Chief Finance Officer. DATE OF PAPER: 3 March 2015 Clinical Assessment and Treatment Service SUBJECT:

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1 NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 8 (b) Item for Decision 25 March 2015 REPORT OF: Chief Finance Officer DATE OF PAPER: 3 March 2015 Clinical Assessment and Treatment Service SUBJECT: (CATS) Re-procurement Update Report IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Community Based Care Integrated Care Steve Dixon Chief Finance Officer Ext 4892 Please tick which strategic priorities the paper relates to: In Hospital Care Long Term Conditions and Mental Health Effective Organisation PURPOSE OF PAPER: The Care UK Greater Manchester Clinical Assessment & Treatment Service (GMCATS) contract will expire on the 2 February 2016 and the Programme Management Group established a Task and Finish Group to consider options to ensure appropriate CATS services are commissioned and in place post GMCATS. This paper provides a summary of the work undertaken by the clinically led Task and Finish Group and puts forward their recommendations for the re-procurement of CATS clinical specialties. As part of the governance decision process these recommendations have been presented and approved by the following CCG groups: Community Based Care Commissioning Group - 27 January 2015 Commissioned Services Quality Group 19 February 2015 Programme Management Group 4 March 2015 The financial value of these services is over 3m and therefore the commissioning decision needs to be endorsed by the CCG s Governing Body. Page 1 of 10

2 Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? WHAT RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. Increase patient access and choice by providing treatment closer to patients homes; Reduce number of unnecessary referrals to secondary/acute care; Improve patient satisfaction and experience of treatment; Improve patient treatment and clinical outcomes; Reduce time patients wait from first referral to diagnosis and treatment; Improve patient quality of life, and return to work or normal social function. Delays to the procurement timetable will result in disruption to patient care this is being mitigated by having a clear agreed procurement process and milestones in place; Risk of Market Management procurement support not being available due to CSU ceasing from end March 2016 mitigated by procurement process being completed by January An EA has been completed (9 February 2015) no risks identified. Not applicable. There may be potential for commercial sensitive information contained within this paper being in the public domain prior to procurement recommendations being endorsed. PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: Footnote: None identified. Members of NHS Salford Clinical Commissioning Group Governing Body will read all papers thoroughly. Once papers are distributed no amendments are possible. Page 2 of 10

3 Document Development Public Engagement Process Yes No (Please detail the method ie survey, event, consultation) Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Programme Management Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Patient panel survey completed Patient focus group delivered The CCG clinically led Task and Finish Group have made recommendations contained in this report Specification development has been clinically led and underpinned by survey of GP practices Liaison with various provider clinicians including Care-UK Greater Manchester market test event delivered 15 January 2015 EA Completed no adverse impacts identified Greater Manchester CCGs have contributed to the costs of legal advice on procurement and employment issues. Presented to Programme Management Group on 4 March 2015 Outcome Informed specification development Informed specification development Awaiting a response but this shouldn t affect the ability to make a decision Recommendations agreed Page 3 of 10

4 Presented to any other groups or committees, including Partnership Groups (Please specify in comments) Community Based Care Commissioning Group - 27 January 2015 Commissioned Services Quality Group 19 February 2015 Recommendations agreed Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 4 of 10

5 CATS Re-procurement Update Report 1 Executive Summary 1.1 Reports have been presented to the CCG throughout 2014 advising that the Greater Manchester wide contract with Care UK to provide Clinical Assessment & Treatment Services (GMCATS) expires on the 2 February Salford CCG s initial commissioning intentions for a local CATS service were approved by the Programme Management Group (PMG) on the 4 June These commissioning intentions were informed and supported by activity analyses and feedback from GPs and patients about the existing CATS service. In order to make timely progress a clinically led Task and Finish Group was set up to consider options for a locally commissioned CATS service to deliver continuity of service when the Care UK contract expired. 1.3 The Task and Finish Group has met regularly since September 2014 reviewing the current service, engaging with clinicians and patients, analysing financial and activity models and revising care pathways and draft service specifications. 1.4 Reports have been presented at both the CCG s Commissioned Services Quality Group (CSQG) and PMG. Both of these groups support the commissioning and procurement of a new local CATS service for the following clinical pathways: Urology; ENT; MSK/Physiotherapy; Gastroenterology and Direct Access Endoscopy. 1.5 The current Gynaecology CATS activity at Care UK represents low volumes of activity. Therefore PMG recommends that the Gynaecology element of the current CATS service is not commissioned as part of the new Salford service. This activity will be absorbed at other current providers that hold an NHS standard contract. 1.6 The PMG has agreed a set of Commissioning Principles to guide the re-provision of its local CATS service which the Task and Finish Group have incorporated into their on-going development of a draft Service Specification and Key Performance Indicators (KPIs) for the new service. 1.7 Salford CCG Governing Body is asked to approve PMG s recommendations in relation to re-providing a new CATS service for Salford, the clinical specialties included and the associated procurement for each clinical specialty. Page 5 of 10

6 2 Introduction and Background 2.1 The GMCATS contract provided by Care UK will expire on the 2 February At a PMG meeting on 4 June 2014, the CCG agreed that a CATS service should be available to provide continuity of service for Salford residents and established a Task and Finish Group to consider options for a locally commissioned CATS service post GMCATS. 2.2 This paper provides an update on work that has been undertaken by the Task and Finish Group and puts forward recommendations for the re-procurement of individual CATS clinical specialties. 3 Contract Exit Arrangements 3.1 Individual CCGs are responsible for taking forward their own future CATS arrangements. Tameside and Glossop CCG, current lead commissioner for GMCATS and NHS England as contract holders, are responsible for contract exit arrangements. 3.2 Currently exit issues being considered include: Finance Negotiations/Referral Cut Off: Discussions and negotiations between Tameside and Glossop CCG, NWCSU Contract Management and NHSE with Care UK are continuing. A risk has been identified that the GMCATS may stop accepting new referrals prior to the end date for the existing contract. The new service might therefore need to be in place before the existing contract ends. There is therefore a potential for a period of double running. A financial contingency has been set aside by the CCG to cover this double running. Procurement and Employment Legal Advice: GM CCGs have contributed to the costs of legal advice on procurement and employment issues. A response is still awaited but this should not affect Salford CCGs ability to make a decision with regards to which services to re-provide and how these services should be re-procured. 4 Engagement 4.1 At every stage of the CATS re-modelling local engagement has been undertaken and is still on-going. To date engagement with the following has been undertaken: Local GPs; Salford CCG Patient Panel; Secondary Care Clinicians; Current Service Provider. Page 6 of 10

7 4.2 Engagement feedback has been used to inform the CCGs CATS commissioning principles, commissioning intentions, draft service specification, KPIs, outcome measures and re-procurement recommendations. 5 Finance and Activity Modelling 5.1 In 2014/15 Salford CCG s contribution to the GMCATS contract was approximately 3.6m. The contract with Care UK is currently a block contract with the CCG having to guarantee a minimum payment to the provider of 85% of the contract value, irrespective of activity volumes. 5.2 A modelling exercise has been undertaken to identify indicative financial and activity envelopes for the future service. The modelling has been based on current Care UK activity and 2014/15 NHS prices over a 12-month rolling period (November 2013 to October 2014) which has taken into account seasonality of demand. 5.3 The modelling reveals, based on current activity volumes, that a re-procured service would cost approximately 3.4m. The reduction in costs is due to both commissioning a service based on appropriate activity volumes and moving away from a block contract going forward. 6 CATS Service Modelling & Service Specification Development 6.1 PMG is recommending that a Salford CATS service is commissioned for the following clinical pathways: MSK/Physiotherapy; ENT; Urology; Gastroenterology and direct access to Endoscopy procedures. 6.2 The rationale for these recommendations is described in further detail below MSK/Physiotherapy Currently there are two separate referral pathways for MSK and Physiotherapy into the CATS service; patients currently access Physiotherapy via two routes which are: Direct referral from GPs; Referral from CATS episode From analysis of the activity data the majority of Salford s overall MSK activity goes through the current Care-UK GMCATS service, suggesting that a significant pressure would be put on other existing services if this pathway was not re-commissioned which would disadvantage patients. Page 7 of 10

8 6.2.4 Direct access to physiotherapy for GPs is a valued element of the current CATS service and therefore the proposal is to re-commission the service as part of an integrated pathway with MSK. This will ensure physiotherapy is embedded within the MSK pathway, it will also ensure a seamless approach for patients who are directly referred by their GP for physiotherapy, but subsequently are found to require a referral into MSK. This will prevent patients having to go back to their GP for an onward referral into MSK, a concern that has been identified by both patients and GPs In summary therefore, the proposal going forward is to re-procure a community based joint MSK and Physiotherapy CATS pathway. 6.3 ENT From the analysis of activity data Care-UK GMCATS currently accounts for approximately 16% of total Salford CCG ENT activity. The majority of the remainder of ENT activity is delivered by the local NHS foundation trust on the hospital site. The current Care-UK GMCATS ENT activity is considered to be sufficient that if not re-commissioned this would place significant pressures on other existing services which would disadvantage patients The ambition to bring services closer to patients and delivered from community settings is a key priority and strategic aim of Salford CCG. The availability of a community based one-stop ENT CATS service could increase overall capacity to assess and treat ENT conditions that could meet these strategic aims Therefore the proposal going forward is to re-procure a community based ENT CATS pathway. 6.4 Urology From analysis of activity data Care-UK GMCATS currently accounts for approximately 8% of total Salford CCG Urology activity. The majority of the remaining Urology activity is delivered by the local NHS foundation trust on the hospital site. The current Care-UK GMCATS Urology activity is considered to be sufficient that if not re-commissioned this would place significant pressures on other existing services which would disadvantage patients In addition the current CATS provider offers direct access vasectomy procedures within the Urology pathway. Anecdotal evidence suggests this direct access service is viewed positively and also offers patient choice The proposal going forward is to re-procure a community based Urology CATS pathway that includes direct access to vasectomy procedures. 6.5 Gastroenterology and Direct Access to Endoscopy The current Care-UK GMCATS provider offers a Gastroenterology pathway under the label of general surgery, and direct access to endoscopy. Analysis of the data Page 8 of 10

9 shows that Care-UK GMCATS manages significant demand and activity for Gastroenterology and direct access endoscopy procedures The local NHS Foundation Trust is currently experiencing demand and capacity issues associated with its Gastroenterology and Endoscopy services. In addition it is expected that NICE Guidelines for direct access to Endoscopy procedures will further increase demand on this service. Therefore, not re-commissioning these services suggests that further pressure would be put on a system that is already over capacity The proposal going forward is to re-procure a community based Gastroenterology and a Direct Access Endoscopy CATS pathway. 6.6 Gynaecology Analysis of current Care-UK GMCATS gynaecology activity data demonstrates very low demand for this service. The current GMCATS provider inform us that this low activity is due to this being managed very well by GPs in primary care, as the majority of gynaecology symptoms includes menstrual disorders and menopausal symptoms In terms of gynaecology procedures the main CATS activity is for hysteroscopy which data analysis demonstrates extremely low demand, in the order of one per week. Patients who received a hysteroscopy from CATS were then required to either be referred back to their GP or onward referred to secondary care It is therefore proposed that gynaecology activity will continue to be picked up in primary care via the patients GPs. Hysteroscopy activity will be picked up through referral to current acute providers that hold an NHS standard contract and will be included in the CCG s 2015/16 Commissioning Intentions to ensure this diagnostic activity continues to be available post GMCATS The proposal going forward therefore is not to re-procure a gynaecology CATS pathway. 7 Re-Procurement Approach 7.1 Having reached a recommendation regarding which services need to be re-procured, the Task and Finish group then considered the re-procurement approach to be taken. For each service the group considered whether to either: Competitive tender or Waiver competitive tender, re-procure via negotiation around contract variation with existing provider(s). Page 9 of 10

10 7.2 The recommendations are: Competitive Tender MSK/Physiotherapy Gastroenterology and Direct Access to Endoscopy Urology ENT 7.3 Procurement advice received recommended that the competitive tender contract will be advertised as a Standard NHS five year contract with options to extend for two years. 8 Timescales and Next Steps 8.1 If the Governing Body approved PMG s recommendations, then a procurement processes will be initiated immediately following the Governing Body decision in order to enable the new service to be mobilised in the autumn. 8.2 The following steps would also be initiated: Salford CCG Communication and Engagement service will lead on the communication plan for CATS and will keep clinicians informed and updated on future arrangements. An Equality Analysis has been completed by Salford CCG and will continue to be reviewed as part of the on-going process. Service Specifications, KPIs, outcome measures and clinical pathways continue to be developed and will be available to support the procurement. Launch competitive procurement process to start 2 April Recommendations 9.1 The NHS Salford Clinical Commissioning Group Governing Body is asked to endorse the following recommendations: Commission a new local CATS model via a competitive tender that includes: o MSK/Physiotherapy service; o Gastroenterology and Endoscopy service via competitive tender; o ENT service; o Urology service. Do not commission a Gynaecology CATS service. The financial envelope for all the new commissioned services would be approximately 3.4m Steve Dixon Chief Finance Officer Page 10 of 10