FREQUENTLY ASKED QUESTIONS EMIS Practices GMS Systems & Services Procurement

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1 FREQUENTLY ASKED QUESTIONS EMIS Practices GMS Systems & Services Procurement Version No. 1.0 Status: Final Author: Project Management Team Approver: Executive Committee Date: 08/02/2018 Next Review Date: 08/03/2018 GMS Systems and Services Procurement Project FAQs Page 1 of 13 Author: Project Management Team

2 TABLE OF CONTENTS 1 Procurement Outcome What was the procurement process? Were NHS Wales unreasonable in setting the Contract requirements? How did you evaluate the suppliers? Why has EMIS Health been unsuccessful? Is the decision to exclude EMIS a financial one? Who was involved in the decision to exclude EMIS from the Framework Contract? Why weren t we told sooner that EMIS would not be on the Framework Contract? Is it possible to work with EMIS to improve their bid and include them on the Framework Contract? Can the decision be overturned? Is there any form of appeal for a supplier? System Choice Why have Microtest and Vision Health been successful? Why has Microtest been appointed to the Framework, while EMIS who has a large market share in England and years of experience in Wales, has not? EMIS provides the functionality that we require as a Practice. How do we find out if Microtest or Vision systems can meet our requirements? Do Microtest have the software developed to allow immediate integration with the NHS Wales architecture? If not, how long will it take to develop the software? Microtest has a very small market share in England will Vision become a single supplier for Wales by default? What is the process for confirming our system choice? When will we need to make our choice of system? My Practice wants to stay with EMIS what are the options? Can I buy EMIS Web? Impact on Practices Has anyone considered the impact of this outcome on GP Practices that are already struggling with workload? This outcome is going to mean huge disruption and extra work for the Practice. How will this be mitigated? Will we receive financial support? How will you ensure that our data will not be affected by the migration to a new system, affecting clinical care? What if our QoF points are affected? GMS Systems and Services Procurement Project FAQs Page 2 of 13 Author: Project Management Team

3 3.5 As a Practice, we have invested in third party applications that work with EMIS Web. If these don t work with Microtest and Vision we will have lost our investment. How will this be addressed? We have invested a considerable amount of time and effort getting EMIS Web to work for the Practice, for example building templates and reports that help us in our everyday work. We don t have time to re-do this work. How will we be supported to ensure our efforts aren t wasted and we don t have to start again? Can you confirm how much training there will be and how we will be supported to release staff to attend this training? What will happen to services like My Health Online (MHOL)? As nearly half the Practices in Wales use EMIS, how long will migration to a new supplier take? When will the migration begin and when can each Practice expect to take on the new system? Does NHS Wales Informatics Service (NWIS) have sufficient support staff to help manage the migration process? GMS Systems and Services Procurement Project FAQs Page 3 of 13 Author: Project Management Team

4 1 Procurement Outcome 1.1 What was the procurement process? The NHS Wales Informatics Service (NWIS) has managed the procurement process on behalf of the NHS Wales Health Boards. The Contract is between the Health Boards, Velindre Trust (hosting NWIS) and the suppliers and as such NWIS are legally required to conduct the procurement process in line with the Public Contract Regulations 2015 (PCR 2015). The procurement process began in February 2017 when NWIS placed a Notice in the Official Journal of the European Union (OJEU) outlining the requirements and the procurement process to be undertaken to appoint suppliers to a framework. A Competitive Dialogue approach was taken (as set out in PCR 2015). This procurement approach allowed NHS Wales to meet with the suppliers over a course of three months and discuss functional and technical requirements, commercial, legal, financial and operational aspects of the systems and services. A total of six days were spent with each supplier discussing requirements and the contractual agreement, with additional workshops in respect of completing the financial model. Following the dialogue period the suppliers were given an opportunity to submit a trial tender and receive feedback to help inform their final bids. When final tenders were submitted, Vision and Microtest were able to submit final tenders which met NHS Wales requirements, but the EMIS response fell short of the levels that would enable them to be appointed to the Framework. As per PCR 2015 the outcome of the award process was based solely on the evaluation of the final tenders that were received. 1.2 Were NHS Wales unreasonable in setting the Contract requirements? The Contract is in line with the model form of agreement from the Office of Government Commerce (OGC), on behalf of the UK Government for IT Contracts over 10M. This model contract has been used for the previous contract with Vision and EMIS and is extensively used for contracts throughout the UK. The requirements built upon the previous Framework issued in 2011, with additions made from England s GPSoC agreement (covering all GP systems in England), and some further changes made to accommodate Wales-specific policy, practice, standards and national technology infrastructure. There was nothing unusual or unduly onerous in the Contract and it reflected current market standards. Vision and Microtest submitted final tenders that met these requirements. GMS Systems and Services Procurement Project FAQs Page 4 of 13 Author: Project Management Team

5 1.3 How did you evaluate the suppliers? The evaluation model forms part of the tender document set. It was drafted and approved by the Project Executive Committee and shared with the suppliers prior to commencing the competitive dialogue sessions. A threshold methodology was used. This was to ensure that a supplier could not provide a large number of sub-optimal responses relating to the requirements, or make changes to the Contract drafting that would have a detrimental impact on or increase the risk position of NHS Wales, and still be appointed to the Framework. The evaluation model enabled suppliers to test how different levels of scores affected the model and the impact this would have in their ability to pass through scoring thresholds. Suppliers therefore were able to see in advance what effect sub-optimal responses or changes to the Contract drafting would have in terms of scoring. All suppliers were given feedback and clarifications on their draft responses during the dialogue sessions. There was also a trial tender process and additional feedback was provided after those submissions were reviewed. 1.4 Why has EMIS Health been unsuccessful? There were 20 sections of functional/technical, operational, commercial, legal and financial requirements that were scored as part of the evaluation, in which the bidders were required to meet a minimum threshold score. The EMIS response fell short of the required score in 8 of these areas. These were: Core System Requirements Requirements for National Integration Service Levels Performance Monitoring Standards Liability and Risk Payments and Charging (note cost of the solution was not evaluated in this section) Partnership approach to working with NHS Wales Cumulatively there were too many areas where EMIS only partially met the requirements or they made too many changes to the contract drafting, which had a detrimental effect on or increased the risk position of NHS Wales. It is important to note that Vision and Microtest passed the minimum threshold score in all 20 areas. 1.5 Is the decision to exclude EMIS a financial one? No. The sections in which the EMIS failed to sufficiently meet our requirements did not relate to cost. GMS Systems and Services Procurement Project FAQs Page 5 of 13 Author: Project Management Team

6 1.6 Who was involved in the procurement process? The Executive Committee, as a subgroup of the GMS IM & T Programme Board, managed the procurement project. On review of the Evaluation Report the Committee accepted the recommendation to appoint Microtest and Vision to the Framework Contract to and that EMIS should not be appointed. The GMS IM & T Programme Board agreed the decision. Details of the membership of the Executive Committee, Work Stream, Dialogue and Evaluation Teams are below: EMIS users (GPs and Practice/Business Managers) were active participants in the procurement process including the evaluation of bids. NWIS provided the commercial, technical and legal support to manage the procurement process on behalf of Health Boards. Executive Committee Name Role Alan Lawrie (Chair) Dr David Bailey * Dr Carwyn Lloyd Jones Martin Dickinson Michelle Sell Paul Carter (until September 2017) Jayne Lawrence (from October 2017) Director of Primary Community and Mental Health (Powys Teaching Health Board/Cwm Taf University Health Board) Deputy Chair GPC Wales Director of ICT, NHS Wales Informatics Service Head of Primary Care Services, NHS Wales Informatics Service Head of Commercial Services, NHS Wales Informatics Service Head of Primary Care Contracting (Betsi Cadwaladwr University Health Board) Head of Primary Care (Powys Teaching Health Board) *deputies Dr Charlotte Jones, Chair GPC Wales, Dr Peter Horvath-Howard, GPC Wales Work Stream, Dialogue and Evaluation Panel Members Role 2 x GP Practice/Business Managers Associate Medical Director for Primary Care, NWIS Commercial Advisor Director of ICT, NWIS Head of Commercial Services, NWIS Head of Management Accounting, NWIS Head of Primary Care Contracting, Betsi Cadwaladwr University Health Board Head of Primary Care Services, NWIS Legal Counsel, Blake Morgan Project Manager/Support, NWIS Senior Procurement Lead, NWIS Subject Matter Experts (Various), NWIS GMS Systems and Services Procurement Project FAQs Page 6 of 13 Author: Project Management Team

7 1.7 Why weren t we told sooner that EMIS would not be on the Framework Contract? This was not known until final tenders had been evaluated and the process above completed. The procurement Executive Committee could not have pre-judged the situation until this was process complete, as this would have been unfair to all bidders. Once the process was complete, practices were informed as soon as possible. 1.8 Is it possible to work with EMIS to improve their bid and include them on the Framework Contract? No. EMIS were provided with every opportunity to meet the NHS Wales requirements that were published. All suppliers were made aware of the likely consequences of not fully meeting these and not agreeing to the standard terms and conditions (which are used extensively across the UK for major IT contracts). Throughout the procurement process, all suppliers were given feedback and clarification on their draft responses, specifically during scheduled dialogue meetings. Suppliers were also invited to submit trial tenders, for which feedback was given to help them understand areas where work was required to enable them to submit a compliant bid. The PCR 2015 sets out clearly that all procurements must be carried out in a fair, equal and nondiscriminatory manner. As two of the three suppliers involved in this process provided compliant bids, to appoint EMIS onto the Framework would be in clear breach of the regulations and could lead to legal challenges and significant cost for NHS Wales. The outcome of the procurement process has been respectfully acknowledged by Andy Thorburn, CEO EMIS Group, in an update to Welsh users on 31 st January Can the decision be overturned? Is there any form of appeal for a supplier? An initial 10-day "standstill" period was allowed in accordance with the PCR 2015, for aggrieved bidders to bring a challenge to prevent the award of the Framework. No such challenge was received in the timescale. Unsuccessful bidders also have 30 days from the date of notification of the award decision to start proceedings to challenge the procurement process. So far, no such challenge has been notified. Throughout the procurement process the Procurement Executive Committee have been supported by Legal and Commercial Advisors to ensure that the procurement is compliant and we are strongly of the opinion that there are no valid grounds for claim. GMS Systems and Services Procurement Project FAQs Page 7 of 13 Author: Project Management Team

8 2 System Choice 2.1 Why have Microtest and Vision Health been successful? The procurement evaluation focused on ensuring that each supplier offered a system that met the minimum functional requirements, in addition to the wider support, service levels, integration with the Welsh architecture, affordability, value for money and acceptance of risk. Vision and Microtest demonstrated a strong commitment and ability to meet these requirements via their bids and were compliant in all 20 areas of the final tender requirements. 2.2 Why has Microtest been appointed to the Framework, while EMIS who has a large market share in England and years of experience in Wales, has not? As per PCR 15 the Contract Award is based solely on the evaluation of the supplier responses. Microtest were compliant in all 20 areas of the Contract. Microtest are GPSOC accredited, supporting circa 100 sites in England, and are participating in the NHS Scotland procurement process currently. While EMIS do have a large number of Practices in England and Wales their response fell short of the levels that would enable them to be appointed onto the Framework Contract. EMIS were only compliant in 12 out of 20 areas of the final tender requirements. 2.3 EMIS provides the functionality that we require as a Practice. How do we find out if Microtest or Vision systems can meet our requirements? You can visit the Microtest website: You can also visit the Vision Health website at: We appreciate that websites do not provide full insight into the supplier systems and it is intended that more detailed information from both suppliers will be made available shortly. Over the coming weeks we will be discussing with Vision and Microtest a variety of ways that they can promote their systems to you. Practices must attend the organised Roadshow Events, where a demonstration of both systems will be provided, along with an opportunity to meet the suppliers and ask questions. Practices will need to undertake a comprehensive evaluation of the systems to inform their choice of supplier under the new Framework. These will be taking place 17 th April and 3 rd May Practices will be notified of the specific dates and venues week commencing 12 th February. GMS Systems and Services Procurement Project FAQs Page 8 of 13 Author: Project Management Team

9 2.4 Do Microtest have the software developed to allow immediate integration with the NHS Wales architecture? If not, how long will it take to develop the software? Although Microtest are new to Wales they already offer much of the required software to NHS England (patient Access: MHOL, Summary Care Record: WGPR) which will require some development to meet the Welsh requirements. Vision will also need to make some changes to their current software to meet requirements. Suppliers will have 11 months from contract award to build, develop and test their services for deployment from January NHS Wales will provide the necessary resources to assist Microtest and Vision to develop and test NHS Wales National Services. 2.5 Microtest has a very small market share in England will Vision become a single supplier for Wales by default? Microtest has a relatively small market share but support circa 100 sites across England today. All Practices will need to participate in the Roadshow events, including current Vision users. The evaluation process will require Practices to score the supplier systems based on the presentations and information provided. Size of market share is not part of the evaluation criteria. Vision and Microtest have indicated their commitment to work collaboratively with NHS Wales. Both suppliers provide an exciting opportunity to develop GP IT systems and services for Welsh Practices. 2.6 What is the process for confirming our system choice? It is essential that all practices participate in the Roadshow Events, to enable a formal evaluation of the two systems to be completed. The evaluation process will provide Practices with the opportunity to identify the parts of the clinical system that are important to them and use this in the scoring process. Each Practice will be able to undertake their scoring independently, or as a Cluster where they choose to do so. Support and guidance will be provided by the NWIS Primary Care Services team throughout the process. Practices will also be given information regarding the differences between the supplier offers, for example, where they are providing added value functionality or services, or where the requirements have not been met in totality. The full process will be published in advance of the Roadshow Events. The process has been reviewed and endorsed by Health Board, GPC Wales and Practice representatives. GMS Systems and Services Procurement Project FAQs Page 9 of 13 Author: Project Management Team

10 2.7 When will we need to make our choice of system? The outcome of the evaluation will need to be submitted by the end of May My Practice wants to stay with EMIS what are the options? There is no option to stay with EMIS. EMIS Practices will need to evaluate and choose either Vision or Microtest as their new supplier. 2.9 Can I buy EMIS Web? There is no procurement mechanism for a Practice to buy EMIS Web in Wales without losing the integration and support with national systems and IT infrastructure. GMS Systems and Services Procurement Project FAQs Page 10 of 13 Author: Project Management Team

11 3 Impact on Practices 3.1 Has anyone considered the impact of this outcome on GP Practices that are already struggling with workload? GPC Wales, Practice and Health Board representatives were involved in the procurement process from the outset and highlighted the significant impact the potential loss of an incumbent supplier would have, whether that be through supplier withdrawal or via a non-compliant bid. As soon as the outcome of the tender evaluation was known discussions commenced between with GPC Wales, Health Board, Welsh Government and NWIS representatives regarding actions that could be taken to mitigate the impact. We will be looking to work together with Practices to build a full support package. 3.2 This outcome is going to mean huge disruption and extra work for the Practice. How will this be mitigated? Following on from award of the contract there will be immediate discussions with the successful suppliers regarding the feasibility of increasing migration, training and post go-live support for Practices changing system, as well as looking at streamlining the migration process. The NHS Wales Informatics Service will increase staff resource capacity to support the Practices with the planning, pre-go-live, go-live and post go-live administrative tasks. GPC Wales and Health Board representatives are working with NWIS and Welsh Government colleagues to identify additional ways to support Practices during and following system change. Some of the options being discussed are financial support and suspending elements of contractual requirements. We will update Practices as soon as possible regarding these discussions. Work is underway to establish a Stakeholder Reference Group, to include Practices representatives, to design and agree the support package. 3.3 Will we receive financial support? Financial support is one of the options being considered, by Welsh Government and Health Boards. Further information will be provided as soon as possible. 3.4 How will you ensure that our data will not be affected by the migration to a new system, affecting clinical care? What if our QoF points are affected? The suppliers are accredited to GPSOC standards and have provided evidence of their migration processes. As with all data migrations there will be an amount of data checking that will need to be completed. We will be working with Primary Care Informatics colleagues to investigate data checking tools which can help to support this process. GMS Systems and Services Procurement Project FAQs Page 11 of 13 Author: Project Management Team

12 We will also be discussing with Welsh Government and Health Board colleagues to ensure that Practices that have to migrate are not disadvantaged in fulfilling their GMS contractual obligations during their transition. 3.5 As a Practice, we have invested in third party applications that work with EMIS Web. If these don t work with Microtest and Vision we will have lost our investment. How will this be addressed? We are unable to confirm a solution at this early stage. However, it has been raised by stakeholder representatives that Practices who have invested in improving their IT services should not be disadvantaged by an enforced change. We will work with Microtest and Vision to explore options to migrate and support these applications. This issue will also be included in discussions regarding financial support. 3.6 We have invested a considerable amount of time and effort getting EMIS Web to work for the Practice, for example building templates and reports that help us in our everyday work. We don t have time to re-do this work. How will we be supported to ensure our efforts aren t wasted and we don t have to start again? We are considering a number of options including: Working with the new suppliers to determine what can be migrated If external resources can support in template/report building and system configuration We hope that the Practices, via the Stakeholder Reference Group, will help to advise on what will work best. 3.7 Can you confirm how much training there will be and how we will be supported to release staff to attend this training? We will be working with suppliers to ensure that the right amount of training is provided, at the right time. We acknowledge that each Practice is different and will work with each on an individual basis to agree a plan. We will take advice from Practices as to how best to enable staff to participate in training sessions. 3.8 What will happen to services like My Health Online (MHOL)? MHOL and all other national services will be provided and further developed by the two successful suppliers. Any migration activities will be planned, supported and undertaken as part of the new system migration process. 3.9 As nearly half the Practices in Wales use EMIS, how long will migration to a new supplier take? Migrations will start in January 2019 and must be completed by the end of July 2020 (19 months). GMS Systems and Services Procurement Project FAQs Page 12 of 13 Author: Project Management Team

13 3.10 When will the migration begin and when can each Practice expect to take on the new system? The majority of Practices will take on the new system in line with current contract dates expiry i.e. 5 years after they went live with their current system. For Practices changing system, it is expected that the migration process will start approximately 3 months before the planned go-live date Does NHS Wales Informatics Service (NWIS) have sufficient support staff to help manage the migration process? The NHS Wales Informatics Service will take on additional staff where required to support the migration process. In addition, we will work with Vision and Microtest to exploit additional resources and available technology to make the process as smooth and cause as little disruption as possible. Many lessons were learnt as a result of the system changes and migrations that Practices undertook, during the previous Framework implementation, which also required a high number of system transitions, and these will be incorporated into the new migration plans and processes. A Stakeholder Reference Group, led by Practices, will be established to agree the best mechanisms to provide support through the process. GMS Systems and Services Procurement Project FAQs Page 13 of 13 Author: Project Management Team