Primary Care Co-Commissioning Joint Committee with NHS England
Proposed revised Establishment Agreement and Terms of Reference – June 2015
Why?
Until April 2015, all primary care was commissioned by NHS England – with only a very limited role for
CCGs.
The CCG, along with the other CCGs of North West London, has therefore embraced cocommissioning as a means of exerting stronger local influence on the development of primary care.
Only with this influence can the CCG be sure that primary care will be able to act as a driver for
ambitious plans for transforming the local health and care economy, both locally and across North
West London.
These plans place GPs at the centre of organising and coordinating care for people, seven days a
week, through both individual practices and practice networks. This will require significant and
sustained investment.
Without co-commissioning, the CCG has only a limited ability to supply this investment. Equally, NHS
England is unable to invest in integrated care because its commissioning role is mainly limited to
primary care.
Expanding the CCG’s role in primary care commissioning provides a mechanism by which money can
be more readily shifted from around the local health economy, designed to support the expanded role
for primary care and, in turn, North West London’s wider out-of-hospital strategy.
What?
The main advantage of co-commissioning is the potential to develop a local and voluntary wraparound contract that sits on top of the GMS contract and meets specific local needs. (The GMS
contract stays with NHS England and will continue to be negotiated nationally.) This local contract will
be co-designed by the North West London CCGs and NHS England, for implementation by practices
in a way that reflects their individual populations’ circumstances. Co-commissioning also provides the
opportunity to:
 Design local PMS and APMS contracts;
 Develop a local incentives framework as an alternative to the Quality and Outcomes Framework;
and
 Exert increased influence over quality improvement, estates development, practice mergers and
closures, and discretionary payments.
Outcomes?
By aligning this with the rest of the ongoing transformation work across North West London, we
believe that we can secure the following patient benefits:
 Services that are joined up, coordinated, and easily navigated, with more services available closer
to people’s homes;
 High quality out-of-hospitals care;
 Improved health outcomes, equity of access, reduced inequalities, and better patient experiences;
and
 Enhanced local patient and public involvement in developing services, with a greater focus on
prevention, staying healthy, and patient empowerment.
How?
The CCG has formed a decision-making joint committee with NHS England, according to the terms of
reference below. So too have the other seven CCGs in North West London. The eight CCGs’ joint
committees will meet together, though each joint committee will retain individual decision-making
authority. Having the committees meet together will enable the strategic discussions on issues
relevant across North West London and, where desirable, consistency across the CCGs.
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Terms of reference
Functions and
duties
The role of the Joint Committee includes the following activities:

Designing new extended scope services (locally commissioned services),
including an additional wrap-around contractual GP offer, to support the
delivery of a new model of care for general practice (in alignment with other
NWL out-of-hospital strategies);

GMS, PMS and APMS contracts (including the design of PMS and APMS
contracts and, jointly with NHS England, contractual GP practice
performance management);*

Designing local incentive schemes as an alternative to the Quality
Outcomes Framework;

Making recommendations on whether to establish new GP practices in an
area (or decisions where additional permissions by NHS England are not
required, e.g. on financial implications);

Making recommendations on practice vacancies and mergers, plus
retirements, dispersals, and contract terminations (or decisions where
additional permissions by NHS England are not required, e.g. on financial
implications);

Making recommendations on discretionary payments according to national
policy (e.g. returner/retainer schemes); and

Oversight of quality and safety standards as delivered through GP contracts
and agreements.
* The following explanation of how this clause will operate in practice across
North West London has been agreed with NHS England and the LMC:
The joint committees will review and agree the framework by which contract
and performance management will be undertaken. A memorandum of
understanding between the joint committee, performance directorate and
contracting team will make explicit the duties and responsibilities of all
parties in contract and performance management, NHS England will
conduct routine contract management of GMS, PMS and APMS contracts
as before, together with offering and monitoring delivery of Directed
Enhanced Services.
Where issues are identified, this will include liaison with practices,
development of appropriate action or improvement plans, and then
monitoring delivery of these plans. The joint committee will receive
aggregate reports on this routine contract and performance management.
Where necessary, the NHS England contracting team will prepare and
present papers with recommendations to the joint committee for individual
practice sanction for non-delivery of its contractual obligations. This includes
making the case for a sanction (with the gathering of appropriate data), plus
liaison with the provider and representative organisations. These individual
cases might be considered in private session. GP members of the joint
committee will not be part of the decision making process, about individual
contracts.
The joint committees will have no part in individual practitioner performance
management, revalidation and appraisal processes relating to being
included on the National Performers List.
The joint committees will be required to implement NHS England policy (for
instance, the PMS review and MPIG redistribution) and also to action
national changes to contracts negotiated with the GPC The joint committees
are also empowered to undertake additional work required to meet the
needs of their local populations. This includes designing local incentive
schemes as an alternative to QOF, designing new extended scope services
(locally commissioned services), and enhancing locally agreed contract
terms to deliver the out-of-hospital agenda.
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CCGs’ involvement with contract and performance management through
co-commissioning is aligned with their existing roles, given their statutory
duty to support NHS England to improve the quality of primary care.
LMCs will be fully consulted on all aspects of these developments.
Key
responsibilities
The key responsibilities of the Joint Committee will be in strategic planning and
coordinating a consistent approach to primary care commissioning in the CCG
through:

Commissioning local needs assessments and reviews in primary medical
care, as required and in line with JSNA work;

Identifying local needs in primary medical care based on the views of
patients, carers, and the local community, as well as reports and
recommendations from the CCG, local Health and Wellbeing Board, NHS
England, and Londonwide and local LMCs;

Developing new models of care for general practice and primary medical
care to align with wider local strategic direction;

Developing quality improvement strategies based on reports and
recommendations from the CCG, local Health and Wellbeing Board, NHS
England, and Londonwide and local LMC;

Recommending appropriate mechanisms to support providers in optimum
delivery, including:
o Supporting the development of GP networks and federations;
o Succession and resilience plans; and
o Strategies for providing additional financial investment in primary care;

Co-developing investment criteria and procurement plans across CCG
boundaries based on an agreed model of care for general practice and
wider local strategic priorities; and

Updating and upholding processes for addressing conflicts of interest
related to primary medical services commissioning across NW London, in
alignment with statutory national guidance and the CCG’s constitution and
conflict of interest policy.
The CCG and NHS England are committed to ensuring that the patient voice is
heard and reflected in the Joint Committee’s work.
Membership
The Joint Committee comprises the following voting members:

CCG lay member;

CCG lay audit committee chair;

CCG Chair;

CCG Accountable Officer;

CCG Chief Financial Officer or Deputy Chief Financial Officer;

CCG secondary care governing body member;

CCG nurse governing body member;

Director of Primary Care Commissioning, NHS England (London);

Director of Commissioning and Operations, NHS England (NW London);

Assistant Medical Director, NHS England (London); and

Medical Director, NHS England (NW London).
As an out-of-area clinician, the secondary care member will serve the additional
function of further militating against conflicts of interests.
Committee members are expected to attend wherever possible but may
nominate a suitable deputy when necessary. All deputies should be fully briefed
and the secretariat informed of any agreement to deputise so that quoracy can
be monitored. Any deputy for the lay audit chair would need to be agreed by all
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the CCGs that he or she represents.
Governing body papers following joint committee decisions will list the members
and deputies present.
The committee will aim to make decisions by consensus wherever possible.
Where this is not achieved, a voting method will be used. The voting power of
each individual present will be weighted so that each group (CCG and NHS
England) possesses 50% of total voting power.
In cases where a vote has not determined an outright decision, the chair will
have a second and deciding vote.
This will not override NHS England’s casting vote in respect of any functions
within its statutory obligations or the CCG’s casting vote in respect of any
functions within its statutory obligations.
The Chair
The CCG’s non-audit lay member (or deputy) will be the chair of the committee.
Non-voting
advisors
Healthwatch
The Strategy and Transformation team is currently liaising with local Healthwatch
committees about the establishment of a pan-North West London Healthwatch
group. This will provide a forum in which Healthwatch is able to discuss and
contribute to the work of the eight Joint Committees (as well as to be involved in
other transformation programmes across the area).
The group will elect two representatives (one from Inner NWL and one from outer
NWL) to attend the Joint Committees as non-voting advisors. This will be an
alternative to a representative from each local Healthwatch committee attending
each Joint Committee.
Health and Wellbeing Board
The Health and Wellbeing Board is entitled to send a representative to the Joint
Committee to act as a non-voting advisor. The CCG will work with the Health and
Wellbeing Board to determine the best way to involve it in local cocommissioning.
LMC
Londonwide LMC is invited to nominate two representatives to attend the eight
Joint Committees as non-voting advisers, representing GPs as providers and
performers and bringing local and clinical expertise to discussions.
Strategy and Transformation
The Director of Strategy and Transformation from the NWL Collaboration of
CCGs is a non-voting advisor of the Joint Committee.

All non-voting advisors have full speaking rights and will receive papers at the
same time as committee members.

The Joint Committee may call additional experts to attend meetings on an ad
hoc basis.
Work outside the
Joint Committee
The Joint Committee is able to agree an operating model and decision-making
processes to support co-commissioning.
Frequency of
meetings
Meetings will typically occur monthly, though this can be varied as business
requires.
Quorum

Non-audit lay member (or deputy);

Audit lay member (or deputy);

CCG chair (or deputy);

One CCG officer (AO or CFO/Deputy CFO, or deputy);

The CCG secondary care governing body member or nurse governing body
member (or nurse governing body member deputy); and

One officer from NHS England.
No person can act in more than one role on the joint committee, meaning that
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each deputy needs to be an additional person from outside the committee
membership.
Again, NHS England has a casting vote for any functions within NHS England’s
statutory obligations and the CCG will have a casting vote on any functions within
its statutory obligations.
Operation of the
Joint Committee
Public
transparency
The Joint Committee will be supported by a secretariat. This will be run by the
Strategy and Transformation team of the NWL Collaboration of CCGs. The
secretariat will produce minutes to be presented to the CCG and NHS England
following each meeting of the Joint Committee.
The secretariat will be responsible for giving notice of meetings. This will be
accompanied by an agenda and supporting papers and sent to each member no
later than seven days before the meeting. When the secretariat of the Joint
Committee deems it necessary, in light of urgent circumstances, to call a meeting
at short notice, the notice period shall be as specified.
The secretariat will:

Circulate the minutes and action notes of the committee; and

Present the minutes and action notes to NHS England and the CCG.
Members of the public shall be able to observe meetings of the Joint Committee.
They shall also be able to submit in advance of each meeting questions related
to the agenda items, which will be addressed during proceedings.
The Joint Committee may resolve to exclude the public from a meeting that is
open to the public (whether during the whole or part of the proceedings)
whenever publicity would be prejudicial to the public interest by reason of the
confidential nature of the business to be transacted or for other special reasons
stated in the resolution and arising from the nature of that business or of the
proceedings or for any other reason permitted by the Public Bodies (Admission to
Meetings) Act 1960 as amended or succeeded from time to time.
The Joint Committee will demonstrate its transparency to local people, as well as
the CCG and NHS England, by:

Including independent lay members and clinicians, plus representation from
Healthwatch, the Health and Wellbeing Board, and LMC;

Publishing these terms of reference;

Publishing minutes for the CCG and the public domain;

Publishing any joint strategies agreed; and

Complying with NHSE guidance and with generally accepted principles of
good governance.
Information regarding the work of the Joint Committee will be made available to
the public through the CCG website.
Changes to the
terms of
reference
These terms of reference will be formally reviewed by NHS England and the
CCG after three months of operation and then in April of each year, following the
year in which the Joint Committee is created. They may be amended by mutual
agreement between the parties at any time to reflect changes in circumstances.
There will be no move to delegated co-commissioning without the explicit
approval of the CCG’s member practices.
Conduct of the
Joint Committee
The Joint Committee shall, at least annually, review its own performance and
membership. This review will reflect experience of the Joint Committee in fulfilling
its functions and the wider experience of NHS England and the CCG in cocommissioning.
Withdrawal from
joint cocommissioning
Withdrawal from co-commissioning may be through mutual agreement between
the CCG and NHS England, with six months’ notice given to all parties. NHS
England reserves the right to terminate the arrangements with immediate effect if
its statutory duties are to be breached.
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