Report Summary Sheet Title Urgent Care Procurements Agenda Item 4.1 Purpose Approval Discussion Information Assurance X Meeting Board Date 29.3.18 Title of Paper Urgent Care Procurements Executive Lead Corinne Edwards, Director of Acute & Primary Care Commissioning Clinical Lead Dr Liz Hersch, GP Board Member & Urgent Care Lead Author Louise Sturgess, Commissioning Manager for Urgent Care Appendices None Executive Lead Sign off Clinical Lead Sign off X X Executive Summary Recommendation The purpose of the paper is to: Briefly summarise the procurement and mobilisation processes following Board agreement on 8/9/16 to re-procure NHS 111, GP Out of Hours, the Urgent Treatment Centre (previously known as the Urgent Care Centre based at the RUH) and the Homeless Healthcare Service. Provide assurance to the Board regarding service commencement on 1 May 2018 The Board is asked to review progress and note assurance given regarding service commencement on 1 May 2018. Risk High Medium X Low Key Risks Risk logs have been maintained for each service mobilisation and reviewed regularly by the commissioners. Key risks for each service are set out in the paper. Impact on Quality The service specifications have been developed to ensure that a high quality, responsive, sustainable service is commissioned and provided. Impact on Finance Report reviewed by Potential Conflicts of Interest No additional financial requirements. All financial implications have been reviewed and agreed during each procurement process. Catherine Phillips, Commissioning Manager for Acute Care Finance Lead Sign off Name Lead: Laura Pickard Urgent Treatment Centre BaNES GP Board members conflicted due to joint bid from the RUH and BEMS+. To manage the conflict a Wiltshire GP participate in bid evaluation leading to contract award. Integrated Urgent Care - BaNES GP Board members conflicted due to BEMS+ being a named subcontractor on the Medvivo bid. The bid evaluation was led by Wiltshire CCG as the lead commissioner with a Wiltshire GP evaluating the bids leading to contract award. Homeless Healthcare Service Dr Ian Orpen is conflicted as GP Partner at St James who will be providing the service. Dr Orpen was excluded from the decision at JCC to increase the budget as part of the procurement. X Urgent Care Procurements Page 1 of 9
Urgent Care Procurements 1. Executive Summary 1.1 In September 2016, the Board gave its approval to align the re-procurement of NHS111, GP OOHs, the Urgent Treatment Centre (UTC) (formerly known as the Urgent Care Centre) and the Homeless Healthcare Service. 1.2 In line with the national direction of travel the BaNES, Swindon and Wiltshire (BSW) Sustainability and Transformation Partnership (STP) agreed to jointly commission an Integrated Urgent Care Service consisting of GP OOH, NHS111 and a clinical hub. 1.3 BaNES CCG separately re-procured and commissioned the Urgent Treatment Centre (UTC) at the front door of the RUH and the health service for the homeless at Julian House Hostel in Bath. 1.4 Following rigorous procurement processes, the Urgent Care contracts have been awarded as follows: Integrated Urgent Care (IUC) awarded to Medvivo as Prime Provider with Vocare and BEMS+ as subcontractors. The UTC contract awarded to the RUH with BEMS+ as a subcontractor. The Homeless Healthcare service to be awarded to St James Surgery (Heart of Bath) 1.5 A contract start date of 1 May 2018 was chosen for all three contracts as 1 April 2018 falls within the Easter Bank Holiday. All three contracts are for 5 years with the option to extend the contract term. 1.6 Following contract award each contract is undertaking a robust mobilisation process to ensure they are ready for service commencement on 1 May 2018. 1.7 Mobilisation for each contract covers: Operations IM&T Workforce including TUPE Quality including clinical governance Premises and facilities Contract and performance management Communications and stakeholder engagement 1.8 As of 15 March 2018 the Commissioner is providing the Board with assurance that all services will commence on 1 May 2018. Each contract has been mobilised within the agreed timeframe and cost envelope. 2. Recommendation / Rationale 2.1 The Board is asked to review progress and note assurance regarding service commencement on 1 May 2018. 3. Background / Statutory Considerations and Basis for Proposal 3.1. In February 2013, Care UK was commissioned to deliver NHS111 services across the Bristol, North Somerset, Somerset, South Gloucestershire, Gloucestershire, BaNES, Swindon and Wiltshire area. The service commenced in October 2013 with the contract concluding 31 March 2018 but extended to 30 th April to facilitate integration. Urgent Care Procurements Page 2 of 9
3.2. In April 2014 BaNES CCG commissioned a combined GP OOH, Urgent Care Centre and Homeless Healthcare Service provided by Vocare. The contract was due to conclude in March 2019 and therefore notice was given to BDUC to terminate their contract early with the last operational day 30 th April 2018. 3.3. In September 2016, the Board gave its approval to align the re-procurement of NHS111, GP OOH, the UTC and the Homeless Healthcare Service. A contract start date of 1 May 2018 was chosen for all three contracts as 1 April 2018 falls within the Easter Bank Holiday. Integrated Urgent Care (IUC) service procurement and mobilisation 3.5. Urgent care is the range of responses that health and care services provide to people who require or perceive the need for urgent advice, care, treatment or diagnosis. In 2016 the CCG recognised the fragmented nature of out of hospital services. The key objective of the IUC procurement was not simply to bolt together existing NHS111 and GP OOH services but to introduce a functionally integrated service model including a new clinical advice element: the Clinical Assessment Service (CAS), sometimes called the clinical hub. The CAS will offer service users access to a broader range of clinicians, both experienced generalists and specialists. It will also offer advice to health professionals in the community. The CAS will be at the centre of the integrated service connecting the IUC services together and providing an interface into the wider system. The model will provide clinical input earlier in the pathway and help people who need urgent care to get the right advice or treatment in the right place, first time. 3.6. The Bristol, North Somerset, Somerset, South Gloucestershire and Gloucestershire CCGs were not in a position to proceed with an IUC procurement in 2016. Therefore, in line with the national direction of travel the BaNES, Swindon and Wiltshire STP agreed to jointly commission an Integrated Urgent Care Service consisting of GP OOH (BaNES and Wiltshire only), NHS111 and a CAS / clinical hub. Wiltshire CCG is the lead commissioner with BaNES and Swindon as associates. 3.7. Based on procurement advice the STP followed a formal competitive process called an Invitation to Negotiate (ITN) rather than the traditional Invitation to Tender (ITT). An ITN process allows extensive negotiations with the shortlisted bidders and is more appropriate where the award decision is not being made on price alone and the scope of work is not clearly defined (due to the innovative nature of the service model). 3.8. Responses to each stage of the ITN process were evaluated and moderated by the 3 CCGs and Wiltshire Council. The contract was awarded to Medivo as the Prime Provider with subcontractors Vocare and BEMS+. 3.9. The Board and JCC have reviewed progress and made key decisions throughout the IUC procurement process. See table below for details. Date Board/Committee Outcome 8.9.16 Board The Board approved the commencement of a procurement process for NHS111, GP OOHs, the Urgent Care Centre and the Homeless Health Care Service. 10.11.16 Board The Board was provided with an update on the Integrated Urgent Care (IUC) Procurement and approved the proportional split of question types for Invitation to Negotiate (ITN1). 24.11.16 JCC The Committee was provided with an update on the IUC procurement, noted the timescales for next steps and approved the IUC draft service specifications. 9.2.17 Board The Board was provided with an update on the IUC procurement, approved the proportional split of question types for the Invitation to Urgent Care Procurements Page 3 of 9
Negotiate stage 2 (ITN2) and approved the recommendation to proceed to ITN2. 27.4.17 Board The Board endorsed the outcomes of the ITN2 process and supported the IUC Project Board s recommendation to identify a Preferred Bidder rather than proceed to Call for Final Tenders as original envisaged. Board also agreed that the procurement process has been followed to enable this recommendation to be ratified. 21.9.17 Joint Extraordinary Governing Body A Joint Extraordinary Governing Body was convened with Board representatives from BaNES CCG, Wiltshire CCG, Swindon CCG and Wiltshire Council where it was agreed to formally award the Integrated Urgent Care contract to Medvivo, as Prime Provider with Vocare and BEMs+ as subcontractors. Wiltshire CCG will act as the Lead Commissioner for the contract, with Bath and North East Somerset, Swindon CCG, Wiltshire Council and NHS England as Associate Commissioners. 3.10. Medvivo have taken a programme approach to mobilise the IUC contract to take account of the interdependencies between the different services/projects. Seven workstreams cut across each of the projects which are: Information Management and Technology including reporting Quality including clinical Governance Workforce including TUPE Premises and Facilities Management Business Continuity and Information Governance Contract and Performance Management Communications and Engagement 3.11. A Joint Integrated Urgent Care Mobilisation Oversight Board (MOB) was established with representation from BaNES, Wiltshire and Swindon CCGs, Wiltshire Council, NHSE and Medvivo. The MOB meets fortnightly and is the key decision making body overseeing the implementation of the mobilisation plan, ensuring it meets the quality, safety and contractual requirements from contract commencement. 3.12. An IUC Clinical Governance Group has been established as a sub group of the Mobilisation Oversight Board. The group is chaired by Dr Liz Hersch and is responsible for ensuring the safe and effective clinical operationalisation of the IUC service. 3.13. The IUC contract mobilisation is subject to a rigorous assurance process requiring sign off by NHS England. The Integrated Support and Assurance Process (ISAP) is a checkpoint Assurance Process which provides CCGs with a framework to ensure that key aspects (based on lessons learnt from previous procurements) have been addressed before service commencement. The ISAP process comprises a number of testing events (NHS111 call mapping, end to end scenario testing, Ambulance dispatch testing) as well as completion of an ISAP checklist. Commissioners have been working with our local NHSE Integrated Urgent Care Transformation Lead to monitor our position against the NHSE ISAP checklist and no concerns have currently being highlighted. 3.14. Risk Management A detailed risk log has been maintained transitioning from procurement into mobilisation. The risk log is regularly reviewed at the fortnightly Mobilisation Board meetings. The current key risks can be seen in the table below. Urgent Care Procurements Page 4 of 9
Risk Finance There is a risk that the contract value may increase if we are not able to reclaim VAT on the 111 Service. CQC inspection of Vocare services in Somerset Somerset CCG have agreed to transfer the management of their GP Out-of-Hours Service from Vocare to Devon Doctors from 1 May 2018 following a CQC rating of inadequate. There is both a reputational risk as Vocare are our future NHS111 provider but also an operational risk as Vocare may shift some of their attention from our mobilisation to the demobilisation of the Somerset GP OOHs Service. Vocare will remain Somerset CCG s NHS 111 provider. Clinical Assessment Service (CAS) There is a risk that the CAS will not be able to manage the volume of calls transferred from NHS111. NHS111 Recruitment There is a risk that Vocare will not be able to recruit sufficient staff to safely run the NHS111 contract. Interoperability There is a risk that access to shared care records and patient information will be limited as a result of interoperability issues. Mitigation A VAT risk sharing agreement is in place while we wait for an update from HMRC regarding the recovery of VAT on the 111 service. VAT liaison continue to progress this with HMRC on our behalf. The changes in Somerset only became public knowledge on 14/3/18. Vocare s NHS 111 service in Somerset were rated Requires Improvement not inadequate. THE BSW NHS111 service will be provided 30% from Medvivo s Headoffice in Chippenham and 70% from Vocare House in Newcastle. Vocare House were rated good by CQC in Dec 17 for their provision of GP OOHs. Medvivo will work closely with Vocare to ensure that the changes in Somerset do not impact on the mobilisation of our service. The CCG will monitor the situation closely. The MOB is updated on recruitment as part of the fortnightly mobilisation meetings. Recruitment for the CAS is currently on track. Medvivo have assured the MOB that the CAS will be sufficiently staffed from go live and SWASFT representatives will be at the NHS111 call centre in Chippenham on 1 May. CAS activity will be closely monitored following go live and the appropriate workforce reviewed by Medvivo. Medvivo continue to monitor Vocare against their recruitment plan for both clinical and non-clinical staff with fortnightly oversight by the Mobilisation Oversight Board. The recruitment situation is improving and Vocare have assured Medvivo that they will redeploy staff from other contracts to guarantee safe staffing levels. Interoperability summit held in January 2018 to raise awareness and seek solutions. CSU assessing feasibility of deploying third party integration software. Communications to primary care will encourage completion of Summary Care Record with additional information (SCR-AI). 3.15. Following service commencement, contract performance will be monitored via monthly contract performance meetings covering activity, quality and finance, led by Wiltshire CCG. Wiltshire CCG is currently in discussion with the Commissioning Support Unit (CSU) to secure contract support from their Provider Performance team. 3.16. A seven month mobilisation period was built into the process to ensure a safe and effective transition from the current providers to Medvivo as the Prime Provider with Vocare and BEMS+ as subcontractors. As a result of the extensive work that has been undertaken during mobilisation and the governance and assurance processes that have been followed, there is no evidence to suggest that the services will not safely commence on 1 May 2018. Urgent Treatment Centre (UTC) procurement and mobilisation 3.13. The aim of UTC is to deliver a streamlined and integrated face to face urgent care service at the front door of the Royal United Hospital. The UTC will operate 24 hours a day, 7 days a week providing Urgent Care Procurements Page 5 of 9
urgent assessment, diagnosis and treatment to patients who cannot wait to be seen by their registered GP. The UTC will triage and stream every patient that attends the Emergency Department to ensure patients get the right care from the right professional. 3.14. The procurement of the UTC commenced on 23rd January 2017 with a traditional pre-qualification questionnaire (PQQ) and Invitation to Tender (ITT). BaNES CCG is the lead commissioner with Somerset as an associate. The financial model for the contract is based on core and variable elements for both streamed patients and UTC appointments. Wiltshire CCG decided not to be part of the procurement, instead opting to be charged by the chosen provider on a cost per case basis for streaming and UTC appointments. The ITT process concluded in June 2017 with the contract being awarded to the RUH with BEMS+ as a subcontractor. 3.15. The Board/Executive Team have reviewed progress and made key decisions throughout the UTC procurement process. See table below for details. Date Board/Committee Outcome 8.9.16 Board The Board approved the re-procurement of NHS111, GP OOHs, the Urgent Treatment Centre and the Homeless Health Care Service 23.1.17 Executive Team The Executive Team reviewed progress and with delegated authority from the Governing Body, approved the proportional split of question types for ITT and approved the final financial value for the contract. 17.3.17 Executive Team The Executive Team reviewed progress to date and approved moving to the next stage of the procurement: Invitation to Tender. 17.7.17 Board The Board reviewed the details of the procurement process undertaken and ratified the outcome of the procurement process and contract award. 3.16. A UTC Mobilisation group was established with representation from BaNES CCG commissioning, quality and finance teams, RUH and BEMS+. The group has met monthly from October 2017 increasing to fortnightly from March 2018. 3.17. Dr Liz Hersch met with Representatives from the RUH and BEMS+ in December to discuss the clinical model. The UTC mobilisation meeting in February was also dedicated to the clinical model and a final walkthrough at the RUH will take place in April 18. 3.18. Risk Management A detailed risk log has been maintained during mobilisation. The risk log is regularly reviewed in Mobilisation meetings with the RUH. The current key risks can be seen in the table below. Risk Activity/Finance There is a risk that we will not be able to calculate baseline activity for the contract as following the RUH change to FirstNet, the CCG has not been receiving the necessary data flows. Activity/Finance There is a risk that the CCG will be unable to agree satisfactory contractual arrangements with the RUH regarding the core and variable elements of the contract. The thresholds Mitigation The CCG has been working with the RUH to resolve this issue and we have been assured that we will receive the backdated data w/c 19/3/18. Following the RUH change to FirstNet, the CCG has not been receiving the necessary data flows to calculate baseline activity. We should receive the data w/c 19/3/18 so the necessary analysis Urgent Care Procurements Page 6 of 9
shared as part of the procurement process were based on historic activity but a change in the service model in 2017 led to significantly more patients being streamed away and fewer patients being treated. If new thresholds cannot be agreed this will lead to larger variable payments than originally forecast. Activity/Finance There is a risk that our activity/finance projections for GP OOHs and the UTC will not be accurate as they have been calculated on historic activity flows. The new IUC contract penalises NHS111 for not choosing the first option returned by the Directory of Services (DOS) which may also significantly change the flow of patients. Interoperability There is a risk that access to shared care records and patient information will be limited as a result of interoperability issues. CQC inspection of Vocare services in Somerset Following a CQC inspection, Somerset CCG have agreed to transfer the management of their GP Out-of-Hours Service from Vocare to Devon Doctors from 1 May 2018. There is a risk that Vocare may shift some of their attention from the de-mobilisation of the UCC to the demobilisation of the Somerset GP OOHs Service can be undertaken and discussions commenced with the RUH. The CCG is working with the UTC and GP OOHs providers to ensure their services are accurately profiled on the DOS. We are also analysing historic data to map the flow of patients had the first option on the DOS been selected. Once the service goes live activity flows will be closely monitored to identify the impact of the service changes. Interoperability summit held in January 2018 to raise awareness and seek solutions. CSU assessing feasibility of deploying third party integration software. Communications to primary care will encourage completion of Summary Care Record with enhanced information. The changes in Somerset only became public knowledge on 14/3/18. Vocare have provided a dedicated exit manager to oversee the demobilisation of the UCC. The CCG will work closely with Vocare to ensure that the changes in Somerset do not impact on the de-mobilisation of our service. 3.19. The UTC contract sits outside of the main RUH contract. Following service commencement, contract performance will be monitored via monthly Contract Performance Meetings covering activity, quality and finance supported by the CSU Provider Performance Team. 3.20. An eight month mobilisation period was built into the process to ensure a safe and effective transition from the current provider to the RUH with BEMS+ as a subcontractor. As a result of the extensive work that has been undertaken during mobilisation there is no evidence to suggest that the services will not safely commence on 1 May 2018. Homeless Healthcare Service procurement and mobilisation 3.21. The procurement of the Homeless Healthcare service commenced in November 2016 with GP Practices/Clusters being asked to express an interest in providing the service. An interest to deliver the service was expressed by St James Surgery. 3.22. The procurement process for the Homeless Healthcare service did not progress as speedily as hoped due to a number of factors. However, the CCG has been working closely with St James Surgery since November 17 and at the time of writing this Board paper, the CCG is confident that the contract will be awarded imminently. 3.23. In January 2018 JCC reviewed progress and agreed to an additional 35,000 re-current funding for the Homeless Healthcare Service bringing the total annual contract value to 95,000. The incumbent provider had reduced the service provision due to the constraints on the budget and were likely Urgent Care Procurements Page 7 of 9
running the service at a loss supported by the wider Urgent Care Centre contract. The increase was seen as an unavoidable cost pressure to secure a new provider and ensure medical cover was available each weekday morning. 3.24. The Urgent Care Commissioner has met with the Practice Manager from St James on a number of occasions to discuss the clinical model and the mobilisation of the service. 3.25. Risk Management Risk Operational issues Due to the delays in the procurement process there is a risk that the new provider will not be fully functioning from day 1. Mitigation The provider has been working towards mobilisation even though a contract has not yet been awarded. The provider will go live on 1 May but some workaround solutions may be in place, eg Paper notes may be used if the practice has not been moved over to TPP and the EMIS license can not be extended. 3.26. Following service commencement, contract performance will be monitored via quarterly contract performance meetings covering activity, quality and finance. 3.27. The timeframe for the mobilisation of the service to commence on 1 May 2018 is challenging but St James have been developing their model and undertaking pre-mobilisation planning so that plans can be progressed swiftly following contract award. The Urgent Care Commissioner is confident that the service will go live from 1 May 2018, however there may need to be some work around systems in place to facilitate this. 4. Resource Implications The table below shows the financial implication of the procurements and the new service configuration. Any additional funding has been agreed during each procurement process. Previous contract value New Contract value NHS111 555k N/A GP OOH Urgent Care Centre, HCP line 2.5m N/A IUC (NHS111, GP OOHs, Clinical Hub, HCP line) N/A 2.297m Urgent Care Centre N/A 750.5K Homeless Health 60k 95k RUH reception costs 100k 100k TOTAL 3.2m 3.24m 6. Next steps The Urgent Care Commissioning teams in BaNES and Swindon and Wiltshire for the IUC contract will be overseeing the final weeks of each mobilisation, with the key focus being on ensuring the services can deliver a safe service from 1 May and testing that the different elements in the new urgent care service model work as expected. 9. Equality and diversity Equality & Diversity Applicable Not Applicable Urgent Care Procurements Page 8 of 9
Equality impact assessments did not identify any potential discrimination between the 9 protected characteristic groups (Age, disability, gender reassignment, pregnancy and maternity, race, religion and belief, sex, sexual orientation, marriage and civil partnership). Health Inequalities Assessment Applicable Not Applicable Health inequalities assessments did not identify any inequalities as a result of these procurements. Public & Patient Engagement Applicable Not Applicable Engagement has been on-going throughout the IUC procurement and mobilisation. Specific task and finish groups have been convened for mental health and end of life to enable the new provider to engage with local services to develop specific pathways and question sets. Presentations have been given to the CCG patient involvement group Your Health, Your Voice to describe the model and receive feedback. A draft communication plan has been developed by Wiltshire CCG for the IUC procurement which will be localised for BANES. Urgent Care Procurements Page 9 of 9