2014-15_AnnRept_ELRCCG-2

1East Leicestershire and Rutland CCG Annual Report | 2014-15
Annual Report and Accounts | 2014-15
NHS EAST LEICESTERSHIRE AND RUTLAND
CLINICAL COMMISSIONING GROUP

High quality care for all, now
and for future generations
“It is there to improve our health and wellbeing,
supporting us to keep mentally and physically
well, to get better when we are ill and, when
we cannot fully recover, to stay as well as we can
to the end of our lives. It works at the limits of
science - bringing the highest levels of human
knowledge and skill to save lives and improve
health.
It touches our lives at times of basic human need,
when care and compassion are what matter most.
The NHS is founded on a common set of
principles and values that bind together the
communities and people it serves - patients and
public - and the staff who work for it.”
The NHS Constitution
The NHS belongs
to the people

Contents
Foreword from our Chair and Managing Director . . . . . . . 4
New services in a year of challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Clinically led . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Informing, involving, innovating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Thinking like a patient, acting like a taxpayer . . . . . . . . . . . . . . . . . . . . . . . . . 7
Transforming how we do things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Supporting our Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Member Practices’ Introduction . . . . . . . . . . . . . . . . . . . . . . 9
Our reflection on Progress and Performance . . . . . . . . . . . . . . . . . . . . . . . . . . 9
The power of clinical leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Patient advocates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Evaluation of our effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Strategic Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Who we are and what we do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Our Vision and Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Our strategic aims and commissioning priorities . . . . . . . . . . . . . . . . . . . . . . 17
Working in partnerships across Leicester, Leicestershire and Rutland . . . . . . . 17
Our population, the communities we serve and their health needs . . . . . . . . 17
Our priorities for new investment in 2014-15 . . . . . . . . . . . . . . . . . . . . . . . . 21
Quality and patient safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Patient Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
The Berwick Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
The Francis Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Winterbourne View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Compassion in practice nursing, midwifery and care staff -
our vision and strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Staff satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Safeguarding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Our commissioning activities and who we commission from . . . . . . . . . . . . . 39
Operating and Financial Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Development and performance in year and in the future . . . . . . . . . . . . . . . . 30
The Resources, Principal Risks and Relationships that may
affect long-term performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Better payments practice code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Prompt payments code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Cost Allocation & Setting of Charges for information . . . . . . . . . . . . . . . . . . 44
Governing Body’s policy for managing risk . . . . . . . . . . . . . . . . . . . . . . . . . . 45
The CCG’s priorities for the next two years (2014-16) . . . . . . . . . . . . . . . . . . 45
Position of the organisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Sustainability Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Equality and Diversity Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Equality Objectives 2013 – 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Publication of Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Information relating to activities of the CCG . . . . . . . . . . . . . . . . . . . . . . . . . 50
Members’ Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Governing Body members’ profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Members of committees of the Governing Body . . . . . . . . . . . . . . . . . . . . . . 61
Sickness absence data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Pension liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
External audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Disclosure of serious untoward incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Principles for Remedy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Employee Consultation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Disabled Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Emergency preparedness, resilience and response . . . . . . . . . . . . . . . . . . . . . 69
Statement as to Disclosure to Auditors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Remuneration Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Salary & Pension Disclosure Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Pension Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Cash Equivalent Transfer Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Statements by the Accountable Officer . . . . . . . . . . . . . . . 81
Statement of the Managing Director’s responsibilities as the
Accountable Officer of NHS East Leicestershire and Rutland
Clinical Commissioning Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Governance Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Appendix 1: Annual Accounts 2014-15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Foreword from our Chair and Managing Director
On behalf of East Leicestershire and Rutland
CCG and the people who work in and with
it, we’re delighted to present our second
Annual Report.
We’re still a relatively new organisation, having become a statutory body just
over two years ago. Our aim is quite simple: to improve health by meeting
our patients’ needs with high quality and efficient services, led by
clinicians and delivered closer to home.
We don’t do that on our own, but by working with our partners and
stakeholders in the local NHS, local government, the voluntary sector and user
and patient groups. Having had the chance to read this Report, we hope you’ll
agree that whilst there is plenty we still need to do, there is already plenty of
which we can be proud.
As an NHS organisation, established under the Health and Social Care Act 2012,
we have a number of legal and constitutional duties.
These can be accessed at:
www.eastleicestershireandrutlandccg.nhs.uk/our-strategies-and-plans
The publication of this Annual Report is amongst one of our most important
duties. It ensures we are publicly accountable to the communities and people
we serve. It sets out our aims and strategies and how we performed against
them. It explains who we are, how we work and the partnerships in which we
are involved.
NEW SERVICES IN A YEAR OF CHALLENGE
There is no doubt that 2014-15 has been a challenging year for everyone
involved in organising and delivering health and social care to the people of
East Leicestershire and Rutland. This Report sets out how we’ve risen to this
challenge.
In the midst of what Simon Stevens, NHS Chief Executive, has called “the
longest period of austerity our health and social care services have faced since
the Second World War”, we are pleased that we have been able to implement
a number of changes to enhance local services. You can read about many of
them in this Report, including:
• New Urgent Care Centres – used by over 4,000 people in their first few
weeks of existence;
• New integrated health and care teams - delivered through the Better
Care Fund - helping hundreds of people get support and treatment in
their own home rather than having to go to hospital or be able to get
home from hospital earlier after treatment;
• Advanced care planning – supporting GPs to develop care plans for
people living in care homes, and those with terminal illnesses, so that
we can understand their wishes, communicate between different
services and better meet their needs;
• Introducing Personal Health Budgets so that people can take control of
their care provision in a way that suits them; and
• Training GPs in managing heart failure and treatment of atrial
fibrillation, thereby preventing some high risk people from suffering a
stroke.

Melton Mowbray
Oakham
Lutterworth
Enderby Market
Harborough
LEICESTER
RUTLAND
Uppingham
Scraptoft
Oadby
Wigston
OOOO
Enderby
LEICESTER
OaOa
Wigston
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Urgent Care Centres
Accident & Emergency
GPs in ELRCCG practices
Loughborough
NOTTINGHAMSHIRE
Nottingham
Derby
Grantham
Peterborough
Kettering
Corby
Rugby
Coventry
Nuneaton
Hinckley
NORTHAMPTONSHIRE
WARWICKSHIRE
CCCCCCCC
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Where our care is delivered
Figure 1: Map of East Leicestershire and Rutland

CLINICALLY LED
As an organisation, we are proud to say we are “clinically led” and praised by
our local NHS England colleagues for visibly being so.
That’s not simply a phrase we use. It’s central to what we’re about and how
we do things. It means that our aims and priorities are driven by local family
doctors and other clinicians, rooted in their own local communities across East
Leicestershire and Rutland. Clinicians are in the majority in our decision makers.
These people are trusted by local people and their families to have their best
interests at heart and deeply committed to helping them get healthy and stay
healthy. Or when they fall ill, to make sure they get the very best treatment and
care possible, in the right place at the right time, and delivered with compassion
and respect.
We were particularly pleased in February 2015 to be selected by NHS England
to be one of the first wave of CCGs to take on responsibility for commissioning
GP services from April 2015. This will give patients, communities and clinicians
more scope in deciding how local services are developed.
Our Clinical Vice Chairs and Locality Leads explain more about what Clinical
Leadership means in the Member Practices Introduction of this Report.
INFORMING, INVOLVING, INNOVATING
The timeless values of the NHS drive everything we do. As the NHS Constitution
says “The NHS belongs to the people”.
That’s why we’re constantly looking for ways, new and old, to listen to people’s
concerns and views, then do something about what they tell us and – crucially -
be seen to do so.
That’s not just good in principle, it’s good in practice. It means we’re much
more likely to get things right first time or be able to put things right if they’re
not working as they should.
As this Report hopefully shows, we’ve had some real successes over the past
year in this regard, including:
• taking a ‘Listening Booth’ to over
25 locations across East Leicestershire
and Rutland to enable our patients,
the public and carers to tell us in
their own words how they feel about
local healthcare;
• collating Patient Stories, captured
direct on film from individual patients
and discussed as a standing item
at Governing Body meetings –
including experiences with infection
control, care in acute hospital wards,
support for patients at risk of self-
harm, bowel cancer diagnosis and
end of life care; and
• conducting detailed engagement
exercises around Urgent Care and
Community Services.
Going forward in 2014-15, we intend
to build on these foundations by
designing and implementing an
integrated web, social media and
mobile engagement strategy – to put
us right at the forefront of the NHS
digital revolution.
Figure 2: Our Listening Booth visited over 25 locations

THINKING LIKE A PATIENT, ACTING LIKE A TAXPAYER
We are constantly looking at ways in which we can work with our partners
across health and social care, as well as with the voluntary sector, to continue
to deliver the best possible outcomes for local people whilst being conscious of
the need to deliver value for money. This Report shows how we’ve done during
2014-15, delivering successfully against all our financial targets, as follows:
• Achieving our planned expenditure against budget;
• Producing a planned surplus of £3.3m; and
• Achievement of in year financial savings plan of £9m.
TRANSFORMING HOW WE DO THINGS
Everybody knows money is tight - exceptionally so - and the financial challenge
is not going to go away any time soon. Our local health economy in Leicester,
Leicestershire and Rutland faces a deficit of almost £400 million by 2018-19 if
we do not fundamentally redesign and transform the way we do things. That
gives us an opportunity to design services that are more convenient for patients,
whilst making the best use of every penny of taxpayers’ money we receive. So
our plans concentrate on transforming from a system that over relies on people
having to stay in hospital beds to one that supports and manages people within
their local communities and in their own homes.
Building on these foundations, our Two Year Operational Plan focuses on
transforming services to enhance the quality of life for people with long-term
health conditions, improve quality of care, reduce inequalities in access to
healthcare and improve joint working and integration with social care.
In particular, in 2015-16, we plan to:
• Lay strong foundations for delivery of new and integrated models of care
in line with the Better Care Together programme and our Better Care Funds
to drive transformational change and improve outcomes for our patients and
population;
• Prioritise programmes of work which offer the best patient outcomes
delivering qualitative change at pace across our health and social care
economy; and
• Focus on developments that deliver financial balance and value for money
redesign which maximises modernisation and transformation of our providers.
In practical terms, this will include:
• Improved performance in waiting at Accident and Emergency;
• Introduction of 7-day working in primary care and improved integration with
community services;
• Improved access to psychological services, through more investment and joint
working with colleagues in West Leicestershire CCG;
• Improved patient choice and delivery of national standards in the time taken
between referral to treatment, cancer and diagnostic standards;
• Increased investment in dementia care management;
• Better outreach for people with complex or multiple needs;
• Rapid access to diagnostics for our frail older people;
• Reduction in avoidable admissions to hospital;
• Improved end of life care, with more people dying in their place of choice;
and
• Implementation of a unified prevention plan, including weight management,
physical activity and sexual health.
Figure 3: Public feedback

SUPPORTING OUR STAFF
Nothing we do or achieve happens by accident. It is the result of an awful lot of hard work, dedication and imagination by our own staff and thousands of people
in the organisations with whom we work and engage.
We take seriously our responsibilities to support and develop our staff and those with whom we work. For example, during the past year, we have provided large
scale educational events (protected learning time) for GPs and practice staff and undertaken a detailed staff survey to help us listen to our staff about the things
that matter to them.
We’d like to take this opportunity to thank them all for all they do.
Karen English Graham Martin
Managing Director Chair
(Accountable Officer)

Member Practices’ Introduction
East Leicestershire and Rutland Clinical
Commissioning Group (ELR CCG) is a NHS
organisation set up by the Health and Social Care
Act 2012 to commission and organise the delivery of
NHS.
During 2014-15, ELR CCG served 321,580 patients registered with 32 GP
practices in Blaby, Lutterworth, Market Harborough, Rutland, Melton Mowbray,
Oadby and Wigston and the surrounding areas.
OUR REFLECTION ON PROGRESS AND PERFORMANCE
Overall, we believe the CCG has made good progress during the 2 years since
it moved from shadow form. In particular, our clinical leaders highlight the
following achievements/new services that have particularly benefited local
patients and clinicians:
• The introduction of new Urgent Care Centres in Oadby, Market Harborough,
Oakham and Melton Mowbray – offering increased access to care for patients
at weekends, evenings and bank holidays;
• Improving services for patients with mental health needs, through redesign
of the acute mental health pathway (how we treat patients), plus a new crisis
house for those finding themselves in immediate need of support;
• Advanced care planning, with everyone proactively planning and working
together to meet the needs of people in care homes and on the palliative care
list;
• Expansion of Increasing Access to Psychological Treatment (IAPT) services,
delivering patient-initiated contact that has resulted in improved take-up;
• Strengthening the crisis pathway for patients with mental health needs,
particularly for those with urgent needs, but not in crisis, so they are now
seen within 5 days;
• Major improvements in mental health out of area placements, working with
our colleagues in Leicestershire Partnership Trust to reduce out of area places
from 37 down to single figures;
• Introducing a training programme for GPs in all practices in atrial fibrillation,
reducing the chance of patients suffering from blood clots or stroke;
• Developing the first Allliance agreement in the country to bring together out-
patient, day case and diagnostic services to be delivered in the community,
closer to patients and their homes, and freeing up bed capacity in the acute
sector hospitals for patients who need them;
• Extending patient choice, reducing waiting times and backlogs through
delivering national standards on Referral to Treatment Times (RTT);
• Ensuring the voice of children and young people is heard in decisions over
local health and care strategies and delivery, recognising that the children of
today are the adults of the future;
• Improving services for children and young people with eating disorders;
• Coming below the national average for antibiotic prescribing, helping avoid
unnecessary use of antibiotics; and
• Development of the intensive community support (ICS) service, provided by
Leicestershire Partnership Trust (LPT), comprising 48 at home places (virtual
beds) across ELR for utilisation for both step up and step down. The service is
able to respond promptly to unscheduled care requests and is integrated
into the Intensive Community Response Service and night assessment services.

THE POWER OF CLINICAL LEADERSHIP
We estimate that during a typical year, well over 2 million individual
consultations take place in doctors’ surgeries in our area. That’s an average of
around 5,500 every day.
The insight gleaned from family doctors and other health professionals carrying
out these consultations gives them a powerful and unique insight into the real
health needs of local people and their families, as well as how the healthcare
system works in day-to-day reality. Together with their clinical colleagues
working in hospitals and other health settings, they hold unique knowledge that
simply cannot be obtained elsewhere.
Clinical leadership is all about harnessing that knowledge and placing it at
the heart of NHS decision-making and local strategies. Our Governing Body
membership includes GP clinical leads, a board nurse and a secondary care
clinician. It means our decisions are informed by direct recent experience of real
work at the NHS coalface, addressing real problems and challenges, looking
after the needs of real patients, their families and carers.
Family doctors are natural problem solvers and good at making practical
decisions. They have a strong tendency to focus on the quality of care their
patients receive from local NHS providers, helping us to hold them to account
and provide practical, constructive challenge to our own organisation. They are
also natural communicators, trusted by patients to tell them the truth. GPs and
local clinicians have an awareness of the needs not just of the patient in front of
them, but all patients in their local area. They are good at prioritising what best
meets local needs and, as natural pragmatists, tend to concentrate on what is
necessary to ‘get the job done’.
PATIENT ADVOCATES
GPs are the CCG’s patient advocates. In our role as clinical leads, we act as the
voice for over 300,000 people registered with our surgeries. In fulfilling that
role, we continually ask:
• What’s the real work needed, the real problems and challenges, the real
needs of our patients?
• Is what the CCG proposing going to work for my patients?
• Is it going to work in Primary Care?
• Is it practical? Is it necessary? Will it work?
Will it deliver
for patients?
Will it
work?
What are the
real needs?
What are the
real challenges?

By concentrating as patient
advocates on the quality of
what we are commissioning
and the outcomes it delivers,
we play a crucial role in
holding local providers to
account.
In our working lives in
surgeries and treatment
rooms, in primary care as
well as the secondary sector,
we constantly provide
constructive challenge to
ourselves and our colleagues.
In our role with the CCG,
we bring that constructive
challenge to those who are
commissioning services.
Clinical Leadership

EVALUATION OF OUR EFFECTIVENESS
During 2014-15 the Governing Body evaluated its own performance through
facilitation by an external consultant which led to the review of the Board
Development programme for the members of the Governing Body, both
individually and collectively. Governing Body development sessions have taken
place at agreed intervals during 2014-15 which involved sessions focusing on
roles, responsibilities, enhancing leadership skills and focusing on collective and
individual responsibility. These sessions are aimed to support members of the
Governing Body to function more effectively as a Governing Body.
Information sessions have also taken place for members of the Governing Body
providing them with an opportunity to review national guidance / initiatives
in greater depth and its implications on the clinical commissioning group’s
business; develop further insight into performance issues with key providers;
enhance their knowledge on a specific topics; and receive detailed information
on key national requirements.
Our Governing Body GP members have played a full and active part in all its
activities, with excellent attendance rates including development/information
sessions as well as public meetings.
ENGAGING AND EMBARKING ON CHANGE
We are embarking upon significant change to commissioning future community
and primary care services which has been clearly articulated in a number
of strategic documents including the CCG’s Integrated Community Services
Strategy, Primary Care Operating Framework: A GP Guide November 2014 and
health economy wide Better Care Together Programme.
The emergence of GP Federated models is also underway and offers the
opportunity for partnership working to strengthen any new community services
model that is commissioned.
To achieve our proposed model for the future of community services we have
spent time engaging with local stakeholders including providers, Local Authority,
voluntary sector and GP locality groups.
Our engagement process has enabled us to understand current issues and the
breadth of potential for bringing together community and primary care services
We have identified a number of areas which need to be addressed through the
proposed model to ensure a solid foundation for community services. We will be
embarking on a further round of engagement in the Autumn to ensure we get
things absolutely right.
These areas are not exhaustive and include:
• Changing the current model of community services commissioning to give the
CCG and its GPs more accountability to influence how services are delivered;
• Creation of joint GP/provider posts to enhance accountability;
• Delivery of a rehabilitation and re-ablement model that moves services from a
hospital to a home environment;
• Improving access to community services that are currently considered sub
optimal including physiotherapy;
• Expanding the times when care is available both at home and in health
facilities;
• Establishing clinical support networks and services in acute and primary care
to identify, enable and manage both complex care, frail elderly and sub-acute
care locally;
• Making the most of the land and estate available to deliver local services
avoiding unnecessary travel to acute hospitals;
• Minimising service barriers through simplified specifications and joint
commissioning of primary, social and community services; and
• Changing the model of community services commissioning to focus on
outcomes rather than inputs.

WHAT FEEDBACK TELLS US
During 2014-15 we carried out detailed Practice Member engagement - visiting our practices and hearing their views, ideas and concerns. A review of this
engagement has clarified many of the problems encountered by patients, carers and GPs when accessing health services. Our programme of change and
improvement during 2015-16 is designed to address these challenges.
These include:
• Home First as a prominent principle of service delivery;
• Demographic pressures – more people in the CCG area will be
over 70 years of age by 2030 and many of those people will be
living with a range of complex health issues requiring rehabilitation
and reablement;
• Patients find accessing care confusing and setting up a care
package for a patient is confusing and time consuming for
primary care;
• Recruitment of GPs is becoming more difficult and it is likely that
recruitment locally will not be able to keep pace with demand;
• GPs will be managing a higher acuity patient in the home;
• GPs and commissioners have little influence over the community
services provided for their population and good response times
are not consistently achieved;
• Community service communication is often poor;
• Significant recruitment and retention issues in community
nursing workforce with a high vacancy rate;
• Community services set up to deliver care aimed at avoiding
hospital admissions is impacted by inability to recruit staff and
the pace of Better Care Together changes;
• Current estate condition in ELR is in variable condition and is - in
parts - poorly utilised;
• Small numbers of physical beds are spread across four sites which
risks compromising clinical quality (limited peer review, isolation
of staff) and is not cost effective; and
• Under-utilisation of current Intensive Community Support (ICS)
beds.
Figure 4: A Word Cloud of what our GP Practices told us via our Practice Engagement Feedback

Dr Andy Ker
Clinical Vice Chair
Dr Richard Hurwood
GP Locality Lead, Melton,
Rutland and Harborough
Dr Richard Palin
Clinical Vice Chair
Dr Hilary Fox
GP Locality Lead Melton,
Dr Girish Purohit
GP Locality Lead, Melton,
Dr Nick Glover
GP Locality Lead,
Blaby and Lutterworth
Dr Graham Johnson
GP Locality Lead, Blaby and
Lutterworth
Dr Vivek Varakantam
GP Locality Lead,
Oadby and Wigston
Representing our Practices

Strategic Report
WHO WE ARE AND WHAT WE DO
East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is a NHS
organisation created by the Health and Social Care Act 2012.
We operate from offices at Thurmaston in Leicester and employed 84 staff as at
end March 2015.
We organise the delivery of NHS services for patients covered by 32 GP member
practices across three localities:
• Melton Mowbray, Rutland and Market Harborough;
• Oadby and Wigston; and
• Blaby and Lutterworth.
We do this by ‘commissioning’ or
buying health and care services
including:
• Primary Care;
• Planned hospital care;
• Urgent Care;
• Rehabilitation care;
• Community health services; and
• Non-urgent patient transport.
Our area of operations contains:
• 5 community hospitals;
• 1 large acute provider;
• 1 large non-acute provider;
• 2 local authorities; and
• 4 district/borough councils.
We commission acute services from out-of-county Trusts and a range of
independent sector providers such as Spire Leicester and Nuffield Leicester and
Circle Healthcare based at the Nottingham Treatment Centre.
Furthermore, ELR CCG provides grants for some voluntary sector providers
including the Alzheimer’s Society (carer’s support service), Carer’s Action (carer’s
support), Leicestershire Organisation for the Relief of Suffering (LOROS) for end-
of-life care, and The Laura Centre (support for adults and children affected by the
death of a child).
We act as the co-ordinating commissioning body to manage the following
contracts on behalf of all three Leicester, Leicestershire and Rutland CCGs:
• NHS111 - Non Emergency Urgent Care number providing call handling and
triage, the Provider is Derbyshire Health United (DHU);
• Out of Hours - GP clinical assessment service during the Out of Hours
period, the Provider is Central Nottinghamshire Clinical Service (CNCS);
• out-of-county contracts (acute);
• out-of-county community health services;
• East Midlands Ambulance Service;
• non-emergency patient transport services – Arriva Transport Solutions;
• any qualified provider contracts;
• Leicester, Leicestershire and Rutland voluntary sector arrangements;
• community based elective care alliance arrangement;
• home oxygen service contract;
• ELR CCG also works with our LLR CCG partners to support the management
of contracts across the three CCGs in line with the NHS Standard Contract
Management Framework.
On 1 February 2015, NHS England announced that from 1 April, we would take
on the management of primary care medical for all the practices in our area.
Planned care Urgent care
Communitycare
Primary care
Mental healthMaternityand neonates/
Childrenand young people
Long term
conditions
Rehabilitation care Non-urgent
patient transfer

OUR VISION AND VALUES
Our vision and values guide what we are trying to achieve and how we wish go
about it.
Our vision is “to improve health by meeting our patients’ needs with high
quality and efficient services, led by clinicians and delivered closer to home.”
In pursuing this vision, we are guided by nine values:
• Quality - ensuring quality underpins everything we do;
• Involvement - involving our patients, practices, staff, partners and the public
in all aspects of our work, with a strong commitment to listen, learn and act
on their views;
• Innovation - embracing new ideas, seeking creative solutions to deliver the
best results;
• Progression - looking ahead to identify and seize opportunities;
• Inspiration - striving for excellence, inspiring confidence and trust in others;
• Respect - championing equality, treating our patients and each other with
respect, dignity and professionalism;
• Education - improving services and quality through effective training and
development for staff and clinicians;
• Economy - spending wisely and preventing waste; and
• People - developing a team people want to work with, where staff are valued
and involved.
To improve health by meeting
our patients’ needs with high
quality and efﬁcient services led
by clinicians and delivered closer
to home
Quality
Involvement
Innovation
Progression
InspirationRespect
Education
Economy
People

OUR STRATEGIC AIMS AND COMMISSIONING PRIORITIES
Our values and strategic aims are based on the views of our member
practices, clinicians, our patients and carers, our staff and partner
organisations. We have spent time talking and listening to people
about the changes they would like to see in local healthcare and
where we should be focusing our efforts.
The broad themes that stood out in what people told us are:
• care delivered closer to home including access to services in patients’ own
homes and other alternatives to hospital admissions;
• closer working with social care to improve care pathways;
• more work on prevention (reducing diseases through screening, advice and
health checks); and
• better quality and more effective services.
Taking into account these themes, we developed the following strategic aims:
• Transform Services and enhance quality of life for people with long-
term conditions - with a particular focus on COPD, diabetes, dementia,
mental health and learning disabilities;
• Improve the quality of care - focusing on clinical effectiveness, safety and
patient experience, with specific goals to deliver excellent community health
services, acute care, mental health care and improve the quality of primary
care;
• Reduce inequalities in access to healthcare - targeting areas and
population groups with the greatest need;
• Improve integration of local services - between health and social care and
between acute and primary/community care;
• Listening to our patients and public - our commitment is to listen, and to
act on, what our patients and public tell us; and
• Living within our means - the effective use of public money.
The CCG’s vision and values are based on ethical, open and transparent
behaviour and all business practices follow this approach. These visions and
values are communicated to staff on commencement in post and office holders
receive contract / terms of office from HR which detail staff code of conduct and
behaviour expected and the consequences of non-compliance.

WORKING IN PARTNERSHIPS ACROSS LEICESTER,
LEICESTERSHIRE AND RUTLAND
Partnership working is vital to East Leicestershire and Rutland Clinical
Commissioning Group and it is the best way to bring about many of the
changes we wish to see implemented. Over the last year ELR CCG has actively
engaged with partner organisations to build on existing relationships, and
develop new and improved relations with clinicians, patients and carers, public
members, staff, partner organisations, including local authorities, and other
commissioning agencies.
We have many partners, and have established key working relationships with
the following:
• Leicester City and West Leicestershire CCGs;
• Leicestershire County Council and Rutland County Council (particularly with
social service commissioners and through Health and Wellbeing Boards) as
well as the borough and district councils within our CCG boundaries;
• Our providers including University Hospitals of Leicester, Leicestershire
Partnership NHS Trust, East Midlands Ambulance Service, voluntary sector
providers and charities;
• Healthwatch Leicestershire, Healthwatch Rutland, and other patient and carer
representative bodies;
• Leicestershire Police and Leicestershire Fire and Rescue Services;
• De Montfort University and the University of Leicester;
• Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU);
and
• Health Education East Midlands (HEEM).
In order to achieve our vision and values we will be work closely with our
local authority, CCG and provider partners to develop our five-year Leicester,
Leicestershire and Rutland strategy. Furthermore, we are working with our local
authority partners to develop our two-year plans, now known as the Better Care
Fund, to ensure health and social care work more closely together.
The CCG is committed to making care more integrated in order to improve
health for its population.
We are working with our local authority partners to ensure that resources are
used effectively. We will do this through the Better Care Fund, strengthening
our joint commissioning and working arrangements to deliver integrated care
for older people and supporting people with long-term conditions (LTCs). This
is particularly crucial if our CCG is to meet its financial challenges through the
transformation of care systems, and improve the quality of healthcare across all
our providers.
Public health input into the development and implementation of the CCG’s
strategic priorities is vital, and we base our priorities and initiatives upon
the Joint Strategic Needs Assessment (JSNA) and the Health and Wellbeing
Strategy of the county council. Public health staff continue to help the CCG to
understand local needs and issues of our diverse population. This contribution
is critical to both inform and develop our strategies, as well as in delivering our
priorities.
We are an active partner key in the Better Care Together (BCT) programme. This
is a significant programme of work which will transform the health and social
care system in Leicester, Leicestershire and Rutland (LLR) by 2019. BCT brings
together partners, including local NHS organisations and councils, to ensure that
services change to meet the needs of local people. We are also working closely
with public and patient involvement (PPI) representatives to develop plans for
change.

A quarter of the population (23.6%)
of East Leicestershire and Rutland is
under the age of 20, and around
25% are aged 60 and over (26.2%).
50.6% of our population is female, which
is similar to the England average of 50.2%.
The average life expectancy within East
Leicestershire and Rutland is 80.5 years for men,
and 83.9 years for women, both of which are
higher than the England average.
The number of people aged 60 and over is higher
than the England average (22.6%), and our older
population is predicted to increase over the next 10
years, with an estimated 19,000 additional people
aged 60 years and over.
In NHS East Leicestershire and Rutland CCG, only a small
proportion of people live in deprived areas. Nevertheless, there
are significent pockets of disadvantage in areas on the edges of
Leicester City and within the market towns. We have to ensure this
deprivation is not overlooked.
OUR POPULATION, THE COMMUNITIES WE SERVE AND THEIR HEALTH NEEDS
The population of ELR CCG as a whole has relatively low levels of material
deprivation, compared to other parts of England. In comparing the various areas
where our population live against the rest of England, we rank overall as 200 out
of 211 CCGs for deprivation (where 1 is the most deprived).
Within the CCG, there are areas that have poorer health outcomes. The main
areas affected are in Oadby and Wigston. These inequalities in health need to be
addressed. In one area of Wigston, residents have a significantly higher rate of
mortality from all causes and mortality from respiratory diseases than the England
average. Although not significantly higher, rates of mortality from circulatory
disease and mortality from stroke are higher than the England average .
Although not as significant as in Wigston, other pockets of greater need exist in
other parts of East Leicestershire and Rutland, including Melton, Harborough and
Blaby.
These inequalities in health need to be addressed. Significant health inequalities
exist for other minority and seldom heard ps, e.g., Black and Minority Ethnic
(BME), and travelling families within specific areas. Hence our plans address issues
relating to diabetes, cardiovascular disease, COPD, dementia, access to primary
care services and mental health.Figure 5: Our CCG population

Evidence suggests that the most effective way to reduce the gap in life
expectancy in the short term is to improve the management of diseases
(including CVD and COPD) and their risk factors (including smoking, alcohol,
hypertension and diabetes) that predominately affect the socially excluded. .
Accounting for 69% of all deaths, the major killers for East Leicestershire and
Rutland CCG are:
• cancer (29%)
• cardiovascular disease – CVD - (27%)
• respiratory disease (13%).
The health of our local population is generally better than the overall population
of England. However, there is a significant number of people affected by
ill health, including GP -diagnosed coronary heart disease (10,739 people),
hypertension (47,770 people), and diabetes (16,625 people).
The CCG currently has high levels of non- elective activity when benchmarked
against similar health economies. Without a focused approach and active
intervention, the ageing population will increase the gap between expected and
actual activity. Elective activity is consistent with the national average.
Figure 6: The major killers

OUR PRIORITIES FOR NEW INVESTMENT IN 2014-15
Our priorities for new investment in 2014-15, and our spending and investment
therein, were:
• Transforming Primary Care;
• Redesigning Community Services;
• Delivering an effective Urgent Care System;
• Improving Mental Health and delivering parity of esteem;
• Developing services for people with long term conditions; and
• Delivering maternity, children and young people’s services.
Transforming Primary care
Evidence shows that there are significant pressures in primary care. There is an
increased patient expectation, attendances have gone up 75% since 1998, and
there has been a slow drift of work from secondary care and community care,
which has put added pressure on staff time and resources.
2014-15 has seen significant developments in Primary Care. A full programme
of engagement with all of our member practices supported the design of the
GP operating framework, which sets out the plan for practices working together
in federation to support improved patient outcomes and alleviate some of the
pressure on general practice from increased demand of an ageing population.
In 2015-16 we expect all of our practices to have formally joined into 8/9
federations to deliver services for a greater population size.
This development of federations has taken place in parallel to the CCG’s
successful bid for delegated responsibility for primary care contracts in 2015-
16. This management of the whole primary care commissioning process will
give the CCG a fantastic opportunity to improve patient care and access whilst
addressing the capacity and workforce gaps in both general practice and
community services.
There will be a continued commitment to annual clinical visits to practices
to inform our future commissioning intentions and to assure the CCG that
practices are following best practice guidelines.
Redesigning Community Services
During 2014-15 we developed a Community Services Strategy, setting out our
vision for a fully integrated, co-ordinated model for health and social care,
delivering seven day services that put people’s care needs at the centre and
reduce the need for bed based provision.
Our vision is supported by a ‘home first’ philosophy. The Strategy aligns with the
Better Care Together five year strategic plan and our Better Care Fund plans and
outlines a model of care with the following key components:
• co-ordinated services with the patient at the centre of care;
• multi-disciplinary teams (primary, community and social care) wrapped round
the patient/citizen offering 24/7 services;
• focus on early intervention along with reablement and promoting
independence;
• specialist medical input as required;
• services that offer an alternative to hospital stay;
• community hospital beds where ‘home first’ is not possible;
• harness the power of the wider community;
• patients will receive education and support to understand and manage their
condition;
• increasing use of Personal Health Budgets;
• carers will receive ‘carer assessments’ and have their needs recognised;
• harnessing the voluntary and independent sectors in the delivery of services
that are co-ordinated with statutory services;
• an innovative environment that embraces the use of new technology; and
• a workforce delivering caring and compassionate care and with the training
and education to take on new roles that support the integration of health and
social care.

The proposed structure for service delivery outlined in our Community Services
Strategy combines wrapping services around primary care, with seamless
delivery of care that is integrated across organisations. The platform for delivery
of services will be the Primary Care localities and GP hubs (GP groups within
the localities, each with a registered population of 30-35,000). Services will be
delivered through co-ordinated pathways of care with integrated working within
healthcare and across health and social care where possible.
The Community Services Strategy has been developed alongside the CCG’s
Primary Care Operating Framework to ensure a fully integrated approach.
End-of-life Care
The CCG’s overall emphasis on delivering end-of-life care between 2014-2016
is to support patients to die in their place of choice and to work with our GP
practices to improve the quality of care for patients who are at the end of their
life.
In 2014/2015, the focus for the CCG has centred on identifying patients within
primary medical care that are approaching the end of their life and ensuring
that an effective care plan is developed with the patient and/or their carer. There
has been continued working with care homes to ensure that care plans are
developed appropriately within the care home environment and communicated
effectively with care home staff.
Delivering an effective Urgent Care System
In line with the national vision Leicester, Leicestershire and Rutland (LLR) has
identified priorities for emergency and urgent care for the next two to five years.
There has been significant emphasis over the last year on operational delivery
and the flow of patients through A&E. While this still remains an imperative, the
wider health and social care strategy for urgent and emergency care must be
in line with the local priorities, national policies and the needs of the people in
Leicester, Leicestershire and Rutland.
Work was undertaken early in 2014-15 to build on the initiatives undertaken in
primary care and community services, including the existing actions to improve
patient flow at the emergency care front door.
To determine the scale of the urgent and emergency care network required, we
used a detailed understanding for our area of:
• patient flows;
• the number and location of emergency and urgent care facilities;
• the service they provide; and
• the most pressing needs for our population.
We worked with social care partners to review and model care for those leaving
hospital care and requiring support for their continuing health and social care
needs.
We recognise the contribution of independent sector providers to support step-
down and support for discharge, and how we can work with these partners to
effectively and appropriately transfer care. Appropriate and effective services
available seven day a week underpinned all the initiatives in order to improve
timely access, continuity of care, and continuing care close to home. This system
based approach was critical to ensure that we were better prepared for winter
2014-15.

Good mental health is fundamental to our well-being,
yet mental health conditions are commonplace and living
with the burden of a mental illness can exact a heavy
price on individuals and those who care for them. It is
well recognised that good mental health is linked to good
physical health and more work is needed to achieve parity
of esteem in mental health support when compared with
the emphasis placed on physical health conditions. Mental
health has been identified as a key priority for joint action
within our five-year Better Care Together Strategic Plan.
During 2014-15 ELR CCG worked with their partners
and stakeholders to sign the Leicester, Leicestershire and
Rutland Crisis Care Concordat which outlines how police,
mental health services, ambulance professionals and health
professionals will work together to help and support
individuals going through a mental health crisis. Plans to
deliver this joined up approach have been developed.
Improving mental health and
delivering parity of esteem

Developing services for people with long term conditions
Respiratory disease
Respiratory disease is a major cause of morbidity
and mortality being the third leading cause of
death in England after circulatory disease and
cancer. It is also one of the principal reasons
for emergency admissions to hospital and, as a
result, it accounts for a substantial proportion of
NHS expenditure.
In England, around 23,000 people die from
chronic obstructive pulmonary disease (COPD)
each year, equivalent to one death every 20
minutes.
Acute exacerbation of COPD is itself a high-mortality condition: 15% of those
admitted to hospital with COPD die within three months which is higher than
the rate for acute myocardial infarction at 13%.
In 2013-2014 and 2014-15, the CCG developed a programme of delivery within
primary medical care linked to secondary and community care regarding the
management of COPD and asthma.
The key components of the improvement programme are:
• case finding patients to increase accurate diagnosis;
• spirometric competency assessed through specialist respiratory clinicians to
confirm the diagnosis of COPD; and
• inhaler technique training with primary healthcare professionals.
Average prevalence rates have increased from 1.2% (2010-2011) to an overall
average of 1.48% (2011-2012) and 1.57% (2012-2013) for all ages of our
registered patient population.
Spirometric competency assessment is a rolling programme across our 32
general medical practices working with our practice nurses. For 2013, just over
two thirds of our practices had achieved an up-to-date spirometry competency
assessment with the remainder of the practices planning to update their
competency training in line with the rolling programme of assessment.

Dementia
Dementia is a term used to describe various different brain disorders where a
loss of brain function is progressive and eventually severe. The most common
form of dementia is Alzheimer’s disease followed by vascular dementia.
Symptoms include loss of memory, mood changes and problems with
communication and reasoning.
Dementia is a long-term condition and people may live with dementia 7-12
years after their diagnosis. Nationally one in four females and one in five males
over the age of 85 have dementia. The higher prevalence in females is to some
degree due to longer life expectancy. In terms of mortality, 10% of deaths
in men over 65 years and 15% of deaths in women have been found to be
attributable to dementia in a UK study (this equates to 59,685 deaths annually).
In 2014 there were 130,400 people over the age of 65 years within
Leicestershire County and Rutland. This is predicted to rise to 186,900 by
2030, an increase of 43.3%. The following information details the number of
estimated people diagnosed with dementia in 2014 and the numbers predicted
for the future.
Area 2014 2030 Increase
Numbers
% Increase
Leicestershire 8,881 15,411 6,530 73.5%
Rutland 611 1,164 553 90.5%
Table 1: Number of estimated people diagnosed with dementia in 2014 and future predictions
Although the dementia registers and the figures show an increase in the
prevalence of dementia over time, 60% of people living with dementia in
Leicestershire and Rutland remain undiagnosed.
The 2013-14 prevalence figures for dementia within Leicestershire and Rutland
indicate similar figures to the England average:
Detail East Leicestershire and Rutland
Clinical Commissioning Group
List size 321,461
Register Count 2,080
Prevalence (unadjusted) 0.647%
Similar to England average
Table 2: 2013/14 prevalence figures for dementia
Work continued during 2014/2015 to develop services that can meet the needs
of an ageing population. This included work to develop the care of dementia
within general medical practice as well as working closely with community and
secondary care to ensure dementia has a key focus on care delivery.
For example, the Alzheimer’s Society began delivery of their Hospital Liaison
Dementia Support Service within University Hospitals of Leicester during 2014-
15 to support carers and people with dementia within a hospital setting,
providing information, and guidance on coping strategies, diagnosis and
support to access community services post hospital stay.

During 2014-15, we worked
with our local authority
partners, supporting the
development of local
authority services for people
with dementia and their
carers. These services provide
advice, information and
support to help people with
dementia and their carers to
maintain their independence
and to continue to live at
home.
Supporting people with dementia

Over the last few years we have seen an
increase in the number of births and an
increase in complexity. Although we have
better than or average rates in relation to,
perinatal / infant mortality, teenage pregnancy
and breastfeeding rates, it is widely accepted
that we have pockets of deprivation where
these rates are significantly higher. This high
level of need results in a greater demand on
maternity and neonatal services.
We provide high quality safe maternity and
neonatal services based on best practice and
which are easily accessible. These services will
be supported by the appropriate infrastructure
across both primary and secondary care.
During 2014-15 the following developments
took place:
• Primary Mental Health Professional Advice
Telephone service was expanded to
be available throughout office hours;
• introductory courses in child mental health
were delivered to over 600 staff
across a range of partner agencies;
• an independent review of CAMHS
community service was commissioned and
completed ; and
• expansion of family therapy service to
support educational psychology and
social care practitioners.
Delivering maternity, children
and young people services

QUALITY AND PATIENT SAFETY
Quality, patient safety, clinical effectiveness
and the experience of patients underpins the
delivery of health and social care services.
A number of recent high profile cases
(Winterbourne View [DH, 2012], the Report
of the Mid Staffordshire NHS Public Enquiry
by Robert Francis QC [2013], and the Saville
Inquiry [2013] have identified that vulnerable
people were not afforded basic standards of
care and their fundamental rights to dignity
were not respected. We must not allow this
scale of poor quality care and abuse to occur
in the services we commission.
We recognise the need for service
improvements to deliver better quality of
patient care and experience in the long-term,
whilst reducing clinical variation, eliminating waste and delivering better value
for money.
We will achieve this through the development of short, medium and long-
term investment in delivering the work that supports our strategic priorities.
This will include accompanying QIPP programmes. Alongside this, through
CCG contractual arrangements with providers we will ensure effective quality
indicators are in place which allow for a greater understanding of the impact of
health interventions on patients and the standard of services commissioned.
During 2014 we have made considerable progress in ensuring that we have
embedded effective systems to ensure that the CCG is able to monitor,
challenge and scrutinise provider performance to ensure improvements in the
quality of care commissioned.
Some examples of this are:
• The continued assessment of ‘patient experience dashboards’ for all of our
out-of-county acute contracts;
• Regular contacts through Quality Contracting Teams with our neighbouring
CCGs to monitor the quality of care being provided by our out of county
providers;
• Continued work with our local Healthwatch organisations to act on
intelligence received about provider performance;
• Understanding and scoping quality assurance systems within primary care;
• Development of quality schedules for Optometry, Pharmacy and General
Practice Community Based Services contracts. This will allow the CCG to
assure itself of the quality of care being provided by these services, and work
with providers to improve where necessary;
• Agreeing systems with NHS England to establish closer links and share
intelligence of primary care quality risks including establishing systems of
escalation where necessary;
• Development of a Care Home Strategy group to ensure all teams within
the CCG whose work involves care homes is executed in a streamlined
manner, to ensure quality care is delivered and compliance is monitored
effectively by maintaining an overview of work streams to deliver a care home
plan setting out aims, objectives, metrics, leads and time scales; and
• Systematic scrutiny and oversight of settings of care for people within
inpatient settings in learning disability services to ensure that safe and
effective discharge arrangements are in place.
However, the CCG is not complacent. We continue to review and refresh the
data sets used against the domains of the NHS Outcomes Framework and
ensure consistency and validation of data sources.
Alongside this we have embedded systems which allow for feedback from
service users using Healthwatch members and stakeholder events as well as via
our Listening Booths.

PATIENT EXPERIENCE
The CCG is committed to ensuring that the patient and service user voice is at
the heart of what we do. Improving patient experience has been a key area of
focus for East Leicestershire and Rutland Clinical Commissioning Group. During
2014-15 the CCG baselined the various elements of patient experience data
routinely collected. We have used this to identify key themes, trends and identify
any information gaps and take action as required.
‘Patient experience dashboards’ have been developed for our main acute
providers as well as the local out of county providers where our residents may
choose to access hospital services, that is:
• University Hospitals of Leicester NHS Trust;
• Kettering General Hospital NHS Foundation Trust;
• United Lincolnshire Hospitals NHS Trust;
• Northampton General Hospital NHS Trust;
• Nottingham University Hospital NHS Trust;
• Oxford University Hospitals NHS Trust;
• Peterborough and Stamford NHS Foundation Trust; and
• University Hospitals Coventry and Warwickshire.
Nine indicators have been developed, incorporating publicly available data and
data sourced by contracting teams. Indicators include a selection of patient
safety and patient experience indicators to provide a high level overview of the
quality of care being provided at each Trust. The dashboards are reported to the
ELR CCG Quality and Performance Committee on a quarterly basis.
Patient Participation Groups (PPGs) are in place at the majority of ELR CCG GP
practices. The CCG engages regularly with Patient Participation and Reference
Group (PPRG) to strengthen the voice of the patient within the work of the
CCG.
Our Chair convenes a quarterly Patient and Public Engagement Groups group.
The group comprises attendees from local third sector organisations, PPG/PRG
Chairs, and members of local Healthwatch. The group provides a sense check
on CCG plans and supports two way communication.
WE ARE LISTENING PROJECT
The “We are Listening” project has continued throughout the year. We have
travelled to over 25 locations, speaking to almost 200 people with the ELR
CCG branded listening booth. The listening booth allows ELR CCG to speak to
the public, patients and carers outside of health locations; approaching people
when they are feeling relaxed and have the time to talk about their experiences
of healthcare. The idea is to focus on how people feel and their attitudes and
opinions. The booth is designed to complement the data already available
through patient surveys and other large scale feedback mechanisms.
During the exercise, we collected positive and negative feedback from patients.
We went out to visit diverse groups including Sure Start centres, Learning
Disability groups,
market stalls and
lunch clubs across
all localities of the
CCG area. The
Listening Booth
formed an integral
part of the Urgent
Care Consultation,
and by accessing
a wide range of
locations with the
listening booth,
representatives
of seldom heard
groups were able
to participate in
the consultation.
Figure 7:Listening Booth Word Cloud

The feedback received via the listening booth has been broken down into
themes and trends, with feedback also provided to providers of services. This
information has been used to influence changes in the way we commission
services, and also to influence improvements in the quality of care being
provided, where patients have highlighted issues.
Patient stories have become an integral part of our public Governing Body
meetings. We use patient stories to drive changes and influence commissioning
decisions through clinical discussions in these meetings. In the last year, we have
been able to demonstrate meaningful changes arising out of the use of patient
stories at Governing Body meetings. Our Patient Stories allow real patients to tell
us their real-life experiences in their own words.
Some highlights include:
• Improvements to managing the risk of clostridium difficle infection;
• Input into the acute mental health pathway redesign;
• Focus on complex children’s care system;
• the impact of fragmentation of pathways for patients who live on borders;
and
• continuing challenges around the cancer diagnosis/treatment pathway.
WEB AND DIGITAL COMMUNICATIONS AND ENGAGEMENT
STRATEGY
We are proud of some of the innovations we have trialled during 2014-15 to
inform and involve local people and stakeholders in what we do and how we do
it. Moving forward, we intend to introduce further major innovations, including:
• a groundbreaking responsive web and digital communications and
engagement strategy, built on a ‘digital first’ integrated approach to our
website and other channels;
• a significant expansion of social media, based around a ‘communitarian’
approach that values and engages our stakeholders and communities as
equals and partners in our social space, rather than simply seeing them as
passive recipients of ‘just another set of broadcast channels’;
• trialling mobile capabilities,
harnessing the power of a true
understanding of
the unique opportunities that
mobile brings, recognising the
opportunities for
engagement afforded by
individualisation, location and
context awarenesss
and user-selected push
notifications;
• combining traditional methods
with the power of web, mobile
and social media to reach out
to hard to reach groups
and those beyond the ‘usual
suspects’ who traditionally have
been involved in health and
care discussion
and debate; and being
recognised as true innovators
in NHS digital and mobile
engagement.
This will enable us to
communicate with more people
in new and additional ways, at
times and through ways that offer
greater choice, convenience and
reach.
Figure 8: Blipfoto - one of our new social media channels being trialled

QUALITY AND EXCELLENCE
We continue to be committed to improving the quality of patient care, by a
focus on clinical effectiveness, patient safety and patient experience with specific
goals to deliver excellent health services and improve the quality of patient care.
This will be achieved by:
• continuously improving the quality of care within providers, including acute,
mental health and community services using contractual processes as a lever;
• combining commissioning and provider data with patient safety data and
carer feedback, including complaints, reference groups and engagement
events, to inform areas requiring improvement and attention and to ensure
on-going improvement;
• reducing variations in primary care for example access to primary care services,
appropriate prescribing, equitable access to health checks for all patients
including hard to reach groups;
• extending patient choice of provider for a range of community and mental
health services through the use of local and national AQP processes;
• delivering efficiency by maximising use of community services through an
integrated care approach with health and social care, to provide a seamless
service for patients; and
• assuring delivery through collaboration with main providers ensuring ‘value
for money’ for all partners.
Our plans for 2015-16 include a review of all quality schedules and local
Commissioning for Quality and Innovation (CQUIN) schemes to ensure
improvements areas have a greater focus.
We routinely review data published by the Care Quality Commission (CQC) to
inform our quality monitoring arrangements. Where providers have received
action plans following inspection visits we monitor progress against these
through our quality contracting processes. During 2015-16 we will be extending
this to include CQC intelligence within our quality data sets for Care Homes and
primary GP practices.
We have built positive relationships with our local CQC inspectors and have
developed joint meetings with Local Authority colleagues to ensure intelligence
sharing around providers; this supports our responsibility following the Francis
Publication in 2013.
Improving quality of
patient care
Excellent Community Health
Services
Improving quality of acute
services
Improving quality of Mental
Health Services
High Quality Responsive
Patient Care
Patient Safety Clinical
Effectiveness
Patient
Experience

PATIENT SAFETY
During 2014-15 we continued to focus our efforts on ensuring providers
actively reduce healthcare acquired infections such as Methicillin Resistant
Staphylococcus Aureus (MRSA) bacteraemia, Clostridium Difficile infection
(CDiff) MSSA and E Coli. This is achieved through monitoring compliance with
and achievement of nationally set trajectories for MRSA, Blood Stream Infections
(BSI) and CDiff and MRSA.
In the last year the CCG has:
• undertaken infection control review of patients in the community with a stool
sample reported as positive for CDiff that was sent from a GP surgery or
within 3 days of admission to UHL;
• addressing antimicrobial prescribing identified as not being in line with LLR
antibiotic guidance for primary care and audit of Proton Pump Inhibitator
prescribing; and
• continuing to support the combination of infection control data with the
data held by the CCG Medicines Management Team in relation to QIPP and
prescribing targets.
This has identified key learning themes, which have been shared via locality
meetings with our membership.
We have continued to review existing programmes associated with patient
safety themes, including:
• reviewing the findings of the Berwick review to reflect how commissioners
can support behavioural change with regard to patient safety;
• ensuring robust investigations of all serious incidents from all providers are
undertaken and submitted in a timely manner;
• continuing with systematic reviews of all serious incidents to identify areas for
targeted work – across providers;
• implementation of the intelligence reporting system across primary care for
GPs to raise issues and concerns to establish themes and trends that may be
developing;
• working with providers to eliminate avoidable pressure ulcers and working in
partnership with the local authorities to eliminate avoidable pressure ulcers in
care homes by including a pressure ulcer CQUINs into Care Home contracts;
• reviewing the outcomes of the Leicester, Leicestershire and Rutland learning
lessons review across primary and secondary care and identify key work-
streams which will improve pathways and outcomes for patients; and
• reviewing locally set infection control indicators in line with Department of
Health set objectives to improve infection control outcomes for patients;
THE BERWICK REVIEW
The publication of “A promise to learn - a commitment to act: Improving the
Safety of Patients in England” Berwick (2013) set out a number of commitments
for clinicians, managers and all staff of the NHS and for organisations leaders
and Boards. These commitments being:
• Listen to and involve patients and carers in every organisational
process and at
every step in their care;
• Monitor the quality and safety
of care constantly, including
variation within
the organisation;
• Respond directly, openly
faithfully and rapidly to
safety alerts, early warning
systems and complain from
staff. Welcome all of these.
• Embrace complete transparency;
• Train and support all staff
all of the time to improve
processes of care;
• Join multi-organisational
collaborative – networks in
which team can learn
from and teach each other; and
• use evidence based tools to
ensure adequate staffing levels.

During 2014-15 we ensured that mechanisms were in place via our contractual
arrangements with providers to respond to the Berwick recommendations. This
has included:
• reviewing and monitoring provider mechanisms to ensure that there are early
warning systems embedded in practice, evidenced by reviewing of nursing
and ward based safety metrics and actions in place where risks are identified;
• publication of staffing levels in line with “Hard Truths” and NICE staffing
guidance;
• ensuring triangulation of patient experience data such as surveys, friends and
family test, feedback from enquires and learning from complaints;
• identification of areas focus through learning from patient safety incidents
and serious incidents; and
• triangulation of provider data with data from GP concerns to improve quality
of discharge summaries to GPs following and inpatient stay.
Our contractual processes are only one way of ensuring the cultural change
needed to ensure a reduction in harm and improve safety across health
services. In August 2014 across Leicester, Leicestershire and Rutland the health
community published the “Learning Lessons to Improve Care”, a case note audit
review of care for people who died in 2012-13. ELR CCG is represented on the
Clinical Task Force convened to oversee the implementation of actions arising
from the review.
During quarter 3 of 2014-15 the East Midlands Patient Safety Collaborative
was convened. Early priorities are being agreed to shape the work plans for the
coming year and ELR CCG are supporting the development of this work plan
through attendance and positive contribution to the collaborative.
Alongside this the Leicester Improvement Innovation and Patient Safety Unit
(LIPS) collaboration between University Hospitals of Leicester and Leicester
University has been set up during 2014. ELR CCG has been invited to join
this collaboration to develop local patient safety initiatives. Both of these
collaboratives have been convened to address the cultural changes required
following publication of the Berwick and Francis reports.
The key safety priorities for 2015-16 will be:
• a commitment to work with the East Midlands Patient Safety Collaborative;
• a commitment to work collaboratively with the Leicester Improvement
Innovation and Patient Safety Unit; and
• Join the Sign up to Safety campaign.
THE FRANCIS INQUIRY
We welcomed the publication of the of the Francis Inquiry in February 2013
and actively engaged across the CCG including Governing Body members, staff,
member practices and the practice nursing community.
We developed a comprehensive plan in response to the recommendations
relevant to the CCG, including those relating to organisational culture which
were built into the CCG’s visions and values.
One of the key outcomes associated with the Francis response has been the
development and implementation of an automated GP intelligence reporting
system. This enables real time reporting of GP concerns relating to patient safety
and experience in any provider organisation.

Contractual mechanisms continue with the strengthening of our approach to
the monitoring of quality in providers. This has included the revision of quality
schedules to ensure they reflect the Francis recommendations and a proactive
approach to unannounced quality visits. The new approach to quality visits
continues to incorporate a multi professional desk top review of various data
sources to inform areas to visit, providers continue to welcome the increased
level of scrutiny and respond positively to this approach.
The thematic analysis of GP concerns has identified two specific work streams
that have commenced in 2014-15 these being: addressing quality of discharge
letters from University Hospitals of Leicester; and scoping of quality and capacity
within the district nursing services provided by Leicestershire Partnership Trust
across LLR.
During 2014-15 the Managing Director and Chief Nurse and Quality Officer
have been active contributors to the Leicestershire Area Team Quality
Surveillance Group. This group brings together a range of organisations
including: Public Health England, Local Authorities, Healthwatch Leicestershire
and Healthwatch Rutland, Health Education England, Trust Development
Agency, Care Quality Commission and partner CCGs. This is to ensure
intelligence sharing about providers in order to prevent a replication of the care
failings that occurred within Mid Staffordshire NHS Foundation Trust
The recent publication of “Freedom to Speak Up” in February 2015, sets out
20 principles for organisations within the NHS to adopt and embed to foster a
change of culture which ensures patients are placed at the heart of everything
we do.
Through 2015-16 we will:
• Use intelligence gathered from the variety of data streams to focus on
continuing quality and safety improvements;
• Continue to work collaboratively across LLR to ensure the cultural changes
required to improve care for our population are embedded; through active
participation within the Clinical Task Group, EM Patient Safety Collaborative
and LIPS; and
• Further develop and embed systems to ensure that staff who raise concerns
regarding poor quality care are listened to and supported in a non blame
culture.
WINTERBOURNE VIEW
The CCG is committed to delivering against the Winterbourne View Concordat.
This is to transform the way services are commissioned and delivered to:
• stop people being placed in hospital inappropriately;
• provide the right model of care and drive up the quality of care; and
• that by 1 June 2014 there is a rapid reduction in hospital placements for this
group of people.
More recently a joint Learning Disabilities Programme Board with clear terms
of reference, governance structure and stakeholder reference group has been
established. It includes representation from ELR CCG, local authority, Local
Area Team children’s and adults’ commissioners. This Programme Board will
oversee the development and delivery of the Winterbourne View action plan.
The Programme Board links back to the Health and Wellbeing Board via an
Integrated Commissioning Board that includes district council representation.

A stakeholder reference group has been established to support this work. This
includes families of children, young people and adults, commissioners and
NHS providers. It is planned to use this group as a longer term stakeholder/
advisory group for the Winterbourne View delivery plan. Additional members
will be brought in as required. There will be a degree of overlap with other
local authorities and CCGs in the Leicester, Leicestershire and Rutland area, and
particularly in relation to work with providers.
During 2014-15 we are systematically reviewing placements for patients within
inpatient settings commissioned by ELR CCG. In December 2014 the Chief Nurse
and Quality Officer chaired Care and Treatment Review panels for commissioned
placements to ensure appropriate arrangements were in place for ensuring
effective discharge when service users are deemed medically fit to transfer to
other settings.
During 2015-16 ELR CCG will:
• as members of the Better Care Together ensure proactive contribution to the
Learning Disability work plans; and
• ensure strengthened mechanisms are in place to review discharge
arrangements for those service users in hospital inpatient settings to ensure
safe and effective transfers to out of hospital care.
COMPASSION IN PRACTICE NURSING, MIDWIFERY AND CARE
STAFF - OUR VISION AND STRATEGY
We have used the publication of Compassion in Practice: Nursing, Midwifery
and Care Staff Our Vision and Strategy (DH 2012) as a key enabler to the
delivery of a long-term sustainable high quality nursing and care staff workforce
which support dignity in care provision.
The Chief Nursing Officer for England has developed the ‘6Cs Live!’ website,
which aims to build an online community of nurses and care givers across health
and social care. We have been actively participating in a range of ‘6Cs Live!’
webinars that support delivery of the six action areas:
• Helping people to stay independent, maximising well-being and improving
health outcomes;
• Working with people to provide a positive experience of care;
• Delivering high quality care and measuring impact;
• Building and strengthening leadership;
• Ensuring we have the right staff, with the right skills, in the right place; and
• Supporting positive staff experience.
The Chief Nurse and Quality Officer has contributed to the work across the
Leicestershire and Lincolnshire Area Team to support implementation of the 6Cs
action areas.
Our Protected Learning Time sessions across the CCG have supported the
development of a nursing forum for primary care nurses. The Practice Nurse
Facilitator has supported inductions programmes for new primary care nurses,
commenced reviewing competencies for clinical training programmes provided
by the LLR GP Training Function (hosted by ELR CCG) and has developed a
primary care nursing forum.
During 2014-15 we have demonstrated that through inclusion within quality
schedules, there has been a strong focus on staffing and skills mix within our
acute and non acute providers.
Through the use of “Safer staffing nursing” and “Birth right plus” staffing tools
our acute providers have assured their Trust Boards that they have reviewed
staffing establishments and published in line
with “Hard Truths” monthly staffing data.
In 2015-16 we will:
• continue to work with our providers to
ensure effective recruitment; and
retention practices of and reduction in
the use of agency staff continues; and
• Review and refresh our local plans to
further develop the action areas within
Compassion in Practice.

STAFF SATISFACTION
Staff satisfaction is an important workforce measure of how content or satisfied
employees are with their jobs and is typically measured using a staff opinion
survey which asks staff for their views about topics such as: remuneration,
workload and perceptions of management, flexibility, resources and teamwork.
The NHS National Staff Survey measures a range of aspects of working life and
enables organisations to monitor how well they are doing against the pledges
made to staff in the NHS Constitution. It has been, and will continue to be, an
enabler for NHS organisations to listen to and act on the views of their staff.
Perhaps more important is that evidence shows there to be a clear relationship
between staff and patient experience so improving the working lives of staff also
helps NHS organisations to provide better care for patients.
During 2014 the CCG implemented a number of actions in response to the
previous year’s survey findings and to further build the level of staff satisfaction.
Some examples include: continuing to improve internal communication
by holding regular staff briefings; the fortnightly publication of an internal
newsletter; and holding regular charity events and celebrations, e.g. the biggest
coffee morning for Macmillan and a Diwali lunch.
For the second year, it was not compulsory for CCGs to undertake the National
Survey, however, given its importance and the information it provides, the CCG
commissioned Picker Institute Europe to provide the online survey and achieved
an impressive 94% response rate which was a 2% improvement on the previous
year. The results of the survey are shared with staff to produce departmental
level action plans to address any areas of concern.
Jan’s Joggers are a new lunchtime group - aiming to get out for a walk every day at lunchtime for a 30 minute
walk

Some highlights from the results of the staff survey are:
• The majority of staff have had an annual appraisal which helped themimprove
how they do their job and agree clear objectives;
• Communication with senior management is effective;
• Team members have a set of shared objectives;
• The majority of staff enjoy coming to work and are enthusiastic about their job;
• Staff believe there are frequent opportunities for them to show initiative in
their roles;
• Three quarters of staff would recommend the CCG as a place to work; and
• The number of alleged incidents of bullying and harassment from managers/
colleagues has significantly reduced and will remain an area of focus.
Listening to staff

SAFEGUARDING
The CCG continues to have a strong focus on safeguarding vulnerable people.
We have developed and adopted a range of policies which underpin how
we approach safeguarding arrangements. The Quality and Performance
Committee of the Governing Body has oversight and scrutiny of safeguarding
arrangements for the CCG. The Chief Nurse and Quality Officer is the Executive
Lead for safeguarding and is a member of the Leicestershire and Rutland Local
Safeguarding Children Board (LSCB) and Safeguarding Adult Board (SAB). The
CCG is supported in its statutory duties by Designated Nurses and a Designated
Doctor for safeguarding.
The CCG uses the Markers of Good Practice for Children and Safeguarding
Adults Framework which meets the requirements set out in Safeguarding
Vulnerable people in the reformed NHS - accountability and assurance
framework published in March 2013 to assess provider compliance against
statutory safeguarding duties.
During 2014-15 the CCG along with NHS England Local Area Team and
the two other Leicester and Leicestershire CCGs, commissioned a review of
the designated function to ensure capacity and capability of this function in
supporting the CCG with delivering statutory duties.
This review has confirmed that the CCG has commissioned the appropriate level
of Designated Doctor and Nurse time and we are reviewing local service levels
agreements to ensure that quality of the service provision for 2015-16.
There have been no serious case reviews commissioned by the Leicestershire
and Rutland Safeguarding Board for people within East Leicestershire and
Rutland CCG area during 2014-15. However the GP Locality forums have
adopted a standardised approach to bringing any issues relating to safeguarding
issues on a monthly basis. In the last year we have supported the partnership
arrangements by contributing to the Child Sexual Exploitation campaign and we
have a local Practice Nurse supporting the work of the multiagency subgroup
within the LSCB.
The CCG has completed and submitted to the LSCB and SAB a self assessment
against Section 11 audit and the Safeguarding Adults Assurance Framework .

OUR COMMISSIONING ACTIVITIES AND WHO WE
COMMISSION FROM
East Leicestershire and Rutland CCG (ELR CCG) commissioned health services
totalling £328 million for people registered with our practices. We hold
contracts ranging from small grants to the voluntary sector, to a £126 million
contract with the main acute provider, University Hospitals of Leicester NHS
Trust.
Although the picture of healthcare providers is becoming more complex with
the roll out of initiatives such as ‘any qualified provider’ (AQP), offering patients
a wider choice of organisations to provide their care, the local services we
commission remain dominated by:
• UHL which provides acute hospital services at three sites in Leicester and in
local community hospitals. UHL provides secondary care to a catchment area
of approximately one million people and specialised services for up to three
million people. It is one of the largest acute trusts in the country;
• Leicestershire Partnership NHS Trust, the main provider of community health
and mental health services. LPT manages most of the community-based teams
serving ELR CCG and is a key provider at the six community hospitals; and
• East Midlands Ambulance Service NHS Trust provides emergency 999 and
urgent care crews across Derbyshire, Leicestershire, Rutland, Lincolnshire
(including North and North East Lincolnshire), Northamptonshire and
Nottinghamshire.
We commission acute services from out-of-county NHS trusts and a range of
independent sector providers such as Spire Leicester, Nuffield Leicester and
Circle, based at the Nottingham Treatment Centre.
Furthermore, ELR CCG provides grants for some voluntary sector providers
including the Alzheimer’s Society (carer’s support service), Carer’s Action (carer’s
support), Leicestershire Organisation for the Relief of Suffering (LOROS) for end-
of-life care, and The Laura Centre (support for adults and children affected by
the death of a child).
We act as the co-ordinating commissioning body to manage the following
contracts on behalf of all three Leicester, Leicestershire and Rutland CCGs:
• out-of-county contracts (acute);
• out-of-county community health services;
• East Midlands Ambulance Service;
• non-emergency patient transport services – Arriva Transport Solutions;
• any qualified provider contracts;
• Leicester, Leicestershire and Rutland voluntary sector arrangements;
• community based elective care alliance arrangement; and
• home oxygen service contract.
ELR CCG also works with our Leicester, Leicestershire and Rutland CCG partners
to support the management of contracts across the three CCGs in line with the
NHS Standard Contract Management Framework.

OPERATING AND FINANCIAL REVIEW
I certify that the Clinical Commissioning Group has complied with the statutory
duties laid down in the National Health Service Act 2006 (as amended by the
Health & Social Care Act 2012) and prepared the accounts under the Directions
issued by NHS Commissioning Board under the National Health Service Act 2006
(as amended). Appendix 1 provides the Annual Accounts for 2014-15.
DEVELOPMENT AND PERFORMANCE IN YEAR AND IN THE FUTURE
During 2014-15 the CCG’s Finance and Performance Committee (and towards
the end of the year by the Finance and Activity Committee) monitored all
performance indicators on a monthly basis, and is responsible for assuring the
Governing Body of compliance. This in turn was assured by the NHS England’s
Area Team at their checkpoint meetings with the CCG.
The CCG had a total allocation of £338,493,000 in the 2014-15 financial year.
NHS England had set a target for the CCG to achieve a surplus of £3,308,000.
Table 3 sets out the 2014-15 summary financial performance for the CCG. The
CCG over-achieved its target by delivering a surplus of £3,310,011.
East Leicestershire
and Rutland Clinical
Commissioning Group
Summary Financial
Performance
Budget
£
Actual
£
Variance
- Under/
Overspend)
£
Total allocation 338,493,000 338,493,000 0
Total Acute Commissioning 154,290,935 160,217,997 5,927,062
Total Non-acute Commissioning 105,584,715 109,084,218 3,499,504
Total Practice Prescribing 46,063,205 46,494,454 431,249
Total Primary Care Services 6,173,187 5,830,086 -343,101
Miscellaneous (inc reserves) 16,134,753 6,394,161 -9,740,592
Total Commissioned Healthcare
Expenditure
328,246,795 328,020,917 -225,878
Total Running Costs 6,938,205 7,162,073 223,868
Total Expenditure 335,185,000 335,182,989 -2,011
Surplus £ £ £
Programme control total 2,308,000 2,512,083 204,083
Running Costs control total 1,000,000 797,927 -202,073
Total control total 3,308,000 3,310,011 2,011
Table 3: ELR CCG 2014-15 Summary Financial Performance

The financial performance of the whole of the health economy in 2014-15 has
been difficult with the main provider of acute services (University Hospitals of
Leicester NHS Trust) reporting a sizeable deficit.
The LLR CCGs have continued to work closely with the trust to ensure that
services to patients have not suffered as a result of the financial problems. The
Commissioning Plans of the CCGs are supportive of the trust in achieving a
financial balance in the next two years. This will result in changes to the way
services are currently provided and the location in which they are provided.
To this end the CCG has significant new investments in community and social
care services with the aim of relieving the reliance and pressure on acute
services. The CCG has also worked alongside Leicestershire Partnership NHS
Trust to develop and improve inpatient services for people who have a mental
health issue.
Also during this year the CCG monitored the NHS Outcomes Framework, the
NHS Constitution and the new Quality Premium. The former is to drive local
improvements in quality and outcomes for patients and the Constitution to
ensure that patients’ rights and pledges were maintained through contracts with
service providers. The Quality Premium brings together a composite of indicators
from the outcomes framework and constitution, and incentivises the CCGs to
improve performance.
One of the ways we measure performance is setting and monitoring Key
Performance Indicators which include descriptions and measures (please see
Table 4).
Whilst we are pleased with performance in many areas of activity (e.g. progress
on time taken from referral to treatment) in several areas over the last year we
and our partners have not managed to hit national performance targets, with
highly publicised challenges at several of our providers including accident and
emergency services at Leicester Royal Infirmary, the Bradgate mental health unit
(Leicestershire Partnership NHS Trust) and East Midlands Ambulance Service.
During 2014-15 the CCG worked closely with all service providers and partners
across health and social care to support the implementation of plans to drive up
quality of care and performance.

The following tables set out East Leicestershire and Rutland CCG’s position on the expected rights and pledges from the NHS Constitution 2014-15
and includes thresholds that the NHS Commissioning Board will use when assessing organisational delivery.
EAST LEICESTERSHIRE & RUTLAND CCG. NHS CONSTITUTION KEY PERFORMANCE INDICATORS. Performance achieved
2014-15
Standard
2014-15
Referral to Treatment (non-admitted) 95% 95.6%
(All Providers)
Referral to Treatment (incomplete) 92% 95%
(All Providers)
Cancer waits - two weeks from urgent referral with breast symptoms 93% 92.99%
(All Providers)
Cancer waits - 31 days for subsequent cancer treatment (drug) 98% 94.29%
(All Providers)
Cancer waits - 31 days for subsequent cancer treatment (radiotherapy) 94% 92.4%
(All Providers)
Care Programme Approach: The proportion of people under adult mental illness specialties on CPA who were
followed up within 7 days of discharge from psychiatric in-patient care during the period
95% 96.1%
(LPT)
Table 4: Key Performance Indicators

EAST LEICESTERSHIRE & RUTLAND CCG. NHS CONSTITUTION KEY PERFORMANCE INDICATORS. Performance achieved
2014-15
Standard
2014-15
Referral to Treatment (admitted) 90% 86.4%
(All Providers)
Cancer waits - two weeks from urgent GP referral 93% 92.9%
(All Providers)
Cancer waits - 31 days to first
definitive treatment
96% 94.2%
(All Providers)
Cancer waits - 31 days for subsequent cancer treatment (surgery) 94% 92.4%
(All Providers)
Cancer waits – 62 days from urgent GP referral to treatment 85% 82.8%
(All Providers)
Cancer waits - 62 days from NHS screening service to treatment 90% 80.8%
(All Providers)
Cancer waits - 62 days for treatment following a consultant’s decision to upgrade the priority of
the patient
100% 92.3%
(All Providers)
Diagnostic waiting times 99% 98.5%
(All Providers)
Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E
department
95% 92%
(UHL only)
Category A Red 1 incidents response within 8 minutes - (conditions that may be immediately life
threatening and the most time critical)
75% 73.2%
EMAS
Category A Red 2 incidents, response within 8 minutes - (conditions which may be life threatening
but less time critical than Red 1)
75% 70.09%
EMAS
Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 93.2%
EMAS
Cancelled ops - All patients who have operations cancelled, for non-clinical reasons, to be offered
date within 28 days, or funded at the time and hospital of the patient’s choice.
100% 95.6%
(UHL Only)
Mixed Sex Accommodation Breaches 0 breaches 5
(All Providers)
NB: Indicators rated as ‘amber’ meet the lower threshold, but do not meet the nationally set target. For example: Referral to treatment (admitted) has a target of
90%, the lower threshold is 85%, therefore a position of 88.7% is between the target and the lower threshold, giving an amber indicator.
Table 5: Key Performance Indicators

THE RESOURCES, PRINCIPAL RISKS AND RELATIONSHIPS THAT
MAY AFFECT LONG-TERM PERFORMANCE
The CCG had an allocation of £338,493,000 in 2014-15. This was managed
through the Accountable Officer and the Chief Finance Officer. The financial
performance of the CCG was monitored on a monthly basis by the Governing
Body and the Finance and Performance Committee (and towards the end of the
year by Finance and Activity Committee) chaired by a lay member.
The main financial risk that the CCG faced throughout the year was over
performance in the Acute Sector against the backdrop of significant emergency
activity pressures experienced during the year. The overspend in the acute sector
at the end of 2014-15 was £5.93 million, as shown in Table 6.
Acute Commissioning Overspend
£m
UHL Contract 3.25
Out of County Contracts 1.29
Non Contracted Activity 0.15
Independent Sector 1.24
Total overspend 5.93
Other key financial risks included:
• increasing expenditure within continuing healthcare;
• Winter Pressures across the health and social care economy;
• Potential non-achievement of QIPP plans; and
• In year management of allocation movements as funding was stabilised.
These risks were mitigated following extensive discussions with providers of
services. Where appropriate, risk sharing strategies were adopted. A number
of the risks were shared on a collaborative basis with the other Leicester and
Leicestershire CCGs alongside underspending in other areas.
The CCG had a total of £7,960,000 to spend on running costs in 2014-15 and a
total of £7,162,073 million was spent (see Table 3).
BETTER PAYMENTS PRACTICE CODE
The Better Payment Practice Code requires the Clinical Commissioning Group
to aim to pay all valid invoices by the due date or within 30 days of receipt of a
valid invoice, whichever is later. The NHS aims to pay at least 95% of invoices
within 30 days of receipt, or within agreed contract terms. Details of compliance
with the code are given in the notes to the financial statements. In 2014-15 all
NHS and Non-NHS invoice payments have exceeded the 95% target for number
of invoices paid and also for value of invoices paid. [See note 6 in the financial
statements for further details].
PROMPT PAYMENTS CODE
On 28 February 2014 the CCG became an approved signatory of The Prompt
Payment Code. This initiative was devised by the government with The Institute
of Credit Management (ICM) to tackle the crucial issue of late payment and to
help small businesses. Suppliers can have confidence in any company that signs
up to the code that they will be paid within clearly defined terms, and that there
is a proper process for dealing with any payments that are in dispute. Approved
signatories undertake to:
• pay suppliers on time;
• give clear guidance to suppliers and resolve disputes as quickly as possible;
and
• encourage suppliers and customers to sign up to the code.
COST ALLOCATION & SETTING OF CHARGES FOR
INFORMATION
We certify that the Clinical Commissioning Group has complied with HM
Treasury’s guidance on cost allocation and the setting of charges for information
Table 6: Acute Commissioning

GOVERNING BODY’S POLICY FOR MANAGING RISK
The CCG Governing Body is committed to commissioning safe and effective
care and leading the organisation to deliver its objectives. It uses approved risk
management strategy and policy to lead the organisation forward to deliver its
objectives.
The CCG acknowledges that risk can bring with it positive advantages, benefits
and opportunities and aims to create an environment where risk is considered
as a matter of course and appropriately identified and managed. A culture of
open reporting is promoted and upheld throughout the CCG to ensure that risks
are identified, evaluated, documented and managed by all who may encounter
them.
Risk management is a core organisational process and is an integral part of
its philosophy, practices and business planning and that responsibility for its
implementation is accepted at all levels of the organisation. The CCG recognises
the importance of involving local stakeholders in its risk management processes
and of working in partnership to identify, prioritise and control shared risks, such
as through collaborative arrangements.
Strategic risks (or principle risks) identified are those that represent major
threats to achieving the CCG’s strategic objectives or to its continued existence.
Strategic risks are recorded in the Board Assurance Framework (the corporate
risk register) and managed by the Executive Management Team and regularly
reported to the Audit Committee and Governing Body.
THE CCG’S PRIORITIES FOR THE NEXT TWO YEARS (2014-16)
The CCG’s Operational Plan 2014-16 details the key priorities for the next
two years and our intentions to further develop partnership and collaborative
working with our local authority partners, neighbouring CCGs and stakeholders
in order to deliver the system redesign that is needed to address our local
challenges and issues. The key priorities include:
• Reshaping community services to deliver locally based provision that enables
patients to remain independent for as long as possible and have a better
quality of life;
• Further integration of health and social care provision to transform care that is
strong, sustainable and person centred which enables the health and social
care system meet the future demands;
• Service improvements which deliver better quality care and patient experience
whilst reducing clinical variation, eliminating waste and delivering better value
for money;
• Reducing pressure within our urgent care system to prevent avoidable
admissions and reduce length of stay for patients who could be cared for at
home;
• Support general practice to come together with new ways of joint working
to enable primary care health teams to have more time to proactively manage
patients with multiple illnesses, at the end of life, in care homes or at risk of
admission;
• Children and their families will continue to be an important priority for the
CCG; and
• Working with our mental health providers, clinicians and service users to
improve our acute mental health pathway.
The CCG is working in partnership with NHS England and other Leicester and
Leicestershire CCG partners, Local Authorities and providers to formulate a five
year strategy that focuses on some strategic health priorities.

POSITION OF THE ORGANISATION
The CCG has applied national guidance and policies to the production of the
financial statements and, as far as the CCG is aware, Arden and GEM CSU has
followed the same process. No use has been made of financial instruments
(including derivatives). There been no significant transactions that are outside
the normal trading activities of our organisation in the 2014-15 financial
year. There are no pension liabilities. The CCG is not impacted by interest rate
changes. The CCG has established effective standard financial management
arrangements, including:
• standing orders and standing financial instructions;
• committee structures, including the Audit Committee and the Finance and
Performance Committee (and then the Finance and Activity Committee);
• scheme of reservation and delegation;
• internal financial/management reporting;
• key financial systems such as accounts payable and receivable, cash and bank;
• internal audit, including arrangements for liaison between internal audit and
the Arden and GEM CSU’s commissioning support unit’s internal audit
provider; and
• counter-fraud and corruption.
We certify that the clinical commissioning group has complied with the statutory
duties laid down in the National Health Services Act 2006 (as amended).
SUSTAINABILITY REPORT
There is a clear need for the NHS to take a lead in energy reduction to reduce
the impact that healthcare activities have on the environment, to improve
health, to improve sustainability and to reduce expenditure on energy. The NHS
aims to reduce its carbon footprint by 10 per cent between 2009 and 2015.
Reducing the amount of energy used in our organisation contributes to this
goal. We remain committed to supporting the NHS in achieving the challenging
national targets and acknowledge the responsibility we have to our patients,
local communities and the environment by working hard to minimise our
footprint.
All of the energy use relating to the CCG’s operations arises from occupation of
rented office spaces. The CCG operates from a single unit based in Thurmaston,
Leicestershire. The property is leased and Raynsway are the landlords with NHS
Horizons supporting the building maintenance through a contract with a facility
management team.
Climate change brings new challenges to our business, in direct effects to the
healthcare estates but also to patient health. Examples in recent years have
included the effects of heat waves and prolonged periods of cold, floods and
droughts.
Greenhouse Gas Emissions
The majority of greenhouse gas emissions attributable to the CCG’s activities are
likely to come from energy used in the buildings the organisation occupies and
from the business travel that staff undertake.
Greenhouse gas emissions information will be published in future annual
reports.
Business travel makes a significant contribution to the greenhouse gas emissions
from NHS England’s activities.
Procurement
The CCG’s standard terms and conditions of contract, which are referenced
on all purchase orders, have given consideration to sustainability. They include
requirements for timely payment of sub-contractors and requirements for
suppliers to give consideration to environmental factors and to act in accordance
with all applicable law relating to the environment and the disposal of goods.

Health & Wellbeing
The benefit to individuals, the CCG and the broader economy that a healthy,
committed and engaged workforce can create is at the core of the organisation’s
approach to employee health and wellbeing. Through the Organisational
Development Plan the CCG aims to develop into an excellent organisation and
an exemplary employer, with a particular focus on the health and wellbeing of
the people that work within the organisation.
Organisations are being encouraged to develop a local strategy, measure their
success with regular reporting, and evaluate their progress as well as joining up
with local Health and Wellbeing Boards.
Sustainability issues are included in our analysis of risks facing our organisation,
there is a statutory duty to assess the risks posed by climate change and the
outcome of these risk assessments inform the review and management of the
local policies and procedures in place.
We are reviewing our business continuity policy and plans to address the
potential need to adapt the organisation’s activities and infrastructure to climate
change and adverse weather events. One of the ways in which we will measure
our impact as an organisation on corporate social responsibility is through the
use of the good corporate citizenship (GCC) tool.
During 2014-15 we have undertaken an initial assessment and compiled our
Sustainable Plan which includes an action plan. The action plan seeks to
achieve measurable sustainable development objectives in accordance with
the NHS national strategy. The CCG seeks to implement the principles of
sustainability within commissioning, and in respect to consumption of energy
and procurement of supplies, by minimising waste, reducing unnecessary travel
and providing training.
For 2015-2018 the action plan will focus on:
• Staff awareness
• Waste, energy and carbon reduction
• Travel and transport.
EQUALITY AND DIVERSITY REPORT
NHS East Leicestershire and Rutland CCG is committed to improving equality
and respect to the whole of the community as well as patients, CCG employees
and potential employees. We are committed to treating everyone who we come
into contact with fairly and not discriminate against anyone because of their
age, disability, gender, gender reassignment, pregnancy and maternity, race,
religion or belief, sexual orientation or whether they are married or in a civil
partnership.
Our aim is to ensure that we commission accessible, high-quality health services,
working on prevention and intervention initiatives aimed at reducing health
inequalities and establishing a culture of inclusion that enables us to meet
the needs of all our diverse communities within the organisation’s culture,
employment practices and commissioning systems.
Public Sector Equality Duty (PSED)
The CCG aims to meet the requirements of the Public Sector Equality Duty
(PSED) and the ‘three aims’ of the duty. The ‘three aims’ are to have due regard
to the need to:
• eliminate unlawful discrimination, harassment, victimisation and any other
conduct that is prohibited by or under act
• advance equality of opportunity between people who share a relevant
protected characteristic and those who do not share it, and
• foster good relations between persons who share a relevant protected
characteristic and persons who do not share it.
The Equality Act 2010 also outlines specific duties on public bodies to meet the
PSED more effectively. These specific duties are to:
• Publish information to demonstrate their compliance with the Equality Duty
at least annually; and
• Set equality objectives at least every four years.
In October 2013 the CCG approved 3 equalities objectives aligned to the Two
Year Operating Plan and published equalities information in January 2014.

The CCG’s Equality Objectives for 2013–2015 are set out below:
i) Addressing needs of older people and access to services
Year 1 - undertake baseline to identify what access looks like at present and
identify gaps. Aligning this to the duty to have regard to reducing health
inequalities, improving access and health outcomes.
Year 2 - review the results of the baseline and identify areas to address / change.
Develop plans for improving access for older people as identified through the
baseline.
ii) Targeting provision and access to seldom heard people and groups –
travelling families, BME, LGBT, rural deprivation
Year 1 - define what is meant by “seldom heard individuals, groups /
communities” in relation to East Leicestershire and Rutland population in
comparison to Leicester, Leicestershire and Rutland. Review how the CCG
is currently engaging with these groups and how these mechanisms can be
strengthened. Identify and map existing mechanisms of engagement through
which the CCG accesses / or can access these groups / communities to gather
intelligence. Consider how the CCG engages with the local authorities in
strengthening engagement with these groups / communities.
Year 2 - using the information / intelligence gathered in year 1, identify how the
CCG is going to target / prioritise provision.
iii) Access to early intervention and prevention of Mental Health issues
Year 1 - evaluate and understand local mental health issues in relation to young
people and other groups. Review access to early intervention and identify what
is currently available in order to prioritise and improve health outcomes across
East Leicestershire and Rutland.
Year 2 - baseline to be undertaken will determine actions for year 2. For
example this could be work with young people to identify mechanisms for
improving access to mental health services. Year 2 will be about using the
information to improve outcomes for patient and prioritise mental health
services.
The equality objectives have been developed to make sure that they are relevant
with focus on outcomes for our patients and are aligned with the CCG’s
strategic aims and refreshed commissioning intentions.
During 2014-2015 the CCG has made positive progress against the public sector
equality duty and achieving our equality objectives. Our achievements include
the following:
• focussed outreach work to enable the CCG to seek the views of
representatives from each of the nine protected characteristics on the future of
urgent care services in the area;
• the Better Care Together Programme has launched an engagement campaign
to ascertain the impact the Programme is having on patients, this includes
engagement with seldom heard groups including Learning Disability groups;
• development of a Community Services Strategy in 2014-15 to deliver our
vision to meet the needs of an increasing older population, particularly the frail
and those with long term conditions through ‘a fully integrated, co-ordinated
model for health and social care, delivering seven day services that puts
peoples’ care needs at the centre.’ This Strategy is primarily concerned with
the service pathways for Frail Older People and Long-Term Conditions
delivered in the settings of ‘Self Care, Education and Prevention’, ‘Community
and Social Care Services’ and ‘Crisis Response, Reablement and Discharge;
• Membership of ELR CCG’s advisory Public and Patient Engagement Group
(PPEG) has also been reviewed and invitations to join this group have been
extended to groups / individuals representing the nine characteristics;
• we continue into 2015-16 with the listening booth which will be visiting a
range of community and voluntary groups to try to access the views of seldom
heard groups in particular. We will also be paying particular attention to those
areas of deprivation within our CCG area.
We continue to work in conjunction with local partners such as our
neighbouring CCGs, our providers, Leicestershire County Council, Rutland
County Council, our local District and Borough Councils and the voluntary
sector – to create and maximise shared opportunities for communication and
engagement enabling and promoting equality, human rights and inclusion.

PUBLICATION OF INFORMATION
The CCG has used the Equality Delivery System 2 (EDS2) as the framework to
evidence compliance with the Public Sector Equality Duty over the last year.
EDS2 is a tool to support organisations to continuously improve their equality
performance and to help meet the requirements of the public sector Equality
Duty of the Equality Act 2010. EDS2 has four goals supported by eighteen
outcomes. The four goals are:
• Better health outcomes;
• Improved patient access and experience;
• A representative and supported workforce; and
• Inclusive leadership.
In meeting the duty to publish information the CCG has collected evidence,
which should provide an understanding of how the CCG is approaching equality
and inclusion in its activities.
The table of evidence which we published on our website, at:
www.eastleicestershireandrutlandccg.nhs.uk/equality-diversity-and-human-rights
demonstrates how the CCG has approached equality and inclusion and how
it will be continuing to develop this over the next year in line with its strategic
priorities and equality objectives.

WORKFORCE
NHS East Leicestershire and Rutland CCG employed 85 members of staff
(headcount figure as at 31 March 2015) and, therefore it is not required to
produce detailed staff profiles by protected characteristics. This also protects
the privacy of employees as any profiles of protected characteristics may
allow individuals to be identified. The table below provides an overview of
the number of persons of each sex who were on the Governing Body and the
number of persons of each sex who were employees of the CCG as at 31 March
2015:
Sex All employees Governing Body
All members of
the Governing
Body
GP members on
the Governing
Body
Disclosed 85 16 8
Female 69 5 1
Male 16 11 7
Total 85 16 8
The CCG is committed to ensuring the working environment is inclusive and
appropriate support is provided to any member of the organisation that may
require it.
All of the CCG’s internal workforce policies have been developed, and continued
to be updated, in line with current legislative requirements, including the
Equality Act 2010.
These policies cover the recruitment, selection and appointment process as well
as all aspects of working for the CCG, including:
• giving full and fair consideration to applications for employment made by
disabled persons, having regard to their particular aptitudes and abilities;
• continuing the employment of, and for arranging appropriate training for,
employees who have become disabled persons during the period; and
• training, career development and promotion of disabled employees.
In addition, the CCG has developed its organisational vision and values to
support continued organisational development in supporting and valuing the
diversity of its employees and creating an inclusive working environment.
INFORMATION RELATING TO ACTIVITIES OF THE CCG
In order to structure the available evidence that demonstrates how the CCG is
working to meet the Public Sector Equality Duty (PSED), the CCG utilised the
following guidance:
• Technical Guidance of the Public Sector Equality Duty England, Equality and
Human Rights Commission (EHRC), Jan 2013;
• Equality Delivery System (EDS) and EDS2, NHS England, Nov 2013.
Equality and inclusion work is an on-going activity for the CCG that will be
consistently incorporated across all of its functions.
Karen English
Managing Director (Accountable Officer)
28 May 2015
Table 7: Workforce

Members’ Report
NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is led by a Governing Body comprising elected GP members, a secondary care clinician
and lead nurse and independent lay members as detailed below.
Name Position
Mr Graham Martin Lay Chair
Dr Andrew Ker (from 1 July 2014) Clinical Vice Chair
Dr Richard Palin (from 1 July 2014) Clinical Vice Chair
Mrs Karen English
(interim Managing Director from 1
January 2015; substantive Managing
Director from 4 March 2015)
Managing Director (Accountable
Officer)
Dr Nicholas Glover Blaby and Lutterworth GP Locality Lead
Dr Graham Johnson Blaby and Lutterworth GP Locality Lead
Dr Hilary Fox (from 1 July 2014) Melton, Rutland and Harborough GP
Locality Lead
Dr Richard Hurwood Melton, Rutland and Harborough GP
Locality Lead
Dr Girish Purohit
(from 1 September 2014)
Melton, Rutland and Harborough GP
Locality Lead
Dr Vivek Varakantam
(from 1 September 2014)
Oadby and Wigston GP Locality Lead
Mr Warwick Kendrick Independent Lay Member
Mr Alan Smith Independent Lay Member
Dr Tabitha Randell Consultant Paediatric Endocrinologist
(secondary care clinician)
Mrs Carmel O’Brien Chief Nurse and Quality Officer
Mrs Donna Enoux Interim Chief Finance Officer
Mrs Jane Chapman Chief Strategy and Planning Officer
Mr Tim Sacks Chief Operating Officer
Dr Tim Daniel Consultant in Public Health Medicine
(in attendance)
Table 8: Members’ Report

GOVERNING BODY MEMBERS’ PROFILES
Mrs Karen English
4 March 2015 to date
Interim Managing Director
1 January 2015 - 3 March 2015
Chief Finance Officer and Deputy
Accountable Officer
January 2013 - 31 December 2014
Karen joined East Leicestershire and Rutland
Clinical Commissioning Group as chief finance
officer in January 2013 and was appointed as
Managing Director in March 2015 after a rigorous
assessment process.
She studied BA (Hons) in Business Studies at Liverpool, and a Post Graduate
Diploma in Managing and Commissioning in Primary Care in Southampton in
2005.
Since joining the NHS as a Graduate Trainee from the private sector in 1983,
Karen has held a range of senior finance roles for a variety of NHS organisations.
Her wealth of experience includes working at an executive level within the
NHS and she has substantial and successful experience as a senior finance
professional in complex health environments in the North West and West
Midlands.
Karen is a member of the Institute of Public Finance and Accountancy (CIPFA)
and a CIPFA consultation panel member.
Dr David Briggs
To 31 January 2015
Dr Briggs qualified as a doctor in 1996 after
studying at Leicester Medical School. He became
a GP Principal practicing in Melton Mowbray in
2001 and was a professional executive committee
member for NHS Leicestershire County and
Rutland Primary Care Trust for five years until
Clinical Commissioning Groups (CCGs) formed.
In April 2011, as part of reforms to the NHS, Dr
Briggs was elected by his peers to the role of
clinical chair of East Leicestershire and Rutland
Clinical Commissioning Group (ELR CCG).
Throughout 2011/12 his ability to place clinicians at the forefront of decision
making strengthened leadership within ELR CCG. Dr Briggs was appointed to
the role of managing director (the organisation’s accountable officer), leaving
full-time general practice. Dr Briggs left ELR CCG in January 2015 to resume his
practice as a GP.
In addition to managing the business of ELR CCG, Dr Briggs played a key
leadership role across the local NHS as part of the collaborative working
arrangements between the three Leicester, Leicestershire and Rutland CCGs.

Mr Graham Martin
Chair
Mr Martin worked in the NHS for over ten
years and has recently retired from leading the
European operations of a large international
management consulting firm.
He is an advisor on healthcare and human
resource issues to Management consulting firms
and is a practicing Executive Coach.
He has long-standing connections with the
NHS and has been a non-executive director
for Nottingham City Hospital NHS Trust, a lay
member with the Leicestershire County and
Rutland community services board and more recently with East Leicestershire
and Rutland Clinical Commissioning Group.
Mr Martin holds an MA(Econ), Post graduate Diploma in Management Studies
and is a Fellow of the Charted Institute of Personnel and Development
Dr Andy Ker
Clinical Vice Chair
1 July 2014 to date
Locality lead - Melton, Rutland and
Harborough
To 31 June 2014
Dr Andy Ker is a senior partner at Oakham
Medical Practice in Rutland.
In 1983 he trained as a doctor at Westminster
Medical School in London, achieving a MBBS,
and then completed his GP Vocational Training in
Guildford in 1987. He went on a travelling “gap
year” in 1989 where he ended up working for six
months in general practice in Christchurch, New Zealand.
He started work as a GP in Oakham in 1990 and has a particular interest in the
musculoskeletal system. He has also worked as an appraiser and trainer of GPs
and been a prison medical officer.
Dr Ker is a governing body member for East Leicestershire and Rutland Clinical
Commissioning Group and one of the Clinical Vice Chairs.
He is the clinical lead for community services and out of county contracts.
His project work includes leading the dementia strategy and developing the
integrated health and social care strategy, and he also represents the CCG on
the Rutland Health and Wellbeing Board.

Dr Richard Palin
Clinical Vice Chair
1 July 2014 to date
Locality lead – Oadby and Wigston
To 31 June 2014
Dr Palin has been a GP Partner at Bushloe End
Surgery in Wigston since 2004. He is currently the
locality lead representing practices in Oadby and
Wigston and a governing body member.
He is one of the Clinical Vice Chairs on the
Governing Body.
Dr Graham Johnson
Locality lead – Blaby and Lutterworth
Dr Johnson is a partner at Wycliffe Medical
Practice in Lutterworth.
He attended the University of Nottingham
Medical School where he achieved a first class
BMedSci (hons) degree in 1992, followed by a
BMBS (hons) in 1994. In 1995 he worked at the
Queen’s Medical Centre hospital in Nottingham,
before completing a GP Vocational Training
Scheme in Nottingham from 1995-1998. In
1998 Dr Johnson qualified as a GP and started
work at Wycliffe Medical Practice.
His areas of interest include prescribing and cardiovascular medicine, and
between 2006 and 2010 he worked as a clinical assistant in cardiology at
Glenfield Hospital in Leicester.
He is a governing body member for East Leicestershire and Rutland Clinical
Commissioning Group (ELR CCG) and is the clinical lead for mental health across
the three CCGs in Leicester, Leicestershire and Rutland.
One of two locality leads for Blaby and Lutterworth, Dr Johnson is also a
member of the ELR CCG quality and clinical governance committee and is one
of two board members on the Leicester, Leicestershire and Rutland Serious
Incident review group..

Dr Nick Glover
Locality lead – Blaby and Lutterworth
Dr Nick Glover gained a Bachelor of Medicine
and Bachelor of Surgery (MBChB) degree
at Leicester Medical School in 1992 and a
Diploma Royal College of Obstetricians and
Gynaecologists (DRCOG) in 1996. He completed
his training in general practice in Leicester
(MRCGP) in 1996 and becoming a GP partner at
Northfield Medical Centre in Blaby in 1997.
He has been training doctors coming into
general practice since 2005.
Dr Glover is the locality lead for Blaby and
Lutterworth and a GP governing body member. With a main responsibility for
primary care, he sits on the quality and clinical governance committee, the
primary care development group, and the serious incident sign-off group.
Dr Richard S Hurwood
Locality lead – Melton, Rutland and
Harborough
Dr Richard Hurwoodhas worked at The County
Practice based at Syston Health Centre since
1984, becoming a senior partner in 2000. He
studied medicine at Guy’s Hospital medical
school in London and graduated MBBS from The
University of London in 1977.
Dr Hurwood has been involved in GP and
medical student education, and has served on
South Charnwood Primary Care Group and
Melton, Rutland and Harborough Primary Care
Trust’s Professional Executive Committee. He
was also a member of Rutland Accident Care Scheme (now EMICS) from 1997
to 2004. He has served as an officer in the Territorial Army and is a Deputy
Lieutenant of Leicestershire.
He represents the Syston, Long Clawson and Melton Mowbray practices within
the Melton, Rutland and Harborough locality and is a governing body member
with portfolio responsibilities for prescribing and urgent care.

Dr Hilary Fox
Harborough
Dr Hilary Fox is a GP in Uppingham, Rutland,
and locality lead for Melton, Rutland and
Harborough. She is a GP trainer and a GP
appraiser for NHS England. Her CCG portfolio
includes planned care and end of life care.
Dr Hilary Fox graduated from the University of
Leicester in 1985. In 2013 Hilary was appointed
a Fellow of the Royal College of General
Practitioners. She also holds the Diploma in Child
Health, and the Diploma of the Royal College of
Obstetricians and Gynaecologists plus a Masters in Sports and Exercise Medicine.
After GP training on the Leicester Vocational Training Scheme, she became a
partner at Market Harborough Medical Centre before moving to Uppingham in
2001. She has an interest in sports injury and health promotion through exercise,
and in family planning including IUD (coil) fittings. She is a GP trainer and
clinical governance lead for the practice and a GP appraiser for NHS England. In
July 2014 she was appointed to the governing body of East Leicestershire and
Rutland Clinical Commissioning Group.
In her spare time Dr Fox is a keen cyclist, church bell-ringer and French Horn
player.
Dr Girish Purohit
Harborough
Dr Girish Purohit is the locality lead for Melton,
Rutland and Harborough.
He is currently a GP Principal at the Jubilee
Medical Practice in Syston, where he has been
since July 2012.
He previously held the posts of Clinical Lead
for Service Innovation and Improvement and
a Teaching Lead in Hammersmith and Fulham
Primary Care Trust.

Dr Vivek Varakantam
Locality lead - Oadby and Wigston
Dr Vivek Varakantam is the GP locality lead in
Oadby and Wigston.
He has been a partner at the Croft Medical
Centre in Oadby since 2009.
He also works as a GP Appraiser and GP
Registrar Associate Trainer, provides foundation
year-two training to those on the way to
becoming GPs, and tutors University of Leicester
medical students at his practice.
Dr Tabitha Randell
Secondary Care Clinician
Dr Tabitha Randell has been a consultant
paediatrician since 2003.
She graduated from Manchester Medical School
in 1992 with an MBChB degree and further
qualified as MRCP(UK) in 1996 and FRCPCH in
2005.
After completing specialist paediatric training
in the West Midlands and Sydney, Australia, Dr
Randell worked as a consultant paediatrician
at Stafford General Hospital from March 2003
to October 2005. She then became consultant
in paediatric endocrinology and diabetes at Nottingham University Hospitals
in October 2005, and is the Deputy Head of Service for Nottingham Children’s
Hospital.
She has been the secondary care representative on East Leicestershire and
Rutland Clinical Commissioning Group’s governing body since November 2012.

Mrs Donna Enoux
Interim Chief Finance Officer
1 January 2015 to date
Mrs Donna Enoux joined East
Leicestershire and Rutland Clinical
Commissioning Group in June 2013 as
Deputy Chief Finance Officer and became
Interim Chief Finance Officer in January
2015.
She studied a Genetics Degree at
Sheffield University and joined the NHS
in 1999 as part of the National Financial
Management Training Scheme. During
this time she undertook a variety of NHS work placements whilst studying for
her CIMA Accountancy qualification which she obtained in 2003.
Previous to joining the CCG she held senior finance posts in Acute and Non
Acute Provider Trusts, Primary Care Trusts and NHS England.
Mrs Carmel O’Brien
Chief Nurse and Quality Officer
Mrs Carmel O’Brien took up the role of Chief
Nurse and Quality Officer for East Leicestershire
and Rutland Clinical Commissioning Group in May
2012.
She has a strong background in quality and
patient safety, with over 25 years’ experience in
both clinical and management roles across acute,
community and primary care.
Mrs O’Brien studied in the West Midlands,
becoming a registered general nurse in 1989
and a registered midwife in 1991, and worked for three years as a midwife in
Australia. She has a BA in Health Studies and a Masters in Leadership across
Health and Social Care.
She was previously the associate director for nursing and quality for NHS
Leicestershire County and Rutland Community Health Services and the associate
director for quality for NHS Leicestershire County and Rutland Primary Care
Trust.

Mr Tim Sacks
Chief Operating Officer
Mr Tim Sacks joined the NHS in 2003 through
the national management training scheme,
bringing eight years work experience in the
private sector from a large insurance company
and a Masters in Health Care Management.
Following strategic and operational roles in West
Kent PCT, Medway Foundation Trust and the
NHS Confederation, he moved to the Leicester,
Leicestershire and Rutland health community in
2005 and carried out predominately operational
roles at Leicester University Hospitals and as head
of primary care at Leicestershire County and
Rutland PCT.
He joined East Leicestershire and Rutland Clinical Commissioning Group (ELR
CCG) during its shadow period in 2011 and was appointed to his current role as
chief operating officer in February 2013.
Tim welcomes the opportunity to work closely with GPs, stakeholders and
patients to collaboratively deliver high quality care.
Jane Chapman
Chief Strategy and Planning Officer
Jane Chapman began her career in health
in 1996 when she joined Leicester Royal
Infirmary. She held a variety of positions in both
administration and management. Prior to this
she was a weapon analyst with the Royal Navy
and she served from 1976 until 1982 on HMS
Excellent. She then worked within the retail
sector and held a position as a training and
development manager for Next from 1988 to
1996.
She has spent all of her NHS career working in
Leicestershire, apart from three years when she
worked for the Arden Cancer Network in Warwickshire. She was part of the
award-winning Leicestershire Lung Cancer Team.
In 2003 she completed a post graduate diploma in Health and Social Care at De
Montfort University. She joined Leicestershire County and Rutland Primary Care
Trust in 2007 and was the associate director for the 18 weeks programme and
then the deputy director of contracting, procurement and performance. She
was appointed to her current role as chief strategy and planning officer for East
Leicestershire and Rutland Clinical Commissioning Group in May 2012.

Mr Warwick Kendrick
Independent Lay Member - Finance &
Performance
Mr Warwick Kendrick studied accountancy at
Birmingham College of Commerce and was
admitted as a Fellow of the Chartered Institute of
Management Accountants (FCMA) in 1982.
He has held senior finance appointments
including Group Financial Controller and
Company Secretary of Vislink Plc, and senior
posts with BOC Healthcare, Mannesmann Group
and MacLellan Group Plc.
In 2001 Warwick established his own consultancy
business providing accountancy services, financial and commercial advice,
business development, strategic planning and general business advice to public
and private companies.
Between 2006 and 2011 he was a Non Executive Director of Leicestershire
County and Rutland Primary Care Trust and was Chair of the Audit Committee,
and Finance and Performance, Charitable Funds and Competition and
Procurement Committees. Following the NHS reforms, he was appointed
an Independent Lay Member of East Leicestershire and Rutland Clinical
Commissioning Group and chairs the Audit Committee and is a member of the
Remuneration Committee.
Mr Alan Smith
Independent Lay Member
Mr Alan Smith has been an independent lay
member of East Leicestershire and Rutland
Clinical Commissioning Group since January
2013. He is a Governing Body and Audit
Committee member, and also chairs the
Finance and Performance and Remuneration
Committees.
He has held a range of senior appointments
during his career including group finance director
and group managing director of Anglian Water
plc, as well as working in local authority posts.
He has also worked in non-executive, part-time
positions for several pharmaceutical and biotech companies including Acambis
Plc, Avlar Bioventures, CeNeS Pharmaceuticals and Medical Device Innovations
Ltd.
He is a member of the Chartered Institute of Public Finance and Accountancy
(Honours) and completed an Advanced Management Programme at Harvard
Business School in 1992.

MEMBERS OF COMMITTEES OF THE GOVERNING BODY
Members of the committees of the Governing Body are detailed within the Governance Statement. Details in respect of Governing Body members’ declarations of
interest are as follows.
Declarations of Interest Register
Declarations of Interest - 2014 - 2015
Name Job Title Category
1 - Direc-
torships
Category 2 -
Remunerated
employment,
office,
profession etc.
Category 3
- Appoint-
ments
Category 4 - Mem-
bership
Category
5 - Owner-
ship
Category 6 - Share-
holdings
Category 8 -
Miscellaneous
Mrs Karen
English
(interim from 1
January 2015,
substantive
from 4 March
2015)
Managing
Director
N/A N/A N/A Member of
Chartered
Institute of Public
Finance and
Accountancy.
Holds a 30%
share in
Graham
English Con-
sultancy Ltd
(a consultan-
cy business).
N/A N/A
Dr David Briggs
(until 31
January 2015)
Managing
Director
N/A Returning to GP
role in General
Practice in early
2015 (reported
on 8 December
2014).
N/A Member of the Brit-
ish Medical Associa-
tion.
N/A N/A Former partner at
Latham House Medical
Practice.
Wife is a partner at St
John’s Medical Cen-
tre in Lincolnshire.
This Practice is also a
minor shareholder in
Ladhams which is a
provider of community
care services.
Dr Nicholas
Glover
GP Govern-
ing Body
Member,
Blaby and
Lutterworth
Locality
Lead
N/A GP Partner at
Northfield Medi-
cal Centre, Blaby.
GP Trainer, East
Midlands
Deanery.
N/A Member of the Royal
College of General
Practitioners, British
Medical Association
and member of the
Leicestershire Local
Medical Committee.
N/A The Northfield
Medical Centre is a
minor shareholder in
Leicester, Leicestershire
and Rutland Provider
Company Ltd. (LLR
Provider Company Ltd).
N/A
Category7-Giftsandhospitality-seeseparateregister

Name Job Title Category 1 -
Directorships
Category 2 -
Remunerated
employment,
office, profes-
sion etc.
Category 3
- Appoint-
ments
Category 4 -
Membership
Category 5 -
Ownership
Category 6 - Share-
holdings
Category 8 -
Miscellaneous
Dr Graham
Johnson
GP Govern-
ing Body
Member,
Blaby and
Lutterworth
Locality
Lead
N/A GP Partner at
Wycliffe Medi-
cal Practice.
N/A Member of the
Leicestershire
Local Medical
Committee
N/A Wycliffe Medical
Practice is a minor
shareholder in Leices-
ter, Leicestershire and
Rutland Provider Com-
pany Ltd. (LLR Provider
Company Ltd).
N/A
Dr Hamant
Mistry
(until 30 June
2014)
GP Govern-
ing Body
Member,
Melton,
Rutland
and Har-
borough
Locality
Lead
N/A GP Partner
at Market
Harborough
Medical Centre
and Husbands
Bosworth Sur-
gery.
Practice is a
provider of
minor injury
services.
N/A Fellow of Royal
College of GPs
and British Med-
ical Association
Member.
N/A Market Harborough
Medical Centre and
Husbands Bosworth
Surgery are minor
shareholders in Leices-
pany Ltd (LLR Provider
Company Ltd).
Shareholder Market
Harborough Medi-
cal Services Limited.
Owner of Market Har-
borough Pharmacy.
N/A
Dr Richard
Hurwood (from
October 2013)
GP Govern-
ing Body
Member,
Melton,
Rutland
and Har-
borough
Locality
Lead
N/A GP Principal
at The County
Practice Syston
Health Cente.
Deputy
Lieutenant
of Leicester-
shire
Member of British
Medical
Association.
Fellow Royal
College of GPs.
Syston Health
Consortium (1
of 10 part-
ners owning
Syston Health
Centre)
The County Practice
is a shareholder in
Leicester, Leicester-
shire and Rutland
Provider Company
Ltd. (LLR Provider
Company Ltd).
Registered with GP in
the area.
Wife is an accu-
puncturist in private
practice.

Directorships
Category 2 -
Remunerated
employment,
office, profes-
sion etc.
Cate-
gory 3
- Appoint-
ments
Category 4 -
Membership
Category 5 -
Ownership
Category 6 - Share-
holdings
Category 8 -
Miscellaneous
Dr David
Andrew James
Ker
GP Govern-
ing Body
Member,
Clinical Vice
Chair
N/A GP Partner in
Oakham Medical
Practice and Mar-
ket Overton and
Somerby Surgery.
Practice is a
provider of minor
injury services.
N/A Member of the
British Medical
Association and
Royal College of
General Practition-
ers.
N/A Minor Shareholder in
the Leicester, Leices-
tershire and Rutland
Provider Company
Ltd. (LLR Provider
Company Ltd).
Oakham Medical
Practice and Market
Overton and Somerby
Surgery are minority
shareholders in The
Leicester, Leicester-
shire and Rutland
Provider Company
Ltd. (LLR Provider
Company Ltd).
Wife is a partner at
Oakham Medical
Practice and Market
Overton and Somerby
Surgery. The Practices
are minority share-
holders in The Leices-
pany Ltd. (LLR Provider
Company Ltd
Dr Richard
Palin
GP Govern-
ing Body
Member,
Clinical Vice
Chair
N/A GP Partner at
Bushloe End Sur-
gery, Wigston.
GP at HMYOI
Glen Parva.
Leicestershire
Partnership Trust
Clinical Director
HMYOI Glen
Parva HMP
Gartree and HMP
Leicester.
N/A Member Royal
College of General
Practitioners and
British Medical As-
sociation Member.
N/A N/A N/A

Directorships
Category 2 -
Remunerated
employment,
office, profes-
sion etc.
Category 3
- Appoint-
ments
Category 4 -
Membership
Category 5 -
Ownership
Category 6 - Share-
holdings
Category 8 -
Miscellaneous
Dr Hilary Fox
(from 1 July
2014)
GP Govern-
ing Body
Member,
Melton,
Rutland
and Har-
borough
Locality
Lead
N/A GP Partner at
The Upping-
ham Surgery,
Northgate,
Uppingham,
Rutland, Leices-
tershire.
GP Trainer
(Health Ed-
ucation East
Midlands).
GP Appraiser
for NHS Eng-
land.
N/A Fellow Royal
College of General
Practitioners and
British Medical As-
sociation member.
N/A The Uppingham
Surgery is a share-
holder in the Leicester,
Leicestershire and
Company Ltd).
N/A
Dr Girish Puro-
hit
(from 1 Sep-
tember 2014)
GP Govern-
ing Body
Member,
Melton,
Rutland
and Har-
borough
Locality
Lead
Director
Holiday Club
4 Kids Ser-
vices Ltd and
Nurseries ‘R’ Us
Ltd - child care
and nursery
manned by
wife.
GP Partner
at The Jubi-
lee Medical
Practice, Syston
Health Centre,
Syston, Leices-
tershire.
N/A Member of the
Royal College of
General Practition-
ers.
Member of the
British Medical
Association.
See Director-
ship section.
The Jubliee Medical
Practice is a share-
holder in The Leices-
Company Ltd).
Wife is dental practi-
tioner at Briar Mead
Dental Practice,
Oadby.

Directorships
Category 2 -
Remunerated
employment,
office, profes-
sion etc.
Category 3
- Appoint-
ments
Category 4 -
Membership
Category 5 -
Ownership
Category 6 - Share-
holdings
Category 8 -
Miscellaneous
Dr Vivek
Varakantam
(from 1 Sep-
tember 2014)
GP Govern-
ing Body
Member,
Oadby and
Wigston
Director Bush-
by Lodge Med-
ical Personal
Health Services
(Out of Hours)
GP Partner at
The Croft Med-
ical Centre,
Oadby, Leices-
ter.
N/A Member of the
Royal College of
General Practi-
tioners and British
Medical Associa-
tion member.
See Director-
ship section.
Bushby Lodge Med-
ical.
The Croft Medical
Centre is a sharehold-
er in the Leicester,
Leicestershire and
Company Ltd).
Wife is shareholder in
Bushby Lodge Med-
ical (medical services
company).
Wife commenced post
in Interserve in care at
home (therefore con-
flicted with e.g. CHC)
- March 2015.
Mr Warwick
Kendrick
Independ-
ent Lay
Member
N/A N/A N/A Member of Char-
tered Institute of
Management Ac-
countants (CIMA).
N/A N/A N/A
Mr Graham
Anthony Mar-
tin
Independ-
ent Lay
Chair
N/A Ad-hoc con-
sulting work
for Hay Group,
an internation-
al management
consulting
firm that does
provide services
for the NHS.
Adviser for
Beamans
Management
Consultants
(Isle of Man).
N/A N/A N/A N/A N/A

Directorships
Category 2 -
Remunerated
employment,
office, profes-
sion etc.
Category 3
- Appoint-
ments
Category 4 -
Membership
Category 5 -
Ownership
Category 6 - Share-
holdings
Category 8 -
Miscellaneous
Mr Alan Fred-
erick Smith
Independ-
ent Lay
Member
N/A N/A N/A Member of the
Chartered Institute
of Public Finance
and Accountancy.
N/A N/A N/A
Mr Tim Sacks Chief
Operating
Officer
N/A N/A N/A N/A N/A N/A Wife was a partner
at Oakham Medical
Practice (from 1st July
2013 - end February
2015).
Mrs Carmel
O’Brien
Chief Nurse
and Quality
Officer
N/A N/A N/A Member of Royal
College of
Nursing.
N/A N/A N/A
Mrs Donna
Enoux (from 1
January 2015)
Interim
Chief
Finance
Officer
N/A N/A N/A Member of the
Chartered Institute
of Management
Accountants.
N/A N/A N/A
Mrs Jane
Chapman
Chief Strat-
egy and
Planning
Officer
Partner is
owner of Hol-
lyview Health
– business
consultancy,
predominantly
healthcare,
likely to under-
take business
with the local
NHS.
N/A N/A Member of the
Institute of
Health Care
Management.
See Director-
ship section.
N/A Daughter is employed
at University Hospi-
tals of Leicester as a
midwife.

Directorships
Category 2 - Remu-
nerated employ-
ment, office,
profession etc.
Category 3
- Appoint-
ments
Category 4 -
Membership
Category 5 -
Ownership
Category 6 -
Shareholdings
Category 8 -
Miscellaneous
Dr Tim Daniel Consultant
in Public
Health
Medicine
N/A Consultant in Public
Health Medicine –
Leicestershire Coun-
ty Council (from
01.04.2013); East
Midlands Public
Health Foundation
Programme Director
for LNR; Salaried
GP Kegworth and
Gotham Medical
Practice; Sessional
GP for Nottingham
Emergency Medical
Services.
N/A Member of Royal
College of General
Practitioners and
British Medical
Association. Fel-
low of Faculty of
Public Health
N/A N/A Wife appointed
as Non-Executive
Director at Derby
Hospitals Founda-
tion Trust (since
October 2014).
Dr Tabitha
Louise Randell
Consultant
Paediatric
Endocrinol-
ogist (Board
member:
secondary
care clini-
cian)
N/A Consultant Paediatric
Endocrinologist, Not-
tingham University
Hospitals NHS Trust.
Clinical Lead for
Paediatric Diabetes,
NHS Diabetes (until
31.03.13).
Associate Clinical
Professor, Warwick
Medical School.
N/A Member of British
Society of Paediat-
ric Endocrinology
and Diabetes.
Member of British
Medical Associ-
ation. Fellow of
the Royal College
of Paediatrics and
Child Health.
N/A N/A Husband is em-
ployed by Leices-
tershire Partnership
Trust as Paediatric
Advanced Nurse
Practitioner.
Table 9: Declarations of Interest Register

SICKNESS ABSENCE DATA
Employees as at 31 March 2015 - 85 (excluding Chair, Lay and GPs)
ELR CCG’s staff consisted of 85 employees at the end of the year. We recognise
the valuable contribution made by each employee to the delivery of its services
and we are committed to the promotion of their health, safety and well-being.
The organisation is also committed to acting as a reasonable employer at all
times in dealing with employees who suffer ill health or incapacity either of a
temporary or permanent nature.
In order to maintain and promote a healthy organisation and ensure the
continued provision of high quality patient care, it is essential that absence
due to ill health is monitored and managed effectively and that managers and
employees are aware of their responsibilities in this process. While accepting that
some absence due to ill health is inevitable, high absence rates not only affect
individuals but place increased pressure on colleagues which may ultimately lead
to deterioration in services that ensure overall quality of patient care. To that end
we are currently reviewing our Absence Policy to ensure it is fit for purpose.
Staff Sickness Absence 2014-15
Total number of staff years 73
Total Days Lost 814
Average absences per staff year 11.1
The CCG’s absence rates outlined in the table above, at an average of 11.1 days
per employee per year is higher than the Public Services average, specifically
within Health, of 9.6 days, in accordance to the CIPD. However, the average
absence rates are affected significantly by a small number of staff who have
taken long term sick leave. If the absence data for those 7 staff is removed then
the average rate falls below the Public Service average.
PENSION LIABILITIES
There are no pension liabilities. See Financial Statements and Remuneration
Report.
EXTERNAL AUDIT
The CCG’s external auditor is Grant Thornton UK LLP and the annual external
audit fee for 2014-15 is £84,000 (inc VAT) relating to the statutory audit.
DISCLOSURE OF SERIOUS UNTOWARD INCIDENTS
We place high importance on ensuring there are robust information
governance systems and processes in place to help protect patient and
corporate information. There are processes in place for incident reporting and
investigation of serious incidents relating to information governance. Please see
our Governance Statement where details of disclosures required for incidents
involving data loss or confidentiality breaches can be found. We can confirm
that there have been no serious or untoward incidents relating to data security
breaches, and no other incidents that were required to be reported to the
Information Commissioner.
Table 10: Staff Sickness Absence

PRINCIPLES FOR REMEDY
ELR CCG’s Policy for Dealing with Complaints is guided by the Principles of
Good Complaints Handling published by the Parliamentary and Health Service
Ombudsman for public bodies:
• getting it right;
• being customer focussed;
• being open and accountable;
• acting fairly and proportionately;
• putting things right; and
• seeking continuous improvement.
This is how we interpret the principles and how we will handle complaints:
• complaints are dealt with efficiently and confidentially
• complaints are properly investigated, monitored and recorded
• complainants receive, so far as reasonably practicable, assistance to enable
them to understand the procedure or advice on where assistance should be
available
• complainants receive a timely and appropriate response
• complainants are told of the outcome of the investigation of their complaint
and action is taken, if necessary, in the light of the outcome of a complaint
• the process for dealing with complaints should be, and be seen to be,
impartial and fair to both staff and complainant alike
• complainants will be treated with respect and courtesy
• complainants will not be discriminated against for making a complaint and
making a complaint will not adversely affect future treatment
• information will be provided to senior management to help services to be
reviewed and improved
• all complainants will receive a sympathetic and caring response and, where
appropriate, an apology given or an expression of regret; and
• staff will receive appropriate training in handling complaints.
EMPLOYEE CONSULTATION
The CCG is committed to informing, communication and consulting with the
workforce as appropriate on its strategic direction, performance and delivery,
and any proposed changes that may affect staff.
There are a number of mechanisms in place which include:
• Bi-annual communication events for all CCG staff;
• Formal consultation processes with staff and their representatives regarding
any proposed changes that affect staff. During 2014-15 the CCG initiated
two consultation processes, one regarding a proposed transfer of a small
number of staff to an NHS provider and the other to restructure a team to
create some roles that are aligned to primary care;
• Informal partnership arrangements with trades unions via Arden GEM
Commissioning Support Unit;
• Monthly team briefings; and
• Two weekly newsletter.
DISABLED EMPLOYEES
The Equality Report provides further detail about the CCG’s policy in
relation to disabled employees.
EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE
We certify that the clinical commissioning group has incident response plans
in place, which are fully compliant with the NHS Commissioning Board
Emergency Preparedness Framework 2013. The clinical commissioning group
regularly reviews and makes improvements to its major incident plan and has a
programme for regularly testing this plan, the results of which are reported to
the Governing Body.

STATEMENT AS TO DISCLOSURE TO AUDITORS
Each individual who is a member of the Governing Body, at the time of the
Governing Body Members’ Report is approved, confirms:
So far as the member is aware, that there is no relevant audit information of
which the clinical commissioning group’s external auditor is unaware; and,
That the member has taken all the steps that they ought to have taken as a
member in order to make them self aware of any relevant audit information
and to establish that the clinical commissioning group’s auditor is aware of that
information.
Karen English
28 May 2015

Remuneration Report
As a public sector body, Clinical Commissioning Groups are required to disclose
information about senior managers’ remuneration. The disclosure includes the
remuneration of ‘those in senior positions having authority or responsibility for
directing or controlling the activities of the NHS body’; this has been interpreted
as Chief Officers, Lay member and GPs who are members of the CCG’s
Governing Body.
The following information is subject to formal audit:
• Table 12 Salaries and Allowances of senior managers and related narratives;
• Table 13 Pensions Benefits of Senior Managers and related narratives; and
• Statement on pay multiples and related narratives
The Remuneration Committee is made up of the following members:
Name Position
Mr Alan Smith Independent Lay Member, Remuneration
Committee Chair
Mr Warwick Kendrick Independent Lay Member, Audit
Committee Chair
The Remuneration Committee, which comprises of the Chairman of the
Governing Body and the two Independent Lay Members, reviews the
remuneration arrangements of its most senior managers including the sessional
rates for GP members of the Governing Body, taking into account market rates
and agenda for change pay awards determined nationally. The Committee held
5 meetings during 2014-15 all of which were quorate and attended by all three
members.
Policy on Remuneration of Senior Managers
East Leicestershire and Rutland Clinical Commissioning Group’s Accountable
Officer is remunerated according to the Very Senior Manager (VSM) Framework.
NHS England’s Remuneration Guidance for Chief Officers (where the senior
manager also undertakes the accountable officer role) and Chief Finance
Officers. This guidance has been used to set the Managing Director, Chief
Finance Officer and Chief Nurse and Quality Officers’ salary.
All other chief officers employed by East Leicestershire and Rutland Clinical
Commissioning Group are paid according to the NHS Agenda for Change pay
scale at a level that is consistent with the contents of the officer’s job role.
East Leicestershire and Rutland Clinical Commissioning Group carried out
regional benchmarking of Managing Director, GP and Lay member CCG
Governing Body members’ remuneration rates for the annual review of
remuneration. Decisions approved by the Remuneration Committee were
presented to the Governing Body for noting. Remuneration for Lay members
was reviewed and the Managing Director and the Lay Chair.
GP members are treated as office holders of the CCG. They are paid via the
payroll, with deductions taken at source.
Senior managers’ performance related pay
The Managing Director (accountable officer) is the only officer that is eligible
to receive performance related pay under the VSM Framework. The Chair of
the Governing Body assesses the accountable officer’s performance against the
objectives and advises the Remuneration Committee accordingly. There were no
bonus payments made in 2014-15.
Policy on senior managers’ contracts
All chief officers, excluding the Managing Director, are employed under the
agenda for change terms and conditions.
Table 11: Remuneration Committee

Senior managers’ service contracts
GP Member practices elected the GP members of East Leicestershire and Rutland
CCG’s Governing Body to their posts for a period of three years. Six months’
prior notice must be given in writing by either party to terminate the agreement
early. The Clinical Vice Chairs were appointed to their positions following
expressions of interest put forward by GPs from member practices and an
interview process.
The independent lay members are appointed for a term of 3 years from
when they commenced in post. The secondary care clinician position on the
Governing Body was appointed for three years from commencement in post
following an open recruitment process.
Payments to Past Senior Managers
There have been no payments outside of contractual entitlements made to CCG
past senior managers in this financial year.
Salaries and allowances
Table12 shows the remuneration for all Governing Body members.
Salary includes:
• all amounts paid or payable by the NHS body including recharges from any
other health body
• the gross cost of any arrangement whereby a senior manager
• receives a net amount and an NHS body pays income tax on their behalf
• any financial loss allowances paid in place of remuneration
• geographical allowances such as London weighting, and
• any other allowance which is subject to UK taxation and any ex-gratia
payments.
Salary excludes:
• recharges to any other health body
• reimbursement of out-of-pocket expenses
• reimbursement of “travelling and other allowances” (paid under
determination order) including home to work travel costs
• taxable benefits
• employers’ superannuation and National Insurance contributions
• performance related bonuses (these are recorded separately)
• golden hellos and compensation for loss of office (these are recorded
separately), and
• any amount paid which the director must subsequently repay.

SALARY & PENSION DISCLOSURE TABLES
Table 12: Salaries and allowances
Name and title (a)
Salary
(bands of
£5,000)
(b)
Expense pay-
ments (taxa-
ble) to nearest
£100
(c)
Performance
pay & bonus-
es (bands of
£5,000)
£000
(d)
Long term per-
formance pay &
bonuses (bands of
£5,000)
£000
(e)
All pension-relat-
ed benefits
(bands of £2,500)
£000
(f)
TOTAL (a-e)
(bands of
£5,000)
£000
Karen English -
Managing Director
and Accountable
Officer
CFO to 31/12/14.
Appointed Interim
Managing Direc-
tor on 01/01/15.
Appointed to the
substantive post on
04/03/15.
2014-15 110-115 10 - 12.5 125-130
2013-14 100-105 0 - 2.5 105 - 110
Dr David Briggs -
Managing Director
and Accountable
Officer
Left the post on
31/01/15.
2014-15 120-125 10 - 12.5 130-135
2013-14 140-145 22.5 - 25 165 - 170
Jane Chapman -
Chief Strategy and
Planning Officer
2014-15 90-95 7.5 - 10 100-105
2013-14 85-90 5 - 7.5 95 - 100
Carmel O’Brien -
Chief Nurse and
Quality Officer
2014-15 80-85 25 - 27.5 105 - 110
2013-14 75-80 67.5 - 70 145 - 150
Timothy Sacks -
Chief Operating
Officer
Expenses payments
and benefits in kind
relates to a leased
car.
2014-15 70-75 22 10 - 12.5 80-85
2013-14 65-70 12 32.5 - 35 100 - 105
Donna Enoux - Interim
Chief Finance Officer
Appointed interim
with effect from
01/01/15.
2014-15
15-20 7.5 - 10 25 - 30
Paul Sherriff - Chief
Corporate Affairs
Officer
Left the post on
19/05/13.
2013-14 10-15 57.5 - 60 70 - 75

Name and title (a)
Salary
(bands of
£5,000)
(b)
Expense pay-
ments (taxa-
ble) to nearest
£100 £000
(c)
Performance
pay & bonus-
es (bands of
£5,000)
£000
(d)
Long term per-
formance pay &
bonuses (bands of
£5,000)
£000
(e)
All pension-relat-
ed benefits
(bands of £2,500)
£000
(f)
TOTAL (a-e)
(bands of
£5,000)
£000
Dr Hilary Fox - Locality
Representative
Appointed on
01/07/14. Locality
Representatives are
Office Holders and
not employees of
the CCG.
2014-15 45-50 n/a 45-50
Dr Nick Glover - Local-
ity Representative
Locality Representa-
tives are Office Hold-
ers and not employ-
ees of the CCG.
2014-15 60-65 n/a 60-65
2013-14 60-65 n/a 60-65
Dr Richard Hurwood –
Locality Representative
Appointed on
01/10/13. Locality
Representatives are
Office Holders and
not employees of
the CCG.
2014-15 60-65 n/a 60-65
2013-14 30-35 n/a 30-35
Dr Graham Johnson –
ers and not employ-
ees of the CCG.
2014-15 70-75 n/a 70-75
2013-14 65-70 n/a 65-70
Dr Andy Ker – Clinical
Vice Chair
Appointed to Clin-
ical Vice Chair on
01/07/14.
2014-15 65-70 n/a 65-70
2013-14 60-65 n/a 60-65
Dr Hamant Mistry –
Left the post on
30/06/14. Locality
Representatives are
Office Holders and
not employees of
the CCG.
2014-15 20-25 n/a 20-25
2013-14 70 -75 n/a 70 -75

Name and title (a)
Salary
(bands of
£5,000)
(b)
Expense pay-
ments (taxa-
ble) to nearest
£100 £000
(c)
Performance
pay & bonus-
es (bands of
£5,000)
£000
(d)
Long term per-
formance pay &
bonuses (bands of
£5,000)
£000
(e)
All pension-relat-
ed benefits
(bands of £2,500)
£000
(f)
TOTAL (a-e)
(bands of
£5,000)
£000
Dr Richard Palin –
Clinical Vice Chair
Locality Represent-
ative to 30/06/14.
Appointed to Clin-
ical Vice Chair on
01/07/14.
2014-15 65-70 n/a 65-70
2013-14 60-65 n/a 60-65
Dr Girish Purohit – Lo-
cality Representative
Appointed to the
CCG on 01/09/14.
ers and not employ-
ees of the CCG.
2014-15 35-40 n/a 35-40
Dr Vivek Varakantam
– Locality Represent-
ative
Appointed to the
CCG on 01/09/14.
ers and not employ-
ees of the CCG.
2014-15 35-40 n/a 35-40
Dr Simon Wooding -
Left the post
09/09/2013. Locality
Representatives are
Office Holders and
not employees of
the CCG.
2013/14 25-30 n/a 25-30
Dr Tabitha Randell
- Secondary Care
Clinician
Employed by Not-
tingham University
NHS Trust to whom
the CCG reimburses
a proportion of the
salary.
2014-15 30-35 n/a 30-35
2013-14 30-35 n/a 30-35

Name and title (a)
Salary
(bands of
£5,000)
(b)
Expense
payments
(taxable) to
nearest £100
£000
(c)
Performance pay &
bonuses (bands of
£5,000)
£000
(d)
Long term
performance pay &
bonuses (bands of
£5,000)
£000
(e)
All pension-
related benefits
(bands of £2,500)
£000
(f)
TOTAL (a-e)
(bands of
£5,000)
£000
Dr Tim Daniels - Public
Health Consultant
Employed by Leices-
tershire County
Council, there is no
charge for the time.
2014-15 n/a n/a n/a n/a n/a n/a
2013/14 n/a n/a n/a n/a n/a n/a
Mr Graham Martin -
Governing Body Chair
Independent Lay
Member and not
an employee of the
CCG.
2014-15 30-35 n/a 30-35
2013/14 25-30 n/a 25-30
Mr Warwick Kendrick
– Independent Lay
Member
Independent Lay
Member and not
an employee of the
CCG.
2014-15 10-15 n/a 10-15
2013/14 10-15 n/a 10-15
Mr Alan Smith – Inde-
pendent Lay Member
Independent Lay
Member and not
an employee of the
CCG.
2014-15 5-10 n/a 5-10
2013/14 5-10 n/a 5-10
Notes
[1] The calculation of the remuneration information is in accordance with the guidance and includes all agreed remuneration allowances such as that for participating in on-call
arrangements.
[2] Pension benefits are applicable to all senior managers unless they wish to opt out of membership of the NHS pension scheme. The GP members of the governing body are not
subject to this disclosure as they make their NHS pension scheme contributions via the GP solo arrangements. Similarly the Lay members of the governing body do not contribute to
the NHS pension scheme and so are not subject to the disclosure.

Table 13: Salary and Pension Disclosure

Table 13: PENSION BENEFITS
Name and title (a)
Real in-
crease in
pension
at age 60
(bands of
£2,500)
£000
(b)
Real in-
crease in
pension
lump sum
at aged 60
(bands of
£2,500)
£000
(c)
Total accrued
pension at
age 60 at 31
March 2015
(bands of
£5,000)
£000
(d)
Lump sum at
age 60 related
to accrued
pension at 31
March 2015
(bands of
£5,000)
£00
(e)
Cash
Equivalent
Transfer
Value at 1
April 2015
£000
(f)
Real
increase
in Cash
Equiv-
alent
Transfer
Value
£000
(g)
Cash
Equivalent
Transfer
Value at
31 March
2015
£000
(h)
Employer’s
contribu-
tion to
stakeholder
pension
£000
Karen English -
Managing Director and
Accountable Officer
CFO to
31/12/14.
Appoint-
ed Interim
Managing
Director on
01/01/15.
Appointed to
the substan-
tive post on
04/03/15.
2014-15 0 - 2.5 (0) - (2.5) 20 - 25 55 - 60 455 507 39 n/a
2013-14 0 - 2.5 (0) - (2.5) 20 - 25 55 - 60 398 455 49 n/a
Dr David Briggs -
Managing Director and
Accountable Officer
Left the post
on 31/01/15.
2014-15 0 - 2.5 2.5 - 5 10 - 15 40 - 45 175 201 18 n/a
2013-14 0 - 2.5 5 - 7.5 10 - 15 35 - 40 142 175 30 n/a
Jane Chapman –
Chief Strategy and
Planning
Officer
2014-15 0 - 2.5 2.5 - 5 10 - 15 40 - 45 247 280 26 n/a
2013-14 0 - 2.5 0 - 2.5 10 - 15 35 - 40 222 247 21 n/a
Carmel O’Brien -
Chief Nurse and
Quality Officer
2014-15 0 - 2.5 2.5 - 5 25 - 30 85 - 90 447 501 41 n/a
2013-14 2.5 - 5 10 - 12.5 25 - 30 75 - 80 369 447 70 n/a
Timothy Sacks -
Chief Operating Officer
2014-15 0 - 2.5 0 - 2.5 10 - 15 30 - 35 130 149 16 n/a
2013-14 0 - 2.5 5 - 7.5 5 - 10 25 - 30 99 130 28 n/a

Name and title (a)
Real in-
crease in
pension
at age 60
(bands of
£2,500)
£000
(b)
Real in-
crease in
pension
lump sum
at aged 60
(bands of
£2,500)
£000
(c)
Total accrued
pension at
age 60 at 31
March 2015
(bands of
£5,000)
£000
(d)
Lump sum at
age 60 related
to accrued
pension at 31
March 2015
(bands of
£5,000)
£00
(e)
Cash
Equivalent
Transfer
Value at 1
April 2015
£000
(f)
Real
increase
in Cash
Equiv-
alent
Transfer
Value
£000
(g)
Cash
Equivalent
Transfer
Value at
31 March
2015
£000
(h)
Employer’s
contribu-
tion to
stakeholder
pension
£000
Donna Enoux - Interim
Appointed
interim Chief
Finance
Officer with
effect from
01/01/15.
2014-15 0 - 2.5 0 - 2.5 10 - 15 40 - 45 202 226 5 n/a
Dr Tabitha Randell -
Secondary Care Clini-
cian
Employed by
Nottingham
University
NHS Trust
to whom
the CCG
reimburses a
proportion of
the salary.
2014-15 n/a n/a n/a n/a n/a n/a n/a n/a
Dr Tim Daniels - Public
Health Consultant
Employed
by Leicester-
shire County
Council,
there is no
charge for
the time.
2014-15 n/a n/a n/a n/a n/a n/a n/a n/a
Table 12: Pension Benefits

CASH EQUIVALENT TRANSFER VALUES
A Cash Equivalent Transfer Value (CETV) 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 pension payable from the scheme. A CETV 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
membership of the pension scheme. This may be for more than just their service
in a senior capacity to which disclosure applies (in which case this fact will be
noted at the foot of the table). The CETV 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.
CETVs are calculated within the guidelines and framework prescribed by the
Institute and Faculty of Actuaries.
Real Increase in CETV
This reflects the increase in CETV effectively funded by the employer. It takes
account of 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.
Pay Multiples
Reporting bodies are required to disclose the relationship between the
remuneration of the highest paid Director in their organisation and the median
remuneration of the organisation’s workforce.
The mid-point of the banded remuneration of the highest paid member of the
Governing Body in the Clinical Commissioning Group as at March 2015 on an
annualised basis was £132,500 (2013-14 - £140,000 to £145,000). This was
4.03 (2013-14 - 4.05) times the median remuneration of the workforce, which
was £32,898 (2013-14 - £34,530).
In 2014-15, no employees received remuneration in excess of the highest-paid
member of the Governing Body.

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

Exit Packages
There were no exit packages made during 2014-15 to individuals named in the
Remuneration report in Table 12.

Off-payroll engagements
Off-payroll engagements as of 31 March 2015, for more than £220 per day and
that last longer than six months are as follows:
Number
Number of existing engagements as of 31 March 2015 9
Of which, the number that have existed:
for less than one year at the time of reporting 3
for between one and two years at the time of reporting 4
for between 2 and 3 years at the time of reporting 2
All existing off-payroll engagements, outlined above, have at some point been
subject to a risk based assessment as to whether assurance is required that the
individual is paying the right amount of tax and, where necessary, that assurance
has been sought.
For all new off-payroll engagements between 1 April 2014 and 31 March 2015,
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 2014 and 31 March 2105
10
Number of new engagements which include contractual clauses
giving East Leicestershire and Rutland CCG the right to request
assurance in relation to income tax and National Insurance
obligations
Number for whom assurance has been requested 10
Of which:
assurance has been received 10
assurance has not been received 0
engagements terminated as a result of assurance not being
received
0
Number
Number of off-payroll engagements of board members, and/or
senior officers with significant financial responsibility, during the
year
0
Number of individuals that have been deemed “board members,
and/or senior officers with significant financial responsibility”
during the financial year. This figure includes both off-payroll
and on-payroll engagements
0
Karen English
28 May 2015
Table 14a: Off-payroll engagements
Table 14b: Off-payroll engagements
Table 14c: Off-payroll engagements

Statements by the Accountable Officer
STATEMENT OF THE MANAGING DIRECTOR’S RESPONSIBILITIES
AS THE ACCOUNTABLE OFFICER OF NHS EAST LEICESTERSHIRE
AND RUTLAND CLINICAL COMMISSIONING GROUP
The National Health Services 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 Managing Director to be the Accountable Officer of the
Clinical Commissioning Group.
The responsibilities of an Accountable Officer, including responsibilities for
the propriety and regularity of the public finances for which the Accountable
Officer is answerable, for keeping proper accounting records (which disclose
with reasonable accuracy at any time the financial position of the Clinical
Commissioning Group and enable them to ensure that the accounts comply
with the requirements of the Accounts Direction) and for safeguarding the
Clinical Commissioning Group’s assets (and hence for taking reasonable steps
for the prevention and detection of fraud and other irregularities), are set out in
the Clinical Commissioning Group Accountable Officer Appointment Letter.
Under the National Health Services 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 Manual for Accounts issued by the
Department of Health and in particular to:
• Observe the Accounts Direction issued by NHS England, including the relevant
accounting and disclosure requirements, and apply suitable accounting
policies on a consistent basis;
• Make judgements and estimates on a reasonable basis;
• State whether applicable accounting standards as set out in the Manual for
Accounts issued by the Department of Health have been followed, and
disclose and explain any material departures in the financial statements; and,
• Prepare the financial statements on a going concern basis.
To the best of my knowledge and belief, I have properly discharged the
responsibilities set out in my Clinical Commissioning Group Accountable Officer
Appointment Letter.
Karen English
28 May 2015

GOVERNANCE STATEMENT
Introduction and Context
The clinical commissioning group was licensed from 1 April 2013 under
provisions enacted in the Health and Social Care Act 2012, which amended the
National Health Service Act 2006.
NHS East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG
or the CCG) is a clinically led membership organisation which comprises 32 GP
member practices across three localities: Melton Mowbray, Rutland and Market
Harborough; Oadby and Wigston; and Blaby and Lutterworth. The CCG is
responsible for commissioning healthcare services for patients across the three
localities. Information about the commissioning priorities and the population
the CCG serves can be found in the Strategic Report .
There is a need to demonstrate probity and governance commensurate with our
considerable responsibilities for our patients’ healthcare and taxpayers’ money.
This means ensuring that we have open, robust and transparent processes
which will give the communities we service the confidence that, through the
appropriate governance arrangements, we can demonstrate how we will play
our part in ensuring that the services our patients receive are safe and delivered
with care and compassion.
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 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 in my Clinical Commissioning Group Accountable
Officer Appointment Letter.
I am also 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.
Compliance with the 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 CCG and best
practice.
For the financial year ended 31 March 2015, and up to the date signing
this statement, the CCG has applied the principles of the Code as we have
considered relevant to the CCG including drawing on other best practice
available. This is evident, for example through the following:
• there was clear division of responsibilities between the Membership Body, the
Governing Body and the executive responsibilities for running the
organisation. The Chair was responsible for leading the Governing Body
and ensuring it is effective in its role, and organising appropriate development
sessions support the Governing Body’s role;
• the Committees of the Governing Body consisted of a balance of skill,
knowledge, independence and experience for them to carry out duties and
responsibilities;
• information was supplied to the Governing Body and its committees in a
timely manner and of a quality that enables the clinical commissioning group
to discharge its duties;
• the Governing Body assessed the nature and extent of the significant risks it is
willing to take in achieving the strategic objectives of the clinical
commissioning group; and it maintains a sound system of risk management
and internal control; and
• The Remuneration Committee had oversight of the arrangements in relation
to policy on the remuneration of members of the Governing Body

The Clinical Commissioning Group Governance Framework
The National Health Service Act 2006 (as amended), at paragraph 14L(2)(b)
states:
The main function of the governing body is to ensure that the group has made
appropriate arrangements for ensuring that it complies with such generally
accepted principles of good governance as are relevant to it.
The clinical commissioning group has in place a Constitution, which provides
its corporate governance framework, as agreed by its member practices. The
CCG’s Constitution consists the following: information about the membership,
Standing Orders, Scheme of Reservation and Delegation and Prime Financial
Policies. The Scheme of Reservation and Delegation clearly details matters
reserved to the membership and authority delegated to the Governing Body, its
committees and officers.
The clinical governance group reviewed its Constitution in May 2014 and
again in January 2015. In respect of the review, legal support was obtained as
required ensuring that governance arrangements remain current, robust, fit for
purpose and remain in line with legal functions and duties. This includes duties
being delegated to the CCG from NHS England, namely in relation to primary
care co-commissioning. The composition of the Governing Body was refined
and roles strengthened in line with the review of the Constitution during 2014-
15.
The Prime Financial Policies and the Scheme of Reservation and Delegation
are underpinned by Detailed Financial Policies and an Operational Scheme of
Delegation respectively.

Membership
The clinical commissioning group Membership consists 32 GP Practices as detailed below::
Blaby and Lutterworth locality
Countesthorpe Health Centre
Central Street, Countesthorpe,
Leicestershire. LE8 5QJ.
Wycliffe Medical Practice
Gilmorton Road,
Lutterworth,
Leicestershire, LE17 4EB.
Kingsway Surgery
23 Kingsway
Narborough Road South,
Leicester, LE3 2JN.
The Limes Medical Centre
65 Leicester Road,
Narborough,
Leics LE19 2DU
Glenfield Surgery
111 Station Road,
Glenfield,
Leicestershire, LE3 8GS.
Forest House Medical Centre
2a Park Drive,
Leicester Forest East,
Leicester, LE3 3FN.
Northfield Medical Centre
Villers Court, Blaby,
Leicestershire,
LE8 4NS.
Hazelmere Medical Centre
58 Lutterworth Road,
Blaby,
Leicester, LE8 4DN.
Narborough Health Centre
Thornton Drive,
Narborough
Leicestershire, LE19 2GX
The Masharani Practice
Gilmorton Road, Lutterworth,
Leicestershire, LE17 4EB.
Enderby Medical Centre
Shortridge Lane, Enderby
Leicestershire, LE19 4LY
Oadby and Wigston locality
Bushloe End Surgery
Two Steeples Health Centre, Abingdon Close, Wigston,
Leicestershire, LE18 2EW
Central Surgery
Brooksby Drive, Oadby
Leicester, LE2 5AA.
Rosemead Drive Surgery
103 Rosemead Drive
Oadby,
Leicestershire, LE2 5PP.
The Croft Medical Centre
2 Glen Road, Oadby
Leicestershire, LE2 4PE.
Wigston Central Surgery
Two Steeples Health Centre, Abingdon Close,
Wigston,
South Wigston Health Centre
80 Blaby Road
South Wigston
Leicestershire, LE18 4SE.
Long Street Surgery
Two Steeples Health Centre, Abingdon Close, Wigston,
Severn Surgery
159 Uplands Road
Oadby, Leicestershire, LE2 4NW.

Melton, Rutland and Harborough locality
Kibworth Health Centre
Smeeton Road,
Kibworth,
Leicestershire, LE8 0LG.
Market Harborough Medical Centre
67 Coventry Road,
Market Harborough,
Leicestershire, LE16 9BX.
Oakham Medical Practice
Cold Overton Road
Oakham,
Rutland, LE15 6NT
Market Overton Surgery (& Somerby)
Thistleton Road,
Market Overton, Oakham,
Leicestershire, LE15 7PP.
Long Clawson Medical Practice
Long Clawson, Nr Melton Mowbray
Leicestershire,
LE14 4PA.
Billesdon Surgery
4 Market Place,
Billesdon
Leicestershire, LE7 9AJ.
Dr Kilpatrick & Partners
2a Station Road
Kibworth,
Leicestershire, LE8 0LN.
Latham House Medical Practice
Sage Cross Street
Melton Mowbray,
Leicestershire, LE13 1NX.
The County Practice
Syston Health Centre
Melton Road, Syston
Leicestershire, LE7 2EQ.
Empingham Medical Centre
Main Street, Empingham
Oakham, Rutland
Leicestershire,
LE15 8PR
The Uppingham Surgery
Northgate
Uppingham,
Rutland,
Leicestershire, LE15 9EG.
The Jubilee Medical Practice
1330 Melton Road
Syston,
Leicestershire, LE7 2EQ.
Husbands Bosworth Surgery Kilworth Road
Husbands Bosworth
Leicestershire, LE17 6JZ.

The clinical commissioning group is led by a Governing Body comprising elected GP members, a secondary care clinician and lead nurse and independent lay
members as detailed below.
Name Position
Dr Andrew Ker Clinical Vice Chair
Dr Richard Palin Clinical Vice Chair
Mrs Karen English Managing Director
Dr Nicholas Glover Blaby and Lutterworth GP Locality Lead
Dr Graham Johnson Blaby and Lutterworth GP Locality Lead
Dr Richard Hurwood Melton, Rutland and Harborough GP Locality Lead
Dr Girish Purohit Melton, Rutland and Harborough GP Locality Lead
Dr Hilary Fox Melton, Rutland and Harborough GP Locality Lead
Dr Vivek Varakantam Oadby and Wigston GP Locality Lead
Mr Warwick Kendrick Independent Lay Member
Mr Alan Smith Independent Lay Member
Dr Tabitha Randell Consultant Paediatric Endocrinologist (secondary care clinician)
Mrs Carmel O'Brien Chief Nurse and Quality Officer
Mrs Donna Enoux Interim Chief Finance Officer
Mrs Jane Chapman Chief Strategy and Planning Officer
Mr Tim Sacks Chief Operating Officer
Dr Tim Daniel Consultant in Public Health Medicine (in attendance)

The overall responsibility for the management of internal control lies with me as the Accountable Officer. The Governing Body, in line with authority delegated to it
by the Membership, collectively and individually ensured that robust systems of internal control and management were in place. This responsibility was supported
through an effective committee structure, including joint committees established with the local authorities; and collaborative arrangements established with
Leicester City CCG and West Leicestershire CCG in respect of services commissioned collaboratively across the three CCGs.
Following an internal review of the governance arrangements during 2014-15 the committee structure was changed to reflect the outcomes of the review. The
table below provides details of committees and members of each committee along with date of establishment of new committees and disestablishment of previous
committees.
Title First
Name
Last Name Governing
Body
Audit
Committee
Finance
and Per-
formance
Commit-
tee (up to
October
2014)
Finance and
Activity
Committee
(from
November
2014)
Quality
and Clin-
ical Gov-
ernance
Committee
(up to
October
2014)
Quality
and Per-
formance
Commit-
tee (from
November
2014)
Remunera-
tion Com-
mittee
Strategy,
Planning
and Com-
missioning
Committee
Primary Care
Commissioning
Committee
(from March
2015)
Mrs. Karen English √ √ √ √
Mrs. Jane Chapman √ √ √ √ √
Mrs. Carmel O'Brien √ √ √ √ √
Mr. Timothy Sacks √ √ √ √ √ √
Mrs Donna Enoux √ √ √ √ √
Dr Nicholas Glover √ √ √ √
Dr Hilary Fox √ √ √
Dr Richard Hurwood √ √
Dr Graham Johnson √ √ √ √
Dr Girish Purohit √ √
Dr Vivek Varakantam √ √ √ √
Dr Andy Ker √ √ √ √ √
Dr Richard Palin √ √ √
Dr Tabitha Randell √ √ √ Chair
Dr Tim Daniel √ √ √ √ √
Mr. Graham Martin Chair √ √ Chair
Mr. Warwick Kendrick √ Chair √ Chair √ √
Mr. Alan Smith √ √ Chair Chair Chair
Table 15: Committees and Members

The committee structure has supported the identification and management of internal controls and risks as follows :
• Audit Committee – the Audit Committee (statutory committee), which is accountable to the group’s governing body. The Audit Committee has responsibility
for reviewing and ensuring that the organisation has established and is maintaining robust and effective systems of integrated governance, risk management
and internal control across all areas of its business. It is responsible for providing assurance to the Governing Body that the Executive Management Team has
appropriate and adequate systems in place to ensure links between risk management, financial risk, corporate and clinical governance. The Audit Committee
terms of reference were reviewed and approved in January 2015 to include an additional scrutiny role for reviewing decision making processes in respect of
primary care commissioning decisions to provide an additional level of assurance demonstrating the management of conflicts on interest. The Audit Committee
reviewed the Board Assurance Framework at every meeting to provide assurance to the Governing Body that the organisation’s risk management processes are
effective and risks are being effectively controlled. The Committee received regular reports on the work and findings of the internal and external auditors;
reports from counter fraud team; reports from management in relation to follow-up and progress in relation to implementation of audit recommendations. The
Audit Committee of significant assurance from the Head of Internal Audit on the degree of assurance that can be derived from the system of internal control.
The Audit Committee is chaired by an independent lay member. The Committee has a schedule to meet at least 6 times a year, which it has done so in 2014-15
with all meetings being quorate, well attended and supported by the Head of Corporate Governance and Legal Affairs.
• Remuneration and Nominations Committee – the Remuneration and Nominations Committee (statutory committee), is accountable to the group’s governing
body makes recommendations to the governing body on determinations about the remuneration, fees and other allowances for employees and for people who
provide services to the group and on determinations about allowances under any pension scheme that the group may establish as an alternative to the NHS
pension scheme. The governing body has approved and keeps under review the terms of reference for the remuneration committee, which includes information
on the membership of the remuneration committee. The Remuneration and Nominations Committee is chaired by an Independent Lay Member. The Committee
convened as required during the year with all meetings being quorate and supported by the Head of Corporate Governance and Legal Affairs in relation to
corporate governance matters.
• Quality and Clinical Governance Committee – the Quality and Clinical Governance Committee, which is accountable to the group’s governing body seeks
assurance and has oversight of quality and clinical governance mechanisms, ensuring quality and patient safety is integral to commissioning processes and to the
monitoring arrangements for all commissioned services. The Quality and Clinical Governance Committee monitored risks in relation to patient safety (e.g.
themes and trends from incidents and serious incidents), quality of care and patient experience (e.g. themes and trends from patient surveys, complaints). The
Committee was chaired by an Independent Lay Member and met on a monthly basis. The Committee held 4 meetings during 2014 /15 and all meetings were
quorate. Two meetings cancelled. Risks identified through this Committee were brought to the attention of the Governing Body and monitored through the
Committee.
• Following the internal governance review in 2014-15 the Quality and Clinical Governance Committee was disestablished in October 2014 and the Quality and
Performance Committee established in November 2014. Previously the Quality and Clinical Governance Committee had a responsibility in respect of review
of the information governance toolkit compliance and information governance related risk; and ensured systems and processes change to mitigate these risks.
Following the governance review, it was agreed that Information Governance reports are to presented and reviewed at the Governing Body providing assurance
in relation to information governance risks and end of year compliance with the Information Governance Toolkit standards.

• Quality and Performance Committee - the Quality and Performance Committee, which is accountable to the group’s governing body was established in
November 2014 following an internal governance review. The Committee has oversight of quality, performance and clinical governance mechanisms, ensuring
quality and patient safety is integral to commissioning processes and to the monitoring arrangements for all commissioned services’. The Committee is also
responsible for seeking assurance and adopting an integrated approach to clinical governance; performance monitoring; and research governance The Quality
and Performance Committee monitored risks in relation to patient safety (e.g. themes and trends from incidents and serious incidents), quality of care and patient
experience (e.g. themes and trends from patient survey, and in addition monitored risks against performance. The Committee is chaired by the Secondary Care
Clinician and meets on a monthly basis. The Committee held 5 meetings during 2014 /15 since it was established and all meetings were quorate. Risks
identified through this Committee were brought to the attention of the Governing Body via a regular summary report from the Committee.
• Finance and Performance Committee – the Finance and Performance Committee, which was accountable to the group’s governing body, was responsible for
overseeing the development of the annual financial plan. The Finance and Performance Committee monitored performance and risks relating to finance and the
performance of the main providers and approved corrective action should excess variances occur. The Committee monitored income and expenditure against
planned levels and made recommendations to the governing body. The Committee was chaired by an Independent Lay Member. The Committee held 3 meetings
during 2014-2015 and 3 were cancelled. All 3 meetings were quorate. This Committee was disestablished in October 2014.
• Finance and Activity Committee - the Finance and Activity Committee was established in November 2014 and is accountable to the group’s governing body.
The Committee monitor the ‘in year’ and end of year financial position and activity position of the CCG ensuring systems and processes are in place to accurately
report on and deliver the agreed control total; and ensure adherence to the CCG’s Prime and Detailed Financial Policies. The Finance and Activity Committee
monitored risks relating to finance and the performance of the main providers and approves corrective action should excess variances occur. The Committee
monitored income and expenditure against planned levels and makes recommendations to the governing body.
• Strategy, Planning and Commissioning Committee – the Strategy, Planning and Commissioning Committee is a committee of the Governing Body and was
established in December 2013. Its purpose is to oversee the development and delivery of the CCG’s commissioning plans, strategies and intentions, ensuring
effective monitoring arrangements are in place and risks associated with this escalated to the Governing Body, ensuring the total resource available is invested
in good quality services that support the delivery of the commissioning intentions. The Committee is chaired by a clinical vice chair. The Committee meets on
a monthly basis and has held 8 meetings during 2014-15 and all meetings have been quorate.
• Primary Care Commissioning Committee – the Primary Care Commissioning Committee is a committee established by the Clinical Commissioning Group in
January 2015 to exercise the primary care commissioning functions that have been delegated from NHS England as of 1 April 2015. The Committee held an
initial meeting in March 2015 and thereafter will hold monthly meetings in public. The meetings are chaired by a lay member.

The clinical commissioning group has joint committees with the following local authorities:
• Leicestershire County Council
• Rutland County Council.
In addition, collaborative arrangements have been established under a Memorandum of Agreement with Leicester City Clinical Commissioning Group and West
Leicestershire Clinical Commissioning Group in respect of services commissioned collaboratively across the three organisations and this arrangement reports to the
Governing Body.
During 2014-15 the Governing Body evaluated its own performance through facilitation by an external consultant which led to the review of the Board
Development programme for the members of the Governing Body, both individually and collectively. Governing Body development sessions have taken place at
agreed intervals during 2014-1515 which involved sessions focusing on roles, responsibilities, enhancing leadership skills and focusing on collective and individual
responsibility. These sessions are aimed to support members of the Governing Body to function more effectively as a Governing Body.
Information sessions have also taken place for members of the Governing Body providing them with an opportunity for Governing Body members to, for example,
review national guidance / initiatives in greater depth and its implications on the clinical commissioning group’s business; develop further insight into performance
issues with key providers; enhance their knowledge on a specific topics; and receive detailed information on key national requirements.
Governing Body members’ attendance record at both the Governing Body development / information sessions and the public meetings of the Governing Body are
positive, all meetings of the Governing Body throughout 2014-15 have been quorate and all or the majority of the of the Governing Body members being present.
The Clinical Commissioning Group Risk Management Framework
Risk management is an integral part of good management processes and the proactive and continuous management of risk is essential to the efficient and effective
delivery of an organisation’s objectives. The organisation’s Risk Management Strategy and Policy sets the strategic and operational frameworks of successful
management and evaluation of risk. The CCG’s chosen method of risk scoring is based on the Australian and New Zealand risk management standard AS/NZ
4360:1999, which is widely adopted.
ELR CCG adopted a common framework for the assessment and analysis of all risks whether they are clinical, financial, information or organisational. The actions
required to manage the risks were documented on the risk registers, which were updated as risks continued to be assessed and treated.
A two-tier process involving local directorate based registers and a corporate register (Board Assurance Framework) have been implemented to reflect the
organisation’s risk profile. The aim of the two tier approach was to ensure that the strategic picture did not become clouded by the day to day risk management
issues that can and were dealt with as a matter of course at local level, whilst still providing a clear route for significant local issues to influence the strategic risk
profile.

The Board Assurance Framework (corporate risk register), which aligned to the CCG strategic aims and objectives, provided the organisation with a comprehensive
method for the effective and focused management of the principle risks with action plans in place to mitigate risks identified. During 2014-15 the Board Assurance
Framework has been reviewed and updated on a regular basis. The Audit Committee, Governing Body members and the Executive Management Team have been
integral in the review and development of the Board assurance Framework and format; and in the review of the risk profile and oversight of individual risks and
action plans. The Executive Management Team has been and continues to be responsible for ensuring corporate risks facing the CCG are current; have been
captured and evaluated appropriately; and actions undertaken in a timely manner.
Each directorate had a directorate (operational) risk register where they monitored their local risks. Risks were linked to strategic aims / objectives and the likelihood
and impact were assessed to ascertain risk appetite depending on the category of risk, the inherent risk and residual risk and individual leads were assigned to
actions. The Board Assurance Framework was built around the proactive and reactive assessment of risks that may have an impact on the achievement of corporate
objectives. This simplified reporting and the prioritisation of action plans which, in turn, allowed for more effective performance management.
Strategic and operational risks on the corporate and local risk registers were regularly reviewed by the Corporate Management Team with the objective of ensuring
risks were effectively managed. These registers were used to record risks using the 5 x 5 risk scoring matrix. Risks were reported and escalated in line with the
CCG’s Risk Management Strategy and Policy.
The Risk Management Strategy and Policy is due for a review in May / June 2015 to ensure that the governance arrangements for managing corporate business
risks and operational risks continue to be robust and reflect the ongoing changing requirements of the organisation.
Summary updates and reports on the status of key risks were presented to the Executive Management Team (EMT) via the EMT meetings and at every meeting of
the Audit Committee and at agreed intervals to the Governing Body.
Whilst the CCG considered risks to the organisation in meeting its objectives and to its staff, it also considered those to whom a service is provided, the
organisations and also the patients themselves. The CCG received risk reports and, where appropriate, assurances and mitigation plans from those organisations
from which it commissioned a service.
The Internal Audit programme of work has been completed and the interim Head of Internal Audit has provided an opinion of significant assurance.
The Clinical Commissioning Group Internal Control Framework
A system of internal control is the set of processes and procedures in place in the clinical commissioning group 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 system of internal control has been in place in the clinical commissioning group for the year ended 31 March 2015 and up to the date of the approval of the
Annual Report and Accounts.
The organisation continued to operate through its comprehensive committee structure which ensures identification,
robust management, reporting and accountability for risk management.

The Governing Body sought assurance through regular review of the Board Assurance Framework at the Governing Body meetings, outcomes from the Executive
Management Team meetings and the Audit Committee (e.g. in relation to effectiveness of internal control mechanisms). The Quality and Clinical Governance
Committee, and then the Quality and Performance Committee, received assurance reports to monitor areas of risk e.g. safeguarding, patient safety, serious
incidents, patient complaints etc. The Finance and Performance Committee received assurance reports in relation to financial and performance risks. From
November 2014 performance risks were escalated via the Quality and Performance Committee and the finance risks via the Finance and Activity Committee.
Regular summary reports from these Committees were presented to the Governing Body drawing the Governing Body’s attention to key financial, performance, and
patient safety and quality risks.
In addition, reports on specific updates and areas of risk were directly reported to the Governing Body including reports on safeguarding adults and children and
serious incident reports. The Governing Body reviewed these reports and sought assurance to demonstrate that providers are learning from incidents. All these
groups had a role to provide regular monitoring to identify themes and trends for learning and sustained improvements. Where provider performance risks were
considered significant and escalated to the Governing Body action was taken by the Governing Body to invite the providers concerned to the Governing Body
meeting to seek assurance.
In addition the Governing Body received assurance reports demonstrating compliance with statutory obligations including compliance with the Public Sector Duty of
Equality.
Delivery of the Risk Management Strategy and Policy was also achieved through the implementation of associated policies and procedures, for example, health and
safety policies / procedures, incident reporting, claims policy, Counter Fraud Policy, HR policies etc. Progress and performance in achieving the aims of the strategy
and adherence to the policy was monitored by the Corporate Management Team, the Chief Nurse and Quality Officer (as the executive lead) and ultimately the
Governing Body via the Audit Committee.
The policies and procedures in place across the CCG aimed to, as far as possible, prevent the identified risks from arising; policies, procedures and codes of conduct
were made available to staff through various mechanisms including through the CCG newsletter. Statutory and mandatory training included raising awareness
about countering fraud, identifying potential risks and also identifying where risks may have materialised (for example, through the incident reporting process).
Equality analysis is integral to core business processes, policies and processes across the organisation. Relevant systems and processes were implemented to support
the policies and procedures, for instance the CCG’s Constitution (which includes the Standing Orders, Scheme of Reservation and Delegation and Prime Financial
Policies) clearly stipulated the delegations to budget holders which was then reflected within the Shared Business Service system to ensure appropriate level of
authorisation is obtained for approval of invoices. Where risks have materialised the Corporate Management Team would review the controls in place to determine
how the controls need to be improved and whether assurances need to be sought from alternative sources.
Control measures are in place to ensure that all the clinical commissioning group’s obligations under equality, diversity and human rights legislation are complied
with.

The NHS Information Governance
Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information.
The NHS Information Governance Framework is supported by an information governance toolkit and the annual submission process provides assurances to the
clinical commissioning group, other organisations and to individuals 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.
We have established an information governance framework and have developed and continue to further develop information governance processes and procedures
in line with the information governance toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff
information governance handbook / leaflets to ensure staff are aware of their information governance roles and responsibilities.
There are processes in place for incident reporting and investigation of serious incidents. We are developing information risk assessment and management
procedures and a programme will be established to fully embed an information risk culture throughout the organisation.
The CCG had in place an Information Governance Strategy and Policy. The final year end self-assessment for 2014-15 was approved at the Governing Body meeting
in March 2015. Specific requirements were submitted to Internal Audit for which the Auditor’s provided an opinion of “significant assurance”. Information risks are
clearly defined within the Risk Management Strategy and Policy including the role of the Senior Information Risk Officer and the Information Asset Owners, which
supports the requirements for identifying and managing information risk.
The NHS Data Mapping exercise was undertaken during 2014 / 15 and involved identification of personal identifiable information (PII) data flows into and out of the
organisation. Systems and processes are in place to ensure the security of data; and to ensure encryption of all electronic PII data transfers, e.g., via email and PII
held on mobile devices such as laptops. All staff are required to complete the annual e-learning training module on information governance. In addition, the CCG’s
Executive Management Team has mandated that all staff attend an organisation specific information governance training event arranged on-site and facilitated by
the information governance lead.
Pension Obligations
As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within
the scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the scheme are in
accordance with the scheme rules, and that member pension scheme records are accurately updated in accordance with the timescales detailed in the regulations.
Equality, Diversity and Human Rights Obligations
Control measures are in place to ensure that the clinical commissioning group complies with the required public sector equality duty set out in the Equality Act
2010.

Sustainable Development Obligations
The clinical commissioning group is required to report its progress in delivering against sustainable development indicators.
We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation
objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in
commissioning.
We will ensure the clinical commissioning group complies with its obligations under the Climate Change Act 2008, including the Adaptation Reporting power, and
the Public Services (Social Value) Act 2012. We are also setting out our commitments as a socially responsible employer.
Risk Assessment in Relation to Governance, Risk Management and Internal Control
The Executive Management Team and members of the Governing Body in the main identified the risks considering the political, economic, social, technological
environment (PEST analysis) in which the CCG operates. In the regular review of the Board Assurance Framework, risks identified from “bottom-up” are also
considered, for example, review of directorate level risk registers, cluster of incidents, cluster of complaints, through performance management arrangements.
Risk identification and management had been incorporated into key processes within East Leicestershire and Rutland CCG ensuring embeddedness of the principles
of risk management and encouraging a proactive approach to identifying risks. The core business processes, for instance, included the review of risk and the impact
on strategic decision making. The organisation’s business cases required leads to identify the risk of not implementing a scheme and the benefits realisation of the
scheme. In addition, it includes the requirement to undertake equality analysis for each case of need.
The following principal risks were identified and captured within the Board Assurance Framework during 2014-15; the following risks are as at end March 2015:
• The quality of care provided by providers does not match commissioner’s expectation with respect to quality and safety;
• An innovative organisational culture and organisational development may not be actively encouraged;
• The CCG fails to ensure effective contract monitoring through hosted contracting arrangements which results in over performance of contracts and poor
outcomes for patients;
• The CCG fails to deliver the outcomes of the programmes of care as identified in the Annual Plan as a result of external influences e.g. changes in demand across
providers, Local Area Team etc. In particular failure to deliver its plans on planned and unplanned care;
• Inability to deliver against the QIPP agenda resulting in failure to transform services;
• Capacity of primary and community services to manage left shift;
• Patients could receive sub-optimal care as a result of increasing pressures in urgent care pathway;
• In year over performance in acute sector (including Independent and out of county providers) continues throughout the year and culminates in a large overspend
against the SLA by the end of the year. The financial risk is further increased by the pressures in the Urgent Care pathway;
• LLR Learning Lessons to Improve Care published July 2014, potential risk of loss of confidence in local NHS providers;
• Continuing Healthcare over performance occurs in year, culminating in a large overspend by year end; and
• Co-Commissioning responsibility

Review of Economy, Efficiency and Effectiveness of the Use of Resources
The effectiveness of the use of resources and financial performance of the CCG was monitored on a monthly basis by the Governing Body and the Finance and
Performance Committee which is a Committee of the Governing Body chaired by a lay member. Corporate risks in respect of financial performance and use
of resources are captured in the Board Assurance Framework and directorate level risk registers and reported to the Audit Committee at each meeting and the
Governing Body every six months.
In addition, where services were commissioned collaboratively in 2014-15 with Leicester City CCG and West Leicestershire CCG provider performance was
monitored via the collaborative arrangements. This in the main was through the Performance Collaborative Board and the Commissioning Collaborative Board
arrangements for which principles of collaboration are detailed within the Memorandum of Agreement between the three CCGs.
The main financial risk that the CCG has faced throughout the year is the over performance in the acute sector against the backdrop of significant emergency
activity pressures experienced during the year. The over performance at the end of 2014-15 was mitigated.
The Audit Committee included within the internal audit plan for 2014-15 the following audit reviews: Budgetary Control and Financial Reporting; and Key Financial
Systems – Payroll. Both audit reviews were provided with an opinion of “significant assurance”. These reports identified areas where efficiency could be gained,
for example, the Budgetary Control audit report identified areas where the reporting system could be used to support budget holders by working with the system
provider to ensure the system is user-friendly. The Finance Team in conjunction with the Finance and Performance Committee (and the Finance and Activity
Committee) also reviewed the content of finance reports to the Governing Body. Reassessing the adequacy of the reports ensured that information was portrayed
more clearly for the Finance and Performance Committee and the Governing Body enabling them to develop a better understanding of the position and make
decisions based on the information.
Review of the Effectiveness of Governance, Risk Management and Internal Control
As the Accountable Officer I have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group.
Capacity to Handle Risk
As stated above, the overall responsibility for the management of risk lies with me as the Accountable Officer and operational implementation with the Executive
Management Team. The Governing Body collectively and individually ensured that robust systems of internal control and management were in place. This
responsibility was supported through an effective Governing Body and committee structure as detailed earlier.
Specialist advice on risk assessment and management has been available to the organisation through: the organisation’s Head of Corporate Governance and
Legal Affairs, Health and Safety Adviser (external), the Information Security lead (external); Information Governance support (external) Local Security Management
Consultant (external, and the Local Counter Fraud specialist. Over the last year there has been continued increase in awareness at all levels of the organisation of
the importance and relevance of risk management to operational processes. This has been through team meetings, one-to-one meetings with individuals, the
requirement for all staff to complete the e-learning and face-to-face training modules covering all aspects of risk (e.g. information, health and safety), circulation of
a variety of policies e.g. finance budget manual, prime and operational financial policies, information security and information governance policies, clinical policies,
policy on Fraud, Corruption and bribery, risk management strategy and policy etc.

Review of Effectiveness
My review of the effectiveness of the system of internal control is informed by the work of the internal auditors and the executive managers (the Executive
Management Team) 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 reports.
The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage risks to the clinical commissioning group achieving
its principle objectives have been reviewed.
I have been advised on the implications of the result of my review of effectiveness of the system of internal control by the Governing Body, the Audit Committee,
the Quality and Clinical Governance Committee, the Quality and Performance Committee, the Finance and Performance Committee, the Finance and Activity
Committee; the Strategy, Planning and Commissioning Committee, and the performance and commissioning collaborative boards. A plan to address weaknesses
and ensure continuous improvement of the system is in place.
The above committees and a number of processes, including the following, have been integral to maintaining and reviewing the effectiveness of the system of
internal control: internal audit; quarterly checkpoint assurance meetings with the NHS England Central Midlands. The specific role of the Governing Body and its
committees in reviewing effectiveness of systems of internal control and risk management is provided earlier.
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:
I am pleased to report that we are providing the CCG with Significant Assurance as there is a generally sound system of internal
control, designed to meet objectives, and that controls are generally being applied consistently. This opinion is determined through
our review of your Governing Board Assurance Framework (GBAF) and associated processes and the work that we have undertaken
throughout the year.
During the year the Internal Audit did not issue any audit report with a conclusion of limited assurance.
During the year the Internal Audit did not issue any audit report with a conclusion of no assurance.
I am not aware of any deficiencies as a result of risks that have materialised. I confirm neither have there been any serious incidents in the last year involving
personal data where the incident is attributable to the CCG. The CCG continues to monitor risks at both operational and corporate level, including review of
systems, processes and policies to ensure ongoing continuous improvement in systems.

An internal audit was carried out by Deloitte LLP during 2014-15 which reviewed the processes / procedures of Greater East Midlands Commissioning Support Unit
(GEM CSU). The findings of the report concluded that there was reasonable assurance that appropriate controls were in place in GEM CSU. Furthermore, many of
the exceptions noted in this internal audit report did not apply to Leicestershire based customers of GEM CSU. For those exceptions noted or process improvements
that did relate to Leicestershire CCGs, GEM CSU has confirmed that an action plan is currently being produced.
ELR CCG has therefore concluded that the findings of this report would not adversely affect the opinion given by our own internal auditors.
Data Quality
Good information underpins sound decision making within the CCG. The CCG is committed to improving data quality and information flows throughout the
organisation and in particular through its committees to the Governing Body and to the membership. Following feedback throughout the year from Governing
Body members and its committees the quality of both qualitative and quantitative data and information has improved. This has enabled information in relation to
performance monitoring and consideration of future commissioning of services to be based on more current information. Internal audit have undertaken various
audits throughout the year where the quality of both data and information was reviewed to provide assurance to the Audit Committee and the Governing Body.
We have submitted a satisfactory level of compliance with the information governance toolkit assessment.
Discharge of Statutory Functions
During establishment, the arrangements put in place by the clinical commissioning group and explained within the Corporate Governance Framework were
developed with extensive expert external legal input, to ensure compliance with all relevant legislation. Legal advice also informed the matters reserved for the
Membership Body and Governing Body decision and the scheme of delegation.
In light of the Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Services Act
2006 (as amended) and other associated legislation and 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 delegations of those functions.
Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary
capability and capacity to undertake all of the clinical commissioning group’s statutory duties.
Conclusion
There are no significant internal control issues that have been identified.
Karen English
28 May 2015

We can provide versions of this plan summary in other languages and formats such as Braille and large print on re-
quest. Please contact the Engagement Team, telephone 0116 295 1486.
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Appendix 1: Annual Accounts 2014-15

East Leicestershire and Rutland CCG
Unit 2-3 (Ground Floor)
Bridge Business Park
674 Melton Road
Thurmaston
Leicestershire
LE4 8BL
T: 0116 295 5105
W: www.eastleicestershireandrutlandccg.nhs.uk

INDEPENDENT AUDITOR'S REPORT TO THE MEMBERS OF NHS EAST
LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP
We have audited the financial statements of NHS East Leicestershire and Rutland Clinical
Commissioning Group(CCG)for the year ended 31 March 2015 under the Audit
Commission Act 1998. 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 the
accounting policies directed by the NHS Commissioning Board with the consent ofthe
Secretary of State as relevant to the National Health Service in England.
We have also audited the information in the Remuneration Report that is subject to audit,
being:
the table of salaries and allowances of senior managers and related narrative note on
pages 73 to 76
• the table of pension benefits of senior managers and related narrative notes on pages
77 to 78
• the disclosures on pay multiples on page 79.
This report is made solely to the members of NHS East Leicestershire and Rutland CCG in
accordance with Part II ofthe Audit Commission Act 1998 and for no other purpose, as set
out in paragraph 44 ofthe Statement of Responsibilities of Auditors and Audited Bodies
published by the Audit Commission in March 2014.To the fullest extent permitted by law, we
do not accept or assume responsibility to anyone other than the CCG's members and the
CCG as a body,for our audit work,for this report, or for the opinions we have formed.
Respective responsibilities ofthe Accountable Officer and auditor
As explained more fully in the Statement of Accountable Officer's Responsibilities, the
Accountable Officer is responsible for the preparation ofthe financial statements and for
being satisfied that they give a true and fair view. 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 also require us to comply with the
Auditing Practices Board's Ethical Standards for Auditors.
Scope ofthe audit ofthe 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 byfraud or error. This includes an assessment of:
whether the accounting policies are appropriate to the CCG's circumstances and have been
consistently applied and adequately disclosed; the reasonableness of significant accounting
estimates made by the Accountable Officer; and the overall presentation ofthe financial
statements. In addition, we read all the financial and non-financial information in the annual
report which comprises the Foreword, Member Practice's Introduction, Strategic Report,
Members Report, Remuneration Report and Statements by the Accountable Officer 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 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 regularity
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 financial statements
In our opinion the financial statements:
give a true and fair view ofthe financial position of NHS East Leicestershire and
Rutland CCG as at 31 March 2015 and of its net operating costs for the year then
ended; and
have been prepared properly in accordance with the accounting policies directed by
the NHS Commissioning Board with the consent ofthe Secretary of State as relevant
to the National Health Service in England.
Opinion on other matters
In our opinion:
the part ofthe Remuneration Report subject to audit has been prepared properly in
accordance with the requirements directed by the NHS Commissioning Board with
the consent ofthe Secretary of State as relevant to the National Health Service in
England; and
the information given in the annual reportfor the financial year for which the financial
statements are prepared is consistent with the financial statements.
Matters on which we report by exception
We report to you if:
• in our opinion the governance statement does not reflect compliance with NHS
England's Guidance;
we refer a matter to the Secretary of State under section 19 ofthe Audit Commission
Act 1998 because we have reason to believe that the CCG,or an officer ofthe CCG,
is about to make,or has made,a decision involving unlawful expenditure,or is about
to take, or has taken, unlawful action likely to cause a loss or deficiency; or
• we issue a report in the public interest under section 8 of the Audit Commission Act
1998.
We have nothing to report in these respects.

Conclusion on the CCG's arrangements for securing economy,efficiency and
effectiveness in the use of resources
Respective responsibilities of the CCG and auditor
The CCG is responsible for putting in place proper arrangements to secure economy,
efficiency and effectiveness in its use of resources,to ensure proper stewardship and
governance,and to review regularly the adequacy and effectiveness ofthese arrangements.
We are required under Section 5 ofthe Audit Commission Act 1998 to satisfy ourselves that
the CCG has made proper arrangementsfor securing economy,efficiency and effectiveness
in its use of resources. The Code of Audit Practice issued by the Audit Commission requires
us to report to you our conclusion relating to proper arrangements, having regard to relevant
criteria specified by the Audit Commission in October 2014.
We report if significant matters have come to our attention which prevent usfrom concluding
that the CCG has put in place proper arrangements for securing economy,efficiency and
effectiveness in its use of resources. We are not required to consider, nor have we
considered, whether all aspects ofthe CCG's arrangements for securing economy,efficiency
and effectiveness in its use of resources are operating effectively.
Scope ofthe review ofarrangements 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 criteria, published by the Audit Commission in
October 2014, as to whether the CCG has proper arrangements for:
securing financial resilience
challenging how it secures economy,efficiency and effectiveness.
The Audit Commission has determined these two criteria as those necessary for us to
consider under the Code ofAudit 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 2015.
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.
Conclusion
On the basis of our work, having regard to the guidance on the specified criteria published by
the Audit Commission in October 2014,we are satisfied that, in all significant respects, NHS
East Leicestershire and Rutland CCG put in place proper arrangements to secure economy,
efficiency and effectiveness in its use of resources for the year ending 31 March 2015.

Certificate
We certify that we have completed the audit of the accounts of NHS East Leicestershire and
Rutland CCG in accordance with the requirements of the Audit Commission Act 1998 and
Code of Audit Practice issued by the Audit Commission.
John Gregory
for and on behalf of Grant Thornton UK LLP, Appointed Auditor
Galmore Plaza
20 Galmore Circus
Birmingham
West Midlands
84 6AT
28 May 2015

NHS East Leicestershire and Rutland Clinical Commissioning Group -AnnualAccounts 2014-15
Statement of Financial Position as at
31 March 2015
31 March 31 March
2015 2014
Note £000 £000
Non-current assets:
Property, plant and equipment 9 1,320 802
Intangible assets 10 46 42
Total non-current assets 1,366 844
Current assets:
Trade and other receivables 11 4,663 3,881
Cash and cash equivalents 12 121 {308)
Total current assets 4,784 3,573
TotalAssets 6,150 4,417
Current liabilities
Trade and other payables 13 (16,664) (23,077)
Provisions 14 (84) {89}
Total current liabilities (16,748) (23,166)
Total assets less Current Liabilities (10,598) (18,749)
Financed by Taxpayers' Equity
General fund (10,601) (18,752)
Revaluation reserve 3 3
Total taxpayers' equity: (10,598) (18,749)
The notes on pages five to twenty nine form part of this statement
The financial statements on pages one to four were approved by the Audit Committee on 26th May
2015 and signed on its behalf by:
Mrs Karen English
Managing Director (Acc�ntable Officer)
2

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