NWL CCGs collaboration board: shared support services 111 service reprocurement Author: Bernard Quinn, Director of Delivery & Performance (SRO) 1. Purpose 1.1 This is the first in a series of 111 updates to the Collaboration Board on the procurement of the service. 2. Background 2.1 There are currently three contracts for the NHS 111 service in North West London, delivered by two different providers. The contracts are split as follows: Hillingdon CCG Service provided by Care UK Annual value: 731k Outer North West London (Brent, Ealing, Harrow, Hounslow CCGs) Service provided by Care UK Annual value: 2.1m Inner North West London (Central London, West London, Hammersmith & Fulham CCGs) Service provided by LCW Annual value: 1.8m 2.2 In March 2014 the NWL CSU held a meeting between commissioning and clinical leads for NHS 111. It identified a preferred option of a a single NWL call handling service for NHS 111 111 would not be integrated with any GP Out of Hours services a single procurement process across the 8 CCGs In August and September 2014 a 111 paper was taken to each CCG who were asked to i) agree the proposed model for the re-procurement of the service; and ii) agree to the principle of funding resource for the procurement process with an initial a contribution of 15,000 per CCG to fund a project manager across all eight CCGs: 1
Brent CCG Executive Committee 10 September 2014 Central London CCG F&P Committee 27 August 2014 Ealing CCG F&P Committee 3 September 2014 Hammersmith & Fulham CCG F&P Committee 26 August 2014 Harrow CCG QIPP & Finance Committee 26 August 2014 Harrow Governing Body 30 September 2014 Hillingdon CCG QIPP & Finance Committee 19 August 2014 Hillingdon CCG Governing Body 22 August 2014 Hounslow CCG F&P Committee 5 August 2014 West London CCG F&P Committee 2 September 2014 3. NHSE guidance on 111 procurement 3.1 NHSE produced a procurement guide to support commissioners and is supplemented by a draft checkpoint assurance process for CCGs to work through with their Area Team. NHSE has held 111 workshops with commissioners on lessons learned from Phase 1 of the National 111 Learning and Development Programme, the Winter Resilience programme, and the strategic direction for 111 in line with the pan London Transformation programme. These are: o Mutual aid platform a technical platform that enables London 111 providers to provide mutual aid within London at times of high volume and route specialist calls o integration between NHS 111 and GPOOH a national preference for an integrated 111 and OOH service o specialist clinicians in 111 within London, but not necessarily at all sites, there are specialist skill sets which can take calls eg Pharmacists, Dental Nurses o digital routes for 111 where calls can be routed to online options 4. NWL 111 Reprocurement Progress 4.1 Following CCG approval a reprocurement programme board was established in January 2015 to oversee and support the programme delivery. Membership of the programme board is below. Brent CCG Central CCG Ealing CCG Nisheeth Rajpal Surjit Bhandal Shanker Vitayadeva Lindsey Wishart (lay) Alan Cook (lay) Isha Coombes Usha Prema Susan Hearn Harrow CCG Hammersmith & Fulham CCG Hillingdon CCG Irfan Sayad Toby Hyde Kuldhir Johal (CRO) Helen Sinton Helen Delaitre Hounslow CCG West London CCG NWL CCGs Brigitte Unger-Graeber Katie Beach Bernard Quinn (SRO) Angela McKenzie Candice Clark Darren Henderson Jonathan Pettit Stephanie Grant 2
BHH CCGs CWHHE CCGs NHSE Amanda Gregory James Eaton Eileen Sutton Carole Mattock Michael Roach Mark Bamlett Ursula Gallagher Procurement advisor Kieran McGowan (SBS) To consider: The Collaboration Board to note programme board membership and advise on changes to be made 4.2 The programme board is accountable to all eight CCGs and the Collaboration Board. Fortnightly updates will be circulated to all CCGs. 5. Model of service: NHS 111 specification 5.1 The service specification is currently being developed by the clinical leads within the 111 programme board. In line with the CSU/CCG former recommendations it is currently being written with interoperability in relation to OOH providers rather than as a fully integrated service. NHSE were aware that the NWL specification was being defined for 111/OOH interoperability. 6. Directory of services (DoS) 6.1 The Directory of Services (DOS) is the core of the Choose and Book application. It holds information that describes the services that organisations offer; It enables referring clinicians to search for appropriate services to which they can refer patients. 6.2 Service providers build and publish their services on the DOS in Choose and Book. This in turn enables referrers to list those services when searching for appropriate services for their patients. In the case of primary care services, commissioners need to specifically choose (commission) which services they wish to appear on the Primary Care Menu. 6.3 Services published on the Secondary Care Menu (those services belonging to Acute and Foundation Trusts as well as many Independent Sector Providers) are available to referrers throughout the country. Services published on the Primary Care Menu are commissioned to appear only to those referrers within the local organisation. 6.4 The 111 procurement board considered whether the DoS specification should be included in the 111 specification and unanimously agreed that it should be procured separately. This differs from the recommendation previously made by the Collaboration Board. The reason identified for keeping 111 and DoS provider separate were identified as: 3
1. CCGs have contractual mechanisms to direct acute, community providers to comply with DoS completion and keeping it current. 2. 111 providers are not directly involved in Contract Management of services, they may struggle to implement changes to profiles of service 3. Some 111 providers operate nationally and may be a challenged to understand local services 4. NHSE London is looking to create a mutual support system for London rather than have calls go elsewhere in the country. 5. DoS needs to be directed to support this mutual aid rather than delegated to 111 suppliers who may not have geographically aligned interests 6. 111 providers may need to manage the profiles of other services also linked to the 111 provider (e.g. UCCs/GP OOH etc.) with potential for conflicts of interest. 7. When DoS has been managed by 111 providers, NHSE have advised that it has been found to be developed to the benefit of the 111 supplier and not necessarily the Healthcare system. 8. Commissioner may not be sighted on issues in the DoS (e.g. incorrect ranking causing increased costs) 9. If 111 provider is managing several different contracts, commissioners may struggle to get their needs/requirements prioritised 6.5 NHSE s is planning to extend the use of DOS across all of the U&EC system including A&E, UCC, OOH and LAS, their strong recommendation is that the DoS is a commissioner tool and should not be delegated via a 111 provider. 6.6 As with the 111 reprocurement, CCGs will be actively engaged in developing and approving the DoS procurement process and specification development. It is recommended that whilst a separate process is undertaken for DoS, the 111 reprocurement programme board maintains project oversight of the process on behalf of the CCGs. To Consider: The Collaboration Board to consider the recommendation form the NWL 111 procurement board, 111 clinical leads and NHSE to separate DoS from 111 procurement. and consider 7. NHSE request for pause the 111 procurement processes 7.1 Following a meeting with Simon Stevens in February, Anne Rainsberry has requested that NWL and South London CCGs pause their 111 reprocurement. He has directed a preference for an integrated 111/Out of Hours (OOH) model of delivery and has tasked Professor Willets to define the model for England. 7.2 The NWL CCGs 111 reprocurement is currently configured as a stand-alone model with OOH interoperability defined contractually. South London CCGs have two models, one standalone and one integrated.. 7.3 NHSE have been asked to describe the steps of the pause which includes a meeting with Simon Weldon in the next fortnight on the model and options. 4
To Note: The Collaboration Board to note the request from NHSE to pause the 111 reprocurement while the national model for 111/OOH integration is clarified by Prof Willets. Confirm the nominated chair to meet with NHSE on the model of service 8. NWL CCGs 111 contract extension 8.1 All three NWL 111 contracts were commissioned on a two year + one year basis. The LCW contract and the Hillingdon Care UK contract began in 2012 and were both extended for the + one year in 2014 (Care UK contract ends end of Feb 15 / LCW contract ends end of March 15). 8.2 The intention is to extend the contracts for the duration of the procurement process i.e. a further 12 months and potentially beyond should there be any unforeseen delays to the process. The ONWL (Brent, Harrow, Ealing and Hounslow) Care UK contract does not end until March 2016. 8.3 Advice from SBS is that contract extensions are permissible when a procurement process is planned, Capsticks have been requested to provide legal advice. 9. Procurement timeline 9.1 The original plan agreed by CCGs was to complete the procurement process, including mobilisation, by October 2015, this would have necessitated awarding the contract in April 2015, NHSE define a lengthy mobilisation period. 9.2 Following NHSE s request to pause the procurement, the procurement timeline has been updated to follow the contractual end dates of the current 111 services with an expectation that the new service will go live in March 2016, thereby avoiding any potential risks associated with a new service going live during the winter period. 5
The delay to the original procurement timeframe will impact on the resource secured for the programme. An extension to the project leads contract from October 2015 to March 2016 will need to be agreed to support the revised timeline. A revised budget for the 111 procurement will be brought back for the collaboration board to consider. To Note: The Collaboration Board to note the revised timetable for 111 reprocurement 10. Governance and engagement 10.1 Communication plans will be developed with each CCG to ensure the plans reflect the level of local engagement required by each CCG and engagement with local governance leads is underway to develop these plans. Regular reports will be presented to the Collaboration Board to ensure Board oversight of the process. 10.2 The 111 clinical and commissioning leads for each CCG are intended to be the CCG champions of the reprocurement process and ensure that each CCG is appropriately updated and engaged enabling local focus and ownership is maintained throughout the process. 10.3 The plan is that the signing off of the specification, approval of the evaluation criteria, the preferred bidder award and the contract award is presented to the collaboration board in regular updates and to the CCG Governing Bodies for approval. 10.4 A risk register is in development and will be presented and monitored at Programme Board, CCG and Collaboration Board level. To consider: The Collaboration Board to consider the sign off process and confirm the governance route for sign off for the plan, specification, approval of the evaluation criteria, the preferred bidder award and the contract award is presented to the collaboration board and CCGs in regular updates and to the CCG Governing Bodies for approval. 6
11. NHSE assurance process NHSE s draft assurance checkpoints that NHSE intend to use for the process is as follows. Checkpoint 1: High level delivery strategy Checkpoint 2: Investment Decision Checkpoint 3: Operational Review (before go-live of new service) CCG specification sign off timeline to be shared with NHSE Draft Specification and supporting documents signed off by CCGs and shared with NHSE Desktop review of procurement plans and specification by Area Team Area Team summary against national template, shared with Simon Weldon and CCG lead/sro CCG and Area Team discussion and review with Simon Weldon NHSE checkpoint agreement CCG final sign off CCG publish ITT Progress review of original procurement plans. CCG and Area Team discussion and review with Simon Weldon NHSE and CCG checkpoint agreement Review of mobilisation plans, risk and mitigations. CCG and Area Team discussion and review with Simon Weldon NHSE and CCG checkpoint agreement 12. For the collaboration board s consideration The Collaboration Board are asked to: 1. note programme board membership and advise on changes to be made 2. consider the recommendation and reason from the NWL 111 procurement board, 111 clinical leads and NHSE to separate DoS from 111 procurement. 3. note that this differs from the recommendation that the collaboration board have previously made on DoS procurement 4. note the request from NHSE to pause the 111 reprocurement while the national model for 111/OOH integration is clarified by Prof Willets 5. note the revised timetable for 111 reprocurement The Collaboration Board are asked to 6. confirm the nominated chair to lead on 111 discussions with NHSE on the service model 7. confirm the governance route for sign off for the plan, specification, approval of the evaluation criteria, the preferred bidder award and the contract award is presented to the collaboration board and CCGs in regular updates and to the CCG Governing Bodies for approval. 7
Appendix A The NWL 111 reprocurement programme Board s terms of reference: To oversee each stage of the NHS 111 procurement, including the initial ratification of the project initiation documents and project plan and sign off by CCGs To assess progress of the project and measure this against the project strategic objectives To monitor progress of the project against the specified success criteria To ensure project assurance is being executed appropriately and that corrective action is taken when necessary in the light of assurance processes To approve project deliverables and ensure they meet high quality standards To receive progress reports from the Project Team and Project Manager and take appropriate action when project issues are highlighted To assess project risks as they arise and allocate responsibility for implementing mitigation or contingency arrangements To ensure that the implementation consequences of the Board s recommendations are understood To ensure engagement with relevant stakeholders, including commissioners, clinicians, patients and public throughout the project is robust To ensure recommended preferred provider arising from the procurement is committed to the successful implementation of the recommendations of the Project Board To ensure that proposals arising from the project are assessed for their equalities impact and can demonstrate that they will contribute to reducing health inequalities To ensure that proposals arising from the project are assessed for their contribution to environmental sustainability To ensure that the procurement is undertaken in full compliance with the Public Contract Regulations 2006, NHS (Procurement, Patient Choice and Competition) No 2 Regulations April 2013, Monitor guidance and relevant NHS Standing financial instructions 8