General duties of clinical commissioning groups

14PDuty to promote NHS Constitution

1

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

a

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

b

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

2

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

14QDuty as to effectiveness, efficiency etc.

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

14RDuty as to improvement in quality of services

1

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

2

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

3

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

a

the effectiveness of the services,

b

the safety of the services, and

c

the quality of the experience undergone by patients.

4

In discharging its duty under subsection (1), a clinical commissioning group must have regard to any guidance published under section 14Z8.

14SDuty in relation to quality of primary medical services

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

14TDuties as to reducing inequalities

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

a

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

b

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

14UDuty to promote involvement of each patient

1

Each clinical commissioning group must, in the exercise of its functions, promote the involvement of patients, and their carers and representatives (if any), in decisions which relate to—

a

the prevention or diagnosis of illness in the patients, or

b

their care or treatment.

2

The Board must publish guidance for clinical commissioning groups on the discharge of their duties under this section.

3

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

14VDuty as to patient choice

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

14WDuty to obtain appropriate advice

1

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

a

the prevention, diagnosis or treatment of illness, and

b

the protection or improvement of public health.

2

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

3

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

14XDuty to promote innovation

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

14YDuty in respect of research

Each clinical commissioning group must, in the exercise of its functions, promote—

a

research on matters relevant to the health service, and

b

the use in the health service of evidence obtained from research.

14ZDuty as to promoting education and training

Each clinical commissioning group must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1F(1) so as to assist the Secretary of State in the discharge of the duty under that section.

14Z1Duty as to promoting integration

1

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

a

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

b

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

c

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

2

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

a

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

b

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

c

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

3

In this section—

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

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

Public involvement

14Z2Public involvement and consultation by clinical commissioning groups

1

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

2

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

a

in the planning of the commissioning arrangements by the group,

b

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

c

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

3

The clinical commissioning group must include in its constitution—

a

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

b

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

4

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

5

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

6

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

Arrangements with others

14Z3Arrangements by clinical commissioning groups in respect of the exercise of functions

1

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

2

The arrangements may provide for—

a

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

b

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

3

For the purposes of the arrangements a clinical commissioning group may—

a

make payments to another clinical commissioning group, or

b

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

4

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

5

A pooled fund is a fund—

a

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

b

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

6

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

7

In this section, “commissioning functions” means the functions of clinical commissioning groups in arranging for the provision of services as part of the health service (including the function of making a request to the Board for the purposes of section 14Z9).

14Z4Joint exercise of functions with Local Health Boards

1

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

2

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

3

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

Additional powers of clinical commissioning groups

14Z5Raising additional income

1

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

2

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

14Z6Power to make grants

1

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

2

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

Board's functions in relation to clinical commissioning groups

14Z7Responsibility for payments to providers

1

The Board may publish a document specifying—

a

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

b

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

2

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

3

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

4

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

5

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

6

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

7

In this section and section 14Z8, “commissioning functions” means the functions of clinical commissioning groups in arranging for the provision of services as part of the health service.

14Z8Guidance on commissioning by the Board

1

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

2

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

3

The Board must consult the Healthwatch England committee of the Care Quality Commission—

a

before it first publishes guidance under this section, and

b

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

14Z9Exercise of functions by the Board

1

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

a

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

b

any other functions of the group which are related to the exercise of those functions.

2

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

3

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

4

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

14Z10Power of Board to provide assistance or support

1

The Board may provide assistance or support to a clinical commissioning group.

2

The assistance that may be provided includes—

a

financial assistance, and

b

making the services of the Board's employees or any other resources of the Board available to the clinical commissioning group.

3

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

4

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

5

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

Commissioning plans and reports

14Z11Commissioning plan

1

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

2

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

a

the period which —

i

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

ii

ends at the end of that financial year, and

b

each subsequent financial year.

3

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

a

sections 14R, 14T and 14Z2, and

b

sections 223H to 223J.

4

The clinical commissioning group must publish the plan.

5

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

6

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

7

The Board may publish guidance for clinical commissioning groups on the discharge of their functions by virtue of this section and sections 14Z12 and 14Z13.

8

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

9

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

14Z12Revision of commissioning plans

1

A clinical commissioning group may revise a plan published by it under section 14Z11.

2

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

a

the group must publish the revised plan, and

b

subsections (5) and (6) of section 14Z11 apply in relation to the revised plan as they apply in relation to the original plan.

3

If the clinical commissioning group revises the plan in any other way, the group must—

a

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

b

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

14Z13Consultation about commissioning plans

1

This section applies where a clinical commissioning group is—

a

preparing a plan under section 14Z11, or

b

revising a plan under section 14Z12 in a way which it considers to be significant.

2

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

3

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

4

The clinical commissioning group must, in particular—

a

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

b

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

5

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

6

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

a

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

b

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

7

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

8

A clinical commissioning group must include in a plan published under section 14Z11(4) or 14Z12(2)—

a

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

b

an explanation of how the group took account of those views, and

c

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

9

In this section, “joint health and wellbeing strategy” means a strategy under section 116A of the Local Government and Public Involvement in Health Act 2007 which is prepared and published by a Health and Wellbeing Board by virtue of section 196 of the Health and Social Care Act 2012.

14Z14Opinion of Health and Wellbeing Boards on commissioning plans

1

A relevant Health and Wellbeing Board—

a

may give the Board its opinion on whether a plan published by a clinical commissioning group under section 14Z11(4) or 14Z12(2) takes proper account of each joint health and wellbeing strategy published by the Health and Wellbeing Board which relates to the period (or any part of the period) to which the plan relates, and

b

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

2

In this section, “joint health and wellbeing strategy” has the same meaning as in section 14Z13.

14Z15Reports by clinical commissioning groups

1

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

2

An annual report must, in particular—

a

explain how the clinical commissioning group has discharged its duties under sections 14R, 14T and 14Z2, and

b

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

3

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

4

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

5

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

6

A clinical commissioning group must—

a

publish its annual report, and

b

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

Performance assessment of clinical commissioning groups

14Z16Performance assessment of clinical commissioning groups

1

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

2

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

3

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

a

sections 14R, 14T, 14W and 14Z2,

b

sections 223H to 223J, and

c

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

4

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

5

The Board must, in particular, have regard to—

a

any document published by the Secretary of State for the purposes of this section, and

b

any guidance published under section 14Z8.

6

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

Powers to require information etc.

14Z17Circumstances in which powers in sections 14Z18 and 14Z19 apply

1

Sections 14Z18 and 14Z19 apply where the Board has reason to believe—

a

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

b

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

2

For the purposes of this section—

a

a failure to discharge a function includes a failure to discharge it properly, and

b

a failure to discharge a function properly includes a failure to discharge it consistently with what the Board considers to be the interests of the health service.

14Z18Power to require documents and information etc.

1

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

2

The persons mentioned in this subsection are—

a

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

b

any member or employee of the group who has possession or control of the item in question.

3

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

4

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

5

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

6

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

14Z19Power to require explanation

1

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

2

The Board may require the explanation to be given—

a

orally at such time and place as the Board may specify, or

b

in writing.

3

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

14Z20Use of information

Any information, documents, records or other items that are obtained by the Board in pursuance of section 14Z18 or 14Z19 may be used by the Board in connection with any of its functions in relation to clinical commissioning groups.

Intervention powers

14Z21Power to give directions, dissolve clinical commissioning groups etc.

1

This section applies if the Board is satisfied that—

a

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

b

there is a significant risk that a clinical commissioning group will fail to do so.

2

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

3

The Board may direct—

a

the clinical commissioning group, or

b

the accountable officer of the group,

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

4

The Board may—

a

terminate the appointment of the clinical commissioning group's accountable officer, and

b

appoint another person to be its accountable officer.

5

Paragraph 12(4) of Schedule 1A does not apply to an appointment under subsection (4)(b).

6

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

a

varying its area,

b

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

c

removing any person from that list.

7

The Board may dissolve the clinical commissioning group.

8

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

a

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

b

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

9

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

a

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

b

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

10

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

11

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

12

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

13

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

14

For the purposes of this section—

a

a failure to discharge a function includes a failure to discharge it properly, and

b

a failure to discharge a function properly includes a failure to discharge it consistently with what the Board considers to be the interests of the health service.

Procedural requirements in connection with certain powers

14Z22Procedural requirements in connection with certain powers

1

Before exercising the power to dissolve a clinical commissioning group under section 14Z21(7) the Board must consult the following persons—

a

the clinical commissioning group,

b

relevant local authorities, and

c

any other persons the Board considers it appropriate to consult.

2

For that purpose, the Board must provide those persons with a statement—

a

explaining that it is proposing to exercise the power, and

b

giving its reasons for doing so.

3

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

4

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

5

Regulations may make provision as to the procedure to be followed by the Board before the exercise of the powers conferred by sections 14Z18, 14Z19 and 14Z21.

6

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

7

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

Disclosure of information

14Z23Permitted disclosures of information

1

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

a

the information has previously been lawfully disclosed to the public,

b

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

c

the disclosure is made in accordance with any enactment or court order,

d

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

e

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

f

the disclosure is made for the purpose of facilitating the exercise of any of the clinical commissioning group's functions,

g

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

h

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

2

Paragraphs (a) to (c) and (h) of subsection (1) have effect notwithstanding any rule of common law which would otherwise prohibit or restrict the disclosure.

Interpretation

14Z24Interpretation

1

In this Chapter—

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

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

• “health services” means services provided as part of the health service and, in section 14Z2, also includes services that are to be provided as part of the health service;

• “relevant Health and Wellbeing Board”, in relation to a clinical commissioning group, has the meaning given by section 14Z11(9).

2

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

• section 6E(7) and (10)(b),

• section 14C(2)(e),

• section 14P,

• section 14Q,

• section 14T,

• section 14U(1),

• section 14V,

• section 14W(1),

• section 14X,

• section 14Y,

• section 14Z,

• section 14Z1(1) and (2),

• section 14Z2(1),

• section 14Z4(1),

• section 14Z5(2),

• section 14Z6(1),

• section 14Z7(7),

• section 14Z11(1),

• section 14Z15(1),

• section 14Z16(2),

• sections 14Z17(1), 14Z19(1) and 14Z21(1) and (3),

• section 14Z23(1),

• section 72(1),

• section 75(1)(a) and (2),

• section 77(1)(b),

• section 82,

• section 89(1A)(d),

• section 94(3A)(d),

• section 223C(2)(b),

• section 223H(1),

• in Schedule 1A, paragraphs 3(1) and (3), 6, 12(9)(b) and 16(3).

3

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

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

• section 199(4) of the Health and Social Care Act 2012 (supply of information to Health and Wellbeing Boards),

• section 291(2)(d) of that Act (breaches of duties to co-operate),

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

4

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