MSK contract award - Frequently asked questions

MSK contract award - Frequently asked questions How and why the CCG went to procurement Why was change needed to local services? We know that the current system could be more joined up and patients could be treated quicker and more effectively if we make improvements to the way that MSK services all work together. We also hear from patients that they want services to be more accessible, for there to be equality in the care available across our area, and they want greater involvement in decisions about their treatment. Currently, if a patient sees a physiotherapist but then needs treatment from another MSK service, they are referred back to their GP. The GP then has to write a second letter to refer the patient on. This adds needless delays and frustration for the patient, and unnecessarily takes up the time of busy GPs. It also costs the NHS and the tax payer more than a single, well-coordinated service. The new MSK Service will bring together the physiotherapy, rheumatology, chronic pain management and elective (planned) orthopaedic services together into a single, coordinated service so that all of the health professionals involved in this area of care can work together to provide a seamless patient experience. It will mean that the prime provider will be accountable for the entire MSK patient journey, rather than individual services taking responsibility only for their own service. Why did the CCG have to go to procurement? The CCG considered whether it needed to go to procurement at its Governing Body Meeting on July 17, 2013, and determined; The regulations indicate that the award of a new contract without competition is only acceptable if there is only one single provider able to provide that service. This is not the case for MSK services and therefore we have no option but to embark on a procurement process. This reflects procurement guidance offered by the NHS Commissioning Board, which was current at the time at which the CCG decision was taken. The CCG also took into account the briefing from the NHS European Office (September 2013) on the New EU Directive on Public Procurement: For health service contracts of a value equal to or above 750,000, the following will be required: ex-ante advertisement in the OJEU, as well as publication of ex-post award notices compliance with national rules ensuring that the key EU principles of transparency and equal treatment of economic operators are respected member states will be free to determine the procedural rules applicable taking into account the specificities of the sector concerned

award criteria can take into consideration important elements in the provision of health services including quality, continuity, accessibility, comprehensiveness Therefore it was agreed procurement was necessary. Our decision-making process Who actually made this decision? Each of our GP member practices are responsible for the decisions we make as a CCG. They have delegated their authority for these decisions to a number of groups which meet regularly to carry out the work of the CCG. Clinical Commissioning Executive The CCG s Clinical Commissioning Executive brings together our clinical directors, locality directors, health professionals and lay representatives to discuss local health services, our current work and make decisions to enable us to move forward. This group meets monthly. The Governing Body - Our Governing Body meets in public four times a year to discuss the CCG s work and hold the CCG to account for the progress it is making. You can read more about Governing Body meeting dates, members and past meeting papers. The decision to award the contract for a new MSK service to Bupa CSH Ltd was made by the CCG s Clinical Commissioning Executive, and supported by the CCG s Governing Body. There are 12 voting members on the Clinical Commissioning Executive. All members were present for a discussion on the process and agreed it was a robust and fair procurement process. For this decision seven members were able to vote the others being conflicted. Following a full discussion, it was a unanimous vote for Bupa CSH Ltd. How have patients been involved in this process? This decision is the result of a three-year procurement process with patient involvement throughout and a patient representative on the formal evaluation panel. During the procurement process we collected intelligence from patients and clinicians through a wide range of channels including surveys, face to face engagement events, patient focus groups and formal project groups. We have in this way brought together local patients, GPs, MSK clinicians and managers in order to reflect on the current services and to see how this could be improved to provide better outcomes for patients. The new MSK service **UPDATED** Who will be running the new service? The new service will be delivered under an NHS contract by Bupa CSH Ltd (the prime provider ). Patients in Coastal West Sussex will continue to receive an NHS MSK service that is free at the point of care. **UPDATED** What services will be included in the new MSK service?

The new service will bring together the existing physiotherapy, rheumatology, chronic pain management and elective (planned) orthopaedic services together into a single, coordinated service. The new contract does not include MSK trauma or A&E work these contracts are completely separate and the CCG will be continuing to commission them from Western Sussex Hospitals NHS Foundation Trust. **UPDATED** Where will this be provided? Where will I get local care? The new service will offer more choice and improved access to clinics for patients. We know Bupa CSH is already in discussions with current providers and local GPs to explore expanding the range and location of clinics so patients benefit from greater flexibility and access. The new service is based on a hub and spoke model. Bupa CSH is planning three one stop treatment hubs across the Coastal West Sussex area for patients whose care and treatment needs a multi-disciplinary clinical team (of consultants, physiotherapists and nurses). These will mean patients can see a physio, nurse and consultant and get any necessary tests/diagnostics all done in the same place and on the same day. There will also be a number of smaller, local clinics (the spokes ) throughout the Coastal West Sussex area. Many of these will be in existing locations, and Bupa CSH is also exploring new sites to improve access to the MSK service. It is also a requirement that community services cover the Coastal West Sussex area, ensuring equity of access for urban and rural communities, and for hard to reach groups. **UPDATED** How will it work? Coordinated care through a single point of access Patients will be referred just once to a dedicated team (in a new Patient Coordination Centre) who will coordinate all of their care and treatment. This clinical and administrative team will manage all patient contact with the service from this point working with local providers to coordinate their treatment and care. The patient won t have to go back to their doctor for further referrals or tests as their entire care and treatment will be arranged and managed by the new service so they will experience a more coordinated and joined up service that will save them time and frustration, and the NHS and tax payer money. Greater patient involvement, control and choice Patients and their carers/families will be more in control of their health, treatment and care as their clinicians will be trained in shared decision making a way of involving patients and their carers/families in decisions about their care and treatment. The new service will provide the national Choose and Book system for patients who need planned surgery, such as hip or knee replacements. Patients will be able to choose which hospital they have their operation at based on quality information and other data, such as waiting lists. Patients who require non surgical treatment will also have more choice of treatment hubs and local clinics throughout the Coastal West Sussex area. Better information, advice and support

Every patient will have a named physiotherapist who they can go to for advice and support. Patients will also benefit from improved advice, information and support via telephone, email and website options helping them to make more informed choices, better manage their conditions themselves and reduce future risk of ill-health. Western Sussex Hospitals NHS Foundation Trust currently provides local hospital services, will this change? This contract appoints an organisation as lead provider who will be responsible for all community and hospital MSK services. This new partnership of Bupa UK and CSH Surrey (Bupa CSH Ltd) will then set up contracts locally with NHS providers and other organisations to provide local care. These contract negotiations are currently underway. Our local NHS partners are aware that we - and the preferred bidder - want their valued services to be part of this contract. As the commissioner, we would expect hospital services to be delivered locally and we are clear that certainty of hospital services will be an explicit term of the contract. We are actively encouraging the discussions between Bupa CSH Ltd and the local NHS providers and other organisations that are now underway to agree how the service will be brought in from next year. Putting patients at the centre of the new service I have heard that this is a new type of contract what does that mean? This is a new kind of contract for the NHS based on the outcome patients achieve not just the number through the door, which is how the current system works. This means Bupa CSH s priority is the patient experience and the quality of their care and treatment. The contract is for a lead provider whose primary role is to coordinate services and to make sure each part of the patient journey works. They will provide some parts of the services e.g. community physio but will buy others parts of the service from local providers such as the hospital trust. In terms of the contract itself, it will be an NHS England standard contract for the provision of NHS services, and services will remain free at the point of access for our local population in line with the NHS framework. The NHS England standard contract requires any healthcare provider, whether that is an NHS organisation or independent sector, to deliver services to the same standards of quality and service; as such Bupa CSH Ltd will be fully accountable for the delivery of all of the services within the integrated MSK service, even those they sub-contract. Sub-contracted services will need to adhere to the conditions, outcome measures, and standards set out in our contract with Bupa CSH Ltd. In addition, the CCG has to approve any subcontractors Bupa CSH Ltd wish to work with that will directly provide patient care. I am currently receiving treatment, how will this affect me? Currently there will be no change to any patients locally receiving care. The current services will continue to be provided in the same way while plans are made to introduce the new service next year. It is absolutely vital for everyone involved to keep any disruption to patients currently receiving care to a minimum. If there are any changes that affect patients, clear information will be provided as soon as possible with contact information for anyone who has queries or questions. Will I still have patient choice? Will we still be able to choose where to have treatment when the new service is launched?

Following the launch of the new service, patient choice will not be affected and should a patient require hospital treatment (for example knee replacement surgery) they will be offered the full choice of all providers both within Coastal West Sussex and nationally, as set out in the NHS Constitution. This is explicit within the new contract. Recognising valued local staff **UPDATED** What will be the impact on staff currently providing these services? The CCG absolutely recognises the hard work and commitment of the staff currently providing these local services. Bupa CSH s intention is to work with existing providers and to retain their staff. We understand they will be creating a number of new roles that will be core to the service, so there will be career development and progression opportunities for existing staff. CSH Surrey, as an experienced provider of NHS community and hospital services in Surrey, will be the employer for the services that the new partnership directly provide, and staff will be offered the opportunity to transfer to CSH Surrey with existing terms and conditions and NHS pension rights. Whilst Bupa CSH Ltd will employ the staff in services that they will directly provide, employment for the members of staff in services that they plan to sub-contract will remain the responsibility of the organisation providing those services. Bupa CSH Ltd are keen to work with WSHFT to sub-contract elective orthopaedic services. We sincerely hope that they will be successful and, on this basis, this existing valued and skilled group of professionals at WSHFT will continue to be employed by the hospital trust. We are working with all of the organisations currently providing this service and they are directly working with staff. We absolutely recognise the hard work and commitment of these staff and understand that each organisation is working with their own staff directly. **UPDATED** About Bupa CSH Bupa CSH Ltd is a 50:50 partnership between CSH Surrey a pioneering, employee-owned social enterprise that s rooted in the NHS and is fully focused on delivering excellent services for NHS patients and Bupa. CSH Surrey was established more than eight years ago in 2006 by its current Managing Directors, Jo Pritchard (nurse and health visitor) and Tricia McGregor (speech and language therapist) and more than 500 other nurses and therapists. They set up CSH Surrey after being asked by the then PCT to find a new and better way of delivering community services in Surrey. They chose to spin out of the NHS the first in the country to do so and set themselves up as an employee-owned social enterprise. They were clear they wanted three things from their new model: 1. To run a healthcare organisation that was led by clinicians not business managers 2. They wanted CSH to be employee-owned because this creates higher staff engagement and ultimately higher quality services (their model is similar to the John Lewis Partnership, although CSH coowners do not receive dividends)

3. They wanted CSH to be a social enterprise this means running it with all the drive, determination and focus of a for profit business, but having a social ethos and purpose rather than existing to make profit for shareholders. When they set up, Jo and Tricia repeatedly took views from across the workforce about whether the employees wanted to make personal profit from CSH the firm answer was always no. They chose instead to invest profits back into improving and expanding their healthcare services so more people could benefit from CSH services. They also allocate surplus into CSH Surrey s Community Fund, which awards grants to community groups to support health and wellbeing projects. A few years ago, CSH Surrey s Managing Director Jo Pritchard recognised they needed to partner with a bigger organisation to grow. After meeting many prospective partners, CSH chose to partner with Bupa as, like CSH, it has no private shareholders, and it also shares CSH s values of putting their patients first. CSH s and Bupa s shared vision is to provide excellent and innovative health and care services for NHS patients. Bupa is an industrial provident society and global healthcare leader with more than 20 years experience of working with and alongside the NHS to improve care and services for patients while also helping NHS funds go further. They also bring significant technology expertise, which they will use to develop tools and aids to support patient care. Bupa CSH has four Directors two from CSH Surrey and two from Bupa. CSH s Directors are Jo Pritchard, Managing Director of CSH Surrey, and Bill Caplan, Chair of CSH Surrey. Bupa s Directors are Andrew Peeler, Commercial and Finance Director, and Peter Lock, Procurement Director. Neither Bupa nor CSH Surrey has private shareholders who are paid dividends so in this respect is it the same as NHS Trusts. All NHS providers (including NHS Trusts such as Western Sussex Hospitals NHS Trust and Sussex Community Trust and GP practices) are required to make a profit to be viable and sustainable. It s what an organisation does with the profit that s important. Without private shareholders, Bupa and CSH Surrey are able to invest surplus into providing better healthcare services for patients (rather than paying out dividends to shareholders). Bupa CSH has chosen to commit to investing 50,000 every year into supporting local health and wellbeing projects in Coastal West Sussex that it hopes will be chosen with the involvement of local patients and the MSK service employees. Listening to concerns Will this new service still be an NHS service or is this turning our local health services private? This is an NHS contract which will provide the same or better quality care, free of charge for all local patients. Neither CSH Surrey nor Bupa UK has private shareholders who are paid dividends. With no private shareholders, both companies are committed to investing in providing more and better healthcare. Together, they have committed to reinvesting 50,000 a year back into local community projects and plan to involve patients and our employees in selecting the projects we support. What will the impact be on local trauma services?

It has been clear throughout the procurement process that trauma and A&E services sit outside of this contract and that the CCG will continue to commission these services from WSHFT. Trauma services are not part of the MSK integrated Musculoskeletal care service. In the information published as part of the Invitation to Tender it states: The CWS CCG will continue to commission MSK related trauma from the current providers and the intention is for this to continue for the duration of this MSK ICS contract period. The Prime Provider service will closely collaborate and will need to ensure integrated working with current trauma service providers. This can be seen here along with further information about what is in and out of scope of the new service. The CCG has no intention of committing to anything that will destabilise trauma services or Western Sussex Hospitals NHS Foundation Trust (WSHFT) and has been assured that Bupa CSH Ltd wishes to sub-contract orthopaedic services from WSHFT. Will the new contract mean that Bupa CSH Ltd is able to cherry pick the work they want to do? The CCG s specification for MSK services, which is set out in our ITT document, is clear that the Prime Provider will be responsible for the care and treatment of all patients with orthopaedic conditions across Coastal West Sussex and not just those requiring straightforward surgical intervention. This includes treatment in both community and hospital settings based on the needs of patients and further to effective shared decision-making with them. A decision to refer for elective surgery will be based on a fully informed discussion between a patient and the multi-disciplinary team supporting them. Did the CCG carry out an impact assessment? In December 2013, the Sussex Collaborative Delivery Team carried out a Trauma Impact Assessment looking at all the procurements taking place across Sussex. They concluded that if all NHS provider trusts engage in the process to support the much needed change in our MSK services, and if all organisations work together, there would be no negative impact on trauma services. NHS England Surrey & Sussex Area Team received that assessment on the 11 December 2013. The full text of the Sussex Collaborative findings1, are as follows: The Sussex CCGs are undertaking the Integrated MSK Service procurements to address the current situation where there are sub-optimal and inconsistent MSK care pathways. The procurement is to secure improvements in quality, patient outcomes and patient experience through new multidisciplinary triage and assessment including shared decision making with patients, undertaken in a community based model. The pathway and service specification which have been developed through clinical leadership and engagement with patients is to improve the clinical outcomes for patients. The intentions of the CCGs are not to change the Trauma pathway or affect Emergency Departments. The expectation and early indication are that the current elective providers will be part of bidders whether as subcontractors and/or partners. In addition all the bidders to date have indicated that they wish to develop a service/relationship with the current providers. 1 Integrated MSK Service Impact on Trauma Services, FINAL v4.0, 13.12.13

In conclusion the assessment shows: 1. The procurement will not impact on the Major Trauma Centres - these will continue to be Brighton, London and Southampton. 2. This procurement will not change how paediatric services are currently being delivered. 3. If the Trusts engage in the process there should be limited impact on the Trauma Units 4. There will be an overall reduction in elective activity as patients are treated in a multidisciplinary manner. Other areas have shown that this can have a positive impact and should not negatively impact on Trauma. 5. There will need to be a change in the way that organisations and workforces work and it will require: cross-organisational working; changes to education delivery across all professions; innovation in delivery of services. 6. The service specifications and contracts have addressed many of the risks raised to ensure that the innovative way of working occurs across the network of care. 7. The mobilisation of the new services will require all parties to work together to ensure that patients are at the forefront of these changes and to limit any negative impact. The CCG has been very clear throughout this process that trauma and A&E are not included in this procurement and that the CCG will continue to commission A&E and trauma services from Western Sussex Hospitals NHS Foundation Trust. 28 January 2015