GP Out of Hours/111 Service Re-commissioning. Graham Clark, Lead Clinician, Out of Hospital Care Chris Coath, AD, Commissioning, Out of Hospital Care

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1 Agenda item: 9.2 Subject: Presented by: Submitted to: GP Out of Hours/111 Service Re-commissioning Graham Clark, Lead Clinician, Out of Hospital Care Chris Coath, AD, Commissioning, Out of Hospital Care Governing Body Date: 4 November 2014 Purpose of paper: For the Governing Body to agree the process for re-commissioning and re-procuring the GP Out of Hours and 111 service for Norfolk. Executive Summary The purpose of this paper is to inform the Governing Body of the procurement process for Norfolk NHS 111 and GP Out of Hours Services, with a view to agreeing the governance process for contract approval. The procurement covers South Norfolk, North Norfolk, West Norfolk and Norwich CCGs and a similar paper will be received by those Governing Bodies. (This does not apply to Great Yarmouth and Waveney, which has a different 111 / OOH GP service.) This paper also provides an overview of the competitive tendering process to be used in this procurement. Note that once the process has started, CCGs cannot change the scope of the procurement or the nature in which it is conducted, other than contributing to the Pre- Qualifying Questionnaire (PQQ) and Invitation to Tender (ITT) documents. Each CCG is requested to agree to the start of the procurement on 3 November 2014 and commit to agreeing the contract with the preferred provider at the conclusion of the procurement. The Governing Body is asked to agree to: Be a named commissioning organisation in the procurement. This will require the CCG to commit to contracting with the preferred provider at the end of the process, providing due process is followed, as outlined in this document. Any subsequent withdrawal will require the process to be terminated and re-started at significant cost. Support the procurement process by nominating appropriate subject matter experts to form the project team. Appoint a project lead and clinical lead to act as the channel for information cascade into the CCG. Agree to make decisions in line with the CCG s governance process in a timely manner to ensure the project delivers to the planned timescales.

2 Norfolk 111 and GP Out of Hours Procurement Governance Report 1. Background and context to the Procurement NHS 111 and GP Out of Hours (OOH) services are critical to the safe delivery of urgent care to patients requiring it and also to the appropriate and effective use of resources. Currently NHS 111 and GP OOH services in Norfolk are provided by the NHS East of England Ambulance Service Trust (EEAST); however, this contract terminates on 1 September Against a national focus on performance, outcome measures and expectations, commissioners need to ensure the successful re-procurement of sound and successful NHS 111 and GP OOH service(s). These will need to meet the national and local specification and deliver safe, quality services with appropriate outcomes and experiences for the population along with value for money. This procurement needs to be informed by the previous procurement experience in Norfolk along with evidence and experience gained locally and nationally in commissioning of NHS 111 and GP OOH services. Engagement and involvement of key stakeholders from all CCGs through the life of the procurement project is critical to ensure its success in selecting the best service provider(s) for Norfolk. As the current contracts are scheduled to terminate on 1 September 2015 these services must be fully functional and ready for safe and seamless launch by 1 September at the absolute latest. The contract will be for a duration of 5 years. The indicative cost envelope will be published as part of the procurement documentation. 2. Key Objectives of the Procurement The key objectives are: 1. To secure clinically safe, effective and efficient NHS 111 and GP OOH services for the resident and transient populations of South Norfolk, North Norfolk, West Norfolk (plus Wisbech) and Norwich CCG areas. South Norfolk CCG will wish to see residents closer to an OOH GP service in Suffolk using that service and vice versa. 2. To secure a provider that plays a pro-active role in integrating services, keeping patients independent and well in the community, agreeing a shared vision, goals and outcomes across the local health and social care system. 3. To find a responsive Provider(s) that will work with CCGs to develop the service innovatively throughout the life of the contract in order to improve the service and its outcomes. 4. For the procurement process to be robust and to not be susceptible to legal challenge. These services must be capable and willing to integrate fully with other services across Norfolk in line with the 5-year strategic vision. The strategic vision for the South Norfolk, North Norfolk and Norwich CCG health and care system in 2019 is to improve our population s health and wellbeing through affordable, integrated, high-quality health and care, tailored to individuals needs and primarily delivered through integrated community and primary care teams. The vision is for integrated health and care services which are accessible, connected and simple to access. These will be based around localities, with multidisciplinary integrated teams delivering a suite of health and care services. West Norfolk CCG has a similar vision for improving the health and well-being of its population through sustainable co-ordinated services with patients in control. The West has a shared commitment across our partnership, called the West Norfolk Alliance, to: reduce organisational boundaries, promote independence, choice and quality through joint assessment, planning and decision-making. This will be achieved through sharing information, utilising technology, developing our workforce and designing innovative commissioning and contracting models. A

3 major reconfiguration programme is underway to develop a sustainable, financially balanced health system, in which 111 and OOHs would play a key role. 3. The Procurement Process The contract value for the services exceeds the Public Contract Regulations threshold of 172,514; therefore a compliant full tender process must be conducted. Because of the complexity of the services, a restricted procurement process is recommended, which is a two-stage process consisting of a PQQ (Pre-Qualification Questionnaire) stage and an ITT (Invitation to Tender) stage. It is recommended that no more than 5 bidders are invited to tender to allow a proportionate process to be managed for both commissioners and providers. The high-level procurement timetable is summarised below: Procurement Timetable: Milestones Advert, Memorandum of Information and Pre- Qualification Questionnaire (PQQ) Published Date 4 th November 2014 Shortlisted bidders Stakeholder Engagement Day Mid December 2014 Invitation to Tender (ITT) Issued 15 th December 2014 Selection of a Preferred Provider 4 th March 2015 New Service Commences 1 st September Service Specification Separate Service Specifications are required for NHS 111 and the GP OOH services. A rigorous process has been undertaken to develop service specifications that both ensure robust and safe services are delivered while enabling prospective provider(s) to be innovative in order to improve the services in terms of experience and outcomes for patients and efficiency for commissioners. Process undertaken: Desk-top research into specification requirements, Preliminary workshop with all CCGs to discuss the requirements; Production of first draft for comment (shared with all CCGs); Feedback incorporated into second draft; Second draft, evaluated feedback and desk-top research shared with CCGs for secondary review; Market engagement day whereby feedback on the specifications was sought from potential bidders; Face to face meeting with individual CCG leads to finalise local requirements; Final draft specifications to be shared with commissioners to gain appropriate CCG sign off. Additionally, specific areas were discussed with subject matter experts such as pharmacy lead and IM&T lead. We expect the NHS 111 and GP OOH service specifications to be agreed by Friday 31 st October The agreed specifications will be re-issued to bidders at PQQ stage with the caveat that there could be minor changes between PQQ and ITT (however, we must ensure that these are minimal). The final specifications will be issued at ITT stage of procurement. 5. Financial Envelope Norwich CCG s finance team has evaluated the financial data regarding the existing contract and have further validated these figures with all CCG CFOs (Chief Financial Officers). A

4 baseline report regarding the financial position for the provision of NHS 111 and GP OOH has been developed for review by all CCGs. 6. PQQ and Tender Evaluation Teams A multi-disciplinary team from participating CCGs will be created to perform the evaluation of PQQ and Tender submissions. The team should be representative of each of the commissioning organisations but should be proportionate to the process to ensure consistency and transparency in performing evaluation to create a robust audit trail. Involvement on the project will require a time commitment from each person involved and will also require contribution in responding to provider clarification questions and supporting on bidder days if requested. Typical time commitment per individual is shown below, but will vary depending on weighting on their area of expertise: PQQ Stage: 0.5 day PQQ question drafting 0.5 day PQQ evaluation preparation 1.0 day PQQ evaluation in own time 1.0 day PQQ moderation ITT Stage: 1.0 day ITT question drafting 1.0 day responding to ITT questions/clarifications 0.5 day ITT evaluation preparation 2.0 days ITT evaluation in own time 1.0 day ITT moderation 1.0 day ITT presentations Total approximate time commitment = 9.5 days per evaluator. Typically a multi-disciplinary evaluation team will consist of individuals from the following disciplines: Clinicians, Quality/Patient Safety, Finance, Contract Management, Human Resources (HR), Information Management &Technology (IM&T), Information Governance (IG) Evaluation Criteria Key to constructing and delivering a successful procurement will be the creation of evaluation criteria for the PQQ and ITT stages. This will require subject matter experts to create suitable questions that seek to ascertain which provider is best able to deliver the service objectives within the financial envelope. Evaluation criteria must be published in detail in both the PQQ and ITT documents. Each question and section must be assigned a weighting that reflects the priority of the service objectives. The evaluation team will jointly work on this task and reach agreement on relative weightings and a proportionate number of questions for each section. The procurement lead will provide guidance, best practice and examples, questions and weightings to assist evaluators, but it is essential that the evaluators take ownership of this guidance and develop targeted questions that probe the key aspects of successful service delivery. The PQQ questions and evaluation criteria to test capability and capacity will be mainly standard questions with a small number of tailored questions, whereas the ITT will contain mainly tailored questions related to service delivery and few standard questions. Legally Compliant Process The procurement process will be conducted in accordance with the Public Contract Regulations. Once the process is commenced there is no ability for CCGs to change the scope of the procurement or the nature in which it is conducted other than contributing to the PQQ

5 and ITT documents. Therefore each CCG is requested to agree commencement of the procurement on 3 November 2014 and commit to agreeing the contract with the preferred provider at the conclusion of the procurement. Any communication to CCG Governing bodies in the interim period will be for information only, and we require this commitment to ensure significant costs are not committed to a process which does not lead to a successful conclusion. 7. Recommendations The Governing Body is asked to agree to: Be a named commissioning organisation in the procurement. This will require the CCG to commit to contracting with the preferred provider at the end of the process, providing due process is followed, as outlined in this document. Any subsequent withdrawal will require the process to be terminated and re-started at significant cost. Support the procurement process by nominating appropriate subject matter experts to form the project team. Appoint a project lead and clinical lead to act as the channel for information cascade into the CCG. Agree to make decisions in line with the CCG s governance process in a timely manner to ensure the project delivers to the planned timescales. 8. Conclusion The next steps are to complete and ratify specification development and commence the procurement. CCG engagement and involvement, as per above, will be critical in ensuring a successful procurement and mobilisation.