NHS shorter-form Contract 2017/18 – 2018/19 NHS Standard Contract Team December 2016 nhscb.contractshelp@nhs.net https://www.england.nhs.uk/nhs-standard-contract/17-18/

Agenda Background to development of NHS shorter-form Contract 1 Background to development of NHS shorter-form Contract 2 Feedback and development for 2017/18-2018/19 3 Uptake and usage 4 Future developments

Background

Background NHS Standard Contract is the single vehicle for commissioning contracts for clinical services Tailorable – but still 200+ pages long Used for a very wide range of services provided by very different types of organisation “One size fits all” Too complex, cumbersome and burdensome for smaller provider organisations NHS England commitment To provide a shorter-form version of the Contract and guidance on its use … which we did, for contracts commencing 1 April 2016 The NHS Standard Contract is the mandated form of contract for commissioning non-primary healthcare services – this means that it has to cope with a very wide range of services, from one bed care home contracts and small community service contract, to very large acute and A&E contracts. The issues that commissioners and providers face is that the contract is large - for 2016/17 it was 190 pages long – and too burdensome for the smaller contracts and providers. So NHS England undertook to produce a shorter-form version of the Standard Contract, for use for contracts commencing 1 April 2016. The result, after a lot of engagement with commissioners and providers and provider groups during 2015, was a contract 76 pages in length ready for use for contracts commencing 1 April 2016. It was published on the NSH Standard Contract web page and as eContract, we publicised it in our 2016/17 workshops, and published a shorter-form Contract User Guide to encourage uptake.

What does the shorter-form Contract look like? What’s the same … Same structure and clause numbering as full length Contract What’s different … About a third of the length of the full length Contract Fewer ‘policy requirements’ placed on providers (though the requirements which most relate to safety and quality have largely been retained) Contract management process are less detailed and complex We retained the same three part structure of the full length contract, and the same clause numbering, as we felt it was important that the shorter-form had the same ‘look and feel’ as the full length Contract – this was a message we received loud and clear during our engagement. But the shorter-form form Contract is about a third of the length of the full length Contract, and it places far fewer policy requirements on providers, and the contract management provisions are simplified.

No financial threshold How can it be used?   non-inpatient mental health and learning disability services community services (eg provided by pharmacies, GPs, optometrists, voluntary sector) hospice care / end of life care services outside acute hospitals continuing health care (care homes) patient transport services non-inpatient diagnostic, screening and pathology services including National Tariff acute services A&E services inpatient mental health services emergency ambulance services 111 services any other hospital inpatient services We determined that the shorter-form Contract could only be used for certain types of service – those on the left hand side of the slide – as this meant that we could further shorten the contract provisions. We didn’t set a financial threshold for its use, but strongly encouraged commissioners to use the contract, by reviewing their contracts on a service type basis to see which could be moved to the shorter-form. It is our general expectation that the SF will be more suitable for lower contract values / simpler packages of services, rather than for complex multi-million packages of different community services (eg provided by a community Trust). No financial threshold

Feedback and development for 2017-19

Engagement for 2017/18 and 2018/19 In year feedback Summer 2016 – invited stakeholder comments on full-length Contract Followed by specific shorter-form questionnaire Formal consultation autumn 2016   Yes No No answer Total Support short-form? 117 9 6 132 Leave broadly unchanged? 68 55 Robust enough? 82 33 17 Slim down further? 35 80 Add back policy detail? 69 58 5 Add back National Prices? 61 53 18 About right Too onerous Too onerous? 91 24 Following the engagement on the full length Contract in July 2016, we undertook a specific engagement on the shorter-form Contract, which told us that we had pitched it about right. The results of the engagement questionnaire are on the slide, and this was followed by the formal consultation in Sept – Oct 2016. [We received feedback that we should add policy detail to the contract – but in the interests in minimising the burden on providers, we took a decision not to do so]. [We did add the National Pricing provisions to the Contract – feedback we received suggested that in removing these, we had in some instances artificially limited the circumstances in which it could be used]

Developments Updated in line with the full length Contract Addition of National Pricing Two year contract 2017/18 – 2018/19 The exact changes between the 2016/17 and the 2017-19 shorter-form Contract are published on the NHS Standard Contract web page. The changes we have made to the full-length version of the Contract have carried over into the shorter-form version where relevant. There has been one significant design change to the shorter-form version for 2017/19. We have now included in it the detailed provisions which are needed to cover services to which National Prices apply (under the National Tariff Payment System). This is in response to feedback that our previous approach had prevented the shorter-form Contract being used for small-scale community-based diagnostic services – for some of which there are National Prices. The biggest change for 2017-19 is the expectation that contracts will be awarded on a two-year basis, as far as possible, to encourage stability in the market.

Uptake and usage

Downloads Snapshot of downloads from NHS Standard Contract 2016/17 web page (March – Sept 2016):   Full-length Shorter-form Particulars 16,731 5,064 Service Conditions 13,297 3,106 General Conditions 10,392 2,703 Total 40,420 10,873 Here is a quick snapshot of the downloads from the NHS Standard Contract web page, of the 2016/17 contracts over the period March – September 2016. We had over 40,000 downloads of the full length Contract documents – that is, the three parts of the Contract taken together – the Particulars, the Service Conditions and the General Conditions – which go to make up each contract. Over the same period, we have nearly 11,000 downloads of the shorter-form Contract documents. So we had fewer downloads of the shorter-form Contract. This may have been due to the fact that it was a new product and that commissioners were in mid-term contracts which could not be moved to the shorter-form.

eContract (https://www.econtract.england.nhs.uk/Home/) Apr – Dec 2016 2016/17 Full length 1892 2016/17 Shorter-form 2288 Nov – Dec 2016 2017-19 Full length 488 2017-19 shorter-form 198 If we look at the eContract system however the situation is different. Here are the figures for the generation of the shorter-form and the full length Contracts – the 2016/17 Contract over the period April – December 2016 and the 2017-19 Contracts over the period November – December 2016. The eContract system hosts the Particulars and the Service Conditions, not the General Conditions. Over the period April – December 2016, nearly 2,000 full length Contract documents were created and over 2200 shorter-form Contract documents were created over the same period. For the 2017-19 Contracts since they were published in November, users have created nearly 200 shorter-form Contracts compared to nearly 500 full length Contracts [perhaps due to the fact that there is a national requirement to get contracts of a higher financial value signed by 23 December].

Future developments

Two-year Contracts Publishing a two-year Contract means that there will probably be no (or minimal) changes for 2018/19. But do send us feedback to england.contractsengagement@nhs.net /

Shorter-form Contract interactive pdf Links Contract text to Technical Guidance Displays Defined Terms New development for 2017-19 – we are publishing the shorter-form Contract as an interactive pdf. This is intended as a training aid to encourage take up of the shorter-form Contract. The interactive pdf displays the Contract text on the left hand side of the screen, and when the user clicks on the ‘i’ icon, the relevant text appears in the right hand panel. When a user hovers their pointed over a defined term in the Contract, the definition appears in the panel. This allows a reader to view the relevant Technical Guidance explanations and the definitions for the defined terms alongside reading the actual contract – so it’s all on one page, rather than having to cross-refer to look things up.

Questions

Questions 1 Question 1 Question 2 I think it may be good it to mention responses to and next steps for the Workforce Disability Equality Standard and 'Disability as an asset' Are there any differences in the due diligence processes/criteria which organisations have to meet in order to enter into a short-form contract compared to the full one? Question 1 We did include a requirement on providers in the full length Contract to implement WDES from 1 April 2018, and to report annually from 31 March 2019. This requirement wasn’t carried over into the shorter-form Contract, as we are trying to reduce the policy and the reporting burden on smaller providers. Of course, the full length Equality and non-discrimination provisions are found in the shorter-form Contract. [Await any feedback from Kate Milton] Question 2 This is handled by the commissioner when they are tendering for the services, but we would expect any due diligence to be proportionate to the type of contract being tendered.

Questions 1 Question 3 Question 4 What guidance is being given to local areas as to when to use the shorter-form Contract? (and any incentives to increase take-up of it?) How will take-up/use be monitored? Question 3 Guidance is provided in the NHS Standard Contract Technical Guidance and in the shorter-form User Guide, and this was reinforced in the Contract training videos for 2017-19. That is, to review service category areas and to see where the shorter-form Contract could be used. Ultimately this is a commissioner decision. A commissioner may decide to not use the shorter-form Contract for a service category or which it is suitable. For example, the contract may be mid term, and changing terms and conditions would bring the risk of procurement challenge; the service categories may be bundled with other categories for which the full length Contract must be used; the contract may require the more stringent contract management processes; etc. Question 4 We don’t have sight of how may contracts there are out there, or how many are on the full length or shorter-form version. But we do know that the shorter-form Contract is being used, as we can see how many times it has been downloaded from our web page and from the eContract system.

Guidance and Support

NHS Standard Contract web page https://www.england.nhs.uk/nhs-standard-contract/17-18/ Contract Technical Guidance https://www.england.nhs.uk/wp-content/uploads/2016/11/7-contract-tech-guid.pdf Shorter-form User Guide https://www.england.nhs.uk/wp-content/uploads/2016/11/9-shorter-form-user-guid.pdf Queries on the NHS Standard Contract (full-length and shorter-form) should be sent to: nhscb.contractshelp@nhs.net