Wandsworth Clinical Commissioning Group Forward Procurement Plan 2015/16

Appendix B Wandsworth Clinical Commissioning Group Forward Procurement Plan 2015/16 1. Introduction The purpose of this report is to inform Wandsworth Clinical Commissioning (CCG) Board about the draft Forward Procurement Plan (Table 1) and seek approval for the open procurement of Improving Access to Psychological Therapies (IAPT) services, the Digital Mental Health Service and Community Musculoskeletal All Body Parts Service. The Plan is based on information from CCG commissioners and from ing existing contracts on Coflow (the CCG Contract Management System) approaching expiry. Entry on the Plan does not guarantee that procurement will happen and the actual costs may vary from the estimates. Timely processing and approval of the plan ensures better procurement planning and allows the market to consider upcoming opportunities, in line with the transparency agenda. The scope of the Plan can be affected by major s or national policy direction which may lead to the extension of existing contracts and changes in approach to future procurements. Contracts listed in Appendix A will be assessed against the Wandsworth CCG Procurement Policy 2015/16, with particular reference to the High Level Flow Chart within the Wandsworth CCG Procurement Decision Process. 2. Strategic Context The procurement plan will be delivered within the context of an increasing expectation on commissioners to deliver value for money, integration and new models of care. Below are the summary of key issues that the CCG will need to consider as part of the case by case assessment of the most appropriate procurement route for contracts listed in Appendix A: There is national support for commissioning of integrated pathways for services. Local commissioning of integrated care pathway can bring substantial risks, with the implication of commissioning across multiple providers. Some partnerships will be more complex, involving financial interdependencies and flows of money between providers. The costs of developing, procuring and maintaining these contractual approaches may be high. There is still a national ambiguity between competition and markets and the integration agenda. There is an increasing possibility that providers will seek to challenge individual CCG s tendering decisions. It is important that Wandsworth CCG ensure the processes are transparent and tendering is handles transparently, fairly and with equal treatment There is a need to develop our understanding about the way in which procurement can be used to support integration in creating challenges and opportunities 1

There are issues with access and sustainability and spread of the current care infrastructure that must be addressed in the coming years. The current make up of much of care provision in Wandsworth is subject to little challenge largely due to near single provider monopolies for many services. Competition, with the aim of improving access for patients, has been introduced in the local healthcare market through the delivery of Any Qualified Provider (AQP) services. The CCG will be exploring opportunities to stimulate the market by ensuring that - where identified as of benefit to patients there is choice of alternative providers. 3. Procurement Update 3.1. Improving Access to Psychological Services The South West London (SWL) and St George s Mental Health NHS Trust is contracted to provide the Wandsworth Improving Access to Psychological Services (IAPT). The IAPT service works with patients who have been assessed to have milder anxiety, depression, and Obsessive Compulsive Disorder (MH Clusters 1-4) and more serious and enduring conditions (Clusters 5-7). Wandsworth CCG has recognised throughout 2015/16 that there are significant problems in the performance of the IAPT service against key national performance targets. In terms of benchmarked performance Wandsworth CCG ranks 29 out of 31 London CCGs. Achieving the IAPT targets is one of the assessment criteria for CCG assurance. Improving the performance of the IAPT services commissioned by WCCG is a high priority for the CCG. Extensive work has been undertaken with the current provider which has improved in year performance but raised a series of questions about ongoing capability and value for money that seem difficult to resolve within the current contractual relationship. Benchmarking information suggest that the national targets are achievable with the current spend by WCCG. Contract value Market Analysis 3.125 million Mental health services are tremendously diverse, from the provision of brief interventions in the form of talking therapies for people with anxiety and depression, to long inpatient stays in secure units, treatment of children with behavioural problems, to care of older people with dementia. Whilst the vast majority of these services are delivered by statutory providers, there are numerous independent organisations providing NHSfunded mental health care, both from the for-profit and not-for-profit sector, across almost the full spectrum of provision. These range from large national chains, to small local charities and social enterprises. The market for IAPT is fairly well established. The introduction of Any Qualified Providers (AQP) IAPT services has enabled market entry for a number of non NHS providers across the country. In addition, other South West London CCGs have successfully re - procured new IAPT services since 2012, with a range of NHS, primary care and private sector providers commissioned to deliver IAPT services. Considering the outputs of the market analysis, this paper proposes that there are sufficient other providers of IAPT services to ensure that a competitive open procurement would result in new, additional options for the service. Clinical View On 27 January 2015 the Clinical Reference Group considered the process for procuring new IAPT service and requested the formation of a shadow 2

IAPT Steering Group that would the current position regarding service. Recommendation Proposed start date for new contract On 26 February 2015, the shadow IAPT Steering Group which is chaired by the Clinical Lead for Mental Health reached a consensus to recommend procurement of all Talking Therapies Services - IAPT and Digital Mental Health Services from April to the CCG Management Team for the following reasons: SWL&STG have struggled to meet the national access and recovery targets and it is evident that greater innovation is required. Current IAPT works with MH Clusters 1-4 (milder anxiety, depression, OCD) and has less clear coverage of Clusters 5-7 (more serious and enduring conditions). There is a gap in service provision for people requiring interventions at Cluster 5-7 which require more skilled and longer interventions. In March 2015, WCCG Management Team supported proposal to jointly procure IAPT and Digital Mental Health Service 1 st September 3.2. Digital Mental Health Service The pilot Digital Mental Health Support Service has been funded on a non-recurrent basis since 2011. The Digital Mental Health Support Service offers digital mental health support through peer support, structured online programmes, and one to one therapy. The service will provide the following benefits: Extend access to mental health services, notably for people who find it difficult to access traditional services due to stigma and/or time pressures Intervene early in mental health problems, and prevent escalation (therefore reducing demand on other mental health services) Widen choice in mental health care provision Reduce health inequalities related to inequitable access to mental health care Increase the number of people who access psychological therapies, with reduced waiting times Offer particular support to carers, particularly sandwich carers who are also in employment or looking after children Contract value 222,136 Market Analysis Mental health services are tremendously diverse, from the provision of brief interventions in the form of talking therapies for people with anxiety and depression, to long inpatient stays in secure units, treatment of children with behavioural problems, to care of older people with dementia. Whilst the vast majority of these services are delivered by statutory providers, there are numerous independent organisations providing NHS-funded mental health care, both from the for-profit and not-for-profit sector, across almost the full spectrum of provision. These range from large national chains, to small local charities and social enterprises. The market for Digital Mental Health is varied and still developing in the UK. 3

The products available range from online support, advice and information; support networks and digitally integrated care and health hubs and ecosystems. 1. There are mobile mental health tools such as mood trackers like Moodscope and Buddy. Computerised cognitive behavioral therapy platforms like Beating the Blues and Living to the Full; telehealth services like Bosch s Health Buddy; patient information portals like MyHealthLocker; and patient communities like PatientsLikeMe 2 Clinical View Recommendation Proposed start date for new contract Considering the market analysis and national reports, this paper proposes Market Testing and procurement of digital mental health service to support the delivering of IAPT service and increase access to patients/service users particularly those who are unable to use traditional mental health services. On 26 February 2015, the shadow IAPT Steering Group which is chaired by the Clinical Lead for Mental Health reached a consensus to recommend procurement Talking Therapies Services - IAPT and Digital Mental Health Services to provide maximum benefit to patients. There is consensus regarding the benefits of integrating the pathways for the IAPT and digital mental health services. In March 2015, WCCG Management Team supported proposal to jointly procure IAPT and Digital Mental Health Support Service 1 st September 3.3. New Community Musculoskeletal All Body Service Management Team is supporting the commissioning of a new Community Musculoskeletal (MSK) All Body Service which will replace existing Any Qualified Provider (AQP) MSK Lower Back and Neck Treatment service that was commissioned in 2013/14 for two years plus an option to extend for another 12 months. The AQP contract will expire on the 31 March. Any Qualified Provider (AQP) services were established by national direction in April 2013 to improve quality of care by: increasing patient choice reducing long waiting times increasing access to community based services improving poor patient experience and outcomes The eight MSK Lower Back and Neck Treatment Service providers are: Premier Therapy Angel and Bowen Ltd The Injury Care Centre Healthshare Ltd Care UK Clinical Services Wallington Physiotherapy Ravenscroft Physiotherapy Centre St George s Hospitals University Foundation NHS Trust 1 http://www.nhsconfed.org/~/media/confederation/files/publications/documents/the-futures-digital.pdf 2 http://mobihealthnews.com/20154/uk-government-weighs-digital-tools-for-mental-health/ 4

Physiotherapy Solutions (Crystal Palace) The providers are established and operate from a number of locations across Wandsworth. Whilst the providers are generally private and independent organisations with their own structures, many of the services are delivered within GP surgeries or available in close proximity to practices. Whilst patients can choose to be referred to any of the AQP providers, the majority choose to be referred to the service provider that is located geographically closest to the GP surgery. In Wandsworth, it is not unusual for patients to be seen within 72 hours for urgent appointment and 10 working days for routine appointment. This approach has been effective in reducing waiting times. Contract value Estimated annual contract value of 2,776,527 Market Analysis Procurement options are being reconsidered in light of increasing interest from potential suppliers and new entrants into the local NHS market. Options ed include: A repeat of the AQP approach, resulting in an unlimited number of accredited providers Implementation of a framework agreement, which would involve the award of a framework agreement to each successful provider followed by subsequent call off agreements as and when the provider was awarded activity Traditional procurement to award one or more Standard NHS contracts, the number being pre-agreed by the CCG in terms of what was appropriate In terms of satisfying the CCGs procurement obligations under the NHS Regulations 2013 any of the above options would provide a compliant route to awarding contracts. Consideration therefore has been given to which route would meet the objectives of improved patient choice, value for money and improved efficiency for the CCG in managing the contracts. Based on the assessment of the procurement options, it is proposed that the CCG follows a traditional procurement process that will aim to award to a minimum of eight providers. The maximum number will be determined following of additional capacity that would be required to maintain patient choice and access to MSK services. The benefits for all stakeholders are as follows: Patients: Significant choice is made available to the best quality providers. The best quality being secured by awarding contracts to the providers scoring highest on quality with value for money being secured through the mandatory acceptance of the Wandsworth tariff, which has been established following extensive benchmarking of MSK prices nationally. The multiple provider model also provides greater capacity thereby improving access to the service. GP Referrers: GPs are able to refer into providers confidently knowing a rigorous procurement process has been followed with contracts only being awarded to the better providers rather than all who meet the basic standards. Providers: Providers have the improved certainty of business knowing a restricted number of providers are competing rather than a vast AQP list. 5

This gives them the confidence to compete on quality and market their service to patients, in line with CCG guidance. Wandsworth CCG: The CCG continues to promote a vibrant market offering choice to patients at the same time of securing best value from the market with the use of a locally set and nationally benchmarked tariff. The manageable number of providers also enables the CCG to undertake effectively contract and performance management as well as work with providers on service improvement and developments. Clinical View Recommendation Proposed start date for new contract In 2014/15, Wandsworth Clinical Commissioning Group (CCG) Clinical Leads and Management Team supported conversion of the existing AQP Musculoskeletal (MSK) Lower Back and Neck Treatment Service to Community MSK All Body to improve patient experience of using the existing AQP service In June 2015. WCCG Management Team supported proposal to procure a new Community Musculoskeletal All Body Service. 4 April 4. Recommendations 4.1. Wandsworth CCG Board is asked to: approve the Wandsworth CCG Forward Procurement Plan 2015/16 (Table 1) accepting that the plan will be subject to regular approve open procurement of Improving Access to Psychological Therapies and Digital Mental Health Service approve open procurement of the new Community Musculoskeletal All Body Service with restricted number of providers 6

Table 1: Wandsworth CCG Forward Procurement Plan 2015/16 No Contract Title Type of contract 1. South East Commissioning Support Unit national direction 2. Specialist Dementia Training for Carers 3. Community Adult Health Service ( pilot) 4. Improving Access to Psychological Services 5. Digital Mental Health Service 6. Adult Rehabilitation in Acute Mental Health 7. Any Qualified Provider Podiatry Community Service 8. Planning All Care Together (PACT) 9. Diagnostic Local Enhanced Services Existing WCCG Contract Collaborative Contract Annual Contract Value Contract Start Date (where known) Contract Expiry Date Possible Extension (months) Status Yes/No? Yes Under 2,974,730 April 2013 March No No 28,000 Not applicable Not applicable - Expression of Interest Clinical Yes No 15,000,000 1 April 2014 31 March Clinical Yes No 3,125,000 1 April 2015 31 July Clinical No No 222,000 1 April 2015 31 March Clinical Yes No 4,000,000 1 April 2015 31 March Clinical Yes No 1,061,204 1 April 2013 31 March Clinical Yes No 2,000,000 1 April 2015 30 September 2015 - Market Testing Clinical Yes No 400,000 1 April 2015 31 March 10. GP Out of Hours Clinical Yes No 2,410,488 25 November 2012 25 February 11. NHS 111 Yes No 732,000.00 25 November 2012 25 February 7

12. In-house GP Redirection Service Clinical Yes No 219,392,00 25 November 2012 25 February 13. Single Point of Contact (SpoC) Yes No 46,720.00 25 November 2012 25 February 14. Community Dermatology Service (pilot) Clinical Yes No 457,000.00 1 April 2013 31 March 15. Community Musculoskeletal Interface Clinical Assessment Service (pilot) 16. MSK ( including Lower Back and Neck Treatment Service) 17. Rapid Response Service Home Care Clinical Yes No 532,775.00 1 April 2013 31 March Clinical Yes No 2,776,527 1 April 2013 30 September 2015 18. Care Home Selection Yes Yes with Wandsworth Council 200,000 20 November 2014 Yes No 192,000 2 February 2015 30 September 2015 1 February 19. Integrated Carers Support Service 20. Physical Activity for Patients with Patients 21. Programme Support for SW London Strategy Programme Implementation 22. Finance and Activity Support SW London Strategy Programme Non - clinical Yes Yes with Wandsworth Council Yes Yes - collaboration with Macmillan Yes Yes - SWL Collaborative Commissionin g Arrangement Yes Yes - SWL Collaborative Commissionin g Arrangement 577,000 1 August 2015 31 July 2018 24 Under negotiation 96,426 1 April 2015 31 March 2018 - Contract Award 749,605 7 April 2015 31 March 1,357,866 7 April 2015 31 March 8

23. Termination Pregnancy Services 24. Community Ophthalmology Service 25. Secure Communication Tool (Online GP Specialist Support) 26. Diagnostic Services Non Obstetric Ultrasound Scan (NOUS) 27. Diagnostic Services Magnetic Resonance Imaging ( MRI) 28. Language Translation and Interpreting Service 29. Soft Facilities Management Clinical Yes Yes with Wandsworth Council 489,985.92 1 April 31 March Clinical Yes No 533,744.10 1 April 2015 31 March Yes No 46,560 1 July 2015 30 June 2018 - Contract Negotiation Clinical Yes No 107,000 1 April 2014 31 March 12 Under Clinical Yes No 679,000 1 April 2014 31 March 12 Under Yes No 170,000 1 April 2014 31 March 24 Under Yes No 96,008.04 1 April 2015 31 March 2018 - Contract Award 9