Monthly Contract Briefing October 2018 - (M5) - NHS Rushcliffe CCG
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Monthly Contract Briefing October 2018 (M5)
Introduction
The contracting function is a central function within GN CCP and manages contracts that relate to services provided for
Greater Nottingham CCP, and includes Acute, Mental Health and Out of Hospital services. The Directorate sits within the
Chief Commissioning Officers portfolio and is split in to two directorates Contracting and Procurement under Maxine
Bunn – Director of Contracting and Procurement, and Acute Contracting under Mark Sheppard – Director of Acute
Contracting.
This report is a joint report with information from both Directorates and is jointly authored.
This paper is to provide an update on the contracting team function and progress and involvement in those areas of the
Greater Nottingham Clinical Commissioning Partnership (GN CCP) business that is broader than just contracting.
This paper does not aim to replicate information contained within the finance report or the performance report that
both include information from contracting as to the metrics and national standards expected of providers, however
where there is escalation or unusual activity this will be covered here.
2Executive Summary
This report is for information and summarises the following;
• National Direction
• Team Structures Update
Acute Contract update
• Treatment Centre Direct Contract Award
• Treatment Centre Procurement
• Acute Contracting and Financial Recovery
• Acute Contracting risks and issues
• Acute Contracting Challenges
• 2019/20 Contract Round
Mental Health and Out of Hospital Contracting
• Mental Health contracting risks and issues
• Mental Health Contracting Challenges
• Community Beds
• Mental Health and Out of Hospital Financial Recovery
• Out of Hospital Contracting Challenges
3Executive Summary: Key Issues & Highlights Dashboard
Acute Out Of Hospital Mental Health
Treatment Centre direct contract in place and New contract with Citycare commenced on 1 July Processes for contract and performance
performing below plan. 2018 for 6 years and 9 months with an option to management are being reviewed and
Treatment Centre ITT published and due to close on 1st strengthened.
Nov. extend for 2 years. Mobilisation has been
Transforming OP at NUH delivering a significant completed. For all other contracts the NHS
reduction in activity ready for 19/20 planning. national variation is in place for 2018/19. New
contracts will be agreed for 2019/20.
Financial Recovery
Financial Recovery Financial Recovery
Financial recovery schemes within the NUH contract
currently sit in an adjustments POD, these are due to be
CV’d on to their individual POD lines. Review of non-acute contracts ending Mar 19, to 2018/19 QIPP schemes delivered. Planning for
Contract challenges and Service Restriction Policy are determine future commissioning intentions. 2019/20 to work within the existing financial
returning savings ahead of plan. envelope and ensure the Mental Health Minimum
Stroke Rehab work is ongoing with all 3 providers PMO has been established with Local Partnerships Investment Standard is met.
however the cost to commissioners in 18/19 is forecast to to review opportunities for efficiencies.
be at least £2m lower than 17/18. Review of commissioned services has started and
NUH incentive scheme continues to be challenged with
will be progressed in quarter 4 2018/19.
regards to delivery but ambition and joint working remain
strong.
Contract Risks Contract Risks
Contract Risks
A number of community bed contracts are due to Processes for managing performance have been
Top risks expire on 31/03/19. Work is ongoing to improve strengthened. Performance has improved across a
Team capacity with recruitment still underway. occupancy and length of stay. number of key performance indicators including
Early Intervention in Psychosis, dementia diagnosis
Full contract round to be delivered with a and a reduction in the number of Out of Area
Reporting requirements for the CityCare contract
predominantly new team. occupied Bed days.
is being reviewed.
Provider planning assumptions for 19/20.
4National Direction
Engagement on the NHS payment system reform To ensure these are realistic and fully aligned
2019/20 Contract negotiations proposals has been published which sets out the between commissioner and
options being considered for the 2019/20 National
Tariff. The planning guidance, with confirmation of the
Planning timetable detailed expectations, is due December 2018. Both
Including a blended payment approach for urgent commissioners and providers are expected to work
Mid December; and emergency care . together during the autumn on aligned, profiled
• Publication of CCG allocations for 5 years demand and capacity planning.
• Near final 2019/20 prices To remove the marginal rate for emergency tariff
• Technical guidance and templates and the emergency readmissions rule, proposed
• 2019/20 standard contract consultation and changes to the Market Forces Factor and a proposed
dispute resolution guidance approach to resourcing of centralised procurement.
• 2019/20 CQUIN guidance
• Control totals for 2019/20 It is also proposed to start the process of
transferring resources from the provider
Mid January sustainability fund into urgent and emergency care
• 2019/20 National Tariff section 118 consultation prices.
Mid February The planning guidance will include further details on
• Standard Contract published the provider and commissioner sustainability funds
for 2019/20.
Early March Incentives and Sanctions
• National Tariff published
From 1 April 2019, the current CQUIN scheme will
Contract signature deadline 21 March 2019 be significantly reduced in value with an offsetting
increase in core prices. It will also be simplified,
Payment reform focussing on a small number of indicators aligned to
key policy objectives drawn from the emerging Long
A revised financial framework for the NHS will be set Term Plan.
out in the Long Term Plan, with detail in the
planning guidance which will be published in early Alignment of commissioner and provider plans
December 2018.
There will be a further expectation regarding plans.
5Team Structures
Vacancies Vacancy Risks Next Steps
Both directorates continue to build the teams to As identified above there are a number of key
align with the published structures. Recruitment is This report will aim to keep the JCC updated on
vacancies within the contracting directorates and
ongoing with both internal and external progress over the coming months will all aspects.
the risk associated to this is capacity to undertake
recruitment. the overall workload at present.
Those vacancies that have been filled are in the The key priorities faced by both functions include
period where the new team members are giving the TC procurement, Financial Recovery, National
notice in their current roles. MH reporting and the maintenance of the daily
function.
This capacity issue is concerning as we are about to
enter the contracting round for 2019-20. The 2019-
20 contracts will also be a full round and not the
second year of a contracting period.
To assist with, and mitigate some of this risk, the
Acute Team is currently making use of a consultant
to expedite some of the financial recovery aspects
of the current workload including Stroke and Service
Restricted Procedures.
The MH team has interim consultancy support until
December to ensure robust preparations are in
place to support the contract round.
6Acute
Contribution to Financial Recovery
The Acute contracting team is working very closely with both Planned Care and
Urgent Care to realise cost savings in year and in future years. Headline
schemes include;
• Service Restriction Policy – new policy now in place, Blueteq approval
system supported and being implemented along with our Mid Notts
colleagues.
• Contract Challenges – joint working across Contracts, BI and Finance to
improve and strengthen the challenge process.
• Stroke Services – Ongoing work with all 3 providers to re-design pathways
to maximise efficiency.
• Transforming Outpatients – Ongoing work with Elective care to move this
scheme in to 2019/20
• NUH Incentive scheme – work ongoing with NUH to understand
opportunities for both parties.
• ED Front Door – working with Urgent care to ensure contracting input with
this project.
Acute Contract Planning
Planning meetings for 2019/20 have been established with our main providers
and high level negotiation principles are being set.
Work underway to review FOTs and ensure these are aligned to form a firm
basis for year end and next years round.
National direction is awaited on a number of issues.
7Acute: Contracting Risk & Issues
Provider Issue Action Outcome
NUH ED Performance Working with the NUH team to ensure the Agreed RAP to be monitored
content of the RAP is appropriate contractually and escalated via
the contract as necessary
NUH Children’s Wheelchairs RAP in place and performance being Likely need to close the CPN at
delivered in line with expectation the next CEB
NUH Uncoded Notes (‘U’Codes) Due to a significant number of uncoded We are in discussion with NUH
notes being submitted within the NUH regarding the recovery model
data we have raised an Information and period and therefore the
Breach Notice (IBN) consequence of the breach.
Circle Within a direct contract award period
until July 2019.
No current issues.
BMI and Ramsey Current contracts expire March 2019 new contracts will be awarded to both Contracts to be awarded.
providers for a further 12 months on a
rolling programme.
Nottingham Procurement underway Undertaking a legally defensible process Outcome awaited
Treatment Centre to select a new provider
8Acute: Contracting Challenges
Total Value Of Contract Monitoring Challenges Submitted [YTD]
Value of Challenge
Nottm City CCG Nottm North & East CCG Nottm West CCG Rushcliffe CCG Other Total % of Contract Value
NUH £1,518,423 £698,613 £387,044 £518,131 £1,164,656 £4,286,867 1%
Circle £6,821 £5,441 -£2,366 £22,065 £20,331 £52,292 0.1%
TOTAL £1,525,244 £704,054 £384,678 £540,196 £1,184,987 £4,339,158 0.8%
Total Value of Successful Contract Monitoring Challenges Submitted [YTD]
Value of Challenge
Nottm City CCG Nottm North & East CCG Nottm West CCG Rushcliffe CCG Other Total % of Challenges Submitted
NUH £641,028 £350,172 £156,825 £177,600 £309,103 £1,634,728 0.3%
Circle 0 0 0 £21,217 £8,649 £29,866 0.04%
TOTAL £641,028 £350,172 £156,825 £198,817 £317,752 £1,664,594 0.3%
The process for contract challenges is currently being reviewed to assure members of its robustness.
9Mental Health
The CCGs are currently in escalation in respect of the following developed which is being monitored on a monthly basis.
performance and transformation standards;
Out of Area Placements
Children and Young People Nottinghamshire has been identified as an outlier in the number of
Target 1 is to increase the number of children and young people patients being treated in an acute inpatient bed classed as ‘out of
receiving treatment from mental health community services. Target area’. A recovery action plan has been developed which outlines
2 is to improve waiting times for access to eating disorder services actions being taken to ensure the national standard of achieving
by 2021. Progress is being made to improve performance in both zero out of area placements is achieved by 31 March 2021. A
target areas, a recovery action plan has been developed, which is performance management structure has been established to
monitored on a monthly basis. oversee the implementation of all actions. The number of out of
area placements has been reducing.
Early Intervention in Psychosis
A recovery action plan has been developed to improve performance
in Early Intervention Psychosis services and achievement of NICE
standards; actions are monitored on a monthly basis.
Early Intervention in Psychosis treatment targets are now being
achieved across the CCP. In August 2018 all CCGs exceeded the 53%
target.
Improving Access to Psychological Therapies (IAPT)
The target for access rates has increased and the targets are being
met in Nottingham North and East, Nottingham West and
Rushcliffe, the target is not being met in Nottingham City. Waiting
times are also increasing and a recovery action plan has been
10Mental Health: Contracting Risk & Issues
Provider Issue Action Outcome
Nottinghamshire Children and Young People Services Recovery Action Plan has been Performance standards are achieved
Healthcare NHS developed which outlines actions and children and young people can
Foundation Trust; being taken to improve performance. access services within nationally set
Nottingham City Council; The action plan is monitored on a waiting times.
Base 51; Kooth monthly basis, all actions are on track.
Nottinghamshire Early Intervention in Psychosis Recovery Action Plan has been Access standards continue to be met
Healthcare NHS developed which outlines actions and services deliver to NICE standards
Foundation Trust being taken to improve performance. of care.
The action plan is monitored on a
monthly basis, all actions are on track.
Multiple – Insight; Improving Access to Psychological Therapies (IAPT) Recovery Action Plan has been Access rates are achieved and waiting
Nottinghamshire developed which outlines actions times are reduced.
Healthcare NHS being taken to improve performance.
Foundation Trust; The action plan is monitored on a
Trent PTS monthly basis, all actions are on track.
Nottinghamshire Out of Area Placements Recovery Action Plan has been The number of out of area placements
Healthcare NHS developed which outlines actions continues to reduce and the 2020/21
Foundation Trust being taken to improve performance. target is achieved.
The action plan is monitored on a
monthly basis, all actions are on track.
11Out of Hospital
A review of all contracts in place for Greater Nottingham CCGs is in progress.
Community Beds
There are ongoing discussions with both community providers regarding an interim position during 2019/20, whilst a further
review and procurement decision is undertaken.
Out of Hospital Contracting and Financial Recovery
The review of contracts in 2018/19 has been achieved.
The potential savings for the 2019/20 plan is low. Contracts have been identified and had an initial screening. Further work
required around potential impact and engagement requirements.
A System Affordability workstream has been established jointly with the provider to develop plans to deliver savings from the
Local Partnership Physical Health Community Contracts. Task and finish groups have been established to review each of the
service areas.
12Out of Hospital: Contracting Risks & Issues
Provider Issue Action Outcome
Citycare and NHT Local Community Beds • Renegotiate contract values with providers for an • Continuity of bed stock in order to
Partnerships Length of stay and occupancy rates remain a interim period during 2019/20. Discussions are meet demand
focus. ongoing and executive meeting to be arranged for • Ensuring value for money of current
w/c 29th October 2019. contracts.
Bed cost rates in a number of facilities are higher • Revised referral criteria to beds immediately.
than expected. • Longer term plan to be drafted.
Potential legal challenge around direct award of
contracts.
Citycare Activity plan and reporting requirements Working with the performance team: • Interim reporting.
Contract requirements are not specific enough to • Agree an interim position. • Agreed reporting for 2019/20
allow performance management of activity • Renegotiation as part of the 2019/20 contract contract.
carried out vs plan. discussions.
NHT Local Partnerships Outcomes Framework • Progress discussions early around the intentions for • Value to be agreed and CV into the
Agreement on the % of contract value which is 2019/20. contract.
attributed to outcomes, has previously been
contentious in contract negotiations.
NHT Local Partnerships Performance management • Contract team to progress actions, as well as • Recommendations to be transacted
Recent 360 audit identified a number of areas for implementing where appropriate to other similar within the contract where
improvement around performance management contracts. appropriate.
(note this has not yet been presented to the audit • Report back to audit committee on
committee). progress. 13Procurement
A review of all CCG commissioned services is underway to determine the Integrated Urgent Care Pathway Procurement
requirement for future procurements. This includes primary care and Nottinghamshire (Mid Notts and Greater Nottingham) commissioners have
locality specific contracts. An update will be provided as the review agreed to explore jointly commissioning an integrated urgent care pathway
progresses. across Nottinghamshire. This will encompass:
• 111 Call Handling
Identified in this report are the two main areas where a procurement is • Clinical Assessment Service (including health care professional calls and
either in progress or a procurement is likely. advice)
• Out of Hours primary care (including home visits)
• Urgent Treatment Centres (likely to be based at Newark hospital, Sherwood
Treatment Centre Procurement (TCP) Forest A&E and NUH A&E)
The procurement process continues and we are currently in the ITT stage A PID is being developed and associated governance structure set up with
where bidders are developing there submissions. The closing date is 1 delegated responsibility for decision making from Governing Bodies.
November 2018.
The team is currently working on identifying those who will be required to It is likely that elements of the above pathway will require procurement for
undertake the evaluation of the submissions. There is a mandated training new contractual arrangements to be in place by October 2019. This is mainly
pack and 3 days for moderated evaluation over the 12th,13th and 14th Nov. driven by the end of the current NEMS contract in October 2019 with no
option to extend. The current contract comprises telephony clinical
assessment (Patient and professional), Out of hours , admission avoidance and
primary care at the front door (QMC and NUH)
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