Question and Answer and Amendment Matrix
NEL COMMUNITY MUSCULOSKELETAL PHYSIOTHERAPY SERVICE
AMENDMENTS
Number
1
Date
29/09/14
Section
Specification Section 7 Quality &
Performance Indicators
Amendment
In light of the questions posed regarding the Pre and Post Client
Reported Outcome Measure we have reviewed the KPIs and amended
them to reflect our minimum position on the PROM measure, as follows:
•
100% of clients to be offered a Client Reported Outcome
Measure (PROM) pre-treatment questionnaire during their initial
assessment. It is expected that there will be at least a completion rate of
90%.
•
Work towards achieving 90% of clients completing a Client
Reported Outcome Measure (PROM) post-treatment questionnaire prior
to discharge that have completed a pre outcome questionnaire. This will
be benchmarked against local performance of other MSK providers and
reviewed annually.
QUESTIONS AND RESPONSES
Number
01.
Date
05/09/14
02.
09/09/14
Question raised
"Assessment and treatment in a client’s
home will occur when the client is unable
to attend for assessment due to their level
of disability."
- Could you advise on the tariff for
domiciliary visits please?
I have been unable to find any
word/character limit relating to the
Commissioner Response
There is no additional tariff for home visits, it is expected that this will fall
within the given prices in the financial section.
We have not set limits on the number of words for responses. Tenderers
should consider their response appropriate to the relevant question.
03.
09/09/14
response document. Can you confirm that
our responses are not restricted to certain
limits please?
Could you confirm the number of IAs and
Follow Up home visits that were
undertaken in the past 12 months please?
04.
11/09/14
What is the criteria for the two tiers
proposed?
05.
11/09/14
The specification suggests providers will
need to also perform a domicillary service.
Is the CCG proposing to disband the
current community physiotherapy team at
DPOW?
06.
11.09.14
07.
11.09.14
How will the average of 3.5 sessions fit
with the NICE guidelines of 8 sessions for
the treatment of LBP when evidence
shows the majority of GP referrals will be
for LBP?
How is the CCG justifying the proposed
tariff as it is significantly below the 2009
figures published by the DOH for MSK
AQP?
08.
11.09.14
The claw back of monies for exceeding an
There are several current contracts for Community MSK. In the main
home visits are not a specific requirement. The number of home visits
are small, with no more than one home visit a month. In the last year, it
is estimated that a total of 12 home visits have been provided.
It is expected that having a community MSK service will support patients
to access the service even further. Therefore while we would not expect
the number to increase.
The Community MSK service being tendered will be for all GP referrals
to MSK provision. Complex MSK will be all consultant referrals to MSK
Provision.
No, the Community Physiotherapy Team will remain operational. It is
proposed that the majority of MSK patients will be seen within
community based MSK clinics, the specification offers the opportunity
for patients to be seen within their own home if they are prevented from
attending the clinic due to their level of disability. This is to ensure equity
of access. It is thought that these would be rare, however essential to
ensure provision of care to meet need. As answered in a previous
question raised, there have been very few home visits to meet current
MSK patients’ needs, in total about 12 in the last year.
The number of follow up sessions will always be based on clinical
decision making, the actual number provided will therefore be based on
need. Using activity data for the last year the local average number of
follow up sessions provided is less than 3.
As part of the Commissioning process we have undertaken research on
current MSK provision, we have then benchmarked ourselves against
those current figures. In addition to this, we have utilised local figures
currently being spent on MSK GP referral community provision and the
volumes of patients being seen and the number of sessions being
delivered. It should also be noted that complex MSK provision will
remain outside of this specification.
It is proposed to be quarterly as stated in the specification ” If the
09.
11.09.14
10.
11.09.14
11.
15.09.14
12
19.09.14
13
23.09.14
average of 3.5 sessions is currently
proposed to be monthly. As fluctuations
are statistically inevitable in short time
frames should this not be annualised?
The Specification mentions onward
referral into the pain service, will AHP's be
able to refer into this service?
Can you please confirm if the group
sessions can be held if there are under 7
patients? For instance if 4-5 patients are
deemed suitable can this session be held?
Whilst we appreciate that as with all
framework contracts there are no
guaranteed or indicative volumes for
individual providers, however can you
please provide the total activity for
previous years in respect of: Initial
assessments, follow up appointments ,
group sessions
Reference question 2.16 you ask for a
tender price and value to date to be
completed; please can you clarify what
you mean by a ‘tender price’?
"100% of clients to complete a Client
Reported Outcome Measure (PROM) pretreatment questionnaire during their initial
assessment - Work towards achieving
100% of clients completing a Client
Reported Outcome Measure (PROM)
post-treatment questionnaire prior to
discharge"
This clause states
that 100% of patients are to complete
PROMS pre and post treatment. This will
be extremely difficult to achieve as not all
patients will agree to complete PROMS.
Other NHS contracts have requested that
average ratio of follow up appointments to initial assessments in any
reporting quarter exceeds 3.5, NELCCG will claw back the cost of the
excess from subsequent payments”.
No, the current system of referral will remain the same, access to the
pain management service will be via a GP referral.
The specification identifies that the minimum number of participants for
a group will need to be 7.
Current annual activity estimates are as follows:Initial Assessments: 4205
Follow Up Appointments: 7418
Group Sessions: 249
The tender price relates to the total value of the contracts listed.
The reason the clause states 100% for a pre-treatment questionnaire is
because it was felt that this should be completed during the initial
assessment and therefore wouldn’t be negotiable as its part of the
assessment. In terms of post treatment, we accept that not all patients
will choose/ not be able to finish the course of treatment and therefore
may not attend their final visit/ session and complete the post treatment
questionnaire at discharge, hence we stated that the provider should
work towards 100%.
In light of the questions posed regarding the Pre and Post Client
Reported Outcome Measure we have reviewed the KPIs and amended
them to reflect our minimum position on the PROM measure, as follows:
100% of patients are "offered" PROMS pre
and post treatment and then set a % for
acceptance - would this not be a more
manageable performance indicator?
•
100% of clients to be offered a Client Reported Outcome
Measure (PROM) pre-treatment questionnaire during their initial
assessment. It is expected that there will be at least a completion rate of
90%.
•
Work towards achieving 90% of clients completing a Client
Reported Outcome Measure (PROM) post-treatment questionnaire prior
to discharge that have completed a pre outcome questionnaire. This will
be benchmarked against local performance of other MSK providers and
reviewed annually.
14
29.09.14
15
29.09.14
16
29.09.14
17
01.10.14
18
01.10.14
Discharge letters- will a summary within
the boundaries given- on System 1, be
acceptable
Clients with deteriorating neurological
conditions- can these patients be seen if
their presenting problem is MSK
Please clarify whether or not Group Work
sessions will count towards a client's total
number of Follow-Up sessions, when
determining: a) their total number of
Follow-Up sessions (not to exceed 5); and
b) the quarterly monitoring ratio of 3.5
Do we have the agreement of the CCG
that we can tentatively start t approach
clinics within the CCG boundaries, to
check for available space, in the event of
us being accredited?
At 3.5, there is a requirement to enclose
audited financial statements. Our company
is exempt an audit, on the grounds of its
size. As such, although we are able to
submit the relevant financial statements,
there is no audit report pertaining to these.
Would this preclude us from participating
in this tender?
YES. Although where a client requests a copy, this should also be sent
directly to the client.
All clients with a presenting MSK need that is appropriate for delivery via
this specification (Via GP referral) can be seen
a) Yes
b) Yes
Potential providers can contact Practices directly but should ensure they
speak to either the Building Manager or the person responsible for the
building.
Being exempt from having to audit your accounts will not preclude you
from participating in the MSK tender.
If you submit an application please provide your accounts as they stand,
but be aware that we may seek further clarification relating to them.
19
09.10.14
Can the CCG supply and exclusion criteria
eg patients that should be referred directly
to the community physiotherapy team and
those that should be seen under this
contract?
Are we to be given access to the
integrated community equipment store for
patients in need of home adaptation or
walking aids?
20
09.10.14
21
09.10.14
Will any safety equipment/procedures be
provided by the CCG for lone workers
attending clients homes as they do in the
community team at the hospital?
22
09.10.14
23
10.10.14
As the service specification calls for
experienced physiotherapists to conduct
the work how will this impact on the role of
technical instructors who currently do
home visits?
Can you confirm that for question 3.9 and
2.10, the contract values you have
requested are for the period from the start
of the contract up to date? Or do you
require annual values for each contract?
The clients who would be excluded from this specification are those who
are referred into MSK services via a consultant or other AHP
professional and those who require physiotherapy input where their
main presenting condition is not an MSK condition.
Physiotherapists from successful Providers on the MSK Provider
Framework will be able to complete an Equipment Prescription utilising
their professional competencies to source equipment from the
Integrated Community Equipment Store subject to clients meeting the
eligibility criteria as determined by the Therapist.
In terms of access to home adaptation, if a therapist wishes to make a
referral for a Home Adaptation, this could be made if they had
evidenced the appropriate Competency Framework required by all
referring therapists.
No, all Providers will have to develop their own procedures for lone
working
Technical Instructors in other community physiotherapy services will not
be affected.
The question requires you to confirm total contract values for the
contracts you currently carry out. These may be an anticipated total
contract value.