South CCG – Annual Report (2013-14)€¦ · South CCG – Annual Report (2013-14) Version: 0.7...

South CCG – Annual Report

(2013-14)

Version: 0.7

Date Approved: 6th June 2014

SMCCG Annual Report June 2014

South Manchester Clinical Commissioning Group Annual Report of 96

Contents

- Title Page ........................................................................................................1

- Contents Page.................................................................................................2

1.0 Introduction......................................................................................................3

2.0 Member Practices’ Introduction .......................................................................4

3.0 Strategic Report ..............................................................................................5

4.0 Members’ Report...........................................................................................25

5.0 Remuneration Report ....................................................................................30

6.0 Sustainability Report......................................................................................40

7.0 Equality Report..............................................................................................40

Appendices

Appendix A - Independent Auitors Assessment ......................................................43

Appendix B - Statement of Accountable Officer’s Responsibilities..........................47

Appendix C - Governance Statement......................................................................48

Appendix D - Financial Statements .........................................................................59



1.0 Introduction

1.1 South Manchester Clinical Commissioning group (CCG) was authorised on 1st April 2013 with no conditions. The CCG has a detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and any other requirements set by the NHSCB and are integrated with the commissioning plan.

1.2 The CCG delivered a 1% surplus in line with NHS England requirements for the financial year 2013/14. Some of our achievements include:

• Authorised without conditions • Maintained financial balance • £14 million invested back into our system • Good relationship building with the team, board and member practices • Member practices engaged on key areas of work - Cancer, AF, Dementia • Neighbourhood Team/Integration pilot - phase 2 gone live • Multi-professional education and training for advanced care planning, places

offered across primary and community care • Development of a Five year strategic plan which describes system change,

process and outcome. SMCCG has also been a partner in the Manchester citywide Integrated Care Programme - Living Longer Living Better (LLLB) along with the following key partner statutory organisations: 1. Manchester City Council 2. North Manchester CCG 3. North Manchester General Hospital 4. Central Manchester CCG 5. Central Manchester Foundation Trust 6. South Manchester CCG 7. University Hospital of South Manchester Foundation Trust 8. Manchester Mental Health & Social Care Trust

At a local level the CCG has worked closely with key partners to deliver local priorities for example the integrated neighbourhood teams (NT) including the University Hospital of South Manchester (UHSM), Manchester City Council (MCC) and the Mental Health & Social Care Trust (MMHSCT), GP practices as the newly formed GP Federation, and third sector organisations. There has also been significant input from patients and carers. The NTs are the bedrock to the delivery of an integrated community based service approach to care delivery in South Manchester. This approach over the next 5 years will expand and evolve to support the population as a whole, with key features of empowerment, self-care, and supporting independence. This will also support delivery of the Healthier Together programme and common standards of care for community and acute services across Greater Manchester. In developing and delivering our plans the CCG has also worked with other organisations including Health Education North West, Manchester Business School and Lancaster University. One of the key targets for the CCG has been to implement



integrated models of working across health and social care; therefore it has been essential to forge strong working partnerships with key stakeholders. The CCG is starting to see the success of working in this way and re-focusing services to improve the quality of care for people with long term conditions and their families and carers.

SMCCG ensures that local environmental, social and community issues are addressed through its partnership arrangements at the Manchester Health and Wellbeing Board. The aim of the Manchester Health and Wellbeing Board is to make a real difference to the health, wellbeing and life chances of the people of Manchester by dealing with the really stubborn challenges and closing the inequalities gap. The HWBB has a vision and strategy for health and wellbeing that connects health, social care and the wider determinants that affect the health and wellbeing of local people. As a partner at the HWBB, SMCCG actively provides the leadership needed across the City to provide better services and better outcomes for communities, families and individuals.

2.0 Member Practices’ Introduction

2.1 South Manchester member practices have continued to build upon the relationship that has been developing across health and social care. We have focused on our people and delivering better outcomes for our residents, and are fully committed to helping our population live longer and better. This vision is shared between the GPs in the 25 practices across South Manchester, who have worked in partnership with our patients, families and carers, social care colleagues, community staff, hospital clinics and managers to deliver better integrated care approaches. We are proud of the achievements in 2013/14 and the delivery of CCG strategic priorities and business plans. New ways of working have resulted in our neighbourhood teams working across 4 GP patches, along with extended access to primary care for Frail Older Adults, Adults with Dementia and End of Life Care for Adults. Avoidable demand for hospital admissions and treatment has reduced, as have admissions to residential and nursing homes for people with long term conditions. Transparent relationships have developed with our residents through our Patient and Public Advisory Group. We have established a provider partnership across South Manchester to take ownership of developing new models of care that uses the variety of skills and expertise that the partnership holds. The CCG has participated in a 360o stakeholder survey to assess relationships with a range of health and care partners – we need strong relationships in order to be successful commissioners within the local system. The survey, conducted by NHS England, allowed stakeholders to provide feedback on working relationships with CCGs. 30 stakeholders participated in the survey and the CCG received a 61% response rate. A snapshot of the results from the survey highlight that member practices have felt very engaged by the CCG in the last 12



months, and 77% rate their working relationship with the CCG as very good. 57% of all stakeholders know a great deal about the CCG’s plans and priorities. An area for development is communication, ensuring our stakeholders are fully aware of our plans and priorities, and that our clinicians are involved in discussions about quality and service redesign. We shall we taking the recommendations forward from our survey to build our capability and organisational development, enabling the CCG to continue to build strong and productive relationships with stakeholders.

3.0 Strategic Report

3.1 The CCG strategic plan 2012-15 whilst ambitious outlined the key aims of the CCGs vision which are:

• To improve patient experience by working in partnership with patients and the local population of South Manchester, and providing care close to home through the integration of health and social care services.

• Improving health and increasing life expectancy by promoting and enabling self care, preventing ill health and providing fair and equitable access to local health and social care services.

• The SMCCG focus is on quality and value for money and to ensure that patient pathways reflect this by all organisations providing health and social care. We have a responsibility to use our resources and finances as efficiently and fairly as possible.

3.2

During 2013/14 the CCG has worked with a range of key partners to ensure that the elements of the vision and actions contained within the strategy were achieved. Significant progress has been made and we continue to build on the relationship that has developed across health and social care; we see this as the key vehicle to delivering better outcomes for our residents. We are focused on our people, pride and place and as a system we are fully committed to helping our population to Live Longer and Live Better. With our member practices across South Manchester we will continue to work in partnership with our patients, their carers and families, our social care colleagues, community staff, hospital clinicians and managers as we collectively have a responsibility to improve the health and well-being of our residents. Patient’s carers and families will notice an improvement in health outcomes because we have driven forward a systematic targeted approach to how services are commissioned and delivered. New models of care have been developed that have a clear focus on;

• The individual - their carers and families and not organisational structures

• Empowering individuals, their carers and families enabling self-care and management of conditions

• A shared care approach between individuals and providers

• Achieving the commissioned specified outcomes for individuals and the population as a whole.



Hilda’s story - a true story of a patient in South Manchester “Hilda had been a patient of Dr Tamkin or thirty years and her story is Dr Tamkin’s personal foundation and motivation to lead SMCCG to radically change the delivery of health and social care in South Manchester. The GPs of SMCCG will do their utmost to ensure all our future Hilda’s get the best possible care”. Hilda was a fiercely-independent 82-year-old, who had long made it clear that she wished to die in her own home in South Manchester. The fact that she did not achieve this, but ended her days in hospital, is an illustration of why health and social care services need to change. Despite a number of health problems, Hilda lived alone at home, with the support of daily visits from family members and from carers, who were left in no doubt that this was where she wanted to die. Even a diagnosis of cancer failed to change her mind. As her health condition deteriorated a stair lift was installed, to make access to all rooms in her home easier. One evening however, Hilda became tired whilst moving around upstairs, decided to lie down and rest on the landing, and was unable to get up from the floor. What followed was a lack of common sense and bureaucracy. When Hilda’s carers arrived, they were unable to help her up, because their protocols did not permit them to lift her. They had to make her comfortable and call the ambulance, even though she had told them she had not fallen. In their turn, the ambulance staff responded to their protocols applying to falls, and took Hilda to the local hospital A&E department despite her protests that she had been resting and had not had an accident. Hilda then endured a three-hour wait, and a further three hours admitted to the Clinical Decision Unit, until she was finally admitted onto a ward. All this time she was insisting to those around her that she wanted to go home. The introduction of an integrated health and social care system for South Manchester will enable this to be possible in the future. Hilda would have been able to go home with the appropriate care she needed to support her. Instead she spent the last five days of her life on three different hospital wards, during which time her condition began to deteriorate. Hilda knew she had not long to live and reiterated her wish to be allowed to spend her final days with her family at home. However, Hilda spent her last seven hours being moved between two different wards. She finally passed away in hospital - the place where she had always been clear she did not want to end her days. During 2013/14 we have put in place changes that help prevent more stories like Hilda’s. These changes have happened as a result of working as a South Manchester system who has championed:

• Listening and responding to patient wishes.

• Patients not being bounced around our systems because of either bureaucracy or lack of common sense.

• Integrated health and social care.

• Use of information technology to support independent living, and share



knowledge about an individual’s needs between professionals.

• Multidisciplinary care planning for patients with long-term conditions, so that they know who and when to contact for assistance as their condition changes.

• 24/7 community emergency response and support.

• A self-reliant population with information and access to healthy lifestyle activities, preventing ill health or managing long term conditions.

• Jointly trained staff across health and social care. Changing the Story – What is different for patients in South Manchester Patients will notice an improvement in health outcomes because of clinicians’ freedom to target and personalise care more effectively. They will also benefit from the removal of two significant historic barriers - the first being the historic divide between primary care (GPs and community services) and secondary care (hospitals and specialist care), and the second being the traditional gap between health and social services. Through this integration of services we can not only provide a better seamless service to patients but also provide those services more efficiently within the resources available. Patients will be encouraged to take increased responsibility for their health and we will build a self-reliant population with access to information and healthy lifestyle activities, preventing ill health and managing long term conditions. We, in South Manchester, have reason to be optimistic about the future and our ability to face the challenges ahead. We have already brought in new ways of working, through our Neighbourhood Teams (NT) working across the 4 GP patches, along with extended access to primary care for the target population group Frail Older Adults/Adults with Dementia and End of Life Care for Adults.

• Prevention During the first year of the CCG’s existence we have worked with our partners in Public Health to improve cancer statistics for cervical, breast and bowel screening. We have also set and achieved a local quality premium target to increase the proportion of cancer diagnoses from 40% to 43% through the two week wait pathway. We have achieved this by working hard with our member practices through our Practice Engagement Scheme to focus on cancer prevention and awareness, early detection and education, reviewing significant events routinely and referral routes. Practices have also monitored attendance of cancer patients at A&E and produced improvement plans to avoid A&E attendance.

• Long term conditions (LTC) In South Manchester, health related quality of life for people with long term conditions (LTCs) is below the local and national average, and emergency admissions for acute conditions that should not usually require hospital admissions are significantly higher than the national average. South Manchester also has high, age-specific rates of LTCs, with many people having more than one LTC, meaning their health and social care needs are more complex. With an increasingly ageing population, the risk of people becoming unwell increases exponentially. SMCCG worked with partner organisations to develop Neighbourhood Teams (NTs) in each of the four ‘patches’ of practices. The teams include community nurses, mental



health practitioners, social care professionals, GPs and practice nurses. Specialist teams are now starting to work with the NTs, including respiratory nurses and the Stroke Early Supported Discharge team.

• Integration and LTC management

We have implemented a pilot across all 25 member practices for integrated NTs where multi disciplinary health and social care teams proactively plan and coordinate care for people with long term conditions who are at high risk of admission. Care plans are developed with the person and their carer where appropriate, to improve the quality of life for people with LTCs. The interim quantitative evaluation of this pilot has shown very encouraging results including: Neighbourhood Teams Neighbourhood Teams are a new way of working. They are designed to deliver integrated care tailored to the individual and delivered by a multi-disciplinary team working towards a common goal. The South Manchester Neighbourhood Team is made up of a key worker, GP, practise nurse, community nurses, social worker, mental health practitioner and health and support worker. By including all relevant professionals in a single patient-centred package of care, Neighbourhood Teams aim to deliver high quality care, improve the patient experience and avoid unnecessary hospital admissions. Sarah’s care history Sarah has been receiving weekly visits from district nurses since 2009. They give her a subcutaneous injection to maintain her renal function each time and every three months give her an intra-muscular injection to treat her chronic anaemia. She also has regular outpatient appointments at the chest clinic, as well as the rheumatology, renal and haematology clinics and eye hospital. Due to problems with her eyesight and her inability to walk anything more than a short distance, Sarah has to travel to these appointments by taxi and is always accompanied by her carer. She is known to social services and has received various aids and adaptations over the years, including the installation of a stair-lift at home. Due to her failing eyesight, she also uses a blister pack to ensure correct and safe administration of her medication. Sarah has been hospitalised with recurring chest infections five times within an eight-month timeframe We seek transparent relationships with our residents through the established partnership with our Patient and Public Advisory Group and continue to act upon the feedback received from patients about their experiences when accessing and using services. The newly established provider partnership in South Manchester will take on the responsibilities of working together to develop and implement new models of care that utilise the variety of skills and expertise that the partnerships holds. The new models of care will have a focus on people, their families and the neighbourhoods and working to a common set of outcomes for the population. These are exciting times for Manchester and the South system is proud to be part of creating a new reality where health and social care services are excellent, streamlined, cost-effective and put the needs of patients at the heart of everything we do.



3.3

South Manchester CCG offices are based in Parkway Business Centre, Princess Road, Manchester M16 7LU. Our Governing Body meetings are usually held bi-monthly from the Lifestyle Centre In Wythenshawe. The meetings are open to the public and further information is available on the CCG website, www.manchester.nhs.uk

3.4

The CCG is responsible for commissioning healthcare services to meet the reasonable needs of our population (i.e. principally for patients registered with our member practices, together with any unregistered patients living in their area), except for those services that the NHS England or the local authority are responsible for. These include:

• Community health services

• Maternity services

• Elective hospital care

• Rehabilitation services

• Urgent and emergency care including A&E, ambulance and out-of-hours services

• Older people’s healthcare services

• Healthcare services for children

• Healthcare services for people with mental health conditions

• Healthcare services for people with learning disabilities

• Continuing healthcare

• Abortion services

• Infertility services

• Wheelchair services

• Home oxygen services

• Treatment of infectious diseases The CCG is made up of the full commissioning group, represented by the 25 practices in South Manchester. The work of the CCG is overseen by the Governing Body. The Audit Committee and Remuneration Committee are required by statute and accountable to the Governing Body. South Manchester CCG has established a number of other committees which also sit under the governing Body. These committees are Finance; Corporate Governance; Clinical Commissioning; Joint Commissioning Management Board; Quality and Performance; Communication and Engagement and Senior Management Team. The CCG has a number of teams in place to support the full group membership, governing body and all the committees of the CCG to effectively carry out its statutory functions. We have a core South Manchester Team made up of medicine management, urgent care, planned care, primary care development, strategy and planning and Finance teams. We also have a number of teams that we share with other CCGs. These are:

• Performance and Quality Team (shared between Central Manchester, North Manchester and Trafford CCGs)

• City Wide Commissioning Team • City Wide Corporate Services



• City Wide Finance Team • City Wide Business Intelligence Team

Our CCG is also supported by Greater Manchester Commissioning Support Unit who provides a number a core services on our behalf, e.g. IT support and HR.

3.5

SMCCG, as a statutory member of the Manchester Health and Wellbeing Board, is jointly responsible for the production of the Joint Strategic Needs Assessment (JSNA). The JSNA provides an assessment of the health profiles and needs of the population of South Manchester and underpins the commissioning of the range of health services that are needed to improve the health and wellbeing of local residents. The JSNA may be read in full at http://www.manchester.gov.uk/info/500230/joint_strategic_needs_ assessment SMCCG covers a growing population of approximately 165,000 people. Projections for 2015 indicate a 4% increase in population ranging from a decrease of 3.3% in Didsbury West to an increase of 8.9% in Sharston. As this happens the age, gender and ethnic structure will also change. While there are successful neighbourhoods across South Manchester, there are also areas that have not benefited in the same way and there are pockets of deprivation across the area, with high levels of worklessness, low skill levels and poor health amongst the population. The quality of local housing, crime and disorder and social cohesion have been identified as key environmental, social and community issues. The Private Sector House Condition Survey for 2006/07 showed 30% of private sector housing in South Manchester was below the decent homes standard. The fear of crime can alter people's lifestyles and may affect them in ways that lessen their quality of life and impact upon their physical and psychological health. According to the Manchester Residents Survey 2008/09, around 81% of people in South Manchester report feeling safe in the daytime with only 33% feeling safe at night. Within South Manchester fear of crime is strongly associated with deprivation with over 95% of people in Didsbury West reporting that they feel safe in the daytime compared with 67% of people in Sharston. Similarly, over 63% of people in Didsbury West report feeling safe at night compared with only 15% in Old Moat and 17% in Baguley. Social capital describes the networks or relationships between people living in a community and the shared values which arise from those relationships. The 2011/2012 Manchester resident telephone survey asked residents about their sense of belonging to their local area and their satisfaction with their area as a place to live. On average in South Manchester the sense of belonging was slightly stronger than in Manchester as a whole. However, Old Moat (71%) and Withington (58%) fell considerably short of the average. The population and relevant demographic detail are summarised in the following charts. Detailed population statistics are available at http://www.manchester.gov.uk/downloads/download/5724/compendium_of_statistics-manchester



Fig 1 Estimated resident population by 5 year age group (mid-2011)

-20.0 -15.0 -10.0 -5.0 0.0 5.0 10.0 15.0 20.0

Under 1

1-4

5-9

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45-49

50-54

55-59

60-64

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70-74

75-79

80-84

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90+

% of Total Population

Males Females England

Fig 2 Proportion of population from a non-white ethnic group (2011 census)

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10.0%

15.0%

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Fig 3 Life expectancy at birth (2010-2012)

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Fig 4 Proportion of births to lone mothers (2010-2012)



Fig 5 Prevalence of obesity in year 6 children

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Fig 6 Proportion of residents reporting a limiting long term health problem (2011

census)

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3.6 The financial duties of a CCG as set out by NHS England are listed below:

- Expenditure not to exceed the revenue resource limit in any one year. - Expenditure not to exceed its capital resource limit in any one year. - To remain within its cash limit in any one year. - To remain within the running costs target of a maximum of £25 per head of

population. The table below demonstrates that South Manchester CCG delivered all of its statutory duties in 2013/14.

Statutory Duty Target (£k) Actual (£k) Variance (£k) Duty Met?

Expenditure not to exceed Revenue Resource Limit 211,137 209,070 (2,067) �

Expenditure not to exceed Capital Resource Limit n/a n/a n/a -

To remain within its Cash Limit 200,878 200,872 (6) �

To remain within the running cost target of £25 per head 3�950 3,919 (31) �

In addition the CCG should comply with the Better Payment Practice Code, which requires the payment of all invoices within 30 days or agreed contract terms. The CCG is classed as compliant if it achieves over 95%. The table below highlights the performance both in terms of the number and value for non-NHS and NHS invoices.



Measure of compliance 2013-14 2013-14

Number £000

Non-NHS Payables

Total Non-NHS Trade invoices paid in the Year 1,960 11,323

Total Non-NHS Trade Invoices paid within target 1,564 9,909

Percentage of Non-NHS Trade invoices paid within target

79.80%

87.51%

NHS Payables

Total NHS Trade Invoices Paid in the Year 1,920 165,849

Total NHS Trade Invoices Paid within target 1,766 163,396

Percentage of NHS Trade Invoices paid within target

91.98%

98.52%

The above table shows that the performance measure has not been met with the exception of NHS invoices by value. However, the performance against this measure has improved over the later part of the financial year and plans are in place to deliver in 2014/5. Expenditure not to exceed revenue resource limit Limits are set by NHS England for clinical commissioning groups, within which they must contain net expenditure for the year. These are termed “resource limits” and there are separate limits issued for revenue and capital. The CCG did not have a capital resource limit in 2013/14 and no capital expenditure. South Manchester CCG’s revenue resource limit for 2013/14 was £211,137k. Against this, costs amounted to £209,070k and therefore the organisation has declared a surplus of £2,067k. To remain within cash limit All CCGs are set a limit on the amount of cash they can spend in a financial year. The cash limit for 2013/14 was £200,878k and the organisation drew down from NHS England cash amounting to £200,872k. As at 31st March 2014 the cash held by the CCG was £6k. To remain within the running costs target The CCG receives an allocation for running costs or administrative expenditure. The target limits the amount the CCG can spend on administrative functions, for instance back office functions, headquarters, training etc to a maximum of £25 per head of population. The allocation for South Manchester CCG in 2013/14 was £3,950k. During 2013/14 the CCG spent £3,919k on administrative expenditure, generating a £31k under spend against the target. The financial statements are included at Appendix D, these include the following statements:

• Statement of Comprehensive Net Expenditure for the year ended 31st March 2014

• Statement of Financial Position as at 31st March 2014



• Statement of Changes in Taxpayers' Equity for the year ended 31st March 2014

• Statement of Cash Flows for the year ended 31st March 2014 These accounts have been prepared for South Manchester CCG under section 17 of schedule 1A 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. Income In total the CCG received funding of £211,137k in 2013/14. The majority of this funding £210,244k is received directly from NHS England in the form of allocations. Other income of £893k has been received from other various organisations. Expenditure The Statement of Net Comprehensive expenditure, included in Appendix D details expenditure split by programme and administration costs. The total costs within 2013/14 are £209,070k, of which £3,919k relates to administrative/running costs expenditure and £205,151k healthcare (programme) spend. South Manchester CCG purchases significant back office functions from other bodies. Spending £1,125k with the Manchester citywide services, hosted by Central Manchester CCG and £1,393k with the Greater Manchester CSU. The chart below details a breakdown of expenditure for the CCG in 2013/14.

Investments



The key investment made by the CCG was in the establishment of the Neighbourhood Teams, the amount invested was £1.4m. The Neighbourhood Teams are an integral part of the CCG’s strategy to ensure good quality community based care. Quality, Innovation, Prevention and Productivity (QIPP) The CCG had a QIPP savings target of £3,812k in the financial year 2013/14. In order to achieve this level of savings a range of initiatives were implemented from secondary care deflection schemes, integration, and medicine management. The Statement of Financial Performance (SoFP) shown in Appendix D is the CCG’s balance sheet. The CCG was established on the 1st April 2013 and inherited no legacy balances or capital assets. The CCG has no capital assets as all premises occupied are leased through PropCo. The CCG did not purchase any assets in the financial year as it only received a revenue allocation. A full set of the accounts can be viewed on the CCG website www.manchester.nhs.uk The CCG’s financial health is monitored on a monthly basis at the CCG’s Governing Body meeting. The Governing Body also delegates much of this detailed scrutiny to the monthly Finance Committee, which is a sub-committee of the Governing Body and has representation from lay members, as well as member practices through their representatives on the CCG governing body. Assurance is provided by External audit who provide the following assurance to the Governing Body.

• An opinion on the accounts.

• Regularity opinion on whether expenditure has been incurred as intended by Parliament. Failure to meet statutory financial targets automatically results in a qualified regularity assertion.

• A conclusion on the arrangements put in place by the CCG to ensure value for money in its use of resources.

External audit work is supported by the Internal audit work program which along with the External audit work program is agreed and monitored by the Audit Committee.

3.7 The high level operational risks facing the CCG are as follows; With a significant proportion of expenditure on a cost per case basis this increases the financial risk the CCG is exposed to.

• The failure to achieve the A&E 4 hour targets by the local provider remains a significant challenge.

• There are continued risks of quality and resource within the mental health services. This is being managed in the longer term through the Mental Health Improvement Programme but the system is requiring day to day management.

• There is a financial risk relating to mental health out of area placements which is requiring significant management.

• The investment decisions through the shadow better care fund will need to



realise the resource required to create the full better care fund in 2015/16.

• Responsibility for GP IT has now transferred to the CCG, work is on-going to understand the financial implications of this service against the funding allocated.

The risks are considered challenging but within acceptable levels for the CCG.

3.8 The CCG had a funding allocation of £211m in the financial year 2013/14. Acute provision: 54% Mental Health: 12% Continuing Health Care/ Funded Nursing Care: 5% Community: 10% Primary Care/Prescribing: 15% Other: 4%

3.9 The CCG has always taken its responsibility in relation to quality very seriously and recognises that strong clinical leadership and clinical engagement is critical in improving quality and improving outcomes for patients. In order to be able to fully recognise our vision for quality the CCG developed a Quality Strategy. This Quality Strategy has four aims: 1. Ensure and improve quality throughout the patient journey. 2. Develop innovative approaches to quality improvement with a focus on improving

outcomes for patients. 3. Work in partnership to develop and support a culture of quality improvement across

the whole health and social care system. 4. Ensure and improve quality within primary care. There have been numerous reports released in this last year some of which have shaken the NHS to its core. Scrutiny of the quality of care for our patients has never been greater and reports such as Winterbourne, Francis, Berwick and Keogh have highlighted failings in care provided to our most vulnerable patients and failings in those responsible for the regulation and commissioning of those providers. Although the reviews in the main have been focused on the acute providers the learning from these reviews are equally applicable to all NHS funded services. As a CCG we have developed and implemented action plans in response to these national reviews of quality and we are now in the process of refreshing the CCG Quality Strategy to ensure the learning from all of these reports is captured and implemented in a timely and measurable way. The findings from the national reviews have also informed the development of our organisational strategic aims and the work plans falling from these and they have changed and strengthened the way we commission providers through all aspects of the commissioning cycle. Our achievements in relation to the Quality Strategy 2013/14 include: 1. Ensure and improve quality throughout the patient journey This aim and the objectives under it outline how as a CCG we ensure our services are



safe for our patients and clinically effective to ensure good patient outcomes and the best patient experience. These standards have allowed the CCG to have a detailed dialogue around quality issues on a regular basis and have provided us with a richer understanding of the complexities of these quality issues within each provider. To provide assurance to the CCG in relation to the quality standards the providers have invited the CCG to attend provider internal governance meetings where these issues are discussed and debated in detail, providing assurance not only around the quality standard but also in relation to the governance of quality. CCG quality walk-rounds In order to bring a stronger patient perspective into the care commissioned from providers a programme of commissioner walk rounds was developed. With the data available the CCG targeted areas where there were quality concerns and areas of good practice to give us a balanced perspective of the care at the provider. These CCG walk-rounds were led by the GP Clinical Leads and CCG Board members participated in these. This area will be developed further in the next year. Quality Dashboard The CCG has developed a quality dashboard. This captures trends over time and allows the CCG to identify early where there are quality concerns in a provider. Information gathered in relation to the quality standards and CQUINs helps to inform this alongside other sources of publically available data. Surveillance of quality at this level has allowed us to identify and act early on areas of concern and work closely with our providers to resolve these. Commissioning for Quality and Innovation (CQUIN) The CQUIN payment framework enables us as a CCG to reward excellence, by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. 100% of the local CQUINs have been achieved in 2013/14 for all the providers we commission care from both directly and indirectly. 2. Develop innovative approaches to quality improvement with a focus on

improving outcomes for patients As a CCG we recognise that to improve quality we need to do things in a different way. With reduced resources and unprecedented financial savings needed the CCG needs to be more innovative utilising evidence based models to ensure sustained quality improvements for the population it serves. As part of this the CCG has adopted and embedded the principles in the NHS Change Model to better support the achievement of high quality care for all, now and for future generations. The NHS Change Model



As a Clinical Commissioning Group we have also thought outside the box in relation to how we can ensure lessons from serious case reviews and serious incidents are embedded into the fabric of our providers using a CQUIN incentivising the use of change improvement methodology to bring this ambition to life. The Learning Lessons Once CQUIN requires providers to use change improvement methodology to embed lessons learnt from serious case reviews or serious incidents. As this progresses we will monitor future serious case reviews and serious incidents to ensure that themes do not reoccur. Work in partnership to develop and support a culture of quality improvement across the whole health and social care system As a CCG we recognise that we cannot improve quality in isolation, healthcare is a complex system and we need to work collaboratively with all of our partners to improve outcomes for our population. Our most important partners are our patients, and the patient voice is integral to everything we do as commissioners and through a strong CCG Strategy for engagement this is weaved into the fabric of the commissioning cycle in its entirety. To support a culture of quality improvement we have developed strong partnerships (sometimes formalised through contractual arrangements). We also have strategic partnership boards in place. We recognize that this aim will always be ongoing and will always need to be refreshed as the landscape of health and social care shifts. Ensure and improve quality within primary care The CCG has a Primary Care Quality Group in place and has worked closely with NHS England throughout the year to better understand and clarify the role and



responsibilities of the CCG in improving quality within this area. As a CCG quality remains the golden thread that runs through every aspect of the commissioning cycle. We have a strong Quality Strategy developed and led by our GP Clinical Leads for Quality that we will build upon in the coming year.

3.10 Each CCG whilst carrying out its functions must have a regard to the need to reduce inequalities between patients with respect to their ability to access health services, and reduce inequalities between patients with respect to the outcomes achieved for them. With a high and above national average prevalence of chronic disease and an ageing population as highlighted in the JSNA, SMCCG’s Strategic Commissioning Plan 2012-15 sets out the intent to shift the emphasis towards self care, prevention, early detection and improved management of conditions; raising the standard of care to ensure consistency across all practices and developing integrated services between health and social care. This strategy of tackling unwarranted variation in outcomes continues to underpin all of SMCCG’s commissioning and quality improvement activities. SMCCG continues to work closely with Public Health Manchester in tackling inequalities in health. At its July meeting, the Board of SMCCG welcomed the Director of Public Health to discuss the Public Health Annual Report. The report identified key local issues for health and wellbeing. It identified population segments at higher risk of morbidity and mortality provided recommendations for improving health and wellbeing and for increasing life expectancy and reducing morbidity. Subsequently, in January 2014, the Board received a detailed report from Public Health Manchester on local health inequalities; identifying the major diseases and risk factors that contribute to low life expectancy and ill health, the evidence-base to support effective commissioning of preventative services and areas for joint working. In 2014/15, SMCCG has used “Commissioning for Value” packs to prioritise clinical pathways for review and redesign; thereby targeting resources where they will have greatest impact on improving health and reducing health inequalities. The CCG commissioned additional “Deep Dive” analyses to further understand cardiovascular and respiratory disease in terms of their major contribution to inequality in terms of morbidity and mortality and actions to tackle variation in outcomes. Improving outcomes by addressing variation in Primary Care has produced positive results. For example, strong GP clinical leadership and improvements in the use of IT is delivering an increase in awareness and diagnosis of atrial fibrillation (AF) across the CCG population, which will directly contribute to a reduction in AF related stroke. The early diagnosis and appropriate referral of suspected cancer cases is another example of SMCCGs focus on improving outcomes at a population level. All GP practices have received support to improve local systems and patient care. Cancer champions have been recruited in each practice. Information on cancer screening is now routinely included in SMCCG practice nurse newsletters. SMCCG chairs the Macmillan Cancer Improvement Partnership in Manchester; bringing significant additional resources to deliver improvements in primary and community care and ensuring that local people affected by cancer are at the centre of the redesign of lung



and breast cancer pathways.

3.11 Public Involvement and Consultation As a CCG, we recognise that we cannot carry out our commissioning responsibilities effectively without understanding the needs, preferences and experiences of local people. Over the last year, we have been developing the ways in which we communicate and engage with the local population to support this aim. These include:

� Our Patient and Public Advisory Group – a ‘committee’ of local people who meet monthly to discuss and inform CCG programmes of work. The Group reports directly to the CCG Board at every Board meeting.

� myNHSmanchester – shared across the 3 CCGs, this is a database of 2000+ stakeholders, who have signed up to receive updates and news about local health services which outline opportunities for them to get involved in our work.

� Social media – we have a number of social media sites shared between the Manchester CCGs. These are used to directly seek feedback, promote engagement opportunities and to communicate news and updates about health matters. We have over 16,000 Twitter Followers and over 1800 Facebook friends.

� www.talkinghealth.net – a public engagement specific website which promotes opportunities for involvement and allows people to feedback to us online.

Throughout 2013/14, we have used these, and other mechanisms, to ensure the voice of our local population drives and informs our work. Examples include: Mental Health Improvement programme – This is a major, citywide CCG programme aimed at improving mental health services in Manchester. We ran a public survey to inform our Commissioning Intentions, we held focus groups with clinicians and service users to inform draft specifications and commissioned a local voluntary sector organisation to run a series of events to inform the development of 17 new care pathways. Macmillan Cancer Improvement Partnership – This is a city wide Cancer Improvement programme with user involvement at its heart. A Cancer Experience Board is being established and ‘Cancer Voices’ are being recruited to inform each element of the programme. A specific post has also been recruited to deliver engagement activity throughout programme. Living Longer, Living Better – This is Manchester’s ‘Integration’ programme which aims to transform community based services to provide joined ups services to target population cohorts. The ‘Care models’ have been informed though use of existing knowledge about patient preference and experience and a ‘co-production’ programme of work is in development, being overseen by the Chief Executive of a local carers’ organisation. We proactively engage with voluntary and community groups to identify issues specific to particular communities of interest.



We commission voluntary sector organisations to collect and feed in views of local communities. We see complaints as a key source of intelligence, as well as an important way for individuals to seek answers and responses to negative incidents they have experienced. Our complaints team manage complaints in line with the ‘Principles of Remedy’ and we analyse the resulting data to identify any particular themes of patient concerns, as well as to inform the management of contracts with our providers. Developments: Our experience during 2013/14 has led us to take the following actions to improve the way we communicate and engage with our local population:

� Creation of a new website and intranet site to come on-line in August 2014. � Adoption of a new stakeholder management system to ensure that we can

better identify gaps in our engagement mechanisms and improve the way we disseminate information to those we are already in touch with.

� Formation of a new, in-house communications and engagement team for the 3 CCGs in Manchester.

� Closer working with Manchester City Council, and other NHS organisations in the city, to ensure we better integrate our communication and engagement channels.

3.12 The strategic priorities of the HWBB are: 1. Getting the youngest people in our communities off to the best start. 2. Educating, informing and involving the community in improving their own health

and wellbeing. 3. Moving more health provision into the community. 4. Providing the best treatment we can to people in the right place at the right time. 5. Turning round the lives of Troubled Families. 6. Improving people’s mental health and wellbeing. 7. Bringing people into employment and leading productive lives. 8. Enabling older people to keep well and live independently.

The Manchester Health and Wellbeing Strategy is available at http://www.manchesterpartnership.org.uk/info/6/health_and_wellbeing_board The Health and Wellbeing Board does not work alone to improve health and wellbeing. The Board acts as part of the Manchester Partnership which works to tackle the problems that residents say affect their lives most. Through the HWBB, SMCCG has close working relationships with the Neighbourhoods Board, Children’s Board, Work and Skills Board, Community Safety Partnership, Strategic Housing Partnership, Valuing Older People Board and Valuing Younger People Board. During 2013/14, as a HWBB partner, SMCCG has contributed to the delivery of the health and wellbeing strategy in the following areas: • Family Poverty Strategy The HWBB oversees the Family Poverty Action Plan. The plan ensures that front line workers across services link families in key areas of low family income and child poverty to the ESF Family Support Programme and the Troubled Families



programme. In addition, the Living Longer, Living Better programme will ensure that services are seamlessly integrated in those areas with greatest family and child poverty.

• Developing the End of Life and Palliative Care Framework for Manchester The HWBB oversees the work of the End of Life and Palliative Care Group for adults in Manchester in developing a strategy to improving the consistency of end of life care across the city, within the context of the wider Living Longer Living Better programme. The aim is that Manchester becomes a social, clinical and academic centre of excellence for palliative and end of life care.

• Pharmacy Needs Assessment As part of its statutory role the Manchester Health and Wellbeing Board has responsibility for the production of the Manchester Pharmaceutical Needs Assessment (PNA). In Manchester, the PNA reviews the current provision of pharmacy services across the city, assesses whether this meets the needs of the population and identifies any gap in provision.

• Promoting social inclusion of older people through the age-friendly city programme The Manchester Health and Wellbeing Board oversees actions to promote social inclusion of older people through Age Friendly Manchester, using the World Health Organisation’s age friendly city methodology. This work directly contributes to the delivery of priority eight of the Joint Health and Wellbeing Strategy. The specific focus is on how older people in Manchester experience social exclusion, the impact of this, and the programmes established in Manchester to promote improved health and social wellbeing. The Health and Wellbeing Board support Age Friendly Manchester in challenging stereotypes, so that older people are considered an asset to the city. In terms of healthcare, the Health and Wellbeing Board endorse a single approach to healthcare provision regardless of age.

• Extra Care Housing Investment Project and opportunities for engagement with the housing sector The Health and Wellbeing Board has recognised and welcomed the need to build strong engagement and communication with the Housing Health and Social Care Programme Board. As a member of the Health and Wellbeing Board, SMCCG has explored how it can work with strategic housing and the wider housing sector to improve health and wellbeing.

• Impact of Alcohol Consumption Alcohol was identified as a priority topic in Manchester’s JSNA, which gives an overview of the impact of alcohol misuse on individuals, families and communities. The Health and Wellbeing Board reviewed the potential impact of alcohol consumption in Manchester on the eight priority areas of the Health and Wellbeing Board and identified the need to improve involvement and collaboration across all public agencies to address the problem.

• CCG allocations The Health and Wellbeing Board supported the CCG in its successful challenge to the initial proposed financial allocations for 2014/15, which would have led to reduced



funding and widening inequalities. With the support of the Health and Wellbeing Board, the CCG produced and presented a case against the initial formula, engaged in discussion with NHS England and Public Health England and worked jointly through the Core Cities Network to achieve a fairer allocation. This will directly lead to increased investment and improved health outcomes in South Manchester.

• Health and Work Through the Health and Wellbeing Board, SMCCG reviewed the evidence base of the health impacts of being out of work, supported the key priorities of the Health and Work Delivery Plan and agreed actions needed across all partners to achieve work as a health outcome for Manchester residents.

3.13 I certify that the Clinical Commissioning Group has complied with the statutory duties

laid down in the NHS Act 2006 (as amended by the Health and Social Care Act 2012), Caroline Kurzeja Accountable Officer June 2014

3.14 The Sustainability Report can be found in section 6.

3.15 The Equality Report in section 7 includes information regarding disabled employees and equal opportunities.

Equality Data SMCCG

The number of persons of each sex who were on the Governing Body

9 male 3 female

The number of other senior managers of each sex who were a grade VSM (other than persons falling within the above disclosure)

None

The number of persons of each sex who were employees of the clinical commissioning group.

6 male 21 female

4.0 Members Report

4.1 Member Practices of South Manchester Clinical Commissioning Group



Al-Shifa Medical Centre Barlow Medical Centre

Benchill Medical Practice Bodey Medical Centre

Bowland Medical Practice Brooklands Medical Practice

Burnage Healthcare Practice Cornishway Group Practice

David Medical Centre Didsbury Medical Centre

Didsbury Medical Centre Fallowfield Medical Centre

Kingsway Medical Practice Ladybarn Group Practice

Maples Medical Centre Mauldeth Medical Centre

Merseybank Surgery Northenden Group Practice

Northern Moor Medical Practice Peel Hall Medical Practice

R K Medical Practice The Borchardt Medical Centre

The Park Medical Centre Tregenna Group Practice

Woodlands Medical Practice

4.2 Members of the Governing Body GP Chair - Dr Bill Tamkin Chief Officer - Caroline Kurzeja Chief Finance Officer - Joanne Newton GP Clinical Lead - Dr Mark Whitaker GP Patient and Public Engagement Lead - Dr Phillip Burns GP Business Contact and Performance Lead - Dr Peter Fink GP Quality and Performance Lead - Dr Naresh Kanumilli Practice Manager, Patient and Public Engagement Lead - Janice Langley Practice Manager - Jayne Cooney (Jayne DaBell) Executive Nurse - Craig Harris Lay Member, Patient and Public Involvement - Richard Caulfield Lay Member, Audit and Governance - Geoffrey Hayward Lay Member, Secondary Care Doctor - Dr Alex Crowe

4.3 Members of the Audit Committee: The Committee comprises of lay members for the Governing body with governance lead responsibility (Geoffrey Hayward) and Patient and Public Involvement responsibility (Richard Caulfield). In addition there is attendance from the following representatives: Chief Financial Officer Head of Finance Head of Internal Audit External Audit Local Counter Fraud Specialist Head of Corporate Services Secretaries to the Committee

4.4 Please see section 5 for details regarding members of the Governing Body and the



relevant profiles and declaration of interest information.

4.5 The Governing Body is not aware of any relevant audit information that has been withheld from the clinical commissioning group’s external auditors, and members of the Governing Body take all necessary steps to make themselves aware of relevant information and to ensure that this is passed to the external auditors where appropriate.

4.6 Pensions Information 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. Please refer to the accounting policy note in the Financial Statements and Remuneration report for statements on pension schemes and details of how pension liabilities are treated.

4.7 Please refer to the employee benefits note in the Financial Statements for details of Sickness absence.

The sickness and absence data is for a nine month period only (from April-December 2013).

4.8 External Audit

The clinical commissioning group’s external auditor is Grant Thornton UK LLP. The fees for 2013/14 are £66k plus vat, giving a total cost of £79k. This is offset by a £6k first year premium funded by the Audit Commission, giving a £73k cost in 2013/14.

Staff sickness absence and ill health retirements

2013-14

Number

Total Days Lost 48 Total Staff Years 18 Average working Days Lost 2.67



The CCG does not commission any other services from Grant Thornton LLP. Internal Audit is provided by Deloitte LLP, so there is no conflict of interest.

4.9 Disclosure of Serious Incidents

Please refer to the Governance Statement for details of disclosures for incidents involving data loss or confidentiality breaches can be found.

4.10 I certify that the Clinical Commissioning Group has complied with HM Treasury‘s

guidance on setting charges for information.

Caroline Kurzeja

Accountable Officer

June 2014

4.11 Principles for Remedy

The Ombudsman’s Principles for Remedy are: 1. Getting it right 2. Being customer focused 3. Being open and accountable 4. Acting fairly and proportionately 5. Putting things right 6. Seeking continuous improvement

The CCG complaints policy references the Ombudsman’s Principles for Remedy on page 5 and is based on these principles. In specific reference to the principles:

1. The CCG aims to get all decisions right first time. If not, an apology is always provided and an action plan given agreed with all services involved in the complaint if mistakes have been made; improvements required are outlined and lessons to be learnt described.

2. The complaints process is designed around the customer. The CCG

commissions Patient Services from GMCSU and this service provides informal and formal resolution to patients’ issues, concerns and complaints. The service is built round the patient including:

• Discussion and/or contact with each complainant in each complaint and agreement sought on how the issues will progress.

• Risk assessment of each case.

• Regular case updates.

• Patient contact via the dedicated Patient Services helpline and email.



3. The CCG adopts an open and accountable culture. The CCG commissions GMCSU Patient Services to manage patient complaints and work in partnership to provide patient focused and detailed responses at all times. CCG complaints responses are signed off by the CCG COO where the accountability/responsibility rests.

4. Each case is risk assessed on receipt to identify key issues, timescales and any

urgent action. This risk assessment supports the investigation of the complaint. Any urgent issues are expedited by senior complaints staff to the CCG Chief Officer for urgent action.

5. If a service improvement is identified, the CCG explains the lessons learnt and

action plans are shared with each complainant where complaints are upheld.

6. The CCG is committed to learning from complaints and all lessons learnt are outlined in individual complaints responses and through quarterly monitoring reports. These reports highlight and share key complaints data, risk assessment, actions, themes and trends, service improvements and remedies and are reviewed regularly at the Quality and Performance Committee to embed learning through the CCG.

4.12 Employee Consultation

SMCCG is committed to securing and promoting staff engagement and involvement. The CCG values the opinions and views of staff and recognises that staff are able to contribute more effectively when they know their duties and responsibilities; obligations, rights and have an opportunity of making their views known on issues that affect them. The CCG is committed to maintaining effective employee relations with its staff and their union representatives and considers that good employee relations are an important factor in achieving its values, behaviours and objectives. The CCG recognises that trade unions can significantly contribute to good employee relations, through joint working and as a result the CCG have joined two partnership forums; the Greater Manchester CCG’s Staff Partnership Forum and a local shared Partnership Forum across North, Central and South Manchester. The purpose of the Forums is to provide a forum across the CCGs for: • information sharing, discussion and consultation (by agreement) between partners

on collective matters relating to general employee relations matters across CCGs such as approaches to managing organisational change,

• for discussion on the key principles for negotiation where appropriate, in relation to Agenda for Change Terms and Conditions that are open to local determination,

• for the discussion and development of strategic joint problem solving approaches to the challenges facing CCG’s to encourage an open, honest and transparent working environment, working towards reducing grievances and avoiding disputes,

• for discussion and agreement where possible on key principles, protocols and processes where appropriate around employee policies and procedures that is reflective of the commitment to partnership working and recognising employee’s



contractual and statutory rights, • to support effective partnership working in SMCCG and those other participating

CCG’s where there is no local Trade Union representation, • for the sharing of good practice and innovation across participating organisations, • to recognise the value of, and encourage, early staff engagement in initiatives,

problems and the decision making process.

4.13 Disabled Employees Please refer to the equality report for details of the clinical commissioning group’s policies in relation to disabled employees.

4.14 Emergency Preparedness, Resilience and Response I certify that the Clinical Commissioning Group has incident response plans in place, which are fully compliant with the NHS Commissioning Board Emergency Preparedness Framework 2013. The Clinical Commissioning Group regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Governing Body. Caroline Kurzeja Accountable Officer June 2014

4.15 Statement as to Disclosure to auditors

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 themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information.

5.0 Remuneration Report

5.1 The remuneration report covers the senior management of the clinical commissioning group. The definition of a senior manager is: “Those persons in senior positions having authority or responsibility for directing or controlling the major activities of the clinical commissioning group. This means those who influence the decisions of the clinical commissioning group as a whole rather than the decisions of individual directorates or departments. Such persons will include advisory and lay members” The clinical commissioning group has agreed that this includes the members of the



Governing Body. The Government Financial Reporting Manual states that “information will be given in all circumstances and all disclosure in the Remuneration report will be consistent with identifiable information of those individuals within the financial statements.” The remuneration report covers the CCG’s governing body including all people who are currently on the board plus any who have left their post during the 2013/14 financial year.

5.2 Remuneration Committee

The Remuneration Committee did not meet this financial year.

5.3 In line with the Health and Social Care Act each individual CCG may appoint persons to be employees as it considers appropriate and is able to:

• Pay its employees remuneration and travelling or other allowances in accordance with determinations made by its governing body.

• Employ them on such terms and conditions as it may determine. The guidance produced by the Commissioning Board was used to support the employment of senior staff following the CCG becoming a statutory and employing body. Whilst it is recognised the CCGs have flexibility in determining remuneration levels, the remuneration committee followed the arrangements set out in the NCB guidance in determining, reviewing and operating their own pay arrangements for senior managers. The guidance was based on the principles, which have been informed by and consistent with the principles set out in the Will Hutton Fair Pay Review. The 12 CCGs in Greater Manchester also requested guidance on the remuneration of clinical boards when the PCTs came together under NHS GM. A review of chairs and boards pay by NHS GM highlighted a wide range of sessional rates being paid to GPs on boards, it was recognised that there was a requirement to have a standardised rate of pay for the new statutory organisations – this was to adequately compensate the GP/Practice for the time spent working for the CCG. The Hay group were commissioned to provide independent guidance and suggested an annual rate of £165,000 for the larger CCG roles with a population of 150,000 and above. This is the guidance that was followed by the CCG. The remuneration of the Governing Body of the CCG is the responsibility of the Remuneration Committee. When taking any decision, any members who are personally affected by this decision are not included in any discussions or vote to avoid any conflict of interest.

5.4 Policy on Remuneration of Senior Managers The Remuneration Committee have responsibility for setting the pay of the CCG Governing Body and senior managers within the CCG. In making its decisions all relevant guidance has been followed including the NHS England document ‘CCGs –



Remuneration Guidance for Chief Officers and Chief Finance Officers’ and CCG Remuneration Guidance issued by the Hay Group. When considering pay awards the Remuneration Committee will consider national awards, affordability and benchmark data for similar size organisations to enable a recommendation to be reached. The pay of the Governing Body is not currently directly linked to performance, that is, there is no specific performance related pay. However, both the Governing Body and its individual members are subject to performance evaluation. The CCG is piloting an initiative called ‘excellence in Clinical Commissioning’ which supports the evaluation of the Governing Body. In addition, each member is subject to Annual Performance Reviews.

5.5 Policy on Senior Managers Contracts The contract for very senior managers states that;

If the employee wishes to terminate their employment, they must give the CCG an appropriate period of notice in writing: A maximum of 6 Months. The CCG will give one week’s notice for each year of service subject to a minimum of one month and a maximum of 6 Months. The CCG shall be entitled to terminate the individual’s employment summarily, i.e. without notice or pay in lieu of notice, without prejudice to any rights or claims it may have against them, if at any time they are guilty of gross misconduct or if they commit any serious breach of a material term of their contract of employment. If the individual is employed on a fixed term contract, their employment will terminate on the expiry of the fixed term without the need for the CCG to give any additional notice. The CCG may require an individual to take any outstanding annual leave entitlement during their notice period, whether notice to terminate is given by them or by the CCG. Once you or the CCG have served notice to terminate your employment, the CCG may require you to remain away from work and to cease to carry out your normal duties for the whole or any part of your notice period (known as “garden leave”). During any period of garden leave:

• The CCG shall be under no obligation to provide the individual with any work but may require them to carry out alternative duties;

• The individual will remain an employee of the CCG, bound by the terms of their contract and will continue to receive their salary in the usual way;

• The CCG may exclude the individual from any of its premises but may require the individual to ensure that their line manager knows where they will be and how they can be contacted during each working day (except when they are on authorised annual leave, booked in the usual way);

• The CCG may require the individual not to contact (or attempt to contact) any employee, client or supplier without the consent of their line manager.

There are no special provisions for termination due to redundancy other than those stated for all employees in the CCG’s Organisational Change policy.

5.6 Senior Managers Service Contracts



There are members of the Governing Body whose services are via a Contract for Services. These are for a 3 year period from 1 April 2013 until 31 March 2016. The termination arrangements for these individuals are as follows:

• Continuation of their appointment is contingent on their continued satisfactory performance and re-election/selection by the members as required by the Constitution. If the members do not re-elect the individual as a Governing Body Member in accordance with the Constitution, their appointment shall terminate automatically and with immediate effect.

• The individual may resign from the CCG at any time by giving written notice to the Chair.

• The CCG reserves the right to terminate their appointment with immediate effect and without payment of compensation by written notice.

• On termination of the appointment, the individual shall only be entitled to accrued fees as at the date of termination, together with the reimbursement of any expenses properly incurred prior to that date.

Due to the terms in the contract for service there is no liability to the clinical commissioning group in the event of early termination.



5.7

Salaries and Allowances For each member of the Governing Body who has served during the financial year 2013/14, remuneration and pension benefits are shown below.

Salary & Fees

for Governing

Body

Other Salary

for additional

clinical posts

(not related to

Governing

Body post)

Taxable

Benefits

Annual

Performance

Related

Bonuses

Long-term

Performance

Related

Bonuses

All Pension

Related

Benefits Total

(bands of

£5,000)

(bands of

£5,000)

(rounded to

the nearest

£00)

(bands of

£5,000)

(bands of

£5,000)

(bands of

£2,500)

(bands of

£5,000)

£000 £000 £00 £000 £000 £000 £000

Dr Bill Tamkin Executive Board Member - GP Chair 90-95 0

Mrs Joanne Newton Executive Board Member - Chief Financial Officer 30-35 72.5-75

Dr Mark Whitaker Executive Board Member - GP Clinical Lead� 40-45 0

Dr Phillip Burns Executive Board Member - GP Patient & Public Engagement Lead� 45-50 215-217.5

Dr Peter Fink Executive Board Member - GP Business Contract and Performance Lead 35-40 0

Dr Naresh Kanumilli Executive Board Member - GP Quality and Performance Lead� 40-45 82.5-85

Caroline Kurzeja Executive Board Member - Chief Operating Officer 105-110 200-202.5

Mr Craig Harris Commissioning and Quality 30-35 65-67.5

Janice Langley Practice Manager, Patient and Public Engagement Lead 5-10 0

Jayne Cooney **** Practice Manager 1-5 0

Richard Caulfield Non Exective Board Member - Lay Member,Chair and PPI Lead 5-10 0

Dr Alex Crowe Non Executive Board Member - Secondary Care Doctor� 10-15 0

Geoffrey Hayward Non Executive Board Member - Lay Member, Audit and Governance 5-10 0

2013/14

Name Title

Note 1 - Joanne Newton and Craig Harris are employed by Central Manchester CCG but are shared posts between Central Manchester CCG, North Manchester CCG and South Manchester CCG. The salary figures presented reflect South Manchester CCG's share of the remuneration but the individual’s total salary is presented below. Joanne Newton - 110k-115k Craig Harris - 100k-105k



****Jayne Cooney (Jayne DaBell) - Left 24th of July 2013 Note 2 – The All Pensions Related benefits section is a calculation based on figures supplied by NHS Pensions Agency. The clinical commissioning group is statutorily bound to use these figures however, a note of caution should be applied when interpreting them as: -

a) The clinical commissioning group has no way of interpreting or verifying the figures provided. b) They do not take into account any period of time where the individual may not have paid into the pension scheme due

to a break in service as an officer c) They are calculated on a notional full time basis when staff are in fact part-time. d) The comparator figures provided may not be on a like for like role. For example some may be based on contributions

made as a junior doctor before taking up a GP role. e) The pensions related benefits note is based on an assumption as required on the Annual Reporting Guidance that

individuals will be in receipt of their pension for 20 years after they have retired. There were no payments made to former senior managers during the financial year. Pension Information The pensions information can be found on the table below:

Name Title

Real

Increase in

Pension at

age 60

(bands of

£2,500)

Real

Increase in

Pension

lump sum at

aged 60

(bands of

£2500)

Total

accrued

pension at

age 60 at 31

March 2014

(bands of

£5000)

Lump sum

at age 60

related to

accrued

pension at

31st March

2014 (bands

of £5000)

Cash

Equivalent

Transfer

Value at 31

March 2014

Cash

Equivalent

Transfer

Value at 31

March 2013

Real

increase in

Cash

Equivalent

Transfer

Value

Employer's

contribution

to

stakeholder

pension

£000 £000 £000 £000 £000 £000 £000 £00

Mrs Joanne Newton Executive Board Member - Chief Financial Officer 2.5-5 7.5-10 40-45 125-130 768 679 74 15.4

Dr Phillip Burns Executive Board Member - GP Patient & Public Engagement Lead� 7.5-10 27.5-30 20-25 65-70 394 213 175 6.5

Dr Naresh Kanumilli Executive Board Member - GP Quality and Performance Lead� 2.5-5 10-12.5 0-5 10-15 57 0 66 6

Caroline Kurzeja Executive Board Member - Chief Operating Officer 7.5-10 25-27.5 25-30 75-80 372 227 140 14

Mr Craig Harris

Executive Board Member - Executive Nurse and Director of City Wide

Commissioning and Quality 2.5-5 7.5-10 10-15 40-45 173 133 38 13.8



Note 1 - The information for Joanne Newton and Craig Harris reflects the accrued pension benefit for the full time employment with Central Manchester CCG. Note 2 – The pensions information has been supplied by NHS Pensions Agency and it has been confirmed that the figures disclosed relate only to the officer role within the clinical commissioning group and any other officer roles held. The clinical commissioning group has no means of interrogating or verifying the figures disclosed. Certain members do not receive pensionable remuneration therefore there will be no entries in respect of pensions for certain members. 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 values 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 membership of the pension scheme. This may be for more than just their service in a senior capacity to which disclosure applies (in which case this fact will be noted at the foot of the table). The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. 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. All other employees within the CCG are subject to national agenda for change terms and conditions. Pay Multiples The banded remuneration of the highest paid member of the Governing Body in the CCG in the financial year 2013/14 was £175- £180k. This was 6.7 times the median remuneration of the workforce, which was £26.5k.



In 2013/14 no employees received remuneration in excess of the highest paid member of the Governing Body. Remuneration ranged from less than £1k to the band of £170k-£175k as above. Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions. There are no comparatives for previous years as the clinical commissioning group existed from 1st April 2013. Off Payroll Engagements The CCG has conducted a review of “off payroll” engagements to move to alternative arrangements. There is one engagement within the reporting period as detailed in the table below.

Number

The number that have existed

- For less than one year at the time of reporting

- For between one and two years at the time of reporting 1

- For between two and three years at the time of reporting

- For between three and four years at the time of reporting

- For four or more years at the time of reporting

Total number of existing engagements as at 31 March 2014 1

The following table highlights the assurance that the CCG has undertaken.

Number of new engagement or those that reached six months in duration, between 1 April 2013 and 31st March 2014.

1

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.

1

Number for whom the assurance has been requested 1

Of which

- For whom assurance has been received 1



5.8 Governing Body and Senior Management Profiles Dr Bill Tamkin - GP Chair Committees: Governance (Chair) Declared Interests: Senior Partner, Borchardt Medical Centre (declared April 2013) MoJ referee – Manchester Crematorium (declared April 2013) Undergraduate Teacher/Interviewer – University of Manchester Undergraduate Examiner – UHSM (declared April 2013) Honorary Medical Advisor – Halle Orchestra (declared April 2013) Member, National Clinical Commissioning Network (declared April 2013) Member, North West Clinical Leaders’ Network (declared April 2013) Member, Health and Wellbeing Board (declared April 2013) Member, Manchester Investment Board (declared April 2013) Member, Greater Manchester Healthier Together Committee in Common (declared April 2013) Married to Senior Partner, Springfield Medical Centre (Salford) and Unscheduled Care Lead, Salford CCG (declared April 2013) Son is an employee of GMCSU (declared April 2013) Caroline Kurzeja - Chief Officer Committees: Governance, Finance, Quality and Performance, Remuneration Declared Interests: Spouse is director of St Helens OOH rota (declared April 2013) Joanne Newton - Chief Finance Officer Committees: Finance, Audit, Remuneration Declared Interests: Holds same role at North and Central Manchester CCGs (declared April 2013) Dr Mark Whitaker - GP Clinical Lead Committees: Clinical Commissioning (Chair) Declared Interests: GP Principal, Didsbury Medical Centre (declared April 2013) Runs Joint Injection Clinic, Withington Community Hospital (SMCCG) (declared April 2013) Musculoskeletal triager, GoToDoc, Manchester Gateway (declared April 2013) Approved Doctor, Maritime & Coastguard Agency (declared April 2013) Married to clinical supervisor, Department of Optometry, University of Manchester (declared April 2013) Dr Phillip Burns - GP Patient & Public Engagement Lead Committees: Communication and Engagement, Clinical Commissioning Declared Interests: GP Partner, Northern Moor Medical Practice (declared April 2013) GP Trainer (declared April 2013) Senior Teaching Fellow, MMS (declared April 2013) Undergraduate admissions interviewer and examiner (declared April 2013) Member of BMA-MDU Anglo-French Medical Society (declared April 2013) Port Health Officer, Manchester Airport (Public Health England) (declared April 2013) Dr Peter Fink - GP Business Contract and Performance Lead Committees: Finance (Chair), Clinical Commissioning



Declared Interests: GP Principle, The Maples Medical Centre (declared April 2013) Member, Manchester Local Medical Committee (declared April 2013) Clinical Lead for GP OOH, NHS Salford (declared April 2013) Director Lead for Clinical Governance, GoToDoc (declared April 2013) Dr Naresh Kanumilli - GP Quality and Performance Lead Committees: Quality and Performance (Chair), Clinical Commissioning Declared Interests: GP Partner, Northenden Group Practice (declared February 2014) GP Trainer (declared February 2014) GPwSI Cardiology, Diabetes (declared February 2014) Director, Catalyst Medical (declared February 2014) Cardiology and Diabetes Triager, GoToDoc (declared February 2014) Committee Member, PCDS (declared February 2014) Acts as GP advisor to pharmaceutical companies (declared February 2014) Janice Langley - Practice Manager, Patient and Public Engagement Lead Committees: Communication and Engagement Declared Interests: Practice Manager, Cornishway Group Practice (declared April 2013) Craig Harris - Executive Nurse Committees: Quality and Performance , Clinical Commissioning Declared Interests: Chairman, Survivors Manchester (declared April 2013) JP, Manchester Magistrates Court (declared April 2013) Richard Caulfield - Lay Member, Patient and Public Involvement Committees: Communication and Engagement (Chair), Audit, Remuneration Declared Interests: Trustee, MMUnion (declared April 2013) Chief Executive, Voluntary Sector North West (declared April 2013) Chair of Governors, Old Trafford Community School (declared April 2013) Geoffrey Hayward - Lay Member, Audit and Governance Committees: Governance, Finance and Audit, Remuneration Declared Interests: Lay Member, Stockport CCG (declared April 2013) Non-Executive Director, Lincolnshire NHS Hospital Trust (declared April 2013)

Dr Alex Crowe - Lay Member -Secondary Care Doctor Committees: Remuneration Declared Interests: Deputy Head of Division of Medical Specialties, Wirral University Teaching Hospital (declared April 2013) Clinical Service Lead Appraisal and Revalidation, Wirral University Teaching Hospital (declared April 2013) Consultant Nephrologist, Wirral University Teaching Hospital, Countess of Chester Hospital (declared April 2013) Honorary Senior Clinical Lecturer, Liverpool University (declared April 2013)



Jayne Cooney (Jayne DaBell) - Practice Manager (left July 2013) Committees: Finance Barlow Medical Practice - Practice Manager at the surgery where one of the Partners was the holder of an APMS contract for Beacon Minor Surgery. (declared April 2014) At the time of involvement with SMCCG, my (now ex-) husband worked for Tameside CCG.(declared April 2014)

5.9 I certify that the information contained within the Remuneration Report is accurate to the

best of my knowledge.

Caroline Kurzeja

Accountable Officer

2014

6.0 Sustainability Report

6.1 The Sustainability Report is awaited from NHS Property Services.

7.0 Equality Report

7.1 NHS South Manchester CCG endeavours to ensure that providing accessible services, challenging discrimination, reducing health inequalities and improving health outcomes are seen as everyone’s business and therefore are reflected in all our activities, plans and strategies. South Manchester CCG signed up to the Manchester Equality Strategy 2012-2015. http://www.manchester.nhs.uk/document_uploads/SMCCG/Manchester_Equality_Strategy_CCGs.pdf This is a single strategy across the three Manchester Clinical Commissioning Groups (South, Central and North). The strategy sets out the CCG’s current equality objectives which are shared across the 3 Manchester CCGs. These citywide objectives meet the legal obligations described in the Public Sector Equality Duty. South Manchester CCG ensures that the objectives are locally relevant by working to meet them via locally developed actions with a specific focus on South Manchester issues. The CCG’s four-yearly Equality Objectives are:



Equality Objective 1: Increasing Awareness of the Equality Agenda for CCGs and their membership practices

This recognises the need to ensure that NHS organisations, leaders and membership practices understand their responsibilities under the Equality Act 2010. Achievements include:

• An identified Senior Executive Equality, Diversity and Human Rights Lead with overall reporting responsibility.

• Equality Analysis training for all lead commissioners.

• Implemented the Pride in Practice Support Package. Pride in Practice enables individuals to effectively meet the needs of lesbian, gay and bisexual patients, within local communities.

Equality Objective 2: Data Collection and Usage

This recognises the need to ensure improvements in data collection across the protected characteristics; enhancing analysis to more effectively inform commissioning and service delivery. Achievements include:

• All major provider contracts include a detailed equality monitoring schedule that requires detailed equality, diversity and human rights evidence as part of contract reporting.

• The Greater Manchester Commissioning Support Unit and the Quality Performance Team have worked closely with providers to ensure that they understand and can effectively report in line with the schedule requirements.

Equality Objective 3: Effectively communicating, engaging and involving all our communities This recognises the need to advise providers of methods of gaining a comprehensive view of service users’ experiences. It also seeks to continue the excellent track record of NHS Manchester in engaging and involving diverse communities. Achievements include:

• Gender focused engagement with the Manchester Endometriosis Support Group, using diaries to gather patient experience.

• Engaged with Manchester Carers’ Forum to deliver a Carers workshop with GP Practice staff.

• Co-designed a Trans, GP Patient Experience survey.

• Facilitated a ‘What makes us healthy session?’ with the South Manchester People First Learning Disability Group.

Equality Objective 4: Quality Service Provision This recognises that quality is a key driver for the CCG. Achievements include:

• Strengthening the equality requirements of providers through



As a new organisation much activity has occurred regarding process, compliance and legal requirements. However, as demonstrated by the achievements under objective 3, the CCG has maintained positive communication, engagement and involvement of people with a range of protected characteristics. It is acknowledged that data analysis and effective usage are critical areas for improvement. SMCCG will continue to work with stakeholders in order to enhance analysis and use of data in order to improve patient access, experience and outcomes. SM CCG is committed to continuously improving its Equality, Diversity and Human Rights base as evidenced in our aspirations and plans for the commissioning of health services for the people of South Manchester. We will report on our achievements in our Equality and Diversity Annual Report January 2015. To view our annual report January 2014, please visit http://www.manchester.nhs.uk/document_uploads/Equality_and_Diversity/SMCCG%20Public%

20Sector%20Equality%20Report.docx

contracting processes.

• Signing up to implementing the Equality Delivery System (EDS2) as a CCG.

• Including implementation of EDS2 as a requirement in provider contracts.



Appendix A – Independent Auditor’s Report To The Members of NHS South

Manchester Clinical Commissioning Group (CCG)

We have audited the financial statements of NHS South Manchester CCG for the year ended 31 March 2014 under the Audit Commission Act 1998. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State. We have also audited the information in the Remuneration Report that is subject to audit, being:

• the table of salaries and allowances of senior managers and related narrative notes

• the table of pension benefits of senior managers and related narrative notes

• the table of pay multiples and related narrative notes.

This report is made solely to the members of NHS South Manchester CCG in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 44 of the Statement of Responsibilities of Auditors and Audited Bodies published by the Audit Commission in March 2014. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Clinical Commissioning Group (CCG)'s members and the CCG as a body, for our audit work, for this report, or for opinions we have formed. Respective responsibilities of the Accountable Officer and auditor As explained more fully in the Statement of Accountable Officer’s Responsibilities, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards also require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the CCG’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the CCG; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the annual report which comprises the Member Practices' Introduction, the Strategic Report, the Members' Report, the Remuneration Report and the Equality Report to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.



In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income reported in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Opinion on regularity In our opinion, in all material respects the expenditure and income have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them. Opinion on financial statements In our opinion the financial statements:

• give a true and fair view of the financial position of NHS South Manchester CCG as at 31 March 2014 and of its net operating costs for the year then ended; and

• have been prepared properly in accordance with the accounting policies directed by the NHS Commissioning Board with the approval of the Secretary of State.

Opinion on other matters In our opinion:

• the part of the Remuneration Report subject to audit has been prepared properly in accordance with the requirements directed by the NHS Commissioning Board with the approval of the Secretary of State; and

• the information given in the annual report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we report by exception We report to you if:

• in our opinion the governance statement does not reflect compliance with NHS England’s Guidance;

• we refer a matter to the Secretary of State under section 19 of the Audit Commission Act 1998 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision involving unlawful expenditure, or is about to take, or has taken, unlawful action likely to cause a loss or deficiency; or

• we issue a report in the public interest under section 8 of the Audit Commission Act 1998.

We have nothing to report in these respects. Conclusion on the CCG’s arrangements for securing economy, efficiency and effectiveness in the use of resources We are required under Section 5 of the Audit Commission Act 1998 to satisfy ourselves that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. The Code of Audit Practice issued by the Audit Commission requires us to report any matters that prevent us being satisfied that the audited body has put in place such arrangements.



We have undertaken our audit in accordance with the Code of Audit Practice, having regard to the guidance issued by the Audit Commission in October 2013. We have considered the results of the following:

• our review of the Governance Statement;

• the work of other relevant regulatory bodies or inspectorates, to the extent that the results of this work impact on our responsibilities at the CCG.

As a result, we have concluded that there are no matters to report. Certificate We certify that we have completed the audit of the accounts of NHS South Manchester CCG in accordance with the requirements of the Audit Commission Act 1998 and the Code of Audit Practice issued by the Audit Commission. Fiona Blatcher Associate Director for and on behalf of Grant Thornton UK LLP, Appointed Auditor 4 Hardman Square Spinningfields Manchester M3 3EB 6 June 2014



Appendix B - Statement of Accountable Officer’s Responsibilities

Statement of the Chief Officer’s Responsibilities as the Accountable Officer of South Manchester Clinical Commissioning Group The NHS Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable 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 NHS 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. Caroline Kurzeja Accountable Officer June 2014



Appendix C – Governance Statement

Introduction & Context The clinical commissioning group was licenced from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006. The clinical commissioning group 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 powers. As at 1 April 2013, the CCG was licensed with conditions as follows:

• 3.1.1B: that the CCG has a clear and credible integrated plan, which includes an operating plan for 2012-13, draft commissioning intentions for 2013-14 and a high-level strategic plan until 2014-15;

• 3.1.1C: that the CCG has a detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance and any other requirements set by the NHSCB, and is integrated with the commissioning plan.

Scope of Responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. Compliance with the UK Corporate Governance Code We are not required to comply with the UK Corporate Governance Code. However, we have reported on our Corporate Governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the CCG and best practice. The Clinical Commissioning Group Governance Framework The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b) states: The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it complies with such generally accepted principles of good governance as are relevant to it. The CCG Constitution states that in accordance with section 14L(2)(b) of the 2006 Act, the group will at all times observe “such generally accepted principles of good governance” in the way it conducts its business. These include:



• the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business;

• the Good Governance Standard for Public Services;

• the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’

• the seven key principles of the NHS Constitution;

• the Equality Act 2010. A total of 25 General Practices form the Membership Body of the Clinical Commissioning Group. Eligibility to become a member practice is outlined in the Constitution which states that providers of primary medical services to a registered list of patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, within the geographical area covered by NHS South Manchester Clinical Commissioning Group, will be eligible to apply for membership of this group. GP locums whose primary place of work is NHS South Manchester CCG may apply to be members of the CCG. Any of the above may stand in elections for membership of the governing body. The CCG Governing Body takes overall responsibility for governance throughout the organisation but discharges some of its responsibilities to a number of committees, primarily the Audit, Remuneration and Governance Committees. The Governing Body and I are happy with the effectiveness of the Board and its Committee structure. Throughout the first full year since authorisation in April 2013, the Board has evolved and reviewed its priorities, effectiveness and vision for the organization on a regular basis. The Board members are sufficiently diverse to contribute to a number of varying CCG duties and together I am assured we comprise an effective group of individuals that are capable of overseeing the effective running of the CCG. During the year training has been provided on a number of governance related topics to the Governing Body and its members. The Board meets on a monthly basis with alternate public and development meetings. In addition to governance, the Governing Body and its delegate Committee’s place a clear focus on the services, performance and patient safety of its commissioned providers. For a full list of committees, including their responsibilities and membership, please refer to the attachment to this statement. The Clinical Commissioning Group Risk Management Framework The CCG Risk Management Framework (RMF) is designed to provide a guideline and strategy for the development of a robust risk management system across the organisation. It includes the key risk principles of initiation, identification, assessment and control. The organisation understands that it is imperative to embed the processes for managing risk within all its activities. Therefore, the RMF outlines that at the start of every new project, work stream or business plan the risk management framework must be considered and implemented. Risk is identified within the organisation in a number of ways, and not just through risk assessments. The CCG understands that incident reporting, complaints, claims, GP identified quality issues, internal and external audits, patient feedback and national or regional guidance can help to identify risk. Once identified, risk is controlled through actions from the CCG officer with designated responsibility for that risk and reported through the



organisational governance structure depending on its grading and impact on objectives. Risks are assessed in regards to the level of controls and assurances that are in place and are scored on the severity (or consequence) and likelihood of occurrence which is plotted on a 5x5 matrix. The resulting score is categorised as either ‘acceptable’, ‘manageable’ or ‘serious’. This outlines the organisation’s risk appetite. The CCG understands that realistically it is never possible to eliminate all risks. There will always be a range of risks identified within the organisation that would require us to go beyond ‘reasonable’ action to reduce or eliminate them and thus all risks graded between one and six are defined as ‘acceptable’. Manageable risk, scores between eight and fourteen, can realistically be reduced within a reasonable time scale through cost effective measures. Lastly serious risks, scoring over fifteen, may have serious consequences that could impact on the organisation and threaten its primary objectives. Risk management is the priority of all staff and the successful management of risk relies on all staff initiating the risk management process. Training has been provided for all staff involved in managing risk at all levels of the organisation. Incident reporting is encouraged at the staff induction and by senior and line managers. The RMF is supplemented by a number of organisational policies and procedures that enhance the risk management capabilities of the CCG. Risk is also discussed with public and patient stakeholders. It is a subject matter presented in depth at the public section of the Board and it’s also discussed at the Patient and Public Advisory Board on an ad hoc basis. The effectiveness of the Risk Management Framework is discussed later in this statement. The Clinical Commissioning Group Internal Control Framework A system of internal control is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. This is supplemented by a number of corporate, financial and business policies, an intensive internal audit programme and effectiveness audits. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. Information Governance All risks that have been highlighted in 2013/14 have come from the Information Asset Register work which has been carried out during the last few months. The risks are identified through the Data Mapping Tool on the IG Toolkit then uploaded on the DATIX system where they are managed. The risk level is identified through the Data Mapping Tool on the IG Toolkit which is determined through the Information Asset Owners confirming the data flows. The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to



the CCG, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and are developing information governance processes and procedures in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management procedures and a programme will be established to fully embed an information risk culture throughout the organisation. Pension Obligations As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations. Equality, Diversity & Human Rights Obligations The CCG has put systems and process in place to ensure that the organisation and its commissioned providers comply with Equality, Diversity & Human Rights Obligations. Furthermore, control measures are in place to ensure that the CCG complies with the required public sector equality duty set out in the Equality Act 2010. Further evidence on the CCG’s commitment to Equality, Diversity & Human Rights Obligations can be found within the Annual Report or on the CCG website. Sustainable Development Obligations The CCG is required to report its progress in delivering against sustainable development indicators. We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning. We will ensure that the CCG complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and the Public Services (Social Value) Act 2012. We are also setting out our commitments as a socially responsible employer. Review of Economy, Efficiency & Effectiveness of the Use of Resources The CCG has an obligation to use its resources efficiently, effectively and economically. In addition it must meet financial requirements as set out by NHS England. This includes delivering a surplus position over and above a balance budget. In order to mitigate and control risks associated with the CCGs use of resources, organisational financial health is



checked and reported to the Governing Body on a monthly basis. The Governing Body has also delegated responsibility for some aspects of financial internal control to the Finance Committee. The CCG has produced, as required, both two year and five year financial plans to ensure and demonstrate that it has robust financial plans in place. These have been reported to the Finance Committee and the Governing Body, providing assurance to the Governing Body and myself that the organisation is effectively managing its resources and understanding the key financial risks. In addition to internal controls, the CCG produces robust Quality, Innovation, Productivity and Prevention (QIPP) plans which aim to mitigate financial pressures and improve healthcare for the local population. The CCG completes monthly and periodic returns to NHS England to report upon how the CCG’s resources have been spent. Additionally the CCG undertakes a monthly self-assessment against the externally monitored financial indicators within ‘Domain 4’ of the national CCG Assurance Framework. Financial monitoring information is monitored by the Finance Committee and reported to the Governing Body on a routine basis. North, South and Central Manchester CCGs have agreed a risk share arrangement in 2013/14 to mitigate and manage financial risk within the first year of operation of each of the CCGs. A full and in-depth outline of the CCGs use of financial resources in 2013/14 can be found in the main body of the Annual Report. Risk Assessment in Relation to Governance, Risk Management & Internal Control The governance, risk management and internal control functions of the CCG are regularly risk assessed and audited. A six monthly audit of the CCG governance and committee structure is undertaken to ensure that the CCG meets its statutory obligations in regards to governance, risk management and internal control. The internal audit function looks at a number of areas, work streams and departments and a schedule of policy audits, assessing the effectiveness of policy processes, are in place and will be monitored by the Board and Committees. In November 2013, during the six monthly audit of the Governance and Committee Structures, one risk was identified. The reporting arrangements between the CCG governance structures and the City Wide Commissioning, Quality and Safeguarding Team’s governance structures were found to be weak. An action plan was promptly developed and implemented in order to address this issue. Other risks in relation to governance, risk management and internal control were identified via the CCG internal audit programme, which are discussed later. Review of the Effectiveness of Governance, Risk Management & Internal Control As Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the Clinical Commissioning Group. Capacity to Handle Risk The Governing Body has placed great emphasis on the responsibility of staff to identify,



manage and mitigate risk. As previously mentioned the Risk Management Framework, approved by the CCG Board, outlines the roles and responsibility for handling risks of all staff and places great emphasis on the role of all staff to be involved within the risk process. The CCG has procured a ‘live’ web based risk management system that has been tailored specifically for the organisation’s needs. This replaces a paper based system which was difficult to manage and labour intensive. The new system has increased the organisation’s capacity to handle risk. Key staff have been provided with in-depth risk management training by the internal Corporate Governance Team as well as training on the web based risk management system. In addition to the approved Risk Management Framework further guidance has been developed for use by staff in handling risk. The organisation’s capacity to handle risk is effective. Review of Effectiveness My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers and clinical leads within the CCG who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. The Risk and Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group of achieving its principle objectives have been reviewed. This is supplemented by a number of ‘effectiveness reviews’ such as the aforementioned Governance and Committee Structure Audits, internal and external audits and reporting by the committees to the board on key issues relevant to their discharged responsibilities of those committees. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Governing Body, the Audit Committee and the Governance committee and a plan is in place to address weaknesses and ensure continuous improvement of the system is in place. Following completion of the planned audit work for the financial year for the CCG, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the Clinical Commissioning Group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: The Head of Internal Audit Opinion (“HoIA”) The purpose of our annual HoIA Opinion is to contribute to the assurances available to the Accountable Officer and the Board which underpin the Board’s own assessment of the effectiveness of the organisation’s system of internal control. This Opinion will in turn assist the Board in the completion of its Governance Statement. Our opinion is set out as follows:

1. Overall opinion; 2. Basis for the opinion; and 3. Commentary.

Our overall opinion is that:



Substantial assurance can be given that there is a generally sound system of internal control, designed to meet NHS South Manchester CCG’s objectives, and that controls are generally being applied consistently; except, for Continuing Healthcare, which was given Limited Assurance. The CCG has action plans in place to address these weaknesses which are being monitored by the Audit Committee.

It should be noted that Assurance Framework and Risk Management was given Limited Assurance, however, as part of our follow up work we found that eight of the nine recommendations raised in our report have now been addressed by management, including the original Priority 1 finding, and there has been significant progress in embedding risk practices across the CCG. The basis for forming my opinion is as follows:

1. An assessment of the range of individual opinions arising from risk-based audit assignments, contained within internal audit risk-based plans that have been reported throughout the year. This assessment has taken account of the relative materiality of these areas and management’s progress in respect of addressing control weaknesses; and

2. An assessment of the CCG’s arrangements for Information Governance and

Transitional Management. We have delivered the Internal Audit services in accordance with Public Sector Internal Audit Standards.

The commentary below provides the context for my opinion and together with the opinion should be read in its entirety. The range of individual opinions arising from risk-based audit assignments, contained within risk-based plans that have been reported throughout the year: The table below provides a summary of the assessments reached on the audits of systems carried out at NHS South Manchester CCG in the year to 31 March 2014.

No. Audit Assessment

2013/14

Review

Status

1. Key Financial Controls Substantial Final

2. Transitional Arrangements Substantial Final

3. Review of CCG Policy & Procedures Substantial Final

4. Arrangement for payments to clinical leads

Substantial Final

5. Continuing Healthcare Service Limited Final

6. Assurance Framework and Risk Management*

Limited Final

7. Information Governance Substantial Final



8. Conflicts of Interest Substantial Final

9. Healthier Together Substantial Final

10. Value for Money/QIPP Substantial Draft

11. CSU Products overview (IMT, TPM, and HR)

Substantial Final

12. Shared Service (Finance/Joint Commissioning/Corporate Services)

Substantial Final

13. Patient Engagement and Patient Experience

Substantial Final

For those audit areas in draft the stated assessment is indicative only, and subject to change as part of the report finalisation process. (*) As part of our follow up work we found that eight of the nine recommendations raised in our Assurance Framework and Risk Management report have now been addressed by management, including the original Priority 1 finding. The following definitions are used to provide an assessment:

Grade Definitions

Full There is a sound system of internal control designed to achieve the

system objectives.

Substantial While there is a basically sound system of internal control, there are

weaknesses, which put some of the system objectives at risk.

Limited Weaknesses in the system of internal controls are such as to put the

system objectives at risk.

Nil Control is generally weak leaving the system open to significant error or

abuse.

The assessment gradings provided in our internal audit report are not comparable with the International Standard on Assurance Engagements (ISAE 3000) issued by the International Audit and Assurance Standards Board. Other areas of work providing context to the opinion and relevant to the Governance Statement: Through our attendance at NHS North, Central and South Manchester CCGs’ Audit Committee meetings and discussions with the Locality Director of Finance, we have been made aware of a number of areas of work in which NHS South Manchester is/has been engaged which provide context to the opinion and we consider relevant to the Governance Statement. These include the following:



• The programme of Counter Fraud Activity undertaken by the CCG’s Local Counter Fraud Specialist during 2013/14 included the strengthening of the fraud prevention and detection controls within existing policies and procedures, provision of fraud awareness training to staff and the investigation of fraud referrals received.

• The CCG has continued to pursue the national NHS Quality, Innovation, Productivity and Prevention (QIPP) agenda. NHS South Manchester CCG has implemented a robust savings plan to deliver efficiency savings.

• A representative from the Finance Team attends the NHS Shared Business Services (SBS) User Group. The aim of the Group is to allow communications and escalation from CCGs with regard to current problems with SBS.

[End of Head of Internal Audit Opinion] During the year the Internal Audit issued the following audit reports with a conclusion of limited assurance:

• Assurance Framework and Risk Management

• Continuing Healthcare The Assurance Framework and Risk Management audit identified one high risk finding which related to action plans. The plans had not been clearly defined and assigned to risks within the organisation. This was found to be a systems error as the CCG had moved from a paper based risk register to an online risk management computer system. Training had not been fully developed and staff were imputing their actions into the wrong field. This was rectified by a systems review and change, further training and a full systematic review of all risks to the organization was carried out. The audit also found a number of areas of good practice:

• The Risk Management Framework reflects Manchester CCG’s risk appetite and provides a clear explanation of risk escalation. The framework uses a traffic light system to prioritise risk. Risks identified as significant (“Red”) risks are risks which score 15-25, these are reported to the Senior Management Team. Manageable (“Orange”) risks, score 8-12, are reported to each Governance Committee. This approach ensures risks are prioritised and receive senior management engagement and action.

• The Corporate Services Team has led a project to collate all three risk registers and to train staff across the three CCGs to enable staff to use risk management software Datix to manage the risk process. This functionality should help improve the management of the risk process across the organisation.

• A risk register was completed as of October 2013 and, at the time of audit, included strategic and non-strategic risks for all three Manchester CCGS.

• There is a documented risk management policy which is available to all staff through the intranet.

The audit for Continuing Healthcare found five high priority issues. There were communication delays in assessing a referred patient for CHC eligibility to the patient and/or the patient’s relatives. In addition there was an issue with adequate segregations of duties between staff responsibility. The audit also found that the CCG processes lacked assurance that reviews of CHC patients are carried out after three months and at least once yearly following eligibility in accordance with the National Framework. Also, findings showed deficiencies in reviewing all outstanding patient assessments and investigating any non compliance. Lastly, the audit found issues with regards to informing the CHC Commissioning team of patients who exit CHC.



The CCG has implemented a number of actions to mitigate these issues. The issue of ‘effective communication with patients’ has been addressed within the context of future management arrangements for the service. ‘Segregation of duties’ has been addressed through additional administrative resource, review of the system and procurement of a new database. To mitigate the risk around ‘key milestones for patient review’ an improvement plan has been agreed with providers and monthly monitoring is performed by the Commissioners. This will be regularly reported to CHC Strategy Group. Lastly, issues regarding ‘communication of patients leaving CHC’ has been addressed by a data cleansing exercise being undertaken and the recruitment of a new administrative assistant to help with work load. A new database will be procured and implemented. Internal Audit conducted a follow up of 31 issues that were assessed in the audit plan for 2013/14. They found that of the 31 issues 11 had action plans full implemented, 8 were partially complete, 8 were still ongoing and 1 was no longer relevant due to changes in process and guidance. During the year the Internal Audit issued no audit reports with a conclusion of no assurance. Data Quality During the organisation’s first year reporting to the Board has been adapted and data quality has evolved to meet the expectation of myself and my fellow Governing Body members. Having assessed the quality of data submitted to and reviewed by the board (with advice taken from my fellow Board members), I am assured that the data is of sufficient quality that the Governing Body can carry out its duties. Data Security The Information Toolkit 2013/2014 was submitted and achieved a satisfactory level of compliance with Interim ASH Status awarded. Discharge of Statutory Functions I can confirm that the correct arrangements are in place for the CCGs to discharge its statutory functions. As outlined in the organisation’s constitution arrangements are in place for the discharge of statutory functions that were developed with external legal input, to ensure compliance with the relevant legislation. In light of the Harris Review, the CCG has outlined all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, I can confirm that the CCG is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Board member. Committees and teams have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties. Conclusion



In conclusion I feel that the CCG has no significant internal controls issues to report. Throughout the year some deficiencies were identified through proactive self-assessment audits as well as internal and external audits. Any issues identified have been fully rectified by the development and implementation of action plans to address the risks to the Governance framework. I am satisfied with the work of the CCG in the financial year of 2013/14 and look forward to continuing to deliver the CCG’s vision and progress its priorities in 2014/15. Caroline Kurzeja Accountable Officer June 2014



Appendix D – Financial Statement

Foreword to the Accounts South Manchester Clinical Commissioning Group was licensed from 1st April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the National Health Service Act 2006. These accounts for the year ending 31st March 2014 have been prepared by South Manchester Clinical Commissioning Group under Section 17 of schedule 1A of the National Health Service Act 2006 (as amended) in the form which the Secretary of State has, with approval of the Treasury, directed. The National Health Service Act 2006 (as amended) required Clinical Commissioning Groups to prepare their Annual Report and Annual Accounts in accordance with Directions issued by NHS England. In accordance with the Directions, as Clinical Commissioning Groups were established on 1st April 2013, no prior year information is required.

Statement of Comprehensive Net Expenditure for the Year Ended 31 March 2014 2013-14

CCG

Note £’000

Commissioning

Other Operating Revenue 2 (893)

Gross Employee Benefits 4 1,604

Other Costs 5 208,359

Net Operating Costs before Financing 209,070

Financing

Investment Revenue 8 0

Other Gains & Losses 9 0

Finance Costs 10 0

Net Operating Costs for the Financial Year 209,070

Net Gain (Loss) on Transfer by Absorption 11 0

Retained Net Operating Costs for the Financial Year

209,070

Other Comprehensive Net Expenditure

Impairments & reversals 0

Net gain (loss) on revaluation of property, plant & equipment

0

Net gain (loss) on revaluation of intangibles 0



2013-14

CCG

Note £’000

Net gain (loss) on revaluation of financial assets 0

Movements in other reserves 0

Net gain (loss) on available for sale financial assets

0

Net gain (loss) on assets held for sale 0

Re-measurement of the defined benefit liability 0

Reclassification Adjustments:

On disposal of available for sale financial assets 0

Total Comprehensive Net Expenditure for the Financial Year

209,070

The notes on pages 75 to 83 form part of this statement.



Statement of Financial Position as at 31 March 2014

31 March 2014

CCG

Note £’000

Non-current Assets

Property, Plant & Equipment 13 0

Intangible Assets 14 0

Investment Property 15 0

Trade & Other Receivables 17 0

Other Financial Assets 18 0

Total Non-current Assets 0

Current Assets

Inventories 16 0

Trade & Other Receivables 17 1,159

Other Financial Assets 18 0

Other Current Assets 19 0

Cash & Cash Equivalents 20 6

1,165

Non-current Assets held for Sale 21 0

Total Current Assets 1,165

Total Assets 1,165

Current Liabilities

Trade & Other Payables 23 (11,393)

Other Financial Liabilities 24 0

Other Liabilities 25 0

Borrowings 26 0

Provisions 30 (255)

Total Current Liabilities (11,648)

Total Assets less Current Liabilities (10,483)

Non-current Liabilities

Trade & Other Payables 23 0

Other Financial Liabilities 24 0

Other Liabilities 25 0

Borrowings 26 0

Provisions 30 0

Total Non-current Liabilities 0

Total Assets Employed (10,483)

Financed by Taxpayers’ Equity



31 March 2014

CCG

Note £’000

General Fund (10,483)

Revaluation Reserve 0

Other Reserves 0

Charitable Reserves

Total Taxpayers’ Equity (10,483)

The notes on pages 84 to 89 form part of this statement. The financial statements on pages 59 to 96 were approved by the Governing Body on 28th May 2014 and signed on its behalf by: Caroline Kurzeja Accountable Officer



Statement of Changes in Taxpayers’ Equity for the Year Ended 31 March 2014

General Fund

Revaluation Reserve

Other Reserves Total

CCG 2013-14 £’000 £’000 £’000 £’000

CCG Balance at 1 April 2013 0 0 0 0

Transfer of assets and liabilities from closed NHS bodies as a result of the 1 April 2013 transition 0 0

Transfer between reserves in respect of assets transferred from closed NHS bodies 0 0 0

Adjusted CCG Balance at 1 April 2013 0 0 0 0

Changes in CCG Taxpayers’ Equity for 2013-14

Net operating costs for the financial year (209,070) (209,070)

Net gain (loss) on revaluation of property, plant & equipment 0 0

Net gain (loss) on revaluation of intangible assets 0 0

Net gain (loss) on revaluation of financial assets 0 0

Net gain (loss) on revaluation of assets held for sale 0 0

Impairments and reversals 0 0

Movements in other reserves 0 0 0

Transfers between reserves 0 0 0

Release of reserves to the Statement of Comprehensive Net Expenditure 0 0

Reclassification adjustment on disposal of available for sale financial assets 0 0

Transfers by absorption to (from) other bodies 0 0

Transfer between reserves in respect of assets transferred under absorption 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Re-measurement of the defined benefit liability 0 0 0

Net Recognised CCG Expenditure for the Financial Year (209,070) 0 0 (209,070)

Net funding 198,587 198,587

CCG Balance at 31 March 2014 (10,483) 0 0 (10,483)



Statement of Cash Flows for the Year Ended 31 March 2014

2013-14

CCG

Note £’000

Cash Flows from Operating Activities

Net operating costs for the financial year (209,070)

Depreciation and amortisation 0

Impairments and reversals 0

Other gains (losses) on foreign exchange 0

Donated assets received credited to revenue but non-cash 0

Government granted assets received credited to revenue but non-cash 0

Interest paid 0

Release of PFI deferred credit 0

Increase (decrease) in inventories 0

Increase (decrease) in trade & other receivables (1,159)

Increase (decrease) in other current assets 0

Increase (decrease) in trade & other payables 11,393

Increase (decrease) in other current liabilities 0

Provisions utilised 0

Increase (decrease) in provisions 255

Net Cash Inflow (Outflow) from Operating Activities (198,581)

Cash Flows from Investing Activities

Interest received 0

(Payments) for property, plant and equipment 0

(Payments) for intangible assets 0

(Payments) for investments with the Department of Health 0

(Payments) for other financial assets 0

(Payments) for financial assets (LIFT) 0

Proceeds from disposal of assets held for sale: property, plant and equipment 0

Proceeds from disposal of assets held for sale: intangible assets 0

Proceeds from disposal of investments with the Department of Health 0

Proceeds from disposal of other financial assets 0

Proceeds from disposal of financial assets (LIFT) 0

Loans made in respect of LIFT 0



2013-14

CCG

Note £’000

Loans repaid in respect of LIFT 0

Rental revenue 0

Net Cash Inflow (Outflow) from Investing Activities 0

Net Cash Inflow (Outflow) before Financing (198,581)

Cash Flows from Financing Activities

Net parliamentary funding received 198,587

Other loans received 0

Other loans repaid 0

Capital element of payments in respect of finance leases and on Statement of Financial Position PFI and LIFT 0

Capital grants and other capital receipts 0

Capital receipts surrendered 0

Net Cash Inflow (Outflow) from Financing Activities 198,587

Net Increase (Decrease) in Cash & Cash Equivalents 6

Cash & Cash Equivalents at the Beginning of the Financial Year 0

Effect of exchange rate changes on the balance of cash and cash equivalents held in foreign currencies 0

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 6



Notes to the Financial Statements

1. Accounting Policies NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Manual for Accounts 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. In accordance with the Directions issued by NHS England comparative information is not provided in 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 the Department of Health Group



Transfers as part of reorganisation fall to be accounted for by use of absorption accounting in line with the Government Financial Reporting Manual, issued by HM 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 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. 1.5.1 Critical Judgements in Applying Accounting Policies The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

• Judgement that the clinical commissioning group remains a going concern. In accordance with the Accounts Directions issued by NHS England, no assets or liabilities transferred to clinical commissioning groups in accordance with transfer orders issued under the Health & Social Care Act 2012 are to be accounted for by the clinical commissioning groups with the exception of those listed below. In addition no transactions relating to the discharge of liabilities or realisation of assets transferred to clinical commissioning groups in accordance with transfer orders issued under the Health and Social Care Act 2012 are to be accounted for by clinical commissioning groups.

• Inventories, non-current assets and their closely related liabilities (meaning those specific liabilities which represent the financing or similar liabilities incurred in the purchase or leasing of those non-current assets) transferred to clinical



commissioning groups in accordance with transfer orders issued under the Health and Social Care Act 2012 are to be accounted for by the clinical commissioning group.

• The payment mechanism relating to ante-natal care changed from 1st April 2013 that on commencement of the pathway the provider charged one tariff to cover the full package of ante-natal care. The accounting treatment of this policy was that the clinical commissioning group should defer the element of the pathway prepaid and accrue for those people who had commenced the pathway prior to the 1st April and had not been charged by the providers. The clinical commissioning group had agreed full and final settlements with providers, which had been invoiced covering the maternity pathway, covering some activity which could have been classed as a prepayment, matched by activity which could have been accrued.

• 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 and 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 clinical commissioning group is disclosed in note 11 to these financial statements. The clinical commissioning group’s arrangements in respect of setline NHS Continuing Healthcare claims are disclosed in Note 30 to these financial statements.

• The clinical commissioning group is part of the shared citywide service hosted by NHS Central Manchester Clinical Commissioning Group, covering provision of corporate functions and citywide commissioning around mental health, continuing healthcare, learning disabilities and funded nursing care.

1.5.2 Key Sources of Estimation Uncertainty The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

• Estimates of acute activity undertaken in March 2014. The clinical commissioning group has estimated activity for the final month of the year to assess its liabilities under the Payment by Results regime. Actual activity data is not available until after the completion of the accounts. These estimates have been agreed with the providers of these services and are based on historic activity trends plus the provider’s local knowledge of activity undertaken during the month in question. For NHS providers, these estimates are agreed as part of the annual Agreement of Balances exercise.

• Estimates of prescribing costs not yet presented to the clinical commissioning group (£4.4m accrual at year end) The clinical commissioning group has estimated the cost of primary care prescribing activity not yet presented to the Prescription Pricing Authority (PPA) and incorporated into the charge to the clinical commissioning group’s cash limit. The estimate is based on the PPA’s forecast which it provides on a monthly basis and is validated by the clinical commissioning group’s medicines management team.

• Other accruals



There are a number of areas where the clinical commissioning group does not have up to date activity or cost information. These are individually not material, but in each case the clinical commissioning group seeks to make an appropriate estimate through its understanding of trends, local intelligence and third party evidence where possible.

1.6 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. 1.7 Employee Benefits 1.7.1 Short-term Employee Benefits Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken. The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period. 1.7.2 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. 1.8 Other Expenses Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable. Expenses and liabilities in respect of grants are recognised when the clinical commissioning group has a present legal or constructive obligation, which occurs when all of the conditions attached to the payment have been met.



1.9 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. 1.9.1 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. 1.10 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. 1.11 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 1.90%

• Timing of cash flows (6 to 10 years inclusive): Minus 0.65%



• Timing of cash flows (over 10 years): Plus 2.20%

• All employee early departures: 1.80% 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. 1.12 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. 1.13 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. 1.14 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. 1.15 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. 1.15.1 Financial Assets at Fair Value Through Profit & Loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial assets at fair value through profit and loss. They are held at fair value, with any resultant gain or loss recognised in calculating the clinical commissioning group’s surplus or deficit for the year. The net gain or loss incorporates any interest earned on the financial asset. 1.15.2 Held to Maturity Assets Held to maturity investments are non-derivative financial assets with fixed or determinable payments and fixed maturity, and there is a positive intention and ability to hold to maturity. After initial recognition, they are held at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method. 1.15.3 Available For Sale Financial Assets Available for sale financial assets are non-derivative financial assets that are designated as available for sale or that do not fall within any of the other three financial asset classifications. They are measured at fair value with changes in value taken to the revaluation reserve, with the exception of impairment losses. Accumulated gains or losses are recycled to surplus/deficit on de-recognition. 1.15.4 Loans & Receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. After initial recognition, they are measured at amortised cost using the effective interest method, less any impairment. Interest is recognised using the effective interest method.



Fair value is determined by reference to quoted market prices where possible, otherwise by valuation techniques. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset. At the end of the reporting period, the clinical commissioning group assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset. For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced through a provision for impairment of receivables. If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised. 1.16 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. 1.16.1 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.

1.16.2 Financial Liabilities at Fair Value Through Profit & Loss Embedded derivatives that have different risks and characteristics to their host contracts, and contracts with embedded derivatives whose separate value cannot be ascertained, are treated as financial liabilities at fair value through profit and loss. They



are held at fair value, with any resultant gain or loss recognised in the clinical commissioning group’s surplus/deficit. The net gain or loss incorporates any interest payable on the financial liability. 1.16.3 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. 1.17 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. 1.18 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. 1.19 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). 1.20 Research & Development Research and development expenditure is charged in the year in which it is incurred, except insofar as development expenditure relates to a clearly defined project and the benefits of it can reasonably be regarded as assured. Expenditure so deferred is limited to the value of future benefits expected and is amortised through the Statement of Comprehensive Net Expenditure on a systematic basis over the period expected to benefit from the project. It should be re-valued on the basis of current cost. The amortisation is calculated on the same basis as depreciation.



1.21 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 2013-14, 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.

2. Other Operating Revenue

2013-14

CCG

£’000

Recoveries in respect of employee benefits 0

Patient transport services 0

Prescription fees and charges 51

Dental fees and charges 0

Education, training and research 91

Charitable and other contributions to revenue expenditure: NHS 0

Charitable and other contributions to revenue expenditure: non-NHS 0

Receipt of donations for capital acquisitions: NHS Charity 0

Receipt of Government grants for capital acquisitions 0

Non-patient care services to other bodies 751

Income generation 0

Rental revenue from finance leases 0

Rental revenue from operating leases 0

Other revenue 0

Total 893

3. Revenue

2013-14

CCG



£’000

From rendering of services 893

From sale of goods 0

Total 893

Revenue is totally from the supply of services. The clinical commissioning group receives no revenue from the sale of goods.

4. Employee Benefits & Staff Numbers 4.1 Employee benefits



4.1.1 Employee benefits expenditure

2013-14

Permanent Employees Other Total

£’000 £’000 £’000

CCG

Salaries and wages 1,167 195 1,362

Social security costs 98 0 98

Employer contributions to the NHS Pension Scheme 144 0 144

Other pension costs 0 0 0

Other post-employment benefits 0 0 0

Other employment benefits 0 0 0

Termination benefits 0 0 0

Gross CCG employee benefits expenditure 1,409 195 1,604

Less: Recoveries in respect of employee benefits (note 4.1.2) 0 0 0

Net CCG employee benefits expenditure including capitalised costs 1,409 195 1,604

Less: Employee costs capitalised 0 0 0

Net CCG employee benefits expenditure excluding capitalised costs 1,409 195 1,604

4.1.2 Recoveries in respect of employee benefits

The clinical commissioning group had no recoveries in respect of employee benefits disclosed separately in 2013-14. 4.2 Average number of people employed

2013-14


Number Number Number

Total CCG 21 4 25

Of the above:

Number of whole time equivalent people engaged on capital projects 0 0 0



2013-14


Number Number Number

4.3 Staff sickness absence and ill health retirements

The staff sickness figures below relate to a nine month period only (April-December 2013).

2013-14

CCG

Number

Total days lost 48

Total staff years 18

Average working days lost 3

2013-14

CCG

Number

Number of persons retiring on ill health grounds 0

Ill-health retirement costs are met by the NHS Pension Scheme.

2013-14

CCG

£’000

Total additional pensions liability accrued in the year 0

Where the clinical commissioning group has agreed early retirements, the additional costs are met by the clinical commissioning group and not by the NHS Pension Scheme. 4.4 Exit packages and severance payments agreed in the financial year There were no exit packages or departures where special payments have been made within the clinical commissioning group during 2013-14. 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. 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.

5. Operating Expenses

2013-14

CCG

£’000

Gross Employee Benefits

Employee benefits excluding governing body members 1,223

Executive governing body members 381

Total gross employee benefits 1,604



2013-14

CCG

£’000

Other Costs

Services from other CCGs and NHS England 4,075

Services from foundation trusts 124,344

Services from other NHS trusts 22,795

Services from other NHS bodies 291

Purchase of healthcare from non-NHS bodies 24,244

Chair and Lay Membership Body and Governing Body Members 136

Supplies and services – clinical 37

Supplies and services – general 1,913

Consultancy services 68

Establishment 83

Transport 4

Premises 920

Impairments and reversals of receivables 0

Inventories written down 0

Depreciation 0

Amortisation 0

Impairments and reversals of property, plant and equipment 0

Impairments and reversals of intangible assets 0

Impairments and reversals of financial assets

• Assets carried at amortised cost 0

• Assets carried at cost 0

• Available for sale financial assets 0

Impairments and reversals of non-current assets held for sale 0

Impairments and reversals of investment properties 0

Audit fees 73

Other auditor’s remuneration

• Internal audit services 0

• Other services 0

General dental services and personal dental services 0

Prescribing costs 27,607

Pharmaceutical costs 0



2013-14

CCG

£’000

General ophthalmic costs 80

GPMS/APMS and PCTMA 344

Other professional fees (excluding audit) 0

Grants to other public bodies 1,050

Clinical negligence 0

Research and development (excluding staff costs) 0

Education and training 40

Change in discount rate 0

Other expenditure 255

Total other costs 208,359

Total operating expenses 209,963

6. Better Payment Practice Code

6.1 Measure of compliance

2013-14

Number £’000

Non-NHS Payables: CCG

Total Non-NHS trade invoices paid in the year 1,960 11,323

Total Non-NHS trade invoices paid within target 1,564 9,909

Percentage of CCG non-NHS trade invoices paid within target 79.80% 87.51%

NHS Payables: CCG

Total NHS trade invoices paid in the year 1,920 165,849

Total NHS trade invoices paid within target 1,766 163,396

Percentage of CCG NHS trade invoices paid within target 91.98% 98.52%

The Better Payment Practice Code requires the clinical commissioning group to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. 6.2 The late payment of commercial debts (interest) act 1998



The clinical commissioning group had not incurred any late payment charges within 2013-14.

7. Income Generation Activities The clinical commissioning group did not undertake any income generation activities.

8. Investment Revenue The clinical commissioning group did not receive any investment revenue within 2013-14.

9. Other Gains & Losses There are no gains or losses on assets for the clinical commissioning group within 2013-14, as the clinical commissioning group does not own any assets.

10. Finance Costs There were no finance costs within the clinical commissioning group during 2013-14.

11. Net Gain (Loss) on Transfer by Absorption There were no functions transferred into South Manchester Clinical Commissioning Group during 2013-14.

12. Operating Leases 12.1 As lessee The clinical commissioning group leases buildings from NHS Property Services Ltd and Community Health Partnerships with the transactions conveying a right to use the asset in return for a payment or series of payments, in the absence of formal lease documentation. 12.1.1 Payments recognised as an expense

2013-14

Land Buildings Other Total

£’000 £’000 £’000 £’000

CCG

Minimum lease payments 0 910 0 910

Contingent rents 0 0 0 0

Sub-lease payments 0 0 0 0

Total CCG 0 910 0 910

The charges in the table are above are the costs charged from NHS Property Services Ltd and Community Health Partnerships for 2013/14.



12.1.2 Future minimum lease payments The clinical commissioning group occupies property owned and managed by Community Health Partnerships Ltd and NHS Property Services Ltd. For 2013-14 a transitional occupancy rent based on annual property cost allocation was agreed. This is reflected in Note 12.1.1 above. Whilst the clinical commissioning group’s arrangements with Community Health Partnerships Ltd and NHS Property Services Ltd, fall within the definition of an operating lease, the rental charge for future years has not been agreed. Consequently this note does not include the future minimum lease payments for these arrangements.

2013-14

Land Buildings Other Total

£’000 £’000 £’000 £’000

CCG

Payable:

• Not later than one year 0 0 0 0

• Between one and five years

0 0 0 0

• After five years 0 0 0 0

Total CCG 0 0 0 0

12.2 As lessor The clinical commissioning group does not own any assets and is not a lessor in 2013-14.

13. Property, Plant and Equipment The clinical commissioning group does not own any assets. Any assets used by the clinical commissioning group are leased from NHS Property Services Ltd and Community Health Partnerships.

14. Intangible Assets The clinical commissioning group had no intangible assets at 31st March 2014.

15. Investment Property The clinical commissioning group had no investment property as at 31st March 2014.

16. Inventories The clinical commissioning group had no inventories as at 31st March 2014.

17. Trade & Other Receivables

Current Non-current

31 March 2014

31 March 2014

£’000 £’000

CCG

NHS receivables: Revenue 119 0

NHS receivables: Capital 0 0

NHS prepayments and accrued income 783 0

Non-NHS receivables: Revenue 59 0

Non-NHS receivables: Capital 0 0

Non-NHS prepayments and accrued income 191 0

Provision for the impairment of receivables 0 0

VAT 7 0

Private finance initiative and other public private partnership arrangement prepayments and accrued income 0 0

Interest receivables 0 0

Finance lease receivables 0 0

Operating lease receivables 0 0

Other receivables 0 0

Total CCG 1,159 0

Total CCG Current and Non-current 1,159

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 provide funding to clinical commissioning groups to commission services, no credit scoring of them is considered necessary. 17.1 Receivables past their due date but not impaired The clinical commissioning group had no receivables past their due date at 31st March 2014. The clinical commissioning group did not hold any collateral against receivables outstanding at 31 March 2014. 17.2 Provision for impairment of receivables The provision for impairment of receivables is not applicable within the clinical commissioning group at 31st March 2014.

18. Other Financial Assets



The clinical commissioning group had no other financial assets as at 31st March 2014.

19. Other Current Assets The clinical commissioning group had no other current assets as at 31st March 2014.

20. Cash & Cash Equivalents

2013-14

CCG

£’000

Balance at 1 April 2013 0

Net change in year 6

Balance at 31 March 2014 6

Made up of:

Cash with the Government Banking Service 6

Cash with Commercial banks 0

Cash in hand 0

Current investments 0

Cash and cash equivalents as in Statement of Financial Position 6

Bank overdraft: Government Banking Service 0

Bank overdraft: Commercial banks 0

Balance at 31 March 2014 6

Patients’ money held by the clinical commissioning group, not included above 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.

22. Analysis of Impairments & Reversals The clinical commissioning group had no impairments or reversals of impairments recognised in expenditure during 2013-14.

23. Trade & Other Payables

Current Non-current



31 March 2014

31 March 2013

£’000 £’000

CCG

Interest payable 0 0

NHS payables: Revenue 3,714 0

NHS payables: Capital 0 0

NHS accruals and deferred income 486 0

Non-NHS payables: Revenue 770 0

Non-NHS payables: Capital 0 0

Non-NHS accruals and deferred income 6,328 0

Social security costs 16 0

VAT 0 0

Tax 20 0

Payments received on account 0 0

Other payables 59 0

Total CCG 11,393 0

Total CCG Current and Non-current 11,393

Included in CCG NHS receivables are pre-paid pension contributions 20

Other payables include £20k outstanding pension contributions at 31st March 2014.

24. Other Financial Liabilities The clinical commissioning group had no other financial liabilities as at 31st March 2014.

25. Other Liabilities The clinical commissioning group had no other liabilities as at 31st March 2014.

26. Borrowings The clinical commissioning group had no borrowings as at 31 March 2014.

27. Private Finance Initiative, LIFT & Other Service Concession Arrangements

27.1 Off-Statement of Financial Position private finance initiative, LIFT

and other service concession arrangements



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 31st March 2014.

27.2 On-Statement of Financial Position private finance initiative, LIFT and other service concession arrangements

The clinical commissioning group had no private finance initiative, LIFT or other service concession arrangements that were included in the Statement of Financial Position as at 31st March 2014.

28. Finance Lease Obligations The clinical commissioning group had no finance lease obligations as at 31st March 2014.

29. Finance Lease Receivables The clinical commissioning group had no finance lease receivables as at 31st March 2014.

29.1 Finance leases as lessor The clinical commissioning group had no unguaranteed residual value accruing as at 31st March 2014. The clinical commissioning group had no accumulated allowance for uncollectible lease receivables as at 31st March 2014

30. Provisions

Current Non-current

31 March 2014

31 March 2014

£’000 £’000

CCG

Pensions relating to former directors 0 0

Pensions relating to other staff 0 0

Restructuring 0 0

Redundancy 0 0

Agenda for change 0 0

Equal pay 0 0

Legal claims 0 0

Continuing care 0 0

Other 255 0



Current Non-current

31 March 2014

31 March 2014

£’000 £’000

Total CCG 255 0

Total CCG Current and Non-current 255

The provision of £255k relates to restructuring costs at Central Manchester University Hospitals Foundation Trust (CMUHFT) as a result of the closure of Trafford Hospital. The provision is based on a Heads of Terms agreement between CMUHFT and Greater Manchester CCG’s. Agreement was reached in 2012/13 that each Greater Manchester CCG would contribute to the costs as part of a Greater Manchester risk share agreement. The costs are based on an agreed transition arising as a result of the new Health Deal within Trafford and the process has been signed off by the Secretary of State and was subject to wider assurances provided in advance of the SOS decision. The termination costs (redundancy and contracts) have a combined maximum limit of £11.0m (with a maximum of £6.5m for GM CCGs as £4.5m was previously settled by GM SHA) final actual values have to be signed off by CMUFHT and Trafford CCG as the lead responsible CCG. However, the exact value is not yet definitive. Exact timing of the discharge of the costs is uncertain but unlikely to be wholly within the next year. Under the Accounts Directions 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 clinical commissioning group. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of South Manchester Clinical Commissioning Group is £975k.

31. Contingencies The clinical commissioning group had no contingencies as at 31st March 2014.

32. Commitments 32.1 Capital commitments The clinical commissioning group had no contracted capital commitments not otherwise included in these financial statements as at 31st March 2014.

32.2 Other financial commitments



The clinical commissioning group had no non-cancellable contracts (which were not leases, private finance initiative contracts or other service concession arrangements) as at 31st March 2014.

33. Financial Instruments 33.1 Financial risk management International Financial Reporting Standard 7: Financial Instrument: Disclosure requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because the clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities. Treasury management operations are carried out by the finance department, within parameters defined formally within the clinical commissioning group’s standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the clinical commissioning group’s internal auditors. 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

At ‘fair value through

profit and loss’

Loans and Receivables

Available for Sale Total

£’000 £’000 £’000 £’000

CCG

Embedded derivatives 0 0

Receivables:

• NHS 119 119

• Non-NHS 59 59

Cash at bank and in hand 6 6

Other financial assets 0 0 0 0

Total CCG at 31 March 2014 0 184 0 184

CCG

Embedded derivatives n/a n/a

Receivables:

• NHS n/a n/a

• Non-NHS n/a n/a

Cash at bank and in hand n/a n/a

Other financial assets n/a n/a n/a n/a

Total CCG at 31 March 2013 n/a n/a n/a n/a

33.3 Financial liabilities



At ‘fair value through

profit and loss’ Other Total

£’000 £’000 £’000

CCG

Embedded derivatives 0 0

Payables:

• NHS 4,200 4,200

• Non-NHS 7,099 7,099

Private finance initiative, LIFT and finance lease obligations 0 0

Other borrowings 0 0

Other financial liabilities 0 59 59

Total CCG at 31 March 2014 0 11,358 11,358

CCG

Embedded derivatives n/a n/a

Payables:

• NHS n/a n/a

• Non-NHS n/a n/a

Private finance initiative, LIFT and finance lease obligations n/a n/a

Other borrowings n/a n/a

Other financial liabilities n/a n/a n/a

Total CCG at 31 March 2013 0 0 0

34. Operating Segments The clinical commissioning group consider they have only one segment: commissioning of healthcare services.

35. Healthier Together The clinical commissioning group contributes into the Healthier Together Programme hosted by Central Manchester CCG on behalf of Greater Manchester. The Healthier Together project supports the objectives of the overall programme for Greater Manchester health and social care reform. South Manchester Clinical Commissioning Group contributed £299k in 2013/14, with total contributions across the Greater Manchester clinical commissioning groups of £5.2m.

36. NHS LIFT Investments The clinical commissioning group had no NHS LIFT investments as at 31st March 2014.



37. Intra-Government & Other Balances

Current Receivables

Non-current Receivables

Current Payables

Non-current Payables

£’000 £’000 £’000 £’000

CCG

Balances with:

• Other Central Government bodies 0 0 0 0

• Local Authorities 0 0 0 0

• NHS bodies outside the Departmental Group 762 0 438 0

• NHS Trusts and Foundation Trusts 140 0 3,762 0

• Public Corporations and Trading Funds 0 0 0 0

• Bodies external to Government 257 0 7,193 0

Total CCG at 31 March 2014 1,159 0 11,393 0

CCG

Balances with:

• Other Central Government bodies n/a n/a n/a n/a

• Local Authorities n/a n/a n/a n/a

• NHS bodies outside the Departmental Group n/a n/a n/a n/a

• NHS Trusts and Foundation Trusts n/a n/a n/a n/a

• Public Corporations and Trading Funds n/a n/a n/a n/a

• Bodies external to Government n/a n/a n/a n/a

Total CCG at 31 March 2013 n/a n/a n/a n/a

38. Related Party Transactions

Details of related party transactions with individuals are as follows:

Payments to

Related Party

Receipts from Related

Party

Amounts owed to

Related Party

Amounts due from Related

Party

£’000 £’000 £’000 £’000

G Hayward (Lincolnshire NHS Hospital Trust) 1 0 0 0

Dr Tamkin & Dr Fink (Salford CCG) 11 0 0 0

Dr A Crowe (Wirral University Teaching Hospital, Countess of Chester)

36 0 0 0

Dr P Burns (Northern Moor Medical Practice, Public Health England)

295 0 0 0

Dr B Tamkin, Dr M Whitaker & Dr P Burns (University of Manchester)

20 0 0 0



Payments to

Related Party

Receipts from Related

Party

Amounts owed to

Related Party

Amounts due from Related

Party

£’000 £’000 £’000 £’000

Dr P Fink (The Maples Medical Centre, Manchester City Council)

2,780 0 0 0

J Langley (Cornishway Group Practice) 54 0 0 0

Dr B Tamkin (Borchardt Medical Centre, GM CSU)

2,241 0 0 0

Dr M Whitaker (Didsbury Medical Centre) 75 0 0 0

Dr N Kanumilli (Northenden Group Practice) 121 0 0 0

Dr M Whitaker, Dr N Kanumilli, & Dr Fink (GoToDoc)

1,522 0 0 0

J Newton & C Harris (NHS Central Manchester CCG, NHS South Manchester CCG)

1,077 0 0 (599)

Jayne Cooney (Jayne DaBell)(Barlow Medical Centre)

73 0 0 0

Total 8,306 0 0 (599)

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 Manchester City Council.

39. Events After the Reporting Period There are no post balance sheet events which will have a material effect on the financial statements of the clinical commissioning group.

40. Losses & Special Payments The clinical commissioning group had no losses and special payments cases during 2013-14.

41. Third Party Assets



The clinical commissioning group held no third party assets as at 31st March 2014.

42. Financial Performance Duties Clinical commissioning groups have a number of financial duties under the National Health Service Act 2006 (as amended). The clinical commissioning group’s performance against those duties was as follows:

National

Health

Service

Act

Section Duty

Maximum

£'000

Performance

£'000

Duty

Achieved

223H(1) Expenditure not to exceed income 212,030 209,963 Yes

223I(2)

Capital resource use does not

exceed the amount specified in

Directions 0 0

Not

applicable

223I(3)

Revenue resource use does not

exceed the amount specified in

Directions 211,137 209,070 Yes

223J(1)

Capital resource use on specified

matter(s) does not exceed the

amount specified in Directions 0 0

Not

applicable

223J(2)

Revenue resource use on specified

matter(s) does not exceed the

amount specified in Directions 0 0

Not

applicable

223J(3)

Revenue administration resource

use does not exceed the amount

specified in Directions 3,950 3,919 Yes

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 limit, notified capital resource and all other amounts accounted as received in the financial year (whether under the provision of the Act or from other sources and included here on a gross basis. 223I(2) and 223J(1) are not applicable as the clinical commissioning group has no capital resources in 2013-14. For the purposes of 223J(3), the revenue administration resource has been identified as the notified allocation and all other amounts accounted as received in the financial year (whether under the provision of the Act or from other sources and included here on a gross basis). All performance targets were met in 2013-14.



43. Impact of IFRS

Accounting under IFRS had no impact on the results of the clinical commissioning group during the 2013-14 financial year.

44. Analysis of Charitable Reserves The clinical commissioning group had no charitable reserves during 2013-14.

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