RE-PROCUREMENT OF 111 SERVICES SOUTH WEST LONDON Introduction SWL CCGs variously let contracts for the provision of 111 during 2012 with contracts let to Care UK (Wandsworth, Kingston and Richmond, Croydon) and NHS Direct (Sutton and Merton). Following the withdrawal of NHS Direct Sutton and Merton moved to a contract with Care UK under agreed stepin arrangements in November 2013. Contract end dates vary however all contracts were due to end during 2014 or early 2015 which has necessitated extensions being negotiated as re-procurement was not possible within the existing contract timeframes. Agreement has been reached with the current provider to extend current SWL contracts until Feb 2016 with appropriate notice clauses for early termination without penalty. Preferred Option The approach agreed by SWL CCG Chief Officers over the summer and adopted at the first SWL 111 Re-procurement Programme Board for the procuring of NHS 111 and joint NHS 111/OOH for South West London is set out below. CCGs in Croydon, Sutton, Merton and Richmond determined that they would procure stand alone 111 services meeting the needs of their local urgent and emergency care strategy. One procurement with 2 Lots: a. Lot 1 for NHS 111 covering Croydon, Merton, Sutton & Richmond CCG s on the Standard NHS 111 Contract. b. Lot 2 for NHS 111/OOH covering Kingston and Wandsworth CCG s, with the addition of Wandsworth SPOC, on the NHS 111/OOH Contract currently being developed by Head of Legal Services at NHSE. Note: The 15/16 NHS National Contracts for 111 and 111/OOH are not yet available, as at 22/02/2015 This could result in the selection of 2 different providers for the two Lots. The Programme The SWL CCGs let the management of the re-procurement programme to the SE CSU and requested the shortest possible delivery timeframe which, following discussion was set for a planned mobilisation date of 25 th November 2015. This resulted in a requirement for key checkpoints to be met in a very short timeframe which following minor amendment will need CCG Boards to sign off final approval of specifications, KPI s and Contract terms by 10 th March 2015 at the latest to enable publication to the market on this day. Key milestones are: Page 1 of 5
Mid March Final Spec and Contract Signed off by CCG s 10/06/15 CCG Ratification of Preferred Bidder 25/11/15 Go Live Programme Structure and Assurance The programme structure consisting of a Delivery Group, reporting to a Programme Board into the SWL Chief Officer Group has enables swift delivery, communication and decision making. The Programme Board is chaired by the Programme SRO from Wandsworth CCG and consists of senior commissioning members of all SWL CCG s plus clinical and patient representation and NHSE London. The 2 nominated clinical leads liaise with the 6 SWL 111 lead clinicians via virtual network. The Programme developed a Programme Initiation document and detailed plans based on meeting draft national CCG guidance for procurement of 111 services cover each stage: Checkpoint 1: Delivery strategy (Pre-tender assurance up to publication of documents) Checkpoint 2: Investment decision (Post-evaluation and before contract award) Checkpoint 3: Operational review (Before go-live of the new service provision) NHSE London Area Team, who are members of the SWL Programme Board, will review documentation and process under each of the checkpoints above and advise CCGs of any issues prior to moving to the next stage. Approach 3.2.1 Development of Specifications and KPI s Specifications are required to meet the National Standards and use NHS accredited Clinical Decision Support Software but in addition the Programme took the approach of building the required specifications and KPI s on local knowledge and requirements and expanding this through links with other national areas currently procuring 111 services and engaging with NHSE London. This approach has enabled SWL to use expertise and specifications developed in other parts of the country who have now published tenders to form a basis on which SWL has built its specification for 111. This was done through a series of meetings and workshops with: Local 111 Commissioners and Clinical Leads Commissioning Leads from other areas i.e. dental, pharmacy, primary care and community care Local Providers from OOH, Community, LPC Patients and the public. There was also a public survey NHSE London Support from the North West of England and West Midlands areas Additionally the Programme used learning from local and London experience, expert knowledge and first hand experience of the Phase 1 National 111 Learning and Development Programme, particularly referrals to ambulance services and the early plans for Phase 2 of this Programme to ensure the specification focusses on evidenced based improved referral and patient experience. Page 2 of 5
3.2.2 Programme Engagement At each stage of the programme CCGs and NHSE London have had communication and engagement in the development of the principles on which the specifications and KPI have been developed, specification documentation, the finance and activity impact, and associated programme documentation including PIDs, plans and risks and issue with locally agreed mechanisms and processes of sharing these with their local teams. The Programme SRO had updated the Chief Officer meeting on a regular basis to ensure the programme has been preceded in line with the SWL CCGs requirements, including timeframes. Feedback from CCG s commissioning and clinical representatives and their associated colleagues has been positive and further improved the specification. 3.2.3 111 Provider as part of wider system The specification makes clear that that the 111 provider must be fully involved and engaged in service and emergency and urgent care systems including close working with NHS providers and commissioners through quality, contract and system resilience and other appropriate groups and boards. 3.2.4 Approach to the Market The Delivery Group, made up of local clinical and commissioning representative took an early view that the specifications needed to be based on an outcomes based approach, following the principles of National and SWL Urgent and Emergency Care strategy which would enable a 111 service to ensure appropriate referrals from 111 to the right place, first time, every time and recognising that as an infant service improvements in this could be made. The specifications therefore reflect the requirement for bidders to propose new and innovative ways of working to meet required outcomes and ensure: Improved referrals and patient experience Ability to meet a broader scope of KPI s tailored to local requirement Application of learning from local and national case reviews, audits and initiatives Closer and more integrated working with other providers across the local areas Applying learning to improve services The key principles and outline of requirements were set out to potential bidders at a market briefing session on 3 rd February 2015. 3. Activity and Cost and Contract Structure Activity analysis and forecasts have been prepared and costs have been estimated however due to uncertainty of future demand, the impact of changing urgent and emergency care systems across SWL and the potential developments in both digital and operational models that services are expected to experience over the next 5 years. Proposals are with CCG Director of Commissioning and Finance Groups and incorporate: 32% increase in 111 calls for first year of the contract. This is based on analysis of demand over the last 12 months. Demand in January 2015 shows a 28% increase over January 2014. Contract structures for 111 and OOH that adopt a block and variable basis with cap and collar and marginal rate application outside the cap and collar limits An 80% block and 20% KPI related value for 111 contracts Page 3 of 5
These approaches limit the risk of both the Commissioners and Providers which should not deter bidders form tendering for the services and avoid inflated prices through placing an imbalance of risk onto potential bidders. 4. Procurement Approach The procurement will be published with 2 Lots and 2 sets of evaluation criteria where the best provider with the highest score for each Lot (qualitative and quantitative) will be selected as the preferred provider. A non-scoring criteria will be included where we will seek an applicable discount applying for all CCGs in the event that the same provider achieves the highest score for both Lots. The aim to achieve this would be by requesting a % discount to the overall prices and/or pricing matrix which combines certain cost lines e.g. mobilisation, overheads, staff etc. The CSU have sourced an experienced procurement lead and procurement processes will meet all legal requirements and will also incorporate national guidance to CCG s for procurement (checkpoint 2) of 111 and joint 111/OOH services. An evaluation panel will be formed with representation for each CCG and incorporating patient representation. A full set of documentation will include: Specification for 111 and 111/OOH Contract structures and 15/16 National Contracts (when available) KPI schedules and payment details for contract Set of Activity and TUPE data Tender Response documentation including ITT, Response templates and financial templates Mobilisation The Programme structure will remain in place for the period between procurement and mobilisation. The original 6 month mobilisation period has been reduced slightly following earlier agreement that additional time would be required for CCG sign off for the specification. Key Risks A comprehensive risk register has been maintained throughout the programme and Chief Officers have regularly been apprised of risks. Boards are asked to note that one of the most significant risks facing the programme as at 22 nd February 2015 is: TUPE The current provider has notified the Programme that none of their staff 111 fall under TUPE arrangements and therefore this could lengthen the time required for mobilisation and therefore delay go live. Recommendation Whist the time available for CCG sign off was increased slightly during the programme this remains a challenge for CCG Boards given the difficulty of aligning Board meeting dates across the 6 SWL CCGs with short time available for delivery of the Programme. Page 4 of 5
It is therefore recommended that the CCG Board approve Chairs action for the publication of documents for tender, noting the work to date in the development of the specifications and associated documentation. This action is necessary owing to the timescales of the Programme. Page 5 of 5