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

2. 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’

3. ‘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.
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4. ‘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
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5. 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
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‘The best possible health outcomes for our local community’

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

7. ‘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’

8. 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’

9. 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’

10. 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’

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

12. 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’

13. 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’

14. 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
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15. 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
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16. 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
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17. 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
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18. ‘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)
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19. ‘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
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