Health and Social Care Bill (HL Bill 119)

(7) Where two or more individuals are parties to an arrangement
mentioned in subsection (4) but are not practising in partnership, those
persons collectively are to be treated for the purposes of this Chapter as
a provider of primary medical services (and the individuals are not to
5be so treated).

14B Applications for the establishment of clinical commissioning groups

(1) An application for the establishment of a clinical commissioning group
may be made to the Board.

(2) The application may be made by any two or more persons each of
10whom—

(a) is or wishes to be a provider of primary medical services, and

(b) wishes to be a member of the clinical commissioning group.

(3) The application must be accompanied by—

(a) a copy of the proposed constitution of the clinical
15commissioning group,

(b) the name of the person whom the group wishes the Board to
appoint as its accountable officer (as to which see paragraph 11
of Schedule 1A), and

(c) such other information as the Board may specify in a document
20published for the purposes of this section.

(4) At any time before the Board determines the application—

(a) a person who is or wishes to be a provider of primary medical
services (and wishes to be a member of the clinical
commissioning group) may become a party to the application,
25with the agreement of the Board and the existing applicants;

(b) any of the applicants may withdraw.

(5) At any time before the Board determines the application, the applicants
may modify the proposed constitution with the agreement of the
Board.

(6) 30Part 1 of Schedule 1A makes provision about the constitution of a
clinical commissioning group.

14C Determination of applications

(1) The Board must grant an application under section 14B if it is satisfied
as to the following matters.

(2) 35Those matters are—

(a) that the constitution complies with the requirements of Part 1 of
Schedule 1A and is otherwise appropriate,

(b) that each of the members specified in the constitution will be a
provider of primary medical services on the date the clinical
40commissioning group is established,

(c) that the area specified in the constitution is appropriate,

(d) that it would be appropriate for the Board to appoint, as the
accountable officer of the group, the person named by the group
under section 14B(3)(b),

(e) that the applicants have made appropriate arrangements to
ensure that the clinical commissioning group will be able to
discharge its functions,

(f) that the applicants have made appropriate arrangements to
5ensure that the group will have a governing body which
satisfies any requirements imposed by or under this Act and is
otherwise appropriate, and

(g) such other matters as may be prescribed.

(3) Regulations may make provision—

(a) 10as to factors which the Board must or may take into account in
deciding whether it is satisfied as to the matters mentioned in
subsection (2);

(b) as to the procedure for the making and determination of
applications under section 14B.

14D 15Effect of grant of application

(1) If the Board grants an application under section 14B—

(a) a clinical commissioning group is established, and

(b) the proposed constitution has effect as the clinical
commissioning group’s constitution.

(2) 20Part 2 of Schedule 1A makes further provision about clinical
commissioning groups.

Variation of constitution

14E Applications for variation of constitution

(1) A clinical commissioning group may apply to the Board to vary its
25constitution (including doing so by varying its area or its list of
members).

(2) If the Board grants the application, the constitution of the clinical
commissioning group has effect subject to the variation.

(3) Regulations may make provision—

(a) 30as to the circumstances in which the Board must or may grant,
or must or may refuse, applications under this section;

(b) as to factors which the Board must or may take into account in
determining whether to grant such applications;

(c) as to the procedure for the making and determination of such
35applications.

14F Variation of constitution otherwise than on application

(1) The Board may vary the area specified in the constitution of a clinical
commissioning group.

(2) The Board may—

(a) 40add any person who is a provider of primary medical services
to the list of members specified in the constitution of a clinical
commissioning group;

(b) remove any person from such a list.

(3) The power conferred by subsection (1) or (2) is exercisable if—

(a) the clinical commissioning group consents to the variation, or

(b) the Board considers that the variation is necessary for the
purpose of discharging any of its duties under section 14A.

(4) Before varying the constitution of a clinical commissioning group
5under subsection (1) or (2), the Board must consult—

(a) that group, and

(b) any other clinical commissioning group that the Board thinks
might be affected by the variation.

(5) Regulations may—

(a) 10confer powers on the Board to vary the constitution of a clinical
commissioning group;

(b) make provision as to the circumstances in which those powers
are exercisable and the procedure to be followed before they are
exercised.

15Mergers, dissolution etc.

14G Mergers

(1) Two or more clinical commissioning groups may apply to the Board
for—

(a) those groups to be dissolved, and

(b) 20another clinical commissioning group to be established under
this section.

(2) An application under this section must be accompanied by—

(a) a copy of the proposed constitution of the clinical
commissioning group,

(b) 25the name of the person whom the group wishes the Board to
appoint as its accountable officer, and

(c) such other information as the Board may specify in a document
published for the purposes of this section.

(3) The applicants may, with the agreement of the Board, modify the
30application or the proposed constitution at any time before the Board
determines the application.

(4) Sections 14C and 14D(1) apply in relation to an application under this
section as they apply in relation to an application under section 14B.

14H Dissolution

(1) 35A clinical commissioning group may apply to the Board for the group
to be dissolved.

(2) Regulations may make provision—

(a) as to the circumstances in which the Board must or may grant,
or must or may refuse, applications under this section;

(b) 40as to factors which the Board must or may take into account in
determining whether to grant such applications;

(c) as to the procedure for the making and determination of such
applications.

Supplemental provision about applications, variation, mergers etc.

14I Transfers in connection with variation, merger, dissolution etc.

(1) The Board may make a property transfer scheme or a staff transfer
scheme in connection with—

(a) 5the variation of the constitution of a clinical commissioning
group under section 14E or 14F, or

(b) the dissolution of a clinical commissioning group under section
14G or 14H.

(2) A property transfer scheme is a scheme for the transfer from the clinical
10commissioning group of any property, rights or liabilities, other than
rights or liabilities under or in connection with a contract of
employment, to the Board or another clinical commissioning group.

(3) A staff transfer scheme is a scheme for the transfer from the clinical
commissioning group of any rights or liabilities under or in connection
15with a contract of employment to the Board or another clinical
commissioning group.

(4) Part 3 of Schedule 1A makes further provision about property transfer
schemes and staff transfer schemes.

14J Publication of constitution of clinical commissioning groups

(1) 20A clinical commissioning group must publish its constitution.

(2) If the constitution of a clinical commissioning group is varied under
section 14E or 14F, the group must publish the constitution as so varied.

14K Guidance about the establishment of clinical commissioning groups
etc.

25The Board may publish guidance as to—

(a) the making of applications under section 14B for the
establishment of a clinical commissioning group, including
guidance on the form, content or publication of the proposed
constitution;

(b) 30the making of applications under section 14E, 14G or 14H;

(c) the publication of the constitutions of clinical commissioning
groups under section 14J.

Governing bodies of clinical commissioning groups

14L Governing bodies of clinical commissioning groups

(1) 35A clinical commissioning group must have a governing body.

(2) The main function of the governing body is to ensure that the group has
made appropriate arrangements for ensuring that it complies with—

(a) its obligations under section 14P, and

(b) such generally accepted principles of good governance as are
40relevant to it.

(3) The governing body also has—

(a) the function of determining the remuneration, fees and
allowances payable to the employees of the clinical

commissioning group or to other persons providing services to
it,

(b) the function of determining the allowances payable under a
pension scheme established under paragraph 10(4) of Schedule
51A, and

(c) such other functions connected with the exercise of its main
function as may be specified in the group’s constitution or by
regulations.

(4) Only the following may be members of the governing body—

(a) 10a member of the group who is an individual;

(b) an individual appointed by virtue of regulations under section
14N(2);

(c) an individual of a description specified in the constitution of the
group.

(5) 15Regulations may make provision requiring a clinical commissioning
group to obtain the approval of its governing body before exercising
any functions specified in the regulations.

(6) Regulations may make provision requiring governing bodies of clinical
commissioning groups to publish, in accordance with the regulations,
20prescribed information relating to determinations made under
subsection (3)(a) or (b).

(7) The Board may publish guidance for governing bodies on the exercise
of their functions under subsection (3)(a) or (b).

14M Audit and remuneration committees of governing bodies

(1) 25The governing body of a clinical commissioning group must have an
audit committee and a remuneration committee.

(2) The audit committee has—

(a) such functions in relation to the financial duties of the clinical
commissioning group as the governing body considers
30appropriate for the purpose of assisting it in discharging its
function under section 14L(2), and

(b) such other functions connected with the governing body’s
function under section 14L(2) as may be specified in the group’s
constitution or by regulations.

(3) 35The remuneration committee has—

(a) the function of making recommendations to the governing
body as to the discharge of its functions under section 14L(3)(a)
and (b), and

(b) such other functions connected with the governing body’s
40function under section 14L(2) as may be specified in the group’s
constitution or by regulations.

14N Regulations as to governing bodies of clinical commissioning groups

(1) Regulations may make provision specifying the minimum number of
members of governing bodies of clinical commissioning groups.

(2) 45Regulations may—

(a) provide that the members of governing bodies must include the
accountable officer of the clinical commissioning group;

(b) provide that the members of governing bodies, or their audit or
remuneration committees, must include—

(i) 5individuals who are health care professionals of a
prescribed description;

(ii) individuals who are lay persons;

(iii) individuals of any other description which is
prescribed;

(c) 10in relation to any description of individuals mentioned in
regulations by virtue of paragraph (b), specify—

(i) the minimum number of individuals of that description
who must be appointed;

(ii) the maximum number of such individuals who may be
15appointed;

(d) provide that the descriptions specified for the purposes of
section 14L(4)(c) may not include prescribed descriptions.

(3) Regulations may make provision as to—

(a) qualification and disqualification for membership of governing
20bodies or their audit or remuneration committees;

(b) how members are to be appointed;

(c) the tenure of members (including the circumstances in which a
member ceases to hold office or may be removed or suspended
from office);

(d) 25eligibility for re-appointment.

(4) Regulations may make provision for the appointment of chairs and
deputy chairs of governing bodies or their audit or remuneration
committees, including provision as to—

(a) qualification and disqualification for appointment;

(b) 30tenure of office (including the circumstances in which the chair
or deputy chair ceases to hold office or may be removed or
suspended from office);

(c) eligibility for re-appointment.

(5) Regulations may—

(a) 35make provision as to the matters which must be included in the
constitutions of clinical commissioning groups under
paragraph 7 of Schedule 1A;

(b) make such other provision about the procedure of governing
bodies or their audit or remuneration committees as the
40Secretary of State considers appropriate, including provision
about the frequency of meetings.

(6) In this section—

• “health care professional” means an individual who is a member
  of a profession regulated by a body mentioned in section 25(3)
  45of the National Health Service Reform and Health Care
  Professions Act 2002;

• “lay person” means an individual who is not—

  (a)

  a member of the clinical commissioning group,

  (b)

  a health care professional, or

  Health and Social Care BillPage 36

  (c)

  an individual of a prescribed description.”

(2) After Schedule 1 to the National Health Service Act 2006 insert the Schedule set
out in Schedule 2 to this Act.

25 Clinical commissioning groups: general duties etc.

5After section 14N of the National Health Service Act 2006 insert—

“General duties of clinical commissioning groups

14O Duty to promote NHS Constitution

(1) Each clinical commissioning group must, in the exercise of its
functions—

(a) 10act with a view to securing that health services are provided in
a way which promotes the NHS Constitution, and

(b) promote awareness of the NHS Constitution among patients,
staff and members of the public.

(2) In this section, “patients” and “staff” have the same meanings as in
15Chapter 1 of Part 1 of the Health Act 2009 (see section 3(7) of that Act).

14P Duty as to effectiveness, efficiency etc.

Each clinical commissioning group must exercise its functions
effectively, efficiently and economically.

14Q Duty as to improvement in quality of services

(1) 20Each clinical commissioning group must exercise its functions with a
view to securing continuous improvement in the quality of services
provided to individuals for or in connection with the prevention,
diagnosis or treatment of illness.

(2) In discharging its duty under subsection (1), a clinical commissioning
25group must, in particular, act with a view to securing continuous
improvement in the outcomes that are achieved from the provision of
the services.

(3) The outcomes relevant for the purposes of subsection (2) include, in
particular, outcomes which show—

(a) 30the effectiveness of the services,

(b) the safety of the services, and

(c) the quality of the experience undergone by patients.

(4) In discharging its duty under subsection (1), a clinical commissioning
group must have regard to any guidance published under section 14Z6.

14R 35Duty in relation to quality of primary medical services

Each clinical commissioning group must assist and support the Board
in discharging its duty under section 13E so far as relating to securing
continuous improvement in the quality of primary medical services.

14S Duties as to reducing inequalities

40Each clinical commissioning group must, in the exercise of its
functions, have regard to the need to—

(a) reduce inequalities between patients with respect to their ability
to access health services, and

(b) reduce inequalities between patients with respect to the
outcomes achieved for them by the provision of health services.

14T 5 Duty to promote involvement of each patient

(1) Each clinical commissioning group must, in the exercise of its
functions, promote the involvement of patients, and their carers and
representatives (if any), in decisions about the provision of health
services to the patients.

(2) 10The Board may publish guidance for clinical commissioning groups on
the discharge of their duties under this section.

(3) A clinical commissioning group must have regard to any guidance
published by the Board under subsection (2).

14U Duty as to patient choice

15Each clinical commissioning group must, in the exercise of its
functions, act with a view to enabling patients to make choices with
respect to aspects of health services provided to them.

14V Duty to obtain appropriate advice

(1) Each clinical commissioning group must obtain advice appropriate for
20enabling it effectively to discharge its functions from persons who
(taken together) have a broad range of professional expertise in—

(a) the prevention, diagnosis or treatment of illness, and

(b) the protection or improvement of public health.

(2) The Board may publish guidance for clinical commissioning groups on
25the discharge of their duties under subsection (1).

(3) A clinical commissioning group must have regard to any guidance
published by the Board under subsection (2).

14W Duty to promote innovation

Each clinical commissioning group must, in the exercise of its
30functions, promote innovation in the provision of health services
(including innovation in the arrangements made for their provision).

14X Duty in respect of research

Each clinical commissioning group must, in the exercise of its
functions, have regard to the need to promote—

(a) 35research on matters relevant to the health service, and

(b) the use in the health service of evidence obtained from research.

14Y Duty as to promoting integration

(1) Each clinical commissioning group must exercise its functions with a
view to securing that health services are provided in an integrated way
40where it considers that this would—

(a) improve the quality of those services (including the outcomes
that are achieved from their provision),

(b) reduce inequalities between persons with respect to their ability
to access those services, or

(c) reduce inequalities between persons with respect to the
outcomes achieved for them by the provision of those services.

(2) 5Each clinical commissioning group must exercise its functions with a
view to securing that the provision of health services is integrated with
the provision of health-related services or social care services where it
considers that this would—

(a) improve the quality of the health services (including the
10outcomes that are achieved from the provision of those
services),

(b) reduce inequalities between persons with respect to their ability
to access those services, or

(c) reduce inequalities between persons with respect to the
15outcomes achieved for them by the provision of those services.

(3) In this section—

• “health-related services” means services that may have an effect
  on the health of individuals but are not health services or social
  care services;

• 20“social care services” means services that are provided in
  pursuance of the social services functions of local authorities
  (within the meaning of the Local Authority Social Services Act
  1970).

Public involvement

14Z 25Public involvement and consultation by clinical commissioning
groups

(1) This section applies in relation to any health services which are, or are
to be, provided pursuant to arrangements made by a clinical
commissioning group in the exercise of its functions (“commissioning
30arrangements”).

(2) The clinical commissioning group must make arrangements to secure
that individuals to whom the services are being or may be provided are
involved (whether by being consulted or provided with information or
in other ways)—

(a) 35in the planning of the commissioning arrangements by the
group,

(b) in the development and consideration of proposals by the
group for changes in the commissioning arrangements where
the implementation of the proposals would have an impact on
40the manner in which the services are delivered to the
individuals or the range of health services available to them,
and

(c) in decisions of the group affecting the operation of the
commissioning arrangements where the implementation of the
45decisions would (if made) have such an impact.

(3) The clinical commissioning group must include in its constitution—

(a) a description of the arrangements made by it under subsection
(2), and

(b) a statement of the principles which it will follow in
implementing those arrangements.

(4) The Board may publish guidance for clinical commissioning groups on
the discharge of their functions under this section.

(5) 5A clinical commissioning group must have regard to any guidance
published by the Board under subsection (4).

(6) The reference in subsection (2)(b) to the delivery of services is a
reference to their delivery at the point when they are received by users.

Arrangements with others

14Z1 10Arrangements by clinical commissioning groups in respect of the
exercise of functions

(1) Any two or more clinical commissioning groups may make
arrangements under this section.

(2) The arrangements may provide for—

(a) 15one of the clinical commissioning groups to exercise any of the
commissioning functions of another on its behalf, or

(b) all the clinical commissioning groups to exercise any of their
commissioning functions jointly.

(3) For the purposes of the arrangements a clinical commissioning group
20may—

(a) make payments to another clinical commissioning group, or

(b) make the services of its employees or any other resources
available to another clinical commissioning group.

(4) For the purposes of the arrangements, all the clinical commissioning
25groups may establish and maintain a pooled fund.

(5) A pooled fund is a fund—

(a) which is made up of contributions by all the groups, and

(b) out of which payments may be made towards expenditure
incurred in the discharge of any of the commissioning functions
30in respect of which the arrangements are made.

(6) Arrangements made under this section do not affect the liability of a
clinical commissioning group for the exercise of any of its functions.

(7) In this section, “commissioning functions” means the functions of
clinical commissioning groups in arranging for the provision of
35services as part of the health service (including the function of making
a request to the Board for the purposes of section 14Z7).

14Z2 Joint exercise of functions with Local Health Boards

(1) Regulations may provide for any prescribed functions of a clinical
commissioning group to be exercised jointly with a Local Health Board.

(2) 40Regulations may provide for any functions that are (by virtue of
subsection (1)) exercisable jointly by a clinical commissioning group
and a Local Health Board to be exercised by a joint committee of the
group and the Board.