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Notice That Contract Will Be Coming to an End document sample
Notice That Contract Will Be Coming to an End document sample
Appendix 3: Functions and activities, WCC Competencies Function 1 - Assessment and Planning Health Needs Assessment Other roles This is fundamentally a PCT / Borough based role, drawing upon the knowledge of the Agency to inform priority setting and advice and expertise from the clinical platform to be established at the LCBSA. The PCT role is to provide JSNA, Health Strategy, key health priorities. Reviewing Service Provision The Agency will lead a process of Service Review, working closely with Borough PCTs to determine priorities from within the acute services portfolio. Based on a combination of Borough expressed priorities and its own sector-wide view on priorities, the Agency will propose a Programme of work, to be delivered throughout the year but recognising the workload peaks in the contracting cycle of the 4th Quarter, and agree this through the JCPCT This programme of reviewing services within the scope of the acute services portfolio, looking at performance in at least the following areas: quality, access and value for money NCLCA will access benchmarking data [e.g. via the LCBSA] NCLCA will develop a process of accreditation, recommending to the JCPCT that certain providers are most capable of delivering certain aspects of acute services provision (e.g. in collaboration with the Cancer Network the NCLCA could accredit a provider for head and neck cancer site specific interventions and seek to decommission another provider) The process will lead to recommendations being made on new commissioning / decommissioning and/or the development of an improvement plan The link to the PCT is essential here as the pathways for acute care cross in to primary and community services. Where a service specific review is taking place the Borough PCTs would be included in the review if it was instigated by the NCLCA. If a PCT identified problems with a service it can request a review from the NCLCA. Other roles The LCBSA will provide raw data on measurable performance indicators and benchmarking data. Designing Services The Agency will lead the development of acute services strategy across the sector, working closely with Borough PCTs [who determine health needs and priorities for investment in healthcare] and Providers who offer current and potential services that meet the requirements of PCTs. This work will take forward local initiatives and be grounded in the strategy Care for London and the principles established nationally in Lord Darzi’s Next Stage Review. The Agency will approach this through the model of clinical leadership. Specifically, the Agency will be the vehicle of choice for progressing strategic initiatives across North Central London in regard to: o [Acute] Paediatrics o Maternity o Planned Care o Acute services o Long-term Conditions [part] This work will require a transition phase as the new organisation is developed and becomes fully resourced. It will result, over time, in the Agency participating in, facilitating and [within 18 months] leading all major reconfiguration discussions resulting from the development of acute strategy in the sector. The work will be documented, shared and provide PCTs with the basis of local consultations, where appropriate e.g. specific documents such as: an acute and an ambulance strategy setting out the key design features of the services within its scope. As a basis for commissioning the NCLCA must produce service specifications. Whilst the new acute contract does not mandate a service specification structure there is a structure in the community contract. (DH are currently considering recommending the use of the community specification template for acute care) To lead the further development of care pathways within the sector, specifically the pathways specified as priorities in the sector Commissioning Intentions for 2009/10 i.e. Stroke, where there are four linked Initiatives: o Stroke Care Pathway o Sector Capability and Capacity o Early Supported Discharge for Stroke o Support the delivery of the Healthcare for London Stroke strategy Trauma – changes in trauma services across London including at the Royal Free Hospital in Camden. Critical Care – moving to an Accredited Provider list, working with the Critical Care Network to develop a “minimum standards specification” for all critical care facilities being commissioned in London in 2009/10. Renal Cancer Maternity The process of design must ensure that there is prevention, evidence, quality, innovation and value for money at its core The design of service MUST link to workforce development and planning The new designs should be fully costed NCLCA will produce detailed process maps to be reflected in specifications Newly designed services will probably require a process of consultation, the NCLCA should ensure that consultation processes are agreed with Borough PCTs as required. Other roles Borough PCTs and NCLCA must work together to ensure the transfer points in a care process are seamless and well managed The Hub will provide evidence of good practice and a tie in for the NCLCA with other acute strategies across London and for the Ambulance strategy The Hub has already appointed a Medical Director and has a role across London for improving patient pathways. At this stage the Hub sees its role as establishing the minimum standards that each pathway should achieve, these standards will then be used as a basis for the detailed pathway re-design work to be led by the NCLCA. The Hub will also seek to agree the metrics to be used in measuring the rate of improvement. Shaping the structure of supply In the long-term this will be achieved through the Agency’s role in shaping the market for acute services through a sector wide acute services strategy [section above refers] The agency will also shape the pattern of supply through: o Accreditation of providers [nb choice agenda] o Its development of more sophisticated specifications of service e.g. translating the pathways approach to specifying cancer services to other care pathway areas o Stimulating the market to deliver new or niche services e.g. in response to pathway-based contracts. More immediately, the Agency approach may be based on a number of source documents that should include capacity required, reviews of service provision (see above) and the designing services strategy the NCLCA must produce an analysis of the current market and a contestability strategy. Such a strategy will determine a framework for change then use that to analyse service categories and recommend action by each service category within the NCLCA scope The NCLCA will need to maintain the element of choice as a key concept Production if the acute hospital and ambulance section of the directory of service to form part of the PCT Prospectus will be required Changes to the structure of supply will probably require a consultation process to be conducted – for acute and ambulance care the NCLCA would lead the process. Other roles Borough PCTs will also play an important role in shaping of supply e.g. through development of non-hospital based alternatives to acute hospital admission [“assertive outreach” teams, new forms of out of hospital triage, better primary care services, intermediate or step-down services]. PCTs, working with PBC groups will need to be fully involved through the PCT structure as the shaping exercise is likely to look towards increased levels of provision in primary and community settings. The Hub will play a role in relation to Healthcare For London and SCG The NCLCA may well identify areas for potential PBC developments, it will be for PCTs and PBCs to agree how to take this forward. Capacity and Demand management The Agency will commission from the LCBSA activity models that forecast an out- turn position for recorded activity to ensure the achievement of key access targets: can be used to determine if there is sufficient capacity available to achieve access targets in–year and produce a forecast financial position. The model will be sensitive to fluctuations in demand and potential supply (e.g. January reductions in elective capacity due to increased rates of admissions with chest problems and fractures) Models developed by the Hub will enable the Agency to produce a contract plan can be agreed and costed – the models will be used to discuss budget requirements for acute care. The NCLCA role in this modelling work will be to give a local reality check to what the results of the modelling is, especially to take in to consideration local PBC and other demand management services already in place Other roles The LCBSA will develop a live and on-going modelling tool that links together the assessment of needs, projecting demand for acute clinical services, comparing and matching this with system capacity. This will represent a development of local and ad hoc modelling / capacity planning approaches. The development and use of a live modelling tool for capacity and demand management will enable an annually produced “run” of the model to determine the activity levels required in future years to achieve access targets, reflect re- design activities and health need. The Hub will provide the core recorded data files for each element of activity and demand Key to this set of outputs is the ability to model demand and capacity and the way changes in demand flow through the care process. The LCBSA planning / modelling tool which will allow the Agency to effectively manage the market e.g. shift demand to other providers if and when required. Managing demand and setting activity levels PbC / PCt interface: The NCLCA will need to reflect what the planned, actual and forecast performance is in demand management settings as the balance between the primary, community and secondary care levels is vital to get understand The NCLCA will therefore challenge PCT and PbC demand management plans in order to assure itself of the robustness of such plans ahead of sector wide discussions with providers. By taking an overview across the Sector, the Agency may develop expert knowledge of what works and what doesn’t, with local knowledge of best practice. It therefore provides an excellent vehicle not just for testing robustness of plans / risk assessing them but also for providing advice and encouragement across the sector to PCTs and PbC to achieve spread of best practice and more rapid advancement of PbC initiatives. The NCLCA may identify to PCTs a range of opportunities where services could be developed in either primary or community settings. Whist this is more likely to be as part of a planned process of review and re-design it may be in year as a response to a policy shift (as happened in dentistry following the “new” dental contract) or escalating secondary care costs NCLCA will share good practice as it is identified and identify problems in any schemes as they become aware of them Provider interface: In managing the sector’s portfolio of contracts with acute providers, the Agency will add value by actively engaging with providers to challenge providers on aspects of performance around “internally driven demand” e.g. o Tertiary referrals [to specialist providers] o Consultant to consultant referrals within the contract / same acute provider o Follow up outpatient attendances e.g. benchmarking and programmes of inspection to validate the authenticity of invoices. o “S22s” – planned procedure [reason for admission] – not carried out, which may result in readmission and potentially a “double charge”. o Readmission rates within 28 days of discharge PCT role here is the development of ideas for demand management and their agreement with PBC scheme providers ensuring that the activity modelling and pathway design work being led by the NCLCA is aware of the issues and actions this in their calculations The Hub will be able to provide examples of good practice across London The Hub will be the data hub from which the NCLCA can run queries from – this could become an automated report run from the hub data. The Hub will be appointing an account manager for the sector with whom detailed analysis requests can be agreed Function 2 - Contracting and procurement Commissioning Decisions NCLCA will need to produce policies for procurement, contestability and decommissioning in year 1 After the review of services [see above], if a fellow commissioner gives notice or the current contract is coming to an end the NCLCA will determine one of these possible actions: leave as is, extend the contract, develop an improvement plan or give notice that a procurement process will be gone through If an improvement plan is required the NCLCA will draw this together and agree it along with performance milestones, the NCLCA will also monitor compliance NCLCA will need to present potential decommissioning decisions to JCPCT as well as the specification of services required from a commissioning process NCLCA will be able to give notice to a provider only when it has been agreed by the JCPCT As the PCT procurement guide states that if there is a reason the NCLCA decides not to go through a procurement process after a review has led to possible decommissioning or a contract is coming to an end and it is decided to continue with the current provider such a decision will need to be taken by the JCPCT and the SHA informed of the reasons for this decision NCLCA will act as the co-ordinating commissioner for those Providers sited within the 5 PCT areas or where one of the PCTs has been allocated co-ordinating commissioner status Informing PBC Priorities PBC priorities are generally developed by PCTs through the innovative ideas of either the PCT or PBC providers. The NCLCA role in this area is not in any way a replacement for the PCT/PBC creativity but there to identify other alternatives. Through the review of services and the work on designing new service pathways the NCLCA will identify opportunities for further potential schemes to be developed in primary and community based services. The NCLCA will identify priorities on at least an annual basis in line with the preparation of commissioning intentions. This gives the PCTs time to develop schemes and judge interest from its supplier base and then to be reflected in activity plans for a subsequent year If the NCLCA identifies a potential quick win through PBC or community initiative it will identify it to PCTs in order for PCTs to determine it possible implementation rate In both the above it will be the responsibility of the NCLCA to determine the anticipated changes in performance at acute care and/or ambulance contracts Other roles The PCT remains the organization that contracts for the PBC initiatives Specification of Service Quality and Activity The London Hub will play a major part in this process as it develops its role in both pathway development and activity modelling – it is however the NCLCA’s role to act on the material from the Hub, identify how this information is translated in to local contracting intentions and capacity plans at a sector level and negotiate the relevant variables through the contract The NCLCA is responsible for developing service specifications and agreeing a timetable for review. Currently there is no required structure for service specifications in acute or ambulance services although there is a structure mandated in the community contract. It is anticipated that the DH will mandate a structure in the near future for acute and ambulance services and it will increasingly shift from an input and output model towards outcome based specifications NCLCA will review the activity modelling received from the Hub and amend for local projections and service understanding. NCLCA will agree activity baselines with PCTs before discussing them with providers in order to establish a financial view prior to the end of December, then to be included in the initial Operating Plan to be produced at the end of January The clinical Directors of the NCLCA will recommend the CQUIN targets that should be adopted for contracts for acute and ambulance services – PCTs will need to agree these before they are discussed formally with providers. Choosing Contracting Routes As the contract type and style for both acute and ambulance services are now mandated by the DH i.e. Operating Framework 2009/10 there is no opportunity for the agency to use alternative structures The NCLCA needs also to agree the scale of the procurement as the process ought to be proportional to the service The NCLCA needs to decide whether the procurement process style -, especially if there is to be a period of competitive dialogue The NCLCAs key role in this area is to identify those agreements that should be subject to a procurement process or whether a formal improvement plan with milestones needs to be developed based on a variety of metrics surrounding access, quality and value for money indicators Procurement Process The NCLCA will lead the procurement of services process for all services within its remit through: o Preparing the documentation for a procurement process – contracts, specifications, legal terms, details of the contract duration and the key variables to be negotiated, preparing the pre-qualification questionnaire o Advertise the procurement though an appropriate system – as a minimum this should utilise the NHS Portal o Short list the potential providers o Go through a formal tendering process, including where appropriate competitive dialogue Other roles The Hub will have an expert procurement service that can be accessed to provide advice and assistance if required. The Hub service may well be appropriate to use for services provided by one provider pan-London (ambulance services may be seen as such a service) Selection Process and Contract It is essential at this stage for the NCLCA to be very clear what determines best value – it is not essentially a lowest price proposal that should win the contract. The NCLCA develops the measures of value, these should be weighted and scored, this allows for a more comprehensive testing. When developing the measures and the weightings it is very important to avoid potentially discriminatory criteria, legal advice in this area may well be prudent. The NCLCA should work with PCTs and PBC providers to cross check their evaluation Once a preferred provider has been selected this should be discussed at a closed meeting of the JCPCT [due to commercial confidentiality] prior to the preferred provider being contacted The NCLCA will provide all bidders with quality feedback. A standstill period between the award of the contract and the start date should be included in the timetable. This gives time for each party to ensure that the key questions have been answered and all are in full agreement. The NCLCA will negotiate all the key variables for inclusion in the contract Function 3 – Contract and Performance Management Transactions NCLCA receive data reports from HUB and check with PbC schemes if any further queries are raised NCLCA will receive “clean” data from Hub [technical queries already resolved between Hub and providers] The London Hub will recommend the activity base for the signing off of invoices to PCTs and NCLCA NCLCA will resolve queries that result from PbC NCLCA will resolve queries from other contractual data sources [non-SLAM, non- SUS], at least in the interim NCLCA will check invoices for each PCT against the activity levels agreed between the parties and recommend (approve) each invoice for payment to PCTs, this will be based on PbR data where available or other data for non PbR activities. Other roles Hub receives SLAM and SUS data and runs queries. Hub will run data quality checks in order to validate activity and pass reports to the NCLCA and to PCTs The Hub checks activity against invoice and recommends action to NCLCA The Hub reviews data queries and seeks to resolve queries Hub produces PCT and PbC based reports as requested PCT will be responsible for authorization of invoices for activity in a fashion that complies with Better Payment Practice Code and Public Sector Payment Policy Responsibility for agreeing balances remains with PCT [sits with authority to sign invoices] Budget and activity management The Agency will adopt a system of Account Management, with designated members of staff at the Agency holding the accounts for specified providers. An emphasis will also be placed on relationship management through this approach. Monthly production of reports on contract compliance covering all areas of contract performance for which there is data to include activity, cost and quality covering the plan for the period to date, the forecast out-turn, reasons for failure to comply, key risk issues and actions to mitigate the risks identified. The NCLCA should agree the style of report, each report should be able to be analysed by service as well as by provider. Such reports must be able to be drilled in to in order to provide PbC reports e.g. data on acute prescribing practice and cost NCLCA should produce a 6 month “mid term” full review of performance for each PCT reflecting on the specific metrics of the contracts and the priorities highlighted in CI 2009/10. A year end out-turn report for each PCT will be produced in a similar format [detail to be agreed] NCLCA is responsible for managing to activity and financial levels agreed with the PCT Other roles PCT will review reports and present them to appropriate Board and Committee structures in order to agree what, if any action should be agreed on a monthly basis PCT will present the 6 month to the Board and action agreed The PCT will present the full year report to the Board PCT will review performance of PBC schemes and agree actions PCT will submit statutory reports Performance Reports The Agency will take the lead on behalf of the sector PCTs in securing remedial actions / development plans in the event of key Access target breaches. TO do this the Agency will ensure at least weekly reporting, to be assured that capacity has been identified so as to achieve key targets. Where there is no plan to comply for an individual patient the NCLCA will act immediately in order to rectify the situation. At the same time the NCLCA will inform the Director of Commissioning of the responsible PCT or appropriate officer. If a breach of any of the key targets takes place the NCLCA will inform designated key sector officers e.g. the Director of Commissioning and the Chief Executive of the PCT immediately and sustain a clear channel of communication between the PCT, Provider and NHS London. NCLCA is responsible for managing achievement of performance targets as identified in the business case on behalf of each PCT The NCLCA will produce monthly reports on performance target achievement along with identification of key risks (including “rising tide” issues) and mitigation actions required. Action to be taken will need to be agreed with PCTs, reports should be produced in order that they can be drilled down to PbC level For relevant WCC agreed targets monthly reports will be produced by NCLCA NCLCA will provide each PCT with a quarterly benchmarking report NCLCA will mange complaints and SUIs on behalf of PCT Chief Executives, reports on both will be made to the host PCT Chief Executive as and when necessary with full compliance with guidance Other roles Hub will provide benchmarking data on performance PCTs will submit statutory reports PCTs will manage performance of PbC providers PCTS will continue to manage Exceptional treatment Panels, supported by expert advice from the LCBSA Patient feedback and clinical intelligence NCLCA must work with PCTs to integrate the communication links with GPs, other clinicians and patients about the services they commission, this must include data on PROMs. In year 1 the NCLCA should agree the system with each PCT The NCLCA should be responsible for producing reports detailing the issues raised by patients and clinicians on at least a quarterly basis Function 4 - Patient and public engagement PCT Prospectus NCLCA will update the prospectus as and when required, especially if there is a change in the Choice “any willing provider” list Other roles PCT is responsible for producing the prospectus Choice advice The NCLCA is responsible for ensuring that there are choices available, sufficient to comply with guidance and that providers seen as “any willing provider” are a provider of high standard care that achieves the requirements of the NCLCA’s minimum requirements as set out in pre-qualification questionnaires Other roles PCTs are responsible for processes to engage patients and public in educating them on choices available to them PCTs to operate the choice system with GPs and patients PCT is responsible for supporting patients through making a choice Engagement, communication and consultation strategies NCLCA should agree with each PCT how the Agency will engage with stakeholders as the systems should dovetail, not overlap or leave a gap in the system NCLCA will assist and advise PCTs on the detailed considerations for consultation NCLCA as World Class Commissioners Overview The proposal involves developing the new Agency as a World Class Commissioner, putting in place the capacity, skills, personal competencies and organisational processes that will allow it to perform at Levels 3 and 4 in its delegated role of commissioning acute services on behalf of PCTs in the sector. Currently the 5 PCTs in the sector are performing at Level 1 or Level 2 and so the investment in the Agency is expected to deliver a significant increase in performance from acute commissioning. In the following section the key headlines of how the Agency is planned to operate have been pulled out for each relevant competency. Competency 1: Recognized as the Leader in the local NHS The NCLCA through its reporting arrangements through the JCPCT will be a clear leader for the commissioning of acute and ambulance services, working as an agent for the 5 PCTs in the sector. Its real visibility and recognition as a leader will stem from the quality of the work it does in the first year. The proposed development plan will ensure that the key building blocks to that level of success are in place to achieve that level of recognition. The clinical leadership will lead to an increased pace of change as the level of planning support behind those leaders will ensure that improvement will be achieved. Competency 2: Partnership Working Across the Community This is not a lead role for the Agency but for PCTs Competency 3: Proactively build continuous and meaningful engagement with the public and patients to shape services and improve health This is a key competency for the Agency. Through pathway redesign work and the development of patient focussed process maps the views of patients and the public will be at the heart of the improvement process delivered by the Agency. Through undertaking the patient journey’s and undertaking “discovery interviews” the live patient experience will directly affect the pathway design processes. The Agency will need to work with PCTs to ensure that the SUI, Complaint and other loops of communication are brought to the Agency, this will be assisted through the account manager concept at the heart of the Agency’s structure where one of the top team will become an account manager to each PCT. Competency 4: Lead continuous and meaningful engagement of all clinicians to inform strategy and drive quality, service design and resource utilisation The goal is for the Agency to be clinically led with the heart of the Agency’s development work being led by a clinician as the Director of Clinical Strategy, supported by clinical directors who will work in as inclusive a fashion as possible. The clinical advisory function will be drawn from PCTs in order that they can ensure there is a two-way communication system with front line primary care staff. The role of the clinical directors is not solely to look at the development of pathways but to be actively involved in the contracting and procurement process – these roles will be part of the role description for these posts. Competency 5: Manage knowledge and undertake robust and regular needs assessments that establish a full understanding of current and future local health needs and requirements The NCLCA is not going to undertake needs assessments as this role is core to the function of Borough structures. The NCLCA has a number of analysts within its structure who will be examining the reasons for any variance from a plan and determining if there are any identifiable reasons for the variations that can be acted upon. The analysts will also be the lead group for working with the Hub on looking at pan London benchmarking (a key deliverable for the Hub) but will also be looking at benchmarking data from within the sector in order to determine reasons behind different access rates to services and whether any good practice exists that can be disseminated. The clinical directors will be supported by public health input and input from the Hub on effectiveness and evidence based practice. Competency 6: Prioritise investment according to local needs, service requirements and the values of the NHS This is mainly a PCT priority. Competency 7: Effectively stimulate the market to meet demand and secure required clinical and health and wellbeing outcomes A key role of the Agency in year 1 is to evaluate the services and providers it works with, assessing current performance against 3 criteria – quality, access and value for money. This information will be used to determine if there needs to be an improvement plan drawn up which can form a part of the contract for services, managed by an account holder for that particular provider or whether a new procurement process ought to be instigated or indeed if no change is required. The development of the provider account holder concept will give each provider a key link in to the Agency in order for there to be regular dialogue on potential developments of different service models. The Agency will need to work closely with the Hub in modelling potential demand in future years. The Hub sees modelling as a key deliverable and the Agency will need to overlay local services in order to alter the demand curve and create a robust capacity plan on at least an annual basis. This could be used as a discussion topic with providers in a period of discussion following the publication of Commissioning Intentions in the autumn of each year. Competency 8: Promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and configuration Continuous improvement systems based on the evidence based practice of the Institute of Healthcare Improvement and the Institute of Innovation form the basis of the improvement processes identified in the work plan for the Agency. The clinical directors will lead the improvement processes in each of the Next Step priority areas and in the Clinical Pathways agreed as falling in the remit of the Agency. The relationship with the clinical leadership at the Hub will be key in achieving the required improvement in the assessment process as the Hub leaders will be identifying the minimum standards and the monitoring metrics. Through the developing relationship between the Agency and the Hub these linkages will be strengthened. Competency 9: Secure procurement skills that ensure robust and viable contracts The agency structure recognises that there is a weakness in the current system and has determined that a Director of Procurement and Contracts should be one of the three Directors in the Agency. Their role in leading the procurement and contracting discipline gives the level of importance this team needs through undertaking the complex tasks within the procurement and contract management processes described in the role descriptions of the Agency. The role descriptions of the procurement posts will be based on the requirements of the IPS qualifications which clearly set out the skills and knowledge required form procurement experts. The procurement and contracting experts recruited to the team will be able to focus on the levers available through the model contracts mandated by the Department of Health. Competency 10: Effectively manage systems and work in partnership with providers to ensure contract compliance and continuous improvement in quality and outcomes an Each provider will have a dedicated account manager allocated to them to lead the on- going engagement process. That account holder will be assisted by people from the different disciplines in the Agency in order to manage the different variables set out in the contract. There will be monthly reports on performance produced by the Agency for detailed review by PCTs these will not only look at pure contract compliance but general performance issues, they will detail the risks emerging from performance to date and for the period to the end of the year and recommended action to address those risks. The dedicated contract managers will progress chase action throughout the process of monthly technical and full contract meetings. The technical meetings will seek to address any residual data issues emerging and the full contract meetings will address the key risks, whether they be about quality, access or value.
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