Wandsworth Clinical Commissioning Group Procurement Plan

Transcription

1 Wandsworth Clinical Commissioning Group Procurement Plan Better Care and a Healthier Future for Wandsworth Page 1 of 34

2 Contents Executive Summary...4 National Context... 5 Local Context... 9 Wandsworth CCG s Approach to Procurement Planning of Procurement Process of Procurement Publishing Procurement Information Procurement Work Programme 2013/ Governance Terms of Reference for the Wandsworth CCG Contract and Procurement Management Group Useful Resources Page 2 of 34

3 Document control Date 10 July 2013 Lead Director Lucie Waters, Director of Commissioning and Planning Responsible Group Contract and Procurement Management Group Further information Lucie Waters Version Date Author Comment Lola Triumph Initial draft for discussion with Director of Commissioning and Planning Lucie Waters Initial amendment to version Lola Triumph Draft for discussion with Director of Commissioning and Planning Lola Triumph Draft for discussion with Director of Commissioning and Planning Lucie Waters Editing of version 4 following Management Team presentation on Procurement Management Strategy and Procurement Management Group on 22 May Lola Triumph Incorporation of comments from Director of Commissioning and Planning Lucie Waters Work in progress version to Management Team for discussion on Lucie Waters Procurement Management Team Lola Triumph Inclusion of governance structure and CCG Prime Financial Policies Lola Triumph Amendments following discussion with Lucie Waters Lucie Waters Final edit before Board meeting on 10 July 2013 Page 3 of 34

4 Executive Summary 1. This is Wandsworth Clinical Commissioning Group first Procurement Plan as an authorised CCG. The Procurement Plan details the CCG s approach to procurement in 2013/14 and steps that the CCG will take towards compliance with the NHS Procurement, Patient Choice and Competition Regulations (no 2), published in April The regulations can be found at: 2. The Regulations will replace existing administrative rules governing procurement of NHS funded services set out in the Principles and Rules for Cooperation and Competition and the Procurement Guide for Commissioners of NHS funded services. 3. The Procurement Plan for 2013/14 is considered to be the first step in development of a Procurement Strategy for a longer time period. The CCG will be engaging patients, clinicians and the wider community in the development of a Procurement Strategy, during a period in which the roles of new organisations, and responsibilities under the regulations above, become clearer. 4. The CCG, as a commissioning organisation, is committed to securing services that will meet the health needs of its local population, delivering the best possible health outcomes through high quality services, within the resources available. 5. One of the tools open to Wandsworth CCG to drive up quality and demonstrate financial best value is through the use of a formal procurement model. 6. Wandsworth CCG will consider services where formal procurement may deliver real benefits for patients against the cost of procuring new services and resource constraints within the CCG 7. Delivering improved services and outcomes to patients will be the starting point of all service reviews undertaken, and procurement decisions made, by the CCG. Service reviews will be initiated when any of the following commissioning responses are required by the CCG: a clinical contract expires or is terminated the CCG is mandated to deliver a new or revised National Programme (e.g. Any Qualified Provider AQP) a clinically led service review or service re-design is initiated the CCG Commissioning Intentions identify the need for additional capacity within the local healthcare system where a healthcare market analysis demonstrates that there are quality and/or best value issues in a clinical service 8. This Procurement Plan outlines the national and local context which informs this Plan and the development of the Procurement Strategy. This plan is based around 3 functions: the PLANNING of procurement the information on population, outcomes, priorities and providers that is required as the basis for good procurement decisions the PROCESS of procurement the stages in the undertaking of a procurement the PUBLISHING of procurement information how the CCG meets its obligation of transparency. Page 4 of 34

5 Introduction 9. Wandsworth Clinical Commissioning Group is committed to meeting its obligations under the NHS Procurement, Patient Choice and Competition Regulations (no 2). This will involve developing the procurement function and processes of the CCG so that: it delivers the commissioning goals and priorities of the CCG it is underpinned by national regulation, good practice and accurate assessment of resources and constraints on the CCG It is focused on delivering value for money through the use of market analysis and a strong focus on provider development It ensures compliance with UK and EU procurement law and regulations 10. The Regulations specify the objectives and requirements of procurement as being: securing the needs of the people who use the services, improving the quality of the services, and improving efficiency in the provision of the services, including through the services being provided in an integrated way (including with other health and/or social care commissioners or providers) In implementing the Procurement Plan, the CCG must: act in a transparent and proportionate way, and treat providers equally and in a non-discriminatory way, including by not treating a provider, or type of provider, more favourably than any other provider, in particular on the basis of ownership. procure the services from one or more providers that: are most capable of delivering the objective referred to in regulation 2 in relation to the services, and provide best value for money in doing so. 11. In acting with a view to improving quality and efficiency in the provision of the services the CCG must consider appropriate means of making such improvements, including through: the services being provided in a more integrated way (with other health care services, health-related services, or social care services), enabling providers to compete to provide the services, and allowing patients a choice of provider of the services National Context 12. The CCG is committed to securing the best services for its local population, reducing health inequalities, increasing access to services and improving clinical quality and outcomes. This Procurement Plan s main focus is on providing a meaningful procurement process to enable the greatest benefit in terms of health outcomes and achieving value for money, and using the learning in 13/14 as the basis for development of a longer term strategy. 13. This Procurement Plan is intended to meet all relevant national and regional guidelines and strategies including but not limited to: the NHS Procurement, Patient Choice and Competition Regulations (no 2) (2013) NHS Operating Framework Page 5 of 34

6 Wandsworth Joint Health and Wellbeing Strategy (2013) Wandsworth Clinical Commissioning Group Operating Plan 2013/14 Wandsworth Clinical Commissioning Group Prime Financial Policies and Scheme of Reservation and Delegation (replacing Standing Financial Instructions) 14. The current national guidance does not introduce any general policy requirement that all NHS services should be subject to competitive tendering. The current policy is to create an NHS that is much more responsive to patients and achieves better quality outcomes, with local determination of the optimal routes for achieving a step change in improvements for patients. Formal open procurement is one tool that a CCG may choose to use. 15. Where the CCG decides to use one or more procurement routes to achieve better services and outcomes for patients, the EU Principles require that the procurement processes used for procuring services from a provider are fair and transparent. CCGs need to ensure potential providers are given clear guidance on what services the CCG wishes to procure and the selection process that will be used to determine the provider. 16. All public procurements in the UK have to comply with the relevant principles of the EU Treaty, and contracts with a value above certain thresholds are subject to the procedural rules in the EU Procurement Directives, and the UK Procurement Regulations that implement these directives. This legal framework helps to ensure that public procurement is conducted in a fair and open manner both within the UK and across the European Union. 17. The CCG s strategic principles, priorities and plans, including this Procurement Plan, need to be understood within the national context of the development of health policy in the UK. Fundamental to the Department of Health s strategy to improve the NHS is the wish to provide better care, better patient experience, improved access and choice of services as well as better value for money. Overview of the Current Provider Landscape 18. A review of the provider landscape, and potential market for services, is an important determinant of procurement options for any particular service. The CCG will only procure clinical services where the CCG holds the commissioning budget and where there is either a clear market available from which to procure, or a clear need to develop a market for services. 19. The CCG holds a total of 720 contracts with providers within the NHS, private sector, voluntary and third sector, including community pharmacies and GP Practices who provide practice based services. The CCG has committed to placing the Contract Register on the CCG website: the contract register can be accessed at orth%20ccg.pdf The number of contracts will vary on a week by week basis as some expire and others are awarded; the CCG commits to an annual update of the contract register on the CCG website. 20. Wandsworth Clinical Commissioning Group is responsible for commissioning the following services: Page 6 of 34

7 Emergency and urgent care including ambulance services, NHS 111 and out of hours services for GP Practices that have opted out of General Medical Service (GMS) arrangement. Community health services Maternity services Elective hospital care Rehabilitation services Older people s healthcare Healthcare services for children Healthcare services for people with mental health conditions Healthcare services for people with learning disabilities Continuing healthcare Abortion services Wheelchair services Practice based primary care services. It is likely that from April 2014 the CCG will also be formally responsible for the commissioning of practice based quality improvement programmes (i.e. additional to the core contract). The CCG will need to consider the best procurement option for current local enhanced schemes post March GP Out of Hours Wandsworth GPs (with the exception of one GP Practice) have opted out of the national General Medical Service (GMS) contract and opted into the local arrangement for delivering GP Out of Hours services. Harmoni Limited is commissioned to provide GP Out of Hours service in Wandsworth between 18:30 and 08:00 seven days a week. Harmoni maintains physical presence at St George s Hospital Urgent Care Centre and Queen Mary s Hospital, Roehampton are designated times. 22. Urgent Care Services - Harmoni Limited is the provider of Wandsworth NHS 111 service. St George s Hospital Accident and Emergency Service can be accessed by Wandsworth and non Wandsworth residents. Wandsworth Clinical Commissioning Group also pays acute providers when its residents are seen at other Accident and Emergency services. Non Accident and Emergency urgent care services can be accessed at St George s Urgent Care Centre in Tooting and Queen Mary s Hospital Minor Injury Unit in Roehampton. Both services are delivered by St George s Healthcare NHS Trust. Harmoni Limited and West Wandsworth Provider Group Limited are commissioned to deliver the GP Service at St George s Hospital Urgent Care Centre and Queen Mary s Hospital respectively. 23. Community Health Services - Community Services are predominantly provided by St George s Healthcare NHS Trust and totalled 42m in 2012/13. Services provided include general and specialist nursing services for adult and children. There is currently limited availability of alternative suppliers and the risk of monopoly provision is real. Other community based services such as End of Life Care by Trinity Hospice, Marie Curie Cancer Care and St Raphael Hospice and Battersea Community Interest Company and Moorfields Eye Hospital for pilot Out of Hospital Initiatives. Third Sector organisation such as Connect is commissioned to support the development of Stroke services in Wandsworth. Musculoskeletal Services for Lower Back and Neck and Podiatry were recently procured through Any Qualified Provider (AQP) procurement route. Wandsworth Clinical Commissioning Group intends to commissions further services through the AQP in financial year Acute services - The main acute provider is St George s Healthcare NHS Trust which accounts for majority of the acute activity relating to Wandsworth. The provider operates from St George s Hospital, Tooting and Queen Mary s Hospital, Roehampton. Acute services such as Kingston Hospital NHS Trust, Guys and St Thomas, Chelsea and Westminster can also be accessed by Wandsworth residents. The CCG pays for noncontracted activity for patients treated at more distant providers. Page 7 of 34

8 25. Rehabilitation services - St George s Healthcare NHS Trust is commissioned to provide rehabilitation services such as community based Intermediate Care Service, Neurology Service and hospital based Brysson Whyte Rehabilitation Outpatient Unit and Mary Seacole Inpatient Rehabilitation Service at Queen Mary s Hospital, Roehampton. Brendoncare Foundation is commissioned to deliver the inpatient Intermediate Care Bed Service. 26. Older people s healthcare - St George s Healthcare NHS Trust is the main provider of older people s healthcare services. Services are delivered through the adult community nursing service and specific services such as Continence Promotion Service. Age UK is commissioned to provide gardening and Handy Man s service to support elderly people at home. 27. Healthcare services for children St George s Healthcare NHS Trust is the main provider of community based and acute services to children and their families. Its portfolio includes speech and language therapies in mainstream and special schools and Continuing Care Services for Children. Eye Screening in schools is provided by Moorfields Eye Service. Child and Adolescent Mental Health Services is delivered by South West London and St George s Mental Health NHS Trust. There are also smaller players in the Voluntary and Third Sector such as Family Action Newpin. Family Action Newpin provides family support to parents with mental health issues who have children 5 years old and under. 28. Healthcare services for people with Mental Health Conditions - Most of Wandsworth based mental health services are provided by the South West London and St George s Mental Health NHS Trust. The Trust provides services both in the community sites and at Springfield Hospital. Its portfolio includes child and adolescent mental health services, mental health services for adults and dementia services for older people. The 30 providers of Individual Mental Health Placements are located across the England. Out of Area community mental health services are provided by Central and North West London NHS Foundation Trust and South London and Maudsley Mental Health NHS Trust. Third Sector organisations such as Alzheimer Society, Rethink Mental Health, Sound Minds, Voicing Views and Wandsworth Bereavement Service are commissioned to provide various mental health support service. Seagull Print provides people with mental health issues with employment skills and Sound Minds is a user lead social enterprise committed to improving the lives of people with mental health through visual art, music and theatre. The Big White Wall provides on-line therapy intervention. 29. Healthcare services for people with Learning Disabilities - Services for People with Learning Disability are commissioned from St George s Healthcare NHS Trust and South West London and St George s Mental Health Trust, and Surrey and Borders Partnerships NHS Trust. Seagull Print support people with learning disability to access employment skills. 30. Continuing healthcare The Continuing Healthcare market is managed through the South London Commissioning Support Unit (SLCSU). The CCG is currently in the process of collaborating with CCGs across South West London regarding agreeing a regional tariff with care home providers across the South West London Market. There are currently 40 providers supporting individuals in registered independent care homes and at home in the community. 31. Abortion services - Termination of Pregnancy service is delivered by Marie Stopes International (MSI) and British Pregnancy Advisory Service (Bpas) and St George s Healthcare NHS Trust deals with more complex cases requiring surgery. The services are supported by a Central Booking Service that is provided by Bpas. Some of the London Clinical Commissioning Groups are now offering Termination of Pregnancy Service through the Any Qualified Provider procurement route to increase women s choice of medical and surgical abortion provision via greater geographical access across London. Wandsworth Page 8 of 34

9 CCG is not currently part of this arrangement and will be reviewing its position over the coming months. 32. Wheelchair services - St George s Healthcare NHS Trust Community Service is commissioned to deliver the wheelchair and equipment service. 33. Home oxygen services - The Air Liquid Limited provides the Home Oxygen Service contract across to Clinical Commissioning Groups across London. Provider performance and usage is monitored by the Wandsworth CCG. 34. Wandsworth Clinical Commissioning Group commissions services across a number of complex health and social care market segments. However, the dominance of provision is by two main providers. Acute and community services are provided by St George s Healthcare NHS Trust and South West London and St George s Mental Health NHS Trust for mental health services. This is primarily due to historic commissioning arrangement with the Trusts. The CCG has made some progress regarding increasing choice of alternative providers to Wandsworth by procuring new services through the Any Qualified Provider route in 2012/13. There are plans to use Any Qualified Provider as a procurement route for increasing patient choice and increasing competition in 2013/14. Local Context 35. Wandsworth is a large, inner London, borough with a proportionately younger and more mobile population than other London boroughs. A detailed Joint Strategic Needs Assessment (JSNA) was prepared and finalised in The JSNA is an evolving piece of work to constantly assess need and is refreshed on a continual basis as new information becomes available. Key messages from the JSNA in 2011 are that there are: Significant geographical variations in ill-health health inequalities Significantly high rates of teenage conceptions Winter deaths are significantly higher than expected Hospital admissions for falls have increased Chlamydia diagnoses rates are higher than London Significant under 75 mortality for cancer and cardiovascular disease Alcohol related hospital admissions have increased A fifth of all year 6 children are obese An increased need to assess personal needs and assistance for carers Maintaining independence for older people High wellbeing and mental health needs 36. The full Joint Strategic Needs Assessment document can be found at What we need to achieve Wandsworth CCG goals. 37. Consideration of the vision, priorities and goals of Wandsworth CCG is important in determining whether, and how, to procure. A service review process will consider whether current or redesigned services can best deliver the following goals and strategic priorities. 38. Wandsworth Clinical Commissioning Group Commissioning Strategy Plan has identified the following strategic goals: Page 9 of 34

10 Reduce health inequalities through helping people to live longer and healthier lives, particularly those living in Wandsworth s most deprived communities Support young people to take control of their own health earlier, so they continue to make healthier choices throughout their lives Educate people about mental wellbeing, sexual health, drugs, alcohol and obesity. Help prevent and diagnose earlier and improve services i.e. improve access, quality and choice of service provision across all care pathways and in appropriate settings Improve the quality of life of people living with long term and complex health conditions and their carers by improving the quality, range and choice of services and giving them information to better manage their own health Detailed information about the CCG Commissioning Strategy for can be accessed here ads/wandsworth%20ccg%20commissioning%20strategy%20plan.pdf 39. The CCG has identified three key priorities (themes) for 2013/14, working within the joint Wandsworth Health and Wellbeing strategy: Prevention (i.e. ensuring that patients have information to manage their own health, stay well longer, and receive early intervention in the next stage of illness. This incorporates promoting resilience to enhance wellbeing) Integration (providing a seamless across organisational boundaries, specifically between health and social care) Collaboration (in particular with other CCGs, and in relation to the major strategic programme across SW London Better Services, Better Value, BSBV) 40. As part of the Operating Plan for 2013/14, Wandsworth CCG will be assessed on improvement to four mandatory and three local outcome measures: National: Reducing years of life lost amenable to healthcare Reducing emergency admissions Improving patient experience (as measured by the Friends and Family test) Reducing Healthcare Acquired Infections Local: Reducing cardiovascular disease (as measured by increase in people stopping smoking) Ensuring effective care planning for those diagnosed with Dementia Reducing secondary fractures in patients who have already had one fracture. Key Challenges Geography - Wandsworth has around 132,000 dwellings, which are home to a population of over 290,000 residents. The largest increase in population by 2030 is projected in the 45-49, and year old age groups. However, in practice, Wandsworth is also a borough which experiences high levels of population turnover year on year. This creates particular issues for NHS services. For example, there is a large cohort of patients who never register with a GP or access healthcare except for emergency services. Provision of prevention and screening services is challenging where there is a high turnover of patients. There are also areas within Wandsworth that do not have good transport links. These Page 10 of 34

11 factors raise challenges for how we engage, educate patients and decision about future commissioning of prevention, screening and emergency services. Diversity - Whilst the population has below national average numbers of people from black and minority ethnic groups. There is increasing demand for language and interpreting service for patients who speak English as a second language and a lack of knowledge about health needs of the people with a sensory impairment. There is much learning to be gained if we are to reduce health inequalities in Wandsworth s most deprived communities. Finance - The challenge for Wandsworth Clinical Commissioning Group in the difficult financial period ahead is to deliver value for money by obtaining the maximum benefit over time, with the resources we have available. Throughout 2013/14 and beyond we will continue to work to embed and develop best practice, building on experience and lessons learnt. We will continue to review the services we need to commission. We will identify opportunities to improve efficiency extend choice and access, improve the quality of outcomes, and enhance patient experience. The local healthcare system - There are issues with access and sustainability and spread of the current care infrastructure that must be addressed in the coming years. The current make up of much of care provision in Wandsworth is subject to little challenge largely due to near single provider monopolies for many services. Competition, with the aim of improving access for patients, has been introduced in the local healthcare market through delivery of Any Qualified Provider (AQP) Low Back and Neck Musculoskeletal Physiotherapy and Podiatry. The CCG will be exploring opportunities to stimulate the market by ensuring that - where identified as of benefit to patients there is choice of alternative providers. Communications and Engagement Plan 41. The NHS Constitution and the Equity and Excellence: Liberating the NHS white paper, resulting in the Health and Social Care Act 2012, requires Clinical Commissioning Groups to promote patient choice by extending the number of available providers of services in their area. 42. Wandsworth CCG has a strong Communications and Engagement Action Plan, which has resulted from the work of the Patient Involvement Reference Group (PPI Reference Group) established by the CCG. 43. The five objectives of the Communications and Engagement Action Plan are: Build and maintain public and stakeholder confidence in the CCG and its leadership Meaningfully engage with patients, carers and their communities to ensure their systematic involvement in the commissioning of health services for local people To have strong clinical engagement from constituent practices and wider local professional groups to gather clinical insights to have a tangible impact and add value to the commissioning process Ensure open and transparent governance and leadership in our CCG. Promote and advance equality to provide assurance and evidence for the Equality Delivery System for protected groups and to meet requirements under the Equality Act Page 11 of 34

12 44. It is important that, in delivery of the Procurement Plan and development of the Procurement Strategy, the CCG engage with patients, carers and the wider community in a proactive way through It is anticipated that patient engagement regarding development of the three year Procurement Strategy will start in October Patient, service user and public engagement will take place through face to face meetings, presentation workshops and detailed questionnaires which will be made available on the CCG website. The Contract and Procurement Management Group will work with the PPI Reference Group to design processes and at what stage patient involvement, consultation and dissemination exercises will take place. 46. Other actions that the CCG will take in 2013/14 to increase the engagement of patients and the transparency of process will be: To ensure service specifications, where possible, have significant levels of patient engagement in the development, testing and sign off of new service proposals To ensure, where possible, that patients/carers/service users are asked to be members of the Evaluation Panels that recommend award of contracts To ensure, where appropriate, that patients are involved in evaluating the performance of new services (through Clinical Reference Groups or other forums) 47. The Wandsworth CCG website will be the main platform for updating the patients, service users and the public on the CCG procurements. Further work will be done with patients and the public to ensure that information on the website is continuously developed through 13/14 to be meaningful, transparent and timely to patients and the public. Clinical Engagement 48. There are 15 Clinical Reference Groups (CRGs) which bring together a multi-disciplinary group of professionals and patient representatives, to consider ways in which improvements to patient pathways can deliver improved outcomes and a better experience for patients. Each Clinical Reference Group has an annual work programme approved at the CCG Board and each has an appointed GP lead as the Clinical Reference Group Chair. 49. It is anticipated that Clinical Reference Groups will be a key source of information and drive for procurement by: Notifying the Contract and Procurement Management Group (CPMG) that a clinical contract is due to expire or needs to be terminated Responding on behalf of the CCG when mandated to deliver a new or revised National Programme (e.g. Any Qualified Provider AQP) Initiating a clinically led service review or service re-design. identifying the need for additional capacity within the local healthcare system where a healthcare market analysis demonstrates that there are quality and/or best value issues in a clinical service It is anticipated that CRGs will where possible identify potential areas for procurement as part of their annual work plans. Locality Commissioning 50. At the heart of the CCG, we have developed, with our three GP Members Forum and partners, a clear set of goals and locality commissioning plans to meet the health needs and address health inequalities of the local population Page 12 of 34

13 Wandsworth CCG s Approach to Procurement The Vision 51. WCCG has a clear vision for delivering better care and a healthier future for Wandsworth. The vision will be achieved by being: Patient focused Outcome driven Principled Collaborative Progressive and Professional 52. We recognise that process for allocating resources and procuring new services play a key role in the realisation of our vision and commissioning priorities. Engagement with patients and providers is an integral part of the commissioning cycle and decision making process for assessing appropriate procurement routes. 53. This procurement plan is part of that approach and sets out the principles, rules and methods we will work to. The plan clearly outlines how we will determine when it is appropriate to seek to introduce competition or to apply other commissioning levers, including working with our partners, to achieve the most beneficial and cost effective models of delivery. Social Value Commissioning 54. The CCG will seek to establish how social value can be brought to both existing service provision and also services that are at the procurement stage. In order to achieve this, we will need to look at the wider value that a service can bring, i.e. the primary outcome for which the service will be commissioned or exists, plus any additional benefits it can have to society and the public. CCG Procurement Capacity 55. Wandsworth CCG obtains expert procurement support from the South London Commissioning Support Unit (SLCSU). The SLCSU sub-contracts expert procurement support to two suppliers Solent Supplies (clinical procurement) and Essentia (non - clinical procurement). 56. It is essential that the CCG has the appropriate organisational structure, capacity, training and infra structure in place to ensure delivery of the Procurement programme of the CCG. 57. The CCG will work with the SLCSU in the area of procurement to ensure the necessary skills and expertise is available to undertake procurement successfully. Wandsworth Clinical Commissioning Group Procurement Framework 58. This procurement plan sets out the framework within which the CCG will work to ensure that procurement directly contributes to the CCG s corporate aims and objectives and meets legal requirements. The framework sets out the principles, rules and methodologies that the CCG will work to and clearly outlines how and when it is appropriate to seek to introduce contestability and competition as a means of achieving the best clinical outcomes and achieve value for money. This Procurement Plan is divided into three sections: Page 13 of 34

14 The PLANNING of procurement the information on population, priorities and providers that is required as the basis for good procurement decision making The PROCESS of procurement the stages in the undertaking of a procurement process The PUBLISHING of procurement information how the CCG meets the obligation of transparency Figure 1: Wandsworth CCG Procurement Framework Diagram 59. The CCG will consider whether the best way to deliver a service is through procurement when any of the following commissioning responses are required: a clinical contract expires or is terminated the CCG is mandated to deliver a new or revised National Programme (e.g. Any Qualified Provider AQP) a clinically led service review or service re-design is initiated the CCG Commissioning Intentions identify the need for additional capacity within the local healthcare system where a healthcare market analysis demonstrates that there are quality and/or best value issues in a clinical service Page 14 of 34

15 The CCG will consider each service on a case-by-case basis. Planning of Procurement 60. The planning of an effective procurement process will require the following inputs: Financial consideration (e.g. value for money of the service, cost effectiveness of undertaking a procurement in relation to the transactional costs of procurement) A clinically led service review process, identifying the quality outcomes to be achieved through the new service specification A market analysis, including capacity forecast Patient and service user involvement Contract update Completion of any new national requirements Finance How we will invest 61. Wandsworth Clinical Commissioning Group has already started an ambitious programme of review and investment to ensure the best use of the resource that it will have at its disposal. Investments for 2013/14 have been prioritised using the Ethical Investment Framework which has been developed in collaboration with the Local Authority Public Health department, to assess proposals for investment in a transparent manner. It is proposed that the CCG develop a new commissioning strategy through its first full year of operation; this will assist the CCG in finalising programme of service review to ensure the CCG can sustain levels of investment that will ensure transformation of services over the next five years. 62. An appropriate procurement process can produce cost savings and quality improvements. In the current NHS economic climate: the CCG will be required to make continuous savings and efficiencies and procurement is a useful tool in achieving this. It will also open up the market to a wider range of providers. This in turn is considered to help to drive up service quality and innovation. 63. Finance input will be required to: Consider the cost-effectiveness of current services Consider local and national benchmarks on cost compared to quality outcomes Support any proposals around innovative pricing or alternative contracting methodologies for new procurements Work with the commissioning or service redesign managers to scope potential transaction costs of each procurement Service Review 64. The decision to procure new services will be underpinned by robust, clinically-led service review which will detail procurement options, risk and benefits. As a minimum, service reviews will include the following: Population based needs assessment Reflection of national policy and good practice Consideration of strategic fit with the CCG vision, corporate goals and 13/14 objectives Consultation with the relevant Clinical Reference Group(s) Consultation with representative group of patients, service users and the public Page 15 of 34

16 Value for money including financial viability of current and proposed model of care Market analysis Benchmarking information Market Development 65. Wandsworth Clinical Commissioning Group has a commissioning budget of around 400m in 2013/14: the services we commission have to be affordable within the limits of the available resources, with emphasis on the quality of outcome, rather than the quantity of provision. 66. The CCG s approach to market management will focus on market analysis and market development in specific sectors where lack of alternative providers is considered to result in: A lack of access for patients (only one access point for service in the borough) A lack of choice (even with multiple access points, patients may want an option of an alternative provider) Poor patient outcomes and poor quality of service High cost of delivery, low productivity and inefficiencies 67. Market development is one of the key principles by which the NHS reform programme aims to ensure that patients are at the heart of commissioning decisions. The NHS Constitution aims to ensure that patients have the right to make choices about the services commissioned by NHS bodies and to have appropriate information to support these choices. The expectation is that the options available to patients will develop over time with the local healthcare market. 68. One of the priorities, through the 13/14 Procurement Plan, and in development of the Procurement Strategy is to establish gaps in the healthcare market and ensure that there is adequate capacity and capability in the local market to deliver the CCG s strategic objectives. Wandsworth Clinical Commissioning Group is also committed to ensuring that there is an adequate provider market to meet local needs and improve patient experience. 69. Wandsworth Clinical Commissioning Group will need to work with existing providers and new providers to help develop the market place by publishing future commissioning intentions and helping potential bidders to understand procurement processes. 70. Wandsworth Clinical Commissioning Group will consider procuring services competitively where commissioners find that there is a mature proven market or there is shortage of capacity or where competition will develop the delivery of services. 71. Competition may not be appropriate in cases where the market is infant or unproven or where there is an urgent, specialist or need for integration. Market Analysis 72. As a minimum, the CCG will undertake market analysis regarding the markets available for each service to be procured. The following will form the basis of the analysis: Structure of market are providers locally, regionally, national or multinational based? Capacity is the size of contract attractive? Are all the necessary attributes in place to deliver the service, for example workforce, equipment, facilities, etc Status is the market established, new, innovative, are there any restrictions, for example types of organisation that can provide services, e.g. emergency ambulance services. Page 16 of 34

17 73. Competitive is there competition in the market place? Can competition be developed? where there are insufficient providers in the market, the CCG may need to put in place plans to address this. These plans could include: Identifying clear commissioning requirements. Identifying the key requirements that providers need to have to enable them to compete for business. Hold Provider Events where interested parties can come and discuss the CCG s requirements, tender processes can be explained, etc. Producing specifications that are output based, that can be delivered and encourage innovation. Contract duration is such that the contract will allow providers the opportunity to recover costs and make a reasonable return on investment. Ensure contracts are clear and are open and fair with agreed performance measures and adequate dispute resolution processes included. Understand the capabilities of providers. Ensure that adequate time is allowed for bidders to respond to tenders bearing in mind some providers may not have commercial departments to deal with tender responses. Where there is a limited concentration of capable alternative providers, the CCG may consider working in partnership with its current provider to develop and improve standards of services offered (negotiated contracts). EU Procurement Thresholds 74. The European public contracts directive (2004/18/EC) applies to public authorities including, amongst others, government departments, local authorities and NHS Authorities and Trusts. Detailed information can be accessed here The directives set out detailed procedures for the award of contracts whose value equals or exceeds specific thresholds. Details of the thresholds, applying from 1st January 2012 are given below. Thresholds are net of VAT. Public Contracts Regulations from 1 January 2012 SUPPLIES SERVICES WORKS Entities listed in Schedule 1 113, , ,348,350 Other public sector contracting 173, ,934 4,348,350 authorities Indicative Notices 652, ,253 4,348,350 Small lots 69,574 69, , Schedule 1 of the Public Contracts Regulations 2006 lists central government bodies subject to the World Trade Organisation's (WTO) Government Procurement Agreement (GPA). These thresholds will also apply to any successor bodies. Clinical Services are classed as Part B (residual) services and they have a threshold of 173, 934. Page 17 of 34

18 CCG Prime Financial Policies 77. The CCG s prime financial policies control the CCG s environment for managing the organisation s financial affairs. They contribute to good corporate governance, internal control and managing risks. The following are the delegated quotation, tendering and contract procedures Goods or services up to 10,000 (Minimum of 2 verbal quotes required) Goods or services up to 10,000-20,000 (Minimum of 3 written quotations required) Goods or services from 10, ,000 (Minimum of 3 written quotations required) Goods or services over 150,000 (Minimum of 3 competitive tenders required) subject to OJEU tender limits (Procurement Part B guidance) Waiving of quotations and tenders subject to Prime Financial Policies Opening Tenders and Quotations Estimated value up to 50,000 Estimated value over 50,000 CCG Commissioning Managers or CCG Executive Directors CCG Commissioning Managers or CCG Executive Directors Chief Finance Officer or CCG Executive Directors Chief Officer and Lay Member under Seal Chief Officer or Chief Finance Officer. The Chief Finance Officer must also ensure the Finance Committee approves instances and these are also reported to the Audit and Governance Committee. Two senior officers/managers designated by the Chief Officer and not from the originating department Two senior officers/managers designated by the Chief Officer and not from the originating department, including a member of the Board Freedom of Information The CCG will ensure that disclosure of procurement information or contract award in connection CCG procurement exercise or with any contract that may be awarded as a result of this exercise is subject to the Freedom of Information Act (FoI) Future bidders will be given the opportunity to indicate which type of material is to be considered confidential and why it is considered to be so (including the section number in the Freedom of Information Act for the exemption that they believe applies), along with the time period for which it will remain confidential in nature. 79. The CCG would make clear to Tenderers its obligations and responsibilities under the FOIA to disclose, on written request, recorded information held by the CCG. 80. The CCG will consult with providers and agree how to respond to request before releasing information under the FOIA, The outcome of the planning stage will form the basis of a procurement recommendation regarding whether the appropriate delivery mechanism is Page 18 of 34

19 competitive procurement, Single Tender Action (procurement without competition) or collaboration/negotiation between commissioner and provider. Process of Procurement Whether to Procure 81. The key questions of whether and how to procure are summarised in Figure 1 on p23. A recommendation on whether to, and how to procure, should be taken on an individual service-by-service basis, as all services have different factors affecting their propensity for formal open procurement. 82. There are a number of procurement options available to Wandsworth Clinical Commissioning Group, and which one is used will be dependent on a number of factors. Contract value the higher the value, the greater the case is likely to be for competitive tendering. Provider Market the greater the number of providers, the stronger the case for open competition. Geography if the service is local in nature, for example, an additional service in a health centre, there may be a case for awarding the contract to the existing provider. Single or multiple provider(s) would the needs of the population be best served by a single or multiple supplier arrangement? Multiple supplier options may lend themselves to framework agreements or Any Qualified Provider arrangements. Regulations These will include the CCG s Prime Financial Policies and Scheme of Reservation and Delegation, EU Procurement Regulations, DH Guidance. Government policy on protected services for key services that are a significant and vital part of the NHS, for example Accident & Emergency Services, Intensive Care Services, Emergency Ambulance Services, etc. will automatically follow a preferred provider route and negotiation would take place directly with that provider. Jointly Funded Projects competition may not be appropriate for jointly funded projects or may be managed by a separate organisation e.g. the Local Authority on behalf of the CCG Patient Choice consider results of consultation. This will include, where appropriate, choice of providers, models of care and location. Patient Safety if there is a risk to patient safety by changing provider then the CCG can negotiate directly with the existing provider of the services. Open 83. The following procurement options will be considered to reflect the market, value and complexity of the service being commissioned so that a proportionate procurement approach is applied: 84. Under this route, all interested parties may respond to the advertisement by tendering for the contract, although only those meeting the selection criteria (if stated) will be entitled to have their tender assessed. Competitive Dialogue 85. This procedure allows input into the tender process by those bidders participating in it. Bidders invited to do so may tender, and there will be a Dialogue phase where Page 19 of 34

20 Negotiated tenderers are able to discuss all aspects of the contract with the purchaser. The dialogue generates solutions to the agreed requirements, and tenders are invited based on the tenderer s solution. The Competitive Dialogue route should only be used where the CCG is unable, due to the complexity of its requirements to define the technical means capable of satisfying the CCG s needs or objectives, specify either the legal or financial makeup of the project, and where neither the open or restricted procedure would be appropriate for the award of the contract. This procedure allows the purchaser to select one or more potential bidders with whom to negotiate the terms of the contract. There are two types of Negotiated procedure either with or without prior advert. Bidders need to be invited to negotiate the terms of the advertised contract. Under the procedure without prior advert, the CCG could negotiate directly with its supplier of choice this is usually due to the protection of exclusive rights where the contract can only be carried out by a particular bidder. The procedure should only be used in limited circumstances detailed in the Regulations. Any Qualified Provider 86. This will allow the CCG to increase choice to patients by allowing providers to qualify and register to provide services via an assurance process that test providers fitness to offer the particular NHS funded service. The CCG sets local pathways and referral protocols which providers must accept. Referring clinicians offer patients a choice of qualified provider for the service being referred to. Competition is based on quality not price, providers are paid a fixed price determined by an national or local tariff. 87. The Government is committed to increased choice and personalisation in NHS funded services through the Any Qualified Provider (AQP) route. AQP is when patient are referred for a particular service, they should be able to choose from a list of qualified providers who meet NHS service quality requirements, prices and normal contractual obligations. Competitive Tendering 88. An increasing number of services will be subject to competitive tendering in order to comply with the requirements of transparency, openness, equitability and obtaining (and proving) value for money. 89. Competition may be waived in circumstances such as (genuine) urgency, monopolistic rights or where only one provider can provide the service for technical reasons or special exclusive rights. In these circumstances the Single Tender Waiver procedures set out in Wandsworth Clinical Commissioning Group s Standing Orders & Standing Financial Instructions must be followed. 90. Where it is decided not to competitively tender for new services or where services are significantly changed, CCG Governing Body approval MUST be obtained following consideration by the Competition and Procurement Panel to proceed. Page 20 of 34