PROPOSED ESCALATION FRAMEWORK FOR CONTRACT MANAGEMENT 2013/14 USING THE NEW NHS STANDARD CONTRACT DIRECTOR, COMMISSIONING & CONTRACTING

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1 MEETING: CCG GOVERNING BODY IN PUBLIC AGENDA ITEM: 3.4 SECTION: OPERATIONS DATE: 4 JUNE 2013 TITLE: FROM: FOR: PROPOSED ESCALATION FRAMEWORK FOR CONTRACT MANAGEMENT 2013/14 USING THE NEW NHS STANDARD CONTRACT HARPER BROWN DIRECTOR, COMMISSIONING & CONTRACTING INFORMATION 1 ISSUE The Governing Body are asked to note the proposed escalation framework for contract management 2013/14 using the 2013/14 NHS standard contract. 2 STRATEGIC AIM / ASSURANCE FRAMEWORK / EQUALITY DELIVERY SYSTEM LINKS This paper is linked to the following risk on the Clinical Commissioning Group (CCG) Assurance Framework - CMP1: Risk to contract negotiations 2013/14. The paper is also linked to Strategic Aim 4 (Contracts Management and Performance) and EDS Goal 2 Improved patient access and experience. 3 KEY POINTS Cambridgeshire and Peterborough CCG (C&P CCG) wishes to make their intentions clear from the outset of the year; as a newly formed Clinically Led Commissioning Group, responsible for securing services for our local population that are cost effective, safe, of high quality and patient focussed. Through the terms of our agreed Contracts we will transparently and fairly enforce all mandatory consequences as set out in the 2013/14 NHS Standard Contract. This will be led by the Local Commissioning Groups (LCG) Clinical leads, with the appropriate contract manager working, through the regular monthly contract management meetings, in partnership with other CCGs and NHS England. Everyone Counts : Planning for Patients 2013/14 sets out the expectation that Commissioners should enforce the standard terms of the contract, including the financial consequences of under-performance or the failure to provide accurate and Page 1

2 timely data on which to assess performance. C&P CCG fully intends to work in this way and expects all providers with NHS contracts to explicitly aspire to adhere to all national standards in a proactive and collaborative working environment for the benefit of all patients. C&P CCG also wishes to address particular local performance issues such as stroke care and delayed transfer of care in a proactive, collaborative and effective way to improve the overall performance of our local health and social care economy. We have proposed a set of local quality and service improvement measures through the local quality measure schedule and proposed consequences for some of these measures which will benefit our local health and social care system. We expect local NHS providers to raise their ambitions and sign up to incremental as well as step changes in service improvement and transformation to benefit patients. We will enforce the national and local performance standards through contract queries when performance is off track. This would constitute an exacting notice if the remedial action plan (RAP) is put into place. We would expect a local NHS provider to be proactive in developing a (RAP) immediately if performance is off track in advance of any query raised. C&P CCG is determined to ensure our local health and social care system performs to the best of its ability on all national performance requirements and therefore contract query notices will be the normal way of initiating performance recovery and we expect the monthly contract and performance meetings to routinely manage RAPs including consequences with LCG Clinical Leadership. The key areas where we till track and monitor performance are 1. Quality and Safety requirements there is a comprehensive set of national and local quality requirements that will be monitored thorough a monthly quality dashboard. 2. NHS Constitution requirements - these are monitored through Trust specific monthly performance reports. 3. Cambridgeshire & Peterborough CCG local contract requirements these include activity and productivity thresholds. 4. Contract Activity and financial performance these are monitored through Trust specific monthly activity and finance reports. Relevant Quality Premium and NHS mandate measures are covered in the requirements above. 1. Performance Thresholds and Escalation Process for non-delivery of requirements: the thresholds that providers have to achieve and the triggers for escalation of performance issues under the contract are set out in Annex A pages 1 to 4. This process will be used across all contract teams. Page 2

3 2. Activity and finance variances from plan: the triggers for escalation of over performance or under performance on activity and finance issues under the contract are set out in Annex B. This process will be used across all contract teams. Commissioners are responsible for managing external demand for services and C & P CCG working through its LCGs and practices will be performance managing activity much more transparently during 2013/14 and expect to work in partnership with NHS providers to manage risk and ensure clinically appropriate work is delivered and paid for correctly. C&P CCG will increase its audit and scrutiny of activity and referral during 2013/14 to ensure clinical appropriateness and improve patient experience in access appropriate care and treatment at the right time and right place. 3. The formal national contractual process for any quality and service Contract Queries is laid out in General Condition 9 of each contract. This process is summarised in Annex C. 4. The formal national contractual process for any Activity Queries is laid out in Service Condition 29 of each contract. These processes are summarised in Annex D. 5. C&P CCG will issue information contract queries in line with Service Condition 28: information requirements where information is submitted inaccurately or incomplete. This will lead to 1% withholding where necessary as accurate and timely information is essential to a fair and transparent contracting process and our local systems need to address this issue openly with some providers. This process is summarised in Annex E. Oversight of the process for each contract will be led by the relevant LCGs clinical contract leads and their contracting team. They will retain a flexibility to make decisions on these processes that are appropriate to local circumstances. These will be reported internally to the Director of Commissioning and Contracting. 4 RECOMMENDATION The Governing Body is asked to note the key actions for contracts in 2013/14 5 BACKGROUND INFORMATION Annex A, B, C, D & E attached. Author: Harper Brown Director Commissioning and Contracting 22 May 2013 Page 3

4 ANNEX A - ESCALATION FRAMEWORK FOR CONTRACT MANAGEMENT 2013/14 Quality and Performance standards 1. QUALITY AND SAFETY Contract escalation te some Quality measures are only reported on a quarterly basis. Delivering required standards? Is this final data for reporting period? Commend Trust at next Formal Review Contact Trust to assure all under control and Trust can deliver requirements Key Measures Threshold for review MRSA: all cases Clostridium Difficile: all cases subject to review panel Never events: all events Mixed sex accommodation: all breaches CQC Concerns and Action Plans: Red All other Quality dashboard indicators: Red Clostridium Difficile CQC concerns Apply Financial Consequences MRSA Cdiff Never events MSA Other indicators Is explanation & evidence satisfactory? How many months of nondelivery? Keep under review until closed 3 months (or 3 reporting periods) on any Quality indicator 1/2 months (or 1/2 reporting periods) Issue Contract Query Contractual Query Process Initiated General Condition Clause 9.4/9.5 (See Annex C) Page 4 If Consider issuing Contract Query

5 2. NHS CONSTITUTION Contract escalation Delivering required standards? Is this final data for reporting period? Commend Trust at next Formal Review Contact Trust to assure all under control and Trust can deliver requirements Key Measures Threshold for review RTT 18 weeks - admitted <90% RTT 18 weeks non-admitted <95% RTT 18 weeks incomplete <92% RTT >52 weeks >0 Diagnostics 6 weeks <99% A&E 4 hours <95% Cancer 2 weeks <93% Cancer 2 weeks breast <93% Cancer 31 days <96% Cancer 31 days sub surgery <94% Cancer 31 days sub drugs <98% Cancer 31 days sub radio <94% Cancer 62 days <85% Cancer 62 days screening <90% Ambulance handovers >15mins >0 Cancelled operations 28 days >0 Apply Financial Consequences Monthly RTT Diagnostics Cancelled Operations Ambulance Handovers Quarterly A&E Cancer Is explanation & evidence satisfactory? How many months of nondelivery? Keep under review until closed 2 months 1 month Monthly standards Quarterly standards Consider issuing Contract Query Issue Contract Query If Contractual Query Process Initiated General Condition Clause 9.4/9.5 (See Annex C) Page 5

6 3. Cambridgeshire & Peterborough local measures Contract escalation Delivering required standards? Is this final data for reporting period? Commend Trust at next Formal Review Contact Trust to assure all under control and Trust can deliver requirements Key Measures Threshold for review Maternity smoking referrals <90% Maternity smoking at delivery no reduction in % Stroke unit 90% time <80% TIA treated within 24 hrs. <60% Discharge summaries not within agreed timeliness Clinical thresholds not within agreed policy Follow-up ratios >agreed ratio C2C policy not within agreed policy A&E zero LOS no reduction A&E conversion Any change Is explanation & evidence satisfactory? Keep under review until closed Apply Financial Consequences In line with specific Trust contracts How many months of nondelivery? 2 months 1 month Monthly standards Quarterly standards Consider issuing Contract Query Issue Contract Query If Contractual Query Process Initiated General Condition Clause 9.4/9.5 (see Annex C) Page 6

7 Annex B - ESCALATION FRAMEWORK FOR CONTRACT MANAGEMENT 2013/14 Contract Activity and Finance Over or under performance Continue to monitor Key Measures Threshold for review Activity against plan: over/under performance Finance against plan: over/under performance Delivery of planned t delivering service changes: planned outcomes Is it significant? Continue to monitor Significant over or under performance will depend on the size of Trust and what activity assumptions underlie plans and have been included in the contract as triggers. In general at a service line it will be any variance from plan of 3% and/or 50k. Analyse potential reasons for over/under performance What are the potential reasons? Reasons potentially within Trust control Consider issuing Activity Query tice Reasons outside Trust control Initiate LCG/CCG action plan Activity Query Process Initiated Service Condition Clause 29.12/29.13 (see Annex D) Page 7

8 ANNEX C Page 8

9 Page 9

10 ANNEX D Page 10

11 ANNEX E Page 11