News / Survey flags CCG audit committee variations

By Steve Brown

The membership and running of audit committees varies significantly across new clinical commissioning groups (CCGs), according to a recent survey.

In the run-up to their creation, CCGs were given only high-level guidance on how to run audit committees. NHS England’s model constitution pointed CCGs to the latest NHS audit committee handbook, which predates CCGs’ creation.

Template audit committee terms of reference are thin on detail. They stipulate that the lay member for governance – one of two lay members on CCG governing bodies – ‘needs to be able to chair the audit committee’. The terms also bar the governing body chair from membership, and suggest excluding full-time CCG staff too.

More than 60% (129) of the 211 CCGs across the country participated in the survey, carried out by South Coast Audit in conjunction with the HFMA’s Governance and Audit Committee, supported by NHS Audit England and other private sector audit providers.  The responses confirm that almost all CCGs have appointed their lay governance member to the committee.  But despite NHS audit committee handbook recommendations that membership should be not less than three non-executive directors, one in five CCGs said their other lay member (for public and patient engagement) was not involved.

Nearly half of CCGs are involving their independent secondary care doctor on the audit committee, while only about a quarter include their independent nurse.  Some CCGs have chosen to appoint a third lay member.  About 25% of CCGs also said they were sharing lay or independent members.

But nearly two-thirds of CCGs have opted to include a GP from their member practices, with some practice manager appointments too. It is unlikely a GP would have been considered eligible in PCTs.

More than 80% of CCGs have adopted the handbook’s suggestion of a quorum of two, with 12% requiring three members present. In one CCG, quorum was defined as two lay members plus the chief finance officer. The survey also identified that one in five CCG audit committees meet with neigh-bouring CCG audit committees.

‘There is a lot of differing practice compared to what the NHS has previously seen,’ said Michael Townsend, managing director for South Coast Audit. ‘This reflects the lack of detailed instruction and relative freedom given to CCGs in this area. We hope to provide an opportunity for comparison and learning as CCG audit committees start to bed in.’ 

l Full details of the survey results will be available shortly at www.hfma.org.uk