Surrey Heath Clinical Commissioning Group Enhanced Services Update Governing Body 4th February 2014 ‘The best possible health outcomes for our local community’

Background and context NHS England delegated authority to CCGs to commission LES (locally enhanced services – primary care service providers ) during 13/14. 1 year only. GB briefed on 2nd July 2013. From April 2014 need to decided whether to re-commission services & add any new Enhanced Services. Member practices asked to submit any potential new enhanced services in March 2013 and discussed at CPDG 19th April and worked up through this committee with final recommendation agreed of 22nd November. Also need to decide procurement route & whether any of Enhanced Services are suitable to be offered out more widely via AQP (Any Qualified provider) or competitive tender. ‘The best possible health outcomes for our local community’

‘The best possible health outcomes for our local community’ Decision Making CPDC made recommendation Review Group Panel to ES Review Group Panel (Lay members and Director of Nursing and Quality) on 3rd December ES Review Group Panel comments integrated into final recommendation to Remuneration Commitee Final decision delegated to Remuneration Committee due to timings of GB meetings. Some further detail/assurance required To NOTE at February GB meeting. Slide 3 ‘The best possible health outcomes for our local community’

‘The best possible health outcomes for our local community’ Decision Making The Remuneration Committee on 17th December were asked to AGREE the following: Which Local Enhanced Services to be re-commissioned (existing) or new services to commission Procurement Route for each service Assure that Conflicts of Interest have been appropriately managed Agree pricing for services Slide 4 ‘The best possible health outcomes for our local community’

Role of NHS England Area Team During 13/14 NHS England has delegated authority to CCGs for Local Enhanced Services (but not related to public health) as part of the CCG’s statutory responsibility for improving the quality and accessibility of primary care Surrey and Sussex AT put process in place to ensure that there was a standardised approach in place for the signing off of the ES future plans The SHCCG procurement decisions for current LES went to an AT panel meeting on the 17th December – all recommendations were supported expect the phlebotomy ES The GB will be updated on the implications of implementing the recommendation to go through a single tender process Slide 5 ‘The best possible health outcomes for our local community’

‘The best possible health outcomes for our local community’ Process ‘The best possible health outcomes for our local community’

‘The best possible health outcomes for our local community’ Note: This original process changed slightly in that the Rem Com replaced the Extraordinary GB meeting with regard to decision making. ‘The best possible health outcomes for our local community’

Clinical Engagement and Managing Conflicts of Interest Managing potential conflicts of interest appropriately is needed to protect the integrity of the NHS commissioning system and protect clinical commissioning groups (CCGs) and GP practices from any perceptions of wrong-doing. Separation of clinical input and decision making. Clinical input from member practices on existing service specifications, new service ideas and specifications, financial framework principles, and clinical implications of procurement options. Advice and guidance via the LMC Not involved in decision making (Governing Body members & Remuneration Committee excluding conflicting members) ‘The best possible health outcomes for our local community’

Financial Framework Principles Greater standardisation Clear, transparent and consistently applied pay rates Consistent medical rate of pay based on GP rates but used for all medical providers A fully costed service including overheads ‘The best possible health outcomes for our local community’

Procurement Considerations Need & strategic fit Quality Patient Safety Clinical effectiveness Access/convenience/choice Integration Patient Access Reducing inequalities Market conditions Service bundling Proportionality ‘The best possible health outcomes for our local community’

Procurement Recommendations ‘The best possible health outcomes for our local community’

Contracting & Procurement Options All Enhanced Services have to be on a Standard NHS Contract Plan to have one contract per practice with specific services in annex Procurement Options Single tender (appointed provider/group of providers without competition) Any qualified provider (enables patient choice from a number of providers, all of whom meet service specification) Competitive tender (appointment of a specific provider(s) ‘The best possible health outcomes for our local community’

Procurement Recommendations - Existing Service Recommendation Rationale for decision 24 hour BP monitoring Single tender Proportionality: low value of the contract prohibitive procurement costs for both providers and commissioners compared to value Phlebotomy The current quality benefits for some (complex/urgent) patients of having an integrated service being delivered by their practice and the potential loss of this service (due to volumes) if the service goes through AWP or competitive tender Zoladex ‘The best possible health outcomes for our local community’

Procurement Recommendations - Existing Service Recommendation Rationale for decision Minor Surgery AQP or equivalent Potential to increase choice of provider for patients and referring GPs (not all provide minor surgery) INR Single tender Proportionality: low value of the contract prohibitive procurement costs for both providers and commissioners compared to value Diabetes significant patient quality benefits of integration and continuity of care with the patients’ primary care provider Slide 14 ‘The best possible health outcomes for our local community’

Procurement Recommendations - New New Services Shared decision making Single tender Proportionality: low value of the contract prohibitive procurement costs for both providers and commissioners compared to value DVT Drug monitoring No other provider possible Slide 15 ‘The best possible health outcomes for our local community’

Costs - Pricing schedule Update at GB meeting following final agreement by Remuneration Committee Represent significant additional investment (40% increase) to support CCG strategy of more community based services through the commissioning of activity from primary care Slide 16 ‘The best possible health outcomes for our local community’

Benefits – Measures of Success Reduction in hospital based activity – CCG to identify which ES should deliver reduction in hospital activity and by how much. ES integration in practice working to improve quality of clinical to patients. Reduction in variation between practices/reduction in inequality – number of ES taken up by all practices Slide 17 ‘The best possible health outcomes for our local community’

‘The best possible health outcomes for our local community’ Next Steps Single tender procurements – share services specification & prices with practices (mid Feb) Ask for expressions of interest by end of Feb Move all contracts onto Standard NHS Contract Prepare for market testing of minor surgery ES – review service specification, prices, test market interest (end March) Take proposed within year ES on medical input into nursing homes via CPDC (decision by end June) Slide 18 ‘The best possible health outcomes for our local community’

‘The best possible health outcomes for our local community’ Next Steps Complete AQP process for minor surgery by end September 2014 Review phlebotomy ES by end September Identify benefits & costs from other CCG procurement processes Assess qualitative benefits of keeping ES as single tender with specific focus on access to phlebotomy expertise within practices & level of same day testing. Beginning of October commence process for 15/16 Slide 19 ‘The best possible health outcomes for our local community’