Procurement in practice: the implications for the new regulations

Transcription

1 Procurement in practice: the implications for the new regulations The legal framework: the new contracts for primary medical care James Clarke, Partner 17 July 2014 Background What is Primary Medical Care? No statutory definition, BUT GMS Regs 2004 (as amended) PMS Regs 2004 (as amended) APMS Directions 2013 (as amended) all govern the provision of primary medical services If it s primary medical care, one of the above regulatory frameworks must apply 12

2 Primary Medical Care GMS Regs 2004 (as amended) Primary medical services comprise essential services, additional services, enhanced services, out of hours services Essential services are defined in Regulation 15 services required for patients who are, or believe themselves to be ill, with conditions from which recovery is generally expected, terminally ill, or suffering from chronic disease. 13 The problem with enhanced services Traditionally considered primary medical services, provided by GPs alongside essential services and delivered in a practice setting If enhanced services are primary medical care then the commissioner is NHS England If enhanced services are not primary medical care, then the commissioner is CCGs When is primary medical care not primary medical care? 14

3 Specification design why is it so important? Patient safety Contractual certainty Effectiveness of remedies To preserve lawfulness of commissioning arrangements NHS England and CCGs avoiding challenge on the basis of regulatory noncompliance CCGs may commission primary medical services with delegated authority from NHS England CCGs already do this for OOH services 15 Prior contracts for Primary Medical Services GMS contract to April 2014 maintained by DH now maintained by Capsticks regular regulatory updates updates served by notice no negotiation required updates consolidated into contract payment governed by regulation (most recent update being The General Medical Services Statement of Financial Entitlements (amendment) Directions 2014) contract form is strongly governed by regulation 16

4 Prior contracts for Primary Medical Services (2) PMS Contract exists in various forms (Lockharts the most common) now drafted and maintained by Capsticks regular regulatory updates updates served by notice no negotiation required unless commercial variation required updates not consolidated into contract payment for local agreement contract form is strongly governed by regulation 17 Prior contracts for Primary Medical Services (3) APMS Contract exists in many forms (Wragges, Beachcrofts, etc) now drafted and maintained by Capsticks annual regulatory updates updates served by notice no negotiation required unless commercial variation required updates consolidated into contract payment for local agreement contract form is flexible draws from PMS Regulations as a minimum standard only for contractor performance 18

5 New national standard primary medical contract forms GMS contract Updated from 2013 version in accordance with the National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) Amendment Regulations 2014 Design based purely on pre-existing form no surprises Full BMA approval has been obtained Gateway process completed now online Variation notices in respect of existing contract to be sent out form to be published 19 New contract forms (1) PMS Contract Completely new format Clarity over financial provisions such as liability for pensions payments all in self-contained finance schedule No licence fee Addresses problems encountered by commissioners in managing previous forms Expected to pass Gateway process later this month 20

6 New contract forms (2) APMS New national standard form for use in respect of all primary medical care services not directly contracted under GMS or PMS forms May be used for any distinct or stand alone services including those commissioned alongside GMS and PMS services A contractor may hold more that one primary medical care contract (unless disqualified) Gateway process completed now online Use of APMS not optional for primary medical care NHS Standard Contract must not be used Note continued relevance and importance of NHS Standard Contract for other services 21 New contract forms (3) APMS (continued) May be followed by a short form APMS for low value/short duration services to increase appeal to providers May apply amends to a version of NHS Standard Contract for certain integrated services, i.e. OOH and Urgent Care, police custody services, etc Subject to minimum requirements set out in PMS, offers full flexibility in term, termination, pricing, subcontracting and other key commercial deal points including KPIs and performance management provisions 22

7 Implementation New contracts GMS Reversions from PMS No entirely new GMS procurement! PMS as a condition for provider requested variations by agreement (as part of review) No entirely new PMS APMS all new procurements of contracts for primary medical care services 23 Use following implementation Contract management Standard statutory updates to be issued when appropriate Variations required by statute to be imposed without agreement (reflects current position) More robust management of updates to APMS contracts closing the gap between theory and reality Link to integration agenda Co-commissioning NHS Standard Overarching Contract widening of application 24

8 Our contact details James Clarke, Partner, Capsticks Tel: Richard Heath, Associate, Capsticks Tel: