Surrey Heath
Clinical Commissioning Group
Enhanced Services Update
Governing Body
4th February 2014
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‘The best possible health outcomes for our local community’
Background and context
• NHS England delegated authority to CCGs to commission LES
(locally enhanced services – primary care service providers )
during 13/14. 1 year only. GB briefed on 2nd July 2013.
• From April 2014 need to decided whether to re-commission
services & add any new Enhanced Services. Member
practices asked to submit any potential new enhanced
services in March 2013 and discussed at CPDG 19th April and
worked up through this committee with final
recommendation agreed of 22nd November.
• Also need to decide procurement route & whether any of
Enhanced Services are suitable to be offered out more widely
via AQP (Any Qualified provider) or competitive tender.
‘The best possible health outcomes for our local community’
Slide 2
Decision Making
• CPDC made recommendation Review Group Panel
to ES Review Group Panel (Lay members and
Director of Nursing and Quality) on 3rd December
• ES Review Group Panel comments integrated into
final recommendation to Remuneration Commitee
• Final decision delegated to Remuneration
Committee due to timings of GB meetings.
• Some further detail/assurance required
• To NOTE at February GB meeting.
‘The best possible health outcomes for our local community’
Slide 3
Decision Making
• The Remuneration Committee on 17th December
were asked to AGREE the following:
– Which Local Enhanced Services to be re-commissioned
(existing) or new services to commission
– Procurement Route for each service
– Assure that Conflicts of Interest have been appropriately
managed
– Agree pricing for services
‘The best possible health outcomes for our local community’
Slide 4
Role of NHS England Area Team
• During 13/14 NHS England has delegated authority to CCGs
for Local Enhanced Services (but not related to public health)
as part of the CCG’s statutory responsibility for improving the
quality and accessibility of primary care
• Surrey and Sussex AT put process in place to ensure that
there was a standardised approach in place for the signing off
of the ES future plans
• The SHCCG procurement decisions for current LES went to an
AT panel meeting on the 17th December – all
recommendations were supported expect the phlebotomy ES
• The GB will be updated on the implications of implementing
the recommendation to go through a single tender process
‘The best possible health outcomes for our local community’
Slide 5
Process
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‘The best possible health outcomes for our local community’
Note:
•
This original process changed
slightly in that the Rem Com
replaced the Extraordinary
GB meeting with regard to
decision making.
‘The best possible health outcomes for our local community’
Slide 7
Clinical Engagement
and Managing Conflicts of Interest
• Managing potential conflicts of interest appropriately is
needed to protect the integrity of the NHS commissioning
system and protect clinical commissioning groups (CCGs) and
GP practices from any perceptions of wrong-doing.
• Separation of clinical input and decision making.
– Clinical input from member practices on existing service
specifications, new service ideas and specifications, financial
framework principles, and clinical implications of procurement
options.
– Advice and guidance via the LMC
– Not involved in decision making (Governing Body members &
Remuneration Committee excluding conflicting members)
‘The best possible health outcomes for our local community’
Slide 8
Financial Framework Principles
 Greater standardisation
 Clear, transparent and consistently applied pay
rates
 Consistent medical rate of pay based on GP
rates but used for all medical providers
 A fully costed service including overheads
‘The best possible health outcomes for our local community’
Slide 9
Procurement Considerations
• Need & strategic fit
• Quality
• Patient Safety
• Clinical effectiveness
• Access/convenience/choice
• Integration
• Patient Access
• Reducing inequalities
• Market conditions
• Service bundling
• Proportionality
‘The best possible health outcomes for our local community’
Slide 10
Procurement Recommendations
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‘The best possible health outcomes for our local community’
Contracting & Procurement Options
• Contracting
• All Enhanced Services have to be on a Standard NHS
Contract
• Plan to have one contract per practice with specific services
in annex
• Procurement Options
• Single tender (appointed provider/group of providers
without competition)
• Any qualified provider (enables patient choice from a
number of providers, all of whom meet service
specification)
• Competitive tender (appointment of a specific provider(s)
‘The best possible health outcomes for our local community’
Slide 12
Procurement Recommendations - Existing
Service
Recommendation
24 hour BP
monitoring
Single tender
Phlebotomy
Single tender
Zoladex
Single tender
Rationale for decision
Proportionality:
low value of the contract
prohibitive procurement costs for both providers
and commissioners compared to value
The current quality benefits for some
(complex/urgent) patients of having an integrated
service being delivered by their practice and the
potential loss of this service (due to volumes) if the
service goes through AWP or competitive tender
Proportionality:
low value of the contract
prohibitive procurement costs for both providers
and commissioners compared to value
‘The best possible health outcomes for our local community’
Slide 13
Procurement Recommendations - Existing
Service
Minor
Surgery
Recommendation
Rationale for decision
AQP or equivalent
Potential to increase choice of provider for patients
and referring GPs (not all provide minor surgery)
INR
Single tender
Proportionality:
low value of the contract
prohibitive procurement costs for both providers and
commissioners compared to value
Diabetes
Single tender
significant patient quality benefits of integration and
continuity of care with the patients’ primary care
provider
‘The best possible health outcomes for our local community’
Slide 14
Procurement Recommendations - New
New Services
Shared
decision
making
Single tender Proportionality:
low value of the contract
prohibitive procurement costs for both
providers and commissioners compared to
value
DVT
Single tender Proportionality:
low value of the contract
prohibitive procurement costs for both
providers and commissioners compared to
value
Drug
monitoring
Single tender No other provider possible
‘The best possible health outcomes for our local community’
Slide 15
Costs - Pricing schedule
 Update at GB meeting following final
agreement by Remuneration Committee
 Represent significant additional investment
(40% increase) to support CCG strategy of
more community based services through the
commissioning of activity from primary care
‘The best possible health outcomes for our local community’
Slide 16
Benefits – Measures of Success
 Reduction in hospital based activity – CCG to
identify which ES should deliver reduction in
hospital activity and by how much.
 ES integration in practice working to improve
quality of clinical to patients.
 Reduction in variation between
practices/reduction in inequality – number of
ES taken up by all practices
‘The best possible health outcomes for our local community’
Slide 17
Next Steps
 Single tender procurements – share services
specification & prices with practices (mid Feb) Ask for
expressions of interest by end of Feb
 Move all contracts onto Standard NHS Contract
 Prepare for market testing of minor surgery ES –
review service specification, prices, test market
interest (end March)
 Take proposed within year ES on medical input into
nursing homes via CPDC (decision by end June)
‘The best possible health outcomes for our local community’
Slide 18
Next Steps
 Complete AQP process for minor surgery by
end September 2014
 Review phlebotomy ES by end September
 Identify benefits & costs from other CCG
procurement processes
 Assess qualitative benefits of keeping ES as single
tender with specific focus on access to phlebotomy
expertise within practices & level of same day
testing.
 Beginning of October commence process for
15/16
‘The best possible health outcomes for our local community’
Slide 19