1. Tendering – How low do you go? Claire Lemer

2. My Roles

3. The Commissioning Process PHASE 2: Procuring services PHASE 1: Strategic planning PHASE 3: Monitoring and evaluation Assessing need Reviewing service provisions Deciding priorities Designing services Shaping structure of supply Planning capacity and managing demand Supporting patient choice Managing performance Seeking public and patient views

4. Why Tender? To introduce new providers To encourage efficiency in the system To drive innovation To ensure value for money

5. Alternatives to tendering Negotiated altered pricing plans Reconfiguration Bringing in external management – Private e.g. Just management – Public e.g. Opth at BGH is by RFH

6. Tendering for the market... Publically available slides by Charlie Davie Neurologist

10. The Big Picture

11. The Slightly smaller picture

12. New buildings Requirement to meet financial targets Articulation of vision and mission Increasing focus on Quality of Care – Francis Report Increasing focus on patient satisfaction Increasing competition from external providers Uncertainty whilst wider changes enfold The Local Picture

13. The Tender Process Advertisement of Intended Tender Intention To Tender Short-listing of ITTs Full Tender Short-listing of Full Tenders Interviews Decision announced Appeals

14. DRSS- Nationally National screening programme v.v. specific rules: – Proportion to invite to screen – Proportion to be screened – Exemptions – Training of screeners Computerised programmes linking GP records to computer system

15. Screening Pathway Result not possible Patient identified as Diabetic from GP records Patient invited to screening Patient screened by photography Patient screened using slit lamp Photograph reviewed Screen result given to patient, GP and entered into record Patient advised

16. Locally NMUH provided DRSS for approximately 50,000 pa Grew organically Started before the national screening programme Covered Enfield and Haringey Camden and Islington Programme suspended NMUH took over C+I for 1 year Tender for 5 areas including Barnet Barnet had their own service provided by GPs – very high standard E+H not quite meeting national targets in 18 months prior to tender

17. How would you go about preparing the proposal?

18. A False Start..

19. ITT Short document Focused on organisational ability to deliver Will ask about insurance, previous history Limited information about planned option Often no cost indication Accompanying this will be a service specification asking identifying what the commissioners want

20. What we did locally.. Disconnect confusing governance lines Improve our local performance Prove ourselves capable of managing a bigger programme Build links with commissioning team Build information about competitors Get the exec on side Decide if we would join a consortia Create a tender team: – Exec – Lead for DRSS – Programme heads – HR – Finance

21. Full Tender -The Proposal Very formulaic, strict word counts Opening page often about costs May even expect a bottom line figure

22. What we did locally.. Map out staff we had Map out staff that we would need to employ Identify what our preferred model of delivery was – Lower banded staff doing work? – Outsourcing reviewing – Numbers of sites – Involvement of opticians – Same day results? Map staffing onto this preferred model Identify the key areas of concern: – Prisons, Mental Health – Hard to reach groups How low could we go... – Was NMUH prepared to subsidise the bid? – Where there any bits of the service that were not included in the bid? – What were the knock on effects of loosing the service? The “brainwave”

23. The Interview Panel of commissioners 15 mins to present and answer questions Limited number of people able to present

24. Interview Team Practiced the pitch Identified who to take Practised potential questions Spent time guessing who the panel was

25. Then the fun really begins – delivery..