ANNUAL REPORT AND ACCOUNTS 2016-17

Website: www.enfieldccg.nhs.uk

Twitter: @EnfieldCCG

Contents PERFORMANCE REPORT ................................................................................................................ 3

Performance Overview .................................................................................................................... 3

Performance Measures ................................................................................................................. 11

Financial Performance ............................................................................................................... 11

Better Care Fund ........................................................................................................................ 11

Performance Analysis .................................................................................................................... 12

Improving quality ........................................................................................................................ 14

Patient and Public Involvement ................................................................................................ 17

Reducing health inequality ........................................................................................................ 19

Working with Local Partners ..................................................................................................... 21

Sustainable Development ......................................................................................................... 24

ACCOUNTABILITY REPORT .......................................................................................................... 26

Corporate Governance Report ......................................................................................................... 26

Members Report ............................................................................................................................. 26

Member practices ....................................................................................................................... 26

Composition of Governing Body .............................................................................................. 26

Statement of Accountable Officer’s Responsibilities .................................................................... 27

Governance Statement ..................................................................................................................... 30

Introduction and context ................................................................................................................ 30

Scope of responsibility ................................................................................................................... 31

Governance arrangements and effectiveness ........................................................................... 32

UK Corporate Governance Code ................................................................................................. 38

Discharge of Statutory Functions ................................................................................................. 38

Risk management arrangements and effectiveness ................................................................ 39

Capacity to Handle Risk ................................................................................................................ 41

Risk Assessment ............................................................................................................................ 43

Other sources of assurance ......................................................................................................... 45

Internal Control Framework ...................................................................................................... 45

Annual audit of conflicts of interest management ................................................................. 46

Data Quality ................................................................................................................................. 47

Information Governance ............................................................................................................ 47

Control Issues ............................................................................................................................. 49

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Review of economy, efficiency & effectiveness of the use of resources ........................... 49

Delegation of functions .............................................................................................................. 50

Counter fraud arrangements .................................................................................................... 50

Head of Internal Audit Opinion ................................................................................................. 51

Review of the effectiveness of governance, risk management and internal control ........ 52

Conclusion ................................................................................................................................... 53

Remuneration and Staff Report ....................................................................................................... 54

Remuneration Report ................................................................................................................ 54

Remuneration & Nominations Committee .............................................................................. 54

Remuneration of Very Senior Managers ................................................................................ 56

Policy on Senior Managers Contracts ..................................................................................... 56

Senior Managers Service Contracts ........................................................................................ 56

Senior manager remuneration (including salary and pension entitlements) ..................... 59

Cash Equivalent Transfer Values (CETVs) ............................................................................ 62

Real increase in Cash Equivalent Transfer Value................................................................. 62

Compensation on early retirement of for loss of office ......................................................... 62

Payments to past members ...................................................................................................... 62

Pay multiples ............................................................................................................................... 63

Expenditure on consultancy ..................................................................................................... 63

Exit packages, including special (non-contractual) payments ............................................. 65

The total number of NHS Clinical Commissioning Group losses and special payments cases, and their total value, was as follows: .............................................................................. 67

Employee benefits .......................................................................................................................... 68

Staff Report ..................................................................................................................................... 70

Parliamentary Accountability and Audit Report ............................................................................. 72

ANNUAL ACCOUNTS ....................................................................................................................... 78

Financial position in 2016/17 ........................................................................................................ 78

2016/17 Expenditure ...................................................................................................................... 78

What we spent in 2016/17 ............................................................................................................ 79

What we plan to spend in 2017/18 .............................................................................................. 80

Planned Expenditure for 2017/18 ................................................................................................ 81

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Annual Accounts for 2016/17 ....................................................................................................... 83

PERFORMANCE REPORT Performance Overview Overview from the Chief Officer Welcome to NHS Enfield CCG’s Annual Report and Accounts for 2016/2017. This overview will provide a summary of the CCG’s purpose, activities, key risks to the achievement of its objectives and how it has performed over the period April 2016 to March 2017.

Clinical Commissioning Groups (CCGs) were created by the Health and Social Care Act 2012.This is Enfield CCG’s third year as an organisation. As more than 90% of patients’ contact with the NHS is with their GP, CCGs were created to enable GPs to buy most of the services that their patients are referred to such as hospital, mental health and community services. Our role as a CCG is to plan, buy (commission) and continuously improve the quality of these services for local people. Our vision since we became an organisation in 2013 has been to work with residents and stakeholders to continually improve the health and well-being of our population and reduce health inequalities.

CCGs are membership organisations made up of local GP practices. In Enfield we have 48 practices. They have signed our Constitution which describes the governance of our organisation and how we work together to plan, buy and monitor health services. The member practices are grouped into four localities: North East, South East, North West and South West. GP practices in each locality meet regularly and work closely together to improve the health of their local populations.

The majority of members of our Governing Body are local doctors. We have eight elected GPs representing our four localities. During this year we have had some important changes to the membership of our Governing Body. A full list of our Governing Body members can be found on our website.

How we buy NHS services The NHS is funded through taxation. This provides a budget to buy health services for the population. Enfield CCG is responsible for assessing the needs of people living in the London Borough of Enfield and deciding which hospital, community and mental health services to purchase for our population. NHS England is responsible for buying services outside the remit of CCGs, namely primary care, public health, offender health, military and veteran health and other specialised services such as transplants and dialysis.

This year, we have held co-commissioning responsibilities for primary care medical services with NHS England. This involves joint decision making with the four other CCGs in North Central London (Barnet, Camden, Haringey and Islington) and NHS England. A joint committee meets in public with the aims of:

• improving access to primary care• improving health outcomes, reducing inequalities; and• a better patient experience

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You can find more details about this committee including its membership and minutes of the meetings here.

Our challenges The challenge faced by organisations across the NHS and, in particular, Enfield CCG as it was placed under Legal Directions by NHSE on 10 August 2015 and subsequently placed in special measures under the newly introduced Improvement and Assessment framework (see page 31), is how to spend the allocated budgets in a way that benefits the health of the whole population, whilst ensuring that services meet the needs of individuals and deliver value for money. Last year we invested £400 million buying health services for people living in Enfield.

Enfield CCG is a financially challenged CCG. With a growing population, rising demand for services and a financial deficit, we have to evaluate every service we commission. At the end of the financial year 2016/2017 we reported a cumulative deficit of £37.2m. Further details are on page 74.

Our local hospital, North Middlesex University Hospital NHS Trust (NMUH), is currently subject to an improvement plan following a Care Quality Commission (CQC) inspection. Enfield CCG, along with Haringey CCG as lead commissioner, is working with the Trust to support the improvements required. Escalation and assurance meetings on Accident and Emergency (A&E) performance, including monthly regional meetings, continue to take place. Haringey CCG, Enfield CCG and North Middlesex University Hospital have submitted a revised A&E performance trajectory in line with the national requirement for recovery along with an associated action plan. Enfield CCG continues to host a separate weekly resilience meeting to discuss and resolve local issues (see page 13, our Integrated Performance and Quality Report and our Quality and Safety Exception Report).

London Ambulance Service (LAS) Trust performance for Enfield is particularly challenged and we are working with the Trust to support the improvements required following the CQC inspection. LAS is working with Enfield CCG to develop a plan to assist in improving service delivery and performance within the CCG area and moving performance to a more equitable position with respect to other boroughs in North Central London. A combined plan for Enfield and Haringey CCGs is being developed. LAS is also exploring the possibility of ring-fencing fast response vehicles within CCG areas, and in the longer term, ‘geo-tethering’ ambulances to only take calls within Sustainability and Transformation Plan boundaries (see page 13, our Integrated Performance and Quality Report and our Quality and Safety Exception Report).

We are the lead commissioner for Barnet, Enfield and Haringey Mental Health Trust. We are working with the Trust on a number of issues including a Cost Improvement Plan following the CQC inspection. Barnet, Enfield and Haringey CCGs have agreed investment and changes for Psychiatric Intensive Care Unit (PICU) services subject to an improvement plan for reduced length of stay. Commissioners are considering the proposals for their respective Child and Adolescent Mental Health Services (CAMHS) in the light of capacity and demand models and national funding bids (see

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our Integrated Performance and Quality Report and our Quality and Safety Exception Report).

Our achievements for 2016/17:

• We commissioned three primary care access hubs that offer patients moreGP and nurse appointments on weekday evenings, weekend and publicholidays.

• 4 new nurses working in our GP practices completed their general practicenurse training, with a further 10 nurses starting their training this year and withanother 12 nurses planned for next year.

• We increased the number of GP practice staff trained to support victims ofdomestic violence and for the first time expanded the training to pharmacists,dentists and optometrists to support victims of domestic violence and theirfamilies who may be at risk.

• We commissioned GP practices to identify patients with Atrial Fibrillation1 toenable more people to be treated to prevent strokes

• We commissioned GP practices to identify patients with pre-diabetes toprevent people developing diabetes

• We commissioned an Integrated Urgent Care service on behalf of all of thenorth central London CCGs (Barnet, Camden, Enfield, Haringey and Islington)which commenced on 4 October 2016. This service provides 111 and out ofhours GP services

• Enfield CCG, as lead commissioner of Barnet, Enfield and Haringey MentalHealth Trust, continued to engage with local service users and commissionedEnfield Mental Health Users Group (EMU) which is an independent voice ofservice users to run an event on how we can improve local mental healthservices, particularly for patients with mental health crisis.

• We exceeded the requirement for 15% of the population with anxiety anddepression to access psychological therapies

• Our Continuing Healthcare team supported the delivery of one of the highestlevels of personal health budgets (PHBs) in London.

• We continue to exceed the national target for the number of people beingdiagnosed with dementia

• We commissioned an out of hours rapid response service to enable people tostay at home if they become ill overnight and at weekends

• We achieved an improved financial position against our planned deficit (seeannual accounts section)

• We achieved a challenging Quality, Innovation, Productivity and Prevention(QIPP) programme which significantly impacted on our improved financialposition (see page 66-68 and our Finance and Contracts Report)

Enfield CCG’s Transformation Programme Enfield CCG has a Transformation Programme that is focused on redesigning local services to improve their quality and value for money. We are investing in Integrated Care Services that co-ordinate care both for patients in hospital and those in care settings such as Nursing Homes. We are also focusing on improving the way in which we manage care for patients in the community and ensuring that we provide

1 Atrial Fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate.

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coordinated care for patients with Long Term Conditions such as Diabetes as well as developing new community based services to build on those we already have for people with Urological and Gynaecological issues.

Medicines Management In 2016/17 the Medicines Management Team has successfully worked with GP practices and localities to encourage cost effective prescribing enabling money to be available for newer therapies. Key areas of work have included reducing medicines waste through introducing a repeat prescribing policy, reducing prescribing of medicines which can be bought over the counter and which encourages and supports patients to self-care and reducing prescribing of gluten free foods which are readily available to purchase.

A campaign to improve Antibiotic Stewardship2 has helped to keep antibiotic use in Enfield lower than the national average. This means that when a patient needs an antibiotic for a life-threatening condition, the antibiotic is more likely to be effective. Audits have been carried out in GP practices to improve the treatment of diabetes and chronic obstructive pulmonary disease (COPD).

Enfield works with the North Central London Joint Formulary Committee to agree which new medicines should be used across Enfield and in hospital trusts in North Central London, this information can be found at: http://ncl-jfc.org.uk/index.html

Looking Forward to 2017/18 Enfield CCG recognises that it cannot deliver sustainable transformation of services for patients and deliver financial balance on its own. We will continue to work with our key stakeholders to develop and commission systems of care across providers to meet the changing needs of our populations. We will:

• be commissioning services that aim to support people with mental health issueswithin the primary care setting

• commission, in collaboration with London Borough of Enfield and voluntary andcommunity groups, a crisis café to enable our patients to have access to supportto help them better manage a crisis

• be commissioning a range of services from our federated GP practices includingsupport to care homes, management of patients with long term conditions andmanagement of patients urgent care needs without the need to attend hospital

• commission long term care from a new nursing home to ensure communitybased provision for our patients with severe dementia

• commission new models of care from all our providers working together for arange of elective areas including musculoskeletal services

2 Antibiotic Stewardship is a co-ordinated programme that promotes the appropriate use of antimicrobials ( including antibiotics), improves patient outcomes, reduces microbial resistance and decreases the spread of infections caused by multidrug-resistant organisms

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• continue to work with our other CCGs, local providers, local authorities and otherstakeholders in north central London to deliver the Sustainability andTransformation Plan

• be developing new services and increasing capacity within existing services forboth adults and children to enable more care to be provided out of hospital

• Ensure fewer of our patients need to be treated outside of Enfield. For bothadults and children with mental health needs, who do not need hospital or bedbased support and treatment, we will be investing more in supporting them in thecommunity

North Central London Sustainability and Transformation Plan Our ambition is that everyone in North Central London is able to get the care they need, when they need it. This means ensuring children have the best start in life, and supporting people to be healthy throughout their lives. When people do need specialist care, we want them to be able to access it quickly and in the most appropriate setting, and to be fully supported to recover in the setting most suited to their needs.

We face significant challenges around the health and wellbeing outcomes for our population, the quality of our services and the financial sustainability of the health and care system.

In North Central London, commissioners, provider and local providers have agreed to work together to agree and deliver the North Central London Sustainability and Transformation Plan.

The Clinical Commissioning Groups across North Central London approved a governance structure at November 2016 Governing Body meetings to enable the NHS providers, commissioners and local government organisations to work together in a new way to develop our Sustainability and Transformation Plan. We are now reviewing this governance structure to ensure that it is fit for purpose as the programme moves from planning to implementation. We have put in place dedicated resources to support the planning process in 2016/17 and we are currently reviewing the capacity we need to drive forward delivery from April 2017. It is crucial that the whole health and social care system is aligned and committed to the delivery of the Sustainability and Transformation Plan and we have ensured that two year health contracts are in place for 2017 - 2019 which are consistent with our plans.

The plan has 13 work-streams each led by a senior responsible officer. Each work-stream has been developing proposals for how they will meet the challenges ahead through introducing new models of care, use of technology and other new ways of working. This level of collaboration and co-operation has not been seen within the health and social care sector before. Our draft plan is available here

Healthy London Partnership – London CCGs working together to support the delivery of better health in London Enfield CCG, along with every other London CCG and NHS England (London), has made a commitment through Healthy London Partnership to unite the work of our

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partners to support the transformation of health and care in London. Our partners include the Greater London Authority, Public Health England, London councils and Health Education England. Through Healthy London Partnership we are working to deliver changes that are best done ‘once for London’. Collectively we believe it is possible to achieve a healthier, more liveable global city by 2020, by delivering on the ambitions set out in Better Health for London: Next Steps and the national NHS Five Year Forward View.

Some of the key achievements of Healthy London Partnership are included in the 2015/16 highlights report on our website here. This report was published in 2016/17 reflecting on the previous year’s achievements.

Highlights this year include:

• the development of the London-wide standards for people experiencingmental health crisis endorsed by all London mental health trusts, LondonAmbulance Service, London Councils and the Metropolitan Police

• a year-long engagement with Londoners on childhood obesity, called theGreat Weight Debate, which reached over half a million Londoners on socialmedia, saw 3,900 people fill in our survey, nearly 2,000 people attendroadshows during October half term and culminated in 60 teenagers workingthrough the issues at a Hackathon in January 2017 at City Hall

• London’s young people also helped us design and launch a mobile healthwebsite and app called NHS Go that gives them targeted health informationplus health advice and signposts to services (approx. 30,000 people are nowusing NHS Go. Watch their launch video.)

• Led on the collaboration that saw all 32 CCGs, all 33 borough councils, theMayor of London, NHS England and Public Health England sign the LondonHealth and Care Collaborative Agreement. Together with the LondonDevolution Agreement, this paves the way for central government andnational bodies to devolve powers and funding to the London system toenable local, sub-regional and London-wide transformation

• Support to the developing sustainability and transformation plans.Sustainability and transformation plans are sub-regional place-based plansacross commissioners, providers and local authorities within five definedfootprints in London. Plans will set out how London’s health and care systemwill improve over the next five years and achieve Better Health for London’s10 aspirations.

Read more about the work of Healthy London Partnership online at www.healthylondon.org

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Taking forward devolution in health and care for London – The London Devolution Agreement London faces significant population, health, organisational and financial challenges which must be addressed if we are to support Londoners to be as healthy as they can be and for services to be sustainable. London partners, including London CCGs, have committed to work more closely together to support those who live and work in London to lead healthier, independent lives, prevent ill-health, and to make the best use of health and care assets. London health and care leaders have worked closely together at local, sub-regional and regional level over a number of years to develop a clear vision for better health and care, built on the views of Londoners, and central government and national bodies backed this commitment through the 2015 London Health Devolution Agreement.

Throughout 2016, local, multi-borough and sub-regional areas in London have worked hard to plan rapid improvements to health and care within existing powers. Five London devolution 'pilots' have explored how more local powers and decision-making could accelerate the improvements that Londoners want to see. Our devolution work has underscored the importance of working at different levels in London under the three themes of prevention of ill health, integration of services and improved estates utilisation. We are clear that changes (transformation) must be locally led and that many services can only be delivered at the borough or smaller locality level, whereas others are more appropriately aggregated across boroughs or London-wide. The forthcoming London Health and Care Devolution Memorandum of Understanding (MoU) will express commitments by national bodies to enable these improvements to go further and faster, based on the different ambition and appetite of local areas. We have been working to commence delivery of more collaborative health and care governance and delivery capability at London-level working within the London Health Board arrangements. This aims to complement and support local areas in their transformation ambitions. As an example the London Estates Board has started to meet in shadow form, looking at what projects need help at a London level to progress more speedily and the utilisation of NHS buildings (estates). This work will help to deliver the modern buildings which London's health service needs, use them as intensively as possible and potentially free up land for much needed new housing.

Chief Officer and Accountable Officer Arrangements and Changes to North Central London Commissioning Arrangements Paul Jenkins was Chief Officer and Accountable Officer for Enfield CCG from 1 April to 30 April 2016. Sarah F Thompson became Chief Officer and Accountable Officer of Enfield CCG on 23 May 2016 through to completion of the year at 31 March 2017 and through to 2 April 2017.

Helen Pettersen commenced in post on 3 April 2017 as the new Chief Officer and Accountable Officer for the five north central London Clinical Commissioning Groups (CCGs) – Barnet CCG, Camden CCG, Enfield CCG, Haringey CCG and Islington

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CCG. This is a new post which has replaced the Accountable Officers in the individual CCGs and is also responsible for leading on the delivery of the north central London Sustainability and Transformation Plan (read more about the STP on page 7).

The chief officer statement has been written by Enfield CCG Chief Officer, Sarah F Thompson, who was Enfield CCG’s accountable officer for the CCG during 2016-2017.

Sarah F Thompson

Accountable Officer for Enfield CCG for 2016-17

30 May 2017

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Performance Measures Financial Performance Enfield CCG is one of the most financially challenged CCGs in London and has been operating within the remit of Legal Directions which were placed on the organisation by NHS England on 10 August 2015.

Our financial plan for 2016/17 was an in-year deficit of £7.7m. This was delivered as per our plan agreed with NHS England. In addition, we were able to release £3.9m into our position reducing our in-year deficit further to £3.8m for 2016/17. This takes the CCG’s cumulative deficit to £37.2m.

We planned a savings programme of £17.2m and successfully delivered £13.6m.

In 2017/18 the CCG needs to make significant further savings to provide a sustainable financial platform for future years.

Better Care Fund In Enfield our vision for integration of health and social care continues to be: “the system responding as a whole with the right intervention at the right time”.

Despite significant challenges across our health and social care services in Enfield, the implementation of our Better Care Fund programme of work has been beneficial in 2016/17:

• Admissions to residential and nursing care homes continue to reduce. Ourtarget, already very ambitious, will be met this year and our enablementservice continues to deliver excellent outcomes with over 71% dischargedwith no further need for support;

• We are on track to achieve 88% of people living independently after receivingthe Care Homes Assessment Team service upon discharge from hospital;

• Our satisfaction measure shows good performance against continuity of careco-ordination (continuity of support and telling your story once);

• Seven day working is already in place across health and social care and ourintegrated locality teams are working well to bring a multi-disciplinaryapproach to supporting people who need our help.

We know that the number of emergency admissions has increased this year as well as the number of days lost to delayed discharges from hospital. This has increased with more people in hospital due to mental ill-health. We know that we must improve access to good information which keeps people well informed about their choices for healthcare before they become too unwell and require hospital admission. This will support timely, informed decision making about the services they can use to stay well in the community.

There is both a shared ambition and acknowledgement of the challenges which we are facing as a partnership. We are already expanding the work we do across integrated pathways to ensure we have the right services in the right place at the right time.

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Performance Analysis The CCG Governing Body assumes ultimate responsibility for the performance of the organisation and receives assurance through a detailed Integrated Performance and Quality Report that is presented and reviewed at its bi-monthly public meetings. To strengthen and support the delivery on our statutory duties, a new performance management framework was implemented across the organisation during 2016/2017. The remit of the Finance Committee of the CCG Governing Body has been expanded to include performance monitoring to provide additional assurance to the Governing Body.

The new Finance and Performance Committee receives detailed Integrated Performance and Quality Reports on a monthly basis which is regularly supplemented by detailed analysis of key performance areas of concern to the Committee. The report is informed by the NHS Constitution, the CCG Improvement and Assessment Framework and the annual Operating Plan ambitions which reflect the NHS Five Year Forward View. In addition to providing extensive commentary on areas of under achievement covering root cause analysis and recovery action plans the report highlights areas of potential risk and mitigating actions. Copies of these reports are included Governing Body papers published on the CCG website:

http://www.enfieldccg.nhs.uk/about-us/ccg-board-meetings.htm

As an associate commissioner to our main local hospitals, the CCG has worked with the respective co-ordinating commissioners (Barnet CCG for Royal Free London NHS Foundation Trust and Haringey CCG for North Middlesex University Hospital) to maintain significant focus on performance during the year. This has delivered improvements in a range of areas whilst others remain challenged.

In 2016/17 Enfield CCG achieved: • compliance against the 18 weeks waiting times for consultant led

appointments• six of the eight cancer waiting time standards• newly introduced mental health waiting time targets relating to first episode

psychosis and talking therapies• 15% access rate ambition for people experiencing depression or anxiety

disorders• dementia diagnosis rate also exceeding the two-thirds national ambition.

Urgent and emergency care services remained challenged throughout the year and this adversely impacted on delayed transfers of care for people requiring support post discharge from hospital. Enfield CCG has daily and weekly system in place to ensure individuals are discharged appropriately from the hospital. We, with the Lead Commissioners have supported the Accident & Emergency Delivery Boards to support improvements in urgent and emergency care. We have worked with the Lead Commissioners to secure improvements on the cancer 62 day waiting standard.

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Performance against National Standards National Standard

2016/17 Performance

RTT waiting times for non-urgent consultant-led treatment -Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral

92% 93.2%

A&E Waits (Enfield CCG) - Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

95%

85.2%

A&E Waits (North Middlesex University Hospital) -Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department 82.0%

A&E Waits (Royal Free London NHS Trust) - Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department 87.7%

London Ambulance Service - Category A Red 1 Response time within 8 minutes performance for Enfield patients

75% 58.6%

Diagnostic test waiting times- Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 99% 98.8%

Cancer Waits – 2 week wait • Maximum two-week wait for first outpatient

appointment for patients referred urgently withsuspected cancer by a GP

• Maximum two-week wait for first outpatientappointment for patients referred urgently with breastsymptoms (where cancer was not initially suspected)

93%

93%

94.2%

93.7%

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Cancer Waits – 31 days • Maximum 31-day wait from diagnosis to first definitive

treatment for all cancers

• Maximum 31-day wait for subsequent treatmentwhere that treatment is surgery

• Maximum 31-day wait for subsequent treatmentwhere that treatment is an anti-cancer drug regimen

• Maximum 31-day wait for subsequent treatmentwhere the treatment is a course of radiotherapy

96%

94%

98%

94%

98.7%

99.4%

99.6%

99.5%

Cancer Waits – 62 days • Maximum 62-day wait from urgent GP referral to first

definitive treatment for cancer

• Maximum 62-day wait from referral from an NHSscreening service to first definitive treatment for allcancers

85%

90%

80.7%

85.2%

Improving quality

In line with its statutory duties, Enfield CCG maintained a significant focus on quality of services provided to its population during 2016/17 in order to secure continuous improvements in outcomes. The CCG Improvement and Assessment Framework including the six clinical priorities introduced by NHS England in 2016/17 was one of the key tools that underpinned the CCG’s priorities and approach to service quality improvements. Our commitment to quality of services was reinforced by putting in place improved governance arrangements that ensured decision-making groups were clinically chaired and/or had a clinical voting majority.

The CCG paid particular attention to the six clinical priorities and baseline assessment ratings as shown in the table below and expects to see improvements in its year end assessment based on the improvement actions that have been undertaken. Of note is the significant increase in the National Diabetes Audit participation rate, from 6% in 2015/16 to 63% in 2016/17 which was achieved through better engagement and support to our GP practices.

2016/17 Baseline Priority Indicator Performance Assessment

Dementia Diagnosis Rate 67.5% Top Performing Care Plan Reviews 79.5%

Mental Health IAPT Recovery Rate 50%

Performing Well First Episode Psychosis Waits 68.6%

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Learning Disabilities

Inpatient Rates (NCL) 67 per million Needs Improvement % Annual Health Checks 52%

Cancer

% Stage 1 and 2 Diagnosis 52% (2014)

Needs Improvement

% Treatments within 62 days 71.2% 1 year survival rates 70.1%* Positive response rate to care 79.3%

Maternity

Women’s experience score 70.9 Needs Improvement

Score of choices offered 62.2 Stillbirth & neonatal mortality 4.5 per 1000 Women smoking at delivery 5.9%

Diabetes NICE Treatment targets <25% participation

Greatest need for improvement

The CCG uses a model for quality which includes the three domains, as set out below, of quality in High Quality Care for All in 2008, following the NHS Next Stage review led by Lord Darzi.

The three key models for evaluating quality are set out in our Governing Body approved Quality Strategy.

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The focus of Enfield CCG’s Quality Strategy and annual work plan is local quality challenges. We provide an integrated quality and performance report to bi-monthly Quality & Safety Committee and a quality report to every Governing Body meeting. The quality report to the Governing Body provides an overview of Quality of our main service providers, highlights any good practice that has been identified and ensures that there is a focus on the key quality issues. The report provides assurance to the Governing Body that the CCG understands the quality issues and that appropriate action is being taken to improve quality.

We hold all of our providers to account through the work of the Quality & Safety Committee. As the co-ordinating commissioner, we lead the management of the Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) Clinical Quality Review Group (CQRG) on behalf of Barnet, Enfield and Haringey CCGs. The CRQ reports into our Quality and Safety Committee.

Our quality highlights include: • Attended an Enfield Borough service user engagement event to inform

commissioning to support those in crisis and feeling suicidal. Attendees were amixture of mental health service users, families and carers, voluntary servicesrepresentatives, local authority colleagues, mental health trust colleagues andcommissioners.

• Hosted a Tri-Borough (Barnet, Enfield and Haringey) workshop on implementingzero tolerance for suicide

• Developed and launched an integrated urgent care service; NHS 111 and GPout of hours for all residents in North Central London.

• Included patient representatives in regularly attending quality review meetingsfor the Integrated Urgent Care Service to enhance patient focused approach toquality monitoring.

• Delivered improvement in Community musculoskeletal physiotherapy waitingtimes resulting in over 90% of non-urgent referrals being seen within 13 weeks

• Additional investment in Enfield Child & Adult Mental Health Service (CAMHS)service to reduce waiting times

• Care Home Assessment Team availability to Enfield care homes providing jointworking with social care to provide comprehensive reviews of safety and quality,and a coordinated approach to supporting improvement

• Exceeded the 50% standard, overall, for treating people with symptoms of earlypsychosis within 2 weeks

• We worked with partners including Public Health England, Local Authority andNHS Haringey CCG to deliver infection prevention and control training to carehomes

• Supported North Middlesex University Hospital in their efforts to improve qualityand safety in response to the Care Quality Commission inspection and willcontinue to monitor delivery of the Trust Improvement plan.

• Oversaw significant improvement in reporting of patient safety incidents atBarnet, Enfield and Haringey Mental Health Trust

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• Co-ordinating Commissioner for the British Medical Institute Healthcare contract(previously Croydon CCG) including setting up a local contract and qualitymonitoring group with regular reporting is in place.

• The CCG safeguarding team hosted a training event for health practitionersacross Enfield on Child Sexual Exploitation. The key note speaker, StephenAshley the former Independent Chair of the Local Safeguarding Children Boardin Rotherham delivered a presentation on his experience in Rotherham at thetime of Professor Alexis Jay report into Child Sexual Exploitation. The audienceincluded GPs, health visitors, school nurses and CAMHS staff.

• Launched the Mental Capacity Act (MCA) Assessments and Deprivation ofLiberty Safeguards (DoLS) policy developed by Enfield CCG on behalf of Barnetand Haringey CCGs for use for Nursing and Residential Care Homes. The policysets out in detail the 5 principles of Mental Capacity Assessment for staff tofollow when undertaking a Best Interest Assessment.

Patient and Public Involvement

There is strong evidence that effective communication and engagement with patients, carers, stakeholders, partners and the public helps to improve commissioning decisions, quality of services, patient satisfaction and a better understanding of how to use the NHS. We want to make sure that we communicate effectively with stakeholders and that engagement is planned throughout the commissioning cycle. We have a corporate Communications and Engagement Strategy that explains our approach and methods of communicating and engaging with our members, stakeholders and the public. We review this strategy annually.

Annual Patient and Public Engagement (PPE) report NHS England requires us to prepare a PPE annual report which describes our local vision for engagement and how we have discharged our individual and collective participation duties. This year’s report (1 April 2015- 31 March 2016) was submitted in October 2016. We are very proud to report that in January 2017 NHS England assured us as “Good” for our Annual PPE report. This is an improvement on last year and is the highest score that the CCG can currently receive. Annual PPE Reports from previous years can be found on our website.

Patient and Public Engagement Committee Our Patient and Public Engagement (PPE) Committee is one of six sub-committees of our Governing Body. The PPE Committee meets six times a year and members include Healthwatch, a voluntary sector representative, public health, an elected Patient Participation Group (PPG) representative, CCG staff and Governing Body members. This year, we expanded membership of the committee to include three PPG locality champions. Together the elected PPG representative and the three PPG locality champions ensure that patients from all of our four localities are represented at the PPE Committee.

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The PPE Committee oversees the discharge of the CCG’s statutory collective and individual participation duties in the Health and Social Care Act 2012, as well as the delivery of our equality and diversity duties. The PPE Committee also receives regular reports from the CCG’s commissioning leads and transformation programmes which explain how engagement activities are aligned to each work-stream.

More information on the PPE Committee’s work this year is available in the Annual Governance Statement (Appendix 1).

Engagement and Consultation The CCG hosts three corporate PPE events a year. These events are open to all our stakeholders and members of the public. The objective of these events is gathering feedback on our commissioning plans and supporting quality improvements. Based on feedback we have received from patients, these events are clinician led with group work and fewer presentations/speakers. A report is prepared after every event and attendees become part of our stakeholder network, receiving email updates. This year we used these events to invite feedback on a number of key work programmes including: reducing prescribing costs, developing primary care services, the North Central London (NCL) Sustainability and Transformation Plan and consultations for the Paediatric Assessment Unit and Adherence to Evidence Based Medicine.

Enfield CCG has an extensive list of stakeholders and takes a proactive approach to networking and communicating. We work closely with patient groups and networks around planned service redesign gathering feedback through: focus groups, surveys and patient involvement on steering groups. As a commissioner, we also contract providers to gather patient experience data through routine surveys that can be used to support service improvements. We also gather general feedback by attending a number of externally organised events including the Over 50s Forum Winter Fair; Patient Participation Group meetings, Bangladeshi Welfare Association, Enfield Racial Equality Council, Youth Parliament, Deaf Forum and others.

During this year we also engaged and consulted extensively on recommissioning the Paediatric Assessment Unit at Chase Farm Hospital. We also began a consultation on 1 March 2017 asking for views on our Adherence to Evidence Based Medicine Programme.

Patient Participation Group (PPG) Network

We host a network for our GP member practices’ Patient and Participation Groups (PPGs). Currently the meetings are quarterly and some support for the network is provided by the Communications and Engagement Team. The meetings are chaired by elected PPG representative, who also sits on the PPE Committee and the Governing Body. The PPG network is made up of volunteers and the elected representative can raise any issues with the CCG.

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This year PPG volunteers have been involved in developing their own work plan for focussing on:

• reducing do not attend (DNA) rates at their practices,• supporting healthy living,• recruiting new PPGs members to their member practices and from different

practices to the network• sharing best practice.

This year the PPG network nominated three locality representatives (the elected PPG representative acts as the locality representative for her own area). These volunteers provide extra support for PPGs in their local area.

Enfield CCG ensures that the PPG network is a key stakeholder in our engagement activities and we contact the groups and their members where we have individual’s details on file regularly with news and updates. The CCG also has a sub-section on our website about the PPG network which we keep up to date with all the details of their meetings and activities. The PPG network can be contacted at ppgs@enfieldccg.nhs.uk.

Enfield CCG Voluntary and Community Stakeholder Group Enfield Clinical Commissioning Group (Enfield CCG) set up a Voluntary and Community Stakeholder Reference Group in September 2015. Details about the group’s meetings and members as well as its terms of reference are available on the CCG’s website. Its aim is to enable voluntary and community sector representatives to provide the patient, service users and public perspective, on the development, planning, implementation and evaluation (success and challenges) of health services commissioned by Enfield CCG. This year, issues discussed at this group included: medicines management, primary care, proposed changes to the Chase Farm Paediatric Assessment unit (PAU), involving people with autism, developing Child and Adolescent Mental Health Services (CAMHS), Primary Care developments and Adherence to Evidence Based Medicine.

Reducing health inequality

The CCG is required to meet both the equality duty (show due regard) under the Equality Act 2010 and also the health inequalities duty (reducing health inequalities) under the National Health Services Act 2016 as amended by the Health and Social Care act 2012.

Public section equality duty under the Equality Act 2010 NHS Enfield CCG is committed to advancing equality, diversity and inclusion through commissioning and workforce development. The CCG recognises its duty to demonstrate due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it.

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Equality and Diversity Strategy The CCG is required by the public sector equality duty to develop and publish equality objectives at least once every four years. In order to meet this duty, in 2016/17 we refreshed our Equality and Diversity Strategy in consultation with stakeholders. The objectives in the Strategy cover commissioning, engagement, workforce and governance. An action plan has been developed with senior managers for 2016-2018 which is refreshed annually. It is monitored by a dedicated Task and Finish Group and the Patient and Public Engagement Committee.

Equality information- public sector equality duty report Our Equality Information provides an overview of how we are meeting our public sector equality duty, both through commissioning and employment. It is an annual performance report that we published on our website in January 2016. The report outlines the work we have done in relation to policy development, commissioning, engagement, current workforce and recruitment of staff from diverse backgrounds. The report also provides links to our main providers’ equality information which sets out how they are meeting their equality duty. After discussion with NHS England, we have changed our Equality Information to cover the financial year rather than publishing in January 2017, so that it can incorporate the Workforce Race Equality Standard (WRES) and Equality Delivery System (EDS2) and the future Workforce Disability Equality Standard (WDES). The 2016/17 Equality Information report will be published in July 2017.

Equality Impact Analysis We routinely analyse our existing and new policies to ensure there is no unintended negative or disproportionate impact on groups that are protected by the Equality Act. At the CCG, no policy decision is made without an equality analysis of the policy. Our Governing Body report cover sheet includes a section specifically about equality impact prompting managers to carrying out an equality analysis of the policy or the function they are reporting to the Governing Body. We maintain a log of all our equality analyses and ensure the actions arising from the analyses are implemented and monitored. Our staff also receive appropriate training and support to complete equality analyses. We have updated our project management templates to include equality impact assessment (due regard) so that this is considered for all projects/service improvements and changes.

Equality Delivery System (EDS2) Enfield CCG has adopted the Equality Delivery System (EDS2) to manage our equality and diversity performance in the organisation. We have assessed our performance against four EDS2 goals and eighteen outcomes to determine the grades. This has helped us to identify gaps, set priorities and develop action plans. Our Equality and Diversity Task and Finish Group which includes representatives from Public Health and the Healthwatch will help us refresh the CCG’s grades against all EDS2 outcomes and develop actions to deliver equality

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objectives. Moreover, all of our providers are now implementing EDS2 and we receive regular assurance updates.

Further information on our EDS2 performance can be found in our annual equality information report on our website.

Workforce Race Equality Standard The Workforce Race Equality Standard (WRES) requires NHS organisations to demonstrate progress against a number of indicators of workforce equality, including a specific indicator to address the low levels of Black and Minority Ethnic (BME) board representation. All providers, as holders of the NHS standard contract (except ‘small providers’), started to implement the WRES from April 2015.

In October 2015 we published a baseline report, showing our compliance against the WRES and a progress report is on our website. The report feeds into our equality objective setting and EDS2 grading processes. In 2016/17 we have implemented the WRES action plan and have worked with our providers to implement the WRES and to ensure they meet the standards; an update will be included in our next equality information to be published July 2017. More information about various equality and diversity activities can be found in our equality information report 2017 on our website.

Working with Local Partners The Enfield Health and Wellbeing Board was set up under the Health and Social Care Act 2012 to create a forum where the key leaders from the health and care system can work together to improve the health and wellbeing of the local population and reduce health inequalities. Health and wellbeing boards play a key role to:

• Ensure stronger democratic legitimacy and involvement• Strengthen working relationships between health and social care, and,• Encourage the development of more integrated commissioning of services.

The Board also aims to help give communities a greater say in understanding and addressing their local health and social care needs.

Enfield CCG plays a key role on the Enfield Health and Wellbeing Board (HWBB), which provides the strategic leadership to inform the overarching priorities and strategic objectives to inform the development of the Enfield Health and Wellbeing Strategy.

The Health and Wellbeing Board meets bi-monthly and is chaired by the Leader of London Borough of Enfield. Enfield CCG is represented by the Chair, Enfield Clinical Commissioning Group (Vice-chair of the HHWB) and the CCG Chief Officer with

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regular contributions from other officers. The membership of the Board includes senior executives and officers representing:

Director of Public Health, Chief Executive, North Middlesex University Hospitals NHS Trust, Chief Executive, Barnet& Enfield and Haringey Mental Health NHS Trust Enfield Healthwatch, Cabinet Members and Executive Officers, London Borough of Enfield Executive Director of Children’s Services, LBE, Enfield Voluntary Sector Enfield Youth Parliament

Full details of all members of the Enfield Health &Wellbeing Board and meeting papers can be found on the Enfield Health & Wellbeing Board website: http://www.enfield.gov.uk/healthandwellbeing/info/10/meet_the_board

The Enfield Joint Health and Wellbeing Strategy (JHWS) 2014-2019 sets the vision of Enfield’s Health and Wellbeing Board. This is informed by NHS national guidance to support our aim for our residents to live longer, healthier, happier lives. The strategy has five priorities:

1. Ensuring the best start in life,2. Enabling people to be safe, independent and well and delivering high quality

health and care services,3. Creating stronger, healthier communities,4. Reducing health inequalities – narrowing the gap in life expectancy,5. Promoting healthy lifestyles and making healthy choices

The strategy’s evidence base is the Joint Strategic Needs Assessment (JSNA) which is a key resource of health and wellbeing information produced by the public health team at Enfield Council in partnership with the CCG.

Having regard to the JHWS, Enfield CCG has continued to embed these five priorities in its commissioning of health and care services for the local population. They are reflected in the Enfield CCG strategic objectives for 2016/17:

1. Deliver financial recovery in line with the terms of the legal directions to thesatisfaction of NHS England

2. Deliver improvements in the quality of local health and primary care services3. Deliver the goals in the Enfield Operating Plan and contribute to NCL

Transformation4. Deliver on the NHS Constitution and access standards5. Develop our Staff and our Organisation6. Deliver on our partnerships with patients, residents and stakeholders

In addition, all CCGs are monitored against the new Improvement and Assessment Framework which includes the following four domains and six clinical priorities:

Domains 1. Better Health2. Better Care

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3. Sustainability4. Leadership

Six clinical priorities 1. Mental Health2. Dementia3. Learning Disabilities4. Cancer5. Diabetes6. Maternity

The Improvement and Assessment Framework both contributes to the delivery of the Enfield JHWS as well as the NHS 5 Year Forward View.

Enfield CCG continues to work closely with the London Borough of Enfield placing the people of Enfield at its heart. We continue to respond to the changing expectations and needs of local residents, ensuring greater access to GP’s and community based services and supporting residents to manage their own care, thereby avoiding unnecessary use of services and avoiding hospital admission, where appropriate.

Recently Enfield CCG has worked within the Health and Wellbeing Board to prioritise work for the final two years of the JHWS. 3 workstreams were selected, where the Board felt it could add particular value as leaders of the local system. The areas were, giving children the best start in Life; healthy weight and mental health resilience. These link closely to the goals of the CCG, local providers and Sustainability and Transformation Plan partners.

Health Inequalities continues to be an important cross cutting theme in all our work. Enfield is a borough of two divided halves in terms of health outcomes. The major causes of early death are heart disease, stroke and cancer with stark contrasts in the health of our communities across the borough. Obesity, sedentary lifestyles, smoking, diabetes, atrial fibrillation and hypertension are key modifiable factors behind those causes.

Working alongside public health services, such as NHS Health Checks and the stop smoking services targeted at areas of need in the borough we are working hard to reduce variation in health across Enfield. A good example of our approach is local work with GPs to reduce variation in the management and prevention of long-term conditions. We are helping people manage their own health, strengthening our offer of structured education in diabetes. Alongside this, we are addressing pre-diabetes with a new locally commissioned service and we proud to play an active part in the National Diabetes Prevention Programme.

In preparation for the refresh of the Joint Health & Wellbeing Strategy in 2018/19, Enfield CCG is part of the development of a new Joint Strategic Needs Assessment (JSNA). The JSNA is in a process of redesign to improve the currency of information and to make it more accessible. CCG colleagues with their Health & Wellbeing partners have been active in determining the form and content of the new JSNA.

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The aim is for a more flexible, interactive, web based resource pulling data from across the partnership in Enfield allowing comparison with neighbours across North Central London.

Sustainable Development

Enfield CCG is committed to contributing to reduced carbon emissions as part of the Government’s plan to decrease overall carbon emissions by 34% by 2020. Our aim is to reduce our overall emissions by 26% by 2020 ultimately enhancing our sustainability. Sustainability in this context means spending public money well, through the smart and efficient use of natural resources.

In 2016/17 Enfield CCG continued its implementation of plans to assess risks, enhance performance and reduce our impact against carbon reduction and climate change adaption objectives, with an overarching strategic objective to establish mechanisms to embed social and environmental sustainability across all areas of work. This objective will be continued in the CCG’s sustainable development principles where actions and measurements are included as an intrinsic part of all policies, strategies and plans.

The CCG’s policy is aligned with the objectives set by the Mayor of London to make the fullest contribution to minimising carbon dioxide emissions in accordance with the following energy hierarchy:

I. Be Lean: Use less energy;II. Be Clean; Supply energy efficiently;

III. Be Green: Use renewable energy.

The table below provides information on the total expenditure on utilities for 2016/17: Financial Data (Spend): Units 2016/17 2015/16

Total Energy Cost (all energy supplies) £ 10,616 13,936

Electricity Cost £ 10,616 13,936

Gas Cost £ 0 0

Water Cost £ 0 0

Resource Use: Units 2016/17 2015/16

Electricity Consumed kWh 105,135 141,614

Gas Consumed kWh 0 0

Water/Sewerage Consumed m3 0 0

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Building Name Tenant Occupancy %

Total Tenant Area (m2)

Electricity Cost 16/17

Gas Cost 16/17

Water Cost 16/17

Holbrook House 89.55% 1932.05 10616.41 0.00 0.00

Building Name Tenant Occupancy %

Total Tenant Area (m2)

Electricity Consumption 16/17

Gas Consumption 16/17

Water Consumption 16/17

Holbrook House 89.55% 1932.05 105134.55 0.00 0.00

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ACCOUNTABILITY REPORT Corporate Governance Report Members Report Information on personal data related incidents where these have been formally reported to the information commissioner’s office is detailed in Appendix 1 of the Annual Governance Statement.

Member profiles The CCG Governing Body comprises 15 voting members as well as non-voting members that include representatives of the London Borough of Enfield (LBE), the LBE Director of Public Health, Healthwatch and the Enfield Patient and Public Participation Group. The 15 voting members include 8 elected GP Governing Body locality leads, two lay members, a secondary care doctor, a nurse member, a practice manager representative, the CCG Chief Officer and the CCG Chief Finance Officer. Full details can be found on the CCG website.

Member practices A list of CCG member practices can be found here and the composition and governance of our membership body is detailed in our Constitution.

Composition of Governing Body The Chair of Enfield CCG for the year 2016-17 is Dr Mo Abedi. The Chief Officer for the period 1 April to 30 April 2016 was Paul Jenkins. For the period from 23 May 2016 to 31 March 2017 the Chief Officer was Sarah Thompson. Further details can be found on our website

Audit Committee The membership of Enfield CCG’s Audit Committee is as follows: Karen Trew Chair and Lay Member for

Governance Dr Puvitha Thambinayagam (April to May 2016)

GP Governing Body Member

Dr Ujjal Sarker (June to December 2016) GP Governing Body Member

Dr Jarir Amarin (January to March 2017) GP Governing Body Member

Teri Okoro Lay Member for Patient and Public Engagement

Rathai Thevananth Governing Body Practice Manager Representative

Adam Sharples External Lay Member - Reciprocal arrangement with Haringey CCG

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The Chief Finance Officer, the Director of Quality and Integrated Governance, Assistant Director of Quality, Governance and Risk and Board Secretary are also in attendance. Additionally, meetings of the committee are also attended by representatives of internal and external audit and the counter fraud service.

Details of members of other committees and sub-committees and details on all committees and sub-committees are given in Appendix 1 – Annual Governance Statement.

Register of Interests Details of conflicts of interest for members of the Governing Body and senior management are given on the Enfield CCG website.

Personal data related incidents There were no serious incidents relating to data security breaches in 2016/2017 reported to the Information Commissioner.

Statement of Disclosure to Auditors Each individual who is a Governing Body member of the CCG at the time the Members’ Report is approved confirms:

• so far as the member is aware, there is no relevant audit information ofwhich the CCG’s auditor is unaware that would be relevant for thepurposes of their audit report

• the member has taken all the steps that they ought to have taken in orderto make him or herself aware of any relevant audit information and toestablish that the CCG’s auditor is aware of it.

Modern Slavery Act Enfield CCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not met the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.

Statement of Accountable Officer’s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed the Chief Officer to be the Accountable Officer of Enfield CCG. The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for:

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• The propriety and regularity of the public finances for which the AccountableOfficer is answerable,

• For keeping proper accounting records (which disclose with reasonableaccuracy at any time the financial position of the Clinical CommissioningGroup and enable them to ensure that the accounts comply with therequirements of the Accounts Direction),

• For safeguarding the Clinical Commissioning Group’s assets (and hence fortaking reasonable steps for the prevention and detection of fraud and otherirregularities).

• The relevant responsibilities of accounting officers under Managing PublicMoney,

• Ensuring the CCG exercises its functions effectively, efficiently andeconomically (in accordance with Section 14Q of the National Health ServiceAct 2006 (as amended)) and with a view to securing continuous improvementin the quality of services (in accordance with Section14R of the NationalHealth Service Act 2006 (as amended)),

• Ensuring that the CCG complies with its financial duties under Sections 223Hto 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual issued by the Department of Health and in particular to:

• Observe the Accounts Direction issued by NHS England, including therelevant accounting and disclosure requirements, and apply suitableaccounting policies on a consistent basis;

• Make judgements and estimates on a reasonable basis;• State whether applicable accounting standards as set out in the Group

Accounting Manual issued by the Department of Health have beenfollowed, and disclose and explain any material departures in the financialstatements; and,

• Prepare the financial statements on a going concern basis.

To the best of my knowledge and belief, with the exception of compliance with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended) in that the CCG both planned for, and achieved, deficits in expenditure not to exceed income and also revenue resource not exceeding the amount specified in Directions, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter. In this respect, I confirm that the CCG has delivered within planned expenditure as agreed with NHS England.

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I also confirm that: • as far as I am aware, there is no relevant audit information of which the

CCG’s auditors are unaware, and that as Accountable Officer, I havetaken all the steps that I ought to have taken to make myself aware of anyrelevant audit information and to establish that the CCG’s auditors areaware of that information.

• that the annual report and accounts as a whole is fair, balanced andunderstandable and that I take personal responsibility for the annualreport and accounts and the judgments required for determining that it isfair, balanced and understandable

Sarah F Thompson

Accountable Officer for Enfield CCG for 2016/17

30 May 2017

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Governance Statement Introduction and context Enfield Clinical Commissioning Group (CCG) is a corporate body established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended).

The CCG’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population.

As at 1 April 2016, the clinical commissioning group was subject to Legal Directions and subsequently Special Measures from NHS England issued under Section 14Z21 of the National Health Service Act 2006 as follows:

NHS England Legal Directions On 10 August 2015, the Clinical Commissioning Group was subject to NHS England Legal Directions in relation to its financial position and governance arrangements relating to the associated recovery plan.

At the time these Directions were passed there was a Turnaround Director in post at NHS Enfield CCG. NHS England directs that should the post of Turnaround Director fall vacant:

(a) NHS England shall determine the process to be followed to appoint anyreplacement Turnaround Director for NHS Enfield CCG

(b) The appointment of any replacement Turnaround Director shall be subject to priorapproval by NHS England.

(c) Enfield CCG shall co-operate with the Board regarding the appointment of anyreplacement Turnaround Director, including but not limited to the prompt provision of information requested by the Board and making senior officers available to meet with the Board.

The Directions also require that: • Enfield CCG shall produce an Improvement Plan that sets out how it shall

ensure that the capacity, capability and governance of the CCG is made fit forpurpose.

• The content of the NHS Enfield CCG Improvement Plan shall meet anyrequirements as set out by the Board.

• This shall include a Financial Recovery Plan that sets out how NHS EnfieldCCG shall operate within its annual budget for the financial years 2015/16 to2019/20 inclusive. This shall include a schedule for the repayment ofoutstanding debt.

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• The Improvement Plan, including the Financial Recovery Plan, shall besubject to the Board's approval.

• NHS Enfield CCG shall implement the Improvement Plan, including theFinancial Recovery Plan.

• Enfield CCG shall co-operate with the Board regarding the implementation ofthe Financial Recovery Plan and the Improvement Plan, including but notlimited to the prompt provision of information requested by the Board andmaking senior officers available to meet with the Board.

• The process to make a permanent appointment to any member of the seniormanagement team at NHS Enfield CCG and the appointment of such officersshall be subject to the Board's approval.

• Enfield CCG shall co-operate with the Board regarding any appointment to itssenior management team, including but not limited to the prompt provision ofinformation requested by the Board and making senior officers available tomeet with the Board.

• Compliance with the Directions requires that NHS Enfield CCG co-operatewith NHS England through prompt provision of information requested andmaking senior officers available to meet with the Board.

These directions will apply until they are varied or revoked by NHS England. Link for further information on NHS England Directions: https://www.england.nhs.uk/commissioning/wp-ontent/uploads/sites/12/2015/08/ccg-

directions-enfield.pdf

NHS England and NHS Improvement Special Measures In July 2016, a new intervention regime was introduced by NHS England and NHS Improvement which can be applied to trusts and CCGs who are failing to meet their financial commitments. NHS England and NHS Improvement published its report on Strengthening Financial Performance & Accountability in 2016/17 to sharpen the direct accountability of trusts and CCGs to live within the public resources made available by Parliament and the Government in 2016/17.

The report concluded that Enfield CCG was one of 26 out of 209 CCGs to be rated overall as inadequate and the CCG was put into ‘special measures’ on 21 July 2016, having failed to meet the financial discipline expected of the CCG and already been subject to NHS England Legal directions’ since 10 August 2015.

Enfield CCG has put in place an Improvement and Financial Recovery Plan in response to this. Enfield CCG is focusing on areas where we have evidence that we can improve or maintain quality while reducing spend. Link for further information on Special Measures: https://www.england.nhs.uk/2016/07/operational-performance/

Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for

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which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter.

I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.

Governance arrangements and effectiveness Enfield CCG was established under the Health and Social Care Act as a statutory body responsible for health services as set out in section 3 of the Act and the regulations made under that provision. Enfield CCG is a clinically led membership organisation made up of local general practices. The members of the CCG are responsible for determining the governing arrangements for their organisation, as set out in Enfield CCG’s Constitution. The key features of our constitution can be found in the members report section of this report.

The main function of the governing body is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it.

Governing Body membership The Chair of Enfield CCG during 2016-2017 was Dr Mo Abedi. A list of Governing Body members during 2016/17 can be found here.

Governing Body Committees In line with statutory requirements and guidance, the Governing Body established the following Committees (against each Committee is a percentage denoting the average attendance as reported to the Audit Committee as part of the effectiveness review):

• Audit Committee (72%)• Remuneration and Nominations Committee (62.5%)• Quality and Safety Committee (66%)• Finance and Performance Committee (75%)• Patient and Public Engagement Committee (65%)• Procurement Committee (85%)• Executive Committee (76%)

Full details of individual’s attendance at Committees can be found on the CCG website as part of the minutes of the Committee to the Governing Body.

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A summary of the responsibilities of these Committees, their membership and delegated responsibilities can be found in the Members’ Report section and our Constitution. The Terms of Reference of each Committee are available on our website.

The CCG’s Committee accountability structure is set out below:

Changes to the CCG’s governance arrangements In 2016/17, a review of the CCG’s governance arrangements was undertaken as recommended by the Audit Committee. Following discussions with GP Clinical Leads, Executive Directors and CCG Committee Chairs, proposals have been made to strengthen clinical leadership and governance in the CCG.

These proposals will enable more efficient and effective utilisation of Enfield CCGs clinical and management time, improve systems for decision making and align with North Central London CCGs and the developing North Central London Sustainability and Transformation Plan Governance arrangements.

The proposals are to:

a) merge the Clinical Reference Group (CRG) with the Executive Committee(currently with similar clinical membership) to form a Clinical CommissioningCommittee (CCC) reporting to the Governing Body;

b) establish a Clinical Review Group (Task and Finish) to focus on the moredetailed requirements of service specifications and quality impactassessments previously undertaken by the Clinical Reference Group

c) transfer of accountabilities from the Executive Committee to the Quality &Safety Committee via the Quality & Risk sub-group for human resourcepolicies, Health & Safety, Emergency Planning, Resilience and Response;

In order to deliver these changes new Terms of Reference have been developed for the Clinical Commissioning Committee and Clinical Review Group (Task and Finish).

CCG Governing Body

Finance & Performance Committee

Procurement Committee

Patient & Public

Engagement Committee

Executive Committee

Remuneration & Nominations Committee

Audit Committee

Quality & Safety

Committee

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It is anticipated that these changes will take effect from July 2017 following the May 2017 Governing Body meeting & NHS England approval.

The effectiveness of the Governing Body and its committees As part of the Audit Committee work plan, all Governing Body Committee Chairs are invited to attend the Audit Committee to report on their Committee’s effectiveness. Committee Chairs also report to each public Governing Body meeting. Following a third year of reviewing the Governing Body Committees’ effectiveness, the Audit Committee requested further refinements be made to the process with the view to focus on outcomes and what added value each committee brings to the Governing Body.

In 2016/17, the Governing Body’s effectiveness was evaluated for the second year using the maturity matrix developed by the Good Governance Institute for supporting board development and improvement. The outcome of this evaluation is highlighted below.

An effectiveness review was also conducted on all Governing Body Committees and the outcome from most reviews has been the development of an action plan to address the issues raised. Highlights of the work of the committees and a summary of their effectiveness can be found below. Further details of the effectiveness reviews can be found in the report of the Audit Committee Chair to public meetings of the Governing Body.

Highlights of Governing Body and committee work during 2016/17 The Governing Body met 6 times in public during the financial year. Highlights of the year include:

• North Central London (NCL) Primary Care co-commissioning whichcommenced in October 2015

• NCL Sustainability & Transformation Plan (STP)• NCL STP Governance Arrangements• CCG Strategic Objectives for 2016/2017• Board Assurance Framework and Corporate Risk Register• Financial matters including:

- monthly monitoring reports- Financial Recovery Plan for CCG- Operating and Financial Plan for 2017/18

• Commissioning intentions for 2017/18• London Devolution Proposal• Safeguarding Annual Report• Performance of NHS provider trusts managed through the CCG Integrated

Performance and Quality Report• Assurance reports from Governing Body committees• Primary Care transformation• NHS 111 and Out of Hours Procurement 5 year contract awarded across

North Central London from October 2016• Healthy London Partnership• Gluten Free Prescribing• Adherence to Evidence Based Medicine

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• CCG 2015/16 Annual Report• Enfield CCG Conflicts of Interest Policy and Procurement Policy

Audit Committee The committee met 5 times during the financial year. The Committee has reviewed and responded to the following:

• The Committee approved KPMG LLP as External Auditors for the CCG for theperiod 1April 2017- 31March 2020

• The Committee approved the one year extension for the contract with RSMUK LPP for the provision of Internal Audit and Counter Fraud Services acrossNorth East London CCGs

• Review of the implementation of actions from the NHS Protect AssessmentAction Plan

• The Internal Audit Plan.• The Counter Fraud Plan & Policy• The External Audit Plan• Review of the effectiveness of Governing Body Committees• Board Assurance Framework and Risk Register• Risk Management Strategy and Deep Dive into Risk• Annual report and accounts• CSU assurance programme• Reviews of debtors and waivers• Counter Fraud Report• Conflicts of Interest & Gifts & Hospitality Register• Conflicts of Interest Breach• Conflicts of Interest Task and Finish Group Terms of Reference and Action

Plan• Committee terms of reference and work plan• Review of CCG Governance Arrangements.

Quality and Safety Committee The Committee met seven times during the financial year. The following areas had been discussed amongst others:

• Monthly quality and performance integrated report• North Middlesex University Hospital (NMUH) quality concerns and Care

Quality Commission Inspection Action Plan• Barnet Enfield & Haringey Mental Health Trust Care Quality Commission

Inspection and Action Plan• Barnet, Enfield & Haringey Mental Health Trust Patient Story• 2015 Provider Staff Survey Analysis• Revised Quality Impact Assessments & Service Specification Aide Memoire• Quality Strategy Implementation Plan – 2016/17• Practice nurse training needs and provision• Extraordinary meeting on NMUH and its Emergency Department• Enfield Referral Service Report• Medicines Management report

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• Contract Negotiations, Commissioning for Quality and Innovation, assurance in provider contracts

• Acute Stroke Care Quality Review • Presentation of provider falls services • Primary Care Support to North Middlesex University Hospital – GP See and

Direct Pilot • North Central London Integrated Urgent Care NHS 111 and GP Out of Hours

Local Key Performance Indicators (KPI’s) • Continuing Health Care KPI • Royal Free London Hospitals Care Quality Commission Inspection • London Ambulance Service (LAS) quality concerns • Quality & Safety Risk Register • Committee terms of reference • Information Governance Toolkit Submission • GP Quality Improvement • Complaints Annual Report • Safeguarding Annual Report • Quality Accounts • Looked After Children Annual Report • Quality & Governance Annual Report • Healthwatch Enter & View Reports • Individual Funding Request Annual Report • Annual Committee Effectiveness review • Work plans including sub group work plans

Finance & Performance Committee The Committee met monthly during the year and highlights from the year include:

• Scrutiny of the Financial Recovery Plan and recommended actions • Review of performance management plans • Integrated Performance and Quality Report • Finance Risk Register • Review of Contracts • The improved monthly finance report • The key contracting variances • Quality Innovation, Productivity and Prevention (QIPP) performance including

transformation programme updates • Development and advice regarding the CCGs Financial Recovery Plan • Authorisation of investments • Forward planner • Annual Committee Effectiveness review • Review of the Terms of Reference for the new Finance & Performance

Committee Patient and Public Engagement Committee The Committee met six times during the year. Highlights from the year include:

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• Approval of the Equality Information Report 2016, including workforce race equality standard

• Patient Participation Group (PPG) elected representative provides updates from the PPG Network work plans

• Terms of Reference amended to enable PPG representation to be increased by the attendance of the Locality PPG Champions with voting rights

• Delivery of 3 corporate Patient and Public Engagement events in 2016/17, areas covered included Paediatric assessment unit; repeat prescribing; looking to the future of GP services in Enfield; Adherence to Evidence Based Medicines; Sustainability and Transformation Plan; Primary Care Developments;

• Overview of engagement across the organisation • Agreed the work programme for 2016/17 • Approval of the Annual Participation Duties Report for 2015/16 • Noting actions being taken by CCG in relation to the results of the 360 Degree

stakeholder survey for 2017 • Considered a variety of topics including European & Social Fund; consultation

on AEBM; patient and public engagement in the CCG’s annual commissioning and planning cycle and personal health budgets

• Noting the Voluntary and Community Stakeholder Reference group minutes and areas of concern

• Approving the establishment of the Equality and Diversity Working Group • PPE Committee noted that not only had the internal auditors confirmed that

engagement was good in the CCG but also that CCG was assured as ‘good ’by NHS England for fulfilling its statutory participation duties. This was reported to the Governing Body at their March 2017 meeting.

Executive Committee The Committee met 10 times during the year and highlights from the year include:

• Primary Care Full Delegation • Review of Organisational Development, Emergency Planning Resilience and

Response (EPRR) and Business Continuity plans • Approval of Human Resources, Health and Safety and Fire policies • Staff survey • Other workforce reports e.g. the Workforce Race Equality Standard • Governing Body Succession Planning • Review North East London CSU Service Level Agreement • Review of NHS England Conflicts of Interest Statutory Guidance, CCG Action

Plan and Task & Finish Group • Scrutiny of the Governing Body Assurance Framework & the Corporate Risk

Register • Strategy and commissioning reports including • The Health and Collaboration Agreement / London Devolution • NCL Commissioning Arrangements • Children and Adolescent Mental Health Services (CAHMS) transformation • Mental Health Crisis Concordat • Mental Health Stocktake • Paediatric Assessment Unit Review

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• Review of the Integrated Performance and Quality Report• Reviewing the 2017/18 NHSE Planning Guidance• Updates on Primary Care including co-commissioning• Quarterly report on Freedom of Information requests• Reports from Locality Commissioning Business meetings• An annual review of the Committee’s effectiveness

Procurement Committee The Committee met 10 times during the year and highlights from the year include:

• A Review of GP Provider Networks• Procurement/ review of options around procuring the following services:- MSK- Community Gynaecology- Ophthalmology- Urology- GP See and Direct Pilot- Pathology- Primary Care 7 day access/GP Access Hubs- Walk in centres- GP Information Technology- Estates management- Complex care• North Central London NHS 1111 and Out of Hours Procurement• Review of the Procurement Policy• Primary Care Urgent Access Service• Contracts Register• Register of Procurement Decisions

UK Corporate Governance Code We are not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider to be relevant to the Clinical Commissioning Group and best practice.

This governance statement is intended to demonstrate CCG regard to the principles set out in the Code considered appropriate for clinical commissioning groups for the financial year ended 31 March 2017. Full details of our Corporate Governance arrangements are set out in our Constitution authorised by NHS England.

Discharge of Statutory Functions During establishment, the arrangements put in place by the clinical commissioning group and explained within the Constitution were developed with extensive external expert legal input, to ensure compliance with the all relevant legislation. That legal

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advice also informed the matters reserved for the Membership Body, Governing Body decision and the scheme of delegation. Enfield CCG has robust arrangements in place for the discharge of its statutory duties as outlined in its constitution. In light of the Harris Review, the CCG has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative regulations. As a result, I can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead director.

Risk management arrangements and effectiveness

Enfield CCG’s Governing Body approved Risk Management Strategy outlines the

CCG’s approach to risk management, including:

• Identifying committees and groups which have responsibility for risk management

• Roles and responsibilities of staff with regards to risk management • The process for identification, assessment and management of including risk

to data security • The process for managing, and Board review of, the Risk Register and Board Assurance Framework • The risk appetite of the organisation which sets out the thresholds for

tolerating, managing and reporting different orders of risk

The CCG Risk Assessment Framework is based on the National Patient Safety Agency (NPSA) guidance and the Australia/New Zealand standard AZ/NZS 4360:1999. This provides guidance on identifying, evaluating and controlling risks. This is a generic method applied in many contexts to assess risks in a consistent manner. In 2016/17 internal audit conducted a review of the CCG’s risk management arrangements and Board Assurance Framework which obtained an amber green rating. The audit recommended the need for risk owners to ensure gaps in control and assurance have actions to address the gaps identified and timely updates of risk. The CCG is working with risk leads and owners to implement the recommendations. Risk identification Risks are identified against strategic, corporate, directorate, programme/project objectives. New risks are identified through directorate risk registers. Methods for identifying risk include: Internal methods such as: quality impact assessments

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quality alerts information governance breaches equality impact assessments counter fraud audits incidents complaints, claims and serious incident reporting and identification of trends audits, quality, innovation, productivity and prevention (QIPP) related risks project risks based on the achievement of project objectives, patient satisfaction surveys risk assessments surveys including staff surveys whistle-blowing Contract quality monitoring of commissioned services

External methods include: Media national reports new legislation reports from assessments and inspections by external bodies reviews of partnership working. Stakeholders are also involved in the identification and management of risk

which impact on them through our Patient & Public Engagement Committeewith responsibility for ensuring equality impact assessments are integratedinto core business.

Risk evaluation As part of Enfield CCG’s risk management process, all risks identified are evaluated and given a risk level rating. The higher the risk level, the greater the likelihood an opportunity or threat will occur and the greater its consequence. An acceptable risk may be defined as a potential hazard that is either small enough to have an immaterial effect on the achievement of organisational objectives, or is a significant risk that has been mitigated by the establishment of effective controls to minimise the likelihood of the risk occurring, or to minimise the adverse consequences should the risk identified occur.

Management of current risks All risks are linked to the CCG’s strategic objectives and assigned a risk owner (i.e. lead director/senior manager), and a lead committee which has oversight for the management and mitigation of the risk.

All CCG risks are managed via the Datix risk management system. Datix captures risks at all levels within the organisation from operational (directorate) to strategic level as well as project risks. These risks are prioritised in accordance with the CCG’s Risk Management Strategy, thereby enabling its principal risks to be fed upwards onto the Board Assurance Framework.

Reporting and monitoring of current risks In 2016/17, the CCG reviewed its risk reporting arrangements as part of continuous improvement, strengthening governance and reducing duplication in reporting. Subsequently, a risk reporting workplan was approved at the Audit Committee. The workplan was revised to include the role of the Executive Committee in reviewing

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and moderating on strategic risks in addition to reviewing risks which are not reported or reviewed at any other CCG Committee. The risk reporting workplan outlines how risks are updated monthly by directorates, reported to the relevant CCG Committees for monitoring ahead of the Governing Body. Enfield CCG’s risk appetite In 2015, the Governing Body approved Risk Management Strategy defined the CCG’s risk appetite as cautious. The CCG will seek to control all highly probable risks which have the potential to:

• cause significant harm to service users, staff, visitors and other stakeholders; • compromise severely the reputation of the organisation; • have financial consequences that could endanger the organisation’s viability; • jeopardise significantly the organisation’s ability to carry out its core purpose; • threaten the organisation’s compliance with law and regulation.”

Capacity to Handle Risk The Effectiveness of our governance structures A system of internal control is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The CCG Board Assurance Framework assesses the effectiveness of systems of internal control and provides assurances that the CCG’s risk management processes are effective. It is a dynamic document that captures the understanding of the risk environment at any given time. The document outlines the CCG’s strategic objectives, the risks to achieving these objectives, key controls and assurances in place, as well as gaps in controls and assurances and the arrangements in place to mitigate these. Risks go through a regular review cycle as summarised above and outlined in the CCGs Risk Management Strategy. The Board Assurance Framework is available on the CCG website. The CCG’s Governing Body Assurance Framework and risk management process was reviewed by our Internal Auditors during 2016/17. While the review was positive overall and rated amber green, it identified some management actions to enhance the Governing Body Assurance Framework. These related to providing greater clarity about the timeliness and nature of actions and sources of assurance, making full reference to existing assurances, ensuring that the implementation dates for planned actions are applied consistently. The individual CCG risk owners subsequently reviewed each risk to address these actions.

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Responsibility of Directors, Clinical Leads and Heads of Services All risks are assigned a relevant Director Lead, Clinical Lead and Head of Service who has accountability for overseeing the management of the risk by identifying the most effective means to minimise, transfer or eliminate the risk and ensure the quality of action plans, controls and assurances are robust. A lead Manager is also assigned with management responsibility for delivering the action plan, developing robust controls and identifying sources of assurance. The Assistant Director of Quality, Governance & Risk and Risk Manager provide professional support and training to staff on the risk management process.

Departmental Risk Champions Each CCG department has a trained Risk Champion who:

- Proactively engages in the implementation of the monthly risk register reviewand update within their directorate.

- Work with Service Leads to ensure risk registers are quality checked withinthe timeframes set out in the risk management strategy

- Input risk register information on to the Risk Module of the Datix database inan accurate and timely manner so that the Risk & Governance Team are ableto supply the Executive Committee, Audit Committee, Finance Committee,Quality & Safety Committee and other bodies with accurate and up to dateCorporate Risk Registers and Assurance Framework.

- Keep up to date with any changes to the database by attending refreshertraining as and when appropriate.

- Report any concerns to their Director and advice directors, managers andother staff within their directorate of identified risks requiring attention

Governing Body oversight and embedding risks To enable successful risk management and assurance reporting and ensure that risk is embedded within the CCG, a monitoring and reporting structure has been established for both strategic and operational risks as set out below.

The CCG operates a Governing Body Assurance Framework and Corporate Risk Register. The Governing Body Assurance Framework and Corporate Risk Register assess the effectiveness of systems of internal control and provide assurances that risk management processes are effective. The Governing Body Assurance Framework outlines the CCG’s principal objectives, the significant risks (12+) to achieving those objectives, key controls and assurances, and gaps in controls and assurances. The Corporate Risk Register contains a mixture of strategic and operational risks (8+) at organisational and directorate level as well as the arrangements in place to mitigate these.

The Assurance Framework and Corporate Risk Register is reported at every Governing Body Meeting. The Finance and Performance Committee and Quality and Safety Committee review relevant risks in line with the risk reporting workplan and the Executive Committee reviews risks not reviewed at any other CCG Committee. These Committees escalate significant risks to the Governing Body Assurance Framework as appropriate.

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Staff training and support - A system of trained risk champions has been established in each directorate

responsible for ensuring their department risk registers are managed and updated.

- A list of named departmental risk champions and risk owners has been shared with staff. Risk owners are members of the Executive Team and are accountable for the identification, assessment and management/ mitigation of all risks in their area

- All staff receive mandatory training annually in health, fire & safety, including risk assessment and management, via the CCG’s corporate learning and development programme.

- General awareness raising for staff is also undertaken through staff briefings, induction programmes and inclusion of relevant documents on the intranet.

Risk Assessment Risks are assessed and moderated at the relevant Committees throughout the year using the process set out in the risk management strategy. Directors report to the Governing Body and its committees at each meeting ensuring complete oversight of the CCGs performance. Representatives of the CCG meet regularly with those of other CCGs in North Central London to share best practice and to ensure a collaborative approach across the five CCGs. The CCG meets regularly with NHS England throughout the year to ensure that the CCG is complying with the terms of its licence. These meetings act as an effective review of the CCG and agreed actions from the meetings implemented promptly. Major risks to governance, risk management and internal control in 2016/2017 2016/2017 has been challenging in meeting in-year delivery targets and meeting our statutory financial obligations. In that context, the most significant and enduring risks as of March 2017 are described below.

Identified significant risks (15+) during the financial year and after the year end

Risk Mitigation or closure 1. Failure to maintain long-term financial sustainability.

The CCG delivered its control total for 2016/17 and with the release of the 1% uncommitted reserve, was able to reduce its cumulative deficit from £41.1m to £37.2m. The 2017/18 plan is for £2.1m surplus and for a £9.4m surplus in 2018/19. Key to this is a £22.5m Quality, Innovation, Productivity and Prevention programme in 2017/18.

2. Failure to deliver the 2016/17 control total

The CCG’s 2016/17 in year deficit is £3.8m and cumulative deficit is £37.2m. This is

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No longer 15+ (Currently 8) – approved by F&P on 29th March 2017

an improvement on the planned in year deficit of £7.7m. This is due to the CCG being able to release £3.859m that had previously been set aside per national instruction.

3. Failure to ensure a safe and high qualityservice is commissioned from and deliveredby our providers. (Serious and specificconcerns relating to the quality and safety ofservices at North Middlesex UniversityHospital, London Ambulance Service quality& patient safety concerns and risk to qualityand safety as a result of failure to deliverBarnet, Enfield and Haringey Mental HealthTrust Care Quality CommissionImprovement Plan). Not a finance risk.

Regular monitoring continues at the monthly Care Quality Review Group and the CCG Quality & Safety Committee including system working with associate commissioners, NHS England and NHS Improvement -Improvement plans following regulatory reviews reported to Care Quality Review Group

4. Risk arising from the ability of theSustainability and Transformation PlanBoard to agree governance, processes andplan to deliver North Central LondonSustainability and Transformation Plan. Nota finance risk.

The North Central London Accountable Officer is now in post and reviewing the North Central London Joint Committee governance arrangements.

Monthly Sustainability and Transformation Plan board meetings in place, bringing together the agencies to develop an agreed plan.

Recruitment to key North Central London director roles to support delivery of the Sustainability and Transformation Plan near completion.

5. Risks associated with aligning the STP,Operating Plan, Quality, Innovation,Productivity and Prevention Plans andContracts

Acute contracts for 17/18 and 18/19 are agreed, including QIPP and marginal rates. NCL executive roles all appointed to with the exception of Enfield CCG Chief Operating Officer.

6. Performance and quality risk arising fromnon-delivery of NHS constitutionalstandards

Recovery Action Plans in place with both North Middlesex University Hospital and Royal Free London currently in assurance process.

7. Insufficient community paediatriciancapacity impacting on waiting times andstatutory duties

No longer 15+ (Currently 10) – approved by Finance &Performance on 29th March 2017

The CCG approved additional Paediatrician capacity to meet the statutory 28 day assessment for Looked after Children.

Referrals are triaged based on referral information held by the Multi-Disciplinary Team (MDT) and urgent referrals seen sooner.

Royal Free London running catch up clinics

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for both the Children Development Team and Looked After Children. Associated risk of the delays included on the Royal Free London Risk Register, and Trust are looking to bring waiting times down to the 18 week Referral To Treatment target by May.

Other sources of assurance Internal Control Framework A system of internal control is the set of processes and procedures in place in the CCG to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The CCG Governing Body Assurance Framework assesses the effectiveness of systems of internal control and provides assurances that the CCG’s risk management processes are effective. It is a dynamic document that captures the understanding of the risk environment at any given time. The document outlines the CCG’s strategic objectives, the risks to achieving these objectives, key controls and assurances in place, as well as gaps in controls and assurances and the arrangements in place to mitigate these. Risks go through a regular review cycle as summarised above and outlined in the CCGs Risk Management Strategy. The Governing Body Assurance Framework is available on the CCG website. The CCG Governing Body Assurance Framework and risk management process was reviewed by our Internal Auditors during 2016/17. While the review was positive overall and rated amber green, it identified some management actions to enhance the Governing Body Assurance Framework. These related to providing greater clarity about the timeliness and nature of actions and sources of assurance, making full reference to existing assurances, ensuring that the implementation dates for planned actions are applied consistently. The individual CCG risk owners subsequently reviewed each risk to address these actions. The CCG’s Standing Orders, Scheme of Reservation and Delegation of Powers, Detailed Financial Policies and Standing Financial Instructions also form part of the internal control framework

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Annual audit of conflicts of interest management The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework. Enfield CCG carried out their annual internal audit of conflicts of interest in 2016/17. The audit confirmed that the CCG is generally compliant with NHS England’s statutory guidance on managing Conflicts of Interest. Internal audit concluded that “Taking account of the issues identified, the Governing Body can take reasonable assurance that the controls in place to manage this risk are suitably designed and consistently applied. However, we have identified issues that need to be addressed in order to ensure that the control framework is effective in managing the identified risk(s).” The audit assessed compliance with NHS England guidance in each of the five areas below, and assigned a compliance rating for each;

- Governance arrangements (Partial Compliance) – raised three management actions in relation to this area.

- Registers of interests, gifts and hospitality and procurement decisions (Partial Compliance) – raised two management actions in relation to this area. .

- Decision making processes and contract monitoring (Fully Compliant) – no actions were raised in this area.

- Declarations of interests and gifts and hospitality (Fully Compliant) – no actions were raised in this area.

- Reporting concerns and identifying and managing breaches/ non-compliance (Fully Compliant) – no actions were raised in this area

Areas requiring improvement Internal audit raised three ‘medium’ and two ‘low’ priority management actions in relation to the design and application of the control as follows:

- Conflicts of interest should be considered during the recruitment process, and any declarations made should be clear throughout this process and referred to in the CCG Recruitment and Retention policy, to make it clear of the need to declare interests from the outset. This will be developed with North Central London CCGs.

- Declarations of interest should be considered during all contract monitoring meetings. This has now been completed.

- Part of the NHS England guidance requires that each CCG has three Lay members attending Governing Body meetings. Currently the CCG has two; however it is in the process of setting up a Task and Finish group to address the Conflicts of Interest Action Plan which includes this action.

Breach of Conflicts of Interest (COI) Policy: A COI breach was reported to the CCG Audit Committee on 15 March and this was included as part of the CCG annual submission to NHS England in April 2017.

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Anonymised details of the breach and the proposed action to address this matter have been published on the CCG’s website.

Data Quality

The North East London Commissioning Support Unit provides a business intelligence service to the Clinical Commissioning Group which supports the management of contract and other data and the production of performance information. This service includes data validation and contract challenges which are then reflected in the reported positions.

Information used by the Governing Body and its Committees enables us to carry out our responsibilities and discharge our statutory functions. Information is operational, financial, or relates to performance, quality and patient experience. The Governing Body and its Committees are engaged in a continuous cycle of improvement with regard to the quality of the information received. The reports received have under gone regular review and improvement.

Information Governance

The supplier of our information governance function is the NEL Commissioning Support Unit. The process for managing and controlling risks including relating to data security can be found in the risk section above.

On Friday 12 May 2017 the NHS was one of many national and international organisations to have been targeted in a “ransomware” cyberattack. Forty seven NHS Trusts across England were affected as a result the incident, including several London Trusts.

NHS Enfield Clinical Commissioning Group took immediate action to limit the impact of the ransomeware by shutting down all IT systems as a precautionary measure following advice from NHS Digital. A software “patch” was installed to ensure our IT systems were not vulnerable to the ransomware.

Other actions taken were:

• Trusts in North Central London, which included North Middlesex UniversityHospital and Royal Free London Hospitals, were not directly infected with thevirus. Services continued to run as normal.

• Protective measures were undertaken, as advised regionally and nationally.• The impact on our services from those hospitals that were infected was

handled in line with usual surge management arrangements.• Patients were advised to attend any hospital or GP appointment they had

unless contacted and told not to.

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• The public were encouraged to continue to use the NHS wisely and to seek help and advice from a range of other sources, such as pharmacies; My Health London website: https://www.myhealth.london.nhs.uk/ or call the NHS 111 service by dialling 111.

Enfield CCG’s Information Governance Framework sets the processes and procedures by which we handle information about patients and employees, in particular personal identifiable information. Our Information Governance Framework and associated policies is supported by an information governance toolkit and the annual submission process provides assurances to the Governing Body, other organisations and to the public that personal information is dealt with legally, securely, efficiently and effectively. We place high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. All staff have undertaken annual information governance training to ensure they are aware of their information governance responsibilities. We have submitted a satisfactory level of compliance at level 2 in the 2016/2017 information governance toolkit assessment with improved level 3 scores from last year. As part of the information governance toolkit, we have undertaken an annual data flow mapping, information risk assessment and management procedures and this is reported to the relevant committee. There are processes in place for incident reporting and investigation of serious incidents. We have developed an information risk assessment and management procedures and a programme has been established to fully embed an information risk culture throughout the organisation. The CCG will continue to monitor information governance via its annual Information Governance Toolkit work plan. Business Critical Models The key business critical models on which the Governing Body relies are in-year financial forecasts, medium term financial planning and financial evaluation and forecasting. These models are the responsibility of the Chief Finance Officer and operated by the Finance and Contracts Team and the Programme Management Office. Operation of these models is delegated from the Governing Body to the Finance and Performance Committee. Quality assurance on these models has been sought, and received, by external expert review and the internal audit programme. The supplier of our Information and Communication Technology and Business Intelligence functions is the NEL Commissioning Support Unit. Business critical models in use within Information and Communication Technology are subject to a number of quality assurance processes which link into the overall framework and management commitment to quality. There is transparency and management oversight for models and data sources used to make business critical and strategic decisions, with scrutiny within the Executive committee. Data inputs and outputs are regularly validated, with senior management responsible for an overall ‘sense check’ before decisions are approved.

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Third party assurances The CCG uses a range of mechanisms to assess the effectiveness of third party providers including formal customer-supplier performance oversight arrangements and the use of Service Auditor Reports to review control procedures. The CCG monitors the performance of NEL Commissioning Support Unit against the Service Level Agreement through regular performance meetings and outturn reports. The CCG also uses Internal Audit to provide assurances in respect of third party arrangements.

Control Issues Based on the work Internal Audit have undertaken on the CCG’s system on internal control, they do not consider that within these areas there are any issues that need to be flagged as significant control issues within the Annual Governance Statement (AGS).

Review of economy, efficiency & effectiveness of the use of resources Processes have been put in place to ensure that resources are used economically, efficiently and effectively. At the beginning of the year budgets are scrutinised to ensure they represent an effective use of public funds and are signed off by the Governing Body. The CCG monitors itself on the “Quality of Leadership” indicator through self-assessment. This assessment is informed by a number of factors including, insights from discussions with NHSE, evidence from IAF, quality of board papers, Annual Report & Accounts, governance statement, Organisation Development plans, staff turnover rates, PPE (Strategy & policy), PDR Completion Rate, up-to-date website information about opportunities for involvement. The Quality, Innovation, Performance and Prevention and budget setting processes are reviewed by Internal Audit and reported through the Audit Committee. Best practice is followed in the compilation of business cases to ensure resources are used effectively in the development of new investment ideas. Detailed monthly finance reports with financial and activity data are received by the Finance and Performance Committee with a summary report going to the Governing Body.

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Due to the CCG being financially challenged, significant emphasis is placed on financial planning and in-year performance monitoring with strict controls in place for containing central management costs within caps set by NHSE. Decisions on whether to proceed with QIPP and other projects using the concept of “Best Possible Value” or BPV. The BPV concept aims to balance improvements in outcomes for patients with the need to achieve improved efficiencies.

Delegation of functions

The CCG purchases a range of support functions from NEL Commissioning Support Unit, as mentioned above. A Quality Assurance Group is in place to provide assurance to the CCG on activity undertaken on their behalf. The Group received Assurance Reports issued by the internal auditors on information governance, Information Technology General, Controls, Business Continuity/Disaster Recovery, Procurement and Provider Quality Management. No significant concerns were identified. A report on this assurance work is a standing item at Audit Committee meetings.

Counter fraud arrangements

Anti-fraud work is overseen at the CCG by Chief Finance Officer and Director of Contracts. ECCG have a contract with RSM to provide the services of an accredited Local Counter Fraud Specialist (LCFS) and have a local nominated LCFS lead who carries out anti-fraud work. This is pre agreed for a set number of agreed days as per the LCFS work plan in order to tackle fraud, bribery and corruption in order to ensure that work is proportionate to identified risks. Reactive work on fraud referrals is also undertaken as and when they arise with support from a senior management team at RSM.

The CCG’s Audit Committee receives a report against the Standards for Commissioners at least annually. There is executive support and direction for a proportionate proactive work plan to address identified risks.

In addition, in 2016/17, the CCG was selected for a focused assessment against the requirements of the NHS Protect Standards for Commissioners 2016 -17, fraud, bribery and corruption.

The CCG was assessed for compliance with the following key areas of activity; Strategic Governance and Inform and Involve which consisted of 14 standards in all.

The CCG was assessed as compliant with nine standards, partially compliant with three standards and not compliant with two standards.

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The CCG was compliant overall with the requirements of Strategic Governance and partially compliant overall with the requirements of Inform and Involve. The CCG had two standards rated red, where the organisation was not compliant; these were standards 1.9 and 2.4. Standard 1.9 follows on from the assurance sought in standard 1.8, whereby where a provider has not met the standards the CCG will ensure any recommendations made by them or by NHS Protect following a quality inspection are implemented. The CCG did not have a protocol in place and had not made any recommendations itself, the CCG had not had received any quality inspection reports from NHS Protect. In relation to standard 2.4, the CCG did not have an appropriate code of conduct in place at the time of the assessment which made appropriate reference to fraud, bribery and corruption and the Bribery Act 2010, which covered all staff. Although policies had been drafted to mitigate this risk, they had not yet been adopted.

The CCG is working closely with LCFS to address the recommendations made.

Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that:

The organisation has an adequate and effective framework for risk management, governance and internal control.

However, our work has identified that further enhancements are required to the framework of risk management, governance and internal control to ensure that the framework remains adequate and effective.

During the year, Internal Audit issued the following audit reports:

Area of Audit Level of Assurance Given

GP Provider Network Reasonable Assurance

Procurement Reasonable Assurance

Board Assurance Framework and Risk

Management

Reasonable Assurance

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Financial Governance and Financial

Reporting

Reasonable Assurance

Quality, Innovation, Productivity and

Prevention (QIPP)

Partial Assurance

Better Care Fund Reasonable Assurance

Conflicts of Interest Reasonable Assurance

Continuing Healthcare Partial Assurance

Quality, Innovation, Productivity and Prevention (QIPP) The partial assurance for QIPP related to the largely transactional nature of the QIPP schemes in 2016/17, which in the long term may not be sustainable. The schemes had not been organised in a coherent way and were therefore not effective to deliver the QIPP programme.

Continuing Healthcare The partial assurance was due to a lack of evidence to support three month and annual reviews, lack of process to demonstrate the review and scrutiny of new providers and monitoring of provider quality, service level agreements not signed with all the care providers and a lack of more detailed analysis and reporting of average cost per patient.

Review of the effectiveness of governance, risk management and internal control My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by the external auditors in their annual audit letter and other reports.

Our assurance framework provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving its principles objectives have been reviewed.

I have been advised on the implications of the result of this review by: • Governing Body• Audit committee

52

• CCG Committees responsible for reviewing risks • Internal audit.

The role and conclusions of each are available in the minutes of the Governing Body available on our website.

Conclusion

No significant internal control issues have been identified during the year. However the CCG will continue to work on strengthening the framework for risk management, governance and internal control to ensure the framework remains adequate and affective and supports the achievement of our objectives, policies, and aims.

53

Remuneration and Staff Report Remuneration Report The NHS has adopted the recommendations outlined in the Greenbury report in respect of the disclosure of senior managers’ remuneration and the manner in which it is determined. This report outlines how those recommendations have been implemented by the CCG in the year to 31 March 2017.

Clinical Commissioning Groups are required to have a Remuneration and Nominations Committee to oversee the pay, terms and conditions of service of senior managers. The main function of the Committee is to make recommendations to the Governing Body on the remuneration, allowances and terms of service of other officer members to ensure they are fairly rewarded for their individual contribution to the organisation, having regard for the organisation’s circumstances and performance, and taking into account national arrangements. Enfield CCG’s Constitution sets out that there should be two lay members on the Remuneration and Nominations Committee and that the Governing Body shall appoint the membership of this Committee in consultation with the Chair of the Committee. The members of the Remuneration Committee are as follows:

Teri Okoro (Chair of the Remuneration and Nominations Committee and Lay member for Patient and Public Engagement) Angela Dempsey (Governing Body Nurse Member) Karen Trew (Governing Body Lay member for Governance) Dr Mo Abedi (GP Chair of the Governing Body)

All members have been on the Committee since April 2016.

Remuneration & Nominations Committee

There have been 10 meetings during the financial year 1 April 2016 to 31 March 2017. Four meetings were held with North Central London (NCL) CCG Remuneration Committees for Barnet, Camden, Enfield, Haringey and Islington CCGs meeting at the same time to consider proposals to appoint a number of joint appointments as agreed by all NCL CCGs of Barnet, Camden, Enfield, Haringey and Islington CCGs at their November 2016 Governing Body meetings including the NCL Accountable Officer, Chief Finance Officer, Director of Strategy, Director of Performance & Acute Commissioning and a Chief Operating Officer for each CCG. There have been other meetings to consider specific issues related to approving the above posts.

54

Other highlights from the year include:

• Consideration of Governing Body succession planning, the appointment of GPand non-GP Members on the Governing Body, the desire to staggerappointments to avoid all GP Members stepping down from the CCG at thesame time;

• Consideration of the need for additional lay member representation includingthis being included as part of NHSE Guidance for CCGs around managingconflicts of interest;

• The Committee undertook a review of its effectiveness in March 2017 and theoutcomes were reported to the Audit Committee in March 2017.

Committee attendance for 2016/17 meetings is set out below:

Members

20 A

pril

2016

28 S

ept

2016

10 N

ov

2016

7 D

ec

2016

12 J

an

2017

9 Fe

b 20

17

16 F

eb

2017

23 F

eb

2017

17 M

arch

20

17

29 M

arch

20

17

Sum

mar

y

Teri Okoro (Chair)

Y Y Y Y N Y Y Y Y Y 9/10

Angela Dempsey

Y N N N Y N Y Y Y Y 6/10

Dr Mo Abedi N Y Y Y Y Y Y Y Y Y 9/10

Karen Trew Y Y N Y N N Y Y Y Y 7/10

Attendance 3 3 2 3 2 2 4 4 4 4 31/40 (77%)

During the financial year 2016/17 the Remuneration and Nominations Committee called upon some specialist advice from North and East London Commissioning Support Unit’s Human Resources Business Partner, a service provided as part of the service level agreement between the CCG and North and East London Commissioning Support Unit. This advice covered all aspects of remuneration and terms and conditions of appointments.

Policy on the remuneration of senior managers The Remuneration Committee sets salaries and terms and conditions of service for all Governing Body Members, including clinical members, lay members and the two executive directors (Chief Officer, Chief Finance Officer) on an annual basis in accordance with the CCG’s constitution. All salaries are set with regard to the guidance laid out in NHS England’s Annex 2: Principles relating to reimbursement and remuneration for governing body members April 2012 and also to local benchmarking provided by NELCSU. The executive directors have their pay and terms and conditions of service set in accordance with the NHS Very Senior Manager (VSM) framework and the NHS London Pay Framework for Very Senior Managers in Strategic and Special Health Authorities, Primary Care Trusts and

55

Ambulance Trusts (June 2013). Pay and terms and conditions for other directors who do not sit on the Governing Body are governed by the national Agenda for Change regulations.”

Remuneration of Very Senior Managers

There has been no payment of performance related pay during the year ending 31 March 2017. Future performance related pay for directors will be subject to the terms and conditions of service for very senior managers and will be considered by the remuneration committee. No additional compensation was payable during the year and no amounts are included that are payable to third parties for the services of senior managers. In the event of redundancy standard NHS packages will apply

The CCG has a local ‘pay progression’ policy for staff with Agenda for Change contracts, which requires senior managers with NHS contracts to meet the standards of performance set by the individual’s line manager in order to receive incremental progression increases to pay. No performance related bonuses are paid to any senior managers.

Policy on Senior Managers Contracts

The Chair, GP members and lay members of the Governing Body are all engaged via a contract for services. The duration and other terms of office of these are set in accordance with the CCG’s constitution. Notice periods for governing body members engaged via a contract for services are set at one month. No termination payments are made on expiry of the contract.

Employed senior managers (the Executive Directors and other directors) are all directly employed on permanent contracts and have notice periods of three-six months, unless employed on interim contracts. No payments are made on termination except in circumstances of redundancy.

Senior Managers Service Contracts

Name and Title Date of the Contract

Unexpired term

Notice Period

Provision for early termination

Executive Directors Ms Sarah Thompson 23 May 2016 Fixed term

contract N/A N/A

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Mr Paul Jenkins 10 August 2015 to 30 April 2016

Fixed term contract to 9 August 2016

N/A N/a

Mr Robert Whiteford 17 November 2014

n/a -permanent

6 months Standard redundancy provision

Deborah McBeal 28 July 2015 n/a -permanent

6 months Standard redundancy provision

Other Governing Body Members

Ms Rathai Thevananth, Practice Manager Representative

18 February 2015

11 months 1 month None

Professor Robert Elkeles, Secondary Care Doctor Representative

1 December 2015

1 years 8 months

1 month None

Ms Angela Dempsey, Registered Nurse Member

1 March 2016 2 years 1 month

1 month None

Elected GP members Dr Alpesh Patel, Clinical Vice Chair

1 August 2014 to 31 March 2017

N/A

Dr Janet High, GP Member

1 August 2014

4 months 1 month None

Dr Jarir Amarin, GP Member

1 September 2015

1 years 5 months

1 month None

Dr Chitra Sankaran, GP Member

1 September 2015

1 year 5 months

1 month None

Dr Puvitha Thambinayagam, Interim GP Member

11 November 2015 to 30 June 2016

N/A

Dr Hetul Shah, GP Member

15 February 2016

1 years 11 months

1 month None

Dr Ujjal Sarkar, GP Member

1 August 2014 – December 2016

N/A

Dr Fahim Chowdhury, GP Member

30 October 2016

2 years 7 months

1 month None

Dr Mo Abedi, Chair 1 August 2014 4 months 1 month None Dr Johan Byran 14 November

2016 to 13 March 2017

N/A

Lay members Ms Karen Trew, Lay Vice Chair

1 July 2016 2 years 3 months

1 month None

57

Teri Okoro, Lay Member

1 January 2016 1 years 9 months

1 month None

Contractual arrangements The Chair and Lay Members are appointed by the Governing Body. Their terms of service are set out in the CCG Constitution.

Termination agreements or exit packages Termination arrangements are applied in accordance with statutory regulations as modified by national NHS conditions of service agreements (specified in Agenda for Change), and the NHS pension scheme. Specific termination arrangements will vary according to age, length of service and salary levels. The Remuneration Committee will agree any severance arrangements. These are subject to audit.

58

Name and Title 2016-17 Dates served

Salary (bands of £5,000)

£000

Expense Payments

(taxable) (to the nearest

£100) £000

Performance Pay and Bonuses (bands of

£5000) £000

Long Term Performance

Pay and Bonuses (bands of £5000)

£000

All Pension Related

Benefits (bands of £2,500)

£000

Total Started Ceased

Executive Directors Mr Paul Jenkins - Chief Officer 35 - 4 0 0 0 0 100 - 102.5 135 - 140 10/08/15 30/04/16 Ms Sarah F Thompson-Chief Officer 105 - 110 0 0 0 65 - 67.5 175 - 180 23/05/16 Ms Deborah McBeal - Deputy Chief Officer 105 - 110 0 0 0 77.5 - 80 180 - 185 28/07/15 Mr Rob Whiteford - Chief Financial Officer 120 - 125 0 0 0 0 120 - 125 18/11/14 Ms Aimee Fairbairns - Director of Service Quality and Integrated

Governance. 100 - 105 0 0 0 45 - 47.5 145 - 150 01/04/13

Ms Carole Bruce-Gordon-Acting Director of Service Quality and Integrated Governance. 75 - 80 0 0 0 47.5 - 50 125 - 130 01/01/17

Mr Graham MacDougall - Director of Commissioning 95 - 100 0 0 0 32.5 - 35 130 - 135 01/04/13 Ms Jane Pike - Director of Operations 100 - 105 0 0 0 0 100 - 105 02/01/15 (1) Mike Seitz- Director of Recovery 170-175 0 0 0 0 170-175 04/04/16 02/09/16 (1) Mark Eaton- Director of Recovery 125-130 0 0 0 0 125-130 05/09/16 Medical Director Dr Jahan Mahmoodi - Medical Director 70 -75 0 0 0 0 70 - 75 20/07/15 GP Governing Body Members Dr Mo Abedi - Chair 80 - 85 0 0 0 0 80 - 85 01/08/14 Dr Alpesh Patel - Chair / Clinical vice chair 40 - 45 0 0 0 0 40 - 45 01/08/14 31/03/17 Dr Janet High - Clinical vice chair / GP Member 25 - 30 0 0 0 0 25 - 30 01/04/13 Dr Fahim Chowdhury - GP Member 25 - 30 0 0 0 0 25 - 30 30/10/13 Dr Ujjal Sarkar - GP Member 15 - 20 0 0 0 0 15 - 20 01/04/13 21/12/16 Dr Hetul Shah - GP Member 05 - 10 0 0 0 0 05 - 10 17/02/16 08/08/16 Dr Chitra Sankaran - GP Member 25 - 30 0 0 0 0 25 - 30 02/09/15 Dr Jarir Amarin - GP Member 20 - 25 0 0 0 0 20 - 25 02/09/15 Dr Puvitha Thambinayagam - Governing Body Locality Lead 05 - 10 0 0 0 0 05 - 10 11/11/15 30/06/16 Dr Johan Bryan - Acting GP Member SE Locality 05 - 10 0 0 0 0 05 - 10 16/11/16 15/02/17 Other Governing Body Members Mrs Rathai Thevananth - Practice Manager Member 10 - 15 0 0 0 0 10 - 15 01/04/13 Prof Robert Elkeles - Secondary Care Doctor Member 10 - 15 0 0 0 0 10 - 15 01/04/13 Mrs Angela Dempsey - Nurse Member 10 - 15 0 0 0 0 10 - 15 01/04/13 Lay Members Ms Karen Trew - Lay Member 20 - 25 0 0 0 0 20 - 25 01/04/13 Dr Teri Okoro - Lay Member 10 - 15 0 0 0 0 10 - 15 01/04/13 (1) Paid to agency, not direct to individual, includes VAT and Agency

Fees

Senior manager remuneration (including salary and pension entitlements) The following tables provide the information required. These are subject to audit

59

Name and Title 2015-16 Dates served

Salary (bands of £5,000)

£000

Taxable Benefits (rounded

to the nearest)

£000

Annual Performance

Related Bonuses (bands of

£5000) £000

Long Term Performance

Related Bonuses (bands of £5000)

£000

All Pension Related

Benefits (bands of

£2,500) £000

Total Started Ceased

Executive Directors Mrs Liz Wise - Chief Officer 40 - 45 0 0 0 22.5 - 25 65 - 70 01/04/13 31/07/15 Mr Paul Jenkins - Chief Officer 80 - 85 0 0 0 155 - 157.5 235 -240 10/08/15 Ms Deborah McBeal - Deputy Chief Officer 70 - 75 0 0 0 47.5 - 50 115 - 120 28/07/15 Mr Rob Whiteford - Chief Financial Officer 120 - 125 0 0 0 0 120 - 125 18/11/14 Ms Aimee Fairbairns - Director of Service Quality and Integrated Governance. 100 - 105 0 0 0 7.5 - 10 105 - 110 01/04/13

Mr Graham MacDougall - Director of Commissioning 90 - 95 0 0 0 22.5 - 25 115 - 120 01/04/13 Ms Jane Pike - Director of Operations 100 - 105 0 0 0 0 100 - 105 02/01/15 Medical Director Dr Jahan Mahmoodi - Medical Director 50 - 55 0 0 0 0 50 - 55 20/07/15

GP Governing Body Members Dr Mo Abedi - Chair 80 - 85 0 0 0 0 80-85 01/08/14 Dr Alpesh Patel - Chair / Clinical vice chair 40 - 45 0 0 0 0 40-45 01/08/14 Dr Janet High - Clinical vice chair / GP Member 25 - 30 0 0 0 0 25 - 30 01/04/13 Dr Anshumen Bhagat - GP Member 0 - 5 0 0 0 0 0 - 5 20/09/12 31/05/15 Dr Hardeep Bhupal - GP Member 15 - 20 0 0 0 0 15 - 20 01/08/14 25/11/15 Dr Fahim Chowdhury - GP Member 25 - 30 0 0 0 0 25 - 30 30/10/13 Dr Mike Gocman - GP Member 0 - 5 0 0 0 0 0 - 5 01/04/13 30/04/15 Dr Ujjal Sarkar - GP Member 25 - 30 0 0 0 0 25 - 30 01/04/13 Dr Hetul Shah - GP Member 0 - 5 0 0 0 0 0 - 5 17/02/16 Dr Chitra Sankaran - GP Member 15 - 20 0 0 0 0 15 - 20 02/09/15 Dr Jarir Amarin - GP Member 10 - 15 0 0 0 0 10 - 15 02/09/15 Dr Puvitha Thambinayagam - Governing Body Locality Lead 5 - 10 0 0 0 0 5 - 10 11/11/15 30/06/17

Other Governing Body Members Mrs Rathai Thevananth - Practice Manager Member 10 - 15 0 0 0 0 10 - 15 01/04/13 Prof Robert Elkeles - Secondary Care Doctor Member 10 - 15 0 0 0 0 10 - 15 01/04/13 Mrs Angela Dempsey - Nurse Member 10 - 15 0 0 0 0 10 - 15 01/04/13

Lay Members Ms Karen Trew - Lay Member 20 - 25 0 0 0 0 20 - 25 01/04/13 Dr Teri Okoro - Lay Member 10 - 15 0 0 0 0 10 - 15 01/04/13

60

Pension benefits as at 31 March 2017

Name and Title

Real increase /decreas

e in pension

at pension

age (bands

of £2500)

Real increase

/decrease in related lump sum at pension

age (bands of £2500)

Total accrued pension

at pension age at

31 March 2017

(bands of

£5000)

Total accrued related

lump sum at pension age at 31

March 2017

(bands of £5000)

Cash Equivalent Transfer

Value (CETV) at 31 March

2017

Cash Equivalent Transfer

Value (CETV) at 31 March

2016

Real increase /

decrease in Cash

Equivalent Transfer

Value

£000 £000 £000 £000 £000 £000 £000 Board Members

Mr Paul Jenkins - Chief Officer 0 - 2.5 0 - 2.5 40 - 45 125 – 130 825 718 9

Ms Sarah F Thompson - Interim Chief Officer 2.5 - 5 7.5 - 10 35 - 40 115 – 120 863 817 39

Ms Deborah McBeal - Deputy Chief Officer 2.5 - 5 12.5 - 15 20 - 25 60 – 65 359 286 73 Ms Aimee Fairbairns - Director. of Service Quality & Integrated Governance. 2.5 - 5 7.5 - 10 25 - 30 80 – 85 531 466 65

Ms Carole Bruce-Gordon - Acting Director of Quality & Integrated Governance. 0 - 2.5 0 - 2.5 30 - 35 90 – 95 588 554 8

Mr Graham MacDougall - Director of Commissioning 0 - 2.5 5 - 7.5 30 - 35 90 – 95 598 541 58

As Lay/Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members.

The Pensions Related Benefits (PRB) figure is calculated using the method set out in the Finance Act 2004(1), and includes using the member's current and prior year pension and lump sum figures. Where there has been only a small increase in pension and lump sum benefits current year compared to last year, this formula can sometimes generate a negative figure. Where this is the case, Department of Health guidance states that a "zero" should be substituted for any negative figures. These benefits are subject to audit.

Pension benefits as at 31 March 2016

Name and Title

Real increase

/decrease in

pension at

pension age

(bands of £2500)

Real increase

/decrease in related lump sum

at pension

age (bands of £2500)

Total accrued pension

at pension

age at 31 March 2016

(bands of £5000)

Total accrued related

lump sum at

pension age at 31

March 2016

(bands of £5000)

Cash Equivalent Transfer

Value (CETV) at 31 March

2016

Cash Equivalent Transfer

Value (CETV) at 31 March

2015

Real increase / decrease in Cash

Equivalent Transfer

Value

£000 £000 £000 £000 £000 £000 £000 Board Members

Mrs Liz Wise - Chief Officer 0 - 2.5 0 - 2.5 25 - 30 85 - 90 675 632 12

Mr Paul Jenkins - Chief Officer 2.5 - 5 12.5 - 15 40 - 45 120 - 125 762 599 100 Ms Aimee Fairbairns - Director of Service Quality & Integrated Governance. 0 - 2.5 2.5 - 5 20 - 25 70 - 75 466 438 22

Mr Graham MacDougall - Director. of Commissioning 0 - 2.5 2.5 - 5 25 - 30 80 - 85 541 501 34

Ms Deborah Mc Beal - Deputy Chief Officer 0 - 2.5 0 - 2.5 15 - 20 45 -50 305 261 28

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Cash Equivalent Transfer Values (CETVs)

A cash equivalent transfer value is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme.

A cash equivalent transfer value is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

The cash equivalent transfer value figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. Cash equivalent transfer values are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real increase in Cash Equivalent Transfer Value This reflects the increase in CETV effectively funded by the employer. It does not include the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

Compensation on early retirement of for loss of office

No significant awards or payments have been made during the financial year 2016/17. These are subject to audit.

Payments to past members

No significant awards or payments have been made during the financial year 2016/17. These are subject to audit.

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Pay multiples

Reporting bodies are required to disclose the relationship between the remuneration of the highest paid member in their organisation and the median remuneration of the organisation’s workforce.

The banded remuneration of the highest paid member in Enfield CCG in the financial year 2016/17 was £130k-135k (2015/16: £125k-£130k). This was 2.97 times (2015/16: 3.54) the median remuneration of the workforce, which was £44,182 (2015/16: £36,000).

In 2016/17, 2 employees received remuneration in excess of the highest-paid member. Remuneration ranged from £0-5k to £285k-290k (2015/2016: £0-5k to £125k-130k). The increase in the upper range is due to the CCG engaging a high cost interim providing highly specialised skills for a short period of time (23 days). The effect of annualising suggest an annual salary of £285k, however the total spend in 2016/17 was only £46k. If we were to remove this ‘outlier’ the upper range would revert to £140k - £145k.

Total remuneration includes salary, non-consolidated performance-related pay, benefits-in-kind, but not severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions.

Where the CCG have employed interim senior managers via an agency, there has been an adjustment for the pay multiples calculation to remove agency commission (10%) and VAT (20%).

These are subject to audit.

Expenditure on consultancy

In 2016/17, the CCG spent £33.9k on external consultancy costs.

Off-payroll engagements longer than 6 months For all off-payroll engagements as at 31 March 2017, for more than £220 per day and that last longer than six months:

Number

Number of existing engagements as of 31 March 2017 18

Of which, the number that have existed:

for less than one year at the time of reporting 13

for between one and two years at the time of reporting 3

for between 2 and 3 years at the time of reporting 1

for between 3 and 4 years at the time of reporting 1

63

for 4 or more years at the time of reporting 0

All existing off-payroll engagements have, though their line manager been subject to

a risk based assessment to confirm that the individual is paying the right amount of

tax and, where necessary, assurance has been sought.

New off-payroll engagements For all new off-payroll engagements between 01 April 2016 and 31 March 2017, for more than £220 per day and that last longer than six months:

Number

Number of new engagements, or those that reached six months in

duration, between 1 April 2016 and 31 March 2017 13

Number of new engagements which include contractual clauses

giving Enfield CCG the right to request assurance in relation to

income tax and National Insurance obligations

8

Number for whom assurance has been requested 8

Of which:

assurance has been received 7

assurance has not been received 1

engagements terminated as a result of assurance not being

received. 0

Off-payroll engagements / senior official engagements Details of any off-payroll engagements of Board members and / or senior officials with significant financial responsibility, between 01 April 2016 and 31 March 2017 is given below:

Number of off-payroll engagements of board members, and/or

senior officers with significant financial responsibility, during

the financial year

2

Total no. of individuals on payroll and off-payroll that have

been deemed “board members, and/or, senior officials with

significant financial responsibility”, during the financial year.

This figure should include both on payroll and off-payroll

engagements.

26

64

Exit packages, including special (non-contractual) payments Exit Packages

Exit package cost band (Inc. any special payment element

Number of compulsory redundancies

Cost of compulsory redundancies

Number of other departures agreed

Cost of other departures agreed

Total number of exit packages

Total cost of exit packages

Number of departures where special payments have been made

Cost of special payment element included in exit packages

WHOLE NUMBERS ONLY

£s WHOLE NUMBERS ONLY

£s WHOLE NUMBERS ONLY

£s WHOLE NUMBERS ONLY

£s

Less than £10,000 0 0 0 0 0 0 0 0

£10,000 - £25,000 0 0 0 0 0 0 0 0

£25,001 - £50,000 0 0 1 £25,500 0 0 0 0

£50,001 - £100,000 0 0 0 0 0 0 0 0

£100,001 - £150,000 0 0 0 0 0 0 0 0

£150,001 –£200,000 0 0 0 0 0 0 0 0

>£200,000 0 0 0 0 0 0 0 0

TOTALS 0 0 1 £25,500 0 0 0 0

Redundancy and other departure cost have been paid in accordance with the provisions of the NHS Scheme name. Exit costs in this note are accounted for in full in the year of departure. Where the Enfield CCG has agreed early retirements, the additional costs are met by the Enfield CCG and not by the NHS Pensions Scheme. Ill-health retirement costs are met by the NHS Pensions Scheme and are not included in the table. These are subject to audit.

65

Analysis of Other Departures

Agreements Total Value of agreements

Number £000s Voluntary redundancies including early retirement contractual costs

0 £0

Mutually agreed resignations (MARS) contractual costs

0 £0

Early retirements in the efficiency of the service contractual costs

0 £0

Contractual payments in lieu of notice* 1 £25.5

Exit payments following Employment Tribunals or court orders

0 £0

Non-contractual payments requiring HMT approval** 0 £0

TOTAL 1 £25.5

As a single exit package can be made up of several components each of which will be counted separately in this Note, the total number above will not necessarily match the total numbers in Note 4 which will be the number of individuals.

*any non-contractual payments in lieu of notice are disclosed under “non-contractedpayments requiring HMT approval” below.

**includes any non-contractual severance payment made following judicial mediation, and X (list amounts) relating to non-contractual payments in lieu of notice.

No non-contractual payments were made to individuals where the payment value was more than 12 months’ of their annual salary.

The Remuneration Report includes disclosure of exit packages payable to individuals named in that Report.

Staff sickness absence and ill health retirements 2016-17 Number

Total Days Lost 949 Total Staff Years 87 Average working Days Lost 10.9 Period covered: January to December 2016

66

Sickness absence figures are provided by the Department of Health and cover the calendar year.

Average Annual Sick Days per Full Time Equivalent (FTE) has been estimated by dividing the estimated number of FTE-days sick by the average FTE, and multiplying by 225 (the typical number of working days per year).

Losses and special payments The total number of NHS Clinical Commissioning Group losses and special payments cases, and their total value, was as follows:

Losses

Total Number of Cases

Total Value of Cases

Total Number of Cases

Total Value of Cases

2016-17 2016-17 2015-16 2015-16

Number £'000 Number £'000

Administrative write-offs 0 0 1 621 Fruitless payments 0 0 0 0 Store losses 0 0 0 0 Book Keeping Losses 0 0 0 0 Constructive loss 0 0 0 0 Cash losses 0 0 0 0 Claims abandoned 0 0 0 0 Total 0 0 1 621

Special payments

Total Number of Cases

Total Value of Cases

Total Number of Cases

Total Value of Cases

2016-17 2016-17 2015-16 2015-16

Number £'000 Number £'000

Compensation payments 0 0 0 0 Extra contractual Payments 1 25 0 0 Ex gratia payments 0 0 0 0 Extra statutory extra regulatory payments 0 0 0 0 Special severance payments 0 0 0 0 Total 1 25 0 0

67

Employee benefits

Employee benefits 2016-17

2016-17 Total Admin Programme

Total Permanent Employees Other Total Permanent

Employees Other Total Permanent Employees Other

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Employee Benefits Salaries and wages 5,722 4,386 1,335 2,855 2,180 675 2,867 2,207 660 Social security costs 492 492 0 266 266 0 225 225 0 Employer Contributions to NHS Pension scheme 525 525 0 253 253 0 272 272 0 Other pension costs 0 0 0 0 0 0 0 0 0 Other post-employment benefits 0 0 0 0 0 0 0 0 0 Other employment benefits 0 0 0 0 0 0 0 0 0 Termination benefits 0 0 0 0 0 0 0 0 0 Gross employee benefits expenditure 6,738 5,403 1,335 3,375 2,699 675 3,364 2,704 660

Less recoveries in respect of employee benefits (27) (27) 0 (27) (27) 0 0 0 0 Total - Net admin employee benefits including capitalised costs 6,711 5,376 1,335 3,347 2,672 675 3,364 2,704 660

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 Net employee benefits excluding capitalised costs 6,711 5,376 1,335 3,347 2,672 675 3,364 2,704 660

68

Employee benefits 2015-16

Employee benefits 2015-16 Total Admin Programme

Total Permanent Employees Other Total Permanent

Employees Other Total Permanent Employees Other

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Employee Benefits Salaries and wages 6,317 4,237 2,079 3,023 1,916 1,107 3,293 2,321 972 Social security costs 404 404 0 206 206 0 197 197 0 Employer Contributions to NHS Pension scheme 524 524 0 231 231 0 292 292 0 Termination benefits 16 16 0 16 16 0 0 0 0 Gross employee benefits expenditure 7,260 5,181 2,079 3,477 2,370 1,107 3,783 2,811 972

Less recoveries in respect of employee benefits 0 0 0 0 0 0 0 0 0 Total - Net admin employee benefits including capitalised costs 7,260 5,181 2,079 3,477 2,370 1,107 3,783 2,811 972

Less: Employee costs capitalised 0 0 0 0 0 0 0 0 0 Net employee benefits excluding capitalised costs 7,260 5,181 2,079 3,477 2,370 1,107 3,783 2,811 972

These are subject to audit. Details of staff numbers are given on page 69.

69

Staff Report Gender breakdown of Governing Body Members at 31 March 2017 GB Member Category Male Female

Elected 6 3

Appointed 3 4

Non-Voting 3 3

Total 10 10

Gender breakdown of all Senior Managers including managers at Very Senior Manager grade At 31 March 2017, there are 2 male and 4 female Senior Managers (Directors)/Very Senior Managers. Very Senior Manager (VSM) information At the 31 March 2017, there are 3 Senior Managers at the CCG who are on a Very Senior Manager (VSM) grade. Senior Manager Information At the 31 March 2017, there are 3 Senior Managers at the CCG who are on band 9. All other employees At 31st March 2017 there are 88 employees at the CCG consisting of 64 female and 24 male staff members. These figures exclude the VSM, Senior Managers (band 9) and agency/contractor workers.

Pay Group Female Male Grand Total Internal

Secondment External Secondment

Band 3 10 3 13 Band 4 6 6 Band 5 7 3 10 Band 6 3 3 Band 7 12 2 14 Band 8a 7 6 13 Band 8b 8 6 14 1 Band 8c 7 3 10 1 Band 8d 4 1 5 Grand Total 64 24 88 1 1

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Staff Sickness Absence The average sickness absence rate for 2016-2017 (01 April 2016 – 28 February 2017) was 10.9 annual sick days. The Governing Body has oversight of the workforce statistics which includes sickness absence. The Governing Body receives assurance from the Finance and Performance Committee on the management of sickness absence, which is included in the monthly Integrated Performance and Quality Report. CCG managers are managing all sickness absence in line with the sickness absence policy. This includes referral to occupational health for advice and support where needed.

Staff policies The CCG is committed to equality of opportunity for all employees and is committed to employment practices, policies and procedures which ensure that no employee, or potential employee receives less favourable treatment on the grounds of their protected characteristics as outlined in the Equality Act 2010 and the CCG HR policies reflect the public sector equality duty and the need to show ‘due regard’ to it. As the CCG has gone through some major changes in 2016/17, the impact of these changes were thoroughly analysed to ensure there would be no unintended negative consequences on staff from protected groups (e.g. disability).

The CCG operates a fair and objective system for recruiting, which places emphasis on individual skills, abilities and experience. This enables a full diversity of people to demonstrate their ability to do a job. The recruitment and selection policy illustrates the steps recruiting managers need to take if an applicant declares themselves as disabled. Reasonable steps are taken to ensure all disabled applicants are treated fairly which includes making adjustments in terms of interviewing venue, selection and aptitude tests. Training was provided to managers involved in recruitment and selection which also covered unconscious bias.

During 2016/17 the CCG continued its commitment to following the requirements of “Positive about Disabled People/2 Tick” accreditation. Regular communication with the occupational health advisers continues to review how we positively support staff with their health and well-being whilst in employment. The selection criteria contained within the job descriptions and person specifications are regularly reviewed to ensure that they are justifiable and so do not unfairly discriminate directly or indirectly and are essential for the effective performance of the role. The CCG offers a guaranteed interview scheme for disabled applicants who meet the essential selection criteria.

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Parliamentary Accountability and Audit Report Enfield CCG is not required to produce a Parliamentary Accountability and Audit Report. Disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges are included as notes in the Financial Statements of this report at page 66. An audit certificate and report is given on page 72.

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INDEPENDENT AUDITOR’S REPORT TO THE MEMBERS OF THE GOVERNING BODY OF NHS ENFIELD CLINICAL COMMISSIONING GROUP

We have audited the financial statements of NHS Enfield Clinical Commissioning Group (the CCG) for the year ended 31 March 2017 under the Local Audit and Accountability Act 2014. The financial statements comprise the Statement of Comprehensive Net Expenditure, the Statement of Financial Position, the Statement of Changes in Taxpayers’ Equity, the Statement of Cash Flows and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2016-17 Government Financial Reporting Manual (the 2016-17 FReM) as contained in the Department of Health Group Accounting Manual 2016-17 (the 2016-17 GAM) and the Accounts Direction issued by the NHS Commissioning Board with the approval of the Secretary of State as relevant to the National Health Service in England (the Accounts Direction).

We have also audited the information in the Remuneration and Staff Report that is described in that report as having been audited.

This report is made solely to the members of the Governing Body of NHS Enfield CCG, as a body, in accordance with part 5 of the Local Audit and Accountability Act 2014 and as set out in paragraph 43 of the Statement of Responsibilities of Auditors and Audited Bodies published by Public Sector Audit Appointments Limited. Our audit work has been undertaken so that we might state to the members of the Governing Body of the CCG those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the CCG and the members of the Governing Body of the CCG, as a body, for this report, or for the opinions we have formed.

Respective responsibilities of the Accountable Officer and auditor

As explained more fully in the Statement of Accountable Officer’s Responsibilities, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income in accordance with the Code of Audit Practice prepared by the Comptroller and Auditor General as required by the Local Audit and Accountability Act 2014 (the "Code of Audit Practice").

As explained in the Governance Statement, the Accountable Officer is responsible for the arrangements to secure economy, efficiency and effectiveness in the use of the CCG's resources. We are required under Section 21(1)(c) of the Local Audit and Accountability Act 2014 to be satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Section 21(5)(b) of the Local Audit and Accountability Act 2014 requires that our report must not contain our opinion if we are satisfied that proper arrangements are in place.

We are not required to consider, nor have we considered, whether all aspects of the CCG’s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively.

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Scope of the audit of the financial statements

An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of:

• whether the accounting policies are appropriate to the CCG’s circumstances and have beenconsistently applied and adequately disclosed;

• the reasonableness of significant accounting estimates made by the Accountable Officer; and• the overall presentation of the financial statements.

In addition, we read all the financial and non-financial information in the annual report and accounts to identify material inconsistencies with the audited financial statements and to identify any information that is apparently materially incorrect based on, or materially inconsistent with, the knowledge acquired by us in the course of performing the audit. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

In addition, we are required to obtain evidence sufficient to give reasonable assurance that the expenditure and income recorded in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources

We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General in November 2016, as to whether the CCG had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people. The Comptroller and Auditor General determined this criterion as that necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the CCG put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017.

We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the CCG had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.

Opinion on financial statements

In our opinion the financial statements:

• give a true and fair view of the financial position of NHS Enfield CCG as at 31 March 2017 andof its net operating expenditure for the year then ended; and

• have been properly prepared in accordance with the Health and Social Care Act 2012 and theAccounts Direction issued thereunder.

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Qualified opinion on regularity arising from non-compliance with governing authorities

The CCG has reported the following breaches in its financial performance targets in Note 17 to the financial statements:

Target performance £000

Actual performance £000

(Excess) £000

Expenditure not to exceed income 365,120 402,361 (37,241)

Revenue resource use does not exceed the amount specified in Directions

362,752 399,993 (37,241)

Except for the incurrence of expenditure in excess of total income and also in excess of the specified resource limit, in our opinion, in all material respects the expenditure and income reported in the financial statements have been applied to the purposes intended by Parliament and the financial transactions conform to the authorities which govern them.

Opinion on other matters

In our opinion:

• the parts of the Remuneration and Staff Report to be audited have been properly prepared inaccordance with the Annual Report Directions made under the National Health Service Act2006 (as amended by the Health and Social Care Act 2012); and

• the other information published together with the audited financial statements in the annualreport and accounts is consistent with the financial statements.

Matters on which we report by exception

Use of resources

The National Audit Office’s Code of Audit Practice requires us to report to you if we are not satisfied that the CCG has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. Our assessment of arrangements is made by reference to the overall criterion: In all significant respects, the audited body had proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people.

Basis for qualified opinion

The CCG has reported an in-year deficit of £3.8m (2015/16: £14.4m deficit), resulting in a cumulative deficit of £37.2m in the year ended 31 March 2017, thereby breaching its duty under the National Health Service Act 2006, as amended by paragraphs 223I (2) and (3) of Section 27 of the Health and Social Care Act 2012, to break even on its commissioning budget. This position is reflected in the table above supporting our qualified Regularity opinion.

Progress has been made during the year in addressing the underlying deficit in its budget, reflected by the reduction of in-year deficit from £14.4m in 2015/16 to £3.8m in 2016/17 and positive performance against a stretching savings target of £17.2m, successfully delivering £13.6m.

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However, the reduced deficit was also supported by the release back to the CCG at the year end of “top-sliced” funding of £3.9m.

The CCG has planned for a £2.1m in-year surplus in 2017/18 and a £9.4 surplus in 2018/19, but will remain in cumulative deficit at the end of these two years. The position for 2017/18 requires achievement of a significant savings target of £25.9m, notably in excess of both the target and achievement in 2016/17.

Consequently, there remain material uncertainties in the CCG’s financial position and ability to return to financial balance in the medium term. This issue is evidence of weaknesses in proper arrangements for planning finances effectively to support the sustainable delivery of strategic priorities and maintain statutory functions.

Qualified conclusion

On the basis of our work, having regard to the guidance issued by the Comptroller and Auditor General in November 2016, with the exception of the matter reported in the basis for qualified conclusion paragraph above, we are satisfied that, in all significant respects, the CCG has put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2017.

Referral to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014

We are required to report to you if we refer a matter to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 because we have reason to believe that the CCG, or an officer of the CCG, is about to make, or has made, a decision which involves or would involve the body incurring unlawful expenditure, or is about to take, or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency.

We issued a referral to the Secretary of State under section 30 of the Local Audit and Accountability Act 2014 on 30 May 2017 in respect of breaches of the CCG’s financial performance targets.

Other matters on which we are required to report by exception

We are required to report to you if:

• in our opinion the Governance statement does not comply with the guidance issued by the NHSCommissioning Board; or

• we issue a report in the public interest under section 24 of the Local Audit and AccountabilityAct 2014; or

• we make a written recommendation to the CCG under section 24 of the Local Audit andAccountability Act 2014.

We have nothing to report in these respects.

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Certificate

We certify that we have completed the audit of the accounts of NHS Enfield CCG in accordance with the requirements of the Local Audit and Accountability Act 2014 and the Code of Audit Practice.

David Eagles

For and on behalf of BDO LLP, Appointed Auditor

Ipswich, UK

31 May 2017

BDO LLP is a limited liability partnership registered in England and Wales (with registered number OC305127).

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ANNUAL ACCOUNTS Financial position in 2016/17

Our financial plan for 2016/17 was a year-end cumulative deficit of £41.1m. We improved on this by being able to release a further £3.8m into the position thus reducing the deficit to £37.2m.

As set out in the 2016/17 NHS Planning Guidance, CCGs were required to hold a 1 percent reserve uncommitted from the start of the year, created by setting aside the monies that CCGs were otherwise required to spend non-recurrently. This was intended to be released for investment in Five Year Forward View transformation priorities to the extent that evidence emerged of risks not arising or being effectively mitigated through other means.

In the event, the national position across the provider sector has been such that NHS England has been unable to allow CCGs’ 1% non-recurrent monies to be spent. Therefore, to comply with this requirement, Enfield CCG has released its 1% reserve to the bottom line, resulting in an additional surplus for the year of £3.9 This additional surplus has been offset against the cumulative deficit from previous years/offset against other cost pressures from the current financial year/will be carried forward for drawdown in future years.

This year was one of critical financial stabilisation following an exceptionally difficult preceding year. This has been achieved through the delivery of a challenging Quality, Innovation, Productivity and Prevention (QIPP) plan, improved contract management and improved financial governance. The CCG planned a QIPP programme of £17.2m and successfully delivered £13.6m.

Whilst this represents a significant improvement we must now move quickly to financial balance in future years.

2016/17 Expenditure

The largest area of expenditure, which is also the most difficult to control, is acute care expenditure. Our major providers of acute care are the Royal Free London NHS Foundation Trust and North Middlesex University Hospital. Both are on “Payment by Results” contracts, which mean we pay on the numbers of patients using the services at a nationally agreed price.

Although the absolute number of outpatients reduced, we saw a higher proportion of “first” appointments. These are charged at a higher price than follow up appointments, causing an increase in expenditure for the CCG. Elective (planned) admissions rose by 1.6%, whilst non-elective admissions (unplanned) rose by 4% reflecting the increasing demand for these services.

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The number of attendances at accident and emergency departments rose by 0.8%.

Our other areas of expenditure are less volatile; however the careful management of these to within small tolerances of plan represents a considerable financial achievement in 2016/17.

What we spent in 2016/17

In 2016/17, Enfield CCG spent £399.8m on commissioning healthcare for Enfield residents. This comprised:

• £236.1m on Acute care• £51.4m on Mental Health services• £38.7m on Primary Care Prescribing• £24.3m on Community Services• £18.8m on Continuing Healthcare• £30.7m on Other (including Primary Care)

Actual Expenditure for 2016/17 2016/17 £k

Available Resource 362,752 Acute services 236,144 Mental Health Services 51,367 Community Health Services 24,289 Continuing Care Services 18,819 Prescribing 38,710 Other Programme Services 19,487 Primary Care 4,099 Running Costs 7,077 Total Expenditure 399,993 Surplus/ (deficit) (37,241) Brought forward deficit (33,399) In year surplus/ (deficit) (3,842)

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Our expenditure is shown in the pie chart below:

The requirement to deliver sustainable finances for 2017/18 and beyond is extremely challenging for Enfield CCG.

In order to deliver the planned surplus of £2.1m for 2017/18 the CCG must save £22.5m. This is an extremely ambitious target and must be considered high risk.

All local NHS organisations are committed to achieving financial balance and the local health economy works together to deliver this as described previously on page 6, this being addressed by our Sustainability and Transformation Plan.

What we plan to spend in 2017/18

In 2017/18, Enfield CCG are planning a total spend of £402.8m as detailed in the table below (‘5 Year Plan’).

Primary Care 1%

Prescribing 10%

Acute Care 59%

Mental Health 12%

Learning Disabilities 1%

End of Life Care 0%

Community Services

6%

Continuing Care 5%

Running Costs Allowance

2%

Other Programme Costs

4%

2016/17 Expenditure

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Planned Expenditure for 2017/18 2017/18 £k

Available Resource 367,680 Acute services 242,959 Mental Health Services 50,151 Community Health Services 24,560 Continuing Care Services 19,800 Prescribing 37,788 Other Programme Services 17,131 Primary Care 3,337 Running Costs 7,095 Total Planned Expenditure 402,821 Planned Surplus/ (deficit) (35,141) Brought forward deficit (37,241) Planned In year surplus/ (deficit) 2,100

The pie chart below provides this information as a percentage of total spend.

Primary Care 1%

Prescribing 9%

Acute Care 60%

Mental Health 12%

Learning Disabilities

1%

End of Life Care 0%

Community Services

6%

Continuing Care 5%

Running Costs Allowance

2%

Other Programme Costs

4%

2017/18

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As in 2016/17, the CCG will spend the largest proportion of its resources on providing services in acute care. Other material areas of expenditure are Mental Health, Prescribing, Community Services and Continuing Care.

Sarah F Thompson,

Accountable Officer for Enfield CCG for 2016-17

30 May 2017

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Data entered below will be used throughout the workbook:

Entity name: NHS Enfield Clinical Commissioning GroupThis year 2016-17Last year 2015-16This year ended 31-March-2017Last year ended 31-March-2016This year commencing: 01-April-2016Last year commencing: 01-April-2015

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

Page Number

The Primary Statements:

Statement of Comprehensive Net Expenditure for the year ended 31st March 2017 85Statement of Financial Position as at 31st March 2017 86Statement of Changes in Taxpayers' Equity for the year ended 31st March 2017 87Statement of Cash Flows for the year ended 31st March 2017 88

Notes to the Accounts1. Accounting policies 892. Employee benefits and staff numbers 923. Operating expenses 944. Better payment practice code 945. Operating leases 956. Trade and other receivables 957. Cash and cash equivalents 968. Trade and other payables 969. Provisions 96

10. Contingencies 9611. Commitments 9712. Financial instruments 9713. Pooled budgets 9814. Risk Share 9915. Related party transactions 10016. Events after the reporting period 10417. Financial performance targets 104

CONTENTS

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

Statement of Comprehensive Net Expenditure for the year ended31 March 2017

2016-17 2015-16Note £'000 £'000

Total Income and ExpenditureIncome from sale of goods and services (2,278) (2,357)Other operating income (90) (298)Total operating income (2,368) (2,655)

Employee benefits 2 6,738 7,260Operating Expenses 3 395,241 389,297Other Operating Expenditure 3 382 999Total Operating Expenditure 402,361 397,556

Net operating expenditure & Total Comprehensive net expenditure for the year 399,993 394,901

The notes on pages 5 to 19 form part of this statement

The CCG made an in-year deficit (before allowing for cumilative deficit reflected in the financial performance in note 17) of £3.8m in 2016/17. (2015/16: deficit of £14.4m).

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

Statement of Financial Position as at31 March 2017

Note £'000 £'000Current assets:Trade and other receivables 6 4,448 4,211Cash and cash equivalents 7 284 280Total current assets 4,732 4,490

Current liabilitiesTrade and other payables 8 (36,581) (53,758)Total current liabilities (36,581) (53,758)

Assets less liabilities (31,849) (49,268)

Financed by Taxpayers’ EquityGeneral fund (31,849) (49,268)Total taxpayers' equity: (31,849) (49,268)

The notes on pages 5 to 19 form part of this statement

Sarah F ThompsonAccountable Officer for Enfield CCG for 2016/17

The financial statements on pages 1 to 19 were approved by the Audit Committee on 24 May 2017 and signed on its behalf by:

31 March 2017

31 March 2016

86

NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

Statement of Changes In Taxpayers Equity for the year ended31 March 2017

General fund£'000

Changes in taxpayers’ equity for 2016-17

Balance at 01 April 2016 (49,268)

Net operating expenditure for the financial year (399,993)

Net funding 417,412

Balance at 31 March 2017 (31,849)

General fund£'000

Changes in taxpayers’ equity for 2015-16

Balance at 01 April 2015 (35,511)Net operating costs for the financial year (394,901)

Net funding 381,144

Balance at 31 March 2016 (49,268)

The notes on pages 5 to 19 form part of this statement

Financial Performance:During 2016/17 NHS Enfield CCG received Revenue Resource Limit funds of £362,752,000 (£361,502,000 2015/16) and incurred expenditure of £399,993,000 (£394,901,000 2015/16). This resulted in a cumulative deficit for the year of £37,241,000 (£33,399,000 deficit 2015/16).

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

Statement of Cash Flows for the year ended31 March 2017

2016-17 2015-16Note £'000 £'000

Cash Flows from Operating ActivitiesNet operating expenditure for the financial year (399,993) (394,901)(Increase)/decrease in trade & other receivables 6 (237) (1,007)Increase/(decrease) in trade & other payables 8 (17,178) 15,012Net Cash Inflow (Outflow) from Operating Activities (417,408) (380,896)

Cash Flows from Financing ActivitiesGrant in Aid Funding Received 417,412 381,144Net Cash Inflow (Outflow) from Financing Activities 417,412 381,144

Net Increase (Decrease) in Cash & Cash Equivalents 7 4 248

Cash & Cash Equivalents at the Beginning of the Financial Year 280 32

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 284 280

The notes on pages 5 to 19 form part of this statement

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

Notes to the financial statements

1 Accounting Policies

NHS England has directed that the financial statements of clinical commissioning groups shall meet the accounting requirements of the Group Accounting Manual issued by the Department of Health. Consequently, the following financial statements have been prepared in accordance with the Group Accounting Manual 2016-17 issued by the Department of Health. The accounting policies contained in the Group Accounting Manual follow International Financial Reporting Standards to the extent that they are meaningful and appropriate to clinical commissioning groups, as determined by HM Treasury, which is advised by the Financial Reporting Advisory Board. Where the Group Accounting Manual permits a choice of accounting policy, the accounting policy which is judged to be most appropriate to the particular circumstances of the clinical commissioning group for the purpose of giving a true and fair view has been selected. The particular policies adopted by the clinical commissioning group are described below. They have been applied consistently in dealing with items considered material in relation to the accounts.

1.1 Going ConcernThese accounts have been prepared on the going concern basis (despite the issue of a report to the Secretary of State for Health under Section 30 of the Local Audit and Accountability Act 2014).Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.Where a clinical commissioning group ceases to exist, it considers whether or not its services will continue to be provided (using the same assets, by another public sector entity) in determining whether to use the concept of going concern for the final set of Financial Statements. If services will continue to be provided the financial statements are prepared on the going concern basis.

1.2 Accounting ConventionThese accounts have been prepared under the historical cost convention.

1.3 Financial Transformation and Risk Share

All Clinical Care Groups are required to budget for a contingency and to set aside a proportion of their overall resource limit for non-recurrent uses. The purpose of this note is to provide a disclosure of the financial transformation and risk-share arrangement which is operated across the CCGs in North Central London.

In 2016-17, to contribute to the health system risk management, HM Treasury stipulated that all commissioning organisations must ensure that 1% non-recurrent spend (as required by the business rules) was fully uncommitted at the start of the financial year. Approval for spending of the 1% non-recurrent monies during the year would be subject to approval by HM Treasury. By commissioning organisations not committing their 1% monies this created c. £800m of additional headroom to mitigate financial risk.

As a result of the requirement to set aside 1% uncommitted, the CCG did not contribute into the NCL risk share and other NCL CCGs were not able to contribute as much as in previous years.

In 2015-16, the risk-share provided financial coverage for both the transformation of healthcare services and in-year financial risks. In 2016/17, the risk share provided coverage for the Royal Free transaction costs and to cover a shortfall in the CCGs Quality Innovation Productivity and Prevention delivery.

The financial statements for 2016-17 include relevant contributions and receipts relating to the risk-share for Enfield CCG. In particular, Note 14, which sets out the financial performance of the CCG in 2016-17, reflects income and expenditure relating to the risk-share.

The overall level of funding received by the CCG from the risk-share in 2016-17 was £3.6m. The key areas of application of these monies included as follows:

· Royal Free Transaction costs £2.7m· Shortfall in QIPP delivery £0.9m

There is a firm commitment from each CCG in NCL to operate a similar transformation and risk-share arrangement for the medium term. This will be overseen by the NCL management team and single Accountable Officer and Chief Finance Officer, and therefore should aid the facilitation of the fund going forward. The collaboration through the transformation and risk-share pool is seen by both the CCGs and NHS England as an important mechanism for both providing a necessary source of funding to facilitate the transformation of local health services and managing financial risk across the local health economy.

1.4 Critical Accounting Judgements & Key Sources of Estimation Uncertainty

In the application of the clinical commissioning group’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

1.5 Critical Judgements in Applying Accounting Policies

The following are the critical judgements, apart from those involving estimations (see below) that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

NHS Property Services/Community Health Partnerships Properties

Under IFRIC 4 the CCG recognises the need to account for payments to NHS Property Services Limited and Community Health Partnerships Limited as a lease arrangement. The indications of a lease include an arrangement comprising a transaction or a series of related transactions, that does not take the legal form of a lease but conveys a right to use an asset in return for a payment or series of payments.

Even though there is no formal contract in place, the transactions involved do convey the right of the CCG to use property assets. As such these transactions are being accounted for as an operating lease in accordance with IAS 17.

1.6 Key Sources of Estimation Uncertainty

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

Notes to the financial statements

The following are the key estimations that management has made in the process of applying the clinical commissioning group’s accounting policies that have the most significant effect on the amounts recognised in the financial statements:

Partially completed spellsExpenditure relating to patient care spells that are part-completed at the year-end are apportioned across the financial years on the basis of length of stay at the end of the reporting period compared to expected total length of stay OR costs incurred to date compared to total expected costs. The estimated balance at 31st March 2017 is £ 2,824,024 (£1,564,357 2016).

Accruals

For goods and/or services that have been delivered but for which no invoice has been received/sent, the CCG makes an accrual based on the contractual arrangements that are in place and its legal obligation. See trade and other payables Note 8.

Prescribing liabilities

NHS England actions monthly cash charges to the CCG for prescribing contracts. These are issued approximately two months in arrears. The CCG uses a forecast based on previous in year charges by the NHS Business Authority to estimate the full year expenditure. The estimated balance at 31st March 2017 is £5,812,131 (£6,351,738 2016).

Maternity pathways

Expenditure relating to all antenatal maternity care is made at the start of a pathway. As a result at the year-end part completed pathways at treated as a prepayment. The CCG agrees to use the figures calculated by the local Providers. The estimated balance at 31st March 2017 is £ 2,134,124 (£1,844,452 2016).

1.7 Employee Benefits

1.7.1 Short-term Employee Benefits

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees, including bonuses earned but not yet taken.The cost of leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

1.7.2 Retirement Benefit Costs

Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, General Practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the clinical commissioning group of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability for the additional costs is charged to expenditure at the time the clinical commissioning group commits itself to the retirement, regardless of the method of payment.

1.8 Other ExpensesOther operating expenses are recognised when, and to the extent that, the goods or services have been received. They are measured at the fair value of the consideration payable.

1.9 Leases - Operating Leases- CCG as lessee

Operating lease payments are recognised as an expense on a straight line basis over the lease term. Contingent rentals are recognised as an expense in the period in which they are incurred.

1.10 Cash & Cash Equivalents

Cash is cash in hand and deposits with any financial institution repayable without penalty on notice of not more than 24 hours. Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.In the Statement of Cash Flows, cash and cash equivalents are shown net of bank overdrafts that are repayable on demand and that form an integral part of the clinical commissioning group’s cash management.

1.11 Continuing healthcare risk pooling

In 2014-15 a risk pool scheme was been introduced by NHS England for continuing healthcare claims, for claim periods prior to 31 March 2013. Under the scheme clinical commissioning group contribute annually to a pooled fund, which is used to settle the claims. In 2016/17 the CCG contributed £232,000 (2015-16 £581,000). y g p

1.13 Financial AssetsFinancial assets are recognised when the clinical commissioning group becomes party to the financial instrument contract or, in the case of trade receivables, when the goods or services have been delivered. Financial assets are derecognised when the contractual rights have expired or the asset has been transferred.All financial assets are classified as loans and receivables.

The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.1.14 Financial Liabilities

Financial liabilities are recognised on the statement of financial position when the clinical commissioning group becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received. Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

All the CCGs financial liabilities are classified as other financial liabilities. Other financial liabilities are measured at amortised cost.

1.15 Value Added Tax

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Notes to the financial statements

Most of the activities of the clinical commissioning group are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.

1.16 Losses & Special PaymentsLosses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had the clinical commissioning group not been bearing its own risks (with insurance premiums then being included as normal revenue expenditure).

1.17 Accounting Standards That Have Been Issued But Have Not Yet Been Adopted

The Government Financial Reporting Manual does not require the following Standards and Interpretations to be applied in 2016-17, all of which are subject to consultation:· IFRS 9: Financial Instruments ( application from 1 January 2018)· IFRS 15: Revenue for Contract with Customers (application from 1 January 2018)· IFRS 16: Leases (application from 1 January 2019)The requirements of these new standards are being analysed to determine if they could have a material impact on the accounts.

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2. Employee benefits and staff numbers

2.1.1 Employee benefits 2016-17 2015-16Total Total£'000 £'000

Employee BenefitsSalaries and wages 5,721 6,316Social security costs 492 404Employer Contributions to NHS Pension scheme 525 524Termination benefits 0 16Gross employee benefits expenditure 6,738 7,260Less recoveries in respect of employee benefits (27) 0Total - Net admin employee benefits including capitalised c 6,711 7,260

Included within the above are termination benefits totaling £25,528 (£16,000 2015/16)

2.1.2 Average number of people employed2016-17 2015-16Number Number

Total 123 115

2.2 Pension costs

b) Full actuarial (funding) valuation

Past and present employees are covered by the provisions of the NHS Pension Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/Pensions.

Both are unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The Scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities.

Therefore, the Scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS body of participating in each Scheme is taken as equal to the contributions payable to the Scheme for the accounting period.

a) Accounting valuation

A valuation of scheme liability is carried out annually by the scheme actuary (currently the Government Actuary’s Department) as at the end of the reporting period. This utilises an actuarial assessment for the previous accounting period in conjunction with updated membership and financial data for the current reporting period, and are accepted as providing suitably robust figures for financial reporting purposes. The valuation of scheme liability as at 31 March 2017, is based on valuation data as 31 March 2016, updated to 31 March 2017 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used. The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts. These accounts can be viewed on the NHS Pensions website and are published annually. Copies can also be obtained from The Stationery Office.

The purpose of this valuation is to assess the level of liability in respect of the benefits due under the schemes (taking into account their recent demographic experience), and to recommend contribution rates payable by employees and employers.

The last published actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2012. The Scheme Regulations allow for the level of contribution rates to be changed by the Secretary of State for Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as deemed appropriate.

In order that the defined benefit obligations recognised in the financial statements do not differ materially from those that would be determined at the reporting date by a formal actuarial valuation, the FReM requires that “the period between formal valuations shall be four years, with approximate assessments in intervening years”. An outline of these follows:

92

The next actuarial valuation is to be carried out as at 31 March 2016. This will set the employer contribution rate payable from April 2019 and will consider the cost of the Scheme relative to the employer cost cap. There are provisions in the Public Service Pension Act 2013 to adjust member benefits or contribution rates if the cost of the Scheme changes by more than 2% of pay. Subject to this ‘employer cost cap’ assessment, any required revisions to member benefits or contribution rates will be determined by the Secretary of State for Health after consultation with the relevant stakeholders.

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3. Operating expenses2016-17 2015-16

Total Total£'000 £'000

Gross employee benefitsEmployee benefits excluding governing body members 5,876 6,604Executive governing body members 862 656Total gross employee benefits 6,738 7,260

Other costsServices from other CCGs and NHS England 4,672 5,561Services from foundation trusts 102,504 106,450Services from other NHS trusts 185,801 177,555Services from other WGA bodies (3) 0Purchase of healthcare from non-NHS bodies 60,118 55,615Chair and Non Executive Members 382 387Supplies and services – clinical 741 1,503Supplies and services – general 310 26Consultancy services 33 589Establishment 399 599Transport 6 61Premises 1,170 1,428Impairments and reversals of receivables 0 621Audit fees * 76 76Other non statutory audit expenditure· Other services 0 0Prescribing costs 38,107 38,411GPMS/APMS and PCTMS 0 153Other professional fees excl. audit 243 162Education and training 831 527CHC Risk Pool contributions 232 581Other expenditure (0) (9)Total other costs 395,622 390,296

Total operating expenses 402,360 397,556

4. Better Payment Practice CodeMeasure of compliance

Number £'000Non-NHS PayablesTotal Non-NHS Trade invoices paid in the Year 9,990 69,202Total Non-NHS Trade Invoices paid within target 9,350 61,837Percentage of Non-NHS Trade invoices paid within target 93.59% 89.36%

NHS PayablesTotal NHS Trade Invoices Paid in the Year 3,354 311,455Total NHS Trade Invoices Paid within target 3,129 302,663Percentage of NHS Trade Invoices paid within target 93.29% 97.18%

Number £'000Non-NHS PayablesTotal Non-NHS Trade invoices paid in the Year 10,293 57,929Total Non-NHS Trade Invoices paid within target 9,644 47,645Percentage of Non-NHS Trade invoices paid within target 93.69% 82.25%

NHS PayablesTotal NHS Trade Invoices Paid in the Year 3,300 282,392Total NHS Trade Invoices Paid within target 2,980 274,234Percentage of NHS Trade Invoices paid within target 90.30% 97.11%

2016-17

2015-16

* The fee to the CCG's external auditors, BDO LLP, is £63,600 excluding VAT. Thefigure shown in the note above includes irrecoverable VAT at 20%.

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

5. Operating Leases

As lesseePayments recognised as an Expense 2016-17 2015-16

Buildings Other Total Total£'000 £'000 £'000 £'000

Payments recognised as an expenseMinimum lease payments 1,094 19 1,113 1,336Total 1,094 19 1,113 1,336

6. Trade and other receivables Current Current

£'000 £'000NHS receivables: Revenue 1,267 1,615NHS prepayments * 2,134 1,884NHS accrued income 821 244Non-NHS and Other WGA receivables: Revenue 96 2,172Non-NHS and Other WGA prepayments 0 253Non-NHS and Other WGA accrued income 98 46Provision for the impairment of receivables 0 (2,041)VAT 32 38Total Trade & other receivables 4,448 4,211

Included above:Prepaid NHS Maternity Pathway Funding * 2,134 1,884WGA above refers to Whole of Government Accounts

6.1 Receivables past their due date but not impaired

£'000 £'000By up to three months 495 501By three to six months 119 22By more than six months 68 6Total 682 529

6.2 Provision for impairment of receivables

£'000 £'000Balance at 01 April 2016 (2,041) (2,436)

Amounts written off during the year 2,041 1,016(Increase) decrease in receivables impaired 0 (621)Balance at 31 March 2017 0 (2,041)

Receivables are provided against at the following rates:NHS debt 0% 100%

The great majority of trade is with NHS England. As NHS England is funded by Government to provide funding to Clinical Commissioning Groups to commission services, no credit scoring of them is considered necessary.

£46,368 of the amount above has subsequently been recovered post the statement of financial position date.

31 March 2016

31 March 2017

31 March 2017

31 March 2016

31 March 2017

31 March 2016

31 March 2017

31 March 2016

The Clinical Commissioning Group occupies property owned and managed by Community Health Partnerships Ltd and /or NHS Property Services Ltd. For 2016/17, a transitional occupancy rent based on annual property cost allocations was agreed. This is reflected in note 6.1.1 above.

Whilst our arrangements with Community Health Partnership's Limited and NHS Property Services Limited fall within the definition of operating leases, rental charge for future years has not yet been agreed. Consequently this note does not include future minimum lease payments.

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7. Cash and cash equivalents

2016-17 2015-16£'000 £'000

Balance at 01 April 2016 280 32Net change in year 4 248Balance at 31 March 2017 284 280

Made up of:Cash with the Government Banking Service 284 280

Current Current

£'000 £'000NHS payables: revenue 9,784 22,203NHS accruals 2,404 5,595Non-NHS and Other WGA payables: Revenue 13,086 12,094Non-NHS and Other WGA accruals 10,965 13,578Social security costs 72 61Tax 70 65Other payables and accruals 200 162Total Trade & Other Payables 36,581 53,758

Total current and non-current 36,581 53,758

9. Provisions

10. Contingencies

Contingent Liability

8. Trade and other payables

Under the Accounts Direction issued by NHS England on 12 February 2014, NHS England is responsible for accounting for liabilities relating to NHS Continuing Healthcare claims relating to periods of care before establishment of the clinical commissioning group. However, the legal liability remains with the CCG. The total value of legacy NHS Continuing Healthcare provisions accounted for by NHS England on behalf of this CCG at 31 March 2017 is £0 (£510,000 at 31st March 2016).

Other payables include £81k outstanding pension contributions at 31 March 2017 (£89k 31 March 2016)

NCL wide commissioning arrangements consultation concluded in April 2017. Potential redundancies identified for as part of this consultation are 1 VSM post with estimated cost of £33,333.35.

31 March 2017

31 March 2016

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11. Commitments

11.1 Other financial commitments

2016-17 2015-16£'000 £'000

In not more than one year 1,871 0In more than one year but not more than five years 7,151 0Total 9,022 0

12. Financial instruments

12.1 Financial risk management

12.1.1 Currency risk

12.1.2 Credit risk

12.1.3 Liquidity risk

Because the majority of the NHS Clinical Commissioning Group and revenue comes parliamentary funding, NHS Clinical Commissioning Group has low exposure to credit risk. The maximum exposures as at the end of the financial year are in receivables from customers, as disclosed in the trade and other receivables note.

NHS Clinical Commissioning Group is required to operate within revenue and capital resource limits, which are financed from resources voted annually by Parliament. The NHS Clinical Commissioning Group draws down cash to cover expenditure, as the need arises. The NHS Clinical Commissioning Group is not, therefore, exposed to significant liquidity risks.

The NHS Clinical Commissioning Group has entered into non-cancellable contracts (which are not leases, private finance initiative contracts or other service concession arrangements) which expire as follows:

Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities.

Because the Clinical Commissioning Group is financed through parliamentary funding, it is not exposed to the degree of financial risk faced by business entities. Also, financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The clinical commissioning group has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the clinical commissioning group in undertaking its activities.

Treasury management operations are carried out by the finance department, within parameters defined formally within the NHS Clinical Commissioning Group standing financial instructions and policies agreed by the Governing Body. Treasury activity is subject to review by the NHS Clinical Commissioning Group and internal auditors.

The NHS Clinical Commissioning Group is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The NHS Clinical Commissioning Group has no overseas operations. The NHS Clinical Commissioning Group and therefore has low exposure to currency rate fluctuations.

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12.2 Financial assets - Loans and Receivables

Total Total

£'000 £'000Receivables:· NHS 2,088 1,859· Non-NHS 194 2,219Cash at bank and in hand 284 280Other financial assets 0 0Total 2,566 4,358

12.3 Financial liabilities

Other Total

£'000 £'000Payables:· NHS 12,187 27,799· Non-NHS 24,252 25,834Total 36,439 53,633

13. Pooled budgets

2016-17 2015-16£'000 £'000

Income 0 0Expenditure (9,151) (9,923)

31 March 2017

31 March 2016

The NHS Clinical Commissioning Group shares of the income and expenditure handled by the pooled budget in the financial year were:

There is joint working between the CCG and the local authority to agree and monitor the use of the funds. The contracting arrangements in place in practice do not constitute a joint operation under IFRS 11 Joint Arrangements. The CCG is considered to be operating as a single entity in this regard and has therefore correctly accounted for its transactions on a gross basis.

31 March 2017

31 March 2016

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14. Risk Share

The key areas of application were as follows:2016-17 2015-16

£000 £000Primary Care Strategy 0 1,134Londonwide Transformation 0 787Mental Health Transformation 0 900Overal CCG Spend 0 2,300Royal Free Transaction costs 2,700 0Shortfall in QIPP delivery 900 0

3,600 5,121

In 2016/17, the fund was used to cover the Royal Free transaction costs and shortfall in QIPP delivery. The CCG did not contribute to the fund in 2016/17 and were net beneficiaries of £3.6m.

As part of the authorisation process for Clinical Commissioning Groups CCGs were advised to work collaboratively where possible. Therefore it was agreed to continue this arrangement within the five North Central London CCGs. In 2015/16 this arrangement was known as the Transformation Investment Fund.

In 2015/16, the Transformation Investment Fund provided financial coverage for both the transformation of healthcare services and in-year financial risks. The financial statements for 2015/16 include relevant contributions and receipts for Enfield CCG. This note sets out the income and expenditure relating to the Transformation Investment Fund.

The CCG contributed £1m in 2015/16. The overall level of funding received by the CCG from the risk-share in 2015/16 was £5.6m. The key areas of application were as follows:

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15. Related party transactions - 2016-17

The transactions listed below are in relation to interests declared, other than those relating to member general practices.

Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£'000 £'000 £'000 £'000

Barndoc Healthcare Ltd 1,695 14 - 2

DR Hetul Shah Ltd 8 - - -Enfield Health Partnership Ltd 701 - - -Enfield Healthcare Alliance Ltd 91 - - -Medicare Medical Services LLP 668 - - -

Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£'000 £'000 £'000 £'000

Abernethy House Surgery 100 - - -Angel Surgery 9 - - -Arnos Grove Medical Centre 5 - - -Bincote Road Surgery 19 - - -Boundary House Surgery Boakye Cowley Jones 17 - - -Bowes Medical Centre 32 - - -Brick Lane Surgery 15 - - -Bush Hill Park Medical Centre 6 - - -Carlton House Surgery 55 - - -Cockfosters Medical Centre 42 - - -Connaught Surgery 19 - - -Curzon Avenue Surgery 9 - 1 -Dean House Surgery 10 - - -Dover House GP Practice 22 - - -Dr H Shah 10DR ME Silvers Practice 7 - - -Eagle House Surgery Enfield 82 - - -East Enfield Medical Practice 9 - - -Edmonton GP Health centre 454Enfield Island Surgery 4 - - -Evergreen PCC 86 - - -Forest Group Practice 98 - 7 -Freezywater Primary Care Centre 53 - - -Gillan House Surgery 48 - - -Green Cedars GP Surgery 5 - - -Green Lanes Surgery 121 - 3 -Green Street Surgery 5 - - -Grovelands Road Medical Centre 34 - - -Haverstock Healthcare Ltd 187 - - -Highlands Practice 50 - 3 -Keats Surgery 17 - - -Latymer Road Surgery 15 - - -Lincoln Road Medical Practice 26 - 1 -Moorfield Road Health Centre 8 - - -Morecambe Surgery 20 - - -Nightingale House Surgery 33 - - -Oakwood Medical Centre N14 4AQ 39 - - -Park Lodge Medical Centre 39 - - -Rainbow Practice 20 - - -Riley House Surgery 29 - 1 -Southbury Surgery 18 - - -Southgate Surgery 37 - 6 -The Bounces Road Surgery 86 - 1 -The North London Health Centre 35 - - -Town Surgery 12 - - -

Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.

The members of Enfield Clinical Commissioning Group are contained within Appendix B of the constitution. Where payments have been made to these practices, these are listed below. The majority of the payments are in relation to agreed locally enhanced services and some prescribing costs.

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Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£'000 £'000 £'000 £'000

Trinity Avenue Surgery 5 - - -White Lodge Medical Practice 51 - 6 -Willow House Surgery 20 - - -Woodberry Practice 81 - 6 -

Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£'000 £'000 £'000 £'000

NHS England 233 422 28 744NHS Haringey CCG 108 558 - 376NHS Islington CCG 260 367 3 259NHS North & East London CSU 4,729 55 457 49Barking, Havering & Redbridge University Hospitals NHS Trust 272 - - 137Barnet, Enfield & Haringey Mental Health NHS Trust 56,724 115 1,867 47Barts Health NHS Trust 7,247 - 74 -Central London Community Healthcare NHS Trust 459 - 47 -East & North Hertfordshire NHS Trust 374 - 253 -Imperial College Healthcare NHS Trust 1,244 - 486 -London Ambulance Service NHS Trust 11,878 - 451 -London North West Healthcare NHS Trust 735 - 202 -North Middlesex University Hospital NHS Trust 99,122 - 1,482 1,254Royal National Orthopaedic Hospital NHS Trust 1,832 - - 60The Princess Alexandra Hospital NHS Trust 523 - 195 -The Whittington Hospital NHS Trust 4,763 - - 249Camden & Islington NHS Foundation Trust 349 - 4 -Central & North West London NHS Foundation Trust 878 - 24 -Chelsea And Westminster Hospital NHS Foundation Trust 346 - 348 -Chesterfield Royal Hospital NHS Foundation Trust 1 - - -Great Ormond Street Hospital for Children NHS Foundation Trust 966 - 73 -Guy's & St Thomas' NHS Foundation Trust 1,704 - 400 -Homerton University Hospital NHS Foundation Trust 2,298 - 467 -King's College Hospital NHS Foundation Trust 356 - 63 -Moorfields Eye Hospital NHS Foundation Trust 4,252 - 63 -North East London NHS Foundation Trust 191 - 148 -Royal Brompton & Harefield NHS Foundation Trust 313 - - 102Royal Free London NHS Foundation Trust 71,825 - 2,091 677South London & Maudsley NHS Foundation Trust 468 - 36 -The Royal Marsden NHS Foundation Trust 304 - 143 -University College London Hospitals NHS Foundation Trust 16,633 - 1,709 133Health Education England -203 689 - 70NHS Property Services 840 1 85 -

Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£'000 £'000 £'000 £'000

HM Revenue and Customs Trust Statement 491 - - -National Health Service Pension Scheme 525 - - -Enfield London Borough Council 14,284 75 9,577 72

The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. A de minimis limit of £250k has been applied in reporting these figures.

In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Local Authorities or HMRC. A de minimis limit of £250k has ben applied in reporting these figures.

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15.1 Related party transactions - 2015-16

Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£000 £000 £000 £000

Barndoc Healthcare Ltd 1,405 15 -19 2Dr Hetul Shah Ltd 7 - 1 -Enfield Health Partnership Ltd 638 - - -Enfield Healthcare Alliance Ltd 320 - - -Medicare Medical Services Llp 450 - 41 -

Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£000 £000 £000 £000

Abernethy House 66 - - -Angel Surgery 10 - - -Angel Surgery 10 2 - -Arnos Grove Medical Centre 2 - - -Bincote Road Surgery 23 - - -Bounces Road Surgery 75 - - -Boundary House Surgery Boakye Cowley Jones 20 - - -Bowes Medical Centre 106 - - -Brick Lane Surgery 14 - - -Bush Hill Park Medical Centre 8 - - -Carlton House Surgery 49 - 10 -Chalfont Road Surgery 7 2 1 2Cockfosters Medical Centre 15 - - -Connaught Surgery 22 - - -Curzon Avenue Surgery 14 - 1 -Dean House Surgery 10 - - -Dover House Gp Practice 23 3 - 3Eagle House Surgery Enfield 55 - 1 -East Enfield Medical Practice 12 - - -Edmonton Medical Centre 11 - 4 -Enfield Island Surgery 11 - 2 -Evergreen Pcc 121 - 2 -Freezywater Primary Care Centre 64 - - -Gillan House Surgery 52 - - -Green Cedars Gp Surgery 13 - - -Green Street Surgery 6 - - -Grovelands Road Medical Centre 24 - - -Highlands Practice 35 - 2 -Keats Surgery 22 - - -Latymer Road Surgery 16 - - -Lincoln Road Medical Practice 39 - 2 -Moorfield Road Health Centre 7 - - -Morecambe Surgery 19 - - -Nightingale House Surgery 36 - - -North London Health Centre 29 - - -Oakwood Medical Centre London 24 - - -Park Lodge Medical Centre 12 - - -Rainbow Practice 19 - - -Riley House Surgery 26 - - -Southbury Surgery 15 - - -Southgate Surgery 37 - - -Town Surgery 11 - - -Trinity Avenue Surgery 9 - - -White Lodge Medical Practice 44 - - -Willow House Surgery 16 - - -Winchmore Practice 24 -4 1 -Woodberry Practice 67 - 1 -

Clinical commissioning groups are clinically led membership organisations made up of general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.

The members of Enfield Clinical Commissioning Group are contained within Appendix B of the constitution. Where payments have been made to these practices, these are listed below. The majority of the payments are in relation to agreed locally enhanced services and some prescribing costs.

The transactions listed below are in relation to interests declared, other than those relating to member general practices.

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Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£000 £000 £000 £000

NHS England 642 487 62 760NHS Haringey CCG 828 330 615 318NHS North & East London CSU 4,560 24 325 24Barking, Havering & Redbridge University Hospitals NHS Trust 259 - 4 -Barnet, Enfield & Haringey Mental Health NHS Trust 56,176 140 2,004 38Barts Health NHS Trust 5,597 - 1,538 -Central London Community Healthcare NHS Trust 452 - 39 -East & North Hertfordshire NHS Trust 444 - 263 -Imperial College Healthcare NHS Trust 939 - 304 -London Ambulance Service NHS Trust 10,849 - 283 -London North West Healthcare NHS Trust 621 - 85 -North Middlesex University Hospital NHS Trust 94,613 - 3,646 1,299Royal National Orthopaedic Hospital NHS Trust 2,002 - 32 -The Princess Alexandra Hospital NHS Trust 443 - 186 -The Whittington Hospital NHS Trust 4,193 - 347 81Non Contracted Activity (NCA) Accruals and unassigned part-completed episodes 83 - 608 -Camden & Islington NHS Foundation Trust 327 - 332 -Central & North West London NHS Foundation Trust 1,167 - 167 -Chelsea And Westminster Hospital NHS Foundation Trust 335 - -1 4Great Ormond Street Hospital for Children NHS Foundation Trust 860 - 96 -Guy's & St Thomas' NHS Foundation Trust 1,368 - 140 -Homerton University Hospital NHS Foundation Trust 1,941 - 232 -King's College Hospital NHS Foundation Trust 350 - 262 -Moorfields Eye Hospital NHS Foundation Trust 3,835 - 83 -Royal Brompton & Harefield NHS Foundation Trust 468 - 118 -Royal Free London NHS Foundation Trust 79,383 - 12,790 396St George's University Hospitals NHS Foundation Trust 236 - 176 -University College London Hospitals NHS Foundation Trust 14,528 - 1,847 108Health Education England 195 447 203 50NHS Property Services 1,228 3 1,351 2National Health Service Pension Scheme 523 - - -

Payments to Related Party

Receipts from

Related Party

Amounts owed to Related

Party

Amounts due from Related

Party£000 £000 £000 £000

Enfield London Borough Council 15,485 860 7,586 2,119HM Revenue and Customs Trust Statement 434 - - -

The Department of Health is regarded as a related party. During the year the clinical commissioning group has had a significant number of material transactions with entities for which the Department is regarded as the parent Department. A de minimis limit of £250k has been applied in reporting these figures.

In addition, the clinical commissioning group has had a number of material transactions with other government departments and other central and local government bodies. Most of these transactions have been with Local Authorities or HMRC. A de minimis limit of £250k has ben applied in reporting these figures.

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NHS Enfield Clinical Commissioning Group - Annual Accounts 2016-17

16. Events after the end of the reporting period

17. Financial performance targets

NHS Clinical Commissioning Group have a number of financial duties under the NHS Act 2006 (as amended).NHS Clinical Commissioning Group performance against those duties was as follows:

2016-17 2016-17 2016-17 2016-17

Target Performance

Actual Performance

Surplus / (Deficit)

Duty Achieved

£000 £000 £000 Yes/NoExpenditure not to exceed income 365,120 402,361 (37,241) NoCapital resource use does not exceed the amount specified in Directions

0 0 0 Yes

Revenue resource use does not exceed the amount specified in Directions

362,752 399,993 (37,241) No

Capital resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 Yes

Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 Yes

Revenue administration resource use does not exceed the amount specified in Directions 7,076 7,076 0 Yes

2015-16 2015-16 2015-16 2015-16Target

PerformanceActual

PerformanceSurplus / (Deficit)

Duty Achieved

£000 £000 £000 Yes/NoExpenditure not to exceed income 364,158 397,557 (33,399) No

Capital resource use does not exceed the amount specified in Directions

0 0 0 Yes

Revenue resource use does not exceed the amount specified in Directions

361,502 394,901 (33,399) No

Capital resource use on specified matter(s) does not exceed the amount specified in Directions

0 0 0 Yes

Revenue resource use on specified matter(s) does not exceed the amount specified in Directions 0 0 0 Yes

Revenue administration resource use does not exceed the amount specified in Directions 7,019 6,999 20 Yes

NHS England recently announced details of the Clinical Commissioning Groups approved to take on greater delegated responsibility or to jointly commission GP services from 1 April 2017. The new primary care co-commissioning arrangements are part of a series of changes set out in the NHS Five Year Forward View

Enfield CCG has been approved under delegated commissioning arrangements which mean that the CCG will assume full responsibility for contractual GP performance management, budget management and the design and implementation of local incentive schemes from 1 April 2017.

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