BRENT CCG Procurement Strategy 1. Introduction Brent CCG has a number of small contracts, most of which are managed by the Central team based at Marylebone Road (the CCG Collaborative team). Given the current guidance and regulations regarding competition and procurement, and the fact that many of these contracts expire or have expired in their current form, there is a need to develop a strategic approach to procurement of these services. This document sets out that approach, with advice relating to on-going management of these contracts and timings of procurement. 2. The Portfolio The small contract portfolio consists of just under 50 contracts ranging in spend from about 10,000 to around 4 million. It is a diverse portfolio incorporating patient support services and direct clinical services. A detailed portfolio spreadsheet is available upon request. 3. Approach A set of criteria was used for reference when determining the priority for scheduling procurement. As part of managing the contract portfolio in Brent CCG it is recognised that contracted services procurement has to be managed in terms of quality and cost of services, but also keeping in mind the length of time, the transaction costs and the capacity required to procure services in the market. Time must be given for reviews of services and continuity of care must be maintained for our patients. A set of criteria was used objectively to prioritise services that will need to go to external procurement. The criteria were intended to maintain an objective and transparent assessment of a two to three year cycle of service procurement and therefore contract lengths for the CCG s service portfolio. The criteria and their weightings are attached at Appendix 2. Also important for this approach was an assessment of the state of current work in respect of any process already commenced or considered for individual contracts or groups of contracts, and the capacity for conducting procurements in the light of current commitments. Based on discussions internally and with the Central team, it is best to look at these contracts thematically, as many share characteristics relevant to the procurement and management approach: 3.1 Mental Health support contracts: There are a number of small mental health support contracts which are planned to be re-procured jointly with Brent Borough Council as part of reshaping peer support in Brent. Originally, this was pencilled in to be done prior to April 2016, but the learning from many of these (previously set up as pilots) is still to be consolidated, although indications are encouraging. These contracts are: 1
Contract Approximate Value Expiry VoiceAbility (Loud and Clear) 59,000 31/1/15 Brent Mind 46,000 31/1/15 Brent User Group 46,000 31/1/15 Brent Carers 34,000 31/1/15 Southside Partnerships (Certitude) 79,000 31/1/15 Twining Enterprise 95,000 31/1/15 Royal Assoc for Deaf People 11,000 31/1/15 TOTAL 370,000 Given the need for a bi-partisan approach (CCG and Council), and the potential for rationalisation of the portfolio above (based on experience to date), there does need to be some consideration of the approach. Re-procurement by 31/1/16 is not practical. However, a commitment to re-procure jointly has been reached this year and the process will be completed during 2016/17. We are expecting to implement a lead provider model for this portfolio. 3.1.1 The proposed process is as follows: 1. Secure commitment from the local authority for joint procurement by end of November 2015 (now secured) 2. Consolidate learning and determine what is decommissioned and/or recommissioned by end of January 2016 3. Adjust specifications (as informed by 2 above) by end of February 2016 4. Determine procurement approach by end of February 2016 5. Procure and mobilise by end September 2016 (max) or earlier if possible. 3.2 End of Life (EoL) Most of these contracts have expired and been extended into 2015/16. They consist of a number of hospice/ charitable sector contracts providing a range of services: Contract Approximate Value Expiry Marie Curie Care 97,000 31/3/2015 St Luke s Hospice 673,000 31/3/2015 St John s Hospice 248,000 31/1/2015 Pembridge Hospice 1,099,000 Part of CLCH contract While it is essential that we maintain service continuity, there is a newly launched initiative in Harrow (in collaboration with the LAS) to improve the model of End of Life care with particular reference to maintaining patients at home and avoiding hospital admissions. Early indications are encouraging and, if Brent chose to follow-up on the learning from this initiative, it will impact on specifications. The CCG also has the opportunity to apply for prime funding for a MacMillan GP to support primary care and review EoL pathways. In addition, the CCG will be considering whether to work with a social investment partnership to improve 24/7 access to community based care for end of life. There is therefore a case for holding back on immediate re-procurement of the Brent contracts to allow for these initiatives to be considered and for the model to be evaluated. 3.2.1 The proposed process is as follows: 2
1. Learn from MacMillan GP (if approved), exploration of potential social investment, and the new EoL initiative in Harrow 2016/17 2. Develop a revised configuration of services accordingly 3. Procure to new specifications in 2017/18 4. In the meantime, maintain service continuity through contract extension. 3.3 AQP Contracts: AQP Ultrasound (USS Ltd) and AQP Audiology (Berkshire Healthcare FT) have been terminated and practically discontinued respectively. No further action is required. AQP TOPS is carried out by 6 providers (BPAS, Marie Stopes, Fraterdrive, Imperial, Chelwest, St Georges). These expire 31/3/16 and any procurement will be carried forward by the Central team across NW London. There is therefore no local action required on these. 3.4 Physiotherapy Contracts: The Physio 33 and Anatomie Physiotherapy contracts (combined value of around 273,000), both formally expired 31/1/15. These contracts are being considered within a wider community physiotherapy procurement process for completion in 2016/17. The proposed timeline for this procurement is set out in Appendix 3. 3.5 Community-based Urgent Care Contracts: There are a number of contracts for urgent care services delivered from community premises within Brent: Contract Approximate Annual Expiry Value Brent Access Walk in Centre at Wembley (Harness) 1,400,000 31/12/2015, extended to 31/12/16 Urgent Care Centre at CMH (Care UK) 4,200,000 31/3/2016, extended to 31/3/2018 Harness GP Access Hub 512,000 31/3/2018 Kilburn GP Access Hub 371,000 31/3/2018 Kingsbury and Willesden GP Access Hub 559,000 31/3/2018 Wembley GP Access Hub 235,000 31/3/2018 All of these services are being reviewed in the context of the urgent care service redesign programme. This is the reason that the Brent Access Walk-In Centre has been extended to 31 st December 2016, while the UCC contract has been extended, subject to 6 months notice of early termination from the CCG, to 31 st March 2018. Neighbouring CCGs in BHH are also seeking to reform urgent care provision, prompted in part by the forthcoming expiry of urgent care contracts, but also by a recognition that some systemic improvement is required. Given the considerable overlapping interest and similarity of the primarycare led vision, there is, and has been for some time, a clinical will to combine effort to achieve improvement across BHH. 3
Overlaying this, at North West London level, is the re-procurement of 111 services and the implications and potential impact of an improved, standardised and integrated 111 service on local urgent care provision. We are tasked in the recently issued NHS Four-year planning guidance (December 2015) with improving access to out of hours care [through] integration and redesign of 111,minor injuries units, urgent care centres and GP out of hours services. All of this is also taking place against a background of new urgent care provision standards promulgated in November 2015 (to which the planning guidance relates), which raise the bar both in terms of consistency and scope of service for the future; new Commissioning Standards for urgent care (also issued in November) and the development of Networks to carry all this through. All local initiatives need to be mindful of these overarching standards and processes, and work within their parameters. There are therefore co-dependent and related processes with procurement implications in the area of urgent care. These can be seen graphically in Appendix 3 3.6 Other Contracts: There are a number of other contracts for individual clinical or support services. These are shown in the table below, with summary recommendations for each: Contract Brent Centre for Young People LB Brent Early support service Silent Sound (Face to Face and British Sign Laungage Service) Language Line Ltd (Telephone interpreter service) Approximate Value Expiry Recommendation 134,000 31/3/15 Based on an evaluation (objective and be extended into 2016/17 and re-procured 2017/18 50,000 31/1/15 Based on an evaluation (objective and be extended up to 2017/18 and re-procured 2018/19 54,000 30/9/18 For re-procurement 2018/19 Variable 31/3/15 Based on an evaluation (objective and be extended into 2016/17 but also re-procured during that year 30,000 31/3/15 This is now subsumed within the wider Kings College contract. No further action required. Kings College Rehab Engineering BEH MHT 174,000 31/3/15 Brent is an associate to a contract led by NEL CSU. No further local action required. Camden & Islington 400,000 31/3/15 Brent is an associate to a contract led by NEL MH Trust CSU. No further local action required. InHealth Diagnostics 1,894,000 1/1/15 Since re-procured. No further action required. The Doctors 3,327,000 5/5/17 Extension proposed to 5/5/2018. For reprocurement Laboratory (pathology) 2018/19, based on expiry date BMI Community 1,900,000 21/8/17 For re-procurement 2017/18, based on expiry Ophthalmology date Royal Free Community 1,470,000 28/2/18 For re-procurement 2017/18, based on expiry Cardiology date 4
Positively UK 51,000 31/1/15 Based on an evaluation (objective and be extended into 2016/17 and re-procured 2017/18 Harness gynaecology Pilot 87,000 31/3/16 This pilot has been extended to 31/3/16 to provide time for evaluation and longer-term decision. If re-procured, this will occur in 2016/17 CLCH 458,000 31/3/15 Brent is an associate to this contract. No Milmay (HIV-related neurodisability) further action required locally. 169,040 31/3/18 For re-procurement 2019/20 4. Transfer of contracts to the Central Team In discussion internally and with the Central Team, the following are the actions advised for contracts currently managed by the CCG directly. The reasons for these recommendations are a need for consistency (where similar services are already being managed by the central team) or, in the case of retention by the CCG, the relative strategic importance of the service : Silent Sound to remain under CCG management The Doctors Laboratory (pathology) to remain under CCG management BMI Community Ophthalmology to remain under CCG management Royal Free Community Cardiology to remain under CCG management Positively UK should transfer to the Central Team, once re-procured St John s Hospice should transfer to the Central Team STARRS Could be done by the Central team, but will be impacted by the urgent care review. Any transfer should occur once that process is complete. BICES As a section 75 contract, this to remain with the CCG. 5. Recommendations 5.1 Brent CCG Management Executive Committee has approved this strategy incorporating the recommendations in paragraphs 3.1.1; 3.2.1; 3.6; 4. (Other recommendations in 3.4 and 3.5 have already been approved through separate specific processes). The Governing body is asked to endorse this. 5.2 This strategy will be shared and discussed with the Central team, to ensure that appropriate documentation and processes are completed for compliance with regulations and arrangements for the future. On the advice of the Management Executive, the issue of equity relating to the Brent CCG workload (relative to other CCGs) will also be addressed. 5
Appendix 1 All contracts re-procurement timescales (Brent only) Name 2016/17 2017/18 2018/19 VoiceAbility (Loud and Clear) Brent Mind Brent User Group Brent Carers Southside Partnerships (Certitude) Twining Enterprise Royal Assoc for Deaf People Marie Curie Care St Luke s Hospice St John s Hospice Pembridge Hospice Physio 33 Anatomie Brent Centre for Young People LB Brent Early support service Silent Sound (Face to Face and British Sign Laungage Service) Language Line Ltd (Telephone interpreter service) The Doctors Laboratory BMI Community Ophthalmology Royal Free Community Cardiology Positively UK Harness gynaecology Pilot Brent Access Walk in Centre at Wembley (Harness)* Urgent Care Centre at CMH (Care UK)* Harness GP Access Hub* Kilburn GP Access Hub* Kingsbury and Willesden GP Access Hub* Wembley GP Access Hub* * subject to outcome of services review 6
Appendix 2 Criteria Considerations Weighting Quality CQC reports or Royal 30% Colleges alerts Patient/GP feedback National/local targets met Value for money Changes to pathways Contract length Strategic fit Benchmarking indicates high costs New model of payment e.g. capitation Set up costs for new service/contract versus expected savings Strategic fit Clinical evidence based changes for better care Move to Integrated care services New providers More than one provider - merging of contracts Strategic fit Time to expiry (consideration should be given to contract lengths for all contracts with similar services consider 3-5 year contracts) Changes to guidance/legal considerations Time and cost to set up service/contract Managerial/clinical capacity required 30% 30% 10% 7