Monthly Contract Briefing October 2018 (M5)

Introduction

The contracting function is a central function within GN CCP and manages contracts that relate to services provided for Greater Nottingham CCP, and includes Acute, Mental Health and Out of Hospital services. The Directorate sits within the Chief Commissioning Officers portfolio and is split in to two directorates Contracting and Procurement under Maxine Bunn – Director of Contracting and Procurement, and Acute Contracting under Mark Sheppard – Director of Acute Contracting. This report is a joint report with information from both Directorates and is jointly authored. This paper is to provide an update on the contracting team function and progress and involvement in those areas of the Greater Nottingham Clinical Commissioning Partnership (GN CCP) business that is broader than just contracting. This paper does not aim to replicate information contained within the finance report or the performance report that both include information from contracting as to the metrics and national standards expected of providers, however where there is escalation or unusual activity this will be covered here.

2

Executive Summary

3

This report is for information and summarises the following; • National Direction • Team Structures Update

Acute Contract update • Treatment Centre Direct Contract Award • Treatment Centre Procurement • Acute Contracting and Financial Recovery • Acute Contracting risks and issues • Acute Contracting Challenges • 2019/20 Contract Round

Mental Health and Out of Hospital Contracting • Mental Health contracting risks and issues • Mental Health Contracting Challenges • Community Beds • Mental Health and Out of Hospital Financial Recovery • Out of Hospital Contracting Challenges

Executive Summary: Key Issues & Highlights Dashboard

4

Acute

Treatment Centre direct contract in place and performing below plan. Treatment Centre ITT published and due to close on 1st Nov. Transforming OP at NUH delivering a significant reduction in activity ready for 19/20 planning.

Out Of Hospital Mental Health

Processes for contract and performance management are being reviewed and strengthened.

Financial recovery schemes within the NUH contract currently sit in an adjustments POD, these are due to be CV’d on to their individual POD lines. Contract challenges and Service Restriction Policy are returning savings ahead of plan. Stroke Rehab work is ongoing with all 3 providers however the cost to commissioners in 18/19 is forecast to be at least £2m lower than 17/18. NUH incentive scheme continues to be challenged with regards to delivery but ambition and joint working remain strong.

Financial Recovery

Contract Risks

Top risks Team capacity with recruitment still underway. Full contract round to be delivered with a predominantly new team. Provider planning assumptions for 19/20.

Financial Recovery

Contract Risks

Financial Recovery

Contract Risks

Processes for managing performance have been strengthened. Performance has improved across a number of key performance indicators including Early Intervention in Psychosis, dementia diagnosis and a reduction in the number of Out of Area occupied Bed days.

New contract with Citycare commenced on 1 July 2018 for 6 years and 9 months with an option to extend for 2 years. Mobilisation has been completed. For all other contracts the NHS national variation is in place for 2018/19. New contracts will be agreed for 2019/20.

2018/19 QIPP schemes delivered. Planning for 2019/20 to work within the existing financial envelope and ensure the Mental Health Minimum Investment Standard is met. Review of commissioned services has started and will be progressed in quarter 4 2018/19.

Review of non-acute contracts ending Mar 19, to determine future commissioning intentions. PMO has been established with Local Partnerships to review opportunities for efficiencies.

A number of community bed contracts are due to expire on 31/03/19. Work is ongoing to improve occupancy and length of stay. Reporting requirements for the CityCare contract is being reviewed.

National Direction

5

2019/20 Contract negotiations

Planning timetable

Mid December; • Publication of CCG allocations for 5 years • Near final 2019/20 prices • Technical guidance and templates • 2019/20 standard contract consultation and

dispute resolution guidance • 2019/20 CQUIN guidance • Control totals for 2019/20 Mid January • 2019/20 National Tariff section 118 consultation Mid February • Standard Contract published

Early March • National Tariff published

Contract signature deadline 21 March 2019 Payment reform

A revised financial framework for the NHS will be set out in the Long Term Plan, with detail in the planning guidance which will be published in early December 2018.

Engagement on the NHS payment system reform proposals has been published which sets out the options being considered for the 2019/20 National Tariff.

Including a blended payment approach for urgent and emergency care .

To remove the marginal rate for emergency tariff and the emergency readmissions rule, proposed changes to the Market Forces Factor and a proposed approach to resourcing of centralised procurement.

It is also proposed to start the process of transferring resources from the provider sustainability fund into urgent and emergency care prices.

The planning guidance will include further details on the provider and commissioner sustainability funds for 2019/20.

Incentives and Sanctions

From 1 April 2019, the current CQUIN scheme will be significantly reduced in value with an offsetting increase in core prices. It will also be simplified, focussing on a small number of indicators aligned to key policy objectives drawn from the emerging Long Term Plan.

Alignment of commissioner and provider plans

There will be a further expectation regarding plans.

To ensure these are realistic and fully aligned between commissioner and

The planning guidance, with confirmation of the detailed expectations, is due December 2018. Both commissioners and providers are expected to work together during the autumn on aligned, profiled demand and capacity planning.

Team Structures

6

Vacancies Both directorates continue to build the teams to align with the published structures. Recruitment is ongoing with both internal and external recruitment. Those vacancies that have been filled are in the period where the new team members are giving notice in their current roles.

Vacancy Risks As identified above there are a number of key vacancies within the contracting directorates and the risk associated to this is capacity to undertake the overall workload at present. The key priorities faced by both functions include the TC procurement, Financial Recovery, National MH reporting and the maintenance of the daily function. This capacity issue is concerning as we are about to enter the contracting round for 2019-20. The 2019-20 contracts will also be a full round and not the second year of a contracting period. To assist with, and mitigate some of this risk, the Acute Team is currently making use of a consultant to expedite some of the financial recovery aspects of the current workload including Stroke and Service Restricted Procedures. The MH team has interim consultancy support until December to ensure robust preparations are in place to support the contract round.

Next Steps This report will aim to keep the JCC updated on progress over the coming months will all aspects.

Acute

7

Contribution to Financial Recovery

The Acute contracting team is working very closely with both Planned Care and Urgent Care to realise cost savings in year and in future years. Headline schemes include; • Service Restriction Policy – new policy now in place, Blueteq approval

system supported and being implemented along with our Mid Notts colleagues.

• Contract Challenges – joint working across Contracts, BI and Finance to improve and strengthen the challenge process.

• Stroke Services – Ongoing work with all 3 providers to re-design pathways to maximise efficiency.

• Transforming Outpatients – Ongoing work with Elective care to move this scheme in to 2019/20

• NUH Incentive scheme – work ongoing with NUH to understand opportunities for both parties.

• ED Front Door – working with Urgent care to ensure contracting input with this project.

Acute Contract Planning

Planning meetings for 2019/20 have been established with our main providers and high level negotiation principles are being set. Work underway to review FOTs and ensure these are aligned to form a firm basis for year end and next years round. National direction is awaited on a number of issues.

Acute: Contracting Risk & Issues

8

Provider Issue Action Outcome

NUH ED Performance Working with the NUH team to ensure the

content of the RAP is appropriate

Agreed RAP to be monitored

contractually and escalated via

the contract as necessary

NUH Children’s Wheelchairs RAP in place and performance being

delivered in line with expectation

Likely need to close the CPN at

the next CEB

NUH Uncoded Notes (‘U’Codes) Due to a significant number of uncoded

notes being submitted within the NUH

data we have raised an Information

Breach Notice (IBN)

We are in discussion with NUH

regarding the recovery model

and period and therefore the

consequence of the breach.

Circle Within a direct contract award period

until July 2019.

No current issues.

BMI and Ramsey Current contracts expire March 2019 new contracts will be awarded to both

providers for a further 12 months on a

rolling programme.

Contracts to be awarded.

Nottingham

Treatment Centre

Procurement underway Undertaking a legally defensible process

to select a new provider

Outcome awaited

Acute: Contracting Challenges

9

Total Value Of Contract Monitoring Challenges Submitted [YTD]

Value of Challenge

Nottm City CCG Nottm North & East CCG Nottm West CCG Rushcliffe CCG Other Total % of Contract Value

NUH £1,518,423 £698,613 £387,044 £518,131 £1,164,656 £4,286,867 1% Circle £6,821 £5,441 -£2,366 £22,065 £20,331 £52,292 0.1%

TOTAL £1,525,244 £704,054 £384,678 £540,196 £1,184,987 £4,339,158 0.8%

Total Value of Successful Contract Monitoring Challenges Submitted [YTD]

Value of Challenge Nottm City CCG Nottm North & East CCG Nottm West CCG Rushcliffe CCG Other Total % of Challenges Submitted

NUH £641,028 £350,172 £156,825 £177,600 £309,103 £1,634,728 0.3%

Circle 0 0 0 £21,217 £8,649 £29,866 0.04%

TOTAL £641,028 £350,172 £156,825 £198,817 £317,752 £1,664,594 0.3%

The process for contract challenges is currently being reviewed to assure members of its robustness.

Mental Health

10

The CCGs are currently in escalation in respect of the following performance and transformation standards; Children and Young People Target 1 is to increase the number of children and young people receiving treatment from mental health community services. Target 2 is to improve waiting times for access to eating disorder services by 2021. Progress is being made to improve performance in both target areas, a recovery action plan has been developed, which is monitored on a monthly basis.

Early Intervention in Psychosis A recovery action plan has been developed to improve performance in Early Intervention Psychosis services and achievement of NICE standards; actions are monitored on a monthly basis. Early Intervention in Psychosis treatment targets are now being achieved across the CCP. In August 2018 all CCGs exceeded the 53% target. Improving Access to Psychological Therapies (IAPT) The target for access rates has increased and the targets are being met in Nottingham North and East, Nottingham West and Rushcliffe, the target is not being met in Nottingham City. Waiting times are also increasing and a recovery action plan has been

developed which is being monitored on a monthly basis. Out of Area Placements Nottinghamshire has been identified as an outlier in the number of patients being treated in an acute inpatient bed classed as ‘out of area’. A recovery action plan has been developed which outlines actions being taken to ensure the national standard of achieving zero out of area placements is achieved by 31 March 2021. A performance management structure has been established to oversee the implementation of all actions. The number of out of area placements has been reducing.

Mental Health: Contracting Risk & Issues

11

Provider Issue Action Outcome

Nottinghamshire

Healthcare NHS

Foundation Trust;

Nottingham City Council;

Base 51; Kooth

Children and Young People Services Recovery Action Plan has been

developed which outlines actions

being taken to improve performance.

The action plan is monitored on a

monthly basis, all actions are on track.

Performance standards are achieved

and children and young people can

access services within nationally set

waiting times.

Nottinghamshire

Healthcare NHS

Foundation Trust

Early Intervention in Psychosis Recovery Action Plan has been

developed which outlines actions

being taken to improve performance.

The action plan is monitored on a

monthly basis, all actions are on track.

Access standards continue to be met

and services deliver to NICE standards

of care.

Multiple – Insight;

Nottinghamshire

Healthcare NHS

Foundation Trust;

Trent PTS

Improving Access to Psychological Therapies (IAPT)

Recovery Action Plan has been

developed which outlines actions

being taken to improve performance.

The action plan is monitored on a

monthly basis, all actions are on track.

Access rates are achieved and waiting

times are reduced.

Nottinghamshire

Healthcare NHS

Foundation Trust

Out of Area Placements Recovery Action Plan has been

developed which outlines actions

being taken to improve performance.

The action plan is monitored on a

monthly basis, all actions are on track.

The number of out of area placements

continues to reduce and the 2020/21

target is achieved.

Out of Hospital

12

A review of all contracts in place for Greater Nottingham CCGs is in progress.

Community Beds

There are ongoing discussions with both community providers regarding an interim position during 2019/20, whilst a further

review and procurement decision is undertaken.

Out of Hospital Contracting and Financial Recovery

The review of contracts in 2018/19 has been achieved.

The potential savings for the 2019/20 plan is low. Contracts have been identified and had an initial screening. Further work

required around potential impact and engagement requirements.

A System Affordability workstream has been established jointly with the provider to develop plans to deliver savings from the

Local Partnership Physical Health Community Contracts. Task and finish groups have been established to review each of the

service areas.

Out of Hospital: Contracting Risks & Issues

13

Provider Issue Action Outcome Citycare and NHT Local

Partnerships

Community Beds

Length of stay and occupancy rates remain a

focus.

Bed cost rates in a number of facilities are higher

than expected.

Potential legal challenge around direct award of

contracts.

• Renegotiate contract values with providers for an

interim period during 2019/20. Discussions are

ongoing and executive meeting to be arranged for

w/c 29th October 2019.

• Revised referral criteria to beds immediately.

• Longer term plan to be drafted.

• Continuity of bed stock in order to

meet demand

• Ensuring value for money of current

contracts.

Citycare

Activity plan and reporting requirements

Contract requirements are not specific enough to

allow performance management of activity

carried out vs plan.

Working with the performance team:

• Agree an interim position.

• Renegotiation as part of the 2019/20 contract

discussions.

• Interim reporting.

• Agreed reporting for 2019/20

contract.

NHT Local Partnerships Outcomes Framework

Agreement on the % of contract value which is

attributed to outcomes, has previously been

contentious in contract negotiations.

• Progress discussions early around the intentions for

2019/20.

• Value to be agreed and CV into the

contract.

NHT Local Partnerships Performance management

Recent 360 audit identified a number of areas for

improvement around performance management

(note this has not yet been presented to the audit

committee).

• Contract team to progress actions, as well as

implementing where appropriate to other similar

contracts.

• Recommendations to be transacted

within the contract where

appropriate.

• Report back to audit committee on

progress.

Procurement

14

Integrated Urgent Care Pathway Procurement Nottinghamshire (Mid Notts and Greater Nottingham) commissioners have agreed to explore jointly commissioning an integrated urgent care pathway across Nottinghamshire. This will encompass: • 111 Call Handling • Clinical Assessment Service (including health care professional calls and

advice) • Out of Hours primary care (including home visits) • Urgent Treatment Centres (likely to be based at Newark hospital, Sherwood

Forest A&E and NUH A&E) A PID is being developed and associated governance structure set up with delegated responsibility for decision making from Governing Bodies. It is likely that elements of the above pathway will require procurement for new contractual arrangements to be in place by October 2019. This is mainly driven by the end of the current NEMS contract in October 2019 with no option to extend. The current contract comprises telephony clinical assessment (Patient and professional), Out of hours , admission avoidance and primary care at the front door (QMC and NUH)

A review of all CCG commissioned services is underway to determine the requirement for future procurements. This includes primary care and locality specific contracts. An update will be provided as the review progresses. Identified in this report are the two main areas where a procurement is either in progress or a procurement is likely.

Treatment Centre Procurement (TCP) The procurement process continues and we are currently in the ITT stage where bidders are developing there submissions. The closing date is 1 November 2018. The team is currently working on identifying those who will be required to undertake the evaluation of the submissions. There is a mandated training pack and 3 days for moderated evaluation over the 12th,13th and 14th Nov.