Hi All

The aim of this blog is to be a resource for  38 degrees and KONP groups taking action on the constitutions of CCGs.

Other suggested areas for information and action-

lay membership of CCGs/ PPGs(patient participation groups)/ Health & Wellbeing Boards/ Foundation Trusts/ attending local Health Scrutiny Committees.

Choose & book, Personal Health Budgets, take over of surgeries by private companies, outsourcing by PCTs and CCGs,  social enterprises, transfer of staff out of the NHS.

All the Best,

Coral Jones

City & Hackney GP, member of KONP


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section 75 regulations threat to fabric of NHS


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Patient view of privatisation threat to CCGs


Ms Heather Mullin
North East London PCT
Dear Ms Mullin,
I am a resident of Hackney and am registered with a GP based at the Lawson Practice.
I attended a Health Scrutiny Committee on 6th February where was discussed your PCT’s last-minute decision to hand OOH care back to Harmoni rather than grant our GPs the running of their own thoroughly-developed, not-for-profit OOH service. As a Hackney resident, I had been delighted by our GPs plan to offer genuine continuity of care and I had considered myself fortunate to have such committed GPs.
Like most of the attendees of the Scrutiny meeting, I was deeply disappointed that this decision of the PCT’s had been reached, and also shocked at the timing of that decision fully two years after a lot of hard work from the GPs, and in the face of increasingly alarming and hard-to-ignore media reports on how Harmoni/Care UK and its owner, Bridgepoint Capital, conducts its work and arranges its tax affairs.
Harmoni/Care UK/Bridgepoint Capital is precisely the kind of “vulture fund”, profit-driven company that we residents of Hackney have very firmly decided that we do not want running our local health provision. At a public meeting of Hackney residents a few months ago, over two hundred people unanimously voted to request our CCG not to outsource any health services to companies such as these.
The HSCA supposedly was designed to ensure the prioritising of patient choice and GP-led commissioning. If these two key precepts are to be instantly put aside for fear of upsetting predatory investment companies, one has to conclude that the Act has become unfit for its original purpose. And if the patients are to be denied their choice and GPs are to be denied their autonomy, one must ask the question: exactly who is benefiting from the Health and Social Care Act?
I shall look into the legal ramifications of your decision from my point of view: I have no other option if I am to prevent the destruction of my local and national health service.
Yours sincerely,
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City & Hackney outrage- PCT continues with Harmoni OOH service despite support for GP led OOH service from local patients, GPs, CCG.

See letter below written by a patient attending the Hackney Health Scrutiny Commission meeting on 6th February, which sums up the betrayal of local people by the PCT.

At this meeting a representative of the NHS NELC board (amalgamation of 7 east London PCTs) explained why they had reversed their earlier decision, made in September 2012, to appoint a local GP-led social enterprise to take over OOH when the Harmoni contract expires 2/4/2013.

Dear Sir

I was one of around 60 Hackney patients who attended Hackney Council’s Health Scrutiny Committee last week because we were concerned at the decision by the Primary Care Trust to continue the contract with the private company Harmoni for Out of Hours Services. Like the members of the committee, and all the Hackney GPs who have been working hard on plans to take over the service in the interest of patients, we were horrified that a private company with a poor record of patient care was to be allowed to continue to run this crucial service.

As we heard representatives of the PCT attempt to defend their decision, it felt more and more that we were in an Alice in Wonderland world in which words no longer mean what we thought they meant.

The word ‘risk’ was used continually, but it soon became apparent that this meant risk of a legal challenge rather than the risk to patient care which should be the overriding criterion for such a decision.

Another word which appears to have changed its meaning was ‘continuity’ but as a former Hackney GP pointed out at the meeting, in the PCT’s world, this meant continuity of provider, not the continuity of care by doctors, which is denied by this decision. Continuity of care – with GPs providing the Out of Hours service – is fundamental to good patient care.

Finally, the PCT spokespeople claimed that there had been ‘consultation’ on their decision, but when pressed, it turned out that this ‘consultation’ had consisted of a private meeting, with just four invited participants, the outcome of which was confidential. Real consultation would be open, public and wide-ranging and allow all with a stake in Hackney’s health services to be able to make their views known.

This decision shows the way in which the Tory-led government has changed the agenda of the NHS. While promising us that changes would be on the principle of Putting Patients First, it is markets which have become the over-riding factor in decision-making and private companies which are benefitting.





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Guildford and Waverley support group- suggested modifications to CCG constitution


Constitution of Guildford and Waverley CCG

Suggested modifications


(From the G&W Support Group, 10th December 2012)



A) Whistle blowing

Almost all the problems which have arisen in public procurement and privatisation of services have been facilitated by the absence of robust provisions to protect whistleblowers.

Best International Practices for Organizations

All organizations, whether public, private, or non-profit (including governmental) should, as a best practice, adopt a robust whistleblower system to induce its employees to internally report illegal or excessively risky activity directly to its board of directors or trustees. Without a robust whistleblower system, directors/trustees of the organization may fail in their oversight responsibilities. A robust whistleblower system encourages internal reporting of misconduct so as to permit it to be corrected. It is particularly important in countries which provide significant financial rewards to whistleblowers who externally report illegal behaviour to government entities.

There have been numerous examples of boards of directors/trustees who have been uninformed as to problems in the organization, even though lower level employees knew about these problems. These boards were misled because they relied primarily on top management and the auditors for their information.

These should be built into the Constitution of the CGG and if at all possible be mandatory for all companies considered for the provision of goods and services to the CGG. This will help to ensure that costs will be lower in the long term.

There is a provision in Clause 9 The Group as Employer, subclause 9.10, which covers employees:

The Group will adopt a Code of Conduct for staff and will maintain and promote effective ‘whistle blowing’ procedures to ensure that concerned staff have means through which their concerns can be voiced.

However, there is no such provision regarding providers of services. It should be considered for instance in 4.2.2 as shown below.


B) Section 4 – Mission, Values and Aims

We suggest the following additions to Section 4.2 Values:

1. Add to existing list in 4.2.2:

Commissioning and procuring services

They shall be secured in a fair and ethical manner. We will only commission services from providers who can demonstrate a commitment to their social responsibilities and to sustainability principles, including effective ‘whistle blowing’ procedures.

Openness and transparency

These will be paramount in the group’s decision-making processes, and service planning, and coupled with the optimum involvement of local people and service users.

Equality and fairness

They will be taken into account in considering the healthcare needs of different groups in the CCG’s area.

2. Modify 4.4.1 in Accountability:

c) Holding meetings of our Governing Body in public on a monthly basis (except where we consider that it would not be in the public interest in relation to all or part of a meeting) that will be communicated well in advance of the meeting date not only through the CCG website and social media, but also via GP surgeries and the local press; [amplifies existing c)]

d) Production of an extensive website, detailing our role, ways of working, policies, performance information, tender, contract, procurement and service details as well as Board papers, consultations, decisions, local pathways, educational material and a Freedom of Information log and responses; [insert after c)]

3. Substitute for l) in 4.5.1 Accountability:

l) complying with the Freedom of Information Act 2000, disclosing on request all information that can lawfully be disclosed and flagging it for inclusion on the website’s Freedom of Information log; [substitute for old l)]

4. Add to 4.5 Accountability before existing 4.5.2:

4.5.2 The Group will also:

(a) disclose upon request all information that can lawfully be disclosed, rather than simply all such information that must be disclosed.

(b) publish all commissioning decisions and consultation exercises on its website.

(c) hold a number of events each year with local people and organisations to explain the progress and work of the CCG.

(d) publicize meetings of the CCG well in advance on the CCG’s website, the local press and in local libraries and GPs’ surgeries.

4.5.3 The Governing Body etc … (as in original G&W draft 4.5.2)


C) Section 5 – Functions and General Duties

Insert the following as preamble either at start of 5.2 or maybe at start of 5.2.7:

The CCG will endeavour to work with as wide as possible cross-section of the people who use or who may use the services provided, and the groups which may represent such people, to provide them with information about the services provided by the CCG in a variety of ways, tailored to the needs of the local community. The CCG will consult as widely as it can on planning and development of services, and take into account the views expressed when making decisions.

The CCG will take all steps that it can to ensure that engagement is adapted to meet the needs of various groups and service users. The CCG will monitor on a regular basis its compliance with this statement of principles.


D) Section 6 – Decision Making: the Governing Structure

Add to 6.4.1 Committees of the Group as a):

a) The Group shall have a committee called the Members’ Forum which shall comprise all of the Practice Representatives at any one time. If a resolution is passed by the Members’ Forum by a majority of at least 51% of all the Practice Representatives, the Governing Body is required to abide by the decision of the Forum. [insert as first committee]


E) Section 8 – Standards of Business Conduct and Managing Conflicts of Interest

Modify 8.4.1 under 8.4 Transparency in Procuring and Managing Services [clause 8.6.1 in the Model] with the passage shown underlined:


The Group recognises the importance in making decisions about the services it procures in a way that does not call into question the motives behind the procurement decision that has been made. The Group will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers. All contracts for services are to be made available for public scrutiny and will not include any clauses restricting this provision by claiming ‘commercial confidentiality’ in any shape or form.


F) Section 10 – Transparency, Ways of Working and Standing Orders

Modify 10.1.3 to read as follows:


The Group may use other means of communication, including circulating information by post.  In addition, information about the Group’s key communications can be inspected at its headquarters, and will be provided to local libraries and will be sent upon request by email to local organisations and individuals.


G) Schedule D – Prime Financial Policies [this was Schedule E in Model from NCB]

We suggest the following additions be considered insofar as they are not covered elsewhere:

The Group:

• will, consistently with its obligations under, inter alia, the Public Contracts Regulations 2006 and applicable Community law, ascertain whether it is necessary, desirable or appropriate to invite competition when purchasing in order to ensure it will incur only budgeted, approved and necessary spending

• will seek value for money for all goods and services by reference to the optimum combination of whole life cost and quality;

• shall ensure that, subject to the threshold provisions of the Public Contracts Regulations 2006, competitive tenders are invited for

• the supply of goods, materials and manufactured articles;

• the rendering of services including all forms of management consultancy services (other than specialised services sought from or provided by the Department of Health); and

• for the design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals

• will, in relation to each purchasing decision concerning health care and social services

• consider the extent to which the Public Contract Regulations 2006 require any form of competition and consider the most appropriate process and procedure for awarding the relevant contract or contracts; and

• in that regard give consideration to whether the use of a framework agreement, including the use of approved lists, is the most appropriate means of appointing providers;

• shall, wherever possible and where it is consistent with legal requirements, ensure that contractual provisions, procurement procedures and selection and award criteria are designed to ensure that contractors and providers are:

• good employers who comply with all relevant employment legislation, including the Public Interest Disclosure Act 1998;

• maintain acceptable standards of health and safety and comply fully with all legal obligations;

• meet all tax and National Insurance obligations;

• meet all equal opportunities legislation;

• are reputable in their standards of business conduct;

• respect the environment and take appropriate steps to ensure that they minimise their environmental impact.

• will, in each procurement and consistently with the relevant law, exclude companies which have been convicted of offences, or whose director(s) or any other person or company who has powers of representation, decision or control of the company has or have been convicted of offences in the conduct of their business or committed an act of grave professional misconduct in the conduct of their business, such as breaches of employment, equal opportunities or environmental legislation. However, any corrective/remedial action taken by the company in response to such an offence should also be taken into account in determining its suitability as a bidder.

• will, in each procurement and consistently with relevant EU and international law, ensure that contractual provisions, procurement procedures and selection and award criteria prohibit or restrict contractors’ use of offshore jurisdictions and/or improper tax avoidance schemes or arrangements and/or exclude companies which use such jurisdictions and/or such schemes or arrangements.

The Guildford and Waverley CCG may only negotiate contracts on behalf of the group, and the group may only enter into contracts, within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with:

(a) the group’s standing orders;

(b) the Public Contracts Regulation 2006, any successor legislation and any other applicable law; and

(c) take into account as appropriate any applicable NHS Commissioning Board or the Independent Regulator of NHS Foundation Trusts (Monitor) guidance that does not conflict with (b) above.

In all contracts entered into, the group shall endeavour to obtain best value for money. The accountable officer shall nominate an individual who shall oversee and manage each contract on behalf of the group.



G) Schedule N – Standing Orders [this was Schedule C in Model from NCB]

Modify 3.2.7 to be in line with the broader recommendations in the Model.

[The Model Constitution suggests in 3.2.2:

For transparency clinical commissioning groups will need to publish these details for the group’s governing body whose meetings must be open to the public, except where the group considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. Groups may choose to publish the agenda and certain papers of other meetings that will be held in public. See also the requirements in relation to transparency in regulation 16 of the National Health Service (Clinical Commissioning Groups) Regulations 2012 (see section 6.8 above).

Groups may wish to consider other ways of making key documentation available to patients and the public (especially those who don’t have access to the internet), which could be outlined in this constitution. Examples include:

 confirming you will make this document available upon request for inspection at your headquarters or local health premises

 confirming that the document is available upon application, either by

o post – in which case you will need to include the postal address of your headquarters

o email – you’ll need to provide an email address

 making arrangements with your local authority(ies) for copies to be made available via local libraries ]


In particular, these papers must be published on the web site – “or made available upon request for inspection at the CCG offices: [address]” is not good enough.


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Update on Guildford and Waverley CCG- response to 38 degrees petition

Hello 38D

This is to update you on what’s been happening here.

1. For background, about 800 had signed the 38D petition here by end November, ca 35 came to a meeting 0n 18 November (and have been kept informed since), and 4 of us actively worked on this afterwards. None of us are health professionals. It is very different from Hackney‘s development over a much longer period.

2. After much delay, we had a meeting with the Chair, Dr Eyre-Brook, GP Board member Dr Barnardo  and the Chief Officer Phil Orwin of the G&W CCG last night as described below. On our side the 4 of us were there plus two other supporters.

(As requested, here are some photos of the handover of the petition by James Winterbotham, coordinator for us. Chair and the two others are on the left. Higher resolution available)

The chances of any of the modifications we have proposed (attached) being introduced are very slim in my view because of procedural reasons: we started late and it took a long time to set up this meeting. The CCG would need to go through several approval loops before the end of March.

3. The Modifs proposed were based first on 38D suggestions then on perusal of draft constitutions from other CCgs eg Hackney at al). I think a key one is that relating to ‘commercial confidentiality‘. We do not have a feeling as to whether it is legally possible to impose this or not. Advice welcome.

4. We are now considering possible follow-up via a meeting of the group of 30 or so when we have some feedback, probably in early March.

Here is a rough draft agenda under consideration  for that meeting:

1. Report on past
* problems on the way
* CCG meeting
* any feedback obtained

2. Outline of possible follow-ups as a pressure group
Via PPGs?
Continue as a pressure group monitoring CCG contracts?
Combine with nearby similar groups and broaden agenda to monitoring also contracts with private companies relating to NHS activities beyond CCGs (which cover GP practices only)  eg hospitals etc?

3. Potential problems
Anything other than individual pursuit via PPGs will require at least 6 new volunteers to become involved  very actively – not all of us will continue probably.
New coordinator among them too

4. What do you think?

5. Next steps if any


1. Any comment on the future?
2. Anybody from 38D interested perhaps in coming to such a meeting to talk about what is going on elsewhere??

George Roussopoulos

——– Original Message ——–

Subject: Meeting conclusions
Date: Tue, 22 Jan 2013 19:33:47 +0000
From: James Winterbotham <jc.winterbotham@ntlworld.com>
To: undisclosed-recipients:;
I am pleased to announce that the meeting has at last gone ahead. We presented the petition to Dr David Eyre-Brook, at which point George took some pictures, and we discussed our concerns regarding the constitution with them. On the whole they were co-operative and told us that they were willing to study the petition and consult George’s notes. If they did change the constitution it seems that these changes would now have to be made via the National Commissioning Board as the application has already been sent off. The deadline for changes is the end of march. The CCG management were unable to tell us when they would be able to get back to us, so it may be a few weeks before we hear anything more.
Afterwards we discussed the possibility of another meeting with the entire group, to discuss the meeting and evaluate what we want to do next. There may be other actions possible and practical within the broad domain of safeguarding the NHS, so we need to have a discussion about the future of this group. I will be unable to have a major involvement after the end of June, as I will be travelling and preparing for university. It’s an option for the group to continue, but after that somebody would need to replace me as co-ordinator.
Please let me know if you have any thoughts on this matter, questions regarding the meeting or suggestions for a time and place to meet up.
James Winterbotham


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NHS Support Federation- The year of cataclysm for the NHS




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Cuts to services by GP practices and consequences of privatisation of practices. Reported by the Guardian



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