Page 1 Memorandum of Information

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					                           Camden Primary Care Trust

                           MSK Services Procurement

                         Memorandum of Information

                           (February 2009 – Version 2)

1. Background and Context

The MSK CAT service pilots opened on Monday 17th September 2007, located at the
University College (UCH) and Royal Free Hospitals (RFH). Until March 2008 the pilots
only received referrals from the 17 practices in the CAMission collaborative (covering
about 50% of the PCT registered population). In April 2008 access was extended to
all remaining general practices in Camden.

 During the whole period self-referral patients have been able to refer themselves to
the RFH site only.

The pilot service was reviewed between July to September 2008. This compared
elements of service between the two providers and identified several areas for
service and clinical performance improvement and development. These have been
captured in the specification for the new service.

A Public Health profile for Camden may be found in the 2007-08 Public Health Annual
Report on the PCT website under the Publications tab.

2. Aims of the New Service

The overall aims of the new musculoskeletal service are to:
   •   Improve access to specialised clinical services and ensure patients are offered
       the most appropriate treatment or management in the shortest possible time.
   •   Limit the physical and associated disabilities that are caused by
       musculoskeletal conditions.
   •   Address historic inequalities in access for people in Camden.
   •   Support General Practice by making available a new and effective pathway for
       patients with musculo-skeletal conditions.
   •   Reduce pressure on secondary care services and enable 18 weeks target to
       be met.

3. New Service Proposal

The PCT Commissioning Executive decided on the configuration of services for the
new service in August 2008.

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It decided that it wanted to continue to offer MSK services from two sites, one north
and one south, and both located within the Camden PCT boundary. It decided that it
would offer two distinct contracts, but that bidders may bid for one or both

The new services are to include:

       •   Clinical Assessment and Treatment Service (MSK CATs) by extended
           scope physiotherapists
       •   Access to Diagnostics (at least – blood testing, X-ray, magnetic resonance
           imaging, nerve conduction studies, ultrasound, as appropriate)
       •   Physiotherapy treatment following triage
       •   Self-referral physiotherapy
       •   Access to consultant within the service (orthopaedic or rheumatology), or
           GPwSI, for initial diagnosis, primary care treatment plan, or minor
           procedure if required
       •   Referral to secondary care consultant (orthopaedic or rheumatology) if
           required – and using Choose and Book
       •   Referral to other appropriate services from CATS

The significant differences or improvements in the new service to the pilot are that:

       •   self-referral would be available from both sites
       •   there would be access to a consultant within the service(s)
       •   the service(s) would additionally have an educational remit for primary
       •   the service(s) would have to comply with 18 week ‘end-to-end’
           requirements – meaning that, if it wasn’t going to begin a first definitive
           treatment, referral to secondary care would have to be made within four
           weeks of initial referral
       •   the range of other appropriate services to refer to from CATs would be

GPs would continue to exercise choice over which service they wished to refer their
patients to, and so would self–referral patients.

4. Procurement Process

The Board approved proceeding to procurement in November 2008. Procurement will
be by invitation to tender.

Marketing Activity

The PCT has advertised for Expressions of Interest for this service provision in the
Health Service Journal, the Camden New Journal (local newspaper), the Chartered

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Society of physiotherapy Journal ‘Frontline’, and the supply2health website.
Advertising began on January 21st 2009.

Current providers of the pilot services have been made aware that the service is
being advertised.

Procurement Timeline

Overall timeline is set out below. Key dates are yet to be finalised but will be in the
weeks indicated wherever possible.

Bidder Briefing Event

February 6th 2009

Expressions of Interest - deadline

Expressions of interest will have to be registered by February 27th 2009.


PQQs will go out w/c March 2nd. Return will be due 15 days later.

Invitation to Tender

Invitation to tender stage will begin during w/c April 6th, and be returned in week
commencing May 18th.

Dates to interview finalists are likely to be in w/c June 8th.

Contract Award

End July – subject to a Board date to approve.

Service Commencement

End August / early September.

Please note all dates contained herein are estimates based on the best knowledge
available to the PCT at the time of writing and as such are subject to change without
notice or prior consultation with bidders.

5. Commercial Framework

Activity and assumptions

In the first full year of the pilot the combined activity for the MSK CATs services
showed that 10080 patients were referred by GPs, and 1512 patients self-referred –
roughly equally split between two current providers. 70% +/- were treated with
physio (most referred from paper triage – 60%, or after face to face triage – the
other 10%). Up to 30% of GP referrals were referred to a secondary care consultant.

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The new service adds the dynamic of introducing a consultant option into the
service. The assumptions made are that the consultant will see / screen half of the
previous secondary care referrals and reduce the number of secondary care referrals
from 30% to below 20%. It is assumed that there will be a consequent increase in
the use of diagnostic tests within the service.

The average number of physiotherapy treatments offered is three (based on one
hour for assessment, advice, initial treatment followed by two half hour treatment

Contract and contract duration

The PCT will be using the new model Community Contract launched by the
Department of Health in December 2008.

The contracts will be offered for 3 years initially, with possible extension of a year
and a further year (to a maximum of 5 years). The service contracts are intended to
start w/c (end August / early September) 2009

Financial issues

The PCT will not be advising of a target budget as part of the tendering process.
Potential providers should be advised, however, that the PCT has undertaken a
rigorous costing exercise to establish what it believes to be a reasonable cost for this
service. Eventual award of the contract will be based on a formula that calculates a
‘cost : confidence in service delivery’ ratio. This will be further advised at ITT stage.


The service has two main components:

Diagnostic component – this part of the service includes paper triage, face to face
triage, any diagnostic test(s) necessary to decide on referral direction, any internal
consultant (or GPwSI) input including advice, clinics, educational input, etc.,
discharge to GP or referral to secondary care, and all admin support to run these
service elements.

Physiotherapy component – this part of the service includes the physiotherapy
assessments and treatments for both self-referrals and all the patients referred
following paper triage, face to face triage or having seen the internal consultant or
GPwSI, together with any admin support to book physio appointments, chase up
patients, and discharge after physio.

The PCT will expect the provider to incorporate all the costs of its activity into two
tariffs which reflect the two components above. In effect there will be a diagnostic
tariff (amount per referred patient) to arrive at decision on any onward referral (and
to include any one-off minor treatment such as a joint injection), and a
physiotherapy tariff to treat those patients referred for physiotherapy.

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The PCT will reimburse the costs of any drugs used in a clinic setting from an agreed

The PCT will reimburse the cost of single appliances / orthotics over a set threshold
price. All regularly used appliances will be within tariff.

Performance Incentives Payments Framework

The PCT is developing a principle that its contracts for services will be incentivised by
the application of an incentives payments framework. In effect this means that XX%
of the value of the contract will be fixed and XX% will vary depending on the
performance of certain specified elements or targets. As a guide that XX% will be
based on the achievement of 1000 points which are likely to be distributed as

       Access                         150 points
       Clinical Management            250points
       Clinical Outcome               300 points
       Governance                     150 points
       Customer satisfaction          150 points

It should be noted at this stage that there are significant weightings within the
framework to ensure that time targets are met so as to achieve 18 week target, and
that the majority of referrals received are managed within the service.

As a guide potential providers should anticipate that the % of the contract price
subject to performance incentive will be in the order of 10% in year one and
increase on an incrementally in successive years. Exact details will be available at the
ITT stage.

Premises / facilities management / equipment

The PCT is has begun development of its polyclinic programme. It will be exploring
the options of placing the MSK services within one or more of the polyclinics as they
come on stream. Details of exact timing and any proposed facilities management or
equipment provision arrangements will be made available at the ITT stage.

In the event of not using a polyclinic site for any reason the PCT can introduce
potential providers to other organisations who may have facilities from where the
service could be provided, though potential providers would have to make their own


Potential providers would have to supply their own clinical system to hold all relevant
patient data and to deliver functionality in pathology / diagnostics ordering, clinical
coding, discharge management, and generating all performance data. New National
Network (N3) connectivity will be required.

The relevant information about service activity will be made available through SUS
system in an agreed timeframe. The provider should expect that Camden PCT will
use SUS data for performance monitoring, reconciliation and payments in an agreed

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The service will need to be set up on the Choose & Book system, with
referrals made through C&B from day one,

Workforce / Staffing

The service(s) will clearly require management and co-ordination of a number of
functions. Paper triage and face-to-face triage will need to be undertaken by
competent Extended Scope Physiotherapists. The service(s) will need to engage
consultant services (or GPwSI as appropriate) sufficient to meet required activity and
waiting time targets, and a qualified physiotherapist workforce sufficient to meet
required activity and waiting time targets.

TUPE requirements may arise if the contracts are not awarded to the current
providers of the pilot services. These will be clarified by the ITT stage.


Potential providers must arrange sufficient medical negligence indemnity insurance
and public liability insurance.

Registration with Healthcare Commission as a Provider

Independent health care providers will be required to have current registration with
the Healthcare Commission.

6. Governance

The provider will carry out the services in accordance with best practice in health
care and shall comply in all respects with the standards and recommendations
contained in, issued or referenced as follows:

a. Issued by Health Care Commission (HCC) including Standards for Better Health
b. Issued by the National Institute for Health and Clinical Excellence (NICE : or
c. Issued by any relevant professional body
d. Implement National Service Frameworks (NSFs)
e. Learning from significant untoward incidents (SUIs)
f. Clinical Negligence Scheme for Trusts (CNST) / National Health Service Litigation
g. National Patient Safety Agency (NPSA)
h. Data Protection Act 1998

And such other best practice guidance or quality standards as shall, from time to
time, be issued by the DoH or related bodies.

The provider will need to demonstrate it has the capacity to meet a number of
service and clinical outcomes. Service outcomes will include meeting a range of
service response times, engaging patients and demonstrating patient satisfaction,
and demonstrating referrer (GP) satisfaction. Clinical outcomes will include the level
of referrals managed within the service, the number of referrals to secondary care
after physiotherapy, and use of a range of before and after treatment assessments.

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The provider will be expected to put in place robust Governance management
arrangements, audit and reporting; and to produce evidence of these.

7. Expressions of Interest

Must be made in writing by February 27th to:

Joseph Poole
Clinical Services Procurement Manager
Estates and Facilities Office
St Pancras Hospital
London NW1 0PE


Annex 1 - List of potential providers of diagnostic services

Royal Free Hospital
University College Hospital
InHealth Net Care (independent sector)
Any other provider on choice menu

Annex 2 - A set of ‘RED FLAG’ conditions exist, where GPs will refer these direct to
consultant appointments:

    •    Suspicion of systemic inflammatory disease requiring medical management
    •    Suspicion of serious pathology (malignancy, infection etc.)
    •    Signs of cord compression/Cauda Equina syndrome
    •    Suspicion of recent fracture requiring intervention
    •    Structural deformity
    •    Progressive neurological deficit
    •    Systemically unwell / weight loss
    •    Severe trauma

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