Equitable Access to Primary Medical Care Potential Bidders Workshop

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Equitable Access to Primary Medical
CarePotential Bidders Workshop

• Stanhill Court Hotel, Gatwick 11th June 2008

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Welcome and IntroductionsStephen Day
Commercial Partnership ManagerKaren Clinton
Project Manager, NHS South East Coast
(SECSHA)
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Introductions

• SECSHA
• Karen Clinton, Project Manager
• Stephen Day, Commercial Partnership Manager
• Abigail Rennie, PASA
• LMC
• David Barr, (Kent LMC)
• Department of Health
• James Gold Commercial Directorate
• Rupert Dunbar- Rees Commercial Directorate
• Jatinder Garcha Commercial Directorate

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Purpose of today

• To provide you with an understanding of
• The ITT Documentation
• Delivering the service specification from a
  clinical perspective
• An understanding of the financial modelling
• We are running an open procurement.
• .and want the widest possible range of potential
  providers to come forward.
• this session is intended to equip and enable
  potential bidders new as well as existing
  providers to respond and, we hope, bid..
• Ps today is not about debating the wisdom of
  Government policy!

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Agenda

• Welcome and Introductions
• Background
• Overview of ITT
• Sessions-
• Session 1
• Financial Model Template
• Session 2
• Understanding Clinical Quality Requirements
• Potential Bidders Question and Answer Session
• Panel to include LMC members
• Close

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BackgroundKaren Clinton, NHS South East Coast

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Key Statistics
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PCTs EAPC Procurement requirements
PCTs managing procurement locally
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Our Vision

• Healthier lives for all
• Fully engaged public
• First class care, treatment and support close to
  peoples homes
• Fast and equal access to services
• More choice and information
• The most appropriate service in an emergency
• Clinically safe, cost effective services which
  meet patient needs
• First class patient experience
• Improved partnership working

Access Reducinginequalities Safety Quality
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Background - national
the issue that has been raised is how
difficult some people still find it to access
primary care
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Background - national

• 100 new GP practices in the 25 of PCTs with the
  lowest levels of provision
• 150 new GP led health centres
• more money to follow the patient
• more information on performance made public

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Background SEC

• Ensuring that GP practices improve access and
  become more responsive to the needs of all
  patients

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Health centres the national givens

• Open 8am 8pm, 7 days a week
• Bookable and walk-in services
• Registered and non-registered
• Core GP services
• Integration with other services
• Accessible locations

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Principles and rules for Cooperation and
Competition

• Commission from providers best placed to deliver
  needs of population
• Providers commissioners cooperate to ensure
  seamless experience
• Commissioning should be transparent and
  non-discriminatory
• Commissioners providers should foster patient
  choice
• Appropriate promotional activity is encouraged
• Providers must not discriminate against patients
  must promote equality
• Payment regimes must be transparent and fair
• Financial intervention in the system must be
  transparent fair
• Mergers, acquisitions, de-mergers and joint
  ventures are acceptable
• Vertical integration is permissible

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Overview of ITTJames Gold Commercial
Directorate
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Purpose of the ITT

• The Invitation to Tender (ITT) provides
• An overview of the remainder of the PCT
  Procurement process
• Rules and instructions on completing the ITT for
  the PCT Procurement
• The PCT Scheme-specific information and
  requirements
• Requests for responses from Bidders and
• The Contract to be signed for the provision of
  the Services.

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ITT DocumentationVolume 1
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ITT Documentation

• Volume 1 Process Overview Guidance to Bidders
• Introduction and Overview
• Purpose, Structure Next Steps for Bidders
• ITT to Contract Signature
• Procurement Rules
• Instructions on completing the ITT
• Administration
• Glossary

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ITT DocumentationVolume 2
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ITT Documentation

• Volume 2 Requirements Bidder Responses
• Structure Organisation
• PCT Scheme Overview
• Clinical Quality Requirements
• Workforce
• IMT
• Premises
• Facilities Management
• Equipment
• Commercial Financial
• Contract Management
• Compliant Bid
• Glossary
• Annexes

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ITT DocumentationVolume 3 APMS Contract
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ITT Volume 3 APMS Contract

• Structured as follows

• Schedule 10 Complaints Procedure
• Schedule 11 Administration
• Schedule 12 Particulars Leaflet
• Schedule 13 Exit Plan
• Schedule 14 Operational Management Plan
• Schedule 15 Termination
• Schedule 16 Approved Subcontractors
• Schedule 17 Training
• Schedule 18 Staff Transfer

• Main Body - Contract
• Schedule 1 Definitions
• Schedule 2 Services
• Schedule 3 Payment Mechanism
• Schedule 4 Workforce
• Schedule 5 IMT
• Schedule 6 Premises
• Schedule 7 Performance Management
• Schedule 8 Change
• Schedule 9 Insurance

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SummaryKaren Clinton, South East Coast
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What will you have to do?

• Plan engage with commissioners then consider
  action outputs.
• Understand need.
• Submit EOI.
• Read absorb MOI.
• Understand need qualify (solution, competition,
  timescales, resources SWOT).
• Complete the PQQ.
• Ensure that expert resource is available for a
  winning team.
• Legal, financial, estates, clinical, operational,
  administration, project bid management
• Plan engage with commissioners then consider
  action outputs.
• Begin drafting response contract TsCs.
• Read the ITT documents! Absorb.
• Refine solution Develop financial model
  obtain funding.
• Develop implementation plan.
• Write the response submit tender - Co-ordinate
  inputs.
• Manage clarification questions.
• Manage the implementation.

Do not underestimate the effort needed to win a
bid
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Session 1 Understanding clinical quality
requirements Dr Rupert Dunbar-Rees MRCGP
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Equitable Access - Core Criteria

• GP practices
• Core GP services
• List size of at least 6,000 patients
• Extended opening hours (minimum of 5 hours per
  week)
• Plan to be a accredited training practice
• Engaged in practice based commissioning
• With extended (and overlapping) practice
  boundaries

• Health Centres
• Core GP services
• Easily accessible locations (e.g. reflect
  commuter needs)
• Open 8am-8pm, 7 days a week
• Bookable GP appointments and walk in services
• Registered and non-registered patients
• GP-led

Diagnostic services Community pathology Radiology
Audiology
Specialist services Minor surgery Dermatology Chro
nic pain GU medicine
Rehabilitation COPD Chronic pain Orthopaedic Strok
e care
Local flexibilities will maximise innovation by
integrating and co-locating health centres with
other services
Social care
Pharmacy services
Palliative care/ end of life care
Urgent out-of-hours care Dental services
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Complete Clinical Specification

• High quality clinical services
• Patient centred and value for money, primary
  medical care services, delivered in a safe and
  effective manner, through a learning environment
• Clinical service specifications go beyond
• what services
• Patient Volumes
• Service Requirements (e.g. Additional Services)
• DES / LES / NES
• amount of services
• Affordability Model
• And include detail on quality/governance
• See Section 3 Clinical Quality Requirements ITT

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Clinical Quality Requirements

• Patient Centred
• Access and Convenient Services minimum access
  requirements- appointments, equity (Hard to
  Reach), translation, convenience
• Appropriate/Responsive Care Identify key patient
  groups/needs, continuity of care issues, children
• Clean and Pleasant Environment dignity, respect,
  gender, confidentiality, infection control
• Safe Delivery/Learning Environment Leadership-
  Governance, clinical safety, Audit, incident
  reporting
• Effective Delivery SBH, QOF, training
  accreditation, health promotion, prescribing and
  referral monitoring, Urgent Care and OOH
  Integration

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Linking the Invitation to Tender and APMS
Contract

• Clinical Sections of ITT/Contract
• Volume 2- Workstream Requirements
• (Section 3) Clinical Quality Requirements
• Volume 3- The APMS Contract
• Schedule 2
• Part 1-Service Requirements (CQRs in contract
  form)
• Part 2- GP Practice Service- Hours, Boundary
• Part 3- Essential, Additional and Enhanced in
  contract form
• Part 4- QOF
• Schedule 7- Performance Management/KPIs

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Schedule 2, Part 1 General Service Delivery
Requirements

• Equity of Access
• Patient Dignity and Respect
• Obtaining Informed Consent
• Obligations relating to Children
• Prescribing Obligations
• Clinical Safety and Medical Emergencies
• Good Clinical Practice
• Medical Equipment
• Obligations relating to Infection Control
• Referral Process
• Health Promotion and Disease Prevention
• Adverse Incidents

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Schedule 2, Part 3 GP Practice Clinical Service
Specifications

• Essential required for Registered Patients who
  are ill but likely to recover, terminally ill or
  suffering from long term conditions
• Additional contraceptive services, maternity
  medical, cervical screening, minor surgery,
  vaccinations and immunisations
• Enhanced examples include weight management,
  smoking cessation, Care of the Homeless, Body
  Mass Index Register, Drug Misuse, Alcohol Misuse
• Directed Enhanced childhood immunisations,
  Access, IMT Adoption, Practice Based
  Commissioning, Choice and Booking

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Quality Control for the patient

• All referrals audited and learning needs
  addressed
• Prescribing monitored and learning needs
  addressed
• All significant events risk stratified, actioned,
  reported
• Collection of patient safety data- infection
  rates etc.
• Any actions identified above implemented
• GP Practices deemed sufficiently high quality to
  train new GPs
• PCTs can choose to make this all happen using an
  APMS Contract
• Translates all of what you hear about today into
  meaningful patient benefits

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Session 2 Financial Model Template James Gold
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Commercial and FinancialVolume 2 Section
9Financial Model Template

• The Financial Model Template (FMT) is intended to
  assist Bidders in pricing their Bid and to
  provide PCT with a cost analysis of each Bid.
• The table below provides an overview of the FMT
  in Annex 9 (A).

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Commercial and FinancialFinancial Model
Switch to excel financial model
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Payment Mechanism

• PCT Options presented below PCT to define local
  model

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Contract Performance Management

• Desired Outcomes
• To drive service quality to the highest standards
  (upper quartile) Band A. KPIs organised into
  the following areas -
• Access
• Quality
• Service Delivery
• Value for Money and
• Patient Experience
• To focus services to address areas of greatest
  need
• To ensure good contract management
• Simplicity

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Performance Management - Illustration

• Assume a bid price of 100
• 75 is paid to the Provider
• 25 is subject to performance management
• KPIs are split into 5 focus areas
• KPIs are banded

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Key Performance Indicators

• KPI focus areas
• Access 5 weighting
• Quality 5 weighting
• Service Delivery 5 weighting
• Value for Money 5 weighting
• Patient Experience 5 weighting
• Individual KPIs
• KPI individual weighting within focus area
• Banded performance A, B or C
• Payment Percentage 100, 75 or 25

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Performance Management Framework

• Performance driven payment
• Within maximum contract value
• Key Performance Indicators (KPIs)
• SMART targets
• Banded Performance
• Monthly exception reporting
• Quarterly performance reporting
• Quarterly Joint Service Reviews
• Provider must drive their own performance

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Potential BiddersQuestion and Answer session
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Panel Members

• Facilitator
• Stephen Day
• SECSHA
• Karen Clinton, Project Manager
• Abigail Rennie, PASA
• LMC
• David Barr, (Kent LMC)
• Department of Health
• James Gold (Programme Lead) Commercial
  Directorate
• Rupert Dunbar- Rees (Clinical Lead) Commercial
  Directorate