Appendix: 3.3b North Central London CCGs Collaboration Arrangements for Contracting 22-1-13 Introduction Across the 5 CCGs in North Central London, the total value of all contracts excluding non clinical services is around 2.5bn, covered by around 6,000 contracts (see appendix 1). From 1 st April contracts relating to services that will be commissioned by public health or the national commissioning board will not be the responsibility of the CCGs. However that will still leave around two thirds (by value) of contracts for services that will remain with the CCGs. With limited resources to deliver commissioning responsibilities, it is sensible for CCGs to consider collaborative working arrangements, which is also a requirement for authorisation. It is also sensible for CCGs to seek working relationships which give them appropriate levels of control over the areas of greatest risk. This paper focuses predominantly on arrangements for acute contracts in relation to the 2013/14 planning round and future years, with some consideration given to other possible areas for collaboration. Acute, community and mental health contracting In discussion, CCGs have expressed concern about the lead commissioner arrangements that have been adopted by PCTs under existing contracting arrangements, because the views of significant associates have not consistently been taken account of. However it is also not practical for all CCGs to be directly represented in all contracting discussions, especially during negotiations. This is in part due to the limitation of resources, and also the need to avoid in-fighting during contract negotiations. Therefore to accommodate these conflicting issues, the following contracting arrangements are proposed: 1. A [core group] of CCGs which will be established for each contract by reference to the contract value of CCGs in relation to each provider (see below), to ensure that CCGs have adequate representation with respect to their key providers. 2. For each acute contract, a negotiating framework will be drawn up by the CSS under direction from the [core group] of CCGs that provides the parameters for the CSS to negotiate the contract on behalf of the CCGs. CCGs outside of the [core group] may also review and comment on the negotiating framework. 3. During the development of the negotiating framework it will be the role of the CSS to identify any conflicts between the aspirations of the [core group] and to broker an acceptable compromise position such that a consistent approach can be taken with each contract.
4. The negotiating framework will be signed off prior to the commencement of negotiations by the [core group] of CCGs. 5. The progress of the negotiations will be monitored by reference to the negotiating framework, and any material departures will be subject to authorisation by the [core group]. Establishing the [core group] The [core group] will be established by reference to the contract values across the acute portfolios of the CCGs which are summarised in appendix 2. The proposed groupings have been selected according to the following principles: 1. To ensure that all CCGs will be represented across around 80% of their contract portfolios, and on all contracts in excess of 20m; 2. To ensure that no single CCG dominates the agenda for any acute trust; 3. To minimise the resource implications for each CCG; and 4. To take account of any existing strategic partnering arrangements. The [core groups] for the NCL providers will be as follows: Trust/CCG Barnet Camden Enfield Haringey Islington University College London Hospitals Royal Free Hampstead NHS Trust Barnet And Chase Farm The Whittington Hospital North Middlesex University Hospital Camden And Islington Trust Specialised Commissioning Barnet, Enfield And Haringey MH Central And North West London Central London Community Healthcare Total 6 5 7 6 5 Portfolio coverage 78.5% 82.2% 85.7% 85.2% 79.7%
Roles and responsibilities and definitions The following table seeks to clarify roles and responsibilities of CCGs involved in contracting. It should be noted that it is possible for two CCGs to share the lead role during contract negotiations. However, one CCG will need to be identified as the day-to-day contact lead for the provider and to hold the contract. Role Description Suggested Threshold/Level of Interest Lead 1 CCG/Commiss ioner Lead 2 CCG/Commiss ioner Negotiation Team Member Responsible as the Day-to-Day contact point for the commissioners with the NCB for issues which relate to the overall contract performance, and communicating the content of these discussions with the negotiation team members and associate commissioners. For example if there was a major incident and NHS CB wanted a single CCG point of contact (instead of CSU) they would go to Lead 1. Or if a one off national or regional exercise or initiative had to be carried out with providers Lead 1 would coordinate for its providers and on behalf of other CCGs. It should be noted that the majority of the day to day contact with the provider on the contract, performance, quality, finance etc. will be led by the CSU. Signs the main contract agreement with the providers on behalf of commissioners, with negotiation team members and associates signing the associate s agreement. Leads the arbitration panel presentation supported by CSU contracting team in the event of a dispute process. Presents the commissioners case and leads mediation sessions prior to formal dispute resolution (i.e. arbitration processes) Chairs internal discussions between commissioners about providers with CSU support. Holds casting vote on negotiation and contracting decisions where a consensus/majority decision cannot be reached. In this scenario where there are two joint leads and if they cannot agree, the Collaboration Agreement dispute resolution process can be used to facilitate a decision. Holds a significant interest in the contract which merits a continuous presence in the negotiations and building of a partnership relationship with the provider. Greatest financial value in the contract (or two CCGs together if that is what is agreed) At least 20% of the contract value or over 20million.
Involved in the majority of contract negotiation and contracting decisions, with voting rights in provider reference groups proportionate to financial value of contract held. Associate Commissioner Hosts/Chairs mediation sessions in escalations of contract disputes prior to formal dispute resolution (i.e. arbitration processes). Holds a financial interest in the contract, but below a level which merits significant commitment of resources to the negotiation. Less than 20% of the contract and under 20million. May wish to join commissioner meetings focusing on the provider and discussions for specific issues of relevance to the services commissioned by the organisation. Consulted regarding views on contentious issues where consensus view cannot be reached by main members of the negotiation team to influence a majority decision.
Other contracting arrangements CCGs may wish to consider collaborative arrangements in these areas for one or more of the following reasons: To share risk in areas which are prone to hard-to-control fluctuations in spend; To reduce the administrative burden of contract management; or To leverage greater buying power (which could be made greater still through collaboration with local authorities in some areas). The collaboration could take the form of any of the following: A single CCG making contracting arrangements on behalf of all five with or without a risk share arrangement; A subset of CCGs contracting on behalf of all five with or without a risk share arrangement; or CCGs making their own contracting arrangements individually, with a risk share arrangement. CCGs may wish to consider collaborative arrangements for the following groups of contracts: (but not all CGs may wish to take part in these). Local enhanced service; Out of hours provision; Continuing care; and Other funded nursing care. Recommendations 1. Adopt the principles for acute, community and mental health collaboration as set out above, and the principles for establishing the [core group] for each contract. 2. Adopt the [core group] for each contract as set out above, or amend as required 3. Consider further collaboration on similar lines for other contracts, including the areas specifically referenced above.
APPENDIX 1 - CONTRACT TOTALS SUMMARY PCT/AREA TOTAL NO. OF CONTRACTS TOTAL VALUE (2011/12) Barnet PCT 1,167 26,778,258 Camden PCT 532 35,520,452 Enfield PCT 798 30,363,590 Haringey PCT 518 31,927,534 Islington PCT 182 43,802,293 Sub-total: 3,197 168,392,127 Acute, community, MH 188 1,865,452,000 Primary Care 2,522 473,653,080 Totals: 5,907 2,507,497,207
Appendix 2: Acute, community and mental health contracts 2011/12 Outturn Values Barnet Camden University College London Hospitals NHS Foundation Trust 31,914 105,913 24,447 29,123 76,130 267,528 Royal Free Hampstead NHS Trust 91,007 84,488 22,940 28,693 21,986 249,113 Barnet Barnet And Chase Farm Hospitals NHS Trust 117,458 353 104,772 8,178 7,628 238,390 The Whittington Hospital NHS Trust 11,188 8,205 3,578 86,275 107,620 216,866 North Middlesex University Hospital NHS Trust 1,802 762 67,678 69,117 2,686 142,045 Camden And Islington NHS Foundation Trust 169 48,370 472 38,071 135,453 Specialised Commissioning 24,973 31,791 24,460 36,204 32,608 150,036 Barnet, Enfield And Haringey Mental Health NHS Trust 30,496 1,725 52,896 71,484 412 157,013 Central And North West London NHS Foundation Trust 2,560 29,688 1,557 15,041 78,535 London Ambulance Service NHS Trust 9,925 9,105 9,788 8,979 7,637 45,434 Central London Community Healthcare NHS Trust 41,493 89 89 331 15 42,017 Imperial College Healthcare NHS Trust 16,178 9,577 1,458 1,873 1,843 30,928 Great Ormond Street Hospital For Children NHS Trust 5,511 13,385 4,125 3,688 3,407 30,116 Barts And The London NHS Trust 4,062 2,258 7,889 6,575 8,709 29,504 Non Contractual Activity 5,154 3,653 5,034 4,132 4,109 22,082 Moorfields Eye Hospital NHS Foundation Trust 3,279 1,914 4,699 4,664 6,580 21,136 Guy'S And St Thomas' NHS Foundation Trust 3,612 3,141 2,216 2,286 2,038 13,293 Royal National Orthopaedic Hospital NHS Trust 6,779 767 2,256 1,903 1,167 12,872 North West London Hospitals NHS Trust 9,574 583 545 507 209 11,418 Homerton University Hospital NHS Foundation Trust 368 348 1,923 4,644 4,128 11,410 Royal Brompton and Harefield NHS Foundation Trust 3,317 1,091 1,072 768 587 6,835 Chelsea And Westminster Hospital NHS Foundation Trust 983 1,771 572 945 1,123 5,393 Tavistock And Portman NHS Foundation Trust 4,572 4,572 King'S College Hospital NHS Foundation Trust 662 904 615 539 459 3,180 The Royal Marsden NHS Foundation Trust 859 427 844 580 351 3,062 East And North Hertfordshire NHS Trust 2,484 281 2,765 Inhealth - DH 716 409 249 563 485 2,421 West Hertfordshire Hospitals NHS Trust 1,309 647 1,956 Whipps Cross University Hospital NHS Trust 647 828 293 1,768 Marie Stopes - ToPs 450 657 446 1,553 BMI Headquarters 1,133 1,133 St George'S Healthcare NHS Trust 199 192 220 218 193 1,022 Other 370 529 745 1,019 2,662 Enfield Haringey Islington Grand Total 429,533 365,480 346,919 376,530 346,990 1,865,452 Coverage for each borough 78.5% 82.2% 85.7% 85.2% 79.7%
Appendix 3 Proposed Lead, Associate and Contract Negotiation Team Membership Barnet Camden Enfield Haringey Islington University College London Hospitals A L1&2 A A, N L2 Royal Free Hampstead NHS Trust L1&2 A, N A A A Barnet And Chase Farm A, N L1&2 The Whittington Hospital A, N L1&2 North Middlesex University Hospital A, N L1&2 Camden and Islington Foundation Trust A, N L1&2 Specialised Commissioning A A A A A Barnet, Enfield And Haringey MH A, N A, N L1&2 Central And North West London L1&2 A, N Central London Community Healthcare L1&2 L1 = Contract Negotiation Lead Commissioner(s) L2 = Day to day lead for the contract A = Associate Commissioner N = Negotiation Team Membership