A meeting of NHS Bromley CCG Governing Body 21 July 2014

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1 South East London Sector A meeting of NHS Bromley CCG Governing Body 21 July 2014 SUMMARY: ENCLOSURE 3 PROCUREMENT UPDATE COMMUNITY-BASED GP DIRECT ACCESS PHYSIOTHERAPY SERVICE This report is to update the Governing Body on progress with the procurement of the GP Direct Access MSK Physiotherapy Service and to seek approval for Chair s Action during August 2014 to avoid a delay in commencement of the new service. KEY ISSUES: a. A GP direct access Community Physiotherapy service has been in place in Bromley since 2010; the current contract expires on 31 August Under procurement rules it is necessary to offer the service for re-tender. The current service has delivered significant savings over the last four years; savings have been achieved through avoidance of hospital attendances and because a lower tariff is available for the community service than is charged for hospital physiotherapy services. b. A procurement process is currently underway that is expected to conclude in early August A mobilisation period of around 3 months is required to enable the safe transfer of patients to a new service should the incumbent provider be unsuccessful in their tender bid. c. A Procurement Team (consisting of 18 members) met in April 2014 (membership list is attached at Appendix A). At this meeting a timeline for the procurement was agreed that would provide sufficient time for robust evaluation of bids and that would support a transparent and fair process. The timeline is provided at Appendix B. d. A contract notice was published on 1 st May 2014 and fifteen organisations requested procurement documents. Five organisations subsequently notified the CCG of their intention to bid and four organisations submitted a bid. e. The revised tariff within the specification for this procurement includes a 5% reduction on previous prices. This will generate a saving of 123,000 a year. For this procurement it was decided to offer a tariff-based rather than a bidder-determined option. This decision was taken for the following reasons: Clinical Chair: Dr Andrew Parson 1 Chief Officer: Dr Angela Bhan

2 I. Bottom up costings for this service were developed in the last procurement round. As the specification for the service did not change significantly we decided to use the current community tariff reduced by 5%. This is approximately in line with tariff reductions for Acute Providers over the same period of time. II. Due to the short timescale of this re-procurement a tariff based option was preferable; it eliminated risk of Providers putting in significantly different bids which could lead to quality and patient experience issues as well as financial risk for the CCG. III. The tariff option also helped to lower risk against achieving the QIPP target for f. It is expected that the Procurement Panel will reach a decision on the preferred bidder at the final procurement review meeting on 24 th July OVERALL RISK ASSESSMENT Risks remain around tight timescales for the procurement. This procurement was initially planned to commence in September 2013 which would have allowed around 12 months to complete the process. However, over the summer of 2013 there was considerable discussion throughout the UK about the benefits of clinical outcome based commissioning (COBIC) and Bromley CCG agreed to review this approach before deciding whether to re-procure the existing community based physiotherapy model or to procure the entire MSK service which would include hospital based orthopaedics and rheumatology services as well as community and hospital based physiotherapy. By January 2014 experience from commissioners adopting the COBIC approach was inconclusive. In addition, Kings College Hospital, whose support was required to write robust clinical specifications for a whole pathway service model, was focused on addressing urgent issues at the Princess Royal University Hospital Farnborough which they took over in September 2013 and it was considered unlikely that Kings could release sufficient capacity to address remodeling of the MSK pathway at this time. An agreement was reached by Bromley CCG in March 2014 that in view of the need to progress the procurement to a conclusion by the end of August 2014, a community based physiotherapy service should be procured at this time and the hospital/community MSK pathway should be reviewed for possible procurement in 2 or 3 years time. A more detailed summary of risks/issues and further detail on the need for Chair s action is provided on page 4. COMMITTEE INVOLVEMENT: The MSK procurement has been discussed at Directors Meetings, Strategy Planned Group, Planned Care Programme Group and Programme Delivery Group. The report reviewed at the April 2014 Directors Meeting is attached at Appendix C. PUBLIC AND USER INVOLVEMENT: Two patient representatives are included in the Procurement Panel and will be evaluating patient information and patient and user involvement elements of bid submissions. Clinical Chair: Dr Andrew Parson 2 Chief Officer: Dr Angela Bhan

3 RECOMMENDATIONS: The Governing Body is asked to: - a) give permission for Chair s action to be taken in August 2014 to ratify the decision of the MSK Procurement Panel on the successful bidder for the community GP direct access MSK physiotherapy service. The Chair will be advised by Lay Members who will review a report from the Procurement Evaluation Panel. The result of this process will be reported at the September 2014 Governing Body meeting. b) note progress with the procurement DIRECTORS CONTACT: Name: Meredith Collins Meredith.collins@bromleyccg.nhs.uk Telephone: AUTHOR CONTACT: Name: Patti Richards, Project Manager, MSK Procurement patti.richards@nhs.net Telephone: GP CLINICAL LEAD: Name: Jon Doyle jon.doyle@nhs.net Clinical Chair: Dr Andrew Parson 3 Chief Officer: Dr Angela Bhan

4 As set out within the NHS Bromley CCG s Standing Orders the powers which the Governing Body has retained to itself within the Standing Orders (section 3.8) may in emergency be exercised by the Accountable Officer and the clinical Chair after having consulted at least two non-employee members (lay or professional members) of the Governing Body. The exercise of such powers by the Accountable Officer and Clinical Chair shall be reported to the September 2014 formal meeting of the Governing Body, in public session, for ratification. Context: GP DIRECT ACCESS MUSCULO-SKELETAL PHYSIOTHERAPY SERVICE The Governing Body is asked to consider the MSK procurement process and to give approval for Chair s action to be taken in August 2014 when ratification of the Procurement Panel s suggested successful bidder is required. This will allow the mobilisation period to start during August 2014 and prevent delays in commencement of the new service. Should an issue arise that requires further discussion (ie. there is disagreement within the Procurement Panel on the preferred bidder) a report will be taken to the 22 nd September 2014 Governing Body for further consideration and Chair s action will not be required during August Summary of issues/risks a) Timescales are tight; and the importance of sound governance in this process is acknowledged. The following measures have been taken to ensure probity: All members are required to sign 2 forms; one confirms agreement to confidentiality of any information relating to the procurement and asks for members to state any conflicts of interest. The second form asks members whether they have any connection/pecuniary interest in any of the organisations who have expressed an interest in bidding for the service. A risk log is being maintained so potential risks can be managed/mitigated appropriately (risk log is attached Appendix D). Members of the Procurement Panel met on 5 th June 2014 to undertake training on evaluation/scoring of bids. This ensures consistency of approach/methodology in scoring bids. The CCG has employed an independent third party to manage the technical aspects of the procurement (to publish contract notice, manage bidder clarification questions, manage the electronic evaluation scoring process etc). This will ensure a fair and equitable process. b) To avoid service disruption, a reasonable mobilization period is required. The incumbent provider has agreed to provide a service until 1 November This will allow for a 12 week mobilization if the contract is awarded in mid-august. Delaying to the September 2014 Governing Body meeting will reduce this period to 6 weeks. (The ten day standstill period starts after the Procurement Panel decision has been ratified by the Governing Body). Clinical Chair: Dr Andrew Parson 4 Chief Officer: Dr Angela Bhan

5 APPENDIX A PROJECT TEAM For the MSK GP Direct Access Physiotherapy Procurement April to August 2014 Area Procurement Clinical Finance Safeguarding Quality Infection Control IT and Performance Contracts Medicines Management Information Governance HR Health and Safety Equipment Patient Representative Member Marlon Roy, Procurement Manager, CSU Patti Richards, Project Manager, BCCG Jon Doyle, GP and MSK Clinical Lead, BCCG Lisa Watson, Lead Physiotherapist, St Georges Hospital Agnes Marossy, Public Health, LBB Lucy Cole, Finance Manager, BCCG Claire Lewin, Designated Nurse Adult Safeguarding, BCCG Devika Govender, Safeguarding Manager, LBB Claire Lewin, Designated Nurse Adult Safeguarding, BCCG Gill Holden, Risk and Patient Safety Lead, BCCG Esther Dias, Health Protection Programme Manager, LBB Peter Lewis, Senior Contracts Manager, BCCG Sarah Osborn, Head of Performance, BCCG Peter Lewis, Senior Contracts Manager, BCCG Amanda Easter, Contracts Manager, BCCG Maeve Kinsey, Prescribing Advisor, BCCG Milton Shoriwa, IG Manager, CSU Nick Marsden, HR Manager, CSU Patti Richards, Care Pathway Redesign Manager, BCCG Janet Edmonds, Planned Care Programme Lead, BCCG Patti Richards, Care Pathway Redesign Manager, BCCG Lisa Watson, Lead Physiotherapist, St Georges Hospital Lyn Wheeler, PAG Representative John Loosemore, PAG Representative Clinical Chair: Dr Andrew Parson 5 Chief Officer: Dr Angela Bhan

6 APPENDIX B TIMELINE Target Date Activity 24 th April 2014 First Meeting of Procurement Project Team 2 nd May 2014 Contract Notice & ITT published 2 nd May to 29 th May 2014 Bidder Clarification Period 5 th June pm Evaluation Training Meeting Meeting Room C, Beckenham Beacon 12 th June 2014 Deadline for completed BQ/ITT Submissions 12 th June to 19 th June 2014 Evaluation of Business Questions 19 th June 2014 Feedback to Marlon on Business Questions to establish Pass/Fail status of bids Marlon will then inform team which bids have Passed and need full evaluation 23 rd June to 4th July 2014 (procurement to take a couple of days to complete Evaluation of bids by the Procurement Team compliance checks) 4 th July 2014 Score sheet and evaluation notes returned to Marlon 10 th July 2014 Moderation Meeting (all day), The w/c 14 th July 2014 Warren, West Wickham Bidder Presentations/Interviews/Site Visits 24 th July am (if required) Final Evaluation/scoring (may be required) Harry Lyne, Beckenham Beacon August/September 2014 Following approval Day 11 To be advised TBA NB. Face to face meetings in blue. Other dates indicate electronic transfer of information. PR/amended Governing Body ratifies successful bidder Alcatel Standstill Period (10 days) Contract awarded Transition for migrating services (mobilisation) Service Commencement Clinical Chair: Dr Andrew Parson 6 Chief Officer: Dr Angela Bhan

7 APPENDIX C Procurement Update GP Direct Access MSK Physiotherapy Date: ( ) Clinical Chair: Dr Andrew Parson 7 Chief Officer: Dr Angela Bhan

8 Document history Include a document history setting out any key changes made as the business case progresses, and any authorisation Version number Date Author Reviewed by Changes made/authority given Patti Richards Authority to proceed The final authority to proceed with a business case, with any tolerances for example, in time or level of benefits expected. Version number Date Author Final authority to proceed and tolerances CONTENTS SECTION TOPIC PAGE 1. The Case for Change 3 2. Procurement Decision 3 3. Procurement Process 4 4. Financial Modelling and Costs 4 5. Risks 5 6. Implementation 5 7. Further Information 5 Clinical Chair: Dr Andrew Parson 8 Chief Officer: Dr Angela Bhan

9 Executive Summary 1. The Case for Change BACKGROUND MSK conditions account for 1 in 4 of all GP consultations so it is important that GPs have easy access to a responsive service that can offer fast, clinically evidenced treatment for patients. Bromley CCG wants to commission a service that supports achievement of these objectives A GP Direct Access MSK Community Physiotherapy Service has been in place since 2010; the contract expires on 31 August 2014 so re-procurement is required. The service was initially procured following a pilot in 2009 to establish demand for the service within the Borough. Objectives of the procurement were to reduce physiotherapy waiting times, ensuring only patients requiring specialist care are referred to hospital and addressing the challenge of the NHS 18 week Referral to Treatment target. The re-designed service aimed to better meet the needs of patients by ensuring they are given appropriate treatment, in a timely way and at a convenient location. The current service continues to deliver against all these measures. Waiting times for treatment are now around 4 weeks for initial assessment and 2 weeks for follow up. Patient satisfaction is high and GP referrals to hospital orthopaedics have reduced by 20%. The service is offered on 5 sites and supports GP education through academic events and MSK club. The service has been further improved by an enhancement that allows the provider to order diagnostic tests (MRI, x-ray, ultrasound and bloods); this has provided more timely management of patients with resulting improvements in clinical outcomes. GP guidelines and timely discharge summaries have helped GPs to more actively manage patients in primary care and reduce the need for referral to hospital. (GPs are expected to follow Bromley MSK guidelines and ensure diagnostic tests are undertaken in primary care prior to referral where indicated in guidelines). The current service is now due for re-procurement and a process to enable this has commenced. 2. Procurement Decision The CCG has considered different models of procurement including prime provider, and concluded that continuation of the current community model was the best option. Procurement of hospital based orthopaedic and rheumatology services will be considered when current procurements (cardiology, dermatology, gynaecology) have concluded with Kings. Clinical Chair: Dr Andrew Parson 9 Chief Officer: Dr Angela Bhan

10 3. Procurement Processes To date: a. A Procurement Project Team has been established consisting of: Lead Jon Doyle Marlon Roy Janet Edmonds Patti Richards Sarah Turner Maeve Kinsey Nick Marsden Ade Oduntan Lucy Cole Michael Fitzsimmons Area of Responsibility Clinical Lead CSU Procurement Lead Planned Care Project Sponsor Project Manager Safeguarding Medicines Management HR/TUPE Information Govenance Finance IT systems An initial meeting of the Team is scheduled for 24 April b. Business questions, ITT questions and a clinical specification have been forwarded to the Procurement Lead to prepare the documentation required to go to advert. 4. Financial Modelling and Costs Bromley Clinical Commissioning Group has considered its own funding availability for the Service and has determined the Tariffs that will be paid for the various elements of the Service. The table below provides these tariffs and also provides an estimated expected level of Activity for one year. Type of appointment* Expected Tariff price activity Triage of referrals 20, First appt assessment 9, Follow up appointment 35, MCATS first appointment 5, MCATS follow up 2, appointment Exercise class appointments 1, Tariffs have been reduced by 5% (based on 13/14 prices) to enable achievement of the 75,000 QIPP target. Contract value: the annual expected contract value for this service is 2,346,647 based on estimated activity levels above. Clinical Chair: Dr Andrew Parson 10 Chief Officer: Dr Angela Bhan

11 Should actual activity be +/- 5% over this value, urgent discussions with the Commissioner will be triggered. 5. Risks Impact Probability Risk H M Timescales are tight and it may be difficult to meet the target service start date of September Contingency: the current provider has indicated they are open to an extension should they not win the contract. H M As UCC procurement will be running at the same time, there could be time constraints for some members of staff involved in both procurements. Contingency: the timeline for the MSK procurement will be agreed taking this into account 6. Implementation Anticipated timescales: Target Date Activity 24 th April 2014 First Meeting of Procurement Project Team 1 st May 2014 Contract Notice & ITT published 1 st May to 29 th May 2014 Bidder Clarification Period w/c 2 nd June 2014 Evaluation Training 12 th June 2014 Deadline for completed ITT Submissions w/c 12 June 2014 (procurement to take a couple of days to complete Bidder submissions to be sent to evaluation team members compliance checks) 3 rd July 2014 Initial Evaluation Meeting w/c 7 th July 2014 Bidder Presentations/Interviews/Site Visits 16 th July 2014 Final Evaluations/scoring 18 th July to 28 th July 2014 Alcatel Standstill Period (10 days) 31 st July 2014 Contract award To be advised Transition for migrating services (mobilisation) TBA Service Commencement 7. FURTHER INFORMATION Updates on progress with the procurement will be provided at regular intervals. Clinical Chair: Dr Andrew Parson 11 Chief Officer: Dr Angela Bhan

12 APPENDIX D RISK LOG MSK GP DIRECT ACCESS PHYSIOTHERAPY PROCUREMENT Risk No. Risk Description A. Initial Procurement Phase A1 A1.1 A1.2 A1.3 A1.4 A1.5 Stage 1 - Business Questions and Award Criteria Latest Action Date TUPE- request for additional information from Physiotherapy Solutions required for the ITT Responses received from Procurement Team on business questions Responses received from Procurement Team on award criteria Confirm topic of presentation for shortlisted bidders Approval from Governing Body Recommended Risk Management Activity Owner Status Comments Response from PS on 14/4 - their HR department will provide Response requested by response requested by Required to go out with ITT PR All All PR Complete Complete Complete Complete MSK procurement has to go to Governing Body for approval. MC/JE Complete Meredith Collins confirmed to Janet Edmonds on 30.4 that as this is a continuation of a current service, it is not necessary to go to the governing body for approval to proceed to procurement and a business case is not required. Clinical Chair: Dr Andrew Parson 12 Chief Officer: Dr Angela Bhan

13 A2.1 A2.2 A2.3 A2.4 A2.5 A2.6 Issues from Procurement Team meeting First meeting of the Procurement Project Team All Complete Include 2 years likely income, amend contract term to 2+1, confirm whether CQC registration is Amendments to specification required PR Complete Work to commence on contract documentation including MDS template, clarify whether national CQUIN Peter In Prepare contract included, Lewis progress As Comms Team to confirm availability to support announcement of new service etc Timelines Current contract with Physiotherapy Solutions to be extended to November Ensure comms team available in August when contract is let so stakeholders can be informed PR Complete Confirm availability for key dates PR Complete Required to ensure sufficient period of mobilisation. Peter to confirm at contract review meeting on 29 April 14. Peter Lewis Complete No problems recorded from Project Team on proposed timeline/dates. Kelly Scanlon will notify who will be supporting from the CSU team Confirmation has been received back from Physio Solutions that they will continue to provide the service until 1 November as requested. Clinical Chair: Dr Andrew Parson 13 Chief Officer: Dr Angela Bhan

14 A2.7 Site visits Confirmation of availability required PR In progress Schedule produced to accommodate 4 shortlisted bidders. Not all team members have responded so it should be possible to add additional slots if required. A3 A3.1 A3.2 A3.3 A3.4 A3.5 A3.6 A3.7 Team membership Agnes to discuss at Planned Care meeting on 1st May 2014 Ask Agnes Marossy to provide public health support Complete Agnes to evaluate clinical areas with Jon Doyle. Additional evaluators provided for safeguarding, quality, contracts, performance, health and safety, IT, health and safety. Awaiting Request additional evaluators where SMEs are confirmation of physio expert and working on their own PR Complete patient rep. Daniel Plummer MSK Physio lead from St Georges is using CSU Hospital is available to support the Expert physiotherapist being sought contacts PR Complete procurement Claire G. to talk to St Georges Confirmed with JE. We will cover finance to agree locum costs. Detail to be agreed Confirm funding for physio expert hourly rate etc. JE/LC Complete between finance departments. Patti working with Paulette Coogan to Patient rep approach PAG PR Complete 2 patient reps confirmed. Outstanding for Amanda, Devika, 2 Forms to be provided for new patient reps, members. Collect at evaluation Confidentiality and conflict of interest declarations Lisa PR Complete training on 5 June. Additional confidentiality and conflict of interest declarations Required for full team to confirm they do not know/ cannot be influenced by bidders PR Complete Check with Marlon Clinical Chair: Dr Andrew Parson 14 Chief Officer: Dr Angela Bhan

15 A3.8 Dr Jon Doyle raised a conflict of interest during the evaluation period Jon's GP practice was awarded a contract that would make GPs in the practice subcontractors to BHC, one of the bidders for the MSK service. PR Complete Advice was sought from Neil Lynch (CCG Procurement Advisor), Meredith Collins and Jim Gunner. The issue was that Jon is one of 3 clinical assessors of the bids received for the MSK procurement and since he commenced work on the procurement his practice has been awarded a Visiting Medical Officer contract with one of the bidders. Jon declared this as a potential conflict of interest. Consideration needed to be given to whether this affected his role as an assessor. There is no direct connection between the practice's VMO contract and the procurement. However, Jon does stand to benefit from the income his practice will earn from this contract. Neil Lynch, our expert interim manager believes that having declared the interest is sufficient. Most GP practices in Bromley have some contracted work with this bidder. The finally agreed view was that as Jon declared the interest from the moment the practice won the contract and that Jon is one of 3 clinical assessors, there is no risk to the integrity of the procurement process. Clinical Chair: Dr Andrew Parson 15 Chief Officer: Dr Angela Bhan

16 A4 A4.1 A4.2 A4.3 A4.4 Bid Evaluation Processes Bids to be evaluated consistently by the team Unsuccessful bidders may challenge evaluation process Site visits - consistency of approach is required To ensure inclusion of relevant policies by bidders Evaluation training set up for 5th June. PR/MR Complete Evaluation team will be advised to take notes so that unsuccessful bidders can receive feedback. Also, FOIs can request this information so content needs to be clear. Team Awaited A site visit template is being produced. Patti will attend all visits to ensure some consistency of approach PR/MR Awaited ITT questions do not specifically request policies. We can expect bidders to provide business continuity plans and disaster recovery plans without specifically being requested PR/Team Complete Policies were included within bids. Clinical Chair: Dr Andrew Parson 16 Chief Officer: Dr Angela Bhan

17 A4.5 Awarding contract Approval of recommended bidder is required from Governing Body. Process information will go to public Governing Body in July September is next public meeting when approval for successful bidder can be sought. PR Awaited A report will be sent to the July 2014 Governing Body updating on progress with the MSK procurement and asking for permission to take Chair's action in August to confirm the preferred bidder. A5 A5.1 Other Risks Bidder clarification question requested list of current physio service venues asking for details on leases and landlords sites are GP practices. Meredith Collins recommended these practices are contacted to ask whether they want their contact details published to avoid a gap in income should the incumbent provider not be successful. The incumbent provider declined to provide details of commercial premises. PR Complete Practices did not wish to be contacted at this time. Clinical Chair: Dr Andrew Parson 17 Chief Officer: Dr Angela Bhan

18 A5.2 A5.3 Timeline is tight Mobilisation period of 3 months may not be sufficient The procurement timelines gives little room for manoeuvre if the contract is to be let by 31 August 2014 PR Awaited Raised by Lay Members at meeting to update them on the procurement PR Complete Careful planning, checking, frequent communication with the Evaluation Panel should mitigate the risk of a tight timescale. This is a relatively simple procurement so tasks should be manageable within the given timeline. 3 months is generally the time given for mobilisation of a service. This issue will be reviewed through the CCG Audit Committee. Clinical Chair: Dr Andrew Parson 18 Chief Officer: Dr Angela Bhan

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