Budget envelopes 348,009 372,023 Reserves and Contingencies 14,458 10,331 Total Programme Budget excluding running costs, net

• f QIPP savings

362,467 382,354

Investing to improve local services

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The CCG will increase investment in mental health services including IAPT and early intervention in psychosis, and in redesign of Adult Mental Health services-these total almost £1.9m. We received the benefit of £1m non-recurrent Challenge Fund funds in 2014-15, and will have two Urgent Access centres in operation at the end of February 2015. These are an investment of over £2m recurrently, offset by savings on the former Walk in Centre and other areas. We are also continuing a programme of development with all member practices and in forming neighbourhood development plans. Further detail of all CCG investments and also the key cost pressures for 2015/16 can be viewed in the CCG’s Budgetary Framework 2015/16.

Investment in 2015/16 £’000 Adult mental health and IAPT Transformation 1,089 Dementia diagnosis and care 100 A&E transformation – Liaison Psychiatry 200 Mental health of older adults SLIC investment 81 Street Triage service 65 Early Intervention in Psychosis 336 Children’s Community Team to deliver 7 day services 300 Early Start children’s services 441 Children’s nutrition and dietetics services 45 Adults dietetics redesign 40 Interpreting services for patients accessing GP services 45 Support Integrated neighbourhood models 500 Southwark group supporting primary care quality 173 Community pharmacy development 125 Enhanced incentives to GPs to improve prescribing 200 Data analyst/intelligence support officer to Medicines Optimisation Team 50 Creation of Better Care Fund- net effect 6,000 Total Investments 9,790

Question and Answers

Council of Members to approve:

CCG Operating Plan 2015/16 CCG Budgetary Framework 2015/16

Refer to both documents, which are included in CoM papers.

Clinical Leads Selection and Election Process

Malcolm Hines, Chief Financial Officer

Clinical Leads Selection and Election

• The CCG is currently seeking four new GP Clinical Leads and one Practice Nurse

Clinical Lead, to take the place of those whose term ends in June 2015.

• All GPs and Practice Nurses registered in Southwark (including locums) working one

session or more per month are eligible to vote for clinical leads in the election. Any member of that electorate will be eligible to stand for selection / election.

• The selection / election process is summarised as follows:

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Date Action w/c 16 March Selection process launches 13 April Selection process closes Up to 30 April All nominees interviewed 5 May Election ballot opens 29 May Election ballot closes Early June Governing Body receive results 15 June New Chair elected 1 July New Governing Body Clinical Leads take up post

Question and Answers of the CCG Governing Body

• Dr. Richard Proctor

Any Other Business

• Dr. Richard Proctor

360° Stakeholder Survey

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