ANY WILLING PROVIDER GUIDELINES
1.1 Any Willing Provider is a recently introduced procurement model that PCTs can use to develop a register of
providers accredited to deliver a range of specified services within a community setting.
1.2 The model aims to reduce bureaucracy and barriers to entry for potential providers, and so improve patient
choice, access, and deliver value for money.
2.1 Practice based Commissioning: Practical Implementation (Department of Health, November 2006) advised that
formal tendering will normally only be required where the result is to create a contract with a provider that
guarantees a volume of activity to that provider under the contract (the same principal would also apply where an
exclusive right was granted – even if there was no volume guarantee).
2.2 The PBC guidance and the ‘Principles and rules for co-operation and competition’ state that for routine elective
care: “Under Free Choice the opportunity for ‘any willing provider’ to supply services should not be constrained by
the commissioner other than in exceptional circumstances e.g. concern about aspects of clinical quality. Any
restriction must be agreed with the SHA.”
2.3 The Any Willing Provider (AWP) model aims to facilitate a range of providers for specific services that meet the
needs of the public to be accredited, with particular emphasis on clinical accreditation, without conducting formal
tender processes. The PBC guidance on AWP states that for providers looking to supply a routine elective service,
including those developed through practice based commissioning, tendering is not required.
2.4 The model will serve to reduce initial procurement timescales and resource, however it does require PCT’s to
maintain accreditation of providers on an ongoing basis.
2.5 The AWP provider model does not guarantee any volume of activity or payment to a provider.
2.6 The PCT will require providers to demonstrate that they can provide a value for money service as an AWP.
3. APPLICATION OF THE MODEL
3.1 The AWP procurement model is only suitable for healthcare services that meet the following criteria:
3.1.1 Routine elective services;
3.1.2 Services to be delivered in a community setting through PBC (see section 5.8);
3.1.3 Where provision of the service will encourage competition within a range of services rather than for
3.1.4 The new service will not create a monopoly provider or serve to limit choice.
3.2 AWP is designed to be a light touch, fast track procurement process to allow the PCT to develop a register of
accredited providers for specific services. The aim is to improve patient choice and access to services and deliver
value for money. AWP is likely to be most suited to high volume, low value, community based services.
3.3 The AWP model is not suitable for the following types of service:
3.3.1 High value and/or specialised services;
3.3.2 Where there is limited contestability;
3.3.3 Where there is significant patient, financial or reputational risk;
3.3.4 Where the service is brand new i.e. has not been previously commissioned by NHS Leicestershire
County and Rutland in any setting;
3.3.5 Where there is a requirement for high levels of consistency and/or control.
4.1 In securing services from willing providers the PCT needs assurance of competence, quality and safety
standards as it would for services secured under a formal tender process. This procedure aims to ensure that
appropriate information is gathered from all willing providers for this assurance to be secured.
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4.2 The PCT will therefore accredit willing providers under the same principles as any other procurement and in
line with the PCT’s Competition Policy.
4.3 The PCT will also apply the EU procurement rules and principles. The general principles are as follows:
4.3.1 Procurement should be subject to competition
4.3.2 All procurements should be fair, open and transparent
4.3.3 Potential providers will be subject to scrutiny to ensure appropriate competence, quality and safety
4.3.4 Procurement will be conducted on the most economically advantageous offer basis, where value for
money (not solely price) is taken into account
4.3.5 The acceptance of a provider onto the list does not guarantee contract activity, which will be subject
to patient choice.
5. AWP PROCESS
5.1 The AWP process can either be open or managed.
5.2 Under the open process the PCT will accept expressions of interest from providers for AWP services on each
occasion that the PCT advertises AWP services. Subject to a provider meeting the required standards in respect of
clinical care and quality, price and regulatory requirements, there should be no cap on the number of providers
within the health economy. Capping of provider numbers will only occur when providers need to achieve a
minimum number of treatments in order to maintain accreditation to provide the service.
5.3 Under the managed process, an AWP contract will be awarded at a specific point in time for a specific purpose.
Providers may be unsuccessful even if they meet the minimum criteria. This is a simplified procurement process,
and will be used only to address demand for specialised services or performance issues.
5.4 AWP services will be advertised via the following methods:
5.5.1 Supply2Health procurement portal;
5.5.2 NHS Leicestershire County and Rutland website
5.5 Expressions of interest from providers to be accredited for advertised AWP services received at any other time
than the advertised window, will be acknowledged and held for evaluation until the next time of advert.
5.6 The PCT will have regard at all times to the EU Treaty principles of non-discrimination, equal treatment,
transparency, mutual recognition and proportionality when applying the AWP process.
5.7 As the NHS moves into a “zero-growth” environment, it is vital that AWP services (including AWP services
through PBC) deliver value to both providers and NHSLCR and so, therefore, caps/thresholds on activity may need
to be introduced. These limits will be at the discretion of the PCT and any scheme failing to remain financially
viable in the context of the whole health economy may be ceased.
6.1 Any provider who wishes to be accredited to deliver an advertised AWP service must in the first instance
register an expression of interest following advert via Supply2Health.
6.2 Providers will have to satisfy the PCT that they are competent and capable of delivering the requirements of the
service specification. Service specifications will be developed based on the PCT’s standard service specification
template and will include as a minimum:
6.2.1 Core Service;
6.2.2 Access and Equity;
6.2.4 Quality Clinical Protocols;
6.2.5 IM&T; and
6.3 All providers who express interest to be accredited to provide one or more AWP services will be required to
complete the AWP accreditation questionnaire and AWP service accreditation questionnaire.
6.4 Stage 1 – AWP accreditation questionnaire (ANNEX A)
6.4.1 Providers will only be required to complete this document once at the point they first apply for
accreditation to become an AWP. Subject to meeting the standards contained within the AWP accreditation
questionnaire and agreement to the standard contract terms, a provider will be entered onto the NHS
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Leicestershire County and Rutland AWP register. Providers will be required to evidence some elements on
an annual basis to maintain their registration e.g. insurance cover.
6.4.2 AWP accreditation questionnaires will be evaluated by the AWP accreditation team against set
6.4.3 Providers will be required to demonstrate how they will manage any conflicts of interest in relation to
horizontal or vertical integration of services. Providers will be required to declare any interests held by the
provider (or members of the provider organisation) in other bodies providing healthcare services in the PCT
6.5 Stage 2 – AWP service accreditation questionnaire
6.5.1 For each specific service, providers will be required to satisfy the PCT that they are competent and
capable of delivering the service to the required standard. Providers will have to complete an AWP service
accreditation questionnaire for each AWP service they want to be accredited to provide.
6.5.2 AWP service accreditation questionnaires will be evaluated by NHS Leicestershire County and
Rutland subject specialists for the specific service against set criteria.
6.5.3 If a provider meets the requirements of the specification and the AWP service accreditation
questionnaire they will be accredited as an AWP for that service, and entered onto the NHS Leicestershire
County and Rutland AWP register as such, subject to agreeing to the contractual terms for that service.
6.6 Failure to meet the standards to be accredited as an AWP on one occasion will not prevent a provider from
subsequently reapplying for accreditation.
6.7 Providers can apply to be on the AWP register without applying to be accredited for a specific AWP service.
This would involve submitting the AWP accreditation questionnaire only.
6.7 Unsuccessful providers will receive feedback from NHS Leicestershire County and Rutland.
7.1 Providers will be required to sign the appropriate Standard NHS Contract at the point of service accreditation.
Depending on the service to be provided the Standard Community Services, Mental Health or Acute contract may
7.2 All subsequent AWP services the Provider is accredited to deliver will be dealt with by a contract variation to
the main contract.
7.3 Agreements will typically run for a period of 12 months, with the opportunity for extension upon successful
completion of the initial contract period, although this is subject to variation.
7.4 Provider’s performance will be monitored on an ongoing basis. Failure to comply with the requirements of the
service specification or the Agreement, or which fail to demonstrate financial viability could be subject to
caps/thresholds or a provider’s service accreditation being withdrawn.
7.5 Any AWP scheme (including AWP schemes through PBC) failing to demonstrate financial viability could be
subject to caps/thresholds and the scheme could potentially be withdrawn by the PCT.
7.6 If the provider’s circumstances change so that it affects their ability or right to deliver the services it may result
in the provider’s accreditation to deliver all AWP services, and contract being withdrawn.
7.7 NHS Leicestershire County and Rutland reserves the right to amend or withdraw AWP services subject to 3
8.1 All referring clinicians must tell their patients about any financial or commercial interest in any organisation they
plan to refer a patient for treatment or investigation and declare this interest in NHS choices. This will be subject to
audit at any time by the appropriate authority.
9. FINANCE AND ACTIVITY
9.1 The AWP provider model does not guarantee any volume of activity or payment to a provider.
9.2 Any AWP scheme (including AWP schemes through PBC) failing to demonstrate financial viability could be
subject to caps/thresholds and the scheme could potentially be withdrawn by the PCT.
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9.3 The price for the provision of AWP services will be determined by the PCT and may be subject to review and
revision every 6 months.
9.4 NHS Leicestershire County and Rutland reserves the right to cap activity levels for any AWP service.
10. TIME LINE
10.1 The completion of the accreditation process should, as a minimum, comply with the following timeline:
Advertisement appears Date
Completed applications submitted by 1 month later
Application Assessment and scoring 2 weeks later
Interview Stage (if required) 1 week later
Approval by Director of Quality 1 week later
Successful applicants informed 1 week later
Contract mobilisation 2 weeks later
Service operational By negotiation
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ANNEX A - AWP Accreditation Questionnaire
Please note ALL questions must be answered in full. If a question is not applicable please write N/A in the box
1. Details of the Applicant
1.1 Please provide the name and other required contact details of the Applicant
1.2 Applicant's nominated representative (person for contact purposes with this application).
1.3 Status of Organisation – Please mark ‘x’ in the appropriate box(es)
Single Candidate Consortium Partnership
Independent Sector Voluntary Sector Provider Mutual Sector Provider
UK registered branch of GMS/PMS Practices, Primary Care Trust
overseas company through a separate APMS
NHS Foundation Trust NHS Acute Trust Other
1.4 Where applicable please provide a one-page chart illustrating the structure of the Applicant including the
relationship to the parent company, other group company and holding company (‘Relevant Organisations’)
Attach response as Annex 1.4
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1.5 Where the Applicant is a partnership, please supply the following:
Current Trading Name:
Previous Trading Name (if different):
Address (if different to 1.1)
Telephone (if different to 1.1):
Fax (if different to 1.1):
E-mail (if different to 1.1):
Total Number of partners
If the partnership has fundamentally
changed in character or composition in
the last five years, please supply details
1.6 State of incorporation – Please mark 'x' in the appropriate box.
Limited Company To be incorporated Not to be incorporated
1.7 Where the Applicant is incorporated, please supply the following:
Current Trading Name:
Previous Trading Name (if different):
Registered Address (if different to 1.1)
Telephone (if different to 1.1):
Fax (if different to 1.1):
E-mail (if different to 1.1):
Year of Registration:
Country of Registration:
1.8 Where the Applicant is a consortium please provide full details below:
2. Financial information
This section must be completed by the Applicant (in respect of all the Applicant Members) indicated in each
2.1 Please attach copies of the last three years’ audited accounts – the latest set of which should be for an
accounting period ending no earlier than 12 months before the date of the application. If accounts are not available
then an explanation should be provided.
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Each set of accounts must show (as a minimum) the following points:
Total Assets less Current Liabilities:
% Profit reinvested into services
Attach response as Annex 2.1
2.2 Please identify any existing financial commitments or liabilities which could impact adversely upon the Applicant
Members’ ability to deliver Services.
This disclosure should include:
(i) As at the last reporting date, any contingent liability or loss which would require disclosure in accordance
with International Accounting Standard 10; and
(ii) Any event between the date on which the latest set of accounts was authorised for issue and the date of
the submission of this questionnaire that, had the accounts not been authorised for issue until this
submission date, would have required to be adjusted for, or disclosed in accordance with, International
Accounting Standard 10. Where there are no financial commitments or liabilities as specified above, state
2.3 Please provide referees from three individuals or organisations (showing the referees’ contact details) that
comment on the professional competence and performance of each Relevant Organisation.
Where less than three years figures are provided for question 2.1, one reference must be from a bank.
3. Legal and regulatory Status
This section must be completed by the Applicant for each Relevant Organisation. The purpose of this section is to
ensure that the Applicant is not barred from entering into a public contract.
3.1 Please provide details (including an estimation of quantum) of any actual or threatened litigation, professional
or regulatory or other legal proceedings against any Relevant Organisation within the past three years. If none,
please state ‘None’.
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3.2 Please provide details of any known circumstances which may give rise to any actual or threatened litigation or
regulatory or other legal proceedings against any Relevant Organisation. If none, please state ‘None’.
3.3 Please provide details of any past (within the past three years) or present or anticipated labour dispute or
industrial action involving any Relevant Organisation. If none, please state ‘None’.
3.4 Please provide details of any criminal conduct of any Relevant Organisation (or any director, officer or senior
employee thereof) resulting in conviction or in respect of which a prosecution or investigation is pending or in
progress. If none, please state ‘None’.
3.5 Please state whether any clinicians or AHPs employed, sub‐contracted or otherwise engaged by a Relevant
Organisation have, during the last three years, had their Professional Registration removed or suspended or
whether they are currently under investigation, and provide relevant details. If none, please state ‘None’.
3.6 Please provide details of appropriate insurance and evidence of relevant professional risk indemnity insurance
Insurance Name of insurance Policy no. Expiry Amount of cover Name of staff
category: company Date (£) member
3.7 Please confirm you have enclosed copies of insurance and indemnity documents as required above. If you do not
yet have appropriate insurance cover, please confirm that you will have this is place, and will provide evidence to the
PCT prior to service commencement.
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4. Statement of Good Standing and Applicant’s Declaration
Statement of Good Standing
While we acknowledge that the Commissioners will not be bound by the requirements of the Public Contracts
Regulations 2006 (except those that relate to Part B services), we confirm that, to the best of our knowledge, the
Applicant is not in breach of the provisions of Regulation 23 of the Public Contracts Regulations 2006 and in
Grounds for obligatory exclusion (ineligibility)
1. The Applicant or its directors or any other person who has powers of representation, decision or control of the
Applicant has not been convicted of any of the following offences:
(a) conspiracy within the meaning of section 1 of the Criminal Law Act 1977 where that conspiracy relates
to participation in a criminal organisation as defined in Article 2(1) of Council Joint Action 98/733/JHA;
(b) corruption within the meaning of section 1 of the Public Bodies Corrupt Practices Act 1889 or section 1
of the Prevention of Corruption Act 1906;
(c) the offence of bribery;
(d) fraud, where the offence relates to fraud affecting the financial interests of the European Communities
as defined by Article 1 of the Convention relating to the protection of the financial interests of the European
Union, within the meaning of:
(i) the offence of cheating the Revenue;
(ii) the offence of conspiracy to defraud;
(iii) fraud or theft within the meaning of the Theft Act 1968 and the Theft Act 1978;
(iv) fraudulent trading within the meaning of section 458 of the Companies Act 1985;
(v) defrauding the Customs within the meaning of the Customs and Excise Management Act 1979
and the Value Added Tax Act 1994;
(vi) an offence in connection with taxation in the European Community within the meaning of
section 71 of the Criminal Justice Act 1993; or
(vii) destroying defacing or concealing of documents or procuring the extension of a valuable
security within the meaning of section 20 of the Theft Act 1968;
(e) money laundering within the meaning of the Money Laundering Regulations 2003; or
(f) any other offence within the meaning of Article 45(1) of the Public Sector Directive.
Grounds for rejection:
2. The Applicant confirms that it:
(a) being an individual is not bankrupt or has not had a receiving order or administration order or
bankruptcy restrictions order made against him or has not made any composition or arrangement with or
for the benefit of his creditors or has not made any conveyance or assignment for the benefit of his
creditors or does not appear unable to pay or to have no reasonable prospect of being able to pay, a debt
within the meaning of section 268 of the Insolvency Act 1986, or article 242 of the Insolvency (Northern
Ireland) Order 1989, or in Scotland has not granted a trust deed for creditors or become otherwise
apparently insolvent, or is not the subject of a petition presented for sequestration of his estate, or is not
the subject of any similar procedure under the law of any other state; or
(b) being a partnership constituted under Scots law has not granted a trust deed or become otherwise
apparently insolvent, or is not the subject of a petition presented for sequestration of its estate; or
(c) being a company or any other entity within the meaning of section 255 of the Enterprise Act 2002 has
not passed a resolution or is not the subject of an order by the court for the company’s winding up
otherwise than for the purpose of bona fide reconstruction or amalgamation, or has not had a receiver,
manager or administrator on behalf of a creditor appointed in respect of the company’s business or any
part thereof or is not the subject of the above procedures or is not the subject of similar procedures under
the law of any other state,
(i) has not been convicted of a criminal offence relating to the conduct of his business or profession;
(ii) has not committed an act of grave misconduct in the course of his business or profession;
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(iii) has fulfilled obligations relating to the payment of social security contributions under the law of any part of the
United Kingdom or of the relevant State in which the Applicant is established;
(iv) has fulfilled obligations relating to the payment of taxes under the law of any part of the United Kingdom or of
the relevant State in which the economic operator is established;
(v) is not guilty of serious misrepresentation in providing any information required of him under this regulation;
(vi) in relation to procedures for the award of a public services contract, is licensed in the relevant State in which he
is established or is a member of an organisation in that relevant State when the law of that relevant State when the
law of that relevant State prohibits the provision of the services to be provided under the contract by a person who
is not so licensed or who is not such a member.
3. Where applicable, the Applicant is registered with the appropriate trade or professional register(s) in the EU
member state where it is established (as set out in Annex IX B of Directive 2004/18/EC) under the conditions laid
down by that member state*.
* In the UK this condition is satisfied by registration with Companies House or a declaration on oath that the
Applicant is carrying on business in the trade in question in the UK at a specific place of business and under a
specific trading name.
Expressions used in this declaration shall, unless otherwise stated, have the meanings assigned to them in this
We certify for ourselves and as agent for and on behalf of each Relevant Organisation that the information supplied
in the application is accurate to the best of our and their knowledge and belief and that we have not collaborated
with other Applicants in the completion of this questionnaire.
We understand that, by supplying this information to the PCT, it may become disclosable to third parties under the
FOIA. We confirm that we have clearly identified any information in our submission which we (or Relevant
Organisations) regard as being confidential or commercially sensitive. However, we understand that the PCT has
the final decision regarding the disclosure of any such information in response to a Request for Information.
We understand that it is a criminal offence, punishable by imprisonment, to give or offer any gift or consideration
whatsoever as an inducement or reward to any servant of a public body, therefore we hereby certify and undertake
and bind and oblige ourselves that the Relevant Organisations, Connected Persons (as defined below), and
advisers of all such parties, have not canvassed or solicited nor will in the future canvass or solicit any officer or
employee of either the NHS or the PCT or any person acting as an adviser for the PCT in connection with the
selection of Applicants and/or, proposals or bids in relation to the Procurement.
For the purposes of this declaration “Connected Persons” means any person connected with us or the Relevant
Organisations or the aforementioned advisers within the meaning given by Section 839 of the Income and
Corporation Taxes Act 1988 and any of the respective directors, officers, employees, solicitors, accountants,
bankers or other financial or professional advisers of us, the Relevant Organisations, and/or of our or their
We agree that we shall be responsible for any failure on the part of the Relevant Organisations, Connected
Persons and our and each of their advisers to abide by such terms to the same extent as to such failure has been
our own action or omission.
We hereby declare that we are authorised by the Relevant Organisations to provide the certification above and, at
the date of signing, the information given by us, and as agents for the Relevant Organisations, is a true and
Authorised Signatory for and on behalf of Applicant
A copy of this declaration must be signed by an authorised signatory, on behalf of the Applicant
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ANNEX B - AWP Service Accreditation Questionnaire
Please note ALL questions must be answered in full. If a question is not applicable please write n/a in the box
1. Provision of Service
1.1 Please describe how your organisation will deliver the service, including:
(i) Key features of your overall service proposal with reference to how it meets the requirements of the
(ii) Details of how many clinics can be delivered each week broken down by number of patients by new
attendees / follow-up attendees and waiting times
(iii) Details of what times you propose to deliver the service
2.1 Please provide details of any relevant experience that Relevant Organisations may have in providing the
Service to individuals or groups over the last three years. This should include:
(i) Type of staff (i.e. clinical, support, management) and their role
(iii) Name and description of contract
3.1 Please give the address(es) of the premises where services will be delivered. Please indicate the type of
service to be offered from each premises listed, whether face-to-face consultation and/or counselling, telephone-
based consultation and/or counselling, or both
3.2 Please describe the arrangements that will be in place to ensure patient confidentiality, for both face-to-face
and telephone-based services, for example the facilities for conducting consultations
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3.3 Please give details of what you expect the geographical coverage to be for referrals into the service. Please
also include details of accessibility to the premises i.e. parking, bus routes, disabled access
3.4 Please confirm the facilities meet the criteria below:
Provides an appropriate recovery area Yes No
Complies with DDA legislation Yes No
3.5 Please list equipment that will be used to deliver the service and maintenance procedures:
4.1 Please provide details of the workforce structure that you intend to have in place to deliver the Services,
including a staffing plan that describes the staffing arrangement that will enable delivery of the services for the
duration of the contract
4.2 Please provide details of the clinical staff that will be responsible for delivering the service. This should include
the following criteria:
(1) Comprehensive job description
(2)Person Specification – to include skills, education and experience and relevant accreditation required
(3) Details of relevant experience in the service (including activity levels, previous roles (duration,
(4) Statement confirming what procedures can be undertaken for the proposed service (including
supporting evidence), and procedures cannot be undertaken
(5)Documentation should demonstrate relevant CPD (past/present)
4.3 Have all staff who have access to patients and patient records undergone an enhanced CRB check?
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5. Quality Assurance
5.1 The Services offered by Applicants must meet quality standards. Please state the quality standard that applies
to the Services you intend to supply, either enclosing relevant documentation or a certification reference where a
recognised quality assurance standard has been achieved, or a full description of the quality assurance scheme
that it has developed. If you intend to apply for quality assurance certification or are in the process of achieving
such certification, please indicate the timescale for achieving certification
5.2 Please describe the complaints procedure that you will have in place when delivering the service
5.3 Please describe the system you will have in place for dealing with Serious Untoward Incidents and Patient
Safety Incidents in accordance with contractual requirements
5.4 Please describe the system you will have in place to prevent and control healthcare associated infection in
accordance with contractual requirements
5.5 Please describe the system that you will have in place to respond to Major Incidents in accordance with
5.6 Please detail your approach to involving patients in the development and improvement of the service
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6. Clinical Audit and Review
6.1 With regard to the specification, please provide details of how and when you intend to audit the proposed
service. Include any extra clinical audits that will be beneficial, and procedures that will take place to ensure
processes meet required turnaround times
6.2 Have you conducted an equality impact assessment for the proposed service?
If yes, what issues have been considered, and how will you ensure the service is accessible to all?
6.3 Please provide details of all appropriate clinical protocols relative to delivering the service and demonstrate
that all clinical activities undertaken will be evidence based and delivered according to local and national
6.4 No clinical work should be undertaken without understanding risks and mitigating against them. Please attach a
risk assessment for anticipated clinical and non-clinical risks and detail what measures will be put in place to
6.5 Please provide an understanding of your approach to patient-centred services, including;
How services can be made accessible and convenient for all patient groups, including Hard-to-Reach
How can services be made appropriate and responsive to patient needs?
How can patients be involved in designing services?
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7.1 Please describe what hardware and software you will use to support delivery of the Services
7.2 Please explain how you will manage the security and confidentiality of service user information. Applicants
should provide examples of any experience in this area which they have had in managing service user information
and should include any existing policies on the security and confidentiality of service user information
7.3 Please give the name and contact details for the person who will act as Caldicott Guardian for the purposes of
7.4 Please describe the system that you will have in place to ensure that accurate, timely information is supplied in
accordance with contractual requirements
7.5 Please state the means of gathering patient experience data and the intention to utilise this data to develop
7.6 Please confirm that you will comply with the following:
Data Protection Act 1998 Yes No
Caldicott Guidelines 1997 Yes No
Access to Health Records 1998 Yes No
Confidentiality Code of Practice 1998 Yes No
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7.7 Please confirm you have the relevant policies to support the service. A copy of each relevant policy must be
included with your response.
Equipment Management Policy Yes No N/A
Infection Prevention and Management
Yes No N/A
Information Management Policy Yes No N/A
Patient, Public and Staff Safety Policy Yes No N/A
Waste Management Registration and
Yes No N/A
Consent Policy Yes No N/A
Chaperone Policy Yes No N/A
Whistle Blowing Policy Yes No N/A
Equality and Diversity Yes No N/A
Quality Assurance Policy relevant to
Yes No N/A
the service provision
Respect and Dignity Policy Yes No N/A
Complaints Policy Yes No N/A
Medicine Management and
Yes No N/A
Medicines Reconciliation Policy in
Yes No N/A
accordance with NICE Guidelines
Referral Policy Yes No N/A
8. Pharmaceutical Support
8.1 Please describe the arrangements that you will have in place to provide pharmaceutical support to service
users, indicating the range of products and whether you are able to supply them directly, prescribe and/or supply
using a voucher scheme. For direct supply, state the PGD (Patient Group Direction) or other recognised protocol
that applies to the supply; for prescribing, state the prescriber name and ID for each location where services will be
offered; for voucher supply, attach a copy of the relevant agreement(s) with participating pharmacies
If this is not applicable please put N/A in the box below
9. Health & Safety
9.1 Please attach copies of your written statement as required by section 2(3), of the Health and Safety at Work Act
1974 and regulation 4 of the Management of Health and Safety at Work Regulations 1992, as a minimum
requirement this must include information on;
i) Policy on the organisations commitment to Health and Safety
ii) Formal health and safety communication between management and staff (including any specific
duties and responsibilities); and
iii) Systems and procedures in place to ensure employee health and safety at work;
iv) The name and status if the person responsible for the implementation of the organisation’s
Health and Safety policy.
If you do not yet have Health and Safety policies in place, please describe the arrangements that they propose to
have in place, consistent with the regulations mentioned above
Attach evidence Attachment 9.1
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10. Environment Management
10.1 Please confirm whether you have an environmental management system:
If the response to the above question is “No” please provide a statement as to the status of environmental issues
within the organisation and your proposed plans to provide a documented environmental management system
11. Local Integration
11.1 Please describe how you propose to ensure your effective and productive integration within the relevant local
healthcare economy. This should include an analysis of the key stakeholders for the service scheme and practical
12. Implementation and Contingency Plans
12.1 Please give a detailed Implementation Plan indicating the timescales within which you will commence the
service, including steps to be actioned, by whom and dates
12.2 Please provide details of your contingency plans that addresses staff illness, unplanned service user demand
and provider insolvency. This should include how and when such a plan will be triggered and your planned
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13113. Commercial response
13.1 Please give a full breakdown of all fees that you would charge for the service
14. Conflicts of interest
14.1 Conflicts of interest arise when an individual or organisation is in a position to exploit a professional or official
capacity, including acquiring information or being involved in processes connected with the procurements, for their
personal or business benefit.
The existence of a conflict of interest does not, in itself, indicate that a person or organisation has acted in an
unprofessional manner or breached any regulations. In some situations conflicts of interest are unavoidable.
From a Bidders perspective any of the following scenarios could be considered to be a potential conflict of interest
(note this list is non-exhaustive):
Your organisation is carrying out, or has carried out, any work for the PCT in the last 12 months (this would
cause a concern, for example, if the bidder organisation has had access to commercially sensitive
information which would give them an unfair advantage over other bidders).
Your organisation is potentially providing services for more than one prospective Bidder in respect of the
PCT Procurement process; or
Your organisation employs or engages, or has employed or engaged, any person currently or formerly
employed or engaged by or otherwise connected with PCT.
14.2 Please confirm whether there are any actual or potential conflicts of interest that may arise from your
participation in the service.
Conflict No conflict
If there are actual or potential conflicts, please provide full details including:
A brief description of the nature of any connections creating actual or potential conflicts of interest;
The full name of any organisation, people or bodies whose involvement gives rise to the actual or
potential conflicts of interest;
Mark with an * any organisation people or bodies that are or are connected with any NHS Body; and
An explanation of how you propose to deal with the actual or potential conflicts, so that they do not
prejudice a fair and competitive procurement process or the position of the PCT.
14.3 If you have identified that there may be a potential conflict of interest that could arise through supplying
services further to this procurement, while being involved in the provision of healthcare services, please
demonstrate how you would ensure this conflict of interest was avoided.
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On completion please read and sign the declaration below.
I certify that the information supplied in the questionnaire is accurate to the best of my knowledge and belief and
accords with the basic criteria of eligibility as set out in the NHS Leicestershire County and Rutland AWP Service
Accreditation Questionnaire and that we have not collaborated with other Potential Bidders in the completion of this
I also understand it is a criminal offence, punishable by imprisonment, to give or offer any gift or consideration
whatsoever as an inducement or reward to any servant of a public body, therefore I hereby certify and undertake
and bind and oblige ourselves and our Connected Persons (as defined below) that we and our Connected Persons
have not canvassed or solicited nor will in the future canvass or solicit any officer or employee of the PCT or the
DH or any person acting as an adviser for the PCT in connection with the selection of Bidders and/or the selection
of any submissions, proposals or bids in relation to this project and that our Connected Persons have not nor will
so canvass or solicit.
For the purposes of this declaration "Connected Persons" means any person connected with us within the meaning
given by Section 839 of the Income and Corporation Taxes Act 1988 and any of the respective directors, officers,
employees, solicitors, accountants, bankers or other financial or professional advisers of us and/or of our
I agree that we shall be responsible for any failure on the part of Connected Persons to abide by such terms to the
same extent as if such failure had been our own action or omission.
I hereby declare that I am authorised by the under mentioned Potential Bidder to supply the information given
above and that, at the date of signing, the information given is a true and accurate record.
An authorised signatory, in his / her own name, on behalf of the Potential Bidder and Relevant Organisations, must
sign a copy of this declaration.
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