our annual report and accounts

Annual Report and Accounts 2013/14

Supporting people in Dorset to lead healthier lives

Front cover - thanks to Enid, Delta and their families

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CONTENTS

Welcome from our Chair and Chief Officer Pages 2 - 3

Member Practices’ Introduction Pages 4 - 5

List of practices Pages 6 - 7

Governing Body / Members’ Report Pages 8 - 39

How we work and our Governing Body Pages 8 - 12

Progress against targets Pages 14 - 15

Highlights of our first year Pages 16 - 22

Our localities Pages 23 - 24

Our Clinical Commissioning Programmes Pages 25 - 39

Strategic Report Pages 40 - 66

Financial Overview Page 42

Progress against national Quality Standards Pages 43 - 45

Outlook for 2014/15 and beyond - Chief Finance Officer Page 46

Business Review including: Pages 47 - 67

Equality and Diversity Pages 51 - 53Improving Quality Pages 55 - 59Engagement Pages 61 - 62Caring for Carers Pages 63 - 64

Governing Body and Senior Managers’ Profiles Pages 67 - 77

Remuneration Report Pages 78 - 85

Financial Performance Pages 86 - 89

Glossary of Terms Page 90

Annual Accounts Addendum Pages 91 onwards


This is the first annual report produced byNHS Dorset Clinical Commissioning Group(CCG) and it marks a year since we – as aclinically led organisation – took on the role ofplanning and funding local healthcare acrossthe county.

In doing so, we have built on the solidfoundation left by our predecessors,Bournemouth & Poole and Dorset PrimaryCare Trusts.

The following pages demonstrate ourcommitment to ensuring that people get thehealthcare they need and it remainsaccessible and appropriate.

Looking Ahead

The NHS in Dorset faces significantchallenges in terms of meeting the healthneeds of the increasing population, ensuringclinical and financial sustainability of NHSservices whilst responding to new nationalpolicy and guidance (e.g. 7 day working,quality standards).

These challenges are no different to those setout nationally within NHS England’s document‘A Call to Action’.

In addition to financial constraints ourproviders of health care are facing

pressures in terms of the profile anddeployment of their existing workforce, whichif we don’t work together to make realistic andsustainable commissioning decisions tore-design some services, will deepen andlead to a financial crisis for the NHS in Dorsetwithin the next two years.

Therefore in Dorset, with our providers andpartners, we will undertake a clinical servicesreview to tell us what services need tochange, and how we should change them toensure that the NHS in Dorset provides high

WELCOME

Welcome to the NHS Dorset Clinical CommissioningGroup Annual Report and Accounts for the year1 April 2013 to 31 March 2014.

Tim Goodson, Chief Officer (left) and ChairDr Forbes Watson

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quality, safe, and clinically and financiallysustainable services for future generations.

Further information on the outlook for 2014/15and beyond can be found as part of theStrategic Report on page 46.

With this in mind, we also took the opportunityto reflect upon these challenges by discussingour strategy through a series of engagementevents with our stakeholders.

As a result of this exercise, our currentstrategy has been refreshed to reflect theirfeedback. Our revised strategy 2014/19outlines how the CCG will support three panDorset transformational programmes:

� Better Together, an integrated health andsocial care model where the NHS andlocal authorities will work together to planand deliver seamless services.

� Clinical Services Review, which willreview clinical services across the healthand social care system within Dorset withthe aim of creating clinical and financialsustainability.

� Urgent Care Review, that aims totransform urgent care services acrossDorset by aligning and integrating themwhere possible, simplifying pathways andusing technologies to improve patientexperiences.

These three transformational programmescomplement our clinical priorities in our

delivery plan for the next two years.

They will enable us to drive the changesrequired to ensure the NHS in Dorset issustainable, innovative and responsive to theneeds of local people.

You can read more about these programmeson page 50.

We would like to take this opportunity to thankall those people working both for us and withus for their continued support since April 2013.

This has helped us develop and grow from afledgling organisation into one which deliversimprovements to healthcare across the countyand will continue to do so.

As a membership organisation, we aregrateful for the support of our 100 GPpractices. Our members offer their reflectionsof our first year on pages 4 and 5.

As with everything we do, your voice is vitaland we actively encourage you to getinvolved. Information on how to have your sayis available on our websitewww.dorsetccg.nhs.uk/involve or email us [email protected].

You can also join our Health InvolvementNetwork and get more involved with our work(see the back page of this report for moreinformation).

We hope you find the report informative andinteresting.

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Introduction to the NHS Dorset CCGAnnual Report on behalf of MemberPractices

NHS Dorset Clinical Commissioning Groupcomprises 100 member practices across thecounty of Dorset. With a registered populationof around 766,000, this makes us the thirdlargest CCG in England in terms of populationand with a commissioning budget of £947M,the second largest in financial terms.

All GP practices belong to a locality which is ageographic area, and each locality has a leadGP who is a member of the CCG GoverningBody. You can read more about the GoverningBody’s role on page 8.

This, our member practices introduction,represents all practices registered in Dorset(see pages 6 and 7 for a full list of memberpractices). It reflects our collective thoughts onthe CCG’s governance, progress,performance and impact at the end of itsfirst year.

Reflections

Reflecting on the CCG’s first year, we havemade a solid start in addressing the healthpriorities of our local communities. We havecaptured this in our “highlights of our firstyear” from page 16 to 22. There is still muchto do to face the significant challenges aheadand to this end we have refreshed ourstrategy to reflect this. You can read more onpage 14 to 15 about our progress andperformance as measured against annualdelivery plan targets.

Impact

The Membership Body came together, duringthe year, at a series of events, focusing on thechallenges of the CCG including its first yearpriorities and how, as members, we saw thedevelopment and their engagement with ourplanned Clinical Services Review.

The Governing Body has also added impact tothe CCG’s ambitions in embracing their newclinical leadership roles and shaping thestrategy and engagement of the CCG withlocal stakeholders.

Please read the case studies on pages25 to 39 which feature each of our ClinicalCommissioning Programmes introduced bythe respective Clinical Chair.

Evaluation

The Governing Body and its ClinicalCommissioning Committee participated,during November 2013, in an independentboard observation exercise with NHSEngland, as part of the CCG’s developmentprocess.

This evaluation exercise focused ongovernance, challenge, individualcontributions, level of discussion, forwardfocus and decision making.

This provided helpful and insightful feedbackfrom which the CCG can further enhance itsclinical leadership and informed the CCGorganisational development planning.

The CCG Governing Body is assessedquarterly by NHS England’s Local Area Team.Most recent reviews assessed us as ‘Assured’and ‘Assured with support’ for all our domainareas.

Members’ engagement

The CCG has developed robust engagementmechanisms to ensure we can all participatein clinical decision making. As each of ourpractices belongs to a locality (a geographicarea) our Locality Lead GP represents us andour patients in their role as a member of theCCG Governing Body. You can read moreabout these key people on pages 9 to 10.

A regular cycle of engagement activity hastaken place during the year to involve us inthe organisation and the development

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MEMBER PRACTICES’ INTRODUCTION

of the strategy and priorities, including:

� four membership events (all GP practicesinvited including practice managers). TheCCG held four events throughout the yearwith a cumulative attendance of 500. Videosummaries of these events were madeavailable via the CCG intranet for GPs whocould not attend

� six workshop and development events forthe Governing Body, comprising clinicalBoard Members, Lay Members, LocalityChairs and Directors with a cumulativeattendance of 216 throughout the year

� monthly locality meetings

� CCG Update – a weekly e-newslettersent to each practice every Friday withcommissioning information and links tothe GP intranet.

The CCG’s approach to clinical engagementformed part of our nomination for TheGuardian’s inaugural Healthcare Innovationawards, which you can read more about onpage 21.

The member practices are supportive of theefforts of the CCG to drive engagement,however, all parties recognise the need to use

technology to enable virtual collaborativediscussion, given the size of the county andthe demands upon local practices.

Summary

We are assured that any matters of concernwill be flagged by the various governancearrangements that are in place to ensure ourstatutory obligations as leaders of healthcareservices for the county of Dorset are fulfilled.

As this Annual Report outlines, we recognisethe difficult challenges ahead both for the NHSnationally and how that translates in Dorset.

We realise we have a strong role to play inhelping the healthcare system overcomethese challenges by our continuinginvolvement and participation in thedevelopment and delivery of NHS DorsetCCG’s Strategy.

Dr Forbes Watson

CCG Chairand on behalf of member practices

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MEMBER PRACTICES’ INTRODUCTION

North DorsetAbbey View Surgery, ShaftesburyApples Medical Centre, SherborneBute House Surgery, SherborneEagle House Surgery, BlandfordGillingham Medical Centre, GillinghamNewland Surgery, SherborneStalbridge Surgery, StalbridgeSturminster Newton Medical Centre,Sturminster NewtonWhitecliff Surgery, BlandfordYetminster Surgery, YetminsterWest DorsetBridport Medical Centre, BridportLyme Regis Medical Centre, Lyme RegisLyme Bay Medical Centre, Lyme RegisCharmouth Medical Practice, CharmouthPortesham Practice, PorteshamBarton House Surgery, BeaminsterTollerford Practice, Maiden NewtonMid DorsetPrince of Wales Surgery, DorchesterCornwall Rd Medical Practice, DorchesterFordington Surgery, DorchesterQueens Avenue, DorchesterThe Atrium Health Centre, DorchesterBroadmayne Surgery, BroadmaynePuddletown Surgery, PuddletownMilton Abbas Practice, Milton AbbasCerne Abbas Surgery, Cerne AbbasWeymouth and PortlandAbbotsbury Road Surgery, WeymouthBridges Medical Centre, WeymouthCross Road Surgery, WeymouthDorchester Road Surgery, Weymouth

Lanehouse Surgery, WeymouthRoyal Crescent Surgery, WeymouthRoyal Manor Surgery, PortlandThe Practice Plc, WeymouthWyke Regis Surgery, WeymouthPurbeckBere Regis Surgery, Bere RegisCorfe Castle Surgery, Corfe CastleSandford Surgery, WarehamSwanage Medical Centre, SwanageThe Wellbridge Surgery, WoolWareham Surgery, WarehamPoole CentralAdam Practice, PooleCarlisle House Surgery, PooleDr Newman's Surgery, PooleEvergreen Oak Surgery, PooleLongfleet House Surgery, PoolePoole Town Surgery, PooleRosemary Medical Centre, PoolePoole NorthBirchwood Medical Centre, PooleCanford Heath Group Practice, PooleHadleigh Practice, PooleHarvey Practice, PoolePoole BayHeatherview Medical Centre, PooleHerbert Avenue, PooleLilliput Surgery, PooleMadeira Medical Centre, PooleParkstone Health Centre, PoolePoole Road Medical Centre, PooleWessex Road Surgery,PooleWestbourne Medical Centre, Poole

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OUR MEMBER PRACTICES

North BournemouthAlma Partnership, BournemouthBanks & Bearwood Medical CentreBournemouthDurdells Avenue Surgery, BournemouthKinson Road Medical Centre, BournemouthLeybourne Surgery, BournemouthNorthbourne Surgery, BournemouthTalbot Medical Centre, BournemouthVillage Surgery, BournemouthCentral BournemouthDenmark Road Medical Centre, BournemouthHoldenhurst Road Surgery, BournemouthJames Fisher Medical Centre, BournemouthMoordown Medical Centre, BournemouthPanton Practice, BournemouthSt Albans Medical Centre, BournemouthWoodlea House Surgery, BournemouthEast BournemouthBeaufort Road Surgery, BournemouthBoscombe Manor Medical CentreBournemouthCrescent Surgery, BournemouthLittledown Surgery, Bournemouth

Marine & Oakridge Partnership, Bournemouth

Providence Surgery, Bournemouth

Shelley Manor Medical Centre, Bournemouth

Southbourne Surgery, Bournemouth

ChristchurchBarn Surgery, Christchurch

Burton Medical Centre, Christchurch

Farmhouse Surgery, Christchurch

Grove Surgery, Christchurch

Highcliffe Medical Centre, Christchurch

Orchard Surgery, Christchurch

Stour Surgery, Christchurch

East DorsetCranborne Surgery, Wimborne

Old Dispensary, Wimborne

Orchid House Surgery, Ferndown

Penny's Hill Surgery, Ferndown

Quarter Jack Surgery, Wimborne

Trickett's Cross Surgery, Ferndown

Verwood Surgery, Verwood

Village Surgery, Poole

Walford Mill Surgery, Wimborne

West Moors Group Practice, West Moors

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OUR MEMBER PRACTICES

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Introduction

NHS Dorset CCG is the third largest clinicalcommissioning group in England, in terms ofpopulation and, with a commissioning budgetof £947M, the second largest in financialterms.

We have a Governing Body and our ownconstitution which sets out how theorganisation will work.

Whilst we do not directly provide any healthservices, we have responsibility forcommissioning (planning and funding) anumber of them for local people. Theseinclude:

� planned hospital care at local hospitals

� urgent and emergency care e.g. A&E,ambulance services, out of hours care andthe NHS 111 service

� community health services

� mental health and learning disabilityservices

� rehabilitation care

� maternity, children’s and family services

� NHS continuing healthcare.

Our mission

Our mission, aims and strategic principleshave been developed through wideconsultation and engagement withstakeholders and partners across Dorset.

Supporting people in Dorset tolead healthier lives

As leaders we will use our clinicalunderstanding to drive forward continuousimprovements in services throughout Dorsetthat support people to lead healthier lives forlonger.

Our aims

We aim to be an organisation that:

� is trusted and builds confidence in ourpublic, patients and stakeholders

� challenges and encourages its partners,members and staff to drive improvementsin services and performance

� values its staff and membership and is agreat place to work

� uses resources effectively and efficiently

� has a local focus but doesn’t lose sight ofthe bigger picture.

Our values

We have six values which underpin everythingwe do. These are:

� Caring

� Collaborative

� Courageous

� Honest

� Responsive

� Responsible.

GOVERNING BODY / MEMBERS’ REPORT

NHS Dorset Clinical Commissioning Group (CCG)was created and fully authorised without conditionson 1 April 2013.

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Who we are: our Governing BodyOur Governing Body is made up of 13 GP Lo-cality Chairs, a chair, a Chief Officer, a ChiefFinance Officer, two Lay Members, one nurselead and one hospital (secondary care) doctorlead. The Chair is Dr Forbes Watson and theChief Officer is Tim Goodson.

The Governing Body has a responsibility toensure there are appropriate healthcareservices for the people of Dorset. All GPpractices belong to a locality which is ageographic area, and each locality has a leadGP who is a member of the CCG GoverningBody. The members of our Governing Body are:

� Dr Forbes Watson, Chair

� Tim Goodson, CCG Chief Officer

� Dr Peter Blick, Locality Chair for CentralBournemouth

� Dr Jenny Bubb, Locality Chair for MidDorset

� Dr Rob Childs, Locality Chair for NorthDorset

� Dr Colin Davidson, Locality Chair for EastDorset

� Dr Paul French, Locality Chair for EastBournemouth

� Dr Richard Jenkinson, Locality Chair forChristchurch

� Dr Tom Knight, Locality Chair for NorthBournemouth

� Dr Chris McCall, Locality Chair for PooleNorth

� Dr Blair Millar, Locality Chair for WestDorset

� Dr Andy Rutland, Locality Chair for PooleBay

� Dr Patrick Seal, Locality Chair for PooleCentral

� Dr Karen Kirkham, Locality Chair forWeymouth and Portland

� Dr David Haines, Locality Chair for Purbeck

� Paul Vater, Chief Finance Officer

� David Jenkins, Lay Member Lead forPatient and Public Involvement and DeputyCCG Chair

� Teresa Hensman, Lay Member Lead forGovernance

� Mary Monnington, Registered Nurse Member

� Dr Chris Burton, Secondary Care Member.

Each GP liaises between the Governing Bodyand practices in the locality to ensuredecisions reflect local issues and needs.

The Governing Body has three committeeswhich report to it: a clinical commissioningcommittee, a remuneration committee and anaudit and quality committee.

The Audit and Quality Committee provides theGoverning Body with an independent andobjective view of the CCG’s financial systems,financial information and compliance withfinance-related laws, regulations anddirections.

It gives assurance on the quality of servicescommissioned and promotes a culture ofcontinuous improvement and innovation withrespect to safety of services, clinicaleffectiveness and patient experience.

Our Governing Body is made up of 13 GP Locality Chairs,a Chair, a Chief Officer, a Chief Finance Officer, two LayMembers, one Nurse Lead and one Doctor Lead.


1010


The Audit and Quality Committee is chaired byTeresa Hensman, Lay Member Lead forGovernance. The further members are:

� Charles Buckle, Non-governing Body LayMember

� Dr Paul French, Governing Bodyrepresentative

� David Jenkins, Lay Member Leadfor Patient and Public Involvement andDeputy CCG Chair

� Mary Monnington, Registered Nurse Member

� Tina Thompson, Non-governing Body LayMember.

The Clinical Commissioning Committee

The Clinical Commissioning Committee isresponsible for developing and recommendingclinical priorities; promoting patient and publicinvolvement and engagement; supporting thedelivery of clinical effectiveness and ensuringa clinical perspective in the business of theCCG.

It is made up of the chairs of the sevenClinical Commissioning Programmes,executive and Lay Members. The CCC ischaired by Dr Forbes Watson. Other membersare:

� Tim Goodson, Chief Officer


� David Jenkins, Lay Member Leadfor Patient and Public Involvement andDeputy CCG Chair

� Dr Chris Burton, Governing Body, SecondaryCare Member

� Dr Lionel Cartwright, Chair, Cancer and Endof Life Clinical Commissioning Programme(CCP)

� Dr Paul French, Chair, Mental Health andLearning Disabilities CCP

� Dr Karen Kirkham, Chair, Maternity,Reproductive and Family Health CCP

� Dr Chris McCall, Chair, General Medicaland Surgical CCP

� Dr Christian Verrinder, Chair,Musculoskeletal and Trauma CCP

� Dr Andy Rutland, Mid LocalityRepresentative

� Dr Craig Wakeham, Chair, CardiovascularDisease, Stroke and Diabetes CCP

� Dr Simon Watkins, Chair, Pan Dorset CCP

� Dr Peter Blick, East LocalityRepresentative

� Dr Rob Childs, West LocalityRepresentative

� Jane Pike, Director of Service Delivery

� Suzanne Rastrick, Director of Quality.

Profiles of members of the Governing Bodyand the register of their interests can be foundon pages 68 to 77.

The Remuneration Committee

The Remuneration Committee makesrecommendations to the Governing Bodyabout the remuneration, fees and allowancesfor senior employees and people who areappointed or who provide services to theCCG. The Remuneration Committee ischaired by David Jenkins, Lay Member Leadfor Patient and Public Involvement andDeputy CCG Chair. Other members are:

� Dr Chris McCall Governing Body,Locality Lead, Assistant Clinical Chair

� Dr Forbes Watson, CCG Chair

� Teresa Hensman, Lay Member Lead forGovernance / Chair of Audit & QualityCommittee

� Mary Monnington, Registered NurseMember


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Engagement: how we work withour partnersEngagement is at the heart of everything wedo and we are committed to meaningfulexternal and internal engagement to helpshape services and improve health outcomesfor the population of Dorset.

Please turn to page 61 for details of how wedo this.

Our future plans and priorities

We have spent time with a number of ourpartners outlining our priorities for the comingyears.

Based on the Department of Health’s Quality,Innovation, Productivity and PreventionProgramme (QIPP), we have integrated thisapproach into all our plans to make sure weare able to reinvest savings required of theNHS over the coming years.

These high-level priorities are consistent withthe priorities identified by both our local Healthand Wellbeing Boards and are:

� improving health and reducing healthinequalities

� integrating and improving services forchildren, young people and their families

� integrating and improving community carefor adults and older people

� improving mental health services

� improving end of life care services

� reshaping acute services, whilstmaintaining access.

These priorities aim to deliver:

� fewer premature deaths

� a better quality of life for people withlong-term conditions

� better recovery from episodes of ill healthor injury

� a positive experience in a safe environmentand protection from avoidable harm.

Our strategy

We have published our five-year strategywhich outlines what our ambitions andpriorities are over the coming years. Thisstrategy also addresses issues and commentsraised by our members, providers, partnersand patients. It focuses on our four strategicprinciples of:

� services designed around people

� preventing ill health and reducinginequalities

� sustainable healthcare services

� care closer to home.

Our initial priorities for the year 2013/14 were:

� improving dementia diagnosis andservices

� reducing avoidable emergency admissions

� reducing preventable deaths.

You can read about our progress againstthese priority areas on pages 14 to 15.

Environmental, social and community issues

You can read more about our commitment tothe environment, community and society inour Sustainability Report on page 52.

Pension liabilities

For more information regarding pensionbenefits and costs please see page 83 in the


Financial Performance section (1.8.2Retirement Benefit Costs and Note 4.5:Pension Costs).

External audit and disclosure

To read the external audit report, please turnto page 4 of 53 in the Accounts Addendum.

Our Governing Body members’ disclosure toauditors is outlined on page 77.

Information governance, complaints andcompliance

For information regarding data loss orconfidentiality, complaint handling and othermatters relating to Principles for Remedy,please see pages 50 to 59 within our Qualitysection. Our Annual Governance Statementon page 6 of 53 (sections 5.5 and 18) in theAccounts Addendum discloses our assuranceprocess regarding these matters.

Equality, diversity and workforce

Policy information regarding our commitmentto equality and diversity, including disabilitiesand gender, is available on pages 51 to 53within the Strategic Report section. Thissection also contains information regardingour approach to employee consultation, whichyou can read under Commissioning SupportDevelopment on page 52.

Emergency preparedness, resilience andresponse (EPRR)

Detailed information on EPRR and how wework with our partners to support the Dorsetcommunity should an incident occur can befound on page 60 to 61.

Progress against targets

Please see the delivery plan progress reporton 14 and 15.

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13


Members of Dorset Ladies County Golf Association keep active at Canford Magna Golf Club

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16


HIGHLIGHTS OF OUR FIRST YEAR

Call 111 for medical helpApril 2013

The new NHS 111 service wasimplemented successfully across Dorsetin April with few of the problems reportedelsewhere in the press and media.

NHS 111 call handling and triage servicesare provided by the South WesternAmbulance Service NHS FoundationTrust.

The aim of the service is to make it easierfor people to access local NHS healthcareservices.

People can call 111 when they needmedical help fast and when it’s not a 999emergency.

111 is a fast and easy way to get the righthelp, whatever the time, day or night,seven days a week.

In excess of 200,000 calls were made tothe service in the first year.

Telehealth referrals reach 300May 2013

The NHS Dorset CCG Telehealth projectteam received their 300th patient referralfor a Homepod Telehealth system in May.

A Homepod is a specialist piece ofequipment that is provided in the patient’shome and is able to take readings andupload results directly to a centralcomputer held at a surgery or hospital.The Homepod reads blood pressure,weight, pulse, temperature and oxygenlevels.

Once installed, the Telehealth equipmentis extremely easy to use. Feedback so farfrom patients and healthcareprofessionals has been very positive.

Telehealth saves time and travel for thepatient as they do not have to attendroutine appointments as regularly as theynormally would. The value of the schemewas recognised by being shortlisted for anational award.

We had some notable successes during our first year inoperation and have launched a range of innovative servicesto improve healthcare in Dorset

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Personal health budgets pilotrolls out for national successMay 2013

The Government has committed the NHSto the national roll-out of personal healthbudgets (PHBs) which were successfullypiloted in Dorset.

From 1 April 2014, CCGs can offer PHBsto people receiving NHS continuinghealthcare. By March 2015 everyone whocould benefit will have the option of aPHB.

Dorset is one of nine ‘Going further, faster’sites which are already offering PHBs. Anational Patient Outcome Evaluation Toolsurvey showed that 92% of Dorsetpatients receiving a PHB reported animprovement in their physical healthcompared to 69% nationally.

Eighty per cent reported an improvementin their mental health against a nationalaverage of 64%.

It also showed that all carers involved inthe pilot felt their views were fully includedin the care planning process.

The Personal Health Budget project inDorset was winner of the Health ServiceJournal Efficiency in Financial Servicesaward in 2012.

Care and CompassionConference a successJune 2013

Compassionate care is as important asthe quality of care and we work withhospitals and services to ensure thatpatients and their families are treated withcompassion.

We brought together health partners andmembers of the public at a conference tolearn how care and compassion iseveryone’s responsibility.

Around 100 delegates representedhospitals, local authorities, serviceproviders and voluntary groups.

Presentations were received fromNational Patient Champion Ashley Brooks,who told of his experiences whilst beingtreated for leukaemia and MRSA, DorsetCounty Council and Dorset HealthcareUniversity NHS Foundation Trust alongwith local hospitals.

London-based Guys’ and St Thomas NHSFoundation Trust showed their award-winning film ‘Barbara’s Story’, which tellsof the experiences of an elderly patientduring a hospital visit and is part of aninnovative dementia training programme.


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The Big Ask tests temperatureof local health servicesJune 2013

Working with local partners, we launchedan ambitious project to get an in-depthinsight into people’s views of Dorsethealth services.

The Big Ask sought views on a range ofNHS services, from local GP and out-of-hours services to community, mentalhealth and hospital services. We wantedto find out how well informed people wereabout the services available locally, howthey choose healthcare and what servicesthey used the most.

We also asked how people think the NHScould provide information in the mosteffective way. Most importantly, we askedfor individual opinions on the NHS inDorset – what people valued most andwhat could be improved.

This is the first time Dorset NHSorganisations have worked together in thisway on an exercise of this scale. Theproject involved Dorset County HospitalNHS Foundation Trust, The RoyalBournemouth and Christchurch HospitalsNHS Foundation Trust and Poole HospitalNHS Foundation Trust and DorsetHealthcare University NHS Foundation Trust.

The Big Ask was carried out byBournemouth University’s MarketResearch Group to ensure itsindependence. More than 12,000 peoplewere sent the survey directly but anyonecould take part and more than 6,000responses were received.

This information will be invaluable whenwe are reviewing and improving services,for example the transformationalprogrammes highlighted on page 50.

Dorset CCG looks to improveservices for those affected byheadachesAugust 2013

Headaches can take many forms andhave a number of causes including stressand lack of sleep.

With around 14% of Dorset residents –over 108,000 people – affected bymigraine or cluster headaches alone, wegathered views on how to improveservices for local sufferers.

As a result of the events, draft proposalsfor new services along with a draft servicespecification have been sent to thosepeople who have registered an interest inheadaches for comment.

More than 10 million people in the UK getheadaches, making them one of the mostcommon health complaints.

Whilst most are not serious and can betreated with some basic remedies orlifestyle changes, some people haveheadaches that are so severe they needto consult medical help.

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Drinkheads: health bodies warnabout mixing alcohol withparentingSeptember 2013

We joined forces with Bournemouth &Poole Local Safeguarding Children Board,Dorset Safeguarding Children Board andPublic Health Dorset to highlight thedangers to parents.

A hard-hitting campaign from local healthpartners was launched in Dorset to alertparents to the dangers of drinking alcoholwhen they are looking after young children.

While thankfully rare in Dorset, there havebeen cases of children coming to harmwhile being under the care of adults whohave had too much to drink.

As part of the campaign, posters have beendisplayed at selected sites in Weymouth,Poole and Bournemouth with radioadvertising running in parallel.

An advertisement also ran in Primary Timesmagazine - 50,000 copies of which wasdistributed to parents through primaryschools across Dorset.

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Study to reduce hip arthritispain launches in Bournemouthand ChristchurchSeptember 2013

A pioneering study to assess the linkbetween regular cycling activity andreduced hip pain or need for hip surgerywas launched in Bournemouth andChristchurch, with local residents beinginvited to sign up and get involved.

Cycling Against Hip Pain (CHAIN) is aconcept proposed by Mr RobertMiddleton, consultant orthopaedicsurgeon and hip specialist at the RoyalBournemouth Hospital, which is a leadingcentre in hip replacement surgery.

The study is based on evidence thatindicates that regular cycling activity andeducation could reduce symptoms forpeople with hip pain, stiffness and arthritisand reduce the need for surgery.

A new patient transport serviceOctober 2013

A new non-emergency patient transportservice for Dorset residents wasintroduced in October. The county-wideservice was designed in consultation withNHS treatment centres and patient groupsto provide an adaptable and reliableservice to the local community.

The service ensures patients with amedical need receive transport suitable fortheir particular health circumstances.Bookings are processed by the DorsetPatient Transport Bureau located inBournemouth.

A separate 24-hour booking line isavailable for NHS personnel bookingtransport on a patient’s behalf.

To ensure all mobility requirements andweather conditions are catered for, acomprehensive fleet of vehicles rangingfrom 4-wheel drive ambulance cars toPatient Transport Service (PTS)ambulances are available.

The new service is run by E-zec Medical,a family-run company set up by formerNHS personnel in 1998.

E-zec Medical operates a number of NHScontracts, including a PTS service inHampshire.

There were some initial teething problemsbecause of heavy demand, but with themobilisation of additional crews, E-zecMedical is now providing a reliable patienttransport service.

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NHS Dorset CCG shortlistedfor leadership programmeOctober 2013

We were delighted to have beenshortlisted for the inaugural GuardianHealthcare Innovation Awards.

We were one of three nominees in thecategory of Leadership Innovation forGreat Leaders for our LeadershipDevelopment Programme.

This was built into transition arrangementsas we moved from our previous primarycare trust status into our first year as NHSDorset CCG.

The aim of Great Leaders was to developclinical leadership and commissioningskills across the NHS.

This is important given the new role GPshave in managing budgets and planninghow NHS funding is spent.

We developed a high-level training andlearning programme for clinicians.

It was designed to enable them to becomeconfident leaders so they can fulfil theirrole as commissioners, lead local healthpriorities and make the best use ofresources as part of the Government’srecent NHS reforms.

Christchurch Health Networkwins national awardDecember 2013

Our Christchurch locality won aprestigious award for Making a Differenceat the NHS Alliance Acorn Awards inNovember for their community health andwellbeing project.

The project, led by Jan Childs, practicemanager of Stour Surgery at the time, wasa winner in the best example of a ‘practiceworking with its community to improvehealth’ category.

The aim of the project was to establish aChristchurch Health Network, which wouldstrengthen links with ChristchurchBorough Council, ChristchurchCommunity Partnership and the voluntarysector.

Feedback to the locality CCG group thenhelps them to improve the health andwellbeing of local people.

Membership of the health network hasnow reached over 175 and includes localgovernment councillors, representativesfrom the health and wellbeing board, thirdsector agencies, police, patients andcarers.

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Video highlights our workwith new mumsMarch 2014

The work of the Maternity, Reproductiveand Family Health commissioning teamhas been highlighted in a video.

Produced by NHS England to mark thembeing a finalist in the NHS EnglandExcellence in Participation Awards, thevideo features interviews with members ofthe team along with local mums (see page35 for more details).

The team was highly commended for theirwork in seeking feedback from localpeople to inform the commissioning ofmaternity services.

The awards were celebrated at the HealthInnovation EXPO 2014 which took placein Manchester.

You can see the video on our website atwww.dorsetccg.nhs.uk

Getting active in Northand East DorsetMay 2013 / January 2014

Two new schemes aimed at helpingpeople to get fit and active have beenpioneered in our North and East localities.

New exercise equipment that is free touse for people living in and aroundBlandford Forum was installed in May,funded by the Blandford Forum TownCouncil and our North Dorset locality.

There is a slightly higher than averagerate of obesity amongst adults in NorthDorset so we hope to encourage them tolead a healthier and more physicallyactive life.

The locality group is working with otherNorth Dorset towns and hopes to be ableto provide similar facilities.

In January 2014, our East Dorset localityworked with Christchurch and East DorsetPartnership (Moors Valley Country Park)and Dorset Partnership for Older PeopleProgramme (POPP) to encourage localpeople to get active.

The initiative Activate East Dorset offers arange of free activities to people who areregistered with local GPs. These include:wellness walks, chair-based exerciseclasses and a green referral scheme.

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We work to ensure our services meet the different localneeds across Dorset through 13 localities

NHS Dorset CCG serves a population ofaround 766,000 people who live in acombination of widespread rural areas alongwith the urban conurbations of Bournemouth,Poole, Dorchester and Weymouth.

All GP practices in Dorset belong to a localitywhich is a geographic area. Each of our 13localities make up the CCG and each has alead GP who also is a member of the CCGGoverning Body.

The Governing Body is responsible forensuring that there are appropriate healthcare services for the people of Dorset.

Localities can help inform and influencecommissioning decisions both within theirspecific area and by working collaborativelywith other localities to improve services acrossDorset.

Each locality is also represented on the localauthorities Health and Wellbeing Boardswhere they work alongside elected councilmembers.

Whilst there are common health needs acrossthe county, the localities ensure that localpopulations have a voice in planning andprioritising health services.

The localities are grouped into three clustersacross Dorset.

The three CCG clusters are:

West Dorset

� Mid Dorset

� North Dorset

� West Dorset

� Weymouth and Portland

East Dorset

� Christchurch

� Central Bournemouth

� East Bournemouth

� North Bournemouth

Mid Dorset

� East Dorset

� Poole Bay

� Poole Central

� Poole North

� Purbeck

You can read more about the lead GP foreach locality on page 68. Locality managersfrom the CCG work alongside the lead GPs,prescribing leads and local clinicians andstakeholders within each of the localitiesensuring that the work of clinicalcommissioners for Dorset and localities isaligned.

OUR LOCALITIES

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Key achievements of the locality teamsduring the year 2013 / 2014 include:

Patient Participation Week took place in earlyJune when members of the engagement teamvisited venues in North Dorset, invitingmembers of the public to come and find outhow they could get involved in shaping localhealthcare in the future.

As part of the implementation of a locally-based 24-hour electrocardiogram (ECG)service, practices in the Mid Dorset localityhave received the equipment and trainingready to start delivery, once the provider isappointed.

This will improve the local cardiology pathway,giving rapid, specialist interpretation ofreadings and a subsequent reduction incardiology referrals and emergencyadmissions for undiagnosed arrhythmiaproblems

During the summer of 2013 members of theWeymouth and Portland locality team helpededucate local people of the dangers of stayingout in the sun without protection.

Working in partnership with a number ofstakeholders the team extended a positive,preventative message through information,awareness, non-clinical advice and a range offree merchandise including 9,000 sachets of

sun screen and 5,000 UV wristbands.

The Safer Sun Initiative worked in partnershipwith a number of stakeholders, includingDorset Cancer Network, Beach Control, RNLILifeguards, beach traders, WeymouthCommunity Volunteers, Weymouth Collegeand local pharmacies.

An initiative to get people active was launchedin Christchurch locality during early 2014 inconjunction with Christchurch and East DorsetPartnership (Moors Valley Country Park) andDorset Partnership for Older PeopleProgramme (POPP).

Activate East Dorset offers a range of freeactivities to people who are registered withlocal GPs.

Dermatoscopes have been purchased forpractices across Purbeck. These will supportlocal dermoscopy services. This is adiagnostic technique used for mole screeningand skin cancer diagnosis. We are sure theywill be of great benefit to local people.

The funding of new exercise equipment that isfree to use for people living in and aroundBlandford Forum.

The equipment has been funded by theBlandford Forum Town Council and NHSDorset CCG’s North Dorset locality.

OUR LOCALITIES


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The Cardiovascular Disease, Stroke andDiabetes Clinical Commissioning Programmeis working to:

� develop a balanced approach to all aspectsof care for people with heart disease

� ensure that people who are having a strokeor have had a TIA (mini stroke) can accessspecialist services 24 hours a day, sevendays a week

� further develop community-based servicesfor people with diabetes, helping to preventcomplications of the disease and enablingthem to receive care closer to home.

While the CCP is working towards providingthe best possible service to stroke patients,steps were also taken during the year to helpprevent people having a stroke in the first place.

In Weymouth and Portland, most GP practicesin the area joined a pilot project to offer peoplea pulse check when they attended flu jabsessions.

One practice carried out a one-month in-house campaign. The aim was to identifypeople with atrial fibrillation (AF), anabnormally fast or irregular heartbeat that canlead to stroke in the future.

If one was detected, an electrocardiogram(ECG) was offered to check electrical activityin the heart and, if that confirmed atrialfibrillation, the patient could be started onmedication.

A total of 6,086 patients were screened and256 found to have an irregular pulse. Somepeople declined to go on for an ECG, but 165patients did have the examination and 22were diagnosed with AF.

The project was not only potentially of greatbenefit to patients with AF who could havegone on to have a stroke, but was costeffective too. It was calculated that by avoidingpotential strokes, every £1 invested in theproject could lead to a saving of £220 to theNHS.

We have a number of Clinical Commissioning Programmes(CCPs) working across Dorset to consider how healthcareservices can be improved. CCPs are led by local GPs.

Mrs PeggyHansford (86)guessed thatsomething waswrong when shewas not able towalk as far as thebus stop she hadalways used andwas ratherbreathless.

‘I was not reallyable to do the things I used to do,’ saidMrs Hansford. But she was caring for herhusband John and didn’t go to the doctors.Then she had her pulse checked whenshe went for her flu jab in the autumn andthat gave her the reason why.

A follow-up ECG confirmed that she hadatrial fibrillation and she is now relievedthat she is on medication to help her avoidhaving a stroke. She has regular checks atLanehouse Surgery in Weymouth.

‘I have been coming to the doctor’s atLanehouse since 1950 when the GP thenheld his surgeries at his home,’ said MrsHansford. ‘They are very good – and theywere always good to my husband too. Ifeel very supported. They are almost like apart of my family.’

CLINICAL COMMISSIONING PROGRAMMES

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Cardiovascular, Stroke and Diabetes CCP

Clinical Chair of the CCP isGP Dr Craig Wakeham. He says,

Despite significantimprovements, coronary heartdisease is the biggest singlecause of deaths in the UK. Every year thereare approximately 152,000 strokes in thecountry, which can lead to severe disability.

There is a considerable rise in the numberof people diagnosed with type 2 diabeteswhich can lead to serious health problems inthe long term. Many more people arethought to have diabetes without knowing it.

This CCP team is working in many differentways to help people lower their risk ofbecoming ill with these diseases.

Eating healthily and taking more exercisecan lower the risk of all three, so we shalllook for ways of helping them to do that.

We shall ensure that if they do become ill,they receive the right treatment, promptly.For example, the speed with which peoplewho have strokes are treated can make ahuge difference to the severity of anydisability they may suffer.

Prevention is better than cure, so we shalltry to identify people at risk of developing illhealth. The atrial fibrillation pilot project (seepage 25) is an example of early intervention.

Helping people to live healthier lives is reallya joint project between them and the NHSand our partners who provide care for them.

We shall work to ensure that people havethe information and support they need tomake the healthy choices that can be ofbenefit to individuals and their families.

‘

’

Another successful project launched during theyear was the self-care My Health My Wayservice aimed at improving the lives ofpeople with long-term conditions, includingdiabetes.

My Health My Way offers information andsupport, giving patients more control andconfidence over their lives and helping themovercome some of the challenges they face.

They are helped to build and maintain theconfidence to self-manage problems like painor fatigue, exercise or dietary changes, anxietyor depression.

That help could be delivered through one-to-one coaching, telephone support, group work,online tools or structured support groups.

People can be referred by their doctor,pharmacist or other health professional or referthemselves.

The service has a dedicated telephonenumber, email address and websitewww.myhealthdorset.org.uk.

Patients with long-term conditions wereinvolved in every stage of the development ofthe project, including during the procurementprocess when it was decided who shouldprovide the service.

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The priorities for the Mental Health andLearning Disabilities Clinical CommissioningProgramme (CCP) are to:

� review and improve the pathway forpeople who have acute mental healthconditions

� review and improve older peoples’ mentalhealth services and increase earlydiagnosis of dementia in our prevalentpopulation

� using learning from the Confidential Inquiryinto Premature Deaths of People withLearning Disabilities (CIPOLD) and theWinterbourne View report, further improvelearning disability services that areprovided jointly by the NHS and our localauthorities

� improve primary care mental healthservices including access to psychologicaltherapies.

The CCP team is working to ensure thatmental health is valued equally with physicalhealth to achieve ‘Parity of Esteem’. It is alsoworking to provide services that are of aconsistently high quality across Dorset forpeople with learning disabilities, dementia andmental health conditions.

Existing services are being reviewed,redesigned if necessary and commissioned inthree main areas:

Mental Health, which includes:

� services for people who are acutely ill

� rehabilitation services for people who arerecovering

� Steps to Wellbeing, a free, confidentialservice for people aged 18 and overoffering a range of different types oftreatment for low mood or depression,anxiety or stress

� assisting people to gain employmentwhen able

� specialised services for people withconditions such as adult eating disordersand Asperger’s assessment and diagnosis.

During this year we have commissioned aCommunity Asperger’s Assessment Serviceacross Dorset, which will go live in early 2014/15.

We have also implemented the mental healthurgent care service in the west of Dorset,including the launch of a recovery house inWeymouth. This led to an increase in crisisresponse home treatment staff, who work tokeep people in their own homes, preventinghospital admissions.

The recovery house run by Rethink MentalIllness was a first for Dorset CCG. It opened inApril 2013 with seven beds for peoplerecovering from acute mental health crisis.

Dementia

The CCG commissions services, often inpartnership, for people living with dementiaand their carers. This includes inpatientservices, the memory assessment service andmemory support and advice services.

We are working with our three local authoritiesto commission a pan Dorset memory supportand advisory service for people living withdementia and their carers.

We have significantly improved dementiadiagnosis rates in Dorset and piloted aninnovative service to help people to gainsupport and advice: the Dorset MemoryGateway.

Learning Disabilities

The White Paper Valuing People defineslearning disability as meaning the presence of:a significantly reduced ability to understandnew or complex information, to learn newskills (impaired intelligence) with a reducedability to cope independently (impaired socialfunctioning) which started before adulthood,with a lasting effect on development.

Mental Health and Learnng Disabilities CCP

28


We commission health services specifically forpeople who have a learning disability. Theseinclude the community learning disabilityteams, which are jointly staffed by localauthorities and the NHS, and an intensivesupport team.

A key focus is to ensure that learning from theWinterbourne View Hospital in Bristol, wherethere was criminal abuse of patients by staff,is taken into consideration and, whereclinically appropriate, as few people aspossible are placed in units outside of theirhome area.

We also work with providers to improve howpeople with a learning disability accessservices and how providers make reasonableadjustments.

Mental Health and Learning Disabilities CCP

Forum values opportunity tohave a say in future servicesChief executive of the West Dorset MentalHealth Forum is Becky Aldridge (picturedabove). She says,

The Dorset Mental Health Forum is anindependent local charity run and led bypeople with lived experience of mental healthproblems and access to services.

We employ people with their own experiences

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Clinical Chair of the CCP isGP Dr Paul French. He says,

One of the principal aims of this CCPteam is to ensure that people with a mentalillness or condition are assessed andtreated by services that are on a par withthose available for people with physical illhealth. This is called Parity of Esteem.

One significant illness which is going tobecome more common as the populationages is dementia. This is a devastatingillness for them, their families and carers.

Before we can help to improve their lives,we need to know who they are, so promptdiagnosis is really important.

We are working hard with the DorsetDementia Partnership to identify dementiapatients early and improve services overall,for them and their carers.

Dementia is a progressive illness but thereis much we can do to help people maintainas good a quality of life for as long aspossible.

For other mental illnesses, the emphasis ison recovery.

To help patients we offer treatment andsupport, exploring ways in which they cangain employment if they are well enough,and play a positive role in their families andlocal communities.

People with learning disabilities are athigher risk of developing certain healthproblems.

We want to ensure they have good accessto health checks so that any problemscan be disagnosed early and treatedeffectively.

‘

’

of mental health problems and we have abroad constituency of people across Dorsetwho are interested and engaged in our work.

Being able to represent the experiences andviews of people with mental health problemsand advocating for services that promotewellbeing and enable recovery is a vital part ofour work in Dorset.

Being part of the CCP team and having avoice within commissioning projects gives usthe opportunity to act as a critical friend and tobring the customer and patient experience tothe heart of the CCP’s business.

We believe that this perspective brings anecessary and sometimes challengingdimension to the CCP’s work in a way that caninfluence and shape services.

We particularly support the CCP’scommitment to ensuring that mental healthhas equal priority with physical health.

As No Health without Mental Health states,‘good mental health and resilience arefundamental to our physical health, ourrelationships, our education, our training, ourwork and to achieving our potential.’

We also welcome the CCP’s review of existingservices, ensuring that providers aredelivering ‘recovery-oriented services that aimto support people to build lives for themselvesoutside of mental health services with anemphasis on hope, control and opportunity.’

We believe that these principles andaspirations sit firmly with ensuring that peoplewith mental health problems have choice andaccess to the right services at the right time,including early intervention and availability ofservices as soon as they are needed, in theleast disruptive, least restrictive and leaststigmatising way.

Mental Health and Learning Disabilities CCP

30


Priorities for the Musculoskeletal and TraumaClinical Commissioning Programme are to:

� develop a comprehensive community-basedmusculoskeletal service

� embed the new approach to themanagement of chronic persisting pain andextend to other areas

� ensure we maximise patient outcomes fromelective surgery.

During the year we have been developing anew care pathway for people suffering fromspinal pain. A project group has beenestablished to agree a service specification,consider the impact this will have on currentservices and engage with patients.

We have also commissioned a new DorsetCommunity Persistent Pain Service from DorsetHealthcare University NHS Foundation Trust.Roll-out of the pain service began in EastDorset in 2013/14 and consultants will be inpost in Bridport Hospital in West Dorset in June2014. See next page for examples of how thisservice is working in action.

We are ensuring that patients of the orthoticsservice receive the same standard of careacross Dorset by drawing up a pan Dorsetservice specification.

The orthotics service provides patients withexternal devices on weak or injured joints thatneed support, for example elbows and wrists.

Oxford Score templates have been provided toGPs to help them assess whether people withhip and knee problems should be referred to aspecialist. Patients are asked to ‘score’ theirpain and mobility difficulties in several activities,for example washing or kneeling. This enablesthe GP to reach an overall assessment of theirproblems and to decide the best course ofaction for them.

Use of the scoring system has led to improvedreferrals, a reduction in waiting times and

improved outcomes for patients. A review ofphysiotherapy services is under way. Allpractice managers, GPs and patients usingservices at our providers are being surveyed.

Clinical guidelines and service specifications willthen be agreed with clinicians andcommunication and training materialsdeveloped for primary care. The public will beconsulted as the service develops.

One of the most significant advances in thetreatment of rheumatoid arthritis in recent yearshas been the development of a group of drugscalled biologics.

Following discussions with rheumatologyspecialists, a service specification has nowbeen drawn up for the use of these drugs totreat psoriatic arthritis and ankylosingspondylitis as well.

The musculoskeletal five-year vision andstrategy project team has been formed tooversee the development and implementation ofservices from 2014/2019.

Patients, carers and the general public will be atthe heart of this work and their views and inputwill drive it forward. Their interest wasdemonstrated by an excellent turn-out for ourfirst public and patient event in February.

Musculoskeletal and Trauma CCP

31


Patients feel the benefitthanks to new pain serviceFor more years than she can remember,Judith Watson has been in pain.

She has scoliosis, an abnormal curvature ofthe spine, and multi-level spondylosis thatincludes age-related wear and tear in herneck.

‘Everything I do is difficult and painful and thatcan lead to all sorts of things, includingdepression,’ she said.

Over the years, Mrs Watson (pictured with herhusband Peter, above right) has had X-ray-guided injections, that helped for a time butalways wore off before the next one wasgiven. ‘Medication helps too but makes mevery tired and I am fighting my eyelids byteatime,’ she said.

But now, she is benefiting from the newDorset Community Pain Service that cameinto operation during the year and aims to seta world-class standard.

Mrs Watson now receives injections at moreregular intervals that she finds beneficial.

The pain service team includes, Dr NaeemAhmed and Dr Mohamed El Toukhy, the PainConsultants, GPs, counsellors, occupationaltherapists, specialist pain physiotherapists,

nurses, and psychology and therapyassistants. The service includes a holisticapproach to pain and Meherzin Das is thelead for this aspect of the service.

It has a ‘Soaring Above Pain’ website forservice users and professionals. The sitefeatures a virtual ‘patient platform’ specificallyfor people who can set and monitorpersonalised goals, obtain information aboutself-management of pain and generally benefitfrom contact with an online community thatunderstands how they feel.

Discussions are taking place with DorsetCounty Council to set up free bespoke classesfor pain patients and free Tai Chi courses arealready on offer in Poole, Bournemouth andBlandford. Coffee mornings are organised andthere is a quarterly newsletter.

A Pain Chain peer support system trainspeople who have already been throughthe pain service to mentor others whoare struggling with their condition.


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Mrs Watson has found the pain managementprogramme particularly effective. ‘It’s veryhelpful to understand how pain works to tryand adjust your attitude to it and “shut the paingates” before it takes over,’ she said.

On one session, Mrs Watson and her fellowparticipants were asked to visualise their painand then think of something that would be anantidote to it. She visualised red hot metal andthen poured cold water on it.

‘It was very, very helpful. At the end almost allof us had reduced our estimation of our pain,’she recalled. ‘They are teaching us the tricksof the trade.’

Mrs Di Smith, who has had severe arthritissince 1976, agreed on the value of theservice.

‘I believe that if I had been referred to a painmanagement service all those years ago, Iwouldn’t be as bad as I am now,’ she said.

‘I would have been taught exercises and howto sit and stand properly to help my joints lastlonger.’

Her husband suffers from arthritis in his neckand spine. Both need regular X-ray-guidedinjections.

Both couples played an important role in theconsultations that took place before the newservice was commissioned through focusgroups and discussions, including helping towrite the service specification, in which bettercommunication was a key requirement.

‘When you ring the pain service now younearly always get to talk to someone insteadof an answerphone. If you have to leave amessage they will phone you back.

‘That’s important because a lot of the timewhen you make that phone call you areat the end of your tether.’

Both couples welcomed the more timelyguided X-ray service and hoped that when allthe patients who need treatment for pain areidentified the correct timetable for each patientcan be maintained.

They also hoped that once the service is fullyup and running it will be a real ‘community’service and available as close as possible totheir homes.

These are some of the challenges faced byCCGs when they are planning localhealthcare and it’s why involving patientswhen reviewing services is so important andvaluable.

Clinical Chair of this CCPis Dr Christian Verrinder.He says,The CCP has achieved a lot

in the last year.

The implementation of the new persistentpain service was always going to be achallenge but has been successfullyembedded now into the Dorset Healthcaresystem.

We have taken on some ambitious areas toreview this year including physiotherapyservices, a five-year vision and developingthe service specification of an exciting newback pain service.

The engagement from patients,stakeholders and clinicians alike hasbeen really encouraging.


‘

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Maternity, Family Services and Reproductive Health CCP

The Maternity, Reproductive and FamilyHealth Clinical Commissioning Programmeteam is working to improve the health of thefamily in several different areas. These arelisted with their individual objectives below:

Maternity

We will work to provide a maternity servicethat is of an equally high standard acrossDorset and that meets the identified needs oflocal mothers-to-be and their families.

We have worked closely with local women andfamilies to seek their views on key prioritiesfor development of maternity services inDorset.

This work led to us being finalists in the NHSEngland Excellence in Participation Awards.

The results of this feedback, as well as thework we have done with our widerstakeholders, has now led to the developmentof a pan Dorset strategy for maternity servicesfor the next five years.

Our vision is that maternity services in Dorsetwork proactively with partners to supportwomen and families to give their children thebest possible start in life.

We want high quality, safe and personalised

services that can meet the needs of allwomen and families and are delivered in asustainable, evidence based, responsiveand compassionate way.

Reproductive and gynaecological services

We will work to ensure that all aspects ofgynaecological care are of a high quality.

During the year we re-commissioned fertilityservices and introduced changes that widenthe age limits that women living in Dorset canqualify for in vitro fertilisation (IVF) from April 12014.

We plan to consult widely on further changesduring the coming year.

We have also carried out a local review oftermination of pregnancy services and will beimplementing its recommendations during thecoming year.

Children with additional needs/disabilities

Children and young people with additionalneeds/disabilities will have their healthcareneeds met in the local community whereverpossible.

To help us do this we have commissionedadditional occupational and physiotherapy

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support for children with complex needs andalso improved services available for childrenneeding palliative care.

A review of services for children with AttentionDeficit Hyperactivity Disorder and AutisticSpectrum Disorders has been carried out andthe findings will be implemented in the comingyear, for example developing pan Dorset jointcare pathways.

Working with partners, we plan to fullyimplement the health elements of the SpecialEducational Needs and Disabilities Bill, whichwill simplify the assessment process forchildren with special educational needs anddisabilities who require support from variousagencies.

They will receive a single education, healthand care plan and every provider of serviceswill be required to publish an offer of servicesto this group of children and young people.

Children with chronic disease or who are inneed of urgent care

We will work to provide high-quality care forchildren and young people with chronicdiseases across Dorset.

For example, we have increased the provisionof insulin pumps for children with diabetes.We have also reviewed communitypaediatric services and will be introducing apan Dorset model of care to ensure all

children in Dorset have access to nursingcare in the community when they need it.

By supporting families and carers, makingsure they are well informed about the healthcondition their child has, and by providingtraining for healthcare professionals in primarycare, we aim to reduce inappropriate A&Eattendances and hospital admissions.

Health outcomes of vulnerable children

The health outcomes of vulnerable and hard-to-reach children, young people and familieswill be improved.

During the year we enhanced services forchildren who are Looked After (in the care ofthe local authority) to ensure that each childhad a timely assessment of their health needsand a plan of how these should be met.

We also improved medical services forchildren who have been abused, ensuringthey have access to health assessments.

Improvements will continue to be made duringthe coming year. The effectiveness and qualityof the services we provide will be monitoredand a designated nurse appointed specificallyfor children who are Looked After.

Comprehensive Child and Adolescent MentalHealth Services (CAMHS)

We will work to provide a comprehensiveCAMHS to meet the identified needs ofchildren and young people

Work has continued with our partnersthroughout the year to implement the panDorset CAMHS Strategy.

We have also reviewed services for childrenwith learning disabilities and additional mentalhealth needs and will implement the findingsof this review in 2014.

These include development of a pan Dorsetpathway of care.


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When it comes to understanding pregnancy,childbirth and those first days and weeks of ababy’s life, there is no-one more qualified tohelp than new mums.

So when we were deciding our priorities forthe development of maternity services, weasked for their views.

We made use of the social network Facebook,which has links to opinion polls and onlinesurveys. That gave us very useful objectivefeedback which we could use in staff training.

A young mum gave a powerful and movingaccount of her struggle with anxiety anddepression after her baby was born which wasanonymised and shared with midwives, healthvisitors and other members of staff developingour commissioning strategy.

Another mum Hannah Baker said that at firstshe did not see how anything she said couldcontribute to future services.

‘I have been amazed that so much had been

Clinical Chair of theMaternity, Reproductive andFamily Health is Dr KarenKirkham. She says,

The CCP team has had a busy yearcompleting the work that was prioritised in2013, including the increased provision ofinsulin pumps for children, more speech andlanguage therapy services and developmentof a pan Dorset palliative care service forchildren.

Alongside this we have been taking forwardthe development of the Maternity Strategyand review of community paediatric services

We have built strong links with acute andcommunity providers, and developed astrong and collaborative commissioningrelationship with our local authoritycolleagues across Dorset, which will lead toimproved commissioning of services forchildren.

We will continue working to improvecommunication with our GP colleaguesregarding new guidelines and improvementsin services with a focus on quality andequity of access to services.

taken into account and there’s a huge amountof outcomes as a direct result of being part ofthe parents’ feedback,’ she said. An online pollalso sought the views of other families togather a range of opinions and suggestions.

Mums highlighted the importance ofbreastfeeding support. As a result shortsoundbites of women talking about theirexperiences are now on our website andavailable for staff.

Mum Lucinda Holman added: ‘Someoneasking how it was for you and what can we doto improve services was really amazing.’

Mums project wins praise

Mum Hannah Baker (centre) with NatalieBain (left) and Frances Aviss of the CCG.

‘

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General Medical and Surgical CCP

The General Medical and Surgical ClinicalCommissioning Programme is working to:

� develop comprehensive communityservices for common conditions so thatpatients can receive their care closer tohome

� review, design and deliver new models ofcare across a number of priority areas toimprove patient outcomes

� ensure that patients receive the right carein the right place.

The new Dorset Adult Integrated RespiratoryService is one example of how theprogramme is meeting these priorities. Thisservice will mainly help people with:

� moderate to severe chronic obstructivepulmonary disease (COPD), a collection oflung diseases including chronic bronchitis,emphysema and chronic obstructiveairways disease

� bronchiectasis where the airways of thelungs become abnormally widened, leadingto a build-up of excess mucus that canmake them more vulnerable to infection

� pulmonary fibrosis, a rare andpoorly-understood condition that causesscarring of the lungs.

People who have one of these diseases aremore likely to have frequent emergencyadmissions to hospital.

To help avoid these admissions, the newservice will enable them to have specialistrespiratory care in the community, closer tohome.

The service extends existing best practice,including early discharge from hospitalwhen admission is unavoidable.

Specialist respiratory nurses working partly inthe community and partly in hospitals to

support patients can enable them to go homeearlier than otherwise might have been thecase.

They can also signpost patients to a range ofadditional services to help them live with andmanage their conditions.

GPs can contact the service for advice andguidance and refer to the specialist respiratoryteam in the first instance, which may avoid thenecessity to admit a patient to hospital.

The new service will be based in the threeacute hospitals in Dorset which will act ashubs to serve the local population.

The Royal Bournemouth Hospital, DorsetCounty Hospital and Poole Hospital arecurrently developing their plans to deliver thisnew service.

There has been wide consultation withclinicians and GPs and a patient referencegroup has met regularly to comment on allstages of the process as the servicespecification has been drawn up.

Michel Hooper-Immins, a member of thegroup and chairman of the Weymouth Locality

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General Medical and Surgical CCP

Network and governor of Dorset CountyHospital, said,

I enjoyed the patient respiratory referencegroup today. I hope it is the start of a usefulexercise in patients influencing the scope andcourse of their future treatment.

As the new service is phased in, the group willcontinue to provide regular feedback, whichwill be taken into account as it develops.

In addition, a patient-reported experiencemeasure will be used to ensure a genuineunderstanding of the patient’s experience.

This new service will be implemented inphases from April 2014 and will includeeducation and training for primary care staff.

Events to promote the new service withprimary care will continue until the newservice is fully phased in.

One of the more common ailments that canseriously affect people’s lives is the headache.

With around 14% of Dorset residents – morethan 108,000 people – affected by migraine orcluster headaches alone, we gathered viewson how to improve services for local sufferers.

One way we did this was to hold a headachediscussion forum at Sturminster Newton.

One participant said,

It’s great that at last people’s opinions arebeing listened to – it’s people living withconditions who know!

‘’

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Clinical Chair of the CCP isDr Chris McCall, who says ofthe new respiratory service,

This project not only delivers equitablecare across Dorset, it helps to meet thewishes of those patients who told us theywanted a proactive, supportive andintegrated healthcare system thatresponds to their needs 24 hours a day,seven days a week.

The links between the specialist respiratoryteam and the team providing ongoing carewill be an important development forimplementation across other clinical areas.

‘

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Cancer and End of Life CCP

The Cancer and End of Life ClinicalCommissioning Programme team is working to:

� reduce cancer deaths through earlydiagnosis

� improve the experience of patients

� recognise and support their needsthroughout treatment and afterwards

� improve end-of-life care for all patients,whatever disease they have and whereverthey spend their last weeks and days

� provide an effective and cost efficientservice.

Improvements in treatment means more peopleare surviving cancer but survival rates in the UKare not as high as the best in Europe and varyacross the country.

By diagnosing cancer at an earlier stage, andensuring access to the best treatment, it ishoped that significant improvements in survivalrates can be made. This year for example wehave:

� supported the Be Clear on CancerCampaign, raising awareness of thesymptoms of cancer

� refreshed the cancer two-week wait referralguidance to make sure anybody with cancersymptoms is referred at the right time to theright place

� appointed two Macmillan GPs to promotebest practice in cancer and end-of-life care.

Most patients would prefer to receive their careand treatment closer to home, reducing thenumber of follow-up hospital visits and theamount of travelling they have to do.

We support this where possible, with the focusinitially on suitable patients with breast cancer,prostate cancer and colorectal cancer.

Patients living with cancer in the long term andthose who are clear of the disease after

treatment may still need some support, whichneed not necessarily be clinical.

We work with partners to provide this in thecommunity and one example is the creation of acommunity choir (see next page) which canhave a very beneficial effect on its members.

End of Life

Since the launch of the national End of LifeCare Strategy, we have maintained our focus onproviding the best care possible for peoplewhose lives are coming to an end.

The publication Planning For Your Future guideencourages patients to ensure their last wishesare written down and can be acted upon whenthey die.

An End of Life Care website has been launchedand education and training programmes put inplace to promote best practice to those involvedin the care of the dying. This has included:

� a conference for more than 300 participants

� the roll-out of the national Gold StandardFramework (GSF) programme across carehomes, primary care, acute and communityhospitals

� the selection of Dorset as one of three GSFIntegrated Cross Boundary Caredemonstrator sites

� the launch of end-of-life care accreditedtraining for people working in patients’ homesand care homes.

In drawing up our priorities, we have consultedwidely and made significant progress indeveloping joint working with patients and local,regional and national partners such as NHSEngland, Macmillan, Cancer Research UK andthe Dorset Cancer Alliance.

An independent review of all health servicesprovided to end-of-life patients has been carriedout. There is widespread consultation on theoptions recommended which may become partof the CCP during 2014/15.

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Cancer and End of Life CCP

Rising Voices Wessex is a community choirfor local people living with and beyond cancer.

It was set up after the Living Well With AndBeyond Cancer In Dorset conference, byVerena Cooper, lead nurse for Dorset CancerNetwork, and Dr Alastair Smith, clinicaladviser to the National Cancer SurvivorshipInitiative.

The project rationale was that singing is fun,and good for you. It can help with breathing,combat fatigue and restore confidence.

It doesn’t need to be complicated orexpensive, you do not even need to be able toread music or sing, but it will help to regain asense of wellbeing.

You can sing for fun - everyone can! As onemember commented,

I want to say how much I enjoyed choir lastevening! What a lovely friendly, cheerfulcrowd of people. I will definitely be back nextweek!

I got home last night and couldn’t rememberany of the tunes to the words I had, but wokeup this morning with the melody of ‘Sing’ in myhead – how amazing was that!

The project is a co-operative venture betweenthe CCG, Dorset Cancer Network, LewisManning Hospice, Macmillan Cancer Support,Dorset Cancer Network Patient PartnershipPanel and Lighthouse in Poole.

Singing the blues away . . .

PicturecourtesyofLewisManningHospice

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Clinical Chair of the CCPis Dr Lionel Cartwright,who says,Despite the relatively high

incidence and prevalence ofcancers in the CCG area, Dorset cancerpatients experience outcomes, survivorship andlife expectancy on a par with the best in thecountry. This is a tribute to the skills of ourclinicians, the tenacity of our patients and thesupport of their families and friends. We are notcomplacent and we aspire to achieve healthoutcomes that match the best in the world.

We are working to raise cancer awareness asmany cancers can be treated successfully ifdiagnosed early. The Be Clear on Cancercampaign has led to an extra 300 cases of lungcancer being identified and treated nationally.We urge people to seek a diagnosis at the firstsigns of a problem.

Non-clinical activities can help maintain a goodsense of wellbeing, even while receivingtreatment. Such projects as ‘Rising VoicesWessex’ provide a chance to have fun which,with healthy eating and regular exercise, canmake a real difference to how people cope.

For people nearing the end of their lives, we areworking with specialist and community-basedservices to provide sensitive and personalisedcare, designed around the individual andprovided closer to home. The patient will alwaysbe at the forefront of services in the future.

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Our business model

NHS Dorset CCG was created on 1 April2013. Our mission is to support people inDorset to lead healthier lives.

To read more about our role as commissionersof healthcare for the county of Dorset, and ouraims and values, please turn to pages 8 and 9within our Governing Body / Members Reportsection. To understand how we work, pleaseturn to pages 48 to 50 in this section.

Our licence conditions

NHS Dorset CCG was created and fullyauthorised without conditions.

Our strategy

You can read more about our strategy andpriorities including the three pan Dorsettransformational programmes on page 11 ofour Governing Body / Members’ Report aswell as within our Business Review on page50 in this section.

You can read more about how our strategy willsupport these challenges, including the threepan Dorset transformational programmes onpage 46.

CCG Assurance Framework

Our assurance framework section outlineshow the CCG has discharged its duties underthe amended NHS Act 2006.

A range of examples within this annual reportevidences how we have applied the requiredassurance frameworks to our business.

We have ensured health services are providedin line with the NHS Constitution targets –more information is available on page 44.

We are committed to supporting the NHSConstitution among patients, public and staff –more information is available on page 46onwards. We also ran a media campaign onlocal radio throughout Dorset from January-

March 2014. The aim of this campaign was tohelp people understand what the NHSConstitution means to them and we developedwebsite information for them to download andcomment upon.

NHS Dorset CCG has supported NHSEngland in ensuring high quality primarymedical services have been maintained.The CCG has indicated that it would wantto further enhance its role to includedeveloping primary care and is discussingwith NHS England

We actively encourages patient choice andthe member practices promote and encouragethe use of Choose and Book services, withvery high levels of usage across the whole ofDorset.

We promoted the involvement of patients,carers and their representatives in decision-making.

Page 22 in our Highlights of the Year sectioncites an example from our work with maternityservices, which was highly commended byNHS England.

We have also been commended for our workin innovation, leadership, education andtraining in the Guardian’s HealthcareInnovation awards (see page 21).

We consulted widely when drawing up ourcommissioning plans. From a range ofengagement events with our stakeholders(see page 2) to a large-scale public surveycalled the Big Ask developed with our otherNHS partners (see page 18).

We have also developed a wide range ofengagement and feedback channels to ensurepeople can get involved in our work. Readmore on pages 61 to 62 and on our backcover.

Through our dedicated emergencypreparedness and resilience team, we havetaken appropriate steps to ensure the CCG

STRATEGIC REPORT

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and its providers are properly prepared for anyincidents. More information on these plans isavailable on pages 60 to 61.

We have cooperated with our Health andWellbeing boards to align our strategy (seepages 11 and 62). We have also worked withour local authorities to prepare Joint StrategicNeeds Assessments (page 48).

Our Quality team takes responsibility for childsafeguarding. Read more about their work onpage 55. We also have a dedicated clinicallead – Dr Peter Blick – for child and adultsafeguarding (please see page 70).

NHS Dorset Clinical Commission Group

certifies that it has complied with the statutoryduties laid down in the NHS Act 2006 (asamended).

Financial Key Performance Indicators (KPIs)

More information regarding our KPIs can befound on pages 14 to 15 within our GoverningBody / Members Report section.

Additional information on KPIs can be found inour financial tables. Specific areas to highlightare: revenue surplus (see next page), staffcosts and average persons employed (seepage 87), running costs (see page 86) andBetter Payments Practice Code (seepage 88).

STRATEGIC REPORT


STRATEGIC REPORT

Financial Overview

We achieved our financial duties for 2013/14 and delivered a surplus of £12.6 million, whichincluded a surplus of £2 million on the CCG running cost allowance, which is set nationally at £25per head of population. This was delivered against the revenue resource limit of £928.4 million anda running cost allowance of £18.7 million, respectively. By spending less on our running costs, weare able to spend more on direct patient care.

There have been a number of challenges for the CCG in the 2013/14 financial year, not least ofwhich was ensuring that the baseline funding from the legacy PCTs was with the rightcommissioner. The biggest challenge in this context was in respect of specialist commissioning.Transfer adjustments were agreed in September 2013 with NHS England.

The CCGs annual revenue performance is set out in Table 1.

Table 1: Summary of 2013/14 Revenue Performance

Although the CCG was only required to deliver a 1% surplus, the decision was taken to maintainthe legacy Dorset PCT and Bournemouth and Poole Teaching PCT levels going forward.

Analysis of Net Operating Costs 2013/14

Performance

The final performance against the 2013/14 indicators will not be available until later in the year, theresults will be published on the CCG's website. The CCG continues to monitor performanceagainst national quality standards and performance against QP (Quality Premium) indicators. Thefollowing position is based on the latest performance.

2013/14 2013/14 2013/14

£'000 £'000 £'000

Programme Running Costs Total

Revenue Resource Limit 928,367 18,730 947,097

Under spend againstRevenue Resource Limit 10,614 2,000 12,614

Percentage under spend 1.1% 10.7% 1.3%

£m

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National Quality Standards Indicator definition Rating

Referral to Treatmentwaiting times for non-urgentconsultant-led treatment

Admitted patients to start treatment within a maximum of 18 weeks from referral(specialty level) Achieved

Non-admitted patients to start treatment within a maximum of 18 weeks from referral(specialty level) Achieved

Patients on incomplete non-emergency pathways (yet to start treatment) should havebeen waiting no more than 18 weeks from referral (specialty level) Achieved

Zero tolerance of over 52 week waiters Achieved

Cancer waits - 2-week waits

Maximum two-week wait for first outpatient appointment for patients referred urgently withsuspected cancer by a GP) Achieved

Maximum two-week wait for first outpatient appointment for patients referred urgently withbreast symptoms (where cancer was not initially suspected) Achieved

Cancer waits - 31 days

Maximum one month (31 day) wait from diagnosis to first definitive treatment for allcancers Achieved

Maximum 31 day wait for subsequent treatment where that treatment is surgery AchievedMaximum 31 day wait for subsequent treatment where that treatment is an anti-cancer drug regime Achieved

Maximum 31 day wait for subsequent treatment where the treatment is a course ofradiotherapy Achieved

Cancer waits - 62 days

Maximum two month (62 day) wait from urgent GP referral to first definitive treatmentfor cancer Achieved

Maximum 62 day wait from referral from an NHS screening service to first definitivetreatment for all cancers Achieved

Maximum 62 day wait for first definitive treatment following a consultant's decision toupgrade the priority of the patient (all cancers) Achieved

Category A ambulance callsCategory A Red 1 calls resulting in an emergency response arriving within 8 minutes AchievedCategory A Red 2 calls resulting in an emergency response arriving within 8 minutes AchievedCategory A calls resulting in an ambulance arriving at the scene within 19 minutes Achieved

Diagnostic test waiting times Patients waiting for a diagnostic test should have been waiting no more than 6 weeksfrom referral Not Achieved

A & E waitsPatients should be admitted, transferred or discharged within 4 hours of their arrivalat an A&E department Achieved

No waits from decision to admit to admission (trolley waits) over 12 hours Not Achieved

Mixed Sex Accommodation Sleeping accommodation breach Achieved

Cancelled operations

All patients who have operations cancelled, on or after the day of admission(including the day of surgery), for non-clinical reasons to be offered another bindingdate within 28 days, or the patient's treatment to be funded at the time and hospital ofthe patient's choice.

Not Achieved

No urgent operation to be cancelled for a 2nd time Achieved

Mental HealthCare Programme Approach (CPA): The proportion of people under adult mentalillness specialties on CPA who were followed up within 7 days of discharge frompsychiatric in-patient care during the period

Achieved

Infection ControlZero tolerance of MRSA Not Achieved

Rates of Clostridium Difficile Achieved


2013/14

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STRATEGIC REPORT

Although NHS Dorset CCG did not achieve in 2013/14 six of the national quality standards shownon page 43, we continue to make progress against them through regular contract review meetingswith providers.

Some further details are provided below:

� MRSA – 7 cases haved been reported in 2013/14 compared to 13 cases in 2012/13 for the twoformer PCTs

� a total of 21 operations cancelled were not rebooked with 28 days. However these patientswere treated within a short period of time after the 28 days

� only 15 cases of mixed sex accommodation breaches were recorded in 2013/14, all of whichrelated to Salisbury NHS Foundation Trust

� a total of 7 trolley waits over 12 hours from decision to admit were recorded in 2013/14, of whichtwo were agreed as being clinically appropriate

� a total of 6 patients (to the end of January 2014) were waiting over 52 weeks for treatment,across all our commissioned providers in England.

Quality Premiums

The Quality Premium is intended to reward the CCG for improvements in the quality of the servicesthat we commission and for associated improvements in health outcomes and reducinginequalities.

Payment will be up to £5 per patient in the CCG as an additional fund, receivable in 2014/15. TheQuality Premium is reduced if the commissioned providers do not meet the NHS Constitutionrequirements.

NHS Constitution requirements for the following patient rights pledges Actual Expected Rating

90% of patients during the year should wait no more than 18 weeks from referralto consultant-led treatment 96% Achieved

95% of patients during the year should be admitted, transferred or dischargedwithin four hours of their arrival at an A&E department 95% Achieved

85% of patients during the year should have a maximum wait of 62 days fromurgent GP referral to first definitive treatment for cancer 87% Achieved

75% 8 minute response for Cat A (RED 1) ambulance calls (based on SouthWest Ambulance full service) 71% Not Achieved

Expected Adjustment (based on Forecast Rating) 25%

2013/14

Although South Western Ambulance Service NHS Foundation Trust has been unable to achievethe 8 minute response rate in 2013/14, continual progress is being made to improve theperformance, taking the South West as a whole into account.

It should also be noted that the performance for the population of Dorset continues to seeresponse rates above the 75% target and it is the areas outside of Dorset in which SouthWest Ambulance NHS Foundation Trust operates that are causing us not to achieve thistarget.

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STRATEGIC REPORT

45

Domain Domain Definition Rating

Preventing people from dyingprematurely

Reducing the potential years of life lost from causesconsidered amenable to healthcare: adults, childrenand young people by at least 3.2% Achieved

Long-term conditions Reducing emergency admissions combined acrossthe following areas1) Unplanned hospitalisation for Chronic

Ambulatory care sensitive conditions2) Unplanned hospitalisation for Asthma, Diabetes

and Epilepsy in under 19s3) Emergency admissions for acute conditions that

should not usually require admission4) Emergency admissions for children with lower

respiratory tract infections (LRTI)Achieved

Recovery from episodes of ill health or injury

Ensuring that people have a positiveexperience of care

1) Roll out of Friends and Family Test2) An improvement in average FFT scores for acute

inpatient care and A&E services between Q12013/14 and Q1 2014/15 for acute hospitals thatserve a CCG's population Achieved

Treating and caring for people in a safeenvironment and protecting them fromavoidable harm

1) No cases of MRSA and2) Clostridium Difficile are at or below defined

thresholds for CCG Not Achieved

Local Priority Quality Premium

Domain Domain Definition 2013/14Expected Rating

Knee replacementsTotal health gain assessed by patients by difference between thepre-operative score and post-operative score as completed by thepatient

Achieved

Dementia Number of people diagnosed / prevalence of dementia Achieved

Under-75 mortality rate Under 75 mortality rate respiratory disease - 21.5 per 100,000population Achieved

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Outlook for 2014/15 and beyond

The level of growth over the next two years forclinical commissioning groups has alreadybeen published nationally and NHS DorsetCCG will receive 2.14% (2014/15) and 1.7%(2015/16) respectively, although nationalplanning commitments against the growthmade available is not fully known.

The current planning assumption for 2014/15and 2015/16 is that we will continue tomaintain surplus levels at £12 million by notutilising any of the brought forward surplus ineither year.

This is in line with NHS England planningguidelines and represents 1.3% of our totalbudget.

The NHS is facing significant and enduringfinancial pressures over the forthcomingperiods and our CCG and Dorset healtheconomy is no exception. Within 2013/14significant non-recurrent financial support hadto be provided to some of our hospitals, andthis has continued into 2014/15.

There is recognition by theCCG that people's needs forservices continue to grow.This means that we have totransform the way servicesare delivered to continue todeliver high quality services within theresources available.

In addition to the challenges facing the localhealth economy, the CCG also recognises theneed to continue to work with localgovernment to develop strong plans to securecontinuity of sustainable services for thefuture.

The recognition of these challenges in thelocal health and care system has resulted instrong partnership working across providersand local government, including planssubmitted under the Better Care Fund nationalinitiative, to provide more integrated healthand social care services, with a particularemphasis on services for the frail elderly.

As part of the recognition and commitment ofthe CCG to provide sustainable and highquality services for the future, we will becommissioning a Clinical Services Review in2014/15 to begin to address the challenges offinancial sustainability, an increasingly ageingpopulation, complex delivery systems andlong term conditions.

It is recognised that we need to be bold andinnovative and have no predeterminedsolutions or options going into the Review,whilst extensively engaging with patients, thepublic, provider organisations and partnerstakeholders to ensure that the 'blueprint' forservices is fit for Dorset.

Paul Vater

Chief Finance Officer

STRATEGIC REPORT

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Business review

NHS Dorset CCG is overseen by NHSEngland and in common with all other CCGs,we have a constitution which sets out ourbusiness processes.

NHS Dorset CCG began from a strongplatform of success with sound finances andstrong clinical leadership left by the twoorganisations it replaced – Bournemouth &Poole and Dorset Primary Care Trusts.

One of the major changes in the healthcaresystem has been the development of GPs asleaders of healthcare commissioning, as eachpractice became members of the CCG.

To prepare them for this new role, weorganised four engagement and developmentevents with more than 545 GPs and practicemanagers attending.

We recorded some milestone achievementsduring our first full year of operation, such assuccessful commissioning of the new NHS111 non-emergency phone service which wentlive in Dorset during April.

Despite negative media attention in otherparts of the country, the 111 service forDorset, delivered by South WesternAmbulance Service Foundation Trust, isperforming well and improving week by week.

The commissioning teams continue to leadmajor programmes including the review ofUrgent Care and Making Purbeck ‘Fit for theFuture’ 2013 which focuses on making localhealthcare sustainable.

There are more details about these and othersuccesses in Highlights of the Year on pages16 to 22.

Recent NHS reforms not only place cliniciansin charge of the budgets but also put patientscentral to the agreement of our healthpriorities.

We began this work in earnest by launching

our strategy and public prospectus. GPs havefacilitated events where more than 300members of the public, patients and healthpartners fed back their views to inform ourstrategy.

As part of our KPIs we committed to deliveringthree priorities by April 2014 – as detailed onpage 11.

The NHS has a challenging time ahead andwe have to be confident about where we needto spend our budget and be creative in howwe spend it – such as ensuring we join up withother healthcare and voluntary organisationsto get the best out of the services on offer.

We start from a robust financial position, clearclinical leadership with a commitment to makea difference to health provision and a firmfoundation of working with partners andstakeholders across health and social care.

We will ensure that we continue to listen to ourpatients and gather their feedback to makethis difference felt in Dorset.

Risks and uncertainties

We will face an increasingly challengingfinancial year in 2014/15 as the NHScontinues to operate within a tight financialframework during a period of further changeand movement towards greater integrationwith social care.

This should be viewed against a backgroundof a rising number of older people in the localpopulation, health inequalities and asignificant number of people living withdisability and long-term conditions.

The emphasis will need to be one ofcontinued financial control to support the CCGto commission sustainable health servicesand deliver the outcomes to meet our strategicobjectives.

This will include providing non-recurrentfunding to support a full clinical servicesreview.

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Although NHS Dorset CCG ended its first yearof operation with a planned underspend of£12 million, financial risks emerged towardsthe end of the year, particularly in the area ofcontinuing healthcare funding.

The increase on emergency pressuresexperienced in all acute hospitals required theCCG to fund non-recurrent schemes toaddress the winter pressures.

GP referrals grew by 4.5 percent in 2013/14and this trend is causing pressures on hospitaland community services.

This increase will require changes to plannedactivity within the secondary care providercontracts for 2014/15.

Our finance and performance teams willcontinue to work very closely with thelocalities to develop referral management andfinancial monitoring systems.

These systems look at referral patterns andthe associated financial impact. A DorsetInformation Dashboard has been developed inpartnership with Somerset CCG and has beenoffered to every practice in Dorset. Uptake forthis commissioning intelligence tool hasbeen high.

The area we serve

Dorset GP practices serve a population ofaround 766,000 living in sparsely distributedrural areas and the urban conurbations ofBournemouth, Poole and Weymouth.

Overall the population of Dorset enjoysrelatively good health with a higher lifeexpectancy than the English average.

The challenges are:

� a high and rising proportion of older people– which is predicted to grow by six per centbetween 2013 and 2020. This poses asignificant challenge for the health andsocial care system

� inequalities in life expectancy acrossDorset – although there have beenreductions, gaps of 4.4 years among menand 3.5 among women still exist in certainareas

� cardiovascular disease (CVD) and cancerare the major causes of death whichtogether accounted for 29 per cent ofdeaths in 2011

� increasing numbers of people living withlong-term conditions (LTCs). In 2011, 19per cent of people in Dorset were livingwith a LTC or disability which impacted ontheir health

� although most people lead healthylifestyles, some issues such as smoking,smoking in pregnancy, sexual health,alcohol consumption and obesity givecause for concern.

In order to address the potential health needsof the population, Joint Strategic HealthNeeds Assessments (JSNAs) have beenproduced in conjunction with local authoritiesacross Dorset.

How we work

We have two business bases: one in Poole inthe east of Dorset and the other in Dorchesterin the west of the county.

Clinical engagement and leadership isprovided via GP leads from each of the 13localities in Dorset who sit on the GoverningBody. Their key roles are:

� shaping the direction and supporting theimplementation of the CCG and health andwellbeing strategies

� representing the views of their practicesand patients on how services are designedand provided

� supporting the delivery and implementationof services within the locality.

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Our member practices are at the heart of ourcommunities and in a good position tounderstand the needs of their populations.

Members can influence decisions and providefeedback through the locality chair and atlocality meetings, so that local focus is not lostamongst the national and wider Dorsetpriorities. There are more details about ourlocalities and how they work on pages23 - 24.

Patients and the public can influence andprovide feedback in many ways such as viatheir practice, the Health InvolvementNetwork, or patient participation groups. Readmore about how you can get involved on theback cover of this report.

We have internal commissioning supportservices, which are provided through fourdirectorates:

� Quality

� Service Delivery

� Finance and Performance

� Engagement and Development.

Each directorate is led by an executivedirector, accountable to the ChiefOfficer, Tim Goodson. They are:

� Suzanne Rastrick, Director of Quality

� Jane Pike, Director of Service Delivery


� Charles Summers, Director of Engagementand Development.

You can read their biographies on pages73 - 74.

Providers

We are able to commission services from arange of providers to ensure we get value formoney and meet local needs.

Providers may include local health partnerse.g. community or acute hospitals, mentalhealth organisations, local pharmacies,private businesses and other organisations.

Our key providers across the county include:

� Dorset County Hospital NHS FoundationTrust

� Dorset HealthCare University NHSFoundation Trust

� Poole Hospital NHS Foundation Trust

� Royal Bournemouth and ChristchurchHospitals NHS Foundation Trust

� Salisbury NHS Foundation Trust

� University Hospital Southampton NHSFoundation Trust

� Yeovil District Hospital NHS FoundationTrust

� South Western Ambulance Service NHSFoundation Trust.

Our plans for improving care in Dorset

If we are to have sustainable health and socialcare services in Dorset that are fit for thefuture, we need to work with stakeholders,partners and providers to make courageousdecisions on how local services are provided.

Over the next two years the CCG will focus ondelivering local priorities as well as nationalobjectives set out in the documents NHSMandate 2013 to 2015 and Everyone Counts:Planning for Patients in 2014/15 to 2018/19.

This national planning guidance sets out thechallenges and priorities for NHS England.

It emphasises that CCGs will need to makecourageous decisions with partners andproviders to change how services aredelivered.

It aims to ensure that the quality of care israised to the best international standards,

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whilst closing a potential funding gap of £30bnby 2020/21.

We are committed to delivering the nationalpriorities and improving the health of thepopulation in Dorset. Through the delivery ofour three transformational programmes andClinical Commissioning Programmes (CCPs)we will:

� improve outcomes for patients asmeasured through the five domains of theNHS Outcomes Framework and sevenoutcome ambition measures

� reduce inequalities

� improve mental health as well as physicalhealth

� involve and engage stakeholders throughevery stage of development and change

� transform service models with our partners

� focus on

� access

� quality (patient safety, experienceand effectiveness, including actionsfrom the Francis, Berwick andWinterbourne View reports and NHSConstitution)

� innovation and research

� value and the best use of resources.

To help us do this, we have a plan for 2014 to2016 which outlines how we will deliver thefirst two years of our five-year strategy.

This plan outlines how we will concentrate onthree transformational programmes:

� Better Together – this aims to transformhealth and social care across Dorset toenable and deliver a sustainableimprovement in health and care throughperson-centred, outcome-focused,preventative, co-ordinated care

� Clinical Services Review – this will reviewclinical services across the health andsocial care system and those that span

Dorset population boundaries to ensurehigh-quality, patient-centred, sustainableservices

� Urgent Care Review – the Pan DorsetUrgent Care Programme aims to transformurgent care services across Dorset byaligning services and simplifying pathways,integration and by using technologies.

These programmes are interlinked and will bedelivered in partnership with the three localauthorities and the four main NHS foundationtrusts in Dorset.

They will look for further opportunities tointegrate health and social care and ensure allservices are provided as close to home aspossible and in community settings unless it isnot appropriate to do so.

The programmes will be overseen by theBetter Together Sponsor Board, with eachpartner organisation having lead responsibilityfor relevant projects within them.

They will be supported by our ClinicalCommissioning Programmes (CCPs) andthrough working in partnership withstakeholders.

The plan includes how our internalcommissioning support team will work to helpdeliver these transformational programmes,support the CCPs and ensure that the CCGcontinues to meet all of its legal duties.

Clinical commissioning

The commissioning of healthcare is organisedwithin Clinical Commissioning Programmes(CCPs).

Each of these programmes is clinically led bya GP and includes members from a range ofdisciplines and professions.

These multidisciplinary members bringtogether their knowledge and expertise toprioritise what needs to be done to redesignand implement improvements to services.

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Each of these programmes involves otherclinicians, patients and providers to considerand deliver improvements to services.

The programmes support the delivery of threetransformation programmes as well as specificpriorities. The CCPs and their GP Leads are:

Maternity, Reproductive and Family HealthDr Karen Kirkham

General MedicalDr Chris McCall

Cardiovascular Disease, Stroke and DiabetesDr Craig Wakeham

Musculoskeletal and TraumaDr Christian Verrinder

Mental Health and Learning DisabilitiesDr Paul French

Cancer and End of LifeDr Lionel Cartwright

The Pan Dorset Programme for Urgent Care,Clinical Services Review and the BetterTogether Programme will go into operationduring 2014/15Dr Simon Watkins.

Read more about how the CCPs aredelivering real benefits for real people onpages 25 to 39.

Equality and Diversity

The CCG is committed to ensuring as anemployer it provides an open and supportiveenvironment to staff, recognising that allemployees have the right to be treated withconsideration, dignity and respect. The CCGensures it meets this commitment by:

� its mission, aims, strategy and supportingobjectives

� supporting employees in their professionaldevelopment

� ensuring employees have access tostatutory and mandatory training includingdevelopment around equality and diversity

� providing a happy and fulfilling environmentin which to work, where staff are engagedand involved in matters which affect theirworking lives

� attracting and retaining high calibre staffthrough an open and transparentrecruitment and selection programmewhich is responsive to the diverse needs ofthe applicants

� creating an environment where staff areable to raise any concerns they may havewith supporting policies in place which areopen and transparent and consistentlyapplied

� providing development to managers toensure they support their members of staff

� supporting staff in their health andwellbeing, through manager involvement,HR intervention and through anoccupational health programme as wellas an employee assistance programmeoffering a completely confidentialcounselling, support and mediation servicefor all staff and their immediate families.

The CCG recognises its obligations under theEquality Act 2010 and the supportingemployment legislation, which is reflected inthe CCG Dignity at Work Policy.

The CCG is committed to ensuring theprinciples of this policy are embedded into theorganisation and actively monitors itsperformance through the production andanalysis of internal workforce data relating toeach of the nine protected characteristics.

Workforce and HR support

Our workforce team supports the organisationwith HR advice and guidance and played animportant role in helping our clinicians andcommissioning staff successfully manage thetransition from PCTs to CCG.

We have amended our HR policies to reflectthe new organisation and during 2014/15 we

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will be strengthening the workforce functionfurther by moving all HR transactional servicesin-house.

Organisational development

Clinical development

During 2013/14 we introduced initiatives tosupport the development of clinicians as leadersof the CCG, ensuring they can fulfil their role asclinical commissioners, leading local healthpriorities and making the right resource choices.

As a membership organisation comprising 100practices in Dorset, we run regular GPmembership events and Governing Bodydevelopment workshops supporting our clinicalleads to fulfil their role. Over 400 GPs attendedthese activities during 2013/14.

We offer communications and public relationstraining and advice to equip the Governing Bodyand GPs with this new aspect to their role, sothey can respond to the media and provide theauthentic clinical voice of the CCG.

We organised commissioning skillsdevelopment for clinical leaders linked to eachof our six Clinical Commissioning Programmes.

GPs also work closely with our engagement andcommunications team at local events, by talkingto patients and the general public about theirhealthcare needs and experience.

Commissioning support development

Throughout the year, nearly 300 peopleattended induction sessions aimed at helpingour support teams develop a clear

understanding of the CCG’s role, purpose,mission and aim.

Each of our four directorates run regulardevelopment days to ensure commissioningsupport teams are fully briefed on the CCGstrategy, the challenges ahead and the changesto our business.

The Chief Officer holds regular briefings wherestaff have the opportunity to discuss concernsand hear ‘from the top’. Staff can access in-house and external training for theirprofessional development, including places onthe NHS leadership academy programmes.

Sustainability

The NHS aims to reduce its carbon footprint by10% between 2009 and 2015. In support of thistarget, NHS Dorset CCG is committed topromoting sustainability and has included arequirement in the NHS contract relating to theCarbon Reduction Strategy, which includes thefollowing elements:

� saving Carbon, Improving Health – thisrequires provider organisations to report onprogress on climate change adaptation,mitigation and sustainable developmentincluding performance against carbonreduction management plans. Theproviders are required to incorporate theoutcome in their respective annual reports

� Sustainable Development Strategy –provider boards are required to approve astrategy

� Carbon Management & Climate ChangeAdaptation Action Plan – providers shouldagree a plan and provide the performanceagainst the agreed standards

� Initial/annual reassessment – providersare required to continually monitor andprovide a report on progress.

Clinical Commissioning Group position

The CCG has a Sustainability Strategy which it

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Male Female

Bands 1-7 16.75% 83.25%

Senior Managers 26.19% 73.81%

Governing Body 76.92% 23.08%

Staff gender analysis

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has adopted from the former Primary CareTrusts, which runs from 2010-2014. Thestrategy recognises the CCG’s responsibilityand has aligned delivery work streams withthe Good Corporate Citizenship model. TheCCG is currently in the process of writing thenew strategy for the 2014/15 – 2018/19 period.

Good Corporate Citizenship model

The key areas for action are energy, waterand carbon management, sustainableprocurement and food, low carbon travel,transport and access, waste reduction andrecycling, green spaces, staff engagementand communication, buildings and site design,organisational and workforce development,partnership and networks, governance, IT andfinance.

Energy, water and carbon management

The CCG is aware of its own responsibilities insupporting sustainability and has alreadygreatly reduced the office space footprint in2013/14 at the Canford House site from 1,899to 941sqm and is continuing to reviewaccommodation requirements. In order tofurther facilitate moves to a smaller footprintthe CCG has introduced smaller desks to bothmaximise the space in its corporate office andalso to create a paperless environment.

It should be noted that the CCG does notdirectly pay for energy and water as theresponsibility for properties within the

commissioning architecture sits with NHSProperty Services Ltd.

Sustainable procurement

The CCG is committed to reducing indirectenvironmental and social impacts associatedwith the procurement of goods and services.Purchasing procedures are constantly beingrefined to help minimise waste, which includesensuring that we incorporate a sustainabilitysection on any procurement.

Waste reduction and recycling

Across all sites used by the CCG, we haveincorporated a paper recycling collectionservice. In addition the CCG has alsoimplemented recycling of computers andrelated items in partnership with widercommunity groups.

Low carbon travel, transport and access

In recognising the benefits of supporting lowcarbon travel the CCG has removed all leasecars for staff and have introduced lowemission pool cars in their place. In additionthe CCG has dedicated car parking spaces forcar sharers. In 2014/15 the CCG is looking tore-introduce a cycle to work scheme, (seetable below).

Partnership and networks

The CCG as part of its wider stakeholderinvolvement has signed up to the

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In 2013/14 Dorset CCG have had the following costs and performance in relation to travel:

Classification Miles Travelled Cost £ tCO2e

Mileage Claims 416,722 217,975 154

Pool Car Usage 59,620 20,684 44

(tCO2e stands for “Tonnes of CO2 equivalent”, which is a measure that allows you to comparethe emissions of other greenhouse gases).


Bournemouth Borough Council sustainablecity plans.

As part of the wider communications with staffregarding restricted parking at CCG sites, theCCG has actively promoted the use of carsharing and park and ride options operated bylocal authorities.

Staff engagement and communications

Included within the job specifications for allnew members of staff there is a requirementto promote and embrace the principles ofsustainable development in their daily dutiesand to ensure that they use energy and othernatural resources as efficiently as possible tominimise their carbon footprint.

In addition we have participated in the NHSSustainability Day by encouraging a paperlessday by staff which was also promoted onTwitter and internal communications.

Governance, IT and finance

In order to support lower waste the CCG iscommitted to using technologies wherepossible, which has resulted in theintroduction of video-conferencing and mobiledevices to reduce the need for travelling andwaste paper.

Key Provider Snapshot

Royal Bournemouth & Christchurch HospitalsNHS Foundation Trust (RBCHFT)

The Trust has continued to make significantprogress in improvements on sustainabilityand have chosen to purchase electricity from100% combined heat & power (CHP)guaranteed sources during 2013/14.

In addition it is worth noting that the Trustgenerates approximately 15% of its energyonsite, through solar panels and low pressurewater.

Poole Hospital NHS Foundation Trust (PHFT)

The Trust has undertaken an investmentgrade audit as part of an Energy PerformanceContract (EPC), working with British Gas &Breathe Energy.

This contract identifies measures to reduceenergy consumption by 25% to supportdelivery towards the 2015 target.

In addition schemes that have been put inplace include LED lighting, cardboardcompactor to support recycling and activepromotion of a dedicated car share scheme.

Dorset Healthcare University NHSFoundation Trust (DHUFT)

The Trust is continuing to make progress onreducing carbon emissions of 10% by 2015,which has included a significant reduction infloor space (m2) since 2007/08, although atthe same time staff numbers have increased.A resulting factor of this reduction is the dropin gas and electricity usage.

The Trust has implemented a number ofimprovements including replacement ofboilers, upgrading lighting to LED andinstallation of combined heat & power (CHP)at St Ann’s Hospital.

Dorset County Hospital NHSFoundation Trust (DCHFT)

The Trust has developed a SustainableDevelopment Management Plan where it isactively monitoring progress on the keythemes identified in the Good CorporateCitizenship model, including detailed actions,which are regularly monitored.

The key performance areas will be reportedas part of the Trust annual report.

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Improving quality

Putting quality at the heart of all we do

The quality team is responsible for patient safety,quality improvement, corporate governance andmedicines management. The team is committed toensuring compassionate care is equally as importantas the quality of treatment. We work closely withproviders of care to ensure that our patients, theirfamilies and carers are treated with compassion,respect and dignity, in safe environments and areprotected from harm. Our outcomes for 2013/14include:

Infection control

We continue to work in partnership with all our providers and have made progress in reducing thenumber of healthcare-acquired infections. These results have been achieved by the provision oftraining, information and advice with infection prevention and control teams across Dorset to sharebest practice and monitor and learn from incidents.

During 2013/14 cases of MRSA in Dorset reduced from 2012/13 figures to a total of seven peryear. Incidences of C-difficile are also declining, as shown overleaf.

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Care homes

We have a number of contracts with carehome providers delivering nursing care toresidents.

To ensure that the type of care being bothcommissioned and provided is meeting theneeds of residents, our Care Home QualityAssurance Team have undertaken joint visitswith three local authorities to review currentarrangements and provide guidance andsupport to care home staff in relation tonursing care.

A key objective of the team is to ensure thatall homes now receive regular reviews of theirstandards of nursing care in line with therecommendations highlighted in theWinterbourne View Report.

The investment we have made by developingthe Quality Assurance Team builds on ourexisting foundations and confirms ourcommitment to ensuring that all residentswithin Dorset care homes receive high-quality,safe care.

Since April 2013 the team have completed125 monitoring visits, with a further six carried

out by May 2014 – bringing our visits to 100%completion.

The team publish a quarterly newsletter whichis circulated to care homes and have recentlyestablished a successful annual care homemanagers’ event.

The team also work closely with both internaland external partners including the ContinuingHealthcare Team and the Care QualityCommission.

Safeguarding children

In partnership with the Dorset SafeguardingChildren Board, Bournemouth & PooleSafeguarding Children Board and PublicHealth Dorset we launched Drinkheads – acampaign to highlight the dangers of drinkingwhile looking after young children. Drinkheadsadvertisements featured in local print mediaand interviews with CCG experts appeared onBBC News.

Safeguarding adults

Adult Safeguarding within the CCG includesmonthly engagement with all NHS providersafeguarding leads, three local authority

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NB Dorset data in this table includes care homes, community hospitals and individuals at home

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safeguarding teams and NHS England. Public engagement has been undertaken through the panDorset Adult Safeguarding Boards.

The CCG receives regular quality reports from data analysis highlighting any areas of concern,repeated issues or significant failures in care. The safeguarding function has ensured the CCG hasmet its obligations and responsibilities in relation to local and national policy. The CCG is an activepartner in the development of Pan Dorset strategies to improve hydration and nutrition and thereduction of pressure ulcers.

Improving the patient experience - Friends and Family Test

Launched in April 2013, the national Friends and Family Test asks patients who have recentlyvisited A & E or had an overnight stay in their local hospital if they would recommend their care. Itaims to improve the hospital experience and raise standards of NHS care. The results for yourlocal hospitals – in Bournemouth, Poole or Dorchester – are available at NHS Choices website atwww.nhs.uk. The test is set to be introduced into GP practices during 2014/15.

Our quality team uses this ‘real-time’ feedback from our patients and carers to reduce poorexperiences as we regularly monitor local results and work with providers to improve scores.

Medicines management

The medicines team implemented a new prescribing dataset to inform discussions on prescribingat General Practice visits.

A team of CCG locality pharmacists now work closely with prescribing lead GPs in each locality.

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July August September OctoberDCHFT 10.1 8.2 12 17.4 20 23.1PHFT 7.6 12.3 13.4 15.6 15.1 14.1RBCHFT 13.5 17 17.2 19.4 21.9 21.6DHUFT 14 20 19 22 18 16England 16.1 17.1 18.6 19.6 20.9 19.9

0

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10

15

20

25

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nse

Rate

(%)

Family and Family Test Response Rates

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They advise prescribers and implement auditsto ensure prescribing is evidence-based andmeets national quality standards.

In October, collaboration between us and ourNHS providers saw the launch of the panDorset formulary on our website and amedicines advisory group which providesrecommendations on the prescribing andcommissioning of medicines.

It is important that the public recognise therole they can play in managing theirmedicines. During the year, we launched aneducation campaign to remind patients toorder repeat prescriptions in plenty of timeand to encourage them to go to the localpharmacy when they run out of medicines,rather than call 111. (One third of calls to the111 service at the weekend were due topeople running out of medicines.)

A series of videos on repeat prescriptions,self-managed care, flu vaccinations andgeneral GP advice was published in our digitalmedia channels to offer practical advice inmanaging healthcare needs.

Learning and development

Throughout the year we held a conferenceand events with providers and otherstakeholders to share findings of the FrancisInquiry and discussed recommendations ofthe report.

Over 100 delegates attended and agreed toshare good practice in future, and to worktowards improving dignity and compassion incare across the local health and social carecommunity.

Information governance and compliance

NHS Information Governance (IG) is aframework for handling personal informationabout patients and employees in a confidentialand secure manner to appropriate ethical andquality standards in a modern health service.

It provides consistent standards enablingemployees to deal with the many differentinformation handling requirements.

The submission of the annual InformationGovernance Toolkit (IGT) to the Health andSocial Care Information Centre givesassurances to the CCG, other organisationsand to individuals that personal information isdealt with legally, securely, efficiently andeffectively. (Submissions are awarded either asatisfactory or unsatisfactory status.)

Successful submission of version 11 of theIGT was achieved and we were awardedsatisfactory status in 31 October 2013.

Information governance training is mandatoryfor staff within the CCG regardless ofdesignation. Twenty IG training sessions wereundertaken during the year and 96% of staffattended.

We certify that NHS Dorset ClinicalCommissioning Group has complied with HMTreasury’s guidance on cost allocation and thesetting of charges for information.

Complaints

We handle complaints sympathetically. Wefollow the guidance provided by the NHSComplaints Procedure and the more recentlypublished Department of Health reportsrelating to NHS complaints handling.

Our approach is a personal one, and weendeavour to ensure concerns and questionsare answered with a written response.

We aim to help all those who contact us, ifnecessary by redirecting them to the relevantorganisation, and will forward complaintsonwards if required.

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During the year from 1 April 2013we have handled 198 complaints:

� 85 related to the CCG and have beenresponded to

� 10 are awaiting a response (as at31/03/2014)

� 103 did not relate to the CCG and, with theagreement of the complainant, have beenforwarded to providers who will provide adirect response.

There has been one request for informationfor a Parliamentary Health ServiceOmbudsman investigation into the handling ofa complaint relating to the CCG.

Data management and confidentiality

There have been no data / confidentialitybreaches.

Challenges

The Care Quality Commission (CQC) hasundertaken a series of inspections, new andfollow up, to providers from which NHS DorsetCCG commissions services.

This included one of the ‘new style’ large CQChospital inspections to the RoyalBournemouth and Christchurch HospitalsNHS Foundation Trust in October 2013. Thefindings showed that standards were notbeing met in two areas of the hospitals andthat staffing and skill mix were an issue acrossmedical and nursing staff.

An action plan is in place and the Trust isbeing supported by the CCG to ensure actionis taken and standards maintained.

Dorset Healthcare University NHS FoundationTrust consists of multiple sites and the CQChave undertaken visits to 11 individual sitesthroughout 2013.

Five sites were completely compliant. Foursites had issues with staffing levels andmanagement and two sites were notcompliant across a number of the standards.

There are robust action plans in place toensure the areas that require action havetaken the necessary steps to improve care sothat standards are compliant.

This is being closely monitored by the CCG inconjunction with Monitor and the CQC, andimprovements have been made.

Poole Hospital and Dorset County Hospitalalso had visits from the CQC during the year,and were found not to be meeting some of therequired standards.

Actions have been taken to address theseissues and the CCG is working with all ofthese providers to ensure standards are metin the future.

Future priorities for the quality team

In addition to the areas outlined above, ourpriorities for 2014/15 include:

� ensuring full implementation of the ‘6Cs’and Compassion in Practice (see diagramand link for more information -http://www.england.nhs.uk/nursingvision/)

� roll out of seven day services across healthproviders

� improving quality of care for people as wemove towards integration of servicesacross the health and social care system

� reduction in the number of pressure ulcers.

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Emergency preparedness and resilience

Under the Health and Social Care Act 2012,clinical commissioning groups were classifiedas Category 2 responders as defined underthe Civil Contingencies Act (2004).

This means we have a legal duty to co-operate with other Category 1 and 2responders (blue light services, healthcareproviders, local authorities, the EnvironmentAgency, the Met Office, utility companies) toplan for, respond to, and recover fromincidents in Dorset.

In addition we have signed a Memorandum ofUnderstanding (MoU) with NHS EnglandWessex Area Team which outlines how we willassist them in discharging aspects of theirCategory 1 duties locally.

Key sections include incident notification,command and control arrangements duringthe different levels of incident response andrecovery in order to clarify how the newEmergency Preparedness, Resilience andResponse (EPRR) arrangements would worklocally.

How this work is organised

Dorset CCG is a key member of the DorsetLocal Health Resilience Partnership (LHRP)which brings together the directorsaccountable for EPRR from all healthorganisations including local authority publichealth departments.

This group meet quarterly to discuss thedirection of work and to ensure that healthpartners are working together to meet sharedgoals, actions/targets and milestoneachievements during the year.

In June we launched on-call packs for seniormanagers which means all key information isnow accessible from tablets, phones and anycomputers with an internet connection.

The CCG is required to conduct a live

exercise every three years, a tabletopexercise every year, and two communicationsexercises a year. A tabletop exercise in whichsenior managers from the CCG and NHSEngland Wessex Area Team talked through an‘incident’ was held in October, followed by asimilar exercise involving the wider healthcommunity. As this is our first year, we areaiming to take part in a live exercise between2014 and 2016.

There was a real test of the emergencyarrangements during the prolonged severeweather during the winter. Lessons have beenlearned and have led to some refinements inour emergency planning.

During the period of severe weather, the CCGwas actively involved in regular emergencyplanning calls with other agencies acrossDorset.

We helped with the identification of vulnerablepatients living in the Winterbourne Abbas andSixpenny Handley areas of Dorset who werein need of evacuation assistance.

Our revised major incident plan has beendeveloped.

Work will now begin on developing an e-learning package to teach all key responsestaff about the major incident plan and this willbe complemented with practical major incidentroom training.

Business continuity plans have been finalisedoutlining how the CCG’s critical functionswould continue in the event of an interruption.

We certify that the NHS Dorset ClinicalCommissioning Group has incident responseplans in place, which are fully compliant withthe NHS Commissioning Board EmergencyPreparedness Framework 2013.

The NHS Dorset Clinical CommissioningGroup regularly reviews and makesimprovements to its major incident plans andhas a programme for regularly testing this

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plan, the results of which are reported to theGoverning Body.

How we have worked with otherstakeholders / partners

We work regularly with other partners to meetour legal obligation to share information andco-operate with other agencies.

There are a number of multi-agency localresilience forum groups which meet regularlyto develop emergency plans.

Following a pilot phase in 2013/14, a civilcontingencies unit (CCU) for Dorset is beinglaunched, supported by Dorset's LocalResilience Forum, comprised of membershipfrom Category 1 organisations. The CCG, andNHS England Wessex Area Team aresupporting the development of the CCU inmutual areas of training, exercising and multi-agency planning.

Future plans

Over the next year the EPRR team will beworking with the wider health community, localresilience forums and the civil contingenciesunit to develop and update the existingpandemic, mass casualty, severe weather andfuel plans.

Within NHS Dorset CCG, the focus will be ondistributing the e-learning packages and thedevelopment of modules for all relevant staff,in addition to practical training sessions.

The final sections of the Business ContinuityPlan will be completed and we will beensuring that all of our plans will be reviewedand updated as part of an annual programme.

Engagement and communications

The CCG has both internal and externalstakeholders. By definition our stakeholdersare taken to be any person, group ororganisation that affects, or can be affected byour actions.

Our stakeholders include the people of

Dorset, all those within the new involvementand engagement networks, localities, theCCPs, HealthWatch Dorset, health andwellbeing boards, health overview andscrutiny committees, local authorities,providers (both NHS and private), voluntaryorganisations, NHS England and MPs.

We are always keen to involve people in ourwork to help us make better informeddecisions about our local NHS services andwork continues to develop our enablingnetworks.

We recognise that everyone is a patient atsome point in their lives and that we all haveexperiences, views and concerns that can beshared to help shape the future.

Gathering views, listening to people andfeeding back this information to ourcommissioning teams is a really important partof our work.

We encourage people to get involved andcomment on local services. This can be bycontacting us by telephone, letter, email orsocial media.

We proactively seek opinions by attendingmeetings, distributing surveys and runningfocus group discussions to canvass a widerange of views and voices to ensure weunderstand about specific issues in Dorset.

Over the past year we have activelydeveloped our Health Involvement Network.This is an opportunity for local people to hearmore about the work we do and get involvedin projects, as well as working collaborativelywith other local organisations and bodies.

People can get involved with the work of theCCG through:

� our website - www.dorsetccg.nhs.uk

� social media such as Facebook, Twitterand YouTube

� information in our newsletters

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� information shared via our health andcouncil partners and network

� local media

� face-to-face meetings and events

� by contacting Lay Members

� local GP practices.

We know it is important to feed back theoutcomes of engagement. We do this in thefollowing ways:

� contacting all those involved in specificwork to thank them and let them know howtheir views have been used

� publicising reports and outcomes innewsletters, bulletins and on the website

� producing an annual report of engagementactivity

� reporting engagement and communicationsactivities to our Governing Body.

During 2013 we conducted a county-widehealth survey – The Big Ask – along with otherNHS partners. More than 6,000 peopleresponded with views on local services andhow we could improve them for the future.

Through a number of events, including theHealth Involvement Network, we havegathered views from the voluntary andcommunity sector, other health professionals,partners, community representatives, carers,patients and the general public.

In addition, our Clinical CommissioningProgrammes have been engaging andinvolving providers, partners and patients todevelop strategic plans for each clinical areaof work. Key areas of engagement worked onduring 2013/14 were:

� developing the new NHS Dorset CCGHealth Involvement Network

� supporting localities and their constituentGPs to undertake involvement andengagement work with local stakeholders

� supporting Clinical CommissioningProgrammes to achieve meaningfulinvolvement and engagement work toinform changes to health services

� continuing to build stakeholderrelationships

� promoting engagement opportunities toensure wide awareness of our engagementwork and advertising opportunities forinvolvement

� continuing to develop our partnerships withlocal people to gather insight into theirviews and experiences to help shapeservices

� monitoring the effectiveness of our workand to let stakeholders know how the viewsof local people have informed change.

Alignment with health and wellbeing strategies

We work with two health and wellbeingboards, one covering Dorset County Counciland one covering the Boroughs ofBournemouth and Poole.

These boards are responsible for producinghealth and wellbeing strategies for theirpopulations.

The strategies have been developed inpartnership with Dorset CCG and otherstakeholders. Our principles and prioritiesreflect those set out in the health andwellbeing strategies.

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This year our funding to support carers in ourarea increased to £1 million from £850,000 in2012/13.

This money has helped to provide them withwhat they often tell us they need the most – abreak from their caring responsibilities. Ourspending plans are in line with the nationalCarers Strategy and our local plans.

We know that many people do not identifythemselves as carers, regarding themselvesas just a relative or friend helping someonewho could not manage without their support.

But we do know that 82,500 identified carersare receiving services commissioned by ourpartner local authorities - Dorset CountyCouncil, Bournemouth Borough Council andthe Borough of Poole.

We are also helping them through theCarers Individual Support Scheme (CISS)commissioned by Dorset County Council andadministered by the charity Help and Care.

This makes small grants to carers which canmake all the difference to their lives. Thescheme is much appreciated and commentshave included:

I am extremely appreciative and it wasused to purchase a computer … it’s never toolate to learn they say. I hope I becomecompetent one day. With renewed thanks toyou and your team.

� � �

A much needed break for me and myhusband, I am really grateful for the help. Iwas able to visit my 90 year old mother andpay for someone to stay with my disabledhusband while I was away.

Around 800 carers have benefited since thegrant opened in June 2012.

Dorset Carers Support Project Fund

Since the fund began 15 carers projects inDorset have been awarded a share of around£45,000. The projects have been diverse andwell spread geographically. Combined theyhave reached over 3,500 carers across thecounty. Some examples of the types ofprojects funded are:

� information, advice and befriending

� creative projects

� support for young carers in transition

� funding for carers groups, peer led trainingfor carers of people with dementia andprofessional counselling for carers.

The fund has just been modified to broadenthe funding levels available and continues toattract lots of interest from potential projectsthat could benefit carers in Dorset.

Dorset Carers Activity Service

The carers activity service has proved to bevery popular and has been busy since itsinception.

A regular bulletin is produced and circulatedwidely around the county and includes detailsof all the service’s activities which have beenarranged including:

� the complementary therapy voucherscheme and day trips

� pre-planned activity sessions

� special events to mark occasions such asCarers Week and Carers Rights Day

� ‘Your Choice’ activity grant scheme.

It also has full details of carers’ support groupsthat operate around the county and otheropportunities of interest, such as other freeactivities available locally.

We recognise the invaluable contribution that carers maketo society by supporting them in their caring role

‘

’

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The number of carers who access the servicehas consistently grown since its launch andwe will continue to work hard to ensure itcontinues to do so.

Our local authority partners in Bournemouthand Poole have started the Carers CarefreeChoir and received very positive feedbackfrom members, including a commentdescribing the choir as ‘one big happy family’.

Our magazine Caring Matters has received amakeover and is now compact and provingvery popular as asource of informationand articles for allcarers.

Our first edition ofthe new formatfeatured TimGoodson, CCGChief Officer,answeringquestions fromcarers, showingour commitment tothem andacknowledging thevital role they play.

David Jenkins, Deputy CCG Chair, is the LayMember with specific responsibility forengagement. He is passionate about his role,making sure the voice of the public is heardwhen new services are planned or existingones redesigned.

So the views of carers are certainly beingsought as we work to ensure they haveaccess to the same standard of serviceswherever they live in Dorset, Bournemouth orPoole. These plans are set out in thedocument ‘Better Together – The pioneerpartnership: improving health and social carewith people in Bournemouth, Dorset andPoole’.

There is more information about theprogramme on the Dorset For You web sitehttps://www.dorsetforyou.com/better-together

This approach will help us to meet the needsof an ageing population by providing high-quality services in difficult financial times.Dorset residents can be assured that we areall committed to rising to these challenges.

Young carersreceive supportfrom the CCGand our localauthoritypartners.

Many have to puttheir childhoodson hold to carefor a parent orsibling, foregoingsome of thecarefree activities of their peers. As onenine-year-old said at a recent DorsetCarers Partnership meeting,

I don't get to do some of the thingsmy friends do but I don’t mind becauseI love my mum and dad.

Giving them a break from their caringresponsibilities is one way they aresupported.

Raising awareness of what they do isanother and in October Val Mitchell,(pictured) the CCG’s carers engagementfacilitator, appeared on local television in avideo about a Dorset young carer who waspromoting awareness about the role ofyoung carers.

The video was made by Fixers, youngpeople using their life’s experience to fixthe future, and the project comes under theumbrella of the Public ServiceBroadcasting Trust.

‘’

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We have already discussed some of the risksand challenges that lie ahead for us. Thissection considers the challenges andopportunities in more detail.

Future Trends: Local challenges andopportunities

As well as the demographic challenges we facein Dorset, there are other challenges andopportunities which must be addressed if weare to maximise health gain and transform andimprove local health and social care services.

Economic

Challenges:

� deliver Quality, Innovation, Productivityand Prevention (QIPP) within budgets

� deliver continuous service improvementsand efficiency savings

� reduce the amount of money spent onavoidable admissions and re-admissionsto hospital

� shifting the spend across different sectorsof healthcare to reflect the need to providecare closer to home.

Opportunities:

� healthy financial position

� large CCG therefore have economies ofscale

� doing things once across Dorset whereappropriate

� in-house commissioning support, enablingresilience, succession planning and skill mix,learning and influence.

Quality

Challenges:

� meeting the rights of our public and patientsas set out in the NHS Constitution

� delivering improved outcomes for people asset out in the NHS Mandate and NHSOutcomes Framework

� ensuring that the providers of healthcareservices understand and deliver services thatmeet and exceed the standards and qualityof care required.

Opportunities:

� implementation of the findings from the NHSreports into the Francis, Berwick andWinterbourne View inquiries

� commissioning organised around healthcarepathways, services improvements andoutcomes

� strong relationships with providers andpartners and forums for feeding back qualityconcerns

� working with nursing and care homes.

Collaboration and integration

Challenges:

� promote, support and participate incollaborative working with othercommissioners of health and social careservices and ensure that the complexities ofthe system do not detract from the ability towork effectively together

� consider innovative solutions to encourageintegrated patient centred services.

Opportunities:

� GP-led Clinical Commissioning Programmes

� coterminosity with the county of Dorsetlocal authority boundaries

� public health single service across Dorsetwith support integrated into clinicalcommissioning programmes

� established Better Care Fund enablinghealth and social care integration

STRATEGIC REPORT


� strong relationships with partners acrossthe health and care system

� history of collaborativecommissioning arrangements.

Patient choice / insight and engagement

Challenges:

� promote, support and participate incollaborative working with othercommissioners of health and social careservices and ensure that the complexitiesof the system do not detract from the abilityto work effectively together

� consider innovative solutions to encourageintegration.

Opportunities:

� clinical engagement and leadership

� strong legacy of public and patientinvolvement and engagement

� responsive to local needs

� locality development into patient insightand feedback

� development of the CCG HealthInvolvement Network

� enhance engagement work of clinicalcommissioning programmes to inform anddevelop clinical services.

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66

We have a Governing Body with amembership comprising:

� 13 GP Locality Chairs

� a Chair

� Chief Officer

� Chief Finance Officer

� two Lay Members

� a Nurse Lead and

� a secondary care Doctor Lead.

Biographies, joining dates and committeemembership for each of the Governing Bodymembers are set out in this section of theannual report.

The 13 GP localities, the GP Chairs for theperiod 1 April 2013 to 31 March 2014 and theirappointment dates are set out below:

Locality GP Chair Date appointed Date stood downCentral Bournemouth Dr Piers Wilde

Dr Peter Blick1 April 20131 August 2013

31 July 2013

Christchurch Dr Richard Jenkinson 1 April 2013

East Bournemouth Dr Paul French 1 April 2013

East Dorset Dr Colin Davidson 1 April 2013

Mid Dorset Dr Jenny Bubb 1 April 2013

North Bournemouth Dr Carol LinnardDr Tom Knight

1 April 20131 September 2013

31 August 2013

North Dorset Dr Rob Childs 1 April 2013

Poole Bay Dr Andy Rutland 1 April 2013

Poole Central Dr Patrick Seal 1 April 2013

Poole North Dr Chris McCall 1 April 2013

Purbeck Dr Christian VerrinderDr David Haines

1 April 20131 October 2013

30 September 2013

West Dorset Dr Blair Millar 1 April 2013

Weymouth and Portland Dr Karen Kirkham 1 April 2013

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GOVERNINGBODY&SENIORMANAGERPROFILES

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Dr Forbes WatsonDorset CCG ChairDorset Health and WellbeingBoard Vice Chair

Dr Forbes Watson is a GPprincipal in Lyme Regis. Trained at theUniversity of Glasgow, he has worked inGlasgow, Cornwall and Australia beforemoving to Lyme Regis, where he has beensince 1997.

Forbes is the Chair of the clinicalcommissioning group for Dorset. He ismarried with children and his interests includerugby union and boating - he is the honorarymedical advisor and chairman of the LymeRegis Royal National Lifeboat Institution.

Tim GoodsonChief Officer (performs thefunction of accountable officer forNHS Dorset CCG)(Appointed 1 April 2013)

Tim originally joined the NHS in 1995 as aninternal auditor following his initialaccountancy training with charteredaccountancy practices in the private sector.

Tim later moved into more mainstream financefunctions with Dorset Community NHS Trustand North Dorset PCT.

Prior to his current role, Tim was the Directorof Finance for Dorset Primary Care Trust,Bournemouth and Poole Teaching PCT, andSouth West Dorset Primary Care Trust.

During Tim's career in the NHS he has had abroad range of executive lead responsibilitiesincluding: Deputy Chief Executive, finance,performance, information, commissioning,primary care, sustainability, support services,information management and technology, riskmanagement, estates and capital planning.He is a Fellow of the Association of CharteredCertified Accountants (ACCA).

Tim enjoys making the most of the outdoorsand enjoys cycling, walking, skiing andkayaking and is a keen follower of rugby andfootball, although his playing days are nowbehind him.

Paul VaterChief Finance Officer(Appointed 1 April 2013)

Paul Vater has worked in both theprivate sector and the NHS in awide range of financial roles including internaland external audit. He is a Fellow of theAssociation of Chartered CertifiedAccountants (ACCA).

Paul is the executive lead on finance,procurement, and performance, includingcontracting, and is also the CCG lead forinformation management and technology.

As a member of the South West HealthcareFinancial Management Association, he hasstrategic interest in the training anddevelopment of NHS finance professionalsacross the South West. Prior to his role withNHS Dorset CCG, he was the Deputy Directorof Finance for Dorset PCT.

GP Locality Lead members

Dr Jenny BubbClinical Chair,Mid Dorset Locality

Dr Jenny Bubb is a GP partner atCerne Abbas surgery and iscurrently the Mid Dorset LocalityLead. She qualified from medical school inSouthampton in 2001 before moving toDorchester to complete GP training. She hasworked at Cerne Abbas surgery since 2008.

She lives in the Piddle Valley with herhusband and son. Her interests include hikingin the beautiful Dorset countryside and playingtennis.


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Dr Rob ChildsClinical ChairNorth Dorset Locality

Dr Rob Childs has been a GPpartner at Bute House SurgerySherborne since 1993. He qualified fromSouthampton University in 1987 and hasworked in the UK, Australia and the ChannelIslands.

He trained as a GP in Bath. He has beenlocality lead for North Dorset since 2008 andalso represents his local GPs on the DorsetLocal Medical Committee. Rob is married withtwo teenage sons and likes to play golf whentime allows.

Dr Colin DavidsonClinical ChairEast Dorset Locality

Dr Colin Davidson has been aprincipal GP working in Cranborne Dorsetsince 1988. He qualified at the MiddlesexHospital in London and worked there andsubsequently in Brighton and Bournemouthbefore following the sunshine again toAustralia.

He followed a physician training programmeto become a Fellow of the Royal College ofPhysicians, but finds general practice the onlyplace to practice true general medicine.

He is married to a doctor and has threechildren. He is a rugby referee, sails, skis andhas been seen on a golf course when not atmeetings; despite his body profile he has runthree London Marathons.

Dr Paul FrenchClinical ChairEast Bournemouth Locality

Dr Paul French is a senior partnerat The Marine and OakridgeSurgery in Southbourne, Bournemouth, wherehe has been working since 1984.

He trained at The Royal London Hospital in

Whitechapel. He has been working forprimary care organisations continuously sincetheir inception.

During this time he was the ProfessionalExecutive Committee (PEC) Chair ofBournemouth PCT for four years and then theinterim PEC chair of Bournemouth and PoolePCT for one year. His main areas of work arecare of the elderly, including stroke anddementia.

He is married with one son and enjoyswalking and skiing. Paul is the chair for theMental Health and Learning DisabilitiesClinical Commissioning Programme.

Dr Richard JenkinsonClinical ChairChristchurch Locality

Dr Richard Jenkinson has beena partner at Burton MedicalCentre, Christchurch since 1995.He qualified in London and worked there andlater in Devon to complete his postgraduatetraining. As well as being a GP he has aspecial interest in ears, nose and throat.

He is married with five children and enjoyswalking and is a silver leader for the Duke ofEdinburgh's award scheme.

Dr Carol LinnardClinical ChairNorth Bournemouth Locality(until 31 August 2013)

Dr Carol Linnard is the seniorpartner of the Alma MedicalCentre and has worked there foralmost three decades.

Throughout that time she has been involvedin the education of the next generation ofdoctors and holds posts at SouthamptonMedical School, Winchester University andWessex Deanery. Over the years she hasbeen part of the changing structures ofmanagement affecting NHS primary care and

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is now committed to locality commissioning.Carol is married with three adult children andalong with the usual leisure activities sheenjoys ‘mending things’.

Dr Tom KnightClinical ChairNorth Bournemouth Locality(From 1 September 2013)

Dr Tom Knight is a GP principal atNorthbourne Surgery in Bournemouth wherehe has been a partner since 2009. Hequalified from Charing Cross and WestminsterUniversity in 1997, and did his vocationaltraining for General Practice in Dorset. Tom ismarried with three young children and hisinterests are in aviation and watersports.

Dr Chris McCallClinical ChairPoole North Locality

Having joined The HadleighPractice in Broadstone and CorfeMullen in 1982 after training in London andDevon / Cornwall but retiring from clinicalpractice in 2002.

Dr Chris McCall is now experiencing the thirditeration of GP / primary care-ledcommissioning but his enthusiasm remainsundaunted and he has been locality lead forPoole North since its inception.

He is married with a grown-up family thatcontinues to arrive on the doorstep at frequentintervals. He is still trying to catch that elusive30lb+ salmon. Chris is the chair for theGeneral Medical and Surgical ClinicalCommissioning Programme and assistantClinical Chair for the CCG.

Dr Blair MillarClinical ChairWest Dorset Locality

Dr Alan Blair Millar is a GPprincipal at The Bridport MedicalCentre where he has been since

1994. He trained at King’s College HospitalSchool of Medicine and he has worked inLondon, Poole and Exeter, which is where hedid his GP training.

Blair has been involved in practice-basedcommissioning since its inception and is nowthe clinical lead for the Dorset West Locality.

He is married with three children and hisinterests include sailing and skiing.

Dr Piers WildeClinical ChairCentral BournemouthBournemouth(until 31 July 2013)

Dr Piers Wilde has been a GP partner atMoordown Medical Centre in Bournemouth fornine years.

He qualified from London’s Kings CollegeHospital in 1993 and completed his GPtraining working in London, Peterborough,Australia and Dorchester.

He has been involved in commissioning for 5years and is married, living in Poole. Hisinterests include music, mountain biking andfood.

Dr Peter BlickClinical ChairBournemouth Central LocalityFrom 1 August 2013)

Dr Peter Blick completed his training as a GPin 1981 and was appointed as a partner in TheHoldenhurst Road Surgery where he workedfor 30 years. He was chairman of Dorset LocalMedical Committee for eight years and hastrained 20 GPs. He currently works clinicalsessions in Blandford and is the GP tutor inBournemouth. He is a GP lead in adult andchildren's safeguarding.

Apart from his medical interests he is a keenyachtsman and skier and enjoys mountainwalking with his wife. He is an active memberof his local church in Sway.


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Dr Andrew RutlandClinical ChairPoole Bay & Parkstone Locality

Dr Andrew Rutland is seniorpartner at The Lilliput Surgery inPoole. Having gained an initial degree atOxford University, he qualified at CharingCross and Westminster Medical School. Heworked in Australia and locally in Dorset,before joining his current practice permanentlyin 1996.

He is married to a GP and has two rapidlygrowing boys. He keeps fit running regularly,dog walking and occasional hockey, and triesto spend as much summer time as possibleon the water. Professionally he is a GP trainerand appraiser, and enjoys life in a proactivepractice.

Dr Patrick SealClinical ChairPoole Central Locality

Dr Patrick Seal is a GP principalat The Adam Practice in Poolewhere he has been a partner since 1991. Hequalified from Cambridge University andUniversity College Hospital in 1985, and didhis vocational training for general practice inDorset.

Married with four children all aged over 20, hewas on the Local Medical Committee for eightyears and has been locality lead for CentralPoole for seven years. He has been a GPtrainer for the past 12 years, and is excitedabout opportunities for closer working withcolleagues in voluntary sector organisationsand with the local authority and public health.

Occasional Alpine air is his favoured form ofrelaxation, and real coffee!

Dr Karen KirkhamClinical ChairWeymouth and Portland Locality

Dr Karen Kirkham qualified in1988 from the Middlesex Hospital

Medical School, trained in general practice inDorset and has been a partner at The BridgesMedical Centre in Weymouth since 1994.

Alongside working in a busy general practice,she has developed an interest in women’shealth and in particular the fields of maternity,fertility, contraception and sexual health.

She is also a speciality doctor in genitourinarymedicine. She is chair of the Maternity,Reproductive and Family Health ClinicalCommissioning Programme.

Dr Christian VerrinderClinical ChairPurbeck Locality(until 30 September 2013)

Dr Christian Verrinder is a GPprincipal at The WellbridgePractice, Wool.

He trained in Nottingham and worked thereafter qualification as well as in Derby,Warwick, Cheltenham and Australia beforemoving to Poole in 2002.

He is married with children. His professionalinterests include GP training, sports andexercise medicine as well as orthopaedicmedicine.

Dr David HainesClinical ChairPurbeck Locality

Dr David Haines has beenpractising in Swanage for 24years.

After training at King’s College Hospital,London, he completed his training in generalpractice in Shaftesbury. Following this heworked as a single-handed locum in Bluff,New Zealand, for a year.

He led fundholding for his practice in Dorset inthe 1990s. He chaired the Purbeck andBlandford PCG and then the Purbeck localityof the South and East Dorset PCT.

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When the Dorset PCT formed, he chaired theMedicines Management Committee. He is anelected member of the Dorset Local MedicalCommittee.

David has interests in ornithology and sport.He still plays cricket and coaches the game inSwanage. He is married with three children.

Dr Ros MaycockChair, Mental Health andLearning Disability ClinicalCommissioning Programme(until October 2013)

Dr Ros Maycock was a GP fornearly 30 years in a practice in Poole and,until October 2013, was chair of the MentalHealth and Learning Disabilities CCP.

Prior to appointment with the CCG, Ros wasChair of the Professional ExecutiveCommittee and a member of theBournemouth and Poole NHS Primary CareTrust Board.

Dr Chris BurtonSecondary Care Member(Appointed 1 April 2013)

Chris qualified in 1987 and wasawarded PhD for work on patho-physiology of kidney tubular cells in 1997. Hewas appointed to the post of ConsultantNephrologist at North Bristol NHS Trust (NBT)in 2000.

Chris has a long-standing interest in improvingthe quality of patient care, including patientexperience. He set up the first kidney patientforum in Bristol to discuss services with patientsin 2006. He was made clinical director of renaland transplantation services at NBT in 2006and established systems of clinical governanceand improved infection control in this role.

Chris was made Medical Director of NBT in2009. His focus is improving the quality ofcare for patients. This includes responding toindividual patient concerns as well as workingwith colleagues within the Bristol health

system to improve services. He worked withBristol PCT PEC in 2010/12. His MedicalDirector portfolio includes improving qualityand safety, Caldicott Guardian, cancerservices quality and the role of Director ofInfection Prevention and Control.

Mary MonningtonRegistered Nurse Member(Appointed 1 April 2013)

Mary qualified as a RegisteredNurse in 1972 at St ThomasHospital, London. She has over40 years’ experience in the National HealthService as both a clinical nurse and director ofnursing in both acute and community providerand clinical commissioning organisations.

Mary is also a registered lecturer practitionerwith experienced of delivering andcommissioning clinical professional educationfor nurses and associated healthprofessionals. She has a special interest inprofessional conduct and competenceencompassing all health professional groups.Mary is married with two daughters and livesin Wiltshire.

Teresa HensmanLay Member Lead forGovernance(Appointed 1 April 2013)

Teresa is a Fellow of theChartered Association of CertifiedAccountants and a member of the Associationof Fraud Examiners.Teresa qualified as anaccountant in 1996 while working for theHammersmith Hospitals NHS Trust.

She has more than 13 years' seniormanagement experience within housingassociations and local government withrevenue budgets in excess of £250 million.

Outside of the CCG, Teresa is an independentMental Health Act hospital manager for DorsetHealthCare, and a member of the Local FoodLinks parent forum.

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David JenkinsLay Member Lead for Patient andPublic Involvement and DeputyCCG Chair(Appointed 1 April 2013)

After beginning his working lifeas a teacher, David qualified as a solicitor,practising mainly in the public service.

He worked with Oxfordshire and HampshireCounty Councils, and with the LocalGovernment Ombudsman service, beforejoining Dorset County Council in 1989. Hebecame their chief executive in 1999, a posthe held until 2012.

David has extensive experience of the publicservice, having chaired the DorsetConnexions company, the Dorset YouthOffending Team Board, the Total Place Boardfor Bournemouth, Dorset and Poole, and thesteering group that put in place thearrangements for the 2012 Olympic andParalympic sailing events. He currently chairsa committee on waste management forGloucestershire County Council.

David is a trustee of a number of localcharities, mainly involved with the arts andmusical education, and is a Fellow of theRoyal Society of Arts.

He is president of the Dorset Association ofParish and Town Councils, and a DeputyLieutenant of Dorset.

Executive Directors

The Governing Body is supported by aninternal commissioning structure with servicesprovided through four directorates:

� quality

� service development

� finance and performance

� engagement and development.

Each directorate is led by an executive

director, accountable to the Chief Officer. TheChief Finance Officer sits on the GoverningBody. Details of the other Executive Directorsare as follows:

Suzanne RastrickDirector of Quality(Appointed 1 April 2013)

Suzanne qualified as anoccupational therapist (OT) andbegan her career in the acute hospital sector,moving to practise in community and primarycare where she then gained her first generalmanagement role.

She was one of the first allied healthprofessionals (AHPs) to hold a substantiveDirector of Nursing post and has since heldthese roles in both providing andcommissioning organisations. She has alsobeen chief executive of a primary care trustcluster.

She has a non-executive portfolio in thecommercial and not-for-profit housing sectorand sits on a number of national groupsincluding NHS Employers Policy Board andHealth Education England AHP AdvisoryGroup.

Jane PikeDirector of Service Delivery(Appointed 1 April 2013)

Jane spent the first 16 years ofher career as a clinicalmicrobiologist both in the NHS and veterinaryfields.

In 1997 she was successful in gaining a placeon the NHS accelerated management trainingscheme, graduating in 2000.

Since that time she has held a variety ofsenior management positions at local,regional and national level, spanningoperational and strategic commissioningresponsibilities.

Jane joined NHS Dorset PCT from NHS



Hampshire PCT, where she had been theProgramme Director - Service Redesign since2007. Prior to this she held the role of head ofadult services at East Hampshire, Fareham andGosport Primary Care Trust, managing all adultcommunity services, including four communityhospitals.

Jane was appointed as director of acute andprimary care service improvement for NHSDorset and NHS Bournemouth and Poole inJuly 2011, and to the Director of ServiceDelivery (designate) for the CCG in October 2012.

Charles SummersDirector of Engagement andDevelopment(Appointed 1 April 2013)

Charles was formerly Director ofWorkforce for NHS Dorset and NHSBournemouth and Poole from July 2011.

He joined the NHS in 1993 and has worked invarious health settings, developing andimproving people management. He is a Fellowof the Chartered institute of Personnel andDevelopment and a qualified executive coach.

Charles provided professional advice on allaspects of workforce and organisationaldevelopment practice to both local PCT boardsand to the leadership of the shadow ClinicalCommissioning Group for Dorset.

Charles has worked at executive level with anumber of NHS boards since 2005 and leadsour equality and diversity, public engagement,organisational development, strategic planningand emergency planning responsibilities.

Charles BuckleNon-governing Lay member

Charles Buckle was appointed a non GoverningBody Lay Member of Dorset CCG in April 2013having earlier been a volunteer Lay Member of

the clinical governance working group of theDorset PCT for two and a half years. Charleshad previously spent six years as a member ofthe senior staff and bursar of a large Dorsetcomprehensive upper school after his principalcareer in the Royal Navy from which he retiredin the rank of Captain in 1993.

Swanage has been home for most of his lifeduring which he has variously been involvedwith the community hospital and the lifeboat.Charles is married with two children. Hisprincipal interest is sailing.

Tina ThompsonNon-governing Lay member

Tina Thompson was appointed a non-GoverningBody Lay Member of Dorset CCG in April 2013

Tina Thompson is a freelance managementconsultant working with voluntary andcommunity sector organisations since 2007.

She undertook a joint honours degree ineconomics and politics as a mature student,graduating in 1992, following which she had acareer in the voluntary sector working inadvocacy and advice agencies includingCitizens Advice.

Tina lives in Bournemouth, was a member ofthe Bournemouth LINK Stewardship Group andis a trustee of Friends of Boscombe ChineGardens. She currently works withBournemouth 2026 Trust – a community landand development trust which she helped to setup; is a lay advisor at Health Education Wessexand undertakes occasional freelance work withother voluntary and community sectororganisations.

Interests outside work include steam trains andshe has volunteered on the Swanage Railwayas a Ticket Inspector.

Declaration of interests Pursuant to our values of openness and honesty, it is a requirement thatall member practices of the Dorset Clinical Commissioning Group (CCG), Governing Bodymembers, GPs who are paid to provide services to the CCG and all staff declare any intereststhat they have that may conflict with the interests of the CCG itself. Please see pages 75 to 77.

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Name and CCG RoleGoverning BodyCommittee,CCP or Staff

Interests DateDeclared

Dr Peter BlickGPLocality Chair for CentralBourmemouth

Governing Body,CCC

Adult Safeguarding Lead,GP Tutor, Bournemouth,Out of Hours Contract for New Wave Care UK,Salaried GP – Whitecliff Surgery, Blandford

17/03/2014

Dr Jenny BubbGPLocality Chair for Mid Dorset

Governing Body Partner, Cerne Abbas GP Surgery,Co-opted member of DCC for HWB purposes

16/11/201104/02/2014

Dr Chris BurtonSecondary Care Member

Governing Body,CCC

Member of the Trust Board of North Bristol NHS Trust which provides a small numberof specialist services (not commissioned by the CCG) to the population of Dorset,Wife is a GPSI in dermatology in the Bristol region

17/02/2013

Dr Lionel CartwrightGP

Governing BodyCCCCCP Lead

Partner, Harvey Practice,Shareholder, Solutions for Health,Medical Advisor, Magna Care Centre, Bed Fund Victoria Hospital Wimborne,Wife is a Community Matron employed by Bournemouth and Poole Community HealthServices

Prior 14/11/2011

Dr Rob Childs,GPLocality Chair for NorthDorset

Governing Body,CCC

GP Partner, Bute House Surgery Sherborne,LMC Representative for North Dorset,Clinical Assistant in Endoscopy, Yeovil District Hospital,Dorset PCT Representative on Yeovil District Hospital Board of Governors,Member of Yeatman Hospital Management Group

14/11/2011

Dr Colin Davidson,GPLocality Chair for East Dorset

Governing Body, Senior Partner, The Cranborne Practice (PMS Dispensing and Training),Director, Dorset Diagnostics Ltd.,Wife is a Director of Dorset Diagnostics Ltd.,Community Endoscopy Lead for DHUFT,Trustee, Boveridge House School,Wife is a GP at Eagle House Surgery, Whitecliff Mill Street, Blandford Forum, DorsetDT11 7DQ,DDL hold an AQP contract for Community Endoscopy,Co-opted member of DCC for HWB purposes

12/05/2010,19/03/2014,19/03/201417/01/201215/01/201304/02/2014

Dr Paul FrenchGPLocality Chair for EastBournemouth

Governing BodyCCCAudit & QualityCommitteeCCP Lead

Co-opted members of the B&P HWB Board 05/02/2014

Tim GoodsonChief Officer

Governing Body,CCC

HFMAMember,HFMA South West Executive Branch Committee Member,Co-opted member of DCC for HWB purposes,Partner works for Bournemouth Borough Council

Prior 30/09/200913/04/201313/04/2013

Dr David Haines,GP,Locality Chair for Purbeck

Governing Body Co-opted member of DCC for HWB purposes 04/02/2014

Teresa Hensman, LayMember Lead forGovernanceChair of the Audit and QualityCommittee

Governing Body,Audit & QualityCommittee,RemunerationCommittee

Mental Health Act Hospital Manager, DHUFT 08/10/2012

Dr Tom KnightGPLocality Chair forNorth Bournemouth

Governing Body GP Partner, Northbourne Surgery,FTSE 100 index linked savings

15/01/2014

Dr Carol LinnardGP,Locality Chair forNorth Bournemouth

Governing Body(Until 31 August 2013)

Partner, Alma PartnershipProgramme Director for Winchester University/Wessex DeaneryPractice holds PMS and Contract for providing a GU and Family Planning ServiceGovernor, Royal Bournemouth Hospital

Prior 17/11/2011

20/01/2013

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InterestsDate

Declared

Dr Ros MaycockGPGP Transition Lead

CCP(Until October2013)

Partner, Evergreen Oak Surgery (Training Practice)Practice is a member of the Poole Central Locality Commissioning GroupMember of Poole Children Trust BoardMember of Bournemouth Children Trust BoardHusband employed by Purbeck CAB

Prior 17/11/2011Prior 17/11/201109/01/201309/01/201309/01/2013

Dr Chris McCallGP,Locality Chair for Poole North,

Governing Body,CCC,RemunerationCommitteeCCP Lead

Nothing to declare 13/02/2012

Dr Blair MillarGP,Locality Chair for West Dorset

Governing Body GP Partner, Bridport Medical Centre Skellern Practice,Wife (Dr Joanna Cotton) is a member of the Cancer Support Group “The Living Tree”Co-opted member of DCC for HWB purposes

08/06/2010,09/01/2013,04/02/2014

Mary MonningtonRegistered Nurse Member

Governing Body,Audit & QualityCommitteeRemunerationCommittee

Council member [UKCCG] United Kingdom Council of Caldicott Guardians, PanelMember Professional Performance Committees Nursing and Midwifery Council [NMC]Nurse Member Wiltshire CCGHusband JET Monnington, Senior Solicitor Moore Blatch Resolve LLP Southampton

05/200902/201304/201306/03/2013

Dr Piers WildeGP,Locality Chair CentralBournemouth Locality

Governing Body(Until 31 July 2013)

Senior Partner Moordown Medical Center, BournemouthMedical Cosmetic Medical Doctor Hyperbaric Doctor for Atlantic EnterpriseCircle. Solutions For Health

Jane PikeDirector of Service DeliveryDorset CCG

Co-opted members of the B&P HWB Board 05/02/2014

Suzanne RastrickDirector of Quality, DorsetCCG

Allied Health Professional/Healthcare ScientistMember, Policy Board, NHS EmployersMember, Health Education England Advisory GroupGroup Board Member and Chair, Audit and Risk Committee, Spectrum Housing GroupLimited which involves oversight of the following companies: Spectrum Housing GroupLimited, Spectrum Property Care Limited, Signpost Homes Limited, Spectrum PremierHomes LimitedMember, Council of the College of Occupational TherapistsChair of the English Board of the College of Occupational Therapists

Prior to30/04/200901/09/200901/12/201020/06/201220/06/2012

Dr Andy RutlandGPLocality Chair for Poole Bay

Governing Body,CCC

GP, Lilliput Surgery,Shareholder, Solutions for Health,Wife is a Partner at The Harvey Practice

Prior to17/11/201113/01/2013

Charles SummersDirector of Engagement andDevelopment, Dorset CCG

Nothing to declare 15/03/2011

Paul VaterChief Finance Officer

Governing BodyCCC

Trustee of Healthcare Financial Management Association (HFMA) – South West Branch 02/04/2013

Dr Christian VerrinderGP

CCCCCP Lead(Until 30 September2013)

GP Partner, Wellbridge Practice Wool (dispensing practice also holds contract to providemedical inpatient care for Wareham and Blandford Hospitals),Employed by Orthopaedic Medical Service (OMS) former Bournemouth & Poole PCT,DHUFT from April 2011

02/03/2011

01/04/2011

Dr Simon WatkinsGP

CCCCCP Lead

Partner at Evergreen Oak Surgery,Deputy Chair, Poole Central Locality,Work Out of Hours shift for provider SWAST,Co-opted members of the B&P HWB Board

22/02/201422/02/201422/02/201405/02/2014

Charles Buckle Lay Member,Member Audit andQuality Committee

Member of DHCUFT (Not on Governing Body, but to keep in touch with priorities)Member of Purbeck Health Network 14/05/13

76



Each declaration is considered individually. In the main, the acts of declaring, recording andpublishing declared interests are sufficient to deal with the interest declared. Where afterconsideration, and having regard to the Nolan principles, a member’s personal or private interestsare such as to prejudice his/her ability to remain disinterested in any particular issue, they will beadvised to withdraw from participating in decision making in that particular issue.

Each individual who is a member of the Governing Body at the time the Members' Report isapproved confirms: so far as the member is aware, that there is no relevant audit information ofwhich the clinical commissioning group's external auditor is unaware; and that the member hastaken all the steps that they ought to have taken as a member in order to make them aware of anyrelevant audit information and to establish that the clinical commissioning group's auditor is awareof that information.


InterestsDate

Declared

Ms Tina Thompson Lay Member,Audit & QualityCommittee

Employee of Bournemouth Borough Council working for Bournemouth 2026 TrustLay Advisor, Health Education Wessex/Wessex DeaneryFreelance Management Consultant, Third Sector Management SolutionsSite Assessor, Quality Performance Mark, Action for AdvocacySecretary, Friends of Boscombe Chine Gardens

14/11/2011

David JenkinsLay Member Lead for Patientand Public Engagement,Deputy Chairman of theGoverning Body,Chairman of theRemuneration Committee

Governing Body,Audit & QualityCommittee,CCC,RemunerationCommittee

Chair of Gloucestershire County Council's Waste Working Group (2 to 3 days amonth)Deputy Lieutenant, Dorset,Trustee, Bournemouth Symphony Orchestra Endowment Fund,Trustee, Richard Ely Trust for Young Musicians.Trustee, Burton Bradstock Festival,Patron, Bridport Arts Centre,President of the Dorset Association of Parish and Town Councils.

21/11/2012,04/11/2013

Dr Richard JenkinsonGPLocality Chair forChristchurch

Governing Body GP Partner, Burton Medical Centre,GPwSI in ENT, employed by DHUFT,Director, Wessex Aviation Medical Services Ltd,Co-opted member of DCC for HWB purposes

10/05/201007/01/201310/05/201004/02/2014

Dr Karen KirkhamGP,Locality Chair for Weymouthand Portland

Governing Body,CCC,CCP Lead

GP Partner, the Bridges Medical Centre Weymouth,Specialty Doctor in Sexual Health, employed by DCHFT,Board Member, Sexual Health South West Regional Office,Member of Children’s Trust Board, Dorset,Governor at Sunninghill Preparatory School,Husband is a GP Partner at Abbotsbury Road Surgery Weymouth,Co-opted member of DCC for HWB purposes

Prior 14/11/201104/02/2014

Dr Patrick Seal, GPLocality Chair for PooleCentral

Governing Body GP, The Adam Practice,Quay Medical Care Limited, the Adam Practice’s provider vehicle for PCOS andPaediatric service

Prior to17/11/2011,16/02/2012

Dr Craig WakehamGP,CCP Lead

CCC Senior Partner, Cerne Abbas Surgery (PMS dispensing practice), Dorset LM 26/04/2012

Dr Forbes WatsonGP,CCG Chair,CCC Chair

Governing Body,CCCRemunerationCommittee

Principal, GP Practice (PMS)in Lyme RegisContract with VH Doctors Ltd for medical care.Spouse clinical employee for DHUFT.Honorary Medical Advisor and Chairman of RNLI Lyme RegisCo-opted member of DCC for HWB purposes

Prior to30/04/200915/05/201315/05/201315/05/201304/02/2014

77

78


Board and Executive Committee Members

Full details of the remuneration paid to theGoverning Body members and senioremployees are provided within theRemuneration Report included herein,together with their pension entitlements anddeclaration of interest.

As part of the governance structure, the CCGhas in place an Audit & Quality Committeewhich is responsible for providing the Boardwith assurance across the range of CCGactivities, whilst retaining a particular financialfocus.

The Audit & Quality Committee is chaired byTeresa Hensman, Lay Member Lead forGovernance, who has relevant and recentfinancial experience. Other Lay Members ofthe Committee during 2013/14 were TinaThompson, Charles Buckle, and DavidJenkins.

The Committee reviews its terms of referenceand its effectiveness annually andrecommends to the Governing Body anychanges required as a result of the review.

In 2013/14, the Audit & Quality Committeedischarged its responsibilities by:

� reviewing and recommending the CCG’sdraft financial statements and the externalauditors detailed reports thereon

� reviewing the effectiveness of the externalaudit process

� reviewing and monitoring the externalauditors’ independence and objectivity andthe effectiveness of the audit process,taking into account relevant UKprofessional and regulatory requirements

� reviewing the external auditors’ annualwork plan, including its non-audit servicesand fees

� reviewing the risks associated with the

CCG’s business and management thereon

� reviewing the policies and procedures forall work related to fraud and corruption

� reviewing investigations as a result of theinstigation of the CCGs whistle blowingpolicy

� reviewing the CCGs system of internalcontrol and its effectiveness, reporting tothe Governing Body on the results of thereview and receiving regular updates onkey processes for management of the risksfacing the CCG

� reviewing the effectiveness of the internalaudit function

� reviewing the internal audit workprogramme, internal audit reports andperiodic progress reports on its work duringthe year; and

� reviewing governance and riskmanagement arrangements to ensureappropriate processesare in place.

The Audit & Quality Committee has widepowers to establish special investigations inthe event that any wrongdoing is brought to itsnotice, in particular, in the case ofdefalcations, fraud or theft.

External Audit

Grant Thornton is the appointed externalauditor for the CCG. The total fee paid toGrant Thornton was £122,000 including VATand was paid to cover the cost of the statutoryaudit and associated services.

Senior Managers Remuneration Report

For the purpose of this report, seniormanagers are defined as being ‘those personsin senior positions having authority orresponsibility for directing or controlling themajor activities of the Clinical CommissioningGroup’.

REMUNERATIONREPORT

79


This means those who influence the decisionsof the organisation as a whole rather than thedecisions of individual directorates ordepartments. Such persons will includeadvisory and Lay Members.

The CCG’s Remuneration Committee ischaired by David Jenkins, Deputy Chair of theCCG Governing Body. The Committee met onfive occasions in 2013/14.

It is the Remuneration Committee thatdetermines the reward packages of ExecutiveDirectors.

The policy on remuneration of seniormanagers has been determined reflecting aDorset based public sector benchmarkingexercise, national CCG remunerationguidance and principles established by theDepartment of Health within a very seniormanagers pay framework.

In the coming year, the committee will reviewits policy with wider CCG benchmarking(following the publication of other CCG annualaccounts) together with any furtherdevelopment of national remunerationguidance for CCGs.

Senior CCG officers are eligible forconsideration of a performance related payaward.

Determination of any award is at thediscretionary recommendation of thecommittee, determined by reference to theachievement of business objectives. Awardsrange from 0-5% of individual basic salary.

Senior officer appointments to the CCG are

offered under substantive employment termsand subject to 6 months’ notice of termination.

Other appointments to the Governing body(excluding Chief Officer and Chief FinanceOfficer) are determined for periods of threeyears, renewable under terms provided for bythe constitution. (Please see pages 68 to 77for Governing Body and Senior Managers’Profiles).

Reporting bodies are required to disclose therelationship between the remuneration of thehighest-paid director in their organisation andthe median remuneration of the organisation’sworkforce.

The mid-point banded remuneration of thehighest paid director in the financial year2013/14 was £132,500. This was 3.6 times themedian remuneration of the workforce, whichwas £36,666.

In 2013/14, no employee’s full time equivalentsalary was in excess of the highest paiddirector. Remuneration ranged from £5,000 to£132,500.

Total remuneration includes salary, non-consolidated performance-related pay,benefits-in-kind as well as severancepayments.

It does not include employer pensioncontributions and the cash equivalent transfervalue of pensions.

Exit Packages

In 2013/14 there were two exit packages, at acost of £11,033.

REMUNERATIONREPORT


REMUNERATIONREPORT

Name and Title

Salary andFees

(Bands of£5,000)

£”000

TaxableBenefits

Roundedto thenearest£’000

£’000

AnnualPerformance-RelatedBonuses(Bands of£5,000)

£’000

Long TermPerformanceRelatedBonusesBands of£5,000)

£’000

All Pension-relatedBenefits

Bands of£2,500)

£’000

Total

Bands of£5,000)

£’000

Dr Forbes Watson, Chair 70 – 75 0 0 0 10 – 12.5 85 –- 90

Mr Tim Goodson, Chief Officer 130 – 135 0 0 0 17.5 – 20 150 – 155Mr Paul Vater, Chief Finance Officer 100 – 105 0 0 0 12.5 – 15 115 – 120Mrs Suzanne Rastrick,Director of Quality 100 – 105 0 0 0 12.5 – 15 115 – 120

Ms Jane Pike,Director of Service Delivery 90 – 95 0 0 0 12.5 – 15 105 – 110

Mr Charles Summers, Director ofEngagement and Development 90 – 95 1 0 0 12.5 – 15 105 – 110

Dr Paul French, GP Locality Chair forEast Bournemouth and GP ClinicalCommissioning Programme (MentalHealth and Learning Disabilities) Lead

55 – 60 0 0 0 0 – 2.5 55 – 60

Dr Jenny Bubb, GP Locality Chair forMid Dorset 25 – 30 0 0 0 2.5 – 5 30 – 35

Dr Robert Childs, GP Locality Chairfor North Dorset 25 – 30 0 0 0 2.5 – 5 30 – 35

Dr Colin Davidson, GP Locality Chairfor East Dorset 25 – 30 0 0 0 0 25 – 30

Dr David Haines, GP Locality Chair forPurbeck (from 1st October 2013) 20 – 25 0 0 0 2.5 – 5 25 – 30

Dr Chris McCall, GP Locality Chair forPoole North and GP ClinicalCommissioning Programme (GeneralMedical and Surgical) Lead

65 – 70 0 0 0 0 65 – 70

Dr Blair Millar, GP Locality Chair forWest Dorset 25 – 30 0 0 0 0 25 – 30

Dr Andy Rutland, GP Locality Chairfor Poole Bay 25 – 30 0 0 0 2.5 – 5 30 – 35

Dr Patrick Seal, GP Locality Chair forPoole Central 25 – 30 0 0 0 2.5 – 5 30 – 35

Dr Tom Knight, GP Locality Chair forNorth Bournemouth (from 1stSeptember 2013)

25 – 30 0 0 0 2.5 – 5 30 – 35

80

Salaries & Allowances (subject to audit)


REMUNERATIONREPORT

Name and Title

Salaryand Fees

(Bands of£5,000)

£’000

TaxableBenefits

Rounded tothe nearest£’000£’000


£’000

Long TermPerformance-RelatedBonusesBands of£5,000)

£’000


Bands of£2,500)

£’000

Total

Bands of£5,000)

£’000

Dr Karen Kirkham, GP Locality Chairfor Weymouth and Portland and GPClinical Commissioning Programme(Maternity, Reproductive and FamilyHealth) Lead

55 – 60 0 0 0 7.5 – 10 65 – 70

Dr Richard Jenkinson, GP LocalityChair for Christchurch 25 – 30 0 0 0 2.5 – 5 30 – 35

Dr Peter Blick, GP Locality Chair forCentral Bournemouth (from 1st August2013)

20 – 25 0 0 0 0 20 – 25

Dr Chris Burton, Secondary CareMember 20 – 25 0 0 0 0 20 – 25

Ms Mary Monnington, RegisteredNurse Member 15 – 20 0 0 0 0 15 – 20

Dr Piers Wilde, Former GP LocalityChair for Central Bournemouth (1st April2013 – 31st July 2013)

20 – 25 0 0 0 0 – 2.5 20 – 25

Dr Carol Linnard, Former GP LocalityChair for North Bournemouth (1st April2013 – 31 August 2013)

10 – 15 0 0 0 0 10 – 15

Dr Christian Verrinder, Former GPLocality Chair for Purbeck (1st April 2013– 30 September 2013) and GP ClinicalCommissioning Programme(Musculoskeletal and Trauma) Lead

25 – 30 0 0 0 2.5 – 5 30 – 35

Lay MembersMrs Teresa Hensman, Lay MemberLead for Governance, Chair of the Audit& Quality Committee

15 – 20 0 0 0 0 15 – 20

Ms Tina Thompson, Lay Member,Member Audit & Quality Committee 0 – 5 0 0 0 0 0 – 5

Mr David Jenkins, Lay Member Leadfor Public Engagement, Deputy Chair ofthe Governing Body and Chair of theRemuneration Committee

15 – 20 0 0 0 0 15 – 20

Mr Charles Buckle, Lay Member,Member Audit & Quality Committee 0 – 5 0 0 0 0 0 – 5

81


REMUNERATIONREPORT

Notes 1. No directors waived any allowances or remuneration during the period 1 April 2013to 31 March 2014.

2. Other remuneration and benefits in kind relate to on-call and mileage above taxablethreshold.

3. No payments have been made to past senior managers by the CCG in 2013/14.

4. No payments have been made to a senior manager for loss of office in 2013/14

5. No member of staff formally identified as a senior manager in the CCG has beengiven additional payments outside of payroll or give in assets in 2013/14.

Name and Title

Salary andFees

(Bands of£5,000)

£’000

TaxableBenefits

Rounded tothe nearest£’000£’000


£’000

Long TermPerformance-RelatedBonusesBands of£5,000)

£’000


Bands of£2,500)

£’000

Total

Bands of£5,000)

£’000

Clinical Commissioning Programme Chairs (not members of Governing Body)

Dr Lionel Cartwright, GP ClinicalCommissioning Programme(Cancer and End of Life) Lead

25 – 30 0 0 0 0 - 2.5 30 - 35

Dr Craig Wakeham, GP ClinicalCommissioning Programme(Cardiovascular Disease, Stroke,Renal and Diabetes) Lead

25 – 30 0 0 0 2.5 - 5 30 – 35

Dr Simon Watkins, GP ClinicalCommissioning Programme (Pan– Urgent Care, Clinical ServicesReview and Better Together) Lead

25 – 30 0 0 0 0 25 – 30

Dr Ros Maycock, Former GPClinical CommissioningProgramme (Mental Health andLearning Disabilities) Lead until31 October 2013

30 – 35 0 0 0 2.5 - 5 35 – 40

82


REMUNERATIONREPORT

Senior Manager Pension Benefits (subject to audit)Real

increase inpension atage 60

(bands of£2,500)

£’000

Realincrease inpension

lump sum atage 60

(bands of£2,500

£’000

Totalaccruedpension atage 60 at31 March2014

(bands of£5,000)

£’000

Lump sumat age 60related toaccruedpension at31 March2014

(bands of£5,000)

£’000

CashEquivalentTransferValue at 31March 2013

£’000

CashEquivalentTransferValue at 31March 2014

£’000

Realincrease inCash

EquivalentTransferValue

£’000

Employerscontribution

topartnershippension

£’000

Mr TimGoodson, ChiefOfficer

5 – 7.5 17.5 – 20 30 – 35 90 – 95 366 476 102 0

Mr Paul Vater,Chief FinanceOfficer

5 – 7.5 15 – 17.5 25 – 30 80 – 85 370 491 114 0

Mrs SuzanneRastrick,Director ofQuality

(2.5) - (0) (7.5) - (5) 30 - 35 100 - 105 605 594 (25) 0

Ms Jane Pike,Director ofService Delivery

0 – 2.5 5 – 7.5 35 – 40 105 – 110 619 693 60 0

Mr CharlesSummers,Director ofEngagementandDevelopment

2.5 – 5 7.5 – 10 20 – 25 65 – 70 318 392 67 0

Dr ChrisBurton,Secondary CareMember

0 – 2.5 5 - 7.5 45 - 50 135 - 140 721 846 109 0

Notes1. Lay Members do not receive pensionable remuneration.2. Full details of the accounting policy regarding pension costs can be found within Note 4 of thefull set of audited financial statements.

3. As it is not possible to apportion the CETV across organisations, the full value for each seniormanager is reported above.

4. Mrs Suzanne Rastrick has a decrease in Pension benefits, due to a change in role; last year’srole was Interim Chief Executive.

5. Dr Chris Burton is recharged to the clinical commissioning group by North Bristol NHS Trustwhich includes pension costs. In accordance with the Manual of Accounts, 100% of Dr Burton’sNHS pension entitlements are shown above, however, only 12% of the pension entitlementsrelate to his clinical commissioning group engagement.

6. GPs who serve on the Governing Body for the CCG are recognised as being under a ‘contractfor service’ and therefore according to the NHS Pension Agency do not fall within the definitionof a senior manager for disclosure under Greenbury.

83


Cash Equivalent Transfer Values

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pensionscheme benefits accrued by a member at a particular point in time. The benefits valued are themember’s accrued benefits and any contingent spouse’s pension payable from the scheme. ACETV is a payment made by a pension scheme or arrangement to secure pension benefits inanother pension scheme or arrangement when the member leaves a scheme and chooses totransfer the benefits accrued in their former scheme.

The pension figures shown relate to the benefits that the individual has accrued as a consequenceof their total membership of the pension scheme, not just their service in a senior capacity to whichdisclosure applies.

The CETV figures and the other pension details include the value of any pension benefits inanother scheme or arrangement which the individual has transferred to the NHS pension scheme.They also include any additional pension benefit accrued to the members as a result of theirpurchasing additional years of pension service in the scheme at their own cost. CETVs arecalculated 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 theincrease in accrued pension due to inflation, contributions paid by the employee (including thevalue of any benefits transferred from another scheme or arrangement) and uses common marketvaluation factors for the start and end of the period.

Off-payroll Engagements

Following the review of Tax arrangements of public sector appointees published by the ChiefSecretary to the Treasury, clinical commissioning groups are required to publish information ontheir highly paid and/or senior off-payroll engagements.

Off-payroll engagements as of 31 March 2014, for more than £220 per day and that last longerthan 6 months are as follows:

All existing off-payroll engagements, outlined above, have at some point been subject to arisk based assessment as to whether assurance is required that the individual is payingthe right amount of tax and, where necessary, that assurance has been sought.

REMUNERATIONREPORT

The number that have existed:� For less than one year at the time of reporting NIl� Total number of existing engagements as of 31 March 2014 Nil

Number

84

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

Number of the above which include contractual clauses giving the clinical commissioning group the right to requestassurance in relation to Income Tax and National Insurance obligations. Nil

Number for whom assurance has been requested. Nil

Of which, the number: Nil

� For whom assurance has been received Nil

� For whom assurance has not been received Nil� That have been terminated as a result of assurance not being received. Nil

Number


REMUNERATIONREPORT

85


FINANCIALPERFORMANCE

SUMMARY FINANCIAL STATEMENTS

The statements below summarise the information contained within the full audited accounts.

Statement of Comprehensive Net Expenditure

Administration Costs and Programme Expenditure

Other Comprehensive Net Expenditure

Gross Employee BenefitsOther CostsLess: Miscellaneous IncomeNet Operating Costs before Financing

13,496926,659(5,672)934,483

Investment RevenueOther (Gains) & LossesFinance CostsNET OPERATING COST FOR THE FINANCIAL YEAR

000

934,483

Impairments and reversals put to the Revaluation ReserveNet (gain)/loss on revaluation of property, plant and equipmentRelease of reserves to Statement of Comprehensive Net ExpenditureTOTAL COMPREHENSIVE NET EXPENDITURE FOR THE YEAR

000

934,483

The purpose of this statement is to summarise, on an accruals basis, the net operating costs ofthe CCG. The statement identifies gross operating costs, less miscellaneous income, to arriveat the net operating costs of the CCG.

86



Overview

The audited accounts show that during the year ended 31 March 2014, the CCG achieved all of itsfinancial duties.

Revenue Resource Limit

The CCG has a statutory duty to maintain expenditure within the resource limits set for revenue,including managing programme and running costs allocations separately.

Revenue expenditure covers the general day to day costs involved in the commissioning ofhealthcare. The CCG met its statutory duty to operate within its revenue resource limit and inaddition is significantly under the £25 per head running cost allowance.

2013/14£’000TOTAL934,483

947,097

12,614

Total net operating costs for the financial year

Revenue Resource Limit

REVENUE SURPLUS

2013/14£’000

Programme917,753

928,367

10,614

2013/14£’000

Running Costs16,730

18,730

2,000

This note measures the CCG’s performance against its statutory duty to operate within therevenue resource limit set by the Department of Health and NHS England.

The revenue resource limit is the maximum the CCG can spend on commissioning healthcare forits resident population.

Staff Costs

2013/14£’000

Salaries and wages 11,396

Employer contributions to NHS Pensions Agency 1,235

Social Security Costs 854

Termination Benefits 11

Other Employment Benefits 0

TOTAL STAFF COSTS 13,496

87

This note includes permanently (those directly emloyed by the CCG) and other employed staff(those on secondment or loan from other organisations, bank / agency / temporary staff andcontract staff).



Average Number of Persons Employed

2013/14

This note has been prepared consistently with total staff costs above.

The above 2013/14 figures relate to commissioning staff only and following nationalguidance, the calculation of sickness absence in a financial year is calculated using workingdays only. The calculation of sickness absence in a financial year is calculated using onlyworking days.

Running Costs

2013/14

Running costs (£’000s) 16,730

Weighted population (number in units) 749,179

Running costs per weighted population (£ per head) £22.33

Average Number of Persons Employed (Other Staff) 295

88

Sickness & Absence Data

2013/14

Total Days Lost 1,220

Total Average Number of Staff (FTE) 234

Average Working Days Lost 5.21

The employee absence level within the CCG is above the national target of 3% and alsoabove the target we have set for ourselves of 2%. In light of this the CCG introduced a newManaging Absence policy in April 2014 as part of a wider re-launch of HR polices.

This has been supported by a series of briefings across CCG sites for managers andemployees. One of the key objectives in the Workforce Plan for 2014/15 is a review of thecurrent managing attendance system from recording through to monitoring andengagement with managers as well as development. We will then develop a new managingattendance system with the appropriate communication, engagement and developmentstrategy to roll out to the organisation.

Number



Better Payments Practice Code

In accordance with the Better Payments Practice Code, valid invoices should be paid by theirdue date or within 30 days of receipt, whichever is later. CCG performance is presented below,measured in terms of both the number and value of invoices received, against an NHSadministrative target to pay over 95% of non-NHS trade creditors in accordance with the code.

Non-NHS Payables

2013/14Number £’000

Total bills paid in the year 27,290

Total bills paid within target 26,441

Percentage of bills paid within target 96.9%

130,783

129,063

98.7%

NHS Payables

Number £’000

2013/14

Total bills paid in the year 3,601

Total bills paid within target 3,534

Percentage of bills paid within target 98.1%

682,215

688,789

101.0%

This note shows the CCG’s performance against its administrative duty to pay allcreditors within 30 calendar days of receipt of goods or valid invoice, whichever is later,unless other payment terms have been agreed.

Losses and Special Payments

The CCG had no losses or special payments during 2013/14.

During 2013/14 the CCG had no lapses of data security.

Losses or special payments are payments that Parliament would not have envisaged healthcarefunds being spent on when it originally provided the funds.

89

The 101.0% is caused by a large credit note. If the credit note could be removed from thefigures, the per centage of NHS invoices paid within target would fall to 99.7%


GLOSSARY

A&E Accident and Emergency

AF Atrial Fibrillation

AHPs Allied health professionals

B&P Bournemouth and Poole

CAAS Community Adult AspergerService

CAMHS Child and Adolescent MentalHealth Services

CCC Clinical CommissioningCommittee

CCG Clinical Commissioning Group

CCP Clinical CommissioningProgramme

CCU Civil Contingencies Unit

CETV Cash Equivalent Transfer Value

CHC Continuing Health Care

CIPOLD Confidential Inquiry intoPremature Deaths of People withLearning Disabilities

COPD Chronic Obstructive PulmonaryDisease

CQC Care Quality Commission

CVD Cardiovascular disease

DCC Dorset County Council

DCHFT Dorset County Hospital NHSFoundation Trust

DSCB Dorset Safeguarding ChildrenBoard

DHUFT Dorset Healthcare UniversityNHS Foundation Trust

ECG Electrocardiogram

EPC Energy Performance Contract

EPRR Emergency preparedness,resilience and response

FFT Friends and Family Test

GSF Gold Standard Framework

HR Human Resources

HWB Health and Wellbeing Board

IG Information Governance

IGT Information Governance Toolkit

IV Intravenous

IVF In Vitro Fertilisation

JSNA Joint Strategic Health NeedsAssessments

KPI Key Performance Indicator

LAT Local Area Team

LHRP Local Health ResiliencePartnership

LRTI Lower Respiratory Tract Infection

LSCB Bournemouth and Poole LocalSafeguarding Children Board

LTC Long Term Condition

MRSA Meticillin-resistantStaphylococcus Aureus, a type ofbacterial infection

MSK Musculoskeletal

NBT North Bristol NHS Trust

OT Occupational therapist

PCT Primary Care Trust

PEC Professional ExecutiveCommittee

PHFT Poole Hospital NHS FoundationTrust

PHB Personal Health Budget

POPP Dorset Partnership for OlderPeople Programme

PROM Patient Reported OutcomeMeasures

PTS Patient Transport Services

RBCHFT Royal Bournemouth andChristchurch Hospitals NHSFoundation Trust

TIA Transient Ischaemic Attack(mini-stroke)

90

NHS DORSET CLINICAL COMMISSIONING GROUP

FINANCIAL STATEMENTS

FOR THE YEAR ENDED

31 MARCH 2014

NHS Dorset Clinical Commissioning Group - Annual Accounts 2013-14

CONTENTS

Foreword to the Accounts 3

Independent Auditor's Report 4

Statement of the Signing Officer Responsibilities 5

Annual Governance Report 6-19

Head of Internal Audit Opinion 20-24

The Primary Statements: 25

Statement of Comprehensive Net Expenditure 26

Statement of Financial Position 27

Statement of Changes in Taxpayers' Equity 28

Statement of Cash Flows 29

Notes to the Accounts: 30

Note 1 Accounting policies 31-36

Note 2 Miscellaneous Revenue 37

Note 3 Revenue 37

Note 4 Employee benefits and staff numbers 38-39

Note 5 Operating Expenses 40

Note 6 Better payments practice code 41

Note 7 Income Generation Activity 41

Note 8 Investment Income 41

Note 9 Other gains and losses 41

Note 10 Finance costs 41

Note 11 Net Gain (Loss) by Absorption 42

Note 12 Operating Leases 42

Note 13 Property, Plant and Equipment 43-44

Note 14 Intangible Non-Current Assets 45

Note 15 Investment Property 45

Note 16 Inventories 45

Note 17 Trade and other receivables 46

Note 18 Other financial assets 46

Note 19 Other current assets 46

Note 20 Cash and cash equivalents 46

Note 21 Non-current assets held for sale 46

Note 22 Analysis of Impairments and Reversals 47

Note 23 Trade and other payables 47

Note 24 Deferred revenue 48

Note 25 Other financial liabilities 48

Note 26 Other liabilities 48

Note 27 Borrowings 48

Note 28 PFI and NHS LIFT contracts 48

Note 29 Finance lease obligations 48

Note 30 Provisions 48

Note 31 Contingencies 49

Note 32 Commitments 49

Note 33 Financial instruments 49

Note 34 Operating segments 50

Note 35 Pooled budget 50

Note 36 NHS LIFT investment 50

Note 37 Intra Government and other balances 50

Note 38 Related Party transactions 51

Note 39 Events after the reporting period 52

Note 40 Losses and special payments 52

Note 41 Third Party Assets 52

Note 42 Financial performance targets 52

Note 43 Impact of IFRS treatment 52

Note 44 Analysis of Charitable reserves 52

Glossary of financial terms 53

Contents Page 2 of 53

FOREWORD TO THE ACCOUNTS

NHS Dorset Clinical Commissioning Group

ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2014

These accounts for the year ended 31 March 2014 have been prepared by the NHS Dorset

Clinical Commissioning Group under section 17 of the National Health Service Act 2006 (as

amended) in the form which the Secretary of State has, with the approval of the Treasury,

directed.

Forward Page 3 of 53


Independents Auditor's Report Page 4i to 4iii of 53


The National Health Service Act 2006 (as amended) states that each Clinical Commissioning

Group shall have an Accountable Officer and that Officer shall be appointed by the NHS

Commissioning Board (NHS England). NHS England has appointed Timothy Goodson to be the

Chief Officer of the Clinical Commissioning Group.

The responsibilities of an Accountable Officer, including responsibilities for the propriety and

regularity of the public finances for which the Accountable Officer is answerable, for keeping

proper accounting records (which disclose with reasonable accuracy at any time the financial

position of the Clinical Commissioning Group and enable them to ensure that the accounts

comply with the requirements of the Accounts Direction) and for safeguarding the Clinical

Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and

detection of fraud and other irregularities), are set out in the Clinical Commissioning Group

Accountable Officer Appointment Letter.

Under the National Health Service Act 2006 (as amended), NHS England has directed each

Clinical Commissioning Group to prepare for each financial year financial statements in the form

and on the basis set out in the Accounts Direction. The financial statements are prepared on an

accruals basis and must give a true and fair view of the state of affairs of the Clinical

Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for

the financial year.

In preparing the financial statements, the Accountable Officer is required to comply with the

requirements of the Manual for Accounts issued by the Department of Health and in particular to:

Observe the Accounts Direction issued by NHS England, including the relevant accounting

and disclosure requirements, and apply suitable accounting policies on a consistent basis;

Make judgements and estimates on a reasonable basis;

State whether applicable accounting standards as set out in the Manual for Accounts

issued by the Department of Health have been followed, and disclose and explain any material

departures in the financial statements; and,

Prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in

my Clinical Commissioning Group Accountable Officer Appointment Letter.

Tim Goodson

Chief Officer / Accountable Officer

4 June 2014

Signing Officer ResponsilbitiesPage 5 of 53


GOVERNANCE STATEMENT FOR NHS DORSET CLINICAL COMMISSIONING GROUP

Governance Statement by Tim Goodson as the Chief Officer of NHS Dorset Clinical

Commissioning Group. 1 Introduction 1.1 The NHS Dorset Clinical Commissioning Group (CCG) was licenced from 1

April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the NHS Act 2006.

1.2 The CCG operated in shadow form prior to 1 April 2013, to allow for the

completion of the licencing process and the establishment of function, systems and processes prior to the CCG taking on its full statutory duties on 1 April 2013.

1.3 As at 1 April 2013, the CCG was licensed without conditions. 2 Scope of Responsibility 2.1 The Chief Officer has responsibility for maintaining a sound system of internal

control that supports the achievement of the CCG’s policies, aims and objectives, whilst safeguarding public funds and departmental assets for which he is personally responsible, in accordance with the responsibilities assigned to him in Managing Public Money. He is also responsible for ensuring that the CCG is administered prudently and economically and that resources are applied efficiently and effectively. The Chief Officer also acknowledges his responsibilities as set out in his Clinical Commissioning Group Accountable Officer Appointment letter.

3 Compliance with the UK Corporate Governance Code 3.1 Whilst the detailed provisions of the UK Corporate Governance Code (the

Code) are not mandatory for public sector bodies, compliance is considered to be good practice. The NHS Clinical Commissioning Groups Code of Governance has been created by extracting from the Code, parts relevant to CCG’s. This Governance Statement is intended to demonstrate the CCG’s compliance with the principles set out in the NHS Clinical Commissioning Group’s Code of Governance.

3.2 For the financial year ended 31 March 2014 and up to the date of signing this

statement, the CCG complied with the provisions set out in the NHS Clinical Commissioning Groups Code of Governance and applied the principles of the Code except as follows:

Annual Governance Statement Page 6 of 53














Principle 5: The CCG has just initiated plans to publish learning from and responses to complaints following recommendations in the Francis report. This will be implemented immediately;

Principle 6: The Governing Body has not received an annual summary of information that is available to the public. This will be addressed and presented at the Governing Body’s May meeting.

4 The CCG Governance Framework 4.1. The National Health Service Act 2006 ( as amended) at paragraph 14L(2)(b)

states: the main function of the governing body is to ensure the group has made appropriate arrangements for ensuring it complies with such generally accepted principles of good governance as are relevant to it.

4.2 The CCG is a membership organisation comprising of 100 GP practices

throughout Dorset. 4.3 The CCG Governing Body is committed to providing the resources and

support systems necessary to support the Risk Management Framework and will ensure that action is taken to address all risks that are identified and assessed as unacceptable.

4.4 The CCG Governing Body reviews the Assurance Framework/Corporate Risk

Register as a whole; six monthly, and through the Audit and Quality Committee, reviews the Assurance Framework/Corporate Risk Register as a whole, every quarter.

4.5 The CCG Governing Body is made up of 13 Locality Chairs who are GP’s or

retired GP’s, the GP Chair, the Accountable Chief Officer, the Chief Finance Officer, two lay members, the Lead Nurse and the Lead Consultant. The CCG Governing Body meets bi-monthly.

4.6 There are three non-voting Executive Directors, the Director of Quality, the

Director of Service Delivery and the Director of Engagement and Development that support the CCG Chief Officer. The Governing Body is supported by the Chief Officer and Governing Body Secretary.

4.7 The first standing agenda item for CCG Governing Body meetings is to

ensure compliance with Standing Order 3.11 (I) that states that no business shall be transacted at a meeting unless at least 1/3 of the whole number of the Chairman and members is present. During 2013-14 quoracy has been maintained for all CCG Governing Body meetings.

4.8 The CCG Governing Body has three committees that report to it. These are

the Remuneration Committee, Clinical Commissioning Committee and the Audit and Quality Committee.















Audit and Quality Committee

4.9 The Audit and Quality Committee is the committee which has delegated responsibility from the CCG Governing Body for the monitoring and oversight of risk and governance.

4.10 The Audit and Quality Committee monitors and provides overall assurance to

the Governing Body that the CCG is delivering quality care that meets the standards laid out in statute and that the CCG is aligning strategic direction with local assurance mechanisms by monitoring the Assurance Framework/Corporate Risk Register on behalf of the Governing Body. As part of this committee’s remit the Audit and Quality Committee will review internal audit reports on the systems in place for risk management.

4.11 The Audit and Quality Committee membership consists of two lay members

from the Governing Body of whom one is the Chair of the committee, two non- Governing Body lay members, one GP Governing Body member and the Lead Nurse Governing Body member. The Director of Quality and the Chief Finance Officer also attend the meetings and support the committee.

4.12 The Audit and Quality Committee meet quarterly. During 2013-14 quoracy has

been maintained for all Audit and Quality meetings 4.13 The Quality Group is a working group reporting to the Audit and Quality

Committee. The Quality Group has delegated responsibility for the management, monitoring and reporting of clinical governance, governance, risk, patient safety and quality. There is a Quality Framework in place which details the structures and processes to ensure quality is embedded throughout the commissioning cycle.

Clinical Commissioning Committee 4.14 The Clinical Commissioning Committee support the Governing Body with

delivery of clinical effectiveness and governance through:

support of the Audit and Quality Committee in discharging the CCG’s responsibility for clinical governance for commissioned services including the monitoring and enforcement of National Service Frameworks, National Institute of Clinical Excellence guidance and Care Quality Commission standards or other agreed standards;

providing clinical oversight to contract management on specific Clinical Commissioning Programme areas;

providing clinical scrutiny of service quality, effectiveness and safety and advising the Governing Body;

providing clinical assessment of commissioning outcomes;















4.15 The Clinical Commissioning Committee also support communication with partners and stakeholders through:

supporting and promoting effective partnership working, including joint planning and commissioning, with other NHS organisations, local authorities and the voluntary and independent sectors;

encouraging and facilitating locality engagement through CCPs;

resolving, through a clinical perspective, conflict with providers of service;

maintaining effective communications and engagement with front-line healthcare professionals.

Remuneration Committee

4.16 The Remuneration Committee is constituted as a standing committee of the

CCG Governing Body. The Committee is a non-executive committee and has no executive powers other than those specifically delegated in these Terms of Reference.

4.17 The Remuneration Committee shall comprise of the Chair, the Deputy Chair,

the Chair of the Audit and Quality Committee, and two other individuals who are members of the Governing Body.

4.18 The Remuneration Committee shall:

review the appraisal of the performance of the Chief Officer, directors and other appropriate members of the senior team;

recommend to the Governing Body the remuneration and terms of service of the Chief Officer, directors and other appropriate members of the senior team and annual salary awards;

recommend to the Governing Body special severance payments of the Chief Officer, directors and all other staff, subject to receiving HM Treasury (if necessary) approval in accordance with any current guidance;

determine a matter where the Governing Body is unable to determine the matter because of an inability to form a quorum and has specifically delegated to the committee a matter or matters to be determined by the committee on behalf of the Governing Body.

determine any matter delegated to it by the Governing Body. 4.19 The CCG Governing Body’s agenda covers all areas of financial accountability

and governance including the following reports made to every meeting:

• Chair’s report;

• Chief Officers update;

• Finance and Performance reports;

• Board Assurance Framework and Risk Register;

Quality Report incorporating the Francis Report Recommendations. 4.20 Other significant reports relating to internal controls that have been received

by the CCG Governing Body during 2013-14 include:

• Annual update for safeguarding Adults and Children;

• Annual Complaints report;

• Annual review of the Governance documents.

• Standing Financial Instructions, Standing Orders and scheme of delegation and committee structures.

4.21 The Audit and Quality committee agenda covers all areas of financial

accountability and governance including the following reports made to every meeting:

Customer Care report;

changes to Assurance Framework/Corporate Risk Register;

investigations following instigation of the Employee Whistle Blowing Policy;

updates on Litigation, Medical Negligence, Inquests and enquiries;

deep dive on significant risk issues;

review of Significant Providers Contracts report;

Safeguarding Adults report;

Safeguarding Children report;

Information Governance report;

Dorset Medicines Advisory Group report;

Internal Audit reports;















External Audit reports;

Counter Fraud reports. 4.22 In relation to Risk Management, the Quality Group seeks to provide assurance

to the Audit and Quality Committee by:

confirming that appropriate Risk Management arrangements are in place;

monitoring all significant risks which may impact on the CCG business planning process;

ensuring action to improve risk management processes and systems, to address all known and previously unidentified risks;

ensuring that patient safety is central to all services commissioned by the CCG including safeguarding of adults and children, via contract and quality monitoring of secondary and tertiary providers;

monitoring the CCG Assurance Framework/Corporate Risk Register.

4.23 The CCG Governing Body has arrangements in place via its Governance Framework and structures to ensure that it discharges its statutory functions and the Chief Officer can confirm that they are legally compliant. The Governing Body will be completing a self -assessment later on in the year.

5 The CCG Risk Management Framework 5.1 The CCG is committed to minimising risks to which it is exposed, strategically

and corporately. The overriding aim is to reduce the potential for loss of services due to adverse events, financial management or performance and quality management of commissioned services that could ultimately be of detriment to the population the CCG serves.

5.2 In order to achieve this aim, risk management has become part of the culture

of the organisation, and become a primary concern of all staff and stakeholders. The Risk Management Strategy was approved and endorsed by the Governing Body in December 2012 ready for use in April 2013 to reflect the CCG’s risk management requirements.

5.3 The Risk Management Strategy:

sets out the organisation’s objective to identify, treat and mitigate risk;

defines the role and objectives of the CCG’s committees and groups. It describes the supporting strategies, policies and procedures that determine the management and ownership of risk and the management of situations in which control failure leads to material realisation of risks;















specifies the way in which risk issues are to be considered at each level of planning, ranging from the corporate objectives set out in the CCG’s Delivery Plan to the individual objectives within Directorates;

specifies risk assessment and identification processes for new and existing activities and the resultant risk action plans and how these are captured within the Corporate Risk Register for the organisation;

standardises and clarifies the terminology of risk management and establishes clear, consistent and effective risk scoring systems;

explains the Assurance Frameworks and assesses the risk and the impact of failure, identifies the control mechanisms to monitor these objectives and clarifies the assurances that are present to review and monitor the implementation of objectives;

explains the risk scoring system that enables the organisation to impartially assess risk and identify high risk areas.

5.4 The CCG identifies the requirements for completing equality impact

assessments when commissioning services, changes to services, use of information within services and within the policies that are used.

5.5 Incident and Serious Incident reporting is openly encouraged from its staff, GP

practices and the provider organisations that it commissions. This information is analysed and used to identify risks which may impact on the business of the CCG.

5.6 The Quality Group and the Audit and Quality Committee have patient

representatives as that attend the meetings regularly to ensure there is a voice for patients and public. They are integral to scrutinising the risks identified and understanding what actions are taken to mitigate and reduce these risks.

5.7 The CCG is able to assure itself of the validity of its Annual Governance Statement in a number of ways. These are:

adherence to the Risk Management Strategy;

the governance framework and reporting mechanisms in place for provision of assurance;

scrutiny of the draft Governance Statement by members of the Audit and Quality Committee prior to submission and sign off at the special meeting for closure of finances in June 2014;















5.8 The cumulative contribution of the above mechanisms assists in the assurance of commissioning services that ensure patient safety is high profile.

6 The CCG Internal Control Framework 6.1 A system of internal control is the set of processes and procedures in place in

a clinical commissioning group to ensure that it delivers it policies, aims and 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.

6.2 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.

6.3 The Assurance Framework/Corporate Risk Register has controls described for every risk entry. The controls are reviewed on a monthly basis along with progress for reducing risk to ensure they are still effective.

7 Information Governance 7.1 The CCG places particular importance on risks for data security and to this

end there is an Information Governance Group which meets quarterly. This group manages risks pertaining to data security as part of its remit. This group reports quarterly to the Audit and Quality Committee.

7.2 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 clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively.

7.3 The CCG has completed the Information Governance Toolkit which is an annual requirement and has achieved level 2 in all standards of the toolkit.

7.4 The CCG has ensured all staff under take annual information governance training face to face and have implemented a staff information governance handbook to ensure staff are aware of the information governance roles and responsibilities.

7.5 There are processes in place for incident reporting and investigation of serious incidents pertaining to information governance.















8 Pension Obligations 8.1 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.

9 Equality Diversity and Human Rights Obligations 9.1 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.

10 Sustainable Development Obligations

10.1 The CCG is required to report its progress in delivering against sustainable development indicators.

10.2 The CCG are developing plans to assess risks, enhance our performance and

reduce our impact against carbon reduction and climate change adaption objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning.

10.3 The CCG will ensure that it complies with its obligations under the Climate Change Act 2008 including the Adaption Reporting power and the Public Services (Social Value) Act 2012. We are also setting out our commitments as a socially responsible employer.

11 Risk Assessment in Relation to Governance, Risk Management and Internal Control

11.1 The CCG operates a declaration of Interest register and this is checked regularly and potential conflicts of interest are taken in to account in all aspects of the CCG’s business.

11.2 The CCG operates a Governing Body Assurance Framework/Corporate Risk

Register which identifies the systems of internal control in place to efficiently, effectively, and economically manage these risks and provide assurance to the CCG and the organisation’s stakeholders that these systems are present.

11.3 All risks identified in the Assurance Framework/Corporate Risk Register

require the formulation of an action plan. A member of the Patient Safety Team meets with risk leads on a monthly basis to record progress against action plans and documents the effect these are having on the residual risk score. All action plans are formally reported via the Board Assurance Framework/Risk Register. The document includes all risks that may impact on the achievement of the Corporate Objectives.















11.4 The Governing Body receives regular assurance on the management of internal risks and assurance both directly via six monthly reports including the full Governing Body Assurance Framework/Corporate Risk Register and via assurance from the Audit and Quality Committee.

11.5 The Audit and Quality Committee reviews the full Governing Body Assurance

Framework/Corporate Risk Register on a quarterly basis.

11.6 Reports are also received on a monthly basis by Directors summarising the top risks to the organisation (those scoring over twelve), new risks, closed risk and any key risk issues. Directors also review the full Governing Body Assurance Framework/Corporate Risk Register every quarter.

11.7 There have been 29 new risks identified for 2013/2014. These are as follows:

3 related to concerns regarding providers which Monitor and CQC have investigated;

8 related to contracts and procurement;

2 related to finance being identified or adjusted;

2 for staff training related to induction;

2 related to targets and objectives;

2 related to performance;

3 related to clarity of functions outside of the CCG remit;

3 related to Business Continuity;

4 related to IT.

11.8 Many of the in year risks related to the start of the CCG to ensure it was set up to be able to operate effectively and fulfil its new functions. These risks have been mitigated over the year and are all now closed.

11.9 The outstanding risks that are in place on 31 March 2014 will be carried over

in to the new financial year and will continue to be managed within the framework described within this statement.

12. Review of Economy, Efficiency and Effectiveness of the Use of resources

12.1 There are procurement processes which the CCG adheres to. There is a

scheme of delegation which ensures that financial controls are in place across the organisation. An audit programme is followed to ensure that resources are used economically, efficiently and effectively.















13. Governance, Risk Management and Internal Control 13.1 The Chief Officer has the responsibility for reviewing the effectiveness of the

system of internal control within the CCG. 14. Capacity to handle risk 14.1 Leadership is provided for the risk management process within the CCG via

the Governing Body. The organisational structure has been established in order to assist with this process and is described in the following paragraphs.

14.2 The Director of Quality has been nominated as the lead Director for Risk

Management activity falling within the remit of the CCG. 14.3 All Directors are responsible for compliance with the Risk Management

Strategy to ensure that remedial actions are identified and taken wherever key risks are identified within their area of responsibility.

14.4 All Deputy Directors, managers and staff are responsible for compliance with

the Risk Management Strategy for ensuring that remedial actions are identified and taken wherever key risks are identified within their area of responsibility.

14.5 The Patient Safety Team within the CCG supports the consistent identification

and assessment and management of risk across the organisation and is central to the dissemination of best practice. The Team administer the key systems, act as a central resource and advisory function, advise upon and deliver key training and education programmes to ensure staff learn through good practice, ensure compliance with policies, procedures and management of risk and support lead officers, groups and committees in undertaking the requirements of their roles.

14.6 The Head of Patient Safety supported by the Patient Safety and Risk

Manager has been appointed to monitor risk management and patient safety within commissioned and corporate services for the CCG, which involves engagement with the Directors and Directorate risk leads to maintain the CCG’s Assurance Framework/Corporate Risk Register.

15 Review of Effectiveness 15.1 The 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. The Chief Officer has drawn on performance information available to him. His review is also informed by comments made by the external auditors in their management letter and other reports.















15.2 The Board Assurance Framework itself provides the Chief Officer with the evidence that the effectiveness of controls that manage risks to the CCG achieving its principal objectives have been reviewed.

15.3 The Chief Officer has been advised on the implications of the result of his

review of the effectiveness of the systems of internal control including the Governing Body, the Audit and Quality Committee, Quality Group and Information Governance Group and a plan to address weaknesses and ensure continuous improvement of the system is in place.

15.4 Executive Directors within the CCG who have responsibility for the

development and maintenance of the system of internal control provide the Chief Officer with assurance.

15.5 The Governing Body Assurance Framework/Corporate Risk Register itself

provides the Chief Officer with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed.

15.6 The Head of Internal Audit provides the Audit and Quality Committee with an

annual report detailing the audit coverage for the year and assessment of the adequacy of the control environment through her annual statement: significant assurance can be given that there is a sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently.

15.7 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 CCG’s system of risk management, governance and internal control. The Head of Internal Audit concluded that:

Significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls put the achievement of particular objectives at risk.

15.8 During the year the Internal Audit issued the following audit reports with a

conclusion of limited assurance:

Contract Monitoring Arrangements for Continuing Healthcare and Section 117 Providers. A follow up audit in this area during April 2014 confirmed that good progress is being made on implementing the agreed actions arising from the internal audit in September 2013. The key findings related to contract monitoring, contract conditions and inter-agency communications for joint contracts for the provision of care with the Local Authorities.

PC Environment. A review took place in July 2013 which identified the existence of sensitive information on some office computer hard-drives. A follow up audit during March 2014 confirmed that there has been good progress in implementing agreed actions from the initial review. However, an additional high priority finding was identified which is being addressed with an associated action plan.

Clinical Commissioning Programmes. A number of recommendations with associated action plans have been agreed for implementation to address the findings. These included the systems and processes around project management, declaration of interest and links with other areas in the organisation in respect of reporting and engagement

15.9 During the year Internal Audit did not issue any audit reports with a conclusion

of no assurance.

16 Data Quality

16.1 The data used by the Governing Body is obtained from various sources of which all are national systems. The Provider data is quality assured through contract and performance monitoring and against the Secondary Uses Service (SUS) quality dashboard.

17 Business Critical Models

17.1 The Chief Officer confirms that there is an appropriate framework and environment in place to provide quality assurance of business critical models, in line with the recommendations from the MacPherson report.

17.2 The Chief Officer confirms that all business critical models have been

identified and that the information about quality assurance processes for those models is currently being worked through. Once this has been completed, it will be shared with all partners including the area team within NHS England.

18 Data Security

18.1 The CCG has completed the Information Governance Toolkit which is an annual requirement and has achieved level 2 in all standards of the toolkit. This is considered a satisfactory level of compliance

18.2 There were no Serious Incidents relating to data security for 2013-2014 that

required reporting to the Information Commissioner. 19 Discharge of Statutory Functions

19.1 The Chief Officer confirms that correct arrangements are in place for the discharge of statutory functions, have been checked for any irregularities and that they are legally compliant in line with the recommendations in the Harris Review.















PC Environment. A review took place in July 2013 which identified the existence of sensitive information on some office computer hard-drives. A follow up audit during March 2014 confirmed that there has been good progress in implementing agreed actions from the initial review. However, an additional high priority finding was identified which is being addressed with an associated action plan.

Clinical Commissioning Programmes. A number of recommendations with associated action plans have been agreed for implementation to address the findings. These included the systems and processes around project management, declaration of interest and links with other areas in the organisation in respect of reporting and engagement

15.9 During the year Internal Audit did not issue any audit reports with a conclusion

of no assurance.

16 Data Quality

16.1 The data used by the Governing Body is obtained from various sources of which all are national systems. The Provider data is quality assured through contract and performance monitoring and against the Secondary Uses Service (SUS) quality dashboard.

17 Business Critical Models

17.1 The Chief Officer confirms that there is an appropriate framework and environment in place to provide quality assurance of business critical models, in line with the recommendations from the MacPherson report.

17.2 The Chief Officer confirms that all business critical models have been

identified and that the information about quality assurance processes for those models is currently being worked through. Once this has been completed, it will be shared with all partners including the area team within NHS England.

18 Data Security

18.1 The CCG has completed the Information Governance Toolkit which is an annual requirement and has achieved level 2 in all standards of the toolkit. This is considered a satisfactory level of compliance

18.2 There were no Serious Incidents relating to data security for 2013-2014 that

required reporting to the Information Commissioner. 19 Discharge of Statutory Functions

19.1 The Chief Officer confirms that correct arrangements are in place for the discharge of statutory functions, have been checked for any irregularities and that they are legally compliant in line with the recommendations in the Harris Review.















19.2 During establishment, the arrangements put in place by the CCG and

explained within the Corporate Governance Framework were developed with extensive expert external legal input, to ensure compliance with all the relevant legislation. The legal advice also informed the matters reserved for the Governing Body and the scheme of delegation.

19.3 In light of the Harris Review, the CCG has reviewed all of the statutory duties

and the powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations. As a result, the Chief Officer 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.

19.4 Responsibility for each duty and power has been clearly allocated to a lead

director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the CCG’s statutory duties.

20 Conclusion 20.1 I can confirm that no significant internal control issues have been identified. Tim Goodson Chief Officer / Accountable Officer 4 June 2014



Head of Internal Audit Opionion Page 20 of 53


Statement of Changes in Taxpayers' Equity

THE PRIMARY STATEMENTS

Statement of Comprehensive Net Expenditure

Statement of Financial Position

Statement of Cash Flows

Primary Statements Page 25 of 53


Statement of Comprehensive Net Expenditure for year ended

31 March 2014

2013-14 2013-14 2013-14

NOTE Admin Programme Total

£000 £000 £000

Commissioning

Other operating revenue 2 (40) (5,632) (5,672)

Gross employee benefits 4 10,682 2,814 13,496

Other Costs 5 6,087 920,571 926,659

Net operating costs before financing 16,730 917,753 934,483

Financing

Investment revenue 8 0 0 0

Other (gains) & losses 9 0 0 0

Finance costs 10 0 0 0

Net operating costs for the financial year 16,730 917,753 934,483

Net Gain (Loss) on transfer by absorption 11 0

Retained Net Operating Costs for the Financial Year 16,730 917,753 934,483

Other Comprehensive Net Expenditure £000 £000

Impairments & reversals 0 0 0

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

Net gain (loss) on revaluation of intangibles 0 0 0

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

Movements in other reserves 0 0 0

Net gain (loss) on available for sale financial assets 0 0 0

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

Re-measurement of the defined benefit liability 0 0 0

Reclassification Adjustments:

On disposal of available for sale financial assets 0 0 0

Total comprehensive net expenditure for the financial year 16,730 917,753 934,483

The notes on pages 31 to 52 form part of this statement.

NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and

because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future

years. This also applies to the notes associated with the statement.

The purpose of this statement is to summarise, on an accruals basis, the net operating costs of the CCG. The statement

identifies gross operating costs, less miscellaneous income, to arrive at the net operating costs of the CCG.

SOCNE Page 26 of 53


Statement of Financial Position at

31 March 201431 March 2014

NOTE £000

Non-current assets

Property, plant and equipment 13 0

Intangible assets 14 0

Investment property 15 0

Trade and other receivables 17 0

Other financial assets 18 0

Total non-current assets 0

Current assets

Inventories 16 576

Trade & other receivables 17 7,279

Other financial assets 18 0

Other current assets 19 0

Cash & cash equivalents 20 5

Total current assets 7,860

Non-current assets held for sale 21 0

Total current assets 7,860

Total assets 7,860

Current liabilities

Trade & other payables 23 (42,242)

Other financial liabilities 25 0

Other liabilities 26 0

Borrowings 27 0

Provisions 30 (2,567)

Total current liabilities (44,809)

Total Assets Less Current Liabilities (36,949)

Non-current liabilities

Trade and other payables 23 0

Other financial liabilities 25 0

Other liabilities 26 0

Borrowings 27 0

Provisions 30 (956)

Total non-current liabilities (956)

Total Assets Employed (37,905)

Financed by taxpayers' equity

General fund (37,905)

Revaluation reserve 0

Other reserves 0

Charitable Reserves 0

Total taxpayers' equity (37,905)

The notes on pages 31 to 52 form part of this statement.

Chief Officer / Accountable Officer

4 June 2014

NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and

because of this, there are no prior year comparators. The CCG will be required to show prior year comparators in future

years. This also applies to the notes associated with the statement.

The financial statements on pages 26 to 29 were approved by the Governing Body on 4 June 2014 and signed on its

behalf by:

SOFP Page 27 of 53


Statement of Changes In Taxpayers Equity for the year ended

31 March 2014

General fund

Revaluation

reserve

Other

reserves Total

£000 £000 £000 £000

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 865 0 0 865

Transfer between reserves in respect of assets transferred from

closed NHS bodies 0 0 0 0

Adjusted CCG Balance at 1 April 2013 865 0 0 865

Changes in taxpayers’ equity for 2013-14

Net operating costs for the financial year (934,483) 0 0 (934,483)

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

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

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

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

Impairments and reversals 0 0 0 0

Movements in other reserves 0 0 0 0

Transfers between reserves 0 0 0 0

Release of reserves to the Statement of Comprehensive Net

Expenditure 0 0 0 0 Reclassification adjustment on disposal of available for sale

financial assets 0 0 0 0

Transfers by absorption to (from) other bodies 0 0 0 0

Transfer between reserves in respect of assets transferred

under absorption 0 0 0 0

Reserves eliminated on dissolution 0 0 0 0

Re-measurement of the defined benefit liability 0 0 0 0

Net Recognised CCG Expenditure for the Financial Year (933,618) 0 0 (933,618)

Net funding 895,713 895,713

CCG Balance at 31 March 2014 (37,905) 0 0 (37,905)

Changes in an entity's equity between the beginning and the end of the reporting period reflect the increase or decrease in its net

assets during the period.

The Statement has been interpreted to include figures for net operating costs for the year and funding for the year.

NHS Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of

this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years.

SOCITE Page 28 of 53


Statement of Cash Flows for the year ended

31 March 20142013-14

NOTE £000

Cash Flows from Operating Activities

Net operating expenses for the financial year 2 & 5 (934,483)

Depreciation and amortisation 0

Impairments and reversals 13 575

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 16 (286)

(Increase) decrease in trade & other receivables 17 (7,279)

(Increase) decrease in other current assets 0

Increase (decrease) in trade & other payables 23 42,242

Increase (decrease) in other current liabilities 0

Provisions utilised 0

Increase (decrease) in provisions 30 3,523

Net Cash Inflow (Outflow) from Operating Activities (895,708)

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 the disposal of financial assets (LIFT) 0

Loans made in respect of LIFT 0

Loans repaid in respect of LIFT 0

Rental revenue 0

Net Cash Inflow (Outflow) from Investing Activities 0

Net cash inflow (outflow) before Financing (895,708)

Cash flows from Financing Activities

Net funding received 895,713

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 surrender 0

Net Cash Inflow (Outflow) from Financing Activities 895,713

Net increase (decrease) in cash & cash equivalents 5

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

Effect of exchange rate changes in the balance of cash held in foreign currencies 0 Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 20 5

The Statement of Cash Flows provides information on CCG liquidity, viability and financial adaptability.

Dorset Clinical Commissioning Group became a Clinical Commissioning Group (CCG) on the 1 April 2013 and because of

this, there are no prior year comparators. The CCG will be required to show prior year comparators in future years. This also

applies to the note associated with this statement.

SCF Page 29 of 53


NOTES TO THE ACCOUNTS

The notes to the accounts provide additional details on the entries on the primary statements as well as

additional disclosures, such as the accounting policies that the organisation follows when preparing its

accounts.

Cover Notes Page 30 of 53


1 ACCOUNTING POLICIES

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements

of the Manual for Accounts issued by the Department of Health. Consequently, the following financial statements have been

prepared in accordance with the Manual for Accounts 2013-14 issued by the Department of Health. The accounting policies

contained in the Manual for Accounts follow International Financial Reporting Standards to the extent that they are meaningful and

appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory

Board. Where the Manual for Accounts permits a choice of accounting policy, the accounting policy which is judged to be most

appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has

been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied

consistently in dealing with items considered material in relation to the accounts.

The accounting arrangements for balances transferred from predecessor PCTs ("legacy" balances) are determined by the

Accounts Direction issued by NHS England on 12 February 2014. The Accounts Directions state that the only legacy balances to

be accounted for by the CCG are in respect of property, plant and equipment (and related liabilities) and inventories. All other

legacy balances in respect of assets or liabilities arising from transactions or delivery of care prior to 31 March 2013 are accounted

for by NHS England. The impact of the legacy balances accounted for by the CCG is disclosed in note 11 to these financial

statements. The CCG's arrangements in respect of settling NHS Continuing Healthcare claims are disclosed in note 30,

Provisions, to these financial statements.

1.1 Going Concern

These accounts have been prepared on the going concern basis. Public sector bodies are assumed to be going concerns where

the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that

service in published documents.

Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using

the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of

Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.

1.2 Accounting Convention

These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant

and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

1.3 Acquisitions & Discontinued Operations

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be

‘discontinued’ only if they cease entirely. They are not considered to be ‘discontinued’ if they transfer from one public sector body

to another.

1.4 Movement of Assets within Department of Health Group

Transfers as part of reorganisation are required to be accounted for by use of absorption accounting in line with the Government

Financial Reporting Manual, issued by HM Treasury. The Government Financial Reporting Manual does not require retrospective

adoption, so prior year transactions (which have been accounted for under merger accounting) have not been restated.

Absorption accounting requires that entities account for their transactions in the period in which they took place, with no

restatement of performance required when functions transfer within the public sector. Where assets and liabilities transfer, the

gain or loss resulting is recognised in the Statement of Comprehensive Net Expenditure, and is disclosed separately from

operating costs.

Other transfers of assets and liabilities within the Department of Health Group are accounted for in line with IAS 20 and similarly

give rise to income and expenditure entries.

For transfers of assets and liabilities from those NHS bodies that closed on 1 April 2013, HM Treasury has agreed that a modified

absorption approach should be applied. For these transactions only, gains and losses are recognised in reserves rather than the

Statement of Comprehensive Net Expenditure.

1.5 Charitable FundsThe clinical commissioning group has no Charitable Funds.

1.6 Pooled BudgetsWhere the clinical commissioning group has entered into a pooled budget arrangement under Section 75 of the NHS Act 2006 the

clinical commissioning group accounts for its share of the assets, liabilities, income and expenditure arising from the activities of

the pooled budget, identified in accordance with the pooled budget agreement.

If the clinical commissioning group is in a “jointly controlled operation”, the clinical commissioning group recognises:

• The assets the clinical commissioning group controls;

• The liabilities the clinical commissioning group incurs;

• The expenses the clinical commissioning group incurs; and,

• The clinical commissioning group’s share of the income from the pooled budget activities.

If the clinical commissioning group is involved in a “jointly controlled assets” arrangement, in addition to the above, the clinical

commissioning group recognises:

• The clinical commissioning group’s share of the jointly controlled assets (classified according to the nature of the assets);

• The clinical commissioning group’s share of any liabilities incurred jointly; and,

• The clinical commissioning group’s share of the expenses jointly incurred.

Note 1 Page 31 of 53


1.7 Critical Accounting Judgements & Key Sources of Estimation Uncertainty

In the application of the clinical commissioning group’s accounting policies, management is required to make judgements,

estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources.

The estimates and associated assumptions are based on historical experience and other factors that are considered to be

relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed.

Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that

period or in the period of the revision and future periods if the revision affects both current and future periods.

1.7.1 Critical Judgements in Applying Accounting Policies

No critical judgements with a significant effect on the amounts recognised on the financial statements were required.

1.7.2 Key Sources of Estimation Uncertainty

Key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies are

detailed within the relevant disclosure notes to these financial statements, most notably Note 30 Provisions.

1.8 Revenue

Revenue in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the

fair value of the consideration receivable.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

1.9 Employee Benefits

1.9.1 Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees,

including bonuses earned but not yet taken.

The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the

extent that employees are permitted to carry forward leave into the following period. The clinical commissioning group allows a

maximum of five days to be carried forward, and only in exceptional circumstances.

1.9.2 Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined

benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of

State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share

of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme:

the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the

scheme for the accounting period.

For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full

amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself

to the retirement, regardless of the method of payment.

1.10 Other Expenses

Other operating expenses are recognised when, and to the extent that, the goods or services have been received. They are

measured at the fair value of the consideration payable.

1.11 Property, Plant & Equipment

1.11.1 Recognition

Property, plant and equipment is capitalised if:

• It is held for use in delivering services or for administrative purposes;

• It is probable that future economic benefits will flow to, or service potential will be supplied to the clinical commissioning group;

• It is expected to be used for more than one financial year;

• The cost of the item can be measured reliably; and,

• The item has a cost of at least £5,000; or,

• Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets

are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal

dates and are under single managerial control; or,

• Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or

collective cost.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the

components are treated as separate assets and depreciated over their own useful economic lives.

1.11.2 Valuation

All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or

constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner

intended by management. All assets are measured subsequently at fair value.

Land and buildings used for the clinical commissioning group’s services or for administrative purposes are stated in the statement

of financial position at their re-valued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that

would be determined at the end of the reporting period. Fair values are determined as follows:

• Land and non-specialised buildings – market value for existing use; and,

• Specialised buildings – depreciated replacement cost.



HM Treasury has adopted a standard approach to depreciated replacement cost valuations based on modern equivalent assets

and, where it would meet the location requirements of the service being provided, an alternative site can be valued.

Properties in the course of construction for service or administration purposes are carried at cost, less any impairment loss. Cost

includes professional fees but not borrowing costs, which are recognised as expenses immediately, as allowed by IAS 23 for

assets held at fair value. Assets are re-valued and depreciation commences when they are brought into use.

Fixtures and equipment are carried at depreciated historic cost as this is not considered to be materially different from fair value.

An increase arising on revaluation is taken to the revaluation reserve except when it reverses an impairment for the same asset

previously recognised in expenditure, in which case it is credited to expenditure to the extent of the decrease previously charged

there. A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an

impairment charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to

expenditure. Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Gains and

losses recognised in the revaluation reserve are reported as other comprehensive income in the Statement of Comprehensive Net

Expenditure.

1.11.3 Subsequent ExpenditureWhere subsequent expenditure enhances an asset beyond its original specification, the directly attributable cost is capitalised.

Where subsequent expenditure restores the asset to its original specification, the expenditure is capitalised and any existing

carrying value of the item replaced is written-out and charged to operating expenses.

1.12 Intangible Assets

1.12.1 Recognition

Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the

clinical commissioning group’s business or which arise from contractual or other legal rights. They are recognised only:

• When it is probable that future economic benefits will flow to, or service potential be provided to, the clinical commissioning

group;

• Where the cost of the asset can be measured reliably; and,

• Where the cost is at least £5,000.

Intangible assets acquired separately are initially recognised at fair value. Software that is integral to the operating of hardware, for

example an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software that is not

integral to the operation of hardware, for example application software, is capitalised as an intangible asset. Expenditure on

research is not capitalised but is recognised as an operating expense in the period in which it is incurred. Internally-generated

assets are recognised if, and only if, all of the following have been demonstrated:

• The technical feasibility of completing the intangible asset so that it will be available for use;

• The intention to complete the intangible asset and use it;

• The ability to sell or use the intangible asset;

• How the intangible asset will generate probable future economic benefits or service potential;

• The availability of adequate technical, financial and other resources to complete the intangible asset and sell or use it; and,

• The ability to measure reliably the expenditure attributable to the intangible asset during its development.

1.12.2 Measurement

The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date

when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is

recognised in the period in which it is incurred.

Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market

exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair

value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and

technological advances.

1.13 Depreciation, Amortisation & ImpairmentsFreehold land, properties under construction, and assets held for sale are not depreciated.

Otherwise, depreciation and amortisation are charged to write off the costs or valuation of property, plant and equipment and

intangible non-current assets, less any residual value, over their estimated useful lives, in a manner that reflects the consumption

of economic benefits or service potential of the assets. The estimated useful life of an asset is the period over which the clinical

commissioning group expects to obtain economic benefits or service potential from the asset. This is specific to the clinical

commissioning group and may be shorter than the physical life of the asset itself. Estimated useful lives and residual values are

reviewed each year end, with the effect of any changes recognised on a prospective basis. Assets held under finance leases are

depreciated over their estimated useful lives.

At each reporting period end, the clinical commissioning group checks whether there is any indication that any of its tangible or

intangible non-current assets have suffered an impairment loss. If there is indication of an impairment loss, the recoverable

amount of the asset is estimated to determine whether there has been a loss and, if so, its amount. Intangible assets not yet

available for use are tested for impairment annually.

A revaluation decrease that does not result from a loss of economic value or service potential is recognised as an impairment

charged to the revaluation reserve to the extent that there is a balance on the reserve for the asset and, thereafter, to expenditure.

Impairment losses that arise from a clear consumption of economic benefit are taken to expenditure. Where an impairment loss

subsequently reverses, the carrying amount of the asset is increased to the revised estimate of the recoverable amount but

capped at the amount that would have been determined had there been no initial impairment loss. The reversal of the impairment

loss is credited to expenditure to the extent of the decrease previously charged there and thereafter to the revaluation reserve.



1.14 Donated AssetsDonated non-current assets are capitalised at their fair value on receipt, with a matching credit to Income. They are valued,

depreciated and impaired as described above for purchased assets. Gains and losses on revaluations, impairments and sales are

as described above for purchased assets. Deferred income is recognised only where conditions attached to the donation preclude

immediate recognition of the gain.

1.15 Government GrantsThe value of assets received by means of a government grant are credited directly to income. Deferred income is recognised only

where conditions attached to the grant preclude immediate recognition of the gain.

1.16 Non Current Assets Held for SaleNon-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction

rather than through continuing use. This condition is regarded as met when:

• The sale is highly probable;

• The asset is available for immediate sale in its present condition; and,

• Management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the

date of classification.

Non-current assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell. Fair

value is open market value including alternative uses.

The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is

recognised in the Statement of Comprehensive Net Expenditure. On disposal, the balance for the asset on the revaluation reserve

is transferred to the general reserve.

Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is

retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

1.17 LeasesLeases are classified as finance leases when substantially all the risks and rewards of ownership are transferred to the lessee. All

other leases are classified as operating leases.

1.17.1 The Clinical Commissioning Group as Lessee

Property, plant and equipment held under finance leases are initially recognised, at the inception of the lease, at fair value or, if

lower, at the present value of the minimum lease payments, with a matching liability for the lease obligation to the lessor. Lease

payments are apportioned between finance charges and reduction of the lease obligation so as to achieve a constant rate on

interest on the remaining balance of the liability. Finance charges are recognised in calculating the clinical commissioning group’s

surplus/deficit.

Operating lease payments are recognised as an expense on a straight-line basis over the lease term. Lease incentives are

recognised initially as a liability and subsequently as a reduction of rentals on a straight-line basis over the lease term.

Contingent rentals are recognised as an expense in the period in which they are incurred.

Where a lease is for land and buildings, the land and building components are separated and individually assessed as to whether

they are operating or finance leases.

1.17.2 The Clinical Commissioning Group as Lessor

Amounts due from lessees under finance leases are recorded as receivables at the amount of the clinical commissioning group’s

net investment in the leases. Finance lease income is allocated to accounting periods so as to reflect a constant periodic rate of

return on the clinical commissioning group’s net investment outstanding in respect of the leases.

Rental income from operating leases is recognised on a straight-line basis over the term of the lease. Initial direct costs incurred in

negotiating and arranging an operating lease are added to the carrying amount of the leased asset and recognised on a straight-

line basis over the lease term.

1.18 Private Finance Initiative Transactions

The clinical commissioning group has no PFI schemes.

1.19 Inventories

Inventories are valued at the lower of cost and net realisable value using the first-in first-out cost formula. This is considered to be

a reasonable approximation to fair value due to the high turnover of stocks.

1.20 Cash & Cash EquivalentsCash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours.

Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to

known amounts of cash with insignificant risk of change in value.

In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and

that form an integral part of the clinical commissioning group’s cash management.

1.21 Provisions

Provisions are recognised when the clinical commissioning group has a present legal or constructive obligation as a result of a

past event, it is probable that the clinical commissioning group will be required to settle the obligation, and a reliable estimate can

be made of the amount of the obligation. The amount recognised as a provision is the best estimate of the expenditure required to

settle the obligation at the end of the reporting period, taking into account the risks and uncertainties. Where a provision is

measured using the cash flows estimated to settle the obligation, its carrying amount is the present value of those cash flows using

HM Treasury’s discount rate as follows:

• Timing of cash flows (0 to 5 years inclusive): Minus 1.9%

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

• Timing of cash flows (over 10 years): Plus 2.2%



• All employee early departures: 1.8%

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the

receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable

can be measured reliably.

A restructuring provision is recognised when the clinical commissioning group has developed a detailed formal plan for the

restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the

plan or announcing its main features to those affected by it. The measurement of a restructuring provision includes only the direct

expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not

associated with on-going activities of the entity.

1.22 Clinical Negligence Costs

The NHS Litigation Authority operates a risk pooling scheme under which the clinical commissioning group pays an annual

contribution to the NHS Litigation Authority which in return settles all clinical negligence claims. The contribution is charged to

expenditure. Although the NHS Litigation Authority is administratively responsible for all clinical negligence cases the legal liability

remains with the clinical commissioning group.

1.23 Non-clinical Risk Pooling

The clinical commissioning group participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both

are risk pooling schemes under which the clinical commissioning group pays an annual contribution to the NHS Litigation Authority

and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses

payable in respect of particular claims are charged to operating expenses as and when they become due.

1.24 Carbon Reduction Commitment Scheme

The clinical commissioning group is not party to a Carbon Reduction Scheme.

1.25 Contingencies

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the

occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning

group, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the

obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the

possibility of a payment is remote.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or

non-occurrence of one or more uncertain future events not wholly within the control of the clinical commissioning group. A

contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

1.26 Financial Assets

Financial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in

the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the

contractual rights have expired or the asset has been transferred.

Financial assets are classified into the following categories:

• Financial assets at fair value through profit and loss;

• Held to maturity investments;

• Available for sale financial assets; and,

• Loans and receivables.

The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

1.26.1 Financial Assets at Fair Value Through Profit and Loss

The clinical commissioning group holds no Financial Assets with embedded derivatives.

1.26.2 Held to Maturity Assets

The clinical commissioning group holds no Held to Maturity Assets.

1.26.3 Available for Sale Financial Assets

The clinical commissioning group holds no Available for Sale Financial Assets.

1.26.4 Loans & Receivables

The clinical commissioning group holds no Loans and Receivables.

1.27 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to

the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been

received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has

expired.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair

value.

1.27.1 Financial Guarantee Contract Liabilities

Financial guarantee contract liabilities are subsequently measured at the higher of:

• The premium received (or imputed) for entering into the guarantee less cumulative amortisation; and,

• The amount of the obligation under the contract, as determined in accordance with IAS 37: Provisions, Contingent Liabilities and

Contingent Assets.

1.27.2 Financial Liabilities at Fair Value Through Profit and Loss

The clinical commissioning group holds no Financial Liabilities with embedded derivatives.



1.27.3 Other Financial Liabilities

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for

loans from Department of Health, which are carried at historic cost. The effective interest rate is the rate that exactly discounts

estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is

recognised using the effective interest method.

1.28 Value Added Tax

Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply

and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in

the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net

of VAT.

1.29 Foreign CurrenciesThe clinical commissioning group’s functional currency and presentational currency is sterling. Transactions denominated in a

foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions. At the end of the reporting

period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March. Resulting

exchange gains and losses for either of these are recognised in the clinical commissioning group’s surplus/deficit in the period in

which they arise.

1.30 Third Party Assets

Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the clinical

commissioning group has no beneficial interest in them.

1.31 Losses & Special Payments

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service

or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control

procedures compared with the generality of payments. They are divided into different categories, which govern the way that

individual cases are handled.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses

which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks

(with insurance premiums then being included as normal revenue expenditure).

1.32 Subsidiaries

The clinical commissioning group has no Subsidiaries.

1.33 Associates

The clinical commissioning group has no Associates, where it has the power to influence decisions.

1.34 Joint Ventures

The clinical commissioning group is not party to any Joint Ventures.

1.35 Joint Operations

The clinical commissioning group is not party to any Joint Operations.

1.36 Research & Development

The clinical commissioning group does not undertake any Research and Development.

1.37 Accounting Standards that have been Issued but have not yet been Adopted

The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 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. Miscellaneous RevenueAdmin Programme 2013-14

Total

£000 £000 £000

Recoveries in respect of employee benefits 0 0 0

Patient transport services 0 0 0

Prescription fees and charges 0 0 0

Dental fees and charges 0 0 0

Education, training and research (19) (175) (194)

Charitable and other contributions to expenditure: NHS 0 0 0

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

Receipt of donations for capital acquisitions: NHS Charity 0 0 0

Receipt of government grants for capital acquisitions 0 0 0

Non-patient care services to other bodies (1) (5,413) (5,414)

Income generation 0 0 0

Rental revenue from finance leases 0 0 0

Rental revenue from operating leases 0 0 0

Other revenue (20) (44) (64)

Total (40) (5,632) (5,672)

3. Revenue

2013-14

Total

£000

From rendering of services (5,672)

From sale of goods 0

Total (5,672)

This note discloses the income that relates directly to the operating activities of the CCG. It excludes cash received

from NHS England by the CCG, which is credited directly to the General Fund.

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

the sale of goods.

Note 2-3 Page 37 of 53


4. Employee Benefits and Staff Numbers

4.1 Employee Benefits 2013-14

Permanently

employed Other Total

£000 £000 £000

Salaries and wages 9,689 1,707 11,396

Social security costs 854 0 854

Employer contributions to the NHS Pension Scheme 1,235 0 1,235

Termination benefits 11 0 11

Gross CCG employee benefits expenditure 11,788 1,707 13,496

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

Net CCG employee benefits expenditure including capitalised costs 11,788 1,707 13,496

Less: Employee costs capitalised

Net CCG employee benefits expenditure excluding capitalised costs 11,788 1,707 13,496

4.1.2 Recoveries in respect of employee benefits

Salaries and wages 0 0 0Total CCG recoveries in respect of employee benefits 0 0 0

4.1.3 Net employee benefits expenditure

Salaries and wages 9,689 1,707 11,396

Social security costs 854 0 854

Employer contributions to the NHS Pension Scheme 1,235 0 1,235

Termination benefits 11 0 11Net CCG employee benefits expenditure including capitalised costs 11,788 1,707 13,496

Less: Employee costs capitalised 0 0 0Net CCG employee benefits expenditure excluding capitalised costs 11,788 1,707 13,496

4.2 Staff Numbers

Average Staff Numbers

Permanently

employed Other Total

Number Number Number

Other 266 35 301

TOTAL 266 35 301

Of the above - staff engaged on capital projects 0 0 0

4.3 Staff Sickness Absence and Ill Health Retirements2013-14

Number

Total days lost 1,220

Total average number of staff (full time equivalent) 234

Average working days lost 5.21

2013-14

Number

Total days lost 2,149

Total average number of staff (full time equivalent) 266

Average working days lost 8.08

2013-14

Number

Number of persons retired early on ill health grounds 0

£000s

Total additional pensions liabilities accrued in the year 0

4.4 Exit packages agreed in the financial year

Number £ Number £ Number £

Less than £10,000 2 11,033 0 0 2 11,033

Total 2 11,033 0 0 2 11,033

Number £

Total 0 0

4.6 Severance payments

Number £

Voluntary redundancies including early retirement contractual costs 0 0

Mutually agreed resignations (MARS) contractual costs 0 0

Early retirements in the efficiency of the service contractual costs 0 0

Contractual payments in lieu of notice 0 0

Exit payments following Employment Tribunals or court orders 0 0

Non-contractual payments requiring HMT approval* 0 0

Total 0 0

2013-14

The average salary is approximately £38,000 excluding on costs. The clinical commissioning groups average costs are higher than other NHS Bodies due to the higher skill mix required in delivering its core

functions.

The two individuals transferred into the CCG on old PCT contracts, which should have been reviewed as part of the close down of the PCT. The roles were critically reviewed and as such it was identified that

the work they covered was being picked up by Clinicians who had been appointed into roles with the CCG. The individuals were fully consulted with and suitable opportunities for employment were explored.

Permanently employed staff are directly employed by the CCG and include those on outward secondment or on loan to other organisations (although the recovery of the cost of these staff is netted off). Other

staff relates to those on inward secondment, on loan from other organisations, bank, agency, temporary staff or contract staff.

2013-14

The first part of this note identifies the days lost due to both long term and short term sickness. The second part discloses the number and average additional pension liabilities of individuals who retired early

on ill health grounds during the year (this information is supplied by NHS Pensions).

This note is analysed over the same column heading as staff costs included within Note 4.1 above. The same definitions apply.

The above figures are provided by the Health and Social Care Information Centre (HSCIC) and must be used. Please note the HSCIC figures are for the calendar year for the 9 months to December 2013,

and not for the Financial Year of 2013/14.

The figures the clinical commissioning group have calculated based on the Financial Year 2013/14, are shown below.

Redundancy and other departure costs have been paid in accordance with the individuals contract of employment.

Exit costs are accounted for in accordance with relevant accounting standards and, at the latest, in full in the year of departure.

* As a single exit package can be made up of several components each of which will be counted separately in this table, the total number will not necessarily match the total number in the table above, which

will be the number of individuals.These tables report the number and value of exit packages agreed in the financial year. The expense associated with these departures may have been recognised in part or in full in a previous period.

Compulsory redundancies Other agreed departures Total

Departures where special

payments have been made

This disclosure reports the number and value of exit packages taken by staff leaving in the year.

Redundancy and other departure costs have been paid in accordance with the provisions of the NHS Scheme. Exit costs in this note are accounted for in full in the year of departure. Where the CCG has

agreed early retirements, the additional costs are met by the CCG and not by the NHS pensions scheme. Ill-health retirement costs are met by the NHS pensions scheme and are not included in the table.

Other agreed departures

Note 4.1-4 & 6 Page 38 of 53


4. Employee Benefits and Staff Numbers

4.5 Pension CostsPast and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under

these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions.

The Scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under

the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable

NHS bodies to identify their share of the underlying scheme assets and liabilities.

Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group

of participating in the Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.

The Scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation

every year. An outline of these follows:

4.5.1 Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the Scheme (taking into

account its recent demographic experience), and to recommend the contribution rates to be paid by employers and scheme

members. The last such valuation, which determined current contribution rates was undertaken as at 31 March 2004 and covered

the period from 1 April 1999 to that date. The conclusion from the 2004 valuation was that the Scheme had accumulated a

notional deficit of £3.3 billion against the notional assets as at 31 March 2004.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March

2004. Consequently, a formal actuarial valuation would have been due for the year ending 31 March 2008. However, formal

actuarial valuations for unfunded public service schemes were suspended by HM Treasury on value for money grounds while

consideration is given to recent changes to public service pensions, and while future scheme terms are developed as part of the

reforms to public service pension provision due in 2015.

In order to defray the costs of benefits, employers pay contributions at 14% of pensionable pay and most employees had up to

April 2008 paid 6%, with manual staff paying 5%.

Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004, and after consideration of

changes to the NHS Pension Scheme taking effect from 1 April 2008, his Valuation report recommended that employer

contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of

employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings.

On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the scheme’s

liabilities.

4.5.2 Accounting valuation

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period by updating

the results of the full actuarial valuation.

Between the full actuarial valuations at a two-year midpoint, a full and detailed member data-set is provided to the scheme

actuary. At this point the assumptions regarding the composition of the scheme membership are updated to allow the scheme

liability to be valued.

The valuation of the scheme liability as at 31 March 2011 is based on detailed membership data as at 31 March 2008 (the latest

midpoint) updated to 31 March 2011 with summary global member and accounting data.

The latest assessment of the liabilities of the Scheme is contained in the scheme actuary report, which forms part of the annual

NHS Pension Scheme (England and Wales) Resource Account, published annually. These accounts can be viewed on the NHS

Pensions website. Copies can also be obtained from The Stationery Office.

4.5.3 Scheme provisions

The NHS Pension Scheme provides defined benefits, which are summarised below. This list is an illustrative guide only, and is

not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits

can be obtained:

• The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for the 1995 section and of the best of

the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of

membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total

pensionable earnings over the relevant pensionable service;

• With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum,

up to a maximum amount permitted under HM Revenue & Customs rules. This new provision is known as “pension

commutation”;

• Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on

changes in retail prices in the twelve months ending 30 September in the previous calendar year;

• Early payment of a pension, with enhancement, is available to members of the Scheme who are permanently incapable of

fulfilling their duties effectively through illness or infirmity. A death gratuity of twice final year’s pensionable pay for death in

service, and five times their annual pension for death after retirement is payable;

• For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full

amount of the liability for the additional costs is charged to the statement of comprehensive net expenditure at the time the

clinical commissioning group commits itself to the retirement, regardless of the method of payment; and,

• Members can purchase additional service in the Scheme and contribute to money purchase AVC’s run by the Scheme’s

approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.

Note 4.5 Page 39 of 53


5. Operating Expenses

Admin Programme 2013-14

Total

£000 £000 £000

Gross Employee Benefits

Employee benefits excluding governing body members 10,387 2,814 13,201

Executive governing body members 295 0 295

Total gross employee benefits 10,682 2,814 13,496

Other Costs

Services from other CCGs and NHS England 167 748 915

Services from foundation trusts 1 674,739 674,740

Services from other NHS trusts 4 6,147 6,151

Services from other NHS bodies 0 0 0

Purchase of healthcare from non-NHS bodies 281 119,921 120,202

Chair and lay membership body and governing body members 650 0 650

Supplies and services – clinical 0 264 264

Supplies and services – general 205 303 508

Consultancy services 11 0 11

Establishment 2,605 1,083 3,688

Transport 46 2 48

Premises 1,628 2,632 4,259

Impairments and reversals of receivables 0 0 0

Inventories written down 0 0 0

Depreciation 0 0 0

Amortisation 0 0 0

Impairments and reversals of property, plant and equipment 0 575 575

Impairments and reversals of intangible assets 0 0 0

Impairments and reversals of financial assets

• Assets carried at amortised cost 0 0 0

• Assets carried at cost 0 0 0

• Available for sale financial assets 0 0 0

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

Impairments and reversals of investment properties 0 0 0

Audit fees 122 0 122

Other auditor’s remuneration

• Internal audit services 76 0 76

• Other services 0 0 0

General dental services and personal dental services 0 0 0

Prescribing costs 0 107,928 107,928

Pharmaceutical services 0 0 0

General opthalmic services 0 574 574

GPMS/APMS and PCTMA 0 5,273 5,273

Other professional fees (excluding audit) 85 211 296

Grants to other public bodies 0 71 71

Clinical negligence 18 0 18

Research and development (excluding staff costs) 0 20 20

Education and training 144 35 179

Change in discount rate 0 0 0

Other expenditure 46 44 90

Total Other Costs 6,087 920,571 926,659

Total Operating Expenses 16,770 923,385 940,155

Premises - The costs of premises is high in 2013/14 due to additional charges received from NHS Property Services

following national guidance from NHS England, these costs will reduce in future years.

GPMS/APMS and PCTMA - The costs are for enhanced services which deliver a range of primary care based enhanced

services locally.



6. Better Payment Practice Code

6.1 Measure of Compliance

2013-14 2013-14

Number £000

Non-NHS Payables

Total Non-NHS trade invoices paid in the year 27,290 130,783

Total Non-NHS trade invoices paid within target 26,441 129,063

Percentage of Non-NHS trade invoices paid within target 96.89% 98.68%

NHS Payables

Total NHS trade invoices paid in the year 3,601 682,215

Total NHS trade invoices paid within target 3,534 688,789

Percentage of NHS trade invoices paid within target 98.14% 100.96%

6.2 The Late Payment of Commercial Debts (Interest) Act 1998

2013-14

£000

Amounts included in finance costs from claims made under this legislation 0

Compensation paid to cover debt recovery costs under this legislation 0

Total 0

7. Income Generation ActivitiesThe clinical commissioning group does not undertake any Income Generation Activities.

8. Investment IncomeThe clinical commissioning group does not have any Investment Income.

9. Other Gains and LossesThe clinical commissioning group does not have any Other Gains and Losses.

10. Finance Costs

2013-14

Total

£000

Other finance costs 0

Total Finance Costs 0

The 100.96% is caused by a large credit note, if the credit note could be removed from the figures, the percentage of NHS

Invoices paid within target would fall to 99.7%.

The total in this note equals the amounted figure (charged)/ credited to the Statement of Comprehensive Net Expenditure.

This note identifies the CCGs interest costs, including the unwinding of discounts on provisions, and corresponds with the

amount shown on the Statement of Comprehensive Net Expenditure.

This note shows the CCG's performance against its administrative duty to pay all creditors within 30 calendar days of receipt

of goods or valid invoice, whichever is later, unless other payment terms have been agreed. There is a performance target

of 95% for each measure.

This note relates to the prompt payment code legislation which allows entities to claim interest from other entities on debts

incurred under contracts.

This note discloses the interest earned on investments.



11. Net Gain (Loss) on Transfer by Absorption

12. Operating Leases

12.1 CCG as Lessee

2013-14

Land Buildings Other Total

£000 £000 £000 £000

Payments recognised as an Expense

Minimum lease payments 0 3,179 0 3,179

Contingent rents 0 0 0 0

Sub-lease payments 0 0 0 0Total 0 3,179 0 3,179

Payable:

No later than one year 0 0 0 0Between one and five years 0 0 0 0After five years 0 0 0 0Total 0 0 0 0

12.2 CCG as Lessor

This relates to sub leases, mainly to healthcare contractors, with medium term leases. The clinical

commissioning group does not act as a lessor.

This note identifies the amount included in operating expenses in respect of operating lease agreements.

It also highlights the amounts the CCG expects to receive under non-cancellable leases over the next five

years.

All operating leases relating to items with a purchase cost above the capitalisation limit are regarded as

non-cancellable.

The clinical commissioning group does not have any Net Gains or Losses on Transfer by Absorption.

The clinical commissioning group currently is lessee in respect of property leases and equipment rental.

The most significant rents are for Trust Headquarters and related buildings across the county. The clinical

commissioning group does not have any contractual option to buy these properties.

The clinical commissioning group occupies property owned and managed by NHS Property Services Ltd.

For 2013-14, a transitional occupancy rent based on annual property costs allocations was agreed.

This note identifies the amount included in operating expenses in respect of operating lease agreements.

It also highlights the amounts the CCG is liable for under non-cancellable leases over the next five years.

All operating leases relating to items with a purchase cost above the capitalisation limit are regarded as

non-cancellable.

While our arrangements with NHS Property Services Ltd fall within the definition of operating leases, the

rental charge for future years has not been agreed. Consequently, this note does not include future

minimum lease payments for these arrangements.



13. Property, Plant and Equipment

2013-14Information

technology

Total

£000 £000

CCG Cost or Valuation at 1 April 2013 0 0

Transfer of assets from closed NHS bodies as a result of the 1 April 2013 transition 575 575

Adjusted CCG Cost or Valuation at 1 April 2013 575 575

CCG Cost or Valuation at 31 March 2014 575 575

CCG Depreciation at 1 April 2013 0 0

Impairments charged to operating expenses (575) (575)

CCG Depreciation at 31 March 2014 (575) (575)

CCG Net Book Value at 31 March 2014 0 0

Purchased 0 0

Donated 0 0

Government Granted 0 0

CCG Total at 31 March 2014 0 0

Asset financing:

Owned 0 0

Held on finance lease 0 0

On-Statement of Financial Position private finance initiative & LIFT contracts 0 0

Private finance initiative residual interests 0 0


Revaluation Reserve Balance for Property, Plant & Equipment

Information

technology

Total

£000's £000's

CCG Cost or Valuation at 1 April 2013 0 0

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

Adjusted CCG Cost or Valuation at 1 April 2013 0 0


13.1 Additions to Assets Under Construction in 2013-14

The clinical commissioning group had no Additions to AUC as at 31 March 2014.

At the 1 April 2013, NHS Dorset CCG received a transfer of Information Technology Assets from NHS Dorset PCT for the

assets held in the PCT's HQ and other offices. Once these assets were transferred, a decision was taken to impair the

assets due to their age/obsolescence.

Note 13-13.1 Page 43 of 53


13.2 Donated AssetsThe clinical commissioning group had no Donated Assets as at 31 March 2014.

13.3 Government Granted AssetsThe clinical commissioning group had no government Granted Assets as at 31 March 2014.

13.4 Property Revaluation

13.5 Compensation from Third PartiesThe clinical commissioning group had no Compensation from Third Parties as at 31 March 2014.

13.6 Write Downs to Recoverable AmountThe clinical commissioning group had no Write Downs to Recoverable Amount as at 31 March 2014.

13.7 Temporarily Idle AssetsThe clinical commissioning group had no Temporarily Idle Assets as at 31 March 2014.

13.8 Cost or Valuation of Fully Depreciated AssetsThe clinical commissioning group had no Fully Depreciated Assets still in use as at 31 March 2014.

13.9 Economic Lives of Property, Plant and Equipment

Minimum Life Maximum Life

(Years) (Years)

Buildings exc Dwellings 0 0

Dwellings 0 0

Plant & Machinery 0 0

Transport Equipment 0 0

Information Technology 0 0

Furniture and Fittings 0 0

The clinical commissioning group has no Property Plant and Equipment that is depreciating in the financial year

2013/14.

The clinical commissioning group has no Land and Buildings and therefore there is no Property Revaluation.

Any properties that are occupied by the CCG are either owned by Private Landlords or are recorded by the

Secretary of State via NHS Property Services Ltd, for which the CCG are liable to incur a charge as part of the

service agreement.

This note records the range of remaining useful economic lives of property, plant and equipment employed by

the CCG.

Note 13.2-13.9 Page 44 of 53


14. Intangible Non-Current AssetsThe clinical commissioning group had no Intangible Non-Current Assets as at 31 March 2014.

14.1 Donated AssetsThe clinical commissioning group had no Donated Assets as at 31 March 2014.

14.2 Government Granted AssetsThe clinical commissioning group had no Government Granted Assets as at 31 March 2014.

14.3 Revaluation

14.4 Compensation from Third PartiesThe clinical commissioning group had no compensation from Third Parties as at 31 March 2014.

14.5 Write Downs to Recoverable AmountThe clinical commissioning group had no Write Downs to Recoverable Amount as at 31 March 2014.

14.6 Non-capitalised AssetsThe clinical commissioning group had no Non-capitalised Assets as at 31 March 2014.

14.7 Temporarily Idle AssetsThe clinical commissioning group had no Temporarily Idle assets as at 31 March 2014.

14.8 Cost or Valuation of Fully Depreciated AssetsThe clinical commissioning group had no fully Depreciated Assets still in use as at 31 March 2014.

14.9 Economic Lives of Intangibles

15. Investment PropertyThe clinical commissioning group had no Investment Property as at 31 March 2014.

16. InventoriesOther Total

£000 £000

CCG Balance at 1 April 2013 0 0

Transfer of assets from closed NHS bodies as a result of the

1 April 2013 transition 290 290

Restated Opening Balance 290 290

Additions 2,650 2,650

Inventories recognised as an expense in the period (2,364) (2,364)

CCG Balance at 31 March 2014 576 576

As the clinical commissioning group had no Intangible Non- Current assets, no Revaluation has been

considered.

As the clinical commissioning group had no intangible non-current assets, no Economic Lives have been

considered.

The Inventories held by the clinical commissioning group relate to the proportion of the items held on its behalf

by two Pooled Budgets. The transfer represents the closing balance held by Bournemouth and Poole PCT

which on the 1st April 2013 was transferred to the CCG.



17. Trade and Other Receivables

Current Non-current

31 March 2014 31 March 2014

£000 £000

CCG

NHS receivables: Revenue 1,523 0

NHS receivables: Capital 0 0

NHS prepayments and accrued income 2,376 0

Non-NHS receivables: Revenue 1,486 0

Non-NHS prepayments and accrued income 1,734 0

VAT 160 0

Total CCG 7,279 0

Total CCG Current and Non-current 7,279

Included in CCG NHS receivables are pre-paid pension contributions 0

17.1 Receivables Past Their Due Date But Not Impaired 31 March 2014

£000

By up to three months 721

By three to six months 25

By more than six months 52

Total 798

17.2 Provision For Impairment of Receivables

The clinical commissioning group has no Provision for the Impairment of Receivables.

18. Other Financial AssetsThe clinical commissioning group had no Other Financial Assets as at 31 March 2014.

19. Other Current AssetsThe clinical commissioning group had no other Current Assets as at 31 March 2014.

20. Cash and Cash Equivalents

31 March 2014

£000

Opening balance 0

Net change in year 5

Closing balance 5

Made up of

Cash with Government Banking Service 4

Cash in hand 1

Current investments 0

Cash and cash equivalents as in statement of financial position 5

Bank overdraft - Government Banking Service 0

Cash and cash equivalents as in statement of cash flows 5

Patients' money held by the CCG, not included above 0

21. Non-Current Assets Held for SaleThe clinical commissioning group had no Non-Current Assets Held for Sale as at 31 March 2014.

The great majority of trade is with NHS England. As NHS England is funded by Government to buy NHS patient care services, no

credit scoring of them is considered necessary.

A provision for the impairment of receivables is where there is a risk of debt not being collected.

This note analyses the amounts owing to the CCG at the Statement of Financial Position date.

This note analyses the length of time beyond their due date the amounts owing to the CCG at the Statement of Financial Position

date have been outstanding.

The level of trade with non-NHS organisations is immaterial and is covered by contractual terms, therefore no credit scoring of

them is considered necessary.

Notes 17-21 Page 46 of 53


22. Analysis of Impairments and Reversals Recognised in 2013-14

22.1 Analysis of Impairments & Reversals: Property, plant & equipment

31 March 2014

£000

Impairments and Reversals charged to SoCNE

Total charged to Departmental Expenditure Limit 0

Unforeseen Obsolescence 575

Total charged to Annually Managed expenditure 575

Total impairments and reversals charged to the Statement of Comprehensive Net Expenditure 575

Impairments and Reversals charged to the Revaluation Reserve

Total Impairments and Reversals charged to the Revaluation Reserve 0

Total Impairments and Reversals of Property, Plant & Equipment 575

22.2 Analysis of Impairments & Reversals: Intangible assets

The clinical commissioning group had no Impairments or Reversals of Impairments recognised in expenditure during 2013-14.

22.3 Analysis of Impairments & Reversals: Investment property


22.4 Analysis of Impairments & Reversals: Inventories

The clinical commissioning group had no Impairments or Reversals of Impairments Recognised in expenditure during 2013-14.

22.5 Analysis of Impairments & Reversals: Financial assets


22.6 Analysis of Impairments & Reversals: Non-current assets held for sale


22.7 Analysis of Impairments & Reversals: Totals

31 March 2014

£000

Total Impairments and Reversals charged to the Statement of Comprehensive Net Expenditure

Departmental Expenditure Limit 0

Annually Managed Expenditure 575

Total Impairments and Reversals charged to the Statement of Comprehensive Net Expenditure 575

Total Impairments charged to Revaluation Reserve 0

Total Impairments 575

Of the above none related to Impairment on revaluation to “modern equivalent asset” basis.

23. Trade and Other PayablesCurrent

31 March 2014 31 March 2014

£000 £000

CCG

Interest payable 0 0

NHS payables: revenue (7,502) 0

NHS accruals and deferred income (2,805) 0

Non-NHS payables: revenue (5,935) 0

Non-NHS accruals and deferred income (25,074) 0

Social security costs (144) 0

Tax (149) 0

Other payables (634) 0

Total CCG (42,242) 0

Total CCG Current and Non-current (42,242)

Non-current

This note analyses the amounts owed by the CCG at the Statement of Financial Position date.

Other payables include £177,146.27 in respect of outstanding pensions contributions at 31 March 2014, and £400,000 of

accruals for invoices registered on the finance ledger, but not approved at 1 April 2014.

The clinical commissioning group have not included any liabilities for people, due in future years under arrangements to buy out

the liability for early retirement over 5 years.

Of the above none related to Total impairments and reversals of Donated and Government Granted Assets charged to the

Statement of Comprehensive Net Expenditure.



24. Deferred RevenueThe clinical commissioning group had no Deferred Revenue as at 31 March 2014.

25. Other Financial liabilitiesThe clinical commissioning group had no Other Financial Liabilities as at 31 March 2014.

26. Other LiabilitiesThe clinical commissioning group had no Other Liabilities as at 31 March 2014.

27. BorrowingsThe clinical commissioning group had no Borrowings as at 31 March 2014.

28. PFI & LIFT Contracts

29. Finance Lease Obligations

The clinical commissioning group had no Finance Lease Obligations or receivables as at 31 March 2014.

30. ProvisionsCurrent Non Current

31 March 2014 31 March 2014

£000s £000s

Continuing care (2,567) (910)

Other 0 (46)

Total CCG (2,567) (956)

Total CCG Current and Non-current (3,523)

Comprising:

Continuing

Care Other Total

£000s £000s £000s

CCG Balance at 01 April 2013 0 0 0

Transfer of assets from closed NHS bodies as a result of the 1 April 2013

transition 0 0 0

Adjusted CCG Balance at 01 April 2013 0 0 0

Arising during the year (3,477) (46) (3,523)

CCG Balance at 31 March 2014 (3,477) (46) (3,523)

Expected Timing of Cash Flows:

No Later than One Year (2,567) 0 (2,567)

Later than One Year and not later than Five Years (910) (46) (956)

CCG Balance at 31 March 2014 (3,477) (46) (3,523)

Amount Included in the Provisions of the NHS Litigation Authority in Respect of Clinical Negligence Liabilities:

£000s

As at 31 March 2014 0

Critical accounting judgments and key sources of estimation uncertainty:

A provision has been made against applications for continuing healthcare support where a panel has not yet met to determine

whether the application is approved. The provision is calculated on a named basis for the period that continuing healthcare

may be eligible, at the probability rate of the application being awarded, which was 30% for Appeals and 15% for Retrospective

Appeals in 2013/14. The provision is calculated at £1,657,350 for Appeals and £1,820,106 for Retrospective Appeals.

The clinical commissioning group had no Private Finance Initiative, LIFT or other service concession arrangements that were

excluded from the Statement of Financial Position as at 31 March 2014.

The provisions shown under the heading 'Other' relate to dilapidation costs associated with leases for Mey House, and the costs

are uncertain.

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for

liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the clinical

commissioning group. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare

provisions accounted for by NHS England on behalf of this CCG at 31 March 2014 is £12,708,000.

This note analyses the amounts recorded as provisions by the CCG at the Statement of Financial Position date.



31. Contingencies 31 March 2014

£000

Contingent liabilitiesOther - Continuing Healthcare 14,226

Net Value of Contingent Liabilities 14,226

There are no contingent Assets

32. Commitments

33. Financial Instruments

33.1 Financial Risk Management

33.1.1 Currency Risk

33.1.2 Interest Rate Risk

33.1.3 Credit Risk

33.1.4 Liquidity Risk

33.2 Financial Assets At ‘fair value

through profit

and loss’

Loans and

receivables

Total

£000 £000 £000

Receivables - NHS 0 1,523 1,523

Receivables - non-NHS 0 1,486 1,486

Cash at bank and in hand 0 5 5

Total at 31 March 2014 0 3,014 3,014

33.3 Financial Liabilities At ‘fair value

through profit

and loss’

Other Total

£000 £000 £000

NHS payables 0 (10,306) (10,306)

Non-NHS payables 0 (31,009) (31,009)

Other financial liabilities 0 0 0

Total at 31 March 2014 0 (41,315) (41,315)

The contingent liability above relates to retrospective continuing care claims, and is directly linked with the continuing care provision included in Note 30. An

estimation has been made of the value based upon the amounts claimed. The uncertainties relate to the eligibility of the claims. Whilst possible, it has been deemed

unlikely that these amounts will be reimbursed. It is not practicable to provide an estimate of the financial effect.

This contingent liability is for the remainder of the risk of 70% for Appeals and 85% for Retrospective Appeals, for those applications not included as a provision

within Note 30 to these accounts. The contingent liability is calculated at £3,912,398 for Appeals and £10,313,932 for Retrospective Appeals.

The purpose of this note is to disclose material contingent liabilities or assets, if there is more than a remote possibility that there will be a transfer of ‘economic

benefit’ as a result of events that existed before the Statement of Financial Position date.

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

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body

faces in undertaking its activities.

Because the clinical commissioning group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also,

financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards

mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day

operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.

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.

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.

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.

Only where the CCG is exposed to material risk should the appropriate IFRS 7 disclosures be made. The headings in IFRS 7 should be used to the extent that they

are relevant.

Financial instruments are a broad range of assets and liabilities that arise from contracts and result in a financial asset being created in one entity and a financial

liability in another. This note discloses the interest rate risks arising from the CCG's financial assets and liabilities, which largely comprise items due after more than

one year, such as long-term debtors and creditors, and provisions made under contract.

Due to the short-term nature of these transactions, the fair value of these financial assets and liabilities approximate the carrying amounts at the balance sheet date.

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.

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.

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.



34. Operating Segments

* that engages in business activities from which it may earn revenues and incur expenses;

* for which discrete financial information is available.

35. Pooled Budget

2013-14

£000

1,419

Dorset Healthcare University NHS Foundation Trust 1,891

Dorset CCG 379

233

200

4,122

4,122

0

2013-14

£000

517

Borough of Poole 479

1,364

346

175

Risk Share 61

2,942

2,942

0

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

37. Intra-Government and Other BalancesCurrent

Receivables

Non-current

receivables

Current

Payables

Non-current

payables

£000s £000s £000s £000s

Other central government bodies 160 0 (554) 0

Local authorities 1,485 0 (1,708) 0

NHS bodies outside the departmental group 1 0 (2,614) 0

NHS trusts & foundation trusts 3,898 0 (7,692) 0

Bodies external to government 1,735 0 (29,674) 0

Total balances at 31 March 2014 7,279 0 (42,242) 0

The clinical commissioning group has only one operating segment, that of commissioning healthcare services for the population of Dorset.

The clinical commissioning group has entered into two pooled budget arrangements, hosted by Dorset County Council and Bournemouth Borough

Council. Under the arrangement, funds are pooled under Section 75 of the National Health Service Act 2006 for the provision of Bournemouth and

Poole's Integrated Community Equipment Service and Dorset IESD. The arrangement with Bournemouth Borough Council transferred from

Bournemouth and Poole PCT which is now closed.

Under/ (over) spend

Integrated Community Equipment Service

An operating segment is a component of an entity:

* whose operating results are regularly reviewed by the entity's chief operating decision maker to make decisions about resources to be allocated to

the segment and assess its performance; and

Revenue

Bournemouth Borough Council

Dorset CCG

As a commissioner of health care services, Dorset CCG makes contributions to the pool, which are used to purchase health care services. At 31

March 2014, the clinical commissioning group had a total payables balance with Bournemouth Borough Council of £50,150 made up of £50,150

trade payables and no cash, which related to the trading transactions within the pooled budget arrangements. Within these arrangements the CCG's

contribution to income for the pool for 2013/14 was £1,364,090, being £1,364,090 partner contribution and no other funding.

The Bournemouth & Poole ICES Memorandum Account for the pooled budget is reproduced below.

Intra-Government balances are defined as balances between the reporting entity and other bodies within the boundary set for the Whole of

Government Accounts.

Poole Hopsital NHS Foundation Trust

Expenditure

As a commissioner of health care services, Dorset CCG makes contributions to the pool, which are used to purchase health care services. At 31

March 2014, the clinical commissioning group had a total payables balance with Dorset County Council of £97,147 made up of £97,147 trade

payables and no cash, which related to the trading transactions within the pooled budget arrangements. Within these arrangements the CCG's

contribution to income for the pool for 2013/14 was £925,652, being £925,652 partner contribution and no other funding.

The Integrated Equipment Services for Dorset (IESD) Memorandum Account for the pooled budget is

reproduced below.

Revenue

Dorset County Council

Total contributions to revenue

Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Re-ablement Board

A pooled budget is the term used to describe a project financed by several mutually interested organisations. By definition, pooled funds are flexible,

intended to meet local needs and priorities. A pooled budget, such as the Integrated Community Equipment Service, is not an entity in its own right.

Dorset County Hospital NHS Foundation Trust

Total contributions to revenue

Expenditure

Integrated Community Equipment Service

Under/ (over) spend



38. Related Party Transactions

• NHS England (including commissioning support units);

• NHS Foundation Trusts;

• NHS Trusts;

• NHS Litigation Authority; and,

• NHS Business Services Authority.

Payments to

Related Party

Receipts from

Related Party

Amounts owed

to Related

Party

Amounts due

from Related

Party

£’000 £’000 £’000 £’000

1 Dr Forbes Watson, CCG Chair. Principal GP Practice in Lyme Bay Medical Centre, Bidder for the Lyme Regis

Contract (20/6/2012), Spouse clinical employee for Dorset Healthcare University NHS FT (DHUFT), Honorary

Medical Advisor and Chairman of RNLI Lyme Regis, Co-opted member of DCC for Health and Wellbeing Board

purposes. Lyme Bay Medical Centre.

262 0 9 0

2 Dr Jenny Bubb, Locality Chair - Mid Dorset . GP and Partner at Cerne Abbas Surgery, Co-opted member of Dorset

County Council (DCC) for Health and Wellbeing Board purposes. Cerne Abbas Surgery.

120 0 10 0

3 Dr Rob Childs, Locality Chair - North Dorset . GP and Partner at Bute House Practice, LMC Representative North

Dorset, Clinical Assistant in Endoscopy at Yeovil District Hospital, NHS Dorset CCG Representative on Yeovil

District Hospital Board of Governors, Member of Yeatman Hospital Management Group. Bute House Practice.

677 0 20 0

4 Dr Colin Davidson, Locality Chair - East Dorset . GP and Partner at Cranborne Practice - PMS Dispensing and

Training, Clinical Lead for East Dorset Locality, Director and wife a director at Dorset Diagnostics Ltd (DDL), Clinical

Lead for Endoscopy - Victoria Hospital in Wimborne, Trustee at Boveridge House School, wife is a GP at Eagle

House Surgery. DDL hold an AQP contract for Community Endoscopy. Co-opted member of DCC for Health and

Wellbeing Board Purposes. Cranborne Practice.

1,149 0 22 0

5 Dr Colin Davidson a Director and his wife is a director at Dorset Diagnostics Ltd. 0 0 0 0

6 Tim Goodson, Chief Officer. Member of Healthcare Financial Management Association (HfMA), South West Branch

HfMA Committee Member, Co-Member of Dorset Health and Wellbeing Board. Partner works in Finance

Department for Bournemouth Borough Council. HfMA.

10 0 0 0

7 Dr Richard Jenkinson, Locality Chair - Christchurch. GP Partner of Burton Medical Centre, GPSI in ENT employed

by DHUFT, Director of Wessex Aviation Medical Services Ltd, Co-opted member of DCC for Health and Wellbeing

Board purposes. Burton Medical Centre.

1,289 0 19 0

8 Dr Tom Knight, Locality Chair - North Bournemouth . GP partner Northbourne Surgery, FTSE 100 index linked

savings. Northbourne Surgery.

655 0 0 0

9 Dr Blair Millar, Locality Chair - Dorset West. GP Partner of Bridport Medical Centre Skellern Practice, Wife (Dr

Joanna Cotton) is a member of the Cancer Support Group “The Living Tree”, Co-opted member of Dorset County

Council for Health and Wellbeing Board purposes. Bridport Medical Centre Skellern Practice.

2,483 0 55 0

10 Dr Andy Rutland, Locality Chair - Poole Bay & Parkstone . GP partner Lilliput Surgery, shareholder of solutions for

health, wife is a partner at the Harvey Practice. Lilliput Surgery.

938 0 19 0

11 Dr Patrick Seal, Locality Chair - Poole Central. GP partner Adam Practice, Quay Medical Care Limited, the Adam

Practice's provider vehicle for PCOS and Paediatric service. Adam Practice.

3,326 0 0 0

12 Dr Karen Kirkham, Locality Chair - Weymouth & Portland . GP Partner of the Bridges Medical Centre Weymouth,

Specialty Doctor in Sexual Health employed by Dorset County Hospital NHS Foundation Trust, Board Member of

Sexual Health South West Regional Office, Member of Children’s Trust Board Dorset, Governor at Sunninghill

Preparatory School, Husband is a GP Partner at Abbotsbury Road Surgery Weymouth , Co-opted member of DCC

for Health and Wellbeing Board purposes. Bridges Medical Centre.

1,947 0 27 0

13 Paul Vater, Chief Finance Officer. Member and Trustee of the South West Healthcare Financial Management

Association (HfMA), FCCA Membership. SW HfMA.

10 0 0 0

14 David Jenkins, Lay Member - Board. Chair of Gloucestershire County Councils Waste Working Group (2 to 3 days

a month), Deputy Lieutenant of Dorset, Trustee of Bournemouth Symphony Orchestra Endowment Fund, Trustee of

Richard Ely Trust for Young Musicians, Trustee of Burton Bradstock Festival, Patron of Bridport Arts Centre,

President of the Dorset Association of Parish and Town Councils. Gloucestershire County Council.

0 0 0 0

15 Teresa Hensman, Lay Member - Board (and Chair of Audit Committee). Mental Health Act Manager Associate,

DHUFT. DHUFT.

0 0 0 0

16 Mary Monnington, Nurse Member. Council member [UKCCG] United Kingdom Council of Caldicott Guardians,

Panel Member Professional Performance Committees Nursing and Midwifery Council [NMC], Nurse Member

Wiltshire CCG, Husband JET Monnington, Senior Solicitor Moore Blatch Resolve LLP Southampton. Moore Blatch

Resolve LLP.

0 0 0 0

17 Chris Burton, Secondary Care Member. Member of the Trust Board of North Bristol NHS Trust which provide

specialist commissioning services for Dorset population commissioned by NHS England. Partner is a GPSI in

dermatology in the Bristol region. North Bristol NHS Trust.

658 0 567 0

18 Suzanne Rastrick, Director of Quality. Allied Health Professional/Healthcare Scientist Member, Policy Board for

NHS Employers. Member of Health Education England Advisory Group. Group Board Member and Chair, Audit

and Risk Committee. Spectrum Housing Group Limited which involves oversight of the following companies:

Spectrum Housing Group Limited, Spectrum Property Care Limited, Signpost Homes Limited, Spectrum Premier

Homes Limited. Member of Council of the College of Occupational Therapists, Chair of the English Board of the

College of Occupational Therapists. Spectrum Housing Group Limited.

0 0 0 0

19 Suzanne Rastrick, Director of Quality. Signpost Homes Limited. 0 0 0 0

20 Suzanne Rastrick, Director of Quality. Spectrum Premier Homes Limited. 0 0 0 0

21 Charles Buckle, Non Governing Body Lay Members. Member of DHUFT (Not on governing body, but to keep in

touch with their priorities), Member of Purbeck Health Network, anticipate being a member of Health Watch.

DHUFT.

0 0 0 0

22 Tina Thompson, Non Governing Body Lay Members. Employee of Bournemouth Borough Council working for

Bournemouth 2026 Trust, Lay Advisor, Health Education Wessex/Wessex Deanery, Freelance Management

Consultant for Third Sector Management Solutions, Site Assessor for Quality Performance Mark, Action for

Advocacy Secretary, Friends of Boscombe Chine Gardens. Wessex Deanery.

0 0 0 0

23 Dr Ros Maycock, GP Transition Lead (Left 31 October 2013). Partner at Evergreen Oak Surgery (Training

Practice), Member of Poole Children Trust Board, Member of Bournemouth Children Trust Board. Evergreen Oak

Surgery.

519 0 14 0

24 Dr Piers Wilde, Locality Chair - Central Bournemouth (Left 31 July 2013). GP Moordown Medical Centre,

Shareholder of Circle & Solutions for Health. Moordown Medical Centre.

760 0 19 0

25 Dr Carole Linnard, Locality Chair - North Bournemouth (Left 31 August 2013). Partner GP Alma Partnership,

Programme Director for Winchester University/Wessex Deanery, Governor at Royal Bournemouth & Christchurch

Hospital NHS Foundation Trust. Alma Partnership.

711 0 0 0

25 Dr Carole Linnard, Locality Chair - North Bournemouth (Left 31 August 2013). Partner GP Alma Partnership,

Programme Director for Winchester University/Wessex Deanery, Governor at Royal Bournemouth & Christchurch

Hospital NHS Foundation Trust. Royal Bournemouth & Christchurch Hospital NHS Foundation Trust.

161,772 0 1,333 877

177,286 0 2,114 877

The CCG has detailed in this note all declarations of interest for Governing Body Members, however only related party transactions have been disclosed where they meet the criteria of having (i)

control or joint control over the reporting entity, (ii) have significant influence over the reporting entity or (iii) are a member of the key management personnel.

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:

In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these

transactions have been with [e.g. Dorset County Council, Bournemouth Borough Council and Borough of Poole Council Local Authorities in respect of joint enterprises].

The clinical commissioning group has received no revenue or capital payments from charitable funds.

Dorset Clinical Commissioning Group is a body corporate established by order of the Secretary of State for Health.



39. Events after the end of the Reporting Period

40. Losses and Special PaymentsThe total number of losses cases in 2013-14 and their total value was as follows:

Total Value Total Number

of Cases of Cases

£s

Losses 0 0

Special payments 0 0Total losses and special payments 0 0

Details of

cases

individually

over

£250,000There were no cases over £250,000.

41. Third Party Assets

31 March 2014

£000

Third party assets held by the clinical commissioning group 0

0

42. Financial Performance TargetsClinical commissioning groups have a number of financial duties under the NHS Act 2006 (as amended).

The clinical commissioning group’s performance against those duties was as follows:

National

Health

Service Act

Section

Duty Maximum PerformanceDuty

Achieved?

£’000 £’000

223H(1) Expenditure not to exceed income (12,614) (12,614) Yes

223I(2) Capital resource use does not exceed the amount specified in Directions 0 0 Yes

223I(3) Revenue resource use does not exceed the amount specified in Directions 947,097 934,483 Yes

223J(1)

Capital resource use on specified matter(s) does not exceed the amount specified

in Directions 0 0 Yes

223J(2)

Revenue resource use on specified matter(s) does not exceed the amount

specified in Directions 0 0 Yes

223J(3)

Revenue administration resource use does not exceed the amount specified in

Directions 18,730 16,730 Yes

43. Impact of IFRS TreatmentThere was no significant impact due to IFRS Accounting Treatment.

44. Analysis of Charitable ReservesThe clinical commissioning group has no Charitable Reserves.

The purpose of this note is to disclose the Financial Performance of the CCG. Where a clinical commissioning group breaches, or plans to breach,

one of the statutory financial provisions, even if this is agreed with NHS England (e.g. setting a deficit budget) local auditors are under a duty to make

a report to the Secretary of State for Health under Section 28 of the Audit Commission Act 1998.

The clinical commisioning group has no Events after the end of the Reporting Period.

2013-14

This note discloses the financial consequences of events (both favourable or unfavourable) that occur between the Statement of Financial Position

date and the date on which the financial statements are approved by the Board, if appropriate.

Two types of events can be identified:

* those that provide evidence of conditions that existed at the end of the reporting period (adjusting events); and

* those that are indicative of conditions that arose after the reporting period (non-adjusting events).

Losses or special payments are payments that Parliament would not have envisaged healthcare funds being spent on when it originally provided the

funds.

The total costs included in this note are on a cash basis and will not reconcile to the amounts shown elsewhere within the accounts which are

prepared on an accruals basis.

Third party assets are held by the CCG on behalf of a third party, for instance as money held on behalf of patients. As these assets do not belong to

the CCG they are not included in the Statement of Financial Position or the trade payables note.

Note: For the purposes of 223H(1); expenditure is defined as the aggregate of gross expenditure on revenue and capital in the financial year; and,

income is defined as the aggregate of the notified maximum revenue resource, notified capital resource and all other amounts accounted as received

in the financial year (whether under provisions of the Act or from other sources, and included here on a gross basis).



Accruals

Assets

Audit

Capital

Cash limit

Commissioning

Current assets

Governance

Gross operating costs

Intangible assets

Miscellaneous revenue

Non-current assets

Resource limit Expenditure limits are determined for each NHS organisation by NHS England

for both revenue and capital, which limit the amount that may be expended on

revenue purchases, as assessed on an accruals basis (that is, after adjusting

for debtors and creditors).

This is the total revenue expenditure, including accruals and provisions,

incurred in the course of performing all aspects of the CCG’s functions during

the year.

Brand value or some other right (for example, a software licence), which

although invisible is likely to derive financial benefit for its owner in the future,

and for which you might be willing to pay.

Governance is the system by which organisations are directed and controlled .

It is concerned with how the organisation is run, how it is structured and how it

is led. Corporate governance should underpin all that an organisation does. In

the NHS, this means it must encompass clinical, financial and organisational

aspects.

Purchase of healthcare from external service providers (NHS, other public

sector, private and voluntary) to meet the needs of the population.

Trade receivables (debtors), inventories (stocks), cash or similar, whose value

is, or can be converted into, cash within the next twelve months.

Land, buildings, equipment and other long term assets that are expected to

have a life of more than one year.

Income that relates directly to the operating activities of the CCG. This

excludes cash from NHS England, which is credited to the general fund.

GLOSSARY OF FINANCIAL TERMS

An accounting concept. In addition to payments and receipts of cash,

adjustment is made for outstanding payments, debts to be collected and stock.

This means that the accounts show all of the income and expenditure that

related to the financial year.

An item that has a value in the future. For example, a debtor (someone who

owes money) is an asset, as they will in future pay. A building is an asset,

because it houses activity that will provide a future income stream.

A limit set by the NHS England which restricts the amount of cash drawings

that the CCG can make in the financial year. There is a combined cash limit

for both revenue and capital.

The process of validation of the accuracy, completeness and adequacy of

disclosure of financial records.

Land, buildings, equipment and other non-current assets owned by the CCG,

the cost of which exceeds £5,000 and has an expected life of more than one

year.

Glossary Page 53 of 53

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