nw london ccgs’ governing bodies meeting-in-common

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NW London CCGs’ Governing Bodies meeting-in-common

Of Brent, Central London, Ealing, Hammersmith & Fulham, Harrow,

Hillingdon, Hounslow and West London CCGs

DRAFT MINUTES

Of the virtual meeting held in public on

Wednesday 25 November 2020 from 15.00–17.00hrs via MS Teams

Governing Body Members Present:

Brent CCG

Alex Johnstone, Lay Member

Central London CCG

Andrew McCall, Lay Member

Jahan Mahmoodi, Elected - Clinical Director

Diana Middleditch, Lay Member

Jonathan Timperley, Secondary Care

Jane Hawdon, Secondary Care

Ketana Halai, Elected - Clinical Director

Mona Vaidya, Elected - Vice Chair

Lindsey Wishart, Lay Member Neville Purssell, Elected - Chair

Lyndsey Williams, Elected - Clinical Director

Niamh McLaughlin, Elected - GP Member

Madhukar C Patel, Elected - Chair Philip Young, Lay Member

Nicholas Young, Lay Member Simon Gordon, Elected - GP Member Shazia Siddiqi, Elected - Vice Chair

Sheik Auladin Officer, Managing Director

Ealing CCG

Alex Fragoyannis, Elected - GP Member

Hammersmith & Fulham CCG

Andy Petros, Secondary Care

Angad Saluja, Elected - GP Member

Bruno Meekings, Lay Member

Annet Gamell, Lay Member Imogen Spencer, Lay Member

Carmel Cahill, Lay Member James Cavanagh, Elected - Chair

Fionnuala O'Donnell, Practice Manager

Janet Cree Officer, Managing Director

Martin Lees, Secondary Care Nick Martin, Lay Member

Mohini Parmar, Elected - Chair Philip Young, Lay Member

Philip Young, Lay Member Pritpal Ruprai, Elected - GP Member

Sally Armstrong, Local Nurse Smitha Addala, Elected - GP Member

Shanker Vijayadeva, Elected - GP Member

Vanessa Andreae, Elected - Vice Chair

Tara-Lee Baohm/ Neha Unadkat Officer - Acting Joint Managing Directors (sharing one vote)

Vicki Cooney, Elected - GP Member

Vijay Tailor Elected - Vice Chair

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Harrow CCG

Alihusein Dhankot, Elected - Clinical Director

Hillingdon CCG


Genevieve Small, Elected - Chair Allison Seidlar, Lay Member

Himagauri Kelshiker, Elected - Clinical Director

Angela Joseph, Elected - GP Member

Hiten Shah, Lay Member Caroline Morison, Officer - Managing Director

Javina Sehgal, Officer - Managing Director

Ian Goodman, Elected - Chair

Laurence Hommel, Elected - Clinical Director

John Riordan, Secondary Care

Muhammad Shahzad, Elected - Vice Chair

Kuldhir Johal, Elected - Vice Chair

Radhika Balu, Elected - Clinical Director

Mayur Nanavati, Elected - GP Member

Richard Smith, Lay Member Mitch Garsin, Elected - GP Member

Alex Johnstone, Lay Member Sarah Crowther, Lay Member

Sandy Gupta, Secondary Care Stephen Vaughan-Smith Elected - GP Member Steven Shapiro, Elected - GP Member

Hounslow CCG

Amit Gupta, Elected – GP Member

West London CCG


Andy Petros, Secondary Care Ali Al-Rufaie, Elected - GP Member

Annabel Crowe, Elected - Chair Andrew Steeden, Elected - Chair

Brigitte Unger-Graeber, Elected - Vice Chair

Edward Farrell, Elected - GP Member

Clive Chalk, Lay Member Imran Sajid, Elected - GP Member

Fabio Conti, Elected - GP Member Jane Hawdon, Secondary Care

Gurcharan Salotera, Elected - GP Member

Karen Rydings, Practice Manager

Parmod Luthra, Elected - GP Member

Louise Proctor, Officer - Managing Director

Philip Young, Lay Member Oisin Brannick, Elected - Vice Chair (job share with Yvonne)

Raquel Delgado, Elected - GP Member

Philip Young, Lay Member

Richard Baxter, Elected - GP Member

Puvana Rajakulendran, Elected - GP Member

Susan Roostan, Officer - Managing Director

Rachael Garner, Elected - Vice Chair

Trevor Woolley, Lay Member Sonia Richardson, Lay Member

Victoria Stark, Lay Member

Yvonne Fraser, Practice Manager (job share with Oisin)

NWL

Jo Ohlson, Officer - Accountable Officer

Diane Jones, Officer - Chief Nurse

Stephen Bloomer, Officer – Chief Finance Officer (CFO)

Jenny Greenshields, Officer – Deputy Finance Officer

Victoria Medhurst, Company Secretary

Simon Carney, Head of Governance and AO’s Office

Emma Raha, Corporate Governance Manager

Roshni Patel, Corporate Governance Officer

Nick Evans, Comms Officer Rory Hegarty, Director of Comms & Engagement

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General Business

1.1

1.2

1.3

1.4

1.5

Welcome, introductions and apologies [Dr MC Patel]

Dr Patel welcomed everyone to the 8 Governing Body meetings in common of the

NW London CCGs, being held virtually. This was a meeting in common, held in

public, to discuss specific issues to be decided on by each sovereign Governing

Body.

Dr Patel outlined the format for the meeting and how it would be managed. He invited

all members to state their name and Governing Body whenever speaking, and

encouraged all participants to re-join in the event of a lost connection.

The main subject for the meeting was the single CCG’s proposed constitution. Each

Governing Body would be asked whether it recommended the proposed constitution

to its member practices, ahead of the membership-wide vote due to take place from

30 November until 4 December.

Each CCG Governing Body would be invited to take their decisions as sovereign

entities, whilst meeting together to discuss the same issues. Dr Patel’s role was to

facilitate the meeting to aid its smooth running, however, for the purpose of decision-

making, his formal authority remained as Chair of Brent CCG under the auspices of

Brent CCG’s constitution.

Dr Patel recorded on behalf of the CCGs the collective thanks to the LMC and to

those in the CCGs who have developed the documents we have today via the

Governance Working Group. The LMC have a standing invitation, and were in

attendance today. We have invited LMC members to observe the meeting and they

may wish to speak during the public section, but not during the members’ debate.

2.1

2.2

2.3

Declarations of Interest and confirmation of quoracy for decision-making

It was noted that almost all GP members around the Governing Body table will, by

virtue of the statutory levy, be members of the LMC. Members were invited to

declare any other interests; no other interests were declared.

Governing Body Quorum: it was noted that this required at least a third of voting

members, including two elected members, one officer and one lay member.

With the support of CCG Chairs, all eight Governing Bodies were declared quorate

by 15.12hrs.

Proposed Single CCG Constitution

3.0

Introduction and background

Changes proposed (para 4 of main paper):

a) LMC in attendance at GB, Borough and Primary Care Committees

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3.1

3.2

3.3

3.4

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3.6

(paras 9-11 of main paper cover preclusion from Part II meetings)

b) Eligibility to stand as a Borough’s Governing Body Member is limited

to Salaried or Principal GPs

c) Increase from one to two LA reps

d) Member vote weighting – no change proposed, sticking with the

NWL median list size weighting model (paras 6 & 7 of main paper)

Jo Ohlson, Accountable Officer, presented. In September 2020, 5 out of 8 CCGs did

not support the draft constitution when it was taken to a membership-wide vote,

therefore we undertook further member engagement through a survey, local events

and a joint event to determine together which areas of the proposed constitution

would be revised. We took on the areas highlighted by members, shown at points a)

to d) noted in bold above.

After careful consideration, it was proposed that the LMC would have standing

attendee status, similar in status to that of Healthwatch and Local Authority, i.e. non-

voting and attending the public session. Similarly, LMC would be standing attendees

for Borough and Primary Care Commissioning Committees – and would be from

outside of NW London in order to be considered non-conflicted.

Secondly, it was proposed that in order to be eligible to serve as the GP borough

representative, such an individual would need to be a salaried, or principled GP.

The third area was about two aspects in respect of voting, which were largely

confined to constitutional issues. The voting provisions would be a reflection of

practice list size, on the basis that the CCGs are a commissioning organisation

responsible for commissioning services for patients. It was proposed that each

member practice would have 1 vote up to a patient list size of 6,300, and 2 votes

above that.

Another aspect that had been raised was around borough weighting. The response

was that it would be important as a single CCG to operate across NWL and do

things across NWL, which borough weighting could detract from, therefore it was not

proposed to be built into the constitution.

We had also consulted with the 8 local authorities as part of proposing the single

CCG, and they expressed concern about loss of representation from 8 to only 1 –

and asked to increase the number of representatives from 1 to 2 – this has been put

forward.

4.1

4.2

Discussion session.

Dr Patel opened up the meeting to questions, following which he would request an

overall view from each CCG spokesperson.

Dr Parmod Luthra, GP Member, Hounslow CCG, asked a question about the

proposed role of the locum representative. SC confirmed that locums can stand to

be Borough Committee members and to be the elected sessional member on the

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4.3

4.4

4.5

4.6

4.7

GB.

Dr Balu Rakhika, GP Member, Harrow CCG, asked what the proportion of salaried/

partnered GPs salaried would be on the Governing Body, when compared with the

locums, noting that locums represented half of the GP workforce, and asked why

this stand had been taken and this distinction was being made. JO responded that

we had identified a Governing Body (GB) role informed by the BMA definition for

sessional GPs, for both the Borough Committee and through one dedicated role on

the GB. The rationale was to ensure a strong link to a member practice, given the

CCG exists as a member-practice based commissioning organisation. In terms of

Borough Committee representation, SC confirmed that there were roles for at least

two GPs, and that a sessional could be nominated by the member practice.

Annet Gamell, Lay Member, Ealing CCG, asked about local non-GP clinical

representatives. JO responded that the draft constitution considered in September

2020 had not specified that you needed to be a GP in order to be elected as a

borough representative on the GB. JO explained that concern had been expressed

that one or more boroughs could therefore potentially be represented on the GB by

non-GPs. Following discussion, it was proposed that the GB representative for the

borough should be a salaried or partnered GP. There was a place available for a

practice nurse or a practice manager on GB, but no other allied health professional.

If the GB wished to open up to other appointees they could do so in the future. JO

asked SC to advise around allied health professionals on the constitution for those

who are standing members. The GB would need to consider this and put it to

member practices in the future.

Dr Mayur Nanavati, GP Member, Hillingdon CCG, asked about the voting process

and the median patient list size of 6,300 and wanted to make sure there were no

unintended aberrations, such as a provider’s overall vote entitlement being based on

the number of contracts held. This would be explored and confirmed. [ACTION.]

Dr Parmar, Chair, Ealing CCG added a point of clarification that voting rights would

be linked to the contract holder, rather than to the number of contracts a provider

held.

Dr Parmod Luthra asked whether voting would be weighted. SC explained it would

be based on the “raw” patient list size and the constitution provided that we should

use this figure as calculated at 1 April 2020 until April 2022, and then review it

annually thereafter.

Bruno Meekings, Lay Member, H&F CCG asked about the patient voice within the

ICS and the challenge of representing patients from across 8 different boroughs. JO

described how the first version of the constitution consulted on had only 3 lay

members; however, we now proposed to increase this to 5, and to also have

Healthwatch standing attendee. Furthermore, it was important to recognise that lay

member involvement would not be achieved solely via who is on the GB itself;

rather, within each Borough Committee there will invite a local Healthwatch

representative and each Borough will additional seek a lay partner to be drawn from

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4.10

4.11

4.12

the local community. JO agreed that patient engagement is a very important issue

and would be inviting RH to discuss patient engagement more broadly later in the

meeting.

Dr Vicky Cooney, GP Member, H&F CCG stated that it would be helpful to have

more clarity on what roles people would have as attendees and how conflicts of

interest were planned to managed. JO advised that the proposal was for LMC to be

a standing attendee at Part 1 (the public session) only. There was no proposal for

any other standing attendee to be present in Part 2 (the closed session). This had

been discussed with the LMC. It was explained that the role of LMC was to provide a

view of member practices more broadly across NWL, rather than within individual

boroughs. MC shared that in Brent, the LMC had brought a different perspective,

which in Brent had been positive and had served to enrich views in a constructive

and helpful way – this had helped deepen the understanding of primary care and the

particular related issues, including a fuller appreciation of procedural matters.

Imogen Spencer, Lay Member, H&F CCG asked whether in terms of addressing

health inequalities and “levelling up” as one single organisation, any consideration

had been given to whether to have a dedicated Equalities and Engagement

Committee to support the work of the GB. JO explained that such a committee

could be established in addition, however, this focus was on statutory committees,

which were described in great detail in our committee TOR. Whilst some things

would need to go back to practices to change, however this was not one such

example, meaning that the GB would be free to establish such a committee.

Nick Young, Lay Member, Brent CCG asked about how transparency and

accountability would be achieved. He noted that we have patient and public

engagement steering group and suggested that we would be looking to establish

relevant committees and sub committees from the local level upwards as part of our

internal organisation. SC thanked members for drawing our attention to that, noting

that this level of detail regarding public engagement was not required in the

constitution itself.

Shazia Siddiqi, GP Member, Vice Chair, Brent CCG expressed her contentment with

the way things have moved forward, observing that in Brent it was always the case

that the LMC were very welcome and productive. In relation to the earlier points

raised around salaried and partnered on GB, SS felt that this was understood and

that opportunities for locums at the borough level were recognised. SS welcomed

the changes and the proposal to recommend the constitution to Brent’s members.

Neville Purssell, GP, Chair, Central London CCG thanked colleagues for their work

in getting us to where we were, noting that CLCCG had in fact approved the

previous version of the constitution by a large majority. With specific reference to the

changes proposed:

o The LMC’s involvement and engagement was valued and progress with the

governance documentation for the merger had been achieved with the LMC’s

help. CLCCG’s GB was content with the proposal for the LMC to attend as a

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4.13

4.14

standing attendee; however, CLCCG’s GB did not support the LMC’s

presence at closed session meetings;

o CLCCG’s GB did not feel the GP eligibility for the GB Borough member was

contentious;

o There was support for increasing local authority representation from one to

two members;

o Regarding voting, CLCCG’s GB held a clear position guided by the principle

of being first and foremost responsible for commissioning services for the

local population, and therefore felt that voting weighting should be

proportionate to that, rather than to practices, so was content to support the

proposed compromise, and recommended on the whole that our members

adopt the constitution.

Dr Mohini Parmar, GP Member and Chair of Ealing CCG, noted that in depth

discussion had taken place among GB members, whose collective feedback she

relayed:

o Ealing CCG’s GB supported the LMC being a standing attendee at Part One

of the GB; however, there was no support for Part Two attendance by the

LMC;

o MP related that whilst Ealing CCG’s GB did understand the desire for a GP

clinical majority, it however had some concerns on this point, namely that the

CCG is a multi-professional workforce in primary care – therefore, Ealing

regarded this caveat as being a retrograde step;

o Ealing CCG’s GB felt that the GPs as a non-conflicted member should be not

from a NWL footprint. There was a strong sense that workload could prove an

issue therefore an opportunity to review this in a year’s time would be

welcome;

o Ealing CCG’s GB accepted the voting weighting and compromise provided to

commission for its population, and there was a strong view that engagement

should be at the local level and not just at the level of the ICS, however, it

was not clear how quality would be represented and followed through in

Ealing’s local borough. So with some caveats, the proposals were broadly

supported.

Annet Gamell, Lay Member, Ealing CCG, supplemented the feedback by sharing the

view that the three changes were pragmatic, however, there was more concern

around provisions and changes that had not been made. This included the apparent

lack of provisions to “flex” GB members based on need as we progress without

having to return to members for further voting – specifically around lay and clinical

representation other than GPs. AG noted that the workforce was widening to include

other clinical members, and observed the very heavily GP-laden membership of the

committees, notwithstanding it is a membership organisation. There were concerns

around lay membership around the depth and breadth of work that can be seen from

committees that will be difficult to cover in terms of process, governance and

managing conflicts of interest, by a single secondary care doctor and 5 lay members

across all the GB committees and GB. AG expressed concern that if the need arose

and we could not cover this, we would then need to wait until future amendments

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4.17

4.18

4.19

could be made.

Dr James Cavanagh, GP Member, Chair, H&F CCG, related the GB’s support for

the LMC’s attendance at the GB public session; GP representation; 2 local authority

representatives, as well as the compromise on the voting weighting structure, as this

more accurately reflected members as commissioning for its local population.

Dr Genevieve Small, GP Member, Chair, Harrow CCG, noted that members had

initially passed the constitution, and welcomed the opportunity to further review it.

Richard Smith, Lay Member and Deputy Chair added that there was GB support for

changes in the constitution regarding LMC, and local authority representatives. He

related some concerns around primary care and the Borough-based and primary

care commissioning committee – the extent of the delegation and the funding that

would go with that so that primary care remains generally local. Regarding lay

members, he anticipated a challenge in managing conflicts of interest within the

boroughs on the present arrangements because the primary care commissioning

committee was high level and far from the boroughs. Thirdly, regarding engagement

and equality – the equalities issues were important, too, and the issue of an

Equalities and Engagement Committee and ensuring we are continuing to focus on

community engagement and equal access was a concern too. So in conclusion,

Harrow GB supported the proposed changes but had additional questions that had

not yet been addressed.

Dr Ian Goodman, GP Member, Chair, Hillingdon CCG related that at the original

vote, Hillingdon’s members had supported both the constitution and merger. In terms

of the three areas for discussion, Hillingdon CCG’s GB agreed to LMC attending

Part 1 and not Part 2, and with the GB members being limited to salaried and

principled GPs, as well as having two local authority reps. There was a question

about the fairness of the weighted voting system and re Richard’s point about

engagement, Hillingdon was also concerned about the lack of provision for this in

the constitution.

Dr Annabel Crowe, GP Member, Chair, Hounslow CCG advised that Hounslow CCG

had not approved the draft constitution in the first round, however it had enjoyed

majority support of over 50%. Susan Roostan added:

o A number of GP members had felt that LMC representation at GB was

inappropriate given nature of role of LMC and that if they attend then other

provider reps could similarly request attendance, however some were

supportive of their attendance.

o Strong views were held by GB members about voting for elected members –

and there were concerns about members not being able to participate in the

elections voting.

o Hounslow CCG’s GB requested that this be actively discussed for review in

April 2022, noting that its workforce perceived this as discriminatory, and that

it was unfair to be able to stand but not participate in vote. Hounslow wished

to encourage the Boroughs to have this conversation. There were concerns

about how the re-vote would be undertaken and the vote made level for

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4.22

4.23

4.24

CCGs.

o Overall, the GB membership recommended that we support the Constitution,

with comments taken on board during first year of establishment.

Dr Andrew Steeden, GP Member, Chair, West London CCG, expressed thanks to

everyone for their support, noting that West London CCG’s membership had initially

rejected the constitution in the September vote. We had since held discussions at

the GB which confirmed:

o Support for the LMC’s attendance at public meetings only;

o Following debate around the eligibility for standing on the local Borough

Committee, there was disappointment that we were not allowing Practice

Managers and Practice Nurses to vote, which is part of West London CCG’s

current constitution;

o Support for the move to local authority representatives, as already in our

constitution;

o That the ICS and Borough Committee relationships needed to be further

explored;

o Concern around conflicts of interest management at the Borough level;

o Concern around assurance mechanisms in the current proposals, including

quality and performance issue for ICS.

o Having always had and enjoyed lay member involvement in WLCCG, there

was a feeling from some members that lay members were being undervalued

in this current constitution and some general points around COI and detailed

points on Remuneration Committee TOR that have been shared with SC.

JO responded to the final point by explaining the proposal for 5 Lay Members on the

GB, however, it was not intended for them to be part of Borough Committees.

Recognising it would be an untenable workload, we have proposed Lay Partners.

In terms of managing conflicts of interest, and primary care commissioning, it will be

for the Primary Care Commissioning committee to determine the range of services in

respect of specifications and remuneration – then for the Borough Committee,

knowing its own local population to determine which of those enhanced services are

relevant to be commissioned for that population.

In terms of the clinical composition of the GB – this is a balance and we have had

member practices who have expressed concern about adequate representation at

Borough level by Practice Nurses or Allied Health Professionals in terms of being at

the key decision making body. It had first been proposed for member practices to

determine this; however, to provide a level of confidence to member practices we

have said that only GPs will be eligible to be the Borough representative on the GB.

It was fully accepted that there are many more involved in primary care other than

general practitioners, and we will review composition over time, recognising we have

Chief Nurse, Practice Nurse and Secondary Care Member.

JO added that in response to points conveyed on behalf of Hounslow CCG’s GB and

West London CCG’s GB – we would note these and seek to review these within the

first year of the single CCG. It was agreed that we would need to update member

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4.30

practices, before we form as a GB, on how we are communicate key information to

member practices around quality and assurance of services, so that we can have a

wider contribution as to what services should be in place. [ACTION]

RH responded to the question raised about the governance of equalities and

engagement. Whilst we have started to talk about committees for this, this will not

necessarily be a formal part of our governance but rather a useful sounding board to

oversee the work.

In response to the wider question around patient engagement and involvement –

through the EPIC programme we have tried to develop and co-produce with patients

and stakeholders how engagement might look in the future. We envisage running a

patient forum in each borough to meet regularly which will feed into the ICS level.

This will come out of conversations with local residents and stakeholders. We want

to get this right and encourage people to get involved. Next network meeting is 9

December, which everyone is encouraged to come along to. We want a patient

voice at all levels in the system.

Imogen Spencer, Lay Member, H&F CCG, expressed her interest in having equality

and engagement committee to help address health inequalities and the ambition to

level up as one organisation. She asked whether there will be sufficient lay

membership to cover that. Another question was how can ensure the GB will be

representative of the population.

Sarah Crowther, Lay Member, Hillingdon CCG asked about the authoritative

assurance structure around engagement to assure the GB and expressed the view

that this does need to be a formal part of governance structure and authoritative

more than a sounding board.

Nick Martin, GP Member, H&F CCG, sought clarification on the role of the LMC at

the GB. It was confirmed that the LMC will not be present at part 2 (closed session).

JO responded by explaining that we would not be relying on individual lay members

to comprehensively represent the diverse needs and views of all borough residents.

Rather, the respective roles were broader, incorporating not just patient and

engagement, and a non-clinical view, but bringing strong assurance and judgement

around good governance – observing that we would never be able to get sufficient

lay members to represent all patients views and a limit in the number they do. Whilst

we would have a Lay Member with a lead responsibility around this area, to fulfil this

duty it is vital to build it into our governance. We are committed to doing that, and it

is a statutory duty to comply with. SC confirmed that that in order to create equalities

and engagement committee, or equivalent mechanism, it would not constitute a

statutory committee, but would form part of the extended governance framework that

will be described in a transparent way in the Governance Handbook. He added that

it was within the gift of the GB to establish it, if it wants that level of assurance

flowing through.

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4.32

4.33

Diane Jones, Chief Nurse for NWL CCGs and Director of Quality described how

equalities are part and parcel of everything we do as an organisation, and added

that Lay Members have patients’ interests at heart; equalities are part of that and

also wider than that. We have an Equality, Diversity and Inclusion (EDI) Steering

Group that works to ensure that EDI is embedded in everything we do, and that we

are held to account, including by our Lay Members who are part of the GB. RH

concurred by stating that lay members convey a patient voice but not in its entirety,

therefore we are conscious that it is important to get diverse perspectives from

across our communities – so part of the role of a sub-committee would be to

facilitate that and to hear form our diverse communities.

Julie Pal, Healthwatch, Brent commented on the related issues of governance and of

meeting the public sector equality duty, and of ensuring the representative voices of

service users inform policy decisions and commissioning, and another area that is

partly covered by the statutory function of Healthwatch. It was observed that some

CCG GBs do not draw as effectively as they could do on local Healthwatch to

provide independent challenge in how services designed and developed, and to

incorporate user voices and use as part of an engagement approach. Historically, it

has been challenging to amplify voices of patients and service users and to

understand how services are improving health outcomes.

MC thanked everyone for their in depth comments and feedback.

5.1

5.2

5.3

5.4

Membership vote next week (paras 12-14 of main paper)

a) Vote to go live on 30 November for all members

b) Vote will be on 1 vote per practice, for all NWL practices as a

single cohort, for this one time only.

c) Vote question.

Simon Carney, AO’s Office and Head of Governance, presented and directed all to .

paras 12-14 of the main paper. It was explained that if GBs decide to support the

proposed constitution, votes will open for member practices on Monday 30

November and close at 5pm on Friday 4 December. Members would be asked

whether they as a proposed member of the NWL CCG supported the adoption of the

proposed constitution. We then expected to be able to announce the results of the

vote (which was being externally and independently conducted) by 8 December.

NHSE/I will take a view on the level of membership support, however it was

important to note that it was ultimately for NHSE/I to approve the merger of the NW

London CCG. NHSE/I had directed the NWL CCGs to create a level playing field by

offering one vote per practice and to run a simple majority of the votes cast. All

member practices were invited on Monday 30 November to a briefing on the

decisions of this meeting and to run through changes made in light of their feedback.

Questions

Richard Smith, Lay Member, Harrow CCG, asked where a company runs multiple

practices, whether this meant they would they have multiple votes. SC responded

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5.6

5.7

that this could not be categorically answered in the meeting, however, he was aware

that Ealing CCG had recently dealt with this issue, and it would be taken trust that

what the CCGs have supplied Civica is what they would normally use.

Dr Parmod Luthra, GP Member, Hounslow CCG, asked about the rationale for the

voting mechanism for the adoption of the proposed constitution. SC responded that

this was a “one time only” mechanism to establish the view ahead of adopting an

entirely new set of thresholds that in some cases differed to CCG’s existing

constitutions, (whereas in other cases it may correlate). JO explained that this was

the advice we had been given by NHSE to take this forward – and that we were not

able to rely on provisions in CCGs’ existing constitutions as this would not offer a

level playing field, that, as the vote to become a single CCG had already taken

place, is that we look to do a simple majority of the practices that have voted. Legal

advice had confirmed the logic and robustness of the proposed approach.

JO added that, finally, the member practice vote was critical in that we would like to

convene January elections for GB members and for people who are elected to the

GB and its committees. In February 2021, we would make the GB appointments,

including Lay Members, with the expectation of seeking and obtaining NHSE’s

formal approval by the end of February allowing us to formally establish as a single

CCG for the new financial year.

There were no further questions.

6.1

6.2

6.3

Governing Body Decisions

Each NWL CCG Governing Body was asked to:

a) note the changes made to the proposed constitution for the single NWL CCG

in light of consultation and engagement;

b) note the arrangements in place for putting the constitution to a vote by all

members-to-be of the single CCG;

c) note that this ballot will be, in line with NHS England’s requirements, a vote

of all NWL practices on a one-vote-per-practice basis so to ensure a level

playing field to judge whether the new CCG’s members, as a cohort, support

the adoption of the proposed constitution;

d) agree to recommend to Practice Members that they support the adoption of

the Constitution and its appendices; and

e) note the timings and next steps.

MC invited each CCG Chair to conduct a live vote of their respective Governing

Bodies, in respect of (d) to be agreed, as above, the results of which are below.

Votes were expressed verbally.

a. Brent – vote conducted by Dr MC Patel, CCG Chair

Vote direction Number cast Voting GB members

Yes 11 Jo Ohlson

Shazia Siddiqi

of 17

6.4

6.5

Ketana Halai

Lindsey Wishart

Lyndsey Williams

Nicholas Young

Alex Johnstone

Jonathan Timperley

Diane Jones

Steve Bloomer/Jenny Greenshields

Madhukar C Patel

Yes with caveats 0

No 0

Unknown (not

available/ audible)

1 Jahan Mahmoodi

Vote result YES (11 out of 11 votes cast)

b. Central London – vote conducted by Dr Neville Purssell, CCG Chair


Yes 10 Jo Ohlson

Diane Jones

Mona Vaidya

Niamh McLaughlin

Simon Gordon

Andrew McCall

Diana Middleditch

Jane Hawdon


Neville Purssell

Yes with caveats 1 Philip Young – subject to review in a year

No 0

Unknown (not

available/ audible)

0


c. Ealing – vote conducted by Dr Mohini Parmar, CCG Chair


Yes 13 Jo Ohlson

Diane Jones

Alex Fragoyannis

Angad Saluja

Annet Gamell

Fionnuala O’Donnell


Vijay Tailor

Shanker Vijayadeva

Martin Lees

Carmel Cahill

of 17

6.6

6.7

Neha Unadkat / Tara-Lee Baohm

Mohini Parmar


No 1 Sally Armstrong

Unknown 0


d. Hammersmith and Fulham – conducted by Dr James Cavanagh, CCG

Chair


Yes 12 Jo Ohlson

Diane Jones


Bruno Meekings

Vanessa Andreae

Pritpal Ruprai

Imogen Spencer

Andy Petros

Nick Martin

Smitha Addala

Vicki Cooney

James Cavanagh


No 0

Unknown 0


e. Harrow – vote conducted by Dr Genevieve Small, CCG Chair


Yes 11 Jo Ohlson

Diane Jones


Alex Johnstone

Radhika Balu

Alihusein Dhankot

Richard Smith

Muhammad Shahzad

Javina Sehgal

Sandy Gupta

Genevieve Small

Yes with caveats 0

No 0

Unknown 0


of 17

6.8

6.9

6.10

f. Hillingdon – vote conducted by Dr Ian Goodman, CCG Chair


Yes 12 Jo Ohlson

Diane Jones


Alex Johnstone

John Riordan

Sarah Crowther

Caroline Morison

Stephen Vaughan-Smith

Steven Shapiro

Angela Joseph

Mayur Nanavati

Ian Goodman

Yes with caveats 1 Allison Seidlar – subject to review in a

year

No 0

Unknown 0


g. Hounslow – vote conducted by Dr Annabel Crowe, CCG Chair


Yes 8 Jo Ohlson

Diane Jones


Clive Chalk

Sue Roostan

Gurcharan Salotera

Andy Petros

Annabel Crowe


No 1 Parmod Luthra

Unknown (not

available/ audible)

0


h. West London – vote conducted by Dr Andrew Steeden, CCG Chair


Yes 9 Jo Ohlson

Diane Jones


Alex Johnstone

Louise Proctor

Oisin Brannick

Victoria Stark

of 17

6.11

Yvonne Fraser

Andrew Steeden


Sonia Richardson – as above

Edward Farrell – as above

No 0

Unknown (not

available/ audible)

2 Ali Al-Rufaie

Puvana Rajakulendran


MC summarised the collective outcome of the vote:

All 8 GBs have agreed to recommend to member practices that they support

the adoption of the Constitution and its appendices. Thank you very much.

MC thanked colleagues and the team of those who have been working to

develop and consult on the governance documentation for the single CCG.

Finally, MC paid tribute to partner organisations doing what they could during

this difficult period, noting that some boroughs have been hit particularly hard

and were coming together – and all Chairs joined together in showing

appreciation for everyone who has worked so hard during this difficult period.

Any Other Business

7.0 There was nothing else to report.

Questions and Answers (Q&A) (responses to written questions received in advance)

8.1

8.2

8.3

8.4

Questions received prior to the meeting that have not already been responded to.

Barbara Benedek (BB), who was a patient representative on a wide number of

committees wanted to stress the work on patient engagement from the Boroughs to

the CCG and to ensure that communication flows smoothly. She noted the speed at

which the Borough Committee has to be voted for, and advised that more work was

needed on its structure, suggesting that it would also be remiss if there were not

Engagement Committees at both the NWL and local level – so this was a statement

of concern.

JO responded. It was recognised that two areas for further work were around

borough and patient committees generally – part of this question related to integrated

care partnerships (ICPs) – an important development alongside the Borough

Committee, which would require some oversight of what the ICP would be doing. For

the Integrated Care System, we would need options for the best means of achieving

patient participation and options in ICPs, for consistency. JO invited RH to comment.

RH noted that BB had been to the ‘EPIC’ network meetings – and that getting these

things right ahead of becoming a single CCG and an ICS was a top priority. We had

talked through involvement and had also co-produced with about 100 stakeholders a

Patient and Public Involvement Charter, which was a real area of focus.

of 17

8.5

8.6

8.8

8.9

BB accepted that EPIC was proving effective in obtaining a range of views, however

that NWL needed to know views and interests as widely as possible – it was not easy

to be a patient representative and be across so many papers, etc; combined with

having the experience to speak out, so that relevant assurance needs are can be met

via the representation. RH responded that NWL would seek to support its lay

partners with appropriate training. [Secretary’s Note: Please see also 4.30, above.]

Dr Sandy Gupta, Secondary Care Doctor, Harrow CCG, enquired whether colleagues

were content with how much role secondary care will play borough-wide, or whether

this will be tapped into as and when. MP responded by expressing the view that we

are in a different world with the ICS – the future is collaboration and working together.

Where we are commissioning services, it is about determining the right service

needed for our populations, what the resource allocation is and the workforce is

required to deliver it. We are in a different place now, and closer working with

secondary care colleagues than before the COVID-19 pandemic.

GS concurred – she had never known such a collaborative time, and we were now

looking at workstreams as one CCG with it being intertwined with ICS system. We

have the ICP Health and Care Partnership set up in Harrow, and our local acute trust,

sitting alongside community and mental health partners – it looks and feels different.

We have had our heads down, but the future is about collaborative working between

all, and not commissioner / provider and primary / secondary care so positive about

the future.

MC agreed that the new world now feels more like a partnership, thanked everyone

for attending. The meeting was closed at 17.00hrs.

nw london ccgs’ governing bodies meeting-in-common

Documents