DECLARATION OF INTERESTS FOR MEMBERS/EMPLOYEES

This form is required to be completed in accordance with the CCG’s Constitution and Section 14O of the National Health Service Act 2006, the NHS (Procurement, Patient Choice and Competition)(No2) Regulations 2013 and the Substantive Guidance on the Procurement, Patient Choice and Competition Regulations.

Please complete the form after referring to the guidance notes attached.

Please choose the following statements that apply: (as defined in the guidance notes)

I have no interests to declare ☐

I am not aware of any relevant interests of close associates☐

I wish to declare my interests recorded overleaf ☐

I wish to declare the interests of close associates recorded overleaf ☐

Signature (required if not sent by email): ______

Name: Click here to enter text.

Date: Click here to enter a date.

Position: Click here to enter text.

Name of Practice: Click here to enter text.

Name of Committee or Sub Committee of which you are a member:

HRW CCG Governing Body☐

Joint Commissioning of Primary Care Committee☐

Audit & Integrated Governance☐

Quality & Safety☐

Other (please state) …………………………………………………………..………

I declare that to the best of my knowledge and belief, the information I have given on this form is correct and complete. I understand that if I knowingly provide false information, this may result in disciplinary action and I may be liable for prosecution and civil recovery proceedings. I consent to the disclosure of information from this form to and by the CCG and NHS Counter Fraud and Security Management Service for the purpose of verification, prevention, detection and prosecution of fraud.

I undertake to update as necessary the information provided and to regularlyreview the accuracy of the information provided.

Appendix B continued

Please note: Nil return is required

Type of Interest / Details & whether
Personal or Pecuniary* / Self or other** / Start
Date
Roles and responsibilities held within member practices. / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Directorships, including non-executive directorships held in private or public limited companies / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG or NHS England / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Material shareholdings in private or public companies in the field of health and social care / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
As an employee or trustee of a voluntary organisation, social enterprise or charity seeking to enter into a contract with the CCG. / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Any interest that they (if registered with the GMC) would be required to declare in accordance with paragraph 55 of the GMC’s publication ‘Management for Doctors’ or any successor guidance. / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Any interest that they (if registered with the Nursing & Midwifery Council) would be required to declare in accordance with paragraph 7 of the NMC’s publication ‘Code of Professional Conduct’ or any successor Code. / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Partner/employee of Click here to enter text. (name of practice) which provides medical services over and above the GP contractual obligations / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Research funding/grants that may be received by the individual or any organisation they have an interest or role in / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgement or actions in their role within the CCG / Click here to enter text. / Click here to enter text. / Click here to enter a date. /
Any other employment or private practice (include hours worked per week) / Click here to enter text. / Click here to enter text. / Click here to enter a date. /

* Pecuniary – of or relating to money i.e. a financial interest

** Specify relationship

Appendix B continued

Guidance Notes

Section 8 of the CCG Constitution and its related Business Conduct and Conflicts of Interest Policies require CCG Shadow Board Members, Council of Members, Members of its Committees and Sub-Committees, CCG staff and individuals working on behalf of the CCG to declare interests which are relevant and material and any positions of influence they hold or are held by a family member, close friend or other acquaintance, in the categories outlined on the form.

If there are no interests to declare A NIL RETURN MUST BE SUBMITTED and the word ‘Nil’ entered against each category.

A declaration must be made of any interest likely to lead to a conflict or potential conflict as soon as the individual becomes aware of it and in any event within 28 days.

Any changes to declarations should also be made within 28 days of a relevant event occurring by completing and submitting a new declaration form.

Any changes should be reported at the start of each Committee/Sub Committee meeting. Members and employees completing this form must provide sufficient detail of each interest so that a member of the public would be able to understand clearly the sort of financial or other interest the member has and the circumstances in which a conflict of interest might arise.

Details of directorships of companies and organisations likely or possibly seeking to do business with the NHS will be published in the CCG’s annual report.

The register will be published on the CCG’s website.

If in doubt as to whether a conflict of interest could arise, a declaration of the interest should be made.

If any assistance is required to complete the form, please contact Business Support Services

The signed hard copy of the completed form should be sent to:

Business Support Services

NHS Hambleton, Richmondshire and Whitby CCG

Civic Centre

Stone Cross

Northallerton

North Yorkshire

DL6 2UU

Alternatively, an electronic version completed and sent from the declarers email address to will be accepted.

Appendix C

Extract from HRW CCG Constitution - Section 8.4 Managing Conflicts of Interest:

8.4.1Individual members of the Group, the Governing Body, committees or sub-committees, the committees or sub-committees of its Governing Body and employees will comply with the arrangements determined by the Group for managing conflicts or potential conflicts of interest.

8.4.2The Audit & Integrated Governance Committee will ensure that for every interest declared, either in writing or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the Group’s decision making processes.

8.4.3Arrangements for the management of conflicts of interest are to be determined by the Audit & Integrated Governance Committeeand will include the requirement to put in writing to the relevant individual arrangements for managing the conflict of interests or potential conflicts of interests, within a week of declaration. The arrangements will confirm the following:

a)when an individual should withdraw from a specified activity, on a temporary or permanent basis;

b)monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual.

8.4.4Where an interest has been declared, either in writing or by oral declaration, the declarant will ensure that before participating in any activity connected with the Group’s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Accountable Officer acting in accordance with a policy approved by the Audit & Integrated Governance Committee.

8.4.5Where an individual member, employee or person providing services to the Group is aware of an interest which:

a)has not been declared, either in the register or orally, they will declare this at the start of the meeting;

b)has previously been declared, in relation to the scheduled or likely business of the meeting, the individual concerned will bring this to the attention of the chair of the meeting, together with details of arrangements* which have been confirmed for the management of the conflict of interests or potential conflict of interests.

The chair of the meeting will then determine how this should be managed and inform the member of their decision. Where no arrangements have been confirmed, the chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual will then comply with these arrangements, which must be recorded in the minutes of the meeting.

*(ie the Conflicts of Interest Policy)

8.4.6Where the chair of any meeting of the Group, including committees, sub-committees, or the Governing Body and the Governing Body’s committees and sub-committees, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy chair will act as chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy chair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair, the members of the meeting will select one.

8.4.7Any declarations of interests, and arrangements agreed in any meeting of the Group, committees or sub-committees, or the Governing Body, the Governing Body’s committees or sub-committees, will be recorded in the minutes.

8.4.8Where more than 50% of the members of a meeting are required to withdraw from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the chair (or deputy) will determine whether or not the discussion can proceed.

8.4.9In making this decision the chair will consider whether the meeting is quorate, in accordance with the number and balance of membership set out in the Group’s standing orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair of the meeting shall review whether a quorum can be reached as set out in Standing Orders section 3.7.1, if not then the chair will consult with the Audit & Integrated Governance Committeeon the action to be taken.

8.4.10The actions taken in accordance with clause 8.4.9 may include:

a)requiring another of the Group’s committees or sub-committees, the Group’s Governing Body or the Governing Body’s committees or sub-committees (as appropriate) which can be quorate to progress the item of business, or if this is not possible,

b)inviting on a temporary basis one or more of the following to make up the quorum (where these are permitted members of the Governing Body or committee / sub-committee in question) so that the Group can progress the item of business:

i)a member of the Group who is an individual;

ii)an individual appointed by a member to act on its behalf in the dealings between it and the Group;

iii)a member of a relevant Health and Wellbeing Board;

iv)a member of a Governing Body of another clinical commissioning group.

These arrangements must be recorded in the minutes.

8.4.11In any transaction undertaken in support of the Group’s exercise of its commissioning functions (including conversations between two or more individuals, e-mails, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and register that interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the Audit & Integrated Governance Committeeof the transaction.

8.4.12The Audit & Integrated Governance Committeewill take such steps as deemed appropriate, and request information deemed appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared.

Appendix D

[To be used when commissioning services from GP, including provider consortia, or organisations in which GPs have a financial interest]

NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group

Service:
Question / Comment/ Evidence
How does the proposal deliver good or improved outcomes and value for money- what are the estimated costs and the estimated benefits? How does it reflect the CCG’s proposed commissioning priorities? How does it comply with the CCG’s commissioning obligations?
How have you involved the public in the decision to commission this service?
What range of health professionals have been involved in designing the proposed service?
What range of potential providers have been involved in considering the proposals?
How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)?
What are the proposals for monitoring the quality of the service?
What systems will there be to monitor and publish data on referral patterns?
Have all conflicts and potential conflicts of interest been appropriately declared and entered in registers which are publicly available? Have you recorded how you have managed any conflict or potential conflict?
Why have you chosen this procurement route?
What additional external involvement will there be in scrutinising the proposed decisions?
How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision- making process and award of any contract?
Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply)
How have you determined a fair price for the service?
Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers
How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?
Additional questions for proposed direct awards to GP providers
What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider?
In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract?
What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

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