Delivering Substance Misuse

Services in a New and

Emerging LandscapeRecommissioning approaches and intentions

South Gloucestershire Drug & Alcohol Action Team

(DAAT)

Welcome and

introductionsHouse keeping, format of morning and

introduction of the Recommissioning

Working Group

Suite of Key Documents

• Commissioning intentions paper

• Pre-engagement consultation report and feedback

• Adults, Housing & Public Health Committee

approval

• Service user feedback analysis

• Substance Misuse Needs Assessment and JSNA

Support Pack

• Joint Strategic Assessment for Crime & Disorder

• Performance scorecards and pilot profiles

• TUPE briefing

Recommissioning Working Group• Matt Wills – Programme Lead & Lead commissioner

• Rosie Collins – SHIP Operational and Shared Care Lead

– (provider liaison outside of recommissioning team)

• Nasrul Ismail – Performance and Commissioning and

Lead for the ProContract

• Jacqui Offer – Specialist Public Health Manager

• Dr Neil Kerfoot and Dr Greg Clarke – Lead GPs

• Christopher Johnson – Solicitor, Legal Services

• Nicola Lewton – Corporate Procurement Manager

• Andy Hichens – CAH Commissioning Hub

• Peter Heffernan– Corporate Consultation

Wider Engagement Partners

• The Care Forum

• CVS South Gloucestershire (CVS/VCSE)

• Office for the Police & Crime Commissioner

• NHS England

• Public Health England (PHE)

• Clinical Commissioning Group (CCG)

• Safe & Strong Communities

• Avon & Somerset Constabulary

• Wider Public Health representatives

• Wrapped around the urban fringe of Bristol

• 53,000 hectare area, making us one of the largest unified local authorities

• 60% of population live in urban fringe suburbs

• Numerous small villages and market towns

• Shared borders with priority authority

• Large commercial centres

• Largest custody suite in Avon & Somerset

Geography of South Gloucestershire

• Wrapped around the urban fringe of Bristol

• 53,000 hectare area, making us one of the largest unified local authorities

• 60% of population live in urban fringe suburbs

• Numerous small villages and market towns

Geography

Key features of South

Gloucestershire

• Location for University of West of England

• Several high value added industries, 46th least deprived local authority in England

• Six priority neighbourhoods across the area

• Economic activity rate above national average

Substance Misuse in South Gloucestershire

• Accessibility issues and housing shortages

• Priority around alcohol, NPS (legal highs) and

opioid analgesics prescribing

• Shared care philosophy and pharmacy

engagement

• Integrated clinical and psychosocial model

• Value for Money - Every £1 spent on substance

misuse in South Gloucestershire will derive an

£8.34 saving in crime reduction and increased

health and wellbeing

What has shaped our decision-making?

• Outcomes of Government Comprehensive

Spending Review

• National Public Health Grant reductions

• Local Authority Savings Plan

• Transfer of responsibilities to Public Health

• More devolved responsibilities

• NHSE, Clinical Commissioning Group and

NOMS reductions

• Department of Health and PHE Directives

Public Health Grant Reductions & Council Savings Plan

Year Public Health Grant

Allocation

Reduction Management Plan

2014/15 £2,500,000 None None

2015/16 £2,300,000 £200,000 In year cost savings, use of

reserves, reduction of

facilitation budgets.

Removal of payment by

results levy. Ending of pilots

and non-essential

commissioned services

2016/17 £2,150,000 £150,000 Variation of contracts with

providers in contract period.

Ceasing innovation and

grant process. Reduction of

facilitation budgets

2017/18 £2,000,000 £150,000 Adjustment of

recommissioning envelope,

full recommissioning, and

service redesign

New landscape of commissioning

• Localism Act 2011

• Transfer of PCT responsibilities

• Change of direction for health & crime

services

• Brave commissioning

• Effective critical analysis

• Robust needs assessments

• Pooling of budgets

• Collaborative relationships

Questions:

• What has altered the landscape of

commissioning?

• What are the new priorities for commissioners?

• What is the impact for providers?

• What are the gaps & unmet need?

• What are the impacts of Payment by Results &

Value For Money?

• Impact/benefit for service users?

How Will We Procure?

• Seek Adult, Housing & Public Health Committee approval

• Assemble a Recommissioning Working Group

• Work within European Union/SGC framework (Light

Touch/Restricted)

• Use the E-Tendering platform (ProContract)

• Ensure a comprehensive consultation window

• 12 month process to allow appropriate process

• Clarity, transparency, openness, fairness, and maximising

opportunity

Commissioning model: IPC joint model for public care

Recommissioning Timeline

• Consultation Period – 4th April – 26th June

• PQQ Stage – 19th July – 17th August

• Notification of PQQ Outcome – 7th

September

• Successful PQQ Providers Meeting – 21st

September

• ITT Stage – 27th September – 31st October

• Evaluation, Moderation, and Committee

Approval – 1st November – 20th December

• Notification of Award – 21st December

• Standstill Period – 21st December – 11th

January 2017

• Contract Finalisation – 12th January 2017 –

31st March 2017

Supplying the

South West Portalhttps://www.supplyingthesouthwest.org.uk/

All communication, questions and tender

submissions will be done through this route

without exception

TUPE

• Currently services are delivered by a number of

external providers all of whom have been notified

of the procurement process

• Although as the commissioning body South

Gloucestershire cannot declare TUPE applies, it

would suggest that under the current regulations

in some cases it may

• All providers have been requested to ensure

TUPE information is prepared and ready to be

submitted as part of the re-procurement process

Solution-focused Outcomes

Clinical Interventions

• Right time, right person, and right treatment

• Patients need to feel they are in a seamless service

• Needs-led intervention, allowing safe clinical decision

making

• More integrated approaches

• Structured expectations early and regular reviews

• Choice of clinical intervention linked with need and best

health outcomes, and NICE compliant

• Bio-psycho-social modelling

• Empowering and improving confidence in GPs

Examples of Barriers to Recovery

• Last 15 years – developed a primary clinically-led

service

• Get them on, keep them on, keep them safe

• Structuring expectations

• Working, earning, living….why take me off my

methadone?

• One size does not fit all

• Poly drug use

What is our direction

of travel?

Where Do We Want to Be?

• More investment in brief interventions and preventative services

• Better validation of the health and cost benefits

• Access to a primary care located package of recovery focused clinical and psychosocial interventions

• More integration of secondary specialist drug services

• Care planned engagement will dictate treatment need (thresholds)

• Understanding the population profile and delivering needs-led services

• Structuring and embedding expectations regarding clinical interventions

• Stepped care approaches

• BBV interventions and harm reduction services

• Continuity of care upon release

• Better use of local hubs and pharmacies

Where Are We Heading?

• Engagement of OCUs & non OCUs

• Clinical interventions - recovery focused

• Bio-psychosocial modelling and strong key working

• Integrated pathways & services, including IOMU

• Conversant with different performance metrics for national and local requirements

• Proactive performance management of the services

• Robust data recording systems are robust and compliant

• Effective and measurable outcomes and can we implement effective payment by results?

• Effective Primary Care Integration

Selection of Consultation Feedback

Trading Standards should be included in

the considerations for the new model.

The new landscape of substance misuse now

dictates that we need to be proactive towards

emerging trends of which NPS and alcohol is

prevalent. We already ensure that our

colleagues in the Trading Standards Department

are included and would be highlighted as

significant stakeholders.

We will continue to ensure that the department

is fully included in the suggested model and

clear working protocols remain in place.

To ensure Equalities and Equalities Impact

Assessments are included as part of the

commissioning as well as the service

model

Equalities & EIA will be completed as part of the re-

commissioning process as well as included on the

PQQ and ITT tendering documents. All potential

providers will be expected to ensure that this is in

place as part of the contractual responsibilities.

To ensure the Local Compact is more

specifically included within the

commissioning and service delivery

Yes, we agree. We will ensure that the Local

Compact is more specifically included and

identified. CVS South Gloucestershire has been

involved in the re-commissioning process and we

rely on them to advise us on the best practices

within COMPACT during the process.

Substance Misuse

Treatment Model

Rosie CollinsSpecialist Health Improvement

Practitioner – Substance Misuse

Shared Care Vision

• The current shared care model and wider

treatment system

• Why does shared care work in South

Gloucestershire?

• Issues for the future

Proposed future model

• Expansion of shared care

• Continuation of effective unstructured

alcohol services

• Consultation with GPs

Performance

Management

Nasrul IsmailPerformance & Commissioning

Officer

Current Case Mix – Structured Treatment YTD

Opiate , 53%

Non-opiate , 18%

Alcohol, 21%

Alcohol and Non-opiate,

8%

Current Case Mix – Non-structured

Treatment and Pilot Projects

Performance Wishlist

• Linking with services that are

considered priorities for the

Director of Public Health,

Health & Wellbeing Board,

and Safer & Strong

Communities

• Linking with Public Health

Outcome Framework (PHOF)

• Proactive management of

performance by the service

providers

• Better data recording for ‘pain’ areas, such as

dual diagnosis and the number of service users

starting Hepatitis B vaccinations

• Improving poor transfer from the prison treatment

and criminal justice system into the community

setting

• Improving transition pathways from young people

into adult services

Managing Performance

• Quarterly performance monitoring based on the

national and local performance indicators

• Reported through performance scorecards

• Half-year reviews

• Annual Needs Assessment and Payment by

Results (PbR)

• Managing underperformance

Remote and Smarter Working

• Using mobile devices within the GP surgeries to

access GP software, such as EMIS, appointment

management systems, and case management

systems

• Providers will need to ensure remote work as

part of their bid

• Consideration of ownership and management of

the implementation, communications, IT

infrastructures, and information governance

Jacqui Offer

Specialist Public Health

Manager

Wider Public Health Agenda

• Emerging Public Health priority regarding alcohol

• Alcohol Stakeholders’ Group subgroup function

• How this fits with the wider substance misuse

agenda?

• Substance Misuse Needs Assessment

• Whilst alcohol is a priority area, we recognise poly

drug use with alcohol as a common substance

• Joint working with the Clinical Commissioning

Group

Embedding Wider Public Health Initiatives

• Expanding primary care to deliver wider Public

Health objectives including smoking cessation,

sexual health, and mental health

• Linking with pharmacies to deliver Healthy Living

Pharmacy accreditation and signposting

• Using key engagement points to Make Every

Contact Count (MECC)

• Mobilising the Health Champion workforce

• Using resources available eg Books on Prescription

Steve Spiers

Public Health Programme Lead

– Mental Health & Emotional

Wellbeing

Linking Mental Health With Substance

Misuse

• Do we build a joint approach around referrals

and community interventions?

• The wellbeing college helps develop protective

factors for all risky behaviours so easily links to

substance misuse?

• Can we link commissioning to ensure

sustainability?

Comfort Break

What are we looking for…• Effective relocation of current SMS to a primary care setting

• Supporting GPs and building trusted relationships

• Embedding specialist services across the system as opposed to discrete

• Maximising entry, effective retention & successful exits

• Appropriate support mechanisms for transition & rapid re-capture

• Maximising the use of IBA, brief interventions and education and preventative approaches

• Effective & measurable recovery outcomes throughout the entirety of the treatment journey

• Pathways supporting sustained abstinence

• Continued engagement and retention of CJ clients and OCU’s as a primary cohort linked to crime and health

Tender Lots

• Lot 1 – Engagement

• Lot 2 – Integrated Primary Care Service (including Single Point of Contact)

• Lot 3 – Community Reintegration

• Excluded: Residential Rehabilitation, Pharmacy IBA, OST element of shared care, Opioid Analgesics Dependency Pilot Project (ending June 2018), and service user advocacy

Lot 1

Engagement and

Primary

Intervention

Engagement and Primary Intervention

• Lot 1 is building from the effective early interventions

and brief advice model delivered so far

• It will need to focus on up and coming trends and

engaging with the hardest to reach groups

• Its primary aim will be:

– Structuring expectation, moving service users

towards care planned interventions

–Delivering brief interventions to reduce the costs

associated with secondary care

–Working with a transitional aim

Key areas of delivery

• Harm reduction and management of the Needle

Exchange (community and pharmacy) and BBV

services

• Managing criminal justice client transfers from

court, custody suites, and prisons

• Leading innovations with emerging drugs such

as NPS and steroids

• Delivering Alcohol IBA services in primary and

secondary care

• Delivering Naloxone programmes

• Working with YPDAS regarding seamless

transition from young people into adult treatment

services

• Assisting community partners in developing

themselves as effective points of information

• Supporting our vision of Healthy Living

Pharmacies

Lot 2

Integrated Primary

Care Service

(including SPOC)

Single Point of Contact• This service will offer a rapid triage assessment,

meet all required targets, and refer service users to

the appropriate services

• To operate as the single point of contact between

Monday and Friday, 09:00am – 17:00pm. Out of

office hours can be agreed

• Attend to ad hoc data requests from the

commissioners

• Moving away from data inputting to data monitoring

• The need for a dedicated data analyst ring-fenced to

South Gloucestershire work only

Case Management System

• The case management system will be chosen

and managed by the service provider

• It must comply with NDTMS core dataset

upgrades and must have the ability to submit

agreed data directly into DAMS

• The service provider will be expected to train all

users of the system and make appropriate

investments into the case management system

• Compliance with the current dataset

• Maintain accurate information

• Capable of generating requested data in a timely

manner

• Data sharing protocols

• Safe haven of data as part of the contingency

plan

Integrated Primary Care Service

•Shared care vision

•Expansion of primary care

•Increased number of shared

care workers

Integrated Primary Care Service

• Consultation so far

• GPs

–Key points

–Concerns or issues raised

• Space

• Cost

• IT and information governance

• Further considerations

Lot 3Throughcare

Services

Housing

• To support people to achieve long-term positive housing outcomes and to promote independence

• To address the barriers for service users’ ability to access and sustain suitable accommodations and to assess if people develop a range of life skills

• To oversee the management of Access Scheme (previously known as the Deposit Bond Scheme)

Peer support

• To provide additional help to service users in

achieving their recovery goals

• To lead in the recruitment, comprehensive

training, line-management supervision, and on-

going support of peer support workers

• To ensure that peer support workers are given

opportunities to work across services as

appropriate and have choices in a variety of roles

that promote development and visible recovery

Employment

• To facilitate access to education, employment, training, and volunteering in order to build upon the service users’ recovery capital

• To forge strong links with statutory and non-

statutory providers, such as JobCentre Plus,

local work programme providers, and further

education establishments

• To work with service users who successfully gain

employment (paid and unpaid) to sustain their

ongoing employment and recovery

What about the

money?Trying to maximise effectiveness

with reduced budgets

Potential Funding Envelopes

• We have not yet finalised the funding elements as we are

still finalising the PHG and elements of provision which

will be included, but what we do know:

– PHG for 2017/18 will be approximately £2,000,000

– We have made the necessary cuts in line with the CSR

and CSP of 21% so currently have met all the

necessary reduction targets

– We are anticipating that by making these advanced

reductions at the start of the process there will be

minimal alterations

– PHG and CSP continues to be challenged for the next

few years so may alter total SMS PHG

Indicative Percentages of the SMS PHG

• Lot 1 – 10%

• Lot 2 – 41%

• Lot 3 – 7.4%

• GP services including Public Health Contract

(previously known as LES) – 8.4%

• Pharmacy services (including LES & IBA) – 3%

• Residential rehabilitation including inpatient

16.2%

• Other ad hoc services – 14%

Any questions?