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					                 ENFIELD PRIMARY CARE TRUST


Report:     Independent sector Contract Primary Care Medical
            services

No:          140/08

Date:        March 2008

Summary:

The Board is asked to approve the letting of an Alternative Provider of
Medical Services Contract to Qube Medical Limited for the provision
of primary care medical services for the Ordnance Road Surgery and
Phoenix practices, following completion of tendering.

Financial Impact:

The APMS Contract has an annual baseline value of £500,000,
equivalent £66 per patient per annum, excluding performance
incentive and QOF payments. The contract duration is three years,
with provision for a two-year extension.

Patient Perspective and Equality impact

The Ordnance Road Surgery and Phoenix practices serve deprived
communities in eastern Enfield. The APMS contract is based on a
high service specification and provides an opportunity to turnaround
these poorly performing practices and improve primary care provision
to the registered patients.

Workforce and Training Impact

Additional primary care medical staff will be recruited in a part of
Enfield classified as under-doctored.

Monitoring Arrangements
The APMS contract will be monitored through the PCT’s Primary
Care Performance Framework.

Recommendation:

The Board is asked to approve the letting of an APMS contract to
Qube Medical Ltd., for the provision of primary care medical services
for the Ordnance Road Surgery and the Phoenix Practice, for a three-
year term, with an annual baseline contract value of £500,000.


Submitted by: Rob Lee, Associate Director Primary Care
                     INDEPENDENT SECTOR CONTRACT
                    PRIMARY CARE MEDICAL SERVICES



1.   Purpose

     The Board is asked to approve the letting of an Alternative Provider of Medical
     Services Contract to Qube Medical Limited for the provision of primary care
     medical services for the Ordnance Road Surgery and Phoenix practices, following
     completion of tendering.

2.   Background

     In March 2007, EPCT issued a tender notice inviting applications for the
     provision of primary care services for four GP practices in eastern Enfield. Two
     were new practices to be located within premises in Edmonton; the other two
     were existing practices, the Ordnance Road Surgery in Ponders End and the
     Phoenix Practice in Edmonton Green, with registered lists of 3,600 and 3,300
     respectively. Applicants were invited to submit bids for any number of the
     practices or for all four. However, due to the PCT’s financial position, it was
     subsequently decided to defer commissioning of the two new practices in
     2007/08.

     A total of 18 applications were submitted. Six applications were disqualified or
     withdrawn during pre qualification assessment. Seven of the remaining 12 were
     shortlisted for interview, which was subsequently narrowed down to 2. Of these,
     the QML bid demonstrated was considered as demonstrating best value, and the
     company was therefore selected as the preferred provider of the two existing
     practices.

3.   Scope of the Contract

     The contracted service extends to the provision of primary care medical services
     to all patients registered with the Ordnance Road and the Phoenix practices,
     including all essential, additional and enhanced services, as defined in the Service
     Specification (appended to this report).

     The agreement will be an Alternative Provider Medical Services (APMS) contract
     that shall run for three years, with provision allowing the possibility of extension
     for a further two years.
     The contract baseline value is £500,000, equivalent to £66.00 per registered
     patient, excluding 10% performance bonus and QOF payments

4.   Terms of Business

     The terms of business for the contract are summarised below:

     (a) Income

     The contractor’s indicative income comprises three components; the respective
     values of each are described below.

      Income Element                                   Estimated Percentage of Total
                                                            Indicative Income
      Baseline Contract
      Based on weighted capitation, adjusted                       70%
      quarterly
      Performance Payments
      Based on maximum payment available                           10%
      QOF
      Based on achievement of 950+ points                          20%

     “Indicative Income” represents 100% of expected PCT funding (excluding
     payments for services not covered by specification, eg. new enhanced services)
     and consists of:

     Baseline Contract - Baseline funding is for the provision of essential services to
     all registered patients and all elements of the service specification not included in
     the performance payments.
     Performance Payments - Payments are made based on performance against the
     identified services on a sliding scale up to a maximum of £10 per registered
     patient.
     Quality & Outcomes Framework - QOF will be paid in accordance with national
     guidance

     The contract makes provision for a 2% annual uplift for inflation for the three-
     year-term.

     (b) Payment Mechanisms

     Payments to the contractor through the Exeter system:

     Monthly payments include:
        Baseline Payment – 1/12th of annual amount
        Performance Payments Aspiration – 1/12th of 60% of maximum
        QOF Aspiration – 1/12th of 60% of estimated QOF achievement
        Reimbursement of Premises expenditure on rent and rates – 1/12th of
           annual expenditure
     Annual payments include:
         Performance achievement
         QOF achievement
]
     (c) Performance Framework

     In addition to standard regulatory arrangements, the contractual monitoring
     regime comprises the following components:

     Performance Management
          Balanced Scorecard (data set)
          Quarterly monitoring
          Recovery plan
          Remedial notice
          Breach notice

5.   Recommendation

     The Board is asked to approve the letting of an APMS contract to Qube Medical
     Ltd., for the provision of primary care medical services for the Ordnance Road
     Surgery and the Phoenix Practice, for a three-year term, with an annual baseline
     value of £500,000.

				
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