Health and Social Care Bill (HL Bill 119)

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

Additional powers of clinical commissioning groups

14Z3 5Raising additional income

(1) A clinical commissioning group has power to do anything specified in
section 7(2)(a), (b) and (e) to (h) of the Health and Medicines Act 1988
(provision of goods etc.) for the purpose of making additional income
available for improving the health service.

(2) 10A clinical commissioning group may exercise a power conferred by
subsection (1) only to the extent that its exercise does not to any
significant extent interfere with the performance by the group of its
functions.

14Z4 Power to make grants

(1) 15A clinical commissioning group may make payments by way of grant
or loan to a voluntary organisation which provides or arranges for the
provision of services which are similar to the services in respect of
which the group has functions.

(2) The payments may be made subject to such terms and conditions as the
20group considers appropriate.

Board’s functions in relation to clinical commissioning groups

14Z5 Responsibility for payments to providers

(1) The Board may publish a document specifying—

(a) circumstances in which a clinical commissioning group is liable
25to make a payment to a person in respect of services provided
by that person in pursuance of arrangements made by another
clinical commissioning group in the discharge of its
commissioning functions, and

(b) how the amount of any such payment is to be determined.

(2) 30A clinical commissioning group is required to make payments in
accordance with any document published under subsection (1).

(3) Where a clinical commissioning group is required to make a payment
by virtue of subsection (2), no other clinical commissioning group is
liable to make it.

(4) 35Accordingly, any obligation of another clinical commissioning group to
make the payment ceases to have effect.

(5) Any sums payable by virtue of subsection (2) may be recovered
summarily as a civil debt (but this does not affect any other method of
recovery).

(6) 40The Board may publish guidance for clinical commissioning groups for
the purpose of assisting them in understanding and applying any
document published under subsection (1).

(7) In this section and section 14Z6, “commissioning functions” means the
functions of clinical commissioning groups in arranging for the
provision of services as part of the health service.

14Z6 Guidance on commissioning by the Board

(1) 5The Board must publish guidance for clinical commissioning groups on
the discharge of their commissioning functions.

(2) Each clinical commissioning group must have regard to guidance
under this section.

(3) The Board must consult the Healthwatch England committee of the
10Care Quality Commission—

(a) before it first publishes guidance under this section, and

(b) before it publishes any revised guidance containing changes
that are, in the opinion of the Board, significant.

14Z7 Exercise of functions by the Board

(1) 15The Board may, at the request of a clinical commissioning group,
exercise on behalf of the group—

(a) any of its functions under section 3 or 3A which are specified in
the request, and

(b) any other functions of the group which are related to the
20exercise of those functions.

(2) Regulations may provide that the power in subsection (1) does not
apply in relation to functions of a prescribed description.

(3) Arrangements under this section may be on such terms and conditions
(including terms as to payment) as may be agreed between the Board
25and the clinical commissioning group.

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

14Z8 Power of Board to provide assistance or support

(1) The Board may provide assistance or support to a clinical
30commissioning group.

(2) The assistance that may be provided includes—

(a) financial assistance, and

(b) making the services of the Board’s employees or any other
resources of the Board available to the clinical commissioning
35group.

(3) Assistance or support provided under this section may be provided on
such terms and conditions, including terms as to payment, as the Board
considers appropriate.

(4) The Board may, in particular, impose restrictions on the use of any
40financial or other assistance or support provided under this section.

(5) A clinical commissioning group must comply with any restrictions
imposed under subsection (4).

Commissioning plans and reports

14Z9 Commissioning plan

(1) Before the start of each relevant period, a clinical commissioning group
must prepare a plan setting out how it proposes to exercise its functions
5in that period.

(2) In subsection (1), “relevant period”, in relation to a clinical
commissioning group, means—

(a) the period which —

(i) begins on such day during the first financial year of the
10group as the Board may direct, and

(ii) ends at the end of that financial year, and

(b) each subsequent financial year.

(3) The plan must, in particular, explain how the group proposes to
discharge its duties under—

(a) 15sections 14Q and 14Z, and

(b) sections 223H to 223J.

(4) The clinical commissioning group must publish the plan.

(5) The clinical commissioning group must give a copy of the plan to the
Board before the date specified by the Board in a direction.

(6) 20The clinical commissioning group must give a copy of the plan to each
relevant Health and Wellbeing Board.

(7) The Board may publish guidance for clinical commissioning groups on
the discharge of their functions by virtue of this section and sections
14Z10 and 14Z11.

(8) 25A clinical commissioning group must have regard to any guidance
published by the Board under subsection (7).

(9) In this Chapter, “relevant Health and Wellbeing Board”, in relation to a
clinical commissioning group, means a Health and Wellbeing Board
established by a local authority whose area coincides with, or includes
30the whole or any part of, the area of the group.

14Z10 Revision of commissioning plans

(1) A clinical commissioning group may revise a plan published by it
under section 14Z9.

(2) If the clinical commissioning group revises the plan in a way which it
35considers to be significant—

(a) the group must publish the revised plan, and

(b) subsections (5) and (6) of section 14Z9 apply in relation to the
revised plan as they apply in relation to the original plan.

(3) If the clinical commissioning group revises the plan in any other way,
40the group must—

(a) publish a document setting out the changes it has made to the
plan, and

(b) give a copy of the document to the Board and each relevant
Health and Wellbeing Board.

14Z11 Consultation about commissioning plans

(1) This section applies where a clinical commissioning group is—

(a) preparing a plan under section 14Z9, or

(b) revising a plan under section 14Z10 in a way which it considers
5to be significant.

(2) The clinical commissioning group must consult individuals for whom
it has responsibility for the purposes of section 3.

(3) The clinical commissioning group must involve each relevant Health
and Wellbeing Board in preparing or revising the plan.

(4) 10The clinical commissioning group must, in particular—

(a) give each relevant Health and Wellbeing Board a draft of the
plan or (as the case may be) the plan as revised, and

(b) consult each such Board on whether the draft takes proper
account of each joint health and wellbeing strategy published
15by it which relates to the period (or any part of the period) to
which the plan relates.

(5) Where a Health and Wellbeing Board is consulted under subsection
(4)(b), the Health and Wellbeing Board must give the clinical
commissioning group its opinion on the matter mentioned in that
20subsection.

(6) Where a Health and Wellbeing Board is consulted under subsection
(4)(b)—

(a) it may also give the Board its opinion on the matter mentioned
in that subsection, and

(b) 25if it does so, it must give the clinical commissioning group a
copy of its opinion.

(7) If a clinical commissioning group revises or further revises a draft after
it has been given to each relevant Health and Wellbeing Board under
subsection (4), subsections (4) to (6) apply in relation to the revised
30draft as they apply in relation to the original draft.

(8) A clinical commissioning group must include in a plan published
under section 14Z9(4) or 14Z10(2)—

(a) a summary of the views expressed by individuals consulted
under subsection (2),

(b) 35an explanation of how the group took account of those views,
and

(c) a statement of the final opinion of each relevant Health and
Wellbeing Board consulted in relation to the plan under
subsection (4).

(9) 40In this section, “joint health and wellbeing strategy” means a strategy
under section 116A of the Local Government and Public Involvement
in Health Act 2007 which is prepared and published by a Health and
Wellbeing Board by virtue of section 195 of the Health and Social Care
Act 2012.

14Z12 45 Opinion of Health and Wellbeing Boards on commissioning plans

(1) A relevant Health and Wellbeing Board—

(a) may give the Board its opinion on whether a plan published by
a clinical commissioning group under section 14Z9(4) or
14Z10(2) takes proper account of each joint health and
wellbeing strategy published by the Health and Wellbeing
5Board which relates to the period (or any part of the period) to
which the plan relates, and

(b) if it does so, must give the clinical commissioning group a copy
of its opinion.

(2) In this section, “joint health and wellbeing strategy” has the same
10meaning as in section 14Z11.

14Z13 Reports by clinical commissioning groups

(1) In each financial year other than its first financial year, a clinical
commissioning group must prepare a report (an “annual report”) on
how it has discharged its functions in the previous financial year.

(2) 15An annual report must, in particular—

(a) explain how the clinical commissioning group has discharged
its duties under sections 14Q and 14Z, and

(b) review the extent to which the group has contributed to the
delivery of any joint health and wellbeing strategy to which it
20was required to have regard under section 116B(1)(b) of the
Local Government and Public Involvement in Health Act 2007.

(3) In preparing the review required by subsection (2)(b), the clinical
commissioning group must consult each relevant Health and
Wellbeing Board.

(4) 25The Board may give directions to clinical commissioning groups as to
the form and content of an annual report.

(5) A clinical commissioning group must give a copy of its annual report
to the Board before the date specified by the Board in a direction.

(6) A clinical commissioning group must—

(a) 30publish its annual report, and

(b) hold a meeting for the purpose of presenting the report to
members of the public.

Performance assessment of clinical commissioning groups

14Z14 Performance assessment of clinical commissioning groups

(1) 35The Board must conduct a performance assessment of each clinical
commissioning group in respect of each financial year.

(2) A performance assessment is an assessment of how well the clinical
commissioning group has discharged its functions during that year.

(3) The assessment must, in particular, include an assessment of how well
40the group has discharged its duties under—

(a) sections 14Q, 14V and 14Z,

(b) sections 223H to 223J, and

(c) section 116B(1) of the Local Government and Public
Involvement in Health Act 2007 (duty to have regard to
assessments and strategies).

(4) In conducting a performance assessment, the Board must consult each
5relevant Health and Wellbeing Board as to its views on the clinical
commissioning group’s contribution to the delivery of any joint health
and wellbeing strategy to which the group was required to have regard
under section 116B(1)(b) of that Act of 2007.

(5) The Board must, in particular, have regard to—

(a) 10any document published by the Secretary of State for the
purposes of this section, and

(b) any guidance published under section 14Z6.

(6) The Board must publish a report in respect of each financial year
containing a summary of the results of each performance assessment
15conducted by the Board in respect of that year.

Powers to require information etc.

14Z15 Circumstances in which powers in sections 14Z16 and 14Z17 apply

(1) Sections 14Z16 and 14Z17 apply where the Board has reason to
believe—

(a) 20that the area of a clinical commissioning group is no longer
appropriate, or

(b) that a clinical commissioning group might have failed, might be
failing or might fail to discharge any of its functions.

(2) Any reference in subsection (1) to failure to discharge a function
25includes a reference to failure to discharge it properly.

14Z16 Power to require documents and information etc.

(1) Where this section applies, the Board may require a person mentioned
in subsection (2) to provide to the Board any information, documents,
records or other items that the Board considers it necessary or
30expedient to have for the purposes of any of its functions in relation to
the clinical commissioning group.

(2) The persons mentioned in this subsection are—

(a) the clinical commissioning group if it has possession or control
of the item in question;

(b) 35any member or employee of the group who has possession or
control of the item in question.

(3) A person must comply with a requirement imposed under subsection
(1).

(4) The power conferred by subsection (1) includes power to require that
40any information, documents or records kept by means of a computer be
provided in legible form.

(5) The power conferred by subsection (1) does not include power to
require the provision of personal records.

(6) In subsection (5), “personal records” has the meaning given by section
12 of the Police and Criminal Evidence Act 1984.

14Z17 Power to require explanation

(1) Where this section applies, the Board may require the clinical
5commissioning group to provide it with an explanation of any matter
which relates to the exercise by the group of any of its functions,
including an explanation of how the group is proposing to exercise any
of its functions.

(2) The Board may require the explanation to be given—

(a) 10orally at such time and place as the Board may specify, or

(b) in writing.

(3) The clinical commissioning group must comply with a requirement
imposed under subsection (1).

14Z18 Use of information

15Any information, documents, records or other items that are obtained
by the Board in pursuance of section 14Z16 or 14Z17 may be used by
the Board in connection with any of its functions in relation to clinical
commissioning groups.

Intervention powers

14Z19 20 Power to give directions, dissolve clinical commissioning group etc.

(1) This section applies if the Board is satisfied that—

(a) a clinical commissioning group is failing or has failed to
discharge any of its functions, or

(b) there is a significant risk that a clinical commissioning group
25will fail to do so.

(2) The Board may direct the clinical commissioning group to discharge
such of those functions, and in such manner and within such period or
periods, as may be specified in the direction.

(3) The Board may direct—

(a) 30the clinical commissioning group, or

(b) the accountable officer of the group,

to cease to perform any functions for such period or periods as may be
specified in the direction.

(4) The Board may—

(a) 35terminate the appointment of the clinical commissioning
group’s accountable officer, and

(b) appoint another person to be its accountable officer.

(5) Paragraph 11(4) of Schedule 1A does not apply to an appointment
under subsection (4)(b).

(6) 40The Board may vary the constitution of the clinical commissioning
group, including doing so by—

(a) varying its area,

(b) adding any person who is a provider of medical services to the
list of members, or

(c) removing any person from that list.

(7) The Board may dissolve the clinical commissioning group.

(8) 5Where a direction is given under subsection (3) the Board may—

(a) exercise any of the functions that are the subject of the direction
on behalf of the clinical commissioning group or (as the case
may be) the accountable officer;

(b) direct another clinical commissioning group or (as the case may
10be) the accountable officer of another clinical commissioning
group to perform any of those functions on behalf of the group
or (as the case may be) the accountable officer, in such manner
and within such period or periods as may be specified in the
directions.

(9) 15A clinical commissioning group to which a direction is given under
subsection (3) must—

(a) where the Board exercises a function of the group under
subsection (8)(a), co-operate with the Board, and

(b) where a direction is given under subsection (8)(b) to another
20clinical commissioning group or to the accountable officer of
another clinical commissioning group, co-operate with the
other group or (as the case may be) the accountable officer.

(10) Before exercising the power conferred by subsection (8)(b) the Board
must consult the clinical commissioning group to which it is proposing
25to give the direction.

(11) Where the Board exercises a power conferred by subsection (6) or (7),
the Board may make a property transfer scheme or a staff transfer
scheme.

(12) In subsection (11), “property transfer scheme” and “staff transfer
30scheme” have the same meaning as in section 14I.

(13) Part 3 of Schedule 1A applies in relation to a property transfer scheme
or a staff transfer scheme under subsection (11) as it applies in relation
to a property transfer scheme or (as the case may be) a staff transfer
scheme under section 14I(1).

(14) 35Any reference in subsection (1) to failure to discharge a function
includes a reference to failure to discharge it properly.

Procedural requirements in connection with certain powers

14Z20 Procedural requirements in connection with certain powers

(1) Before exercising the power to dissolve a clinical commissioning group
40under section 14Z19(7) the Board must consult the following persons—

(a) the clinical commissioning group,

(b) relevant local authorities, and

(c) any other persons the Board considers it appropriate to consult.

(2) For that purpose, the Board must provide those persons with a
45statement—

(a) explaining that it is proposing to exercise the power, and

(b) giving its reasons for doing so.

(3) After consulting those persons (and before exercising the power), the
Board must publish a report containing its response to the consultation.

(4) 5If the Board decides to exercise the power, the report must, in
particular, explain its reasons for doing so.

(5) Regulations may make provision as to the procedure to be followed by
the Board before the exercise of the powers conferred by sections
14Z16, 14Z17 and 14Z19.

(6) 10The Board must publish guidance as to how it proposes to exercise the
powers conferred by those sections.

(7) For the purposes of subsection (1) a local authority is a relevant local
authority if its area coincides with, or includes the whole or any part of,
the area of the clinical commissioning group.

15Disclosure of information

14Z21 Permitted disclosures of information

(1) A clinical commissioning group may disclose information obtained by
it in the exercise of its functions if—

(a) the information has previously been lawfully disclosed to the
20public,

(b) the disclosure is made under or pursuant to regulations under
section 113 or 114 of the Health and Social Care (Community
Health and Standards) Act 2003 (complaints about health care
or social services),

(c) 25the disclosure is made in accordance with any enactment or
court order,

(d) the disclosure is necessary or expedient for the purposes of
protecting the welfare of any individual,

(e) the disclosure is made to any person in circumstances where it
30is necessary or expedient for the person to have the information
for the purpose of exercising functions of that person under any
enactment,

(f) the disclosure is made for the purpose of facilitating the exercise
of any of the clinical commissioning group’s functions,

(g) 35the disclosure is made in connection with the investigation of a
criminal offence (whether or not in the United Kingdom), or

(h) the disclosure is made for the purpose of criminal proceedings
(whether or not in the United Kingdom).

(2) This section has effect notwithstanding any rule of common law which
40would otherwise prohibit or restrict the disclosure.

Interpretation

14Z22 Interpretation

(1) In this Chapter—

Health and Social Care BillPage 49

• “financial year”, in relation to a clinical commissioning group,
  includes the period which begins on the day the group is
  established and ends on the following 31 March;

• “the health service” means the health service in England;

• 5“health services” means services provided as part of the health
  service and, in section 14Z, also includes services that are to be
  provided as part of the health service;

• “relevant Health and Wellbeing Board”, in relation to a clinical
  commissioning group, has the meaning given by section
  1014Z9(9).

(2) Any reference (however expressed) in the following provisions of this
Act to the functions of a clinical commissioning group includes a
reference to the functions of the Secretary of State that are exercisable
by the group by virtue of arrangements under section 7A—

• 15section 6E(7) and (10)(b),

• section 14C(2)(e),

• section 14O,

• section 14P,

• section 14S,

• 20section 14T(1),

• section 14U,

• section 14V(1),

• section 14W,

• section 14X,

• 25section 14Y(1) and (2),

• section 14Z(1),

• section 14Z2(1),

• section 14Z3(2),

• section 14Z4(1),

• 30section 14Z5(7),

• section 14Z9(1),

• section 14Z13(1),

• section 14Z14(2),

• sections 14Z15(1), 14Z17(1) and 14Z19(1) and (3),

• 35section 14Z21(1),

• section 72(1),

• section 75(1)(a) and (2),

• section 77(1)(b),

• section 82,

• 40section 89(1A)(d),

• section 94(3A)(d),

• section 223C(2)(b),

• section 223H(1),

• in Schedule 1A, paragraphs 3(1) and (3), 5, 11(9)(b) and 15(3).

(3) 45Any reference (however expressed) in the following provisions of other
Acts to the functions of a clinical commissioning group includes a
reference to the functions of the Secretary of State that are exercisable
by the group by virtue of arrangements under section 7A—

Health and Social Care BillPage 50

• sections 116 to 116B of the Local Government and Public
  Involvement in Health Act 2007 (joint strategic needs
  assessments etc.),

• section 198(4) of the Health and Social Care Act 2012 (supply of
  5information to Health and Wellbeing Boards),

• section 287(2)(d) of that Act (breaches of duties to co-operate),

• in Schedule 6 to that Act, paragraph 8(4).

(4) The Secretary of State may by order amend the list of provisions
specified in subsection (2) or (3).”

26 10Financial arrangements for clinical commissioning groups

After section 223F of the National Health Service Act 2006 insert—

“Clinical commissioning groups

223<no value\>G Means of meeting expenditure of clinical commissioning groups out
of public funds

(1) 15The Board must pay in respect of each financial year to each clinical
commissioning group sums not exceeding the amount allotted for that
year by the Board to the group towards meeting the expenditure of the
group which is attributable to the performance by it of its functions in
that year.

(2) 20In determining the amount to be allotted to a clinical commissioning
group for any year, the Board may take into account—

(a) the expenditure of the clinical commissioning group during any
previous financial year, and

(b) the amount that it proposes to hold, during the year to which
25the allotment relates, in any contingency fund established
under section 223F.

(3) An amount is allotted to a clinical commissioning group for a year
under this section when the group is notified in writing by the Board
that the amount is allotted to it for that year.

(4) 30The Board may make a new allotment under this section increasing or
reducing an allotment previously so made.

(5) Where the Board allots an amount to a clinical commissioning group or
makes a new allotment under subsection (4), it must notify the
Secretary of State.

(6) 35The Board may give directions to a clinical commissioning group with
respect to—

(a) the application of sums paid to it by virtue of a new allotment
increasing an allotment previously so made, and

(b) the payment of sums by it to the Board in respect of charges or
40other sums referable to the valuation or disposal of assets.

(a)(a)the application of sums paid to it by virtue of a new allotment
increasing an allotment previously so made, and

(b) the payment of sums by it to the Board in respect of charges or
other sums referable to the valuation or disposal of assets.

(7) 45Sums falling to be paid to clinical commissioning groups under this
section are payable subject to such conditions as to records, certificates
or otherwise as the Board may determine.

(8) In this section and sections 223H to 223K “financial year” includes the
period which begins on the day the clinical commissioning group is
established and ends on the following 31 March.

223<no value\>H Financial duties of clinical commissioning groups: expenditure

(1) 5Each clinical commissioning group must, in respect of each financial
year, perform its functions so as to ensure that its expenditure which is
attributable to the performance by it of its functions in that year does
not exceed the aggregate of—

(a) the amount allotted to it for that year under section 223G,

(b) 10any sums received by it in that year under any provision of this
Act (other than sums received by it under section 223G), and

(c) any sums received by it in that year otherwise than under this
Act for the purpose of enabling it to defray such expenditure.

(2) The Board may by directions determine—

(a) 15whether specified sums must, or must not, be treated for the
purposes of this section as received by a specified clinical
commissioning group,

(b) whether specified expenditure must, or must not, be treated for
those purposes as expenditure within subsection (1) of a
20specified clinical commissioning group, or

(c) the extent to which, and the circumstances in which, sums
received by a clinical commissioning group under section 223G
but not yet spent must be treated for the purposes of this section
as part of the expenditure of the group, and to which financial
25year’s expenditure they must be attributed.

(b)(b)whether specified expenditure must, or must not, be treated for
those purposes as expenditure within subsection (1) of a
specified clinical commissioning group, or

(c) the extent to which, and the circumstances in which, sums
30received by a clinical commissioning group under section 223G
but not yet spent must be treated for the purposes of this section
as part of the expenditure of the group, and to which financial
year’s expenditure they must be attributed.

(3) The Secretary of State may by directions require a clinical
35commissioning group to use specified banking facilities for any
specified purposes.

(4) In this section, “specified” means specified in the directions.

223<no value\>I Financial duties of clinical commissioning groups: use of resources

(1) For the purposes of this section and section 223J—

(a) 40a clinical commissioning group’s capital resource use, in
relation to a financial year, means the group’s use of capital
resources in that year, and

(b) a clinical commissioning group’s revenue resource use, in
relation to a financial year, means the group’s use of revenue
45resources in that year.

(2) A clinical commissioning group must ensure that its capital resource
use in a financial year does not exceed the amount specified by
direction of the Board.

(3) A clinical commissioning group must ensure that its revenue resource
50use in a financial year does not exceed the amount specified by
direction of the Board.

(4) Any directions given in relation to a financial year under subsection (6)
of section 223D apply (in relation to that year) for the purposes of this
section as they apply for the purposes of that section.

(5) The Board may by directions make provision for determining to which
clinical commissioning group a use of capital resources or revenue
resources is to be attributed for the purposes of this section or section
223J.

(6) 5Where the Board gives a direction under subsection (2) or (3), it must
notify the Secretary of State.

223<no value\>J Financial duties of clinical commissioning groups: additional controls
on resource use

(1) The Board may direct a clinical commissioning group to ensure that its
10capital resource use in a financial year which is attributable to matters
specified in the direction does not exceed an amount so specified.

(2) The Board may direct a clinical commissioning group to ensure that its
revenue resource use in a financial year which is attributable to matters
specified in the direction does not exceed an amount so specified.

(3) 15The Board may direct a clinical commissioning group to ensure that its
revenue resource use in a financial year which is attributable to
prescribed matters relating to administration does not exceed an
amount specified in the direction.

(4) The Board may give directions, in relation to a financial year, specifying
20uses of capital resources or revenue resources which must, or must not,
be taken into account for the purposes of subsection (1) or (as the case
may be) subsection (2) or (3).

(5) The Board may not exercise the power conferred by subsection (1) or (2)
in relation to particular matters unless the Secretary of State has given
25a direction in relation to those matters under subsection (1) of section
223E or (as the case may be) subsection (2) of that section.

(6) The Board may not exercise the power conferred by subsection (3) in
relation to prescribed matters relating to administration unless the
Secretary of State has given a direction in relation to those matters
30under subsection (3)(a) of section 223E.

223<no value\>K Payments in respect of quality

(1) The Board may, after the end of a financial year, make a payment to a
clinical commissioning group.

(2) For the purpose of determining whether to make a payment under
35subsection (1) and (if so) the amount of the payment, the Board must
take into account at least one of the following factors—

(a) the quality of relevant services provided during the financial
year;

(b) any improvement in the quality of relevant services provided
40during that year (in comparison to the quality of relevant
services provided during previous financial years);

(c) the outcomes identified during the financial year as having
been achieved from the provision at any time of relevant
services;

(d) 45any improvement in the outcomes identified during that
financial year as having been so achieved (in comparison to the

outcomes identified during previous financial years as having
been so achieved).

(3) For that purpose, the Board may also take into account either or both of
the following factors—

(a) 5relevant inequalities identified during that year;

(b) any reduction in relevant inequalities identified during that
year (in comparison to relevant inequalities identified during
previous financial years).

(4) Regulations may make provision as to the principles or other matters
10that the Board must or may take into account in assessing any factor
mentioned in subsection (2) or (3).

(5) Regulations may provide that, in prescribed circumstances, the Board
may, if it considers it appropriate to do so—

(a) not make a payment that would otherwise be made to a clinical
15commissioning group under subsection (1), or

(b) reduce the amount of such a payment.

(6) Regulations may make provision as to how payments under subsection
(1) may be spent (which may include provision as to circumstances in
which the whole or part of any such payments may be distributed to
20members of the clinical commissioning group).

(7) A clinical commissioning group must publish an explanation of how
the group has spent any payment made to it under subsection (1).

(8) In this section—

• “relevant services” means services provided in pursuance of
  25arrangements made by the clinical commissioning group—

  (a)

  under section 3 or 3A or Schedule 1, or

  (b)

  by virtue of section 7A;

• “relevant inequalities” means inequalities between the persons for
  whose benefit relevant services are at any time provided with
  30respect to—

  (a)

  their ability to access the services, or

  (b)

  the outcomes achieved for them by their provision.”

27 Requirement for primary medical services provider to belong to clinical
commissioning group

(1) 35In section 89 of the National Health Service Act 2006 (general medical services
contracts: required terms), after subsection (1) insert—

“(1A) Regulations under subsection (1) may, in particular, make provision—

(a) for requiring a contractor who provides services of a prescribed
description (a “relevant contractor”) to be a member of a clinical
40commissioning group;

(b) as to arrangements for securing that a relevant contractor
appoints one individual to act on its behalf in the dealings
between it and the clinical commissioning group to which it
belongs;

(c) 45for imposing requirements with respect to those dealings on the
individual appointed for the purposes of paragraph (b);

(d) for requiring a relevant contractor, in doing anything pursuant
to the contract, to act with a view to enabling the clinical
commissioning group to which it belongs to discharge its
functions (including its obligation to act in accordance with its
5constitution).

(1B) Provision by virtue of subsection (1A)(a) may, in particular, describe
services by reference to the manner or circumstances in which they are
performed.

(1C) In the case of a contract entered into by two or more individuals
10practising in partnership—

(a) regulations making provision under subsection (1A)(a) may
make provision for requiring each partner to secure that the
partnership is a member of the clinical commissioning group;

(b) regulations making provision under subsection (1A)(b) may
15make provision as to arrangements for securing that the
partners make the appointment;

(c) regulations making provision under subsection (1A)(d) may
make provision for requiring each partner to act as mentioned
there.

(1D) 20Regulations making provision under subsection (1A) for the case of a
contract entered into by two or more individuals practising in
partnership may make provision as to the effect of a change in the
membership of the partnership.

(1E) The regulations may require an individual appointed for the purposes
25of subsection (1A)(b)—

(a) to be a member of a profession regulated by a body mentioned
in section 25(3) of the National Health Service Reform and
Health Care Professions Act 2002, and

(b) to meet such other conditions as may be prescribed.”

(2) 30In section 94 of that Act (regulations about arrangements under section 92 of
that Act for provision of primary medical services), after subsection (3) insert—

“(3A) Regulations under subsection (3)(d) may—

(a) require a person who provides services of a prescribed
description in accordance with section 92 arrangements (a
35“relevant provider”) to be a member of a clinical commissioning
group;

(b) make provision as to arrangements for securing that a relevant
provider appoints one individual to act on its behalf in dealings
between it and the clinical commissioning group to which it
40belongs;

(c) impose requirements with respect to those dealings on the
individual appointed for the purposes of paragraph (b);

(d) require a relevant provider, in doing anything pursuant to
section 92 arrangements, to act with a view to enabling the
45clinical commissioning group to which it belongs to discharge
its functions (including its obligation to act in accordance with
its constitution).

(3B) Provision by virtue of subsection (3A)(a) may, in particular, describe
services by reference to the manner or circumstances in which they are
performed.

(3C) In the case of an agreement made with two or more persons—

(a) 5regulations making provision under subsection (3A)(a) may
require each person to secure that the persons collectively are a
member of the clinical commissioning group;

(b) regulations making provision under subsection (3A)(b) may
make provision as to arrangements for securing that the
10persons collectively make the appointment;

(c) regulations making provision under subsection (3A)(d) may
require each person to act as mentioned there.

(3D) Regulations making provision under subsection (3A) for the case of an
agreement made with two or more persons may make provision as to
15the effect of a change in the composition of the group of persons
involved.

(3E) The regulations may require an individual appointed for the purposes
of subsection (3A)(b)—

(a) to be a member of a profession regulated by a body mentioned
20in section 25(3) of the National Health Service Reform and
Health Care Professions Act 2002, and

(b) to meet such other conditions as may be prescribed.”

Further provision about local authorities’ role in the health service

28 Other health service functions of local authorities under the 2006 Act

(1) 25The National Health Service Act 2006 (c. 41)National Health Service Act 2006 (c. 41) is amended as follows.

(2) In section 111 (dental public health)—

(a) in subsection (1) for “A Primary Care Trust” substitute “A local
authority”,

(b) in subsection (2)—

(i) 30for “Primary Care Trust” (in each place where it occurs)
substitute “local authority”, and

(ii) in paragraph (b) for “other Primary Care Trusts” substitute
“other local authorities”, and

(c) after subsection (2) insert—

“(3) 35In this section, “local authority” has the same meaning as in
section 2B.”

(3) In section 249 (joint working with the prison service) after subsection (4)
insert—

“(4A) For the purposes of this section, each local authority (within the
40meaning of section 2B) is to be treated as an NHS body.”

29 Appointment of directors of public health

In Part 3 of the National Health Service Act 2006 (local authorities and the

NHS) before section 74 insert—

“73A Appointment of directors of public health

(1) Each local authority must, acting jointly with the Secretary of State,
appoint an individual to have responsibility for —

(a) 5the exercise by the authority of its functions under section 2B,
111 or 249 or Schedule 1,

(b) the exercise by the authority of its functions by virtue of section
6C,

(c) anything done by the authority in pursuance of arrangements
10under section 7A,

(d) the exercise by the authority of any of its functions that relate to
planning for, or responding to, emergencies involving a risk to
public health,

(e) the functions of the authority under section 325 of the Criminal
15Justice Act 2003, and

(f) such other functions relating to public health as may be
prescribed.

(2) The individual so appointed is to be an officer of the local authority and
is to be known as its director of public health.

(3) 20Subsection (4) applies if the Secretary of State—

(a) considers that the director has failed or might have failed to
discharge (or to discharge properly) the responsibilities of the
director under—

(i) subsection (1)(b), or

(ii) 25subsection (1)(c) where the arrangements relate to the
Secretary of State’s functions under section 2A, and

(b) has consulted the local authority.

(4) The Secretary of State may direct the local authority to—

(a) review how the director has discharged the responsibilities
30mentioned in subsection (3)(a);

(b) investigate whether the director has failed to discharge (or to
discharge properly) those responsibilities;

(c) consider taking any steps specified in the direction;