Commissioning NHS Health Checks via the Local Authority November 2012 Hilary Sharpe, Consultant in Public Health Darren Plant, Healthy Lifestyles Commissioning Manager

Local Picture  Large, semi-rural county, population 530K  Eligible population = 190,000 (38,000 per year)  67 GP practices, three CCGs  Current performance  GP LES  4.5% of eligible population invited by end Q2  Pilot outreach provider commissioned

LA Commissioning Process  Contract novation workstream of PH Transition planning  ID need for commissioning support for NHS HC in light of GP LES coming to an end  Initial meetings with LA contracting and brokerage lead to discuss procurement process  Contracting support officer assigned to support HCs  Procurement timescales agreed  Cabinet approval

Service Delivery Model StrengthsWeaknesses Single Provider  Easier to contract manage and quality assure  Single IT system and ability to set up a single call-recall process  Equitable service delivery  ? Access to patient lists  Loss of primary care engagement  Risk of under performance  Limited number of potential providers Multiple Providers  Maximum of 6 contracts to manage  Easier for primary care/CCGs to engage  Equitable service delivery  Easier to facilitate engagement between providers  GP federation model in its infancy  Risk of underperformance e.g. if individual GPs don’t engage with CCG model  Not all residents are registered with a Worcestershire GP Any Qualified Provider  Ability to engage a range of providers including smaller providers  GP practices could undertake activity on behalf of neighbouring practices  Reduced risk of underperformance  Open contracting process  Difficult and time-consuming to manage and QA multiple contracts  Difficult to manage a call-recall list  External providers will rely heavily on opportunistic invitations  Risk of over performance  V. difficult to record no. of invites

Procurement timescales  Contracts for 2 years plus option of extending for 2 further years Tender pack preparedSept / October 2012 Advert out on council’s e-tendering portal (open for 6-wks) November 2012 Evaluation and accreditationJanuary 2012 Standstill periodFebruary 2012 Contracts issuedMarch 2012 Service deliveryFrom April 2013

Procurement Process  Service specification  Inclusion of alcohol and dementia  Agreement of a single HC process for all providers  Tariff agreement  Clinical input  Development of quality criteria  Involvement of council legal team  Worcestershire County Council standard contract  Learning from recent smoking cessation services procurement process

Ongoing issues  GP concerns re. use of external providers  Quality  Additional workload  Liability for high risk cases  Lack of tendering knowledge amongst GP practices  IT issues  No single call-recall process  National data reporting via GP clinical systems  Issues with existing GP IT system  POCT

Key learning to date  Ensure service spec. is robust  Dedicated support from council contract officers  Clinical input required but potential conflict of interest  Need to ensure process is fair to all potential providers  Support for GPs to write tenders - who should provide?  AQP is not an easy solution  Contact details:  Or