Outcomes Based Commissioning Update for Governing Body 19 May 2015
Background To enable the commissioning of the outcomes based contract (OBC) for out of hospital health and social care an outcomes framework has been developed and using this framework detailed work on the scope of the contract and model of care has been conducted. The initial scope of the framework and contract is focused on physical health and social care, however, the OBC Programme Board recognised the need for parity between physical and mental health and aim to bring community mental health services within the scope of the contract as soon as possible. An engagement programme has been undertaken between January and April to determine the outcomes that are important to those with mental health needs and their carers. With the results of this engagement work an outcomes framework for community mental health services has been completed and signed off by the OBC Programme Board. Work is currently being undertaken to determine the next steps for bringing mental health services within the scope of the OBC contract. It was agreed by the November OBC Programme Board that the implementation of the outcomes based contract would be a two stage process from 15/16 to 16/17. This means that the community services contract with Hounslow and Richmond Community Healthcare NHS Trust for 15/16 will move towards an outcomes based approach. These negotiations have now concluded and more information is on the following slide. The remainder of the slides outline the approach to reaching the 16/17 outcomes based contract.
Community services contract for 15/16 The HRCH contract for 15/16 has been finalised with areas for change negotiated. The priority areas that have been negotiated are: 1. Better integrated District Nursing 2. Improvements to discharge planning with an immediate focus on RRRT service 3. Overall better integrated care planning across the services; and 4. Support reductions in non-elective admissions (supported by points 1-3) Where linkages or changes relevant to all providers have been identified, discussions held between CCG and other providers (GP/ Acute) to reflect changes in their contracts. This includes introducing a formal mechanism via existing GP connect system which GP s can raise concerns / issues with HRCH. Outcome measures: Outcomes, measures and indicators have been incorporated on the basis of the following: those which support the service changes identified; and which will support the transition to an outcomes based contract from 2016. The specific outcomes & measures are: Requirement to achieve % reduction in non-elective emergency admissions specifically related to the RRRT service. This will be linked to a financial incentive and assessed according HRCH s ability to work with LA s to divert admissions, increase community referrals along with other related measures (e.g. catheter passports) Requirement to achieve 100% attendance at MDTs by community nursing to support co management of conditions, & co production of care plans (existing and new). Requirement to achieve 100% of patients with long terms conditions to have care and self-care plan Improvement of existing patient surveys approach with a view to develop in year a more streamlined format to be used for the different services (and possibly providers) to better understand service performance Requirement to provide quarterly feedback in relation to areas to be addressed around staff turnover, retention and recruitment. This will allow RCCG to assess performance.
Coordinating providers for 16/17 contract and LBRuT have asked a selected group of local organisations to come together as a group of Coordinating Providers to develop and deliver this contract: Hounslow and Richmond Community Healthcare NHS Trust; Richmond General Practice Alliance; Kingston Hospital NHS Foundation Trust; and West Middlesex University Hospital NHS Trust We would like to let the contract to a single contractual counter-party in December 2015. The form of the vehicle is for the providers to propose, but we anticipate some form of joint venture or alliance which each party equally represented (rather than a lead provider model for instance).
Contracting process The Most Capable Provider route is not a competitive tendering process, but it is a robust assessment to determine if the Coordinating Providers are the most capable organisation to deliver OBC. Although Commissioners want to emphasise collaboration and co-development with the Coordinating Providers throughout the assessment, it will still be possible for the Coordinating Providers to fail the evaluation. Failure to meet the criteria at key gateways would trigger the start of a competitive dialogue process. Providers will be required to engage in the process in a meaningful way and again if they fail to meet the criteria may trigger a competitive dialogue process. However, if the Coordinating Providers fail the assessment they (or their individual organisations) will not be precluded from being part of any future bid under a competitive dialogue process. The Coordinating Providers will have an opportunity to demonstrate they can deliver the required care outcomes. The process will include assessment gateways based on agreed criteria. We expect the four providers to agree a Memorandum of Understanding in the next two weeks. They will then be issued with detailed contractual and financial information. The next main gateway will be September 2015.
September gateway In September we will evaluate the Coordinating Providers proposed service design/model. This component of the assessment will require Providers to actively engage patients, carers and other organisations such as the voluntary sector within the service design. Patient and carer representatives will also form part of the formal evaluation panel. It will include: Evaluation of capability: this requirement is to test the capability of the Coordinating Providers as a group or organisation. The Coordinating Providers will be able to partner with external organisations should this help demonstrate aspects of capability where required. An assessment of the key enablers required to deliver OBC. This will include the proposed IT solution, workforce and use of estates. An evaluation of the Coordinating Providers transition and implementation plans. An assessment of an agreed set of performance metrics over the year. An evaluation of the associated financial plan provided by the Coordinating Providers The measurement and evaluation of performance against agreed service transformational objectives, for example, evidence of collaborative and joined up working between the Coordinating Providers.
Timeline and process for 2016/17 OBC contract Route A: Coordinating provider development Jan 15 END FEB Finalise selection of Healthcare Most Capable Providers and notify existing providers of decision and process MARCH Publish MOI to providers setting out overall terms and process from March 2015 to April 2016, including requirement for providers to submit Governance Qualification MOU Mar 15 Jun 15 Oct 15 Jan 16 Providers develop Memorandum of Understanding (MOU) MAY Confirm collaboration between Social Care and OBC Governance Qualification Most Capable Providers submit MOU demonstrate collective agreement JUNE MCP OBC dialogue documents released Contract negotiation MCP Response SEPTEMBER Interim Checkpoint Review and Feedback DECEMBER Formal Evaluation Contract negotiation 6 weeks MARCH Mobilisation Checkpoint Review of initial mobilisation and transition plan April 16 Phased transition Fail On-going dialogue and performance assessment Fail Route B: Open Market Procurement MCP Most Capable Provider