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28. Primary Care Groups will operate as part and parcel of the NHS and will therefore be required to abide by national priorities for the health service, the Health Improvement Programme and other local accountability arrangements. They will need to ensure that they pursue the development of the highest quality of provision for the population within their area, (including the development of clinical governance in primary care) whilst also acting to ensure the best value for money from the resources available to them. Further detail on how Primary Care Groups can contribute to and take forward the public health role, development of primary care and community health services, and commissioning functions (including commissioning for mental health and learning disability services), will be contained within the autumn guidance.
Accountability to the Health Authority
29. As a committee of the Health Authority, the Primary Care Group Board will be accountable through its Chair to the Chief Executive of the Health Authority. The establishment of Primary Care Groups does not diminish the Health Authority Chief Executive's responsibilities for ensuring both propriety and value for money in the use of public funds.
30. The Chair of the Primary Care Group will be formally and individually designated "responsible officer" for the delegated budget, with responsibilities analogous to those of an accountable officer. Primary Care Groups will, therefore, operate within the powers delegated to them in agreement with the Health Authority and will only be able to commit resources in line with their delegated powers and budgets, the Health Authority's standing orders and standing financial instructions, Revised model standing order and standing financial instructions will be issued in the autumn reflecting the establishment of Primary Care Groups and the duty of the "responsible officer".
31. The degree to which the Health Authority devolves its responsibilities to Primary Care Groups is a matter for local agreement between the Group and the Health Authority. (There are a number of functions such as the administration of Part II services where it would not be appropriate for the Health Authority to delegate its responsibilities - A full list of these functions will be set out in autumn guidance). It is fully expected that Health Authorities devolve as much responsibility as the Primary Care Group feel able to take, on subject to their ability to demonstrate that they have the capability and competence to discharge these responsibilities.
32. The establishment of Primary Care Groups with a Chair and Chief Officer creates new organisational relationships for the Health Authority. The lines of accountability will need to reflect the responsibilities of the Primary Care Group Chief Officer and other Group staff to report to the Primary Care Group board even though they are likely to be Health Authority employees. Therefore, it will be the case that the Chief Officer of the Primary Care Group will be accountable to the Chair of the Primary Care Group who will, in turn, be accountable to the Health Authority Chief Executive. These lines of accountability would be reflected in the assessment of individual performance but would not override the contract of employment which the individual would hold with the Health Authority. The arrangements for shadow Primary Care Group managers should reflect these arrangements once the shadow Primary Care Group board has been established.
Accountability for cross border patients
33. HSC 1998/065 made clear that Primary Care Groups should not normally cross Health Authority boundaries. Clearly, as patients have the right to register with any GP, it is likely that some Primary Care Groups will have patients registered with GPs who are resident in neighboring Health Authorities. However, the accountability of Primary Care Groups can only be to one Health Authority. The Primary Care Group is responsible for all patients registered with GPs, and any unregistered patients within that geographical area, covered by the practices contained in that Primary Care Group. Health Authorities have the powers under section 16(1 B) of the National Health Service Act, 1977 (as modified by the Health Authorities Act 1995), to delegate certain responsibilities for exercising functions to a committee of the Health Authority or another Health Authority, These functions include responsibility for commissioning Part I services for any of its patients. Therefore, where patients who are residents within one Health Authority, but registered with a GP within a Primary Care Group accountable to another Health Authority, it will be necessary to provide for these functions to be carried out by the "relevant Health Authority or Primary Care Group committee" which will be the Health Authority where the majority of the Group's population resides, This will ensure that each Primary Care Group will be responsible for all of the population registered with GPs and within that geographical area of the Primary Care Group.
34. The introduction of Primary Care Groups does not affect the current arrangements between Health Authorities, patients and GPs in respect of General Medical Services and Personal Medical Services. However, Paragraph 72 of the Statement of Fees and Allowances makes it possible for "the responsible Health Authority" to also be "the relevant Health Authority'" and all parties will wish to consider the advantages of aligning the responsible Health Authority for Part 1 and Part 2 services and functions wherever possible.
Annual accountability agreements
35. The Health Improvement Programme, to which the Primary Care Groups locally will have contributed, will set the framework within which Primary Care Groups will operate, including the commissioning and provision of services for their local community. Health Authorities and Primary Care Groups will be bound by the duty of partnership laid on Health Authorities and other health service bodies to co-operate in the implementation of the Health Improvement Programme.
36. The relationship between the Health Authority and Primary Care Groups will be expressed in an annual accountability agreement. This will contain key targets, objectives and standards for the delivery or commissioning of services. The agreement will also be the vehicle for setting out the Group's Primary Care Investment Plan. Progress will be monitored against this agreement. It will need to be consistent with national priorities and the local Health Improvement Programme and should be expressed in such a way as to be monitored in line with the Performance Assessment Framework for the NHS. The annual accountability agreement should not become a bureaucratic document but should be relevant to the aims and objectives agreed between the Health Authority and the Primary Care Group.
Accountability between Primary Care Groups and their stakeholders
37. As well as being accountable to the Health Authority, it is essential that Primary Care Groups are responsive to their stakeholders. The mechanisms for electing or selecting Primary Care Group board members provides one route for achieving this, but it will also be necessary for Primary Care Groups to:
l have open and transparent processes (including open meetings) to allow stakeholders and the public to see the basis upon which Primary CareGroups take decisions
have regular communications with stakeholders to inform and disseminate their decisions
produce annual accountability agreements setting out their plans and reflecting on their outturn performance. These will be public documents available through the Health Authority
have clear and open clinical governance arrangements to enable stakeholders to develop confidence in the operation of the Group
38. In setting out the Primary Care Group's annual accountability agreement, the Group will need to have discussed and agreed the aspirations and responsibilities of individual practices and professionals.
39. Primary Care Groups will also need to be accountable for their actions to the public. It will be important to establish open and transparent processes (including public access to board meetings; whilst recognizing the need to protect confidential business where necessary) and to involve lay members on the Primary Care Group board in order to foster local opportunities for public involvement and scrutiny of strategic and operational decisions.
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| Book Title: NHS Circulars | ||