Annex G: Procurement template Enfield Clinical Commissioning Group Service: Walk In Service Question How does the proposal deliver good or improved outcomes and value for money what are the estimated costs and the estimated benefits? How does it reflect the CCG s proposed commissioning priorities? How does it comply with the CCG s commissioning obligations? Comment/Evidence The delivery of walk-in services is a priority for NHS Enfield CCG. The Walk-in service improvement agenda is aimed at re-procuring an enhanced service to build on the previous 8 years of the service, and align service delivery with Enfield s Seven Day Primary Care Access service. The proposed benefit to the patients and CCG are: - Deployment of additional walk-in centre sites (patient choice) - Greater integration of prebookable, same day and walk-in provision (easier system for patients to navigate at their point of need). - Access to Enfield patient clinical records, by expressed consent (better continuity of care). - On the day alternative to A&E and other unscheduled care services. The CCG is committed to transforming the primary and community landscape to include GP networks as local provider organisations, with more care being provided in the community and developing access for acute episodes while enabling complex patients with long-term conditions to receive continuity of care.
NHS Enfield CCG is committed to working collaboratively and the vision for improving healthcare locally has been developed with GP practices, patients and service users, key local partners and stakeholders across the borough. How have you involved the public in the decision to commission this service? Enfield CCG draws upon patient experiences as expressed from the ongoing seven day access patient experience surveys, and the annual Ipsos Mori GP Survey. The surveys confirm that Enfield patients views on access to general practice are similar to those in neighbouring CCGs areas, and across London. The results demonstrate increasing confidence and trust in the GP seen or spoken to, however overall experience of obtaining a GP appointment and convenience of appointments are declining. The WIC is a further example of Enfield CCG intention to commission accessible services that delivers both a comprehensive and convenient service, to support growing primary care demand, and provide patients with a real alternative to A&E and other unscheduled care services. What range of health professionals have been involved in designing the proposed service? The WIC offers additional primary care capacity within Enfield. The service will be provided by local GP organisations from accessible hubs within the borough. GPs from all of the networks have been involved in the development of the service. All GP practices have been informed of the plans for this service and how patients will be able to access the service. What range of potential providers have been involved in considering the proposals? NHS Enfield CCG has drawn on the findings the service over the previous 8 years, other WIC services
commissioned across London, and emerging The refined service specification was reviewed at the clinical reference group. How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)? What are the proposals for monitoring the quality of the service? The Health & Wellbeing Board has been kept up to date through its commissioning intentions update. The Walk-in Centres will be monitored monthly through the usual contractual mechanisms under an NHS Standard Contract mandated by NHS England. Contract clauses will enable the CCG to give notice to amend or cease a contract should it be necessary. Service quality will be measured using the contractual mechanisms of Key Performance Indicators and outcome measures seeking to assure service quality under an NHS Standard Contract mandated by NHS England. What systems will there be to monitor and publish data on referral patterns? Reporting of a number of measures is included within the performance management regime (under the NHS Standard Contract). The CCG will be monitoring the usage of the service and will be working with the provider to make the appropriate adjustments in response to the patterns of usage that emerge from the pilot. Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available? Have you recorded how you have managed any conflict or potential conflict? The CCG s COI declarations are available at: http://www.enfieldccg.nhs.uk/aboutus/declaration-of-interests.htm or available to view upon request at the CCG s headquarters at Holbrook House. Conflicts are managed appropriately (in line with the CCG s procedures). In general, those with potential conflicts
that cannot be appropriately managed are excluded from being involved in procurement decisions e.g. selection decisions. In addition, information not in the public domain, but pertinent to the commercial aspects have not been shared with those with potential conflicts. For the purposes of this procurement there are no declared conflicts of interest for any individuals involved in this procurement. In addition, as part of the CCG assurance processes, GPs were asked to declare all conflicts of interest with the CCG. A non-conflicted assurance panel was chaired by the CCGs Head of Primary Care and independent, external clinical input was sought outside of the borough to ensure/safeguard against potential conflict of interest. Why have you chosen this procurement route? Various factors were taken into consideration, including: a. NHS Guidance states: It is for commissioners to decide how best to secure services that meet patients needs and improve the quality and efficiency of services, including whether to use choice and competition, beyond the rights set out in the NHS Constitution. b. The accessibility to patient records c. The ability to align walk-in services and pre-bookable services that drives better integration and continuity of services. What additional external involvement will there be in scrutinising the proposed decisions? NHS Enfield CCG has sought and received legal external guidance and advice on its assurance processes.
How will the CCG make its final commissioning decision in ways that preserve the integrity of the decisionmaking process and award of any contract? The service will also be reviewed by the CCG s auditors as part of the CCG s usual governance framework. 1. The clinical specification was reviewed and scrutinised at the clinical reference group. 2. The financial envelope / contract value was approved by Enfield Finance and Performance Committee. 3. The procurement route, process and award was approved by Enfield Procurement Committee. Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply) How have you determined a fair price for the service? The tariff price is based on similar services and contract terms commissioned in other CCG areas. Additional questions when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers How will you ensure that patients are aware of the full range of qualified providers from whom they can choose? The provider and commissioners will undertake internal and external engagement to raise awareness of this service. The CCG is also raising awareness at
locality meeting, and through Urgent Care Centres, the local Out Of Hours provider and the 111 service which will be able to navigate patients to the access hubs. The service is also being advertised on the CCG website. Patient choice remains, as constituted, and patients can and will continue to access their usual GP practices for care, in addition to having access to the GP Access Hubs. Additional questions for proposed direct awards to GP providers What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider? Decisions have been made in accordance with prevailing procurement law, NHS rules and guidance. The procurement route was supported through a non-conflicted assurance panel process, and a series of mobilisation meetings. The provider has satisfactorily completed an assurance questionnaire process and submitted evidence that demonstrates compliance with a series of both national, and local, criteria. The provider also presented its service implementation plans at meetings where CCG senior management received clarity and final assurance that the provider had the capability to deliver this service. In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract? Walk-in services is an extension of existing GP practice provision to support local capacity. The service is operational 8am-8pm Saturdays, Sundays and public holiday s outside of GP core hours. What assurances will there be that a GP
practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services? The provider has successfully provided CCG-commissioned services previously that has demonstrated a good track record of delivering services to the local population.