Item 7 1 1 Creswell and Langwith December Board Paper final version25 11 11

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Item 7 1 1 Creswell and Langwith December Board Paper final version25 11 11 Powered By Docstoc
					                                               Cluster Board meeting 7th December 2011
                                                              Agenda item number 7.1.1




           DERBYSHIRE CLUSTER BOARD MEETING
                    7th December 2011

Report Title:      Future Primary Care Services for patients                 Item No: 7.1.1
                   in Creswell and Langwith from October
                   2012

1.   Background and context
     A five year APMS contract was awarded in 2007 to provide primary care medical
     services in Creswell and Langwith. This contract reaches its natural end in October
     2012. A decision needs to be made about what happens in October 2012.

2.   Matters for consideration
     The Board are asked to consider the consultation process undertaken and the six
     options set out for procuring a service in future, ranging from tendering ‘like for like’
     to local practices absorbing services at both sites. The Board also need to consider
     the requirement to procure on time limited contracts and ratify a previous decision
     on the implications of that for premises development. The Board will need to
     consider who leads this area of work, and finally to note the risks and mitigating
     contingencies.

3.   Actions and recommendations

            i.    Note the consultation process undertaken, and;
           ii.    Agree the recommended option to tender with option for providers to bid
                  for Creswell and/ or Langwith (i.e. separately or both together)
           iii.   Note the possible requirement for an APMS time-limited contract,
                  depending on the successful bidder
           iv.    Ratify the previous agreement for the PCT to underwrite or hold the lease
                  for the Langwith new build (and for Creswell in the future) if the successful
                  contractor only holds a short term contract
           v.     Note the potential risk in this process, ratify the proposed contingency plan
                  and mandate the procurement project group to put in other contingency
                  plans as required.

Name:         Clive Newman
Sponsor:      Martin Whittle, Deputy Chief Executive/Director of Assurance
Date:         24th November 2011




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                                               Cluster Board meeting 7th December 2011
                                                              Agenda item number 7.1.1



A. Aim of paper

1. To set out the situation for the patients currently served by ‘The Practice Plc’ in
   Creswell and Langwith
2. To discuss the options for the provision of services after the current contract ends in
   October 2012
3. To discuss and agree the recommended option, describing the process by which this
   recommendation was reached
4. To seek any further comments and input


B. Background

1. A five year APMS contract was awarded to the Chilvers McCrae (now ‘The Practice
   Plc’) to provide services from Creswell Primary Care Centre and Langwith Surgery in
   October 2007. This contract reaches its natural end in October 2012. A decision
   needs to be made about what happens in October 2012.

2. The PCT undertook a public consultation from 1st August – 31st October 2010. This
   comprised: letters out to all practice households and stakeholders; meetings with the
   parish councils; meetings with the Creswell Patient Group; four public meetings in
   Creswell and Langwith; meetings with the Improvement and Scrutiny Committee;
   meetings with Bolsover District Council. Further detail is appended.

3. Discussion focused in two areas: whether patients would prefer for the service to go
   out to tender again, or for services to be absorbed by other local practices, and; what
   the key priorities were for the service in the future. A summary and frequently asked
   questions arising from the consultation are attached.

4. In 2009 the PCT agreed in principle to support the development of a GP branch
   surgery site in Langwith. The Parish Council own a site, and with input from the
   PCT, have sourced a developer (Brackley Investments Plc) and in consultation with
   the local community, have set out plans for a new build. In October 2010 the PCT
   approved this in principle, agreeing to underwrite the lease in view of the short term
   nature of the APMS contract. This project is now on hold pending a decision on the
   future provider.

5. Following the consultation a reference group was formed to make a recommendation
   on the way forward. The terms of reference are appended. This group included
   patient representatives and undertook an options appraisal looking at the public
   consultation, the financial information, and all other relevant information.


C. Information to support the options appraisal and agreed criteria

1. The reference group considered the following information
       The outcome of the public consultation (appended)
       The financial envelope
       The contract content and types (appended)
       Informal market intelligence about local providers




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                                                Cluster Board meeting 7th December 2011
                                                               Agenda item number 7.1.1

2. Noting that the price of the contract is set and is therefore a given, the reference
   group identified key essential criteria for a future service, and used these to appraise
   the options, as follows:

          High quality service: the provider would be required to provide the full range
           of services commissioned from all other Derbyshire practices to the highest
           possible standard

          Locally accessible GP practice: this was defined as the requirement for GP
           practice sites in both Creswell and Langwith, at least as good as the current
           premises

          Continuity of clinical staff: this was defined as ensuring the continued
           employment of the existing clinical staff. It was noted that this was protected
           in law regardless of the future management / provider

          Excellent opening hours: this was defined as 8-6.30. This was agreed as an
           essential requirement for Creswell, and would be the starting point and
           default position for Langwith. However it was agreed that the opening hours
           in Langwith could be more flexible as long as they suited the demand of
           patients. The assumption was that the service should be open five days a
           week, and that any reduction in hours would need to be justified or offset by
           an agreed improvement in service provision in some other way.

          Comprehensive range of services: This was agreed as essential across the
           sites, though it was recognised that it may not be possible to provide a full
           range of services out of Langwith. The criteria would be that Langwith
           patients should be able to access a comprehensive range of services from
           their provider.

          Well-appointed premises: provider would need to commit to work within/
           ensure premises that would be ‘fit for purpose’. As a minimum it was agreed
           that the Langwith premises could not fall below their current state and would
           need to achieve CQC status.

          Continuity of service: aim would be to seek a service that remained stable
           and continuous for as long as possible i.e. to minimise or eliminate need to
           re-procure and disruption and anxiety that this causes

   It was noted that the price of the contract is set and is therefore a given.

3. In addition the group identified a number of desirable criteria. These were: services
   for young people, particularly at Langwith; a commitment to strengthening services in
   Langwith; improved access to appointments; strengthened contraceptive services to
   reduce teenage pregnancy.


D. Options Considered

1. The group considered the following six options:

   1. Tender Creswell & Langwith as a single practice ‘like for like’
   2. Tender Creswell separately and Langwith separately



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                                                Cluster Board meeting 7th December 2011
                                                               Agenda item number 7.1.1

   3. Tender with option for providers to bid for Creswell and/ or Langwith (i.e.
      separately or both together)
   4. Tender Creswell only. Langwith absorbed by other local practices
   5. Tender Langwith only. Creswell absorbed by other local practices
   6. Creswell and Langwith both absorbed by other practices

2. The group considered each of these options in two ways: in terms of their strengths
   and weaknesses, and; their RAG rating against the essential criteria outlined above
   (with additional criteria as to their viability, the impact on patient choice and input
   from the consultation ‘the public voice’). These options appraisals are appended.


E. Recommended Option and Discussion

1. The group recommended option (iii) that the service go out to tender, with an option
   for providers to bid for Creswell and/or Langwith (i.e. separately or both together). It
   was felt that this:

          Maximised the number of bidders and the flexibility of response
          Incorporates option (i) allowing for a provider to bid for both services,
           together, but also;
          Gives opportunity for bids focused on either Creswell or Langwith

2. As evidenced in the consultation results, the reference group recognised that there
   was considerable support for the existing provider and substantial public opposition
   to any option perceived as allowing other local practices to ‘take over’ services.
   Thus the public preference might be for the first option. However it was agreed that
   option iii was to be preferred for the reasons set out above. The group strongly
   supported the proposed approach to the procurement process which will make sure
   that the public continue to be involved in an open and transparent process.

3. The group discussed the trade-off between continuity of provider and accountability.
   It was agreed that the ability to bring the provider to account, and to control the
   provider through the contract, should have a greater weight than continuity of service
   provider.

4. Following advice from the Strategic Health Authority and the Primary Care
   Contracting Team it was agreed that legally an APMS contract would have to be time
   limited to 5 years with an option to extend for a further 2 years. This was felt to be
   acceptable in light of the decision set out in (3) above

5. This agreement was brought to bear when considering the type of contract. In this
   discussion the group also considered the desirability of maximising the number of
   bidders. It was recommended that the service should be tendered without reference
   to a particular contract type and that this would be considered in more detail as part
   of the procurement process. The group stated that commissioners should establish a
   contract which ensured they retained the necessary levers to ensure a high quality
   service was provided.

6. Finally, the group discussed premises. If the contract was agreed on a shorter term
   basis (in line with legal requirements and to ensure accountability) then it was noted
   that the PCT / SHA and ultimately the NHS Commissioning Board may be required to
   take additional responsibility to underwrite or hold the lease of any new build. The
   circumstances are extraordinary because of the short term nature of the APMS


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                                                              Cluster Board meeting 7th December 2011
                                                                             Agenda item number 7.1.1

             contract. This would also be the case in the event of a new build in Creswell. As
             outlined in paragraph B(4) above the PCT previously agreed this in principle in
             discussion regarding the Langwith new build, and this agreement will need to be
             ratified by the PCT Board.


    F. The Procurement Process

     1. The procurement process will take approximately seven to eight months (i.e.
        December 2011 – June/ July 2012). If necessary this should then allow sufficient
        time for a new provider to establish itself in time for the contract end in October
        2012. However the Board are asked to note the risk to primary care services of
        delay, and to ratify the proposed contingency plan to extend the lease arrangement
        for the current premises to ensure facilities are available and to discuss and agree
        contingency plans for temporary provision of services with other practices if
        required. The Clinical Governance Team has placed this issue on the risk register
        and will report accordingly.


    G. Summary

    1. The Board are therefore asked to:

        i.      Note the consultation process undertaken, and;
       ii.      Agree the recommended option to tender with option for providers to bid for
                Creswell and/ or Langwith (i.e. separately or both together)
      iii.      Note the possible requirement for an APMS time-limited contract, depending on
                the successful bidder
      iv.       Ratify the previous agreement for the PCT to underwrite or hold the lease for the
                Langwith new build (and for Creswell in the future) if the successful contractor
                only holds a short term contract
      v.        Note the potential risk in this process, ratify the proposed contingency plan and
                mandate the procurement project group to put in other contingency plans as
                required.


Appendices

The following appendices can be accessed via our web-site: www.derbycitypct.nhs.uk




 Process & outcome Contract content &     C&L QIA for       Creswell and     CL Options Appraisal
of C&L consultation .doc types.doc                                             final version.doc
                                      December Board.doc Langwith options appraisal 11.11.11.doc




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