RCCG/GB/16/008 Rushcliffe CCG Nottingham West CCG Commissioning Support Services Update 1.0 Introduction & Background When CCG s were established in April 2013 NHS England also established a number of Commissioning Support Units (CSUs). In April 2013 all Nottinghamshire CCGs signed a Service Level Agreement (SLA) with the Greater East Midlands Commissioning Support Unit (GEM CSU) for a range of services. The SLA was signed for a period of 18 months for the five Nottinghamshire County CCGs. The SLA values were based on predecessor PCT direct staffing costs and a proportion of shared overheads. These costs were based on a weighted capitation on the principle of a common service offer to all CCG s. The CSU costs contribute to overall CCG running costs. A paper was taken to all Nottinghamshire Governing Bodies in May 2014 with proposed commissioning support intentions following a make/share/buy review and a further paper with service line options was approved by individual Governing Bodies in September 2014. The September 2014 Governing Body decisions resulted in differing requirements for the Mid Notts and South Notts CCG s. All service specifications were subject to review prior to signing the SLA covering the period October 2014 March 2016. There are some in-house services that are hosted/shared by CCGs in Nottinghamshire on behalf of each other. They are covered in the Memorandum of Understanding for Collaborative Governance Arrangements. This paper does not cover those services as there is no specific end date for this MOU and no service issues have been identified through review and audit processes with any of the hosted/shared services. 2.0 National Position & Lead Provider Framework Since April 2013 the NHS England Hosted CSUs have gone through a period of review and consolidation, this has resulted in a number of mergers and some CSUs have ceased to operate. As at 1 st April 2015 there are eight NHS England Hosted CSUs. GEM has merged with the Arden CSU and now operates as a single organisation under the name of NHS Arden & GEM CSU. Also, during 2014/2015 NHS England completed a procurement project to create a Lead Provider Framework (LPF) agreement for commissioning support services. The LPF has been put in place to make it easier for CCGs to procure services without the need to complete a full OJEU procurement. Only six of the eight CSUs (2015) are on the LPF along with a number of private sector organisations and consortia. NHS England expects every CCG, by April 2016, to have given a firm commitment as to when it intends to launch its procurement from the LPF or open market. All CCGs are expected to have launched their procurements, or other solutions, by no later than July 2016, with the expectation of mobilisation of new contracts with providers no later than 1 April 2017.
3.0 Arden GEM CSU Service Provision 2015/2016: NHS Mansfield & Ashfield CCG s Information Governance (Inc. FOI Requests) HR Services (recruitment service only)** 15/16 Contract Value - 444,632.00 NHS Newark & Sherwood CCG Information Governance (Inc. FOI Requests) HR Services (recruitment service only)** 15/16 Contract Value - 368,277.67 NHS Nottingham West CCG Information Governance (Inc. FOI Requests) (Oct 2014 Jan 2015) Service brought back in-house (Oct 2014) Service brought back in-house HR Services (recruitment service only) 15/16 Contract Value - 184,715.33 NHS Nottingham North East CCG Information Governance (Inc. FOI Requests) (Oct 2014 Jan 2015) Service brought back in-house*** (Oct 2014) Service brought back in-house HR Services (recruitment service only) (Service Decommissioned) 15/16 Contract Value - 257,606.33
NHS Rushcliffe CCG Information Governance (Inc. FOI Requests) (Oct 2014 Jan 2015) Service brought back in-house *** (Oct 2014) Service brought back in-house HR Services (recruitment service only) 15/16 Contract Value 211,215.00 *The Governing Body approved the decision to re-procure the Continuing Healthcare Service. This process has been concluded. The contract has been awarded to CityCare. The new contract commenced on the 1 st July 2015. **In addition to the above, an agreement is in place for additional Communications and HR services to be delivered on a pay as you go basis. *** In house FOI service shared across 3 south Notts CCG s and IG services shared with City CCG Mid Notts CCGs Recurrent s with Arden Gem (annual cost) Communications Information Governance (Inc. FOI Requests) Finance (Inc Purchase to Pay, Treasury & Cash and Statutory Reporting) (Oct 2014) HR Services (recruitment service only) Recurrent CSU Contract Value - 480,902.00 South Notts CCGs Recurrent s with Arden Gem (annual cost) Communications HR Services (recruitment service only) (NW & Rushcliffe only) Recurrent CSU Contract Value - 279,445.00 County CCGs Recurrent s with Arden Gem (annual cost) Communications - (All) Information Governance (Inc. FOI Requests) (M&A and N&S only) (All) (M&A and N&S only) HR Services (M&A, N&S, NW and Rushcliffe) (All) (All)
Recurrent CSU Contract Value - 760,347.00 4.0 Next Steps The current SLAs with Arden Gem for each of the above service lines expire at the end of March 2016. Current NHS England guidance to CCGs is that existing SLAs should not be extended beyond 31 March 2017. NHS England has indicated that extensions are permissible on condition that the CCG has robust procurement plans in place by July 2016. These commissioning support services are subject to the current Public Contract Regulations. The current contract value threshold is 106K. Therefore CCGs are required to procure via OJEU or a framework if the total contract value is estimated to exceed this threshold. This threshold applies to the total contract value, not the annual contract value. The future options for each of the above service lines are: 1. Undertake a competition process via the NHS England Lead Provider Framework. 2. Undertake a full OJEU compliant open procurement process. 3. Decommission service and bring back in-house on either an individual or shared basis. Option Advantages Disadvantages Option 1 Fully compliant with EU Limited providers Procurement Regulations. Shorter procurement process Free centrally provided procurement and legal support Option 2 Access wider market including local providers. Local providers not able to bid. Timescale Option 3 Competitive process More flexible use of CCG resource TUPE issues Exit Costs In addition to these three options, consideration needs to be given to the potential benefits or otherwise of procuring on a countywide basis (or Mid Notts/South Notts) and whether the service lines should be procured together on a one stop shop basis or on a line by line basis. The collaborative options will impact on the final procurement decisions as they will impact on potential contract value and potential provider options. Also, future decisions will need to consider the potential for current New Care Models Vanguards to look at innovative options to share back office functions between commissioners and providers. Where the recommendations propose a solution that may have TUPE or redundancy implications, the CCGs will ensure that they comply with relevant legislation and NHS employment requirements. Where the recommendations propose a re-procurement, additional resource may be required to undertake the procurement. Arden GEM currently provides this service to the
CCGs. However, for reasons of conflicts of interest, it would not be good practice to ask Arden Gem to undertake procurement for services that they are likely to bid for. Free procurement support is available nationally if the LPF is used however some local project management would still be required. Service Overview & 4.1. Communications & Engagement Communications and engagement is a service that includes a range of proactive and reactive services including engagement and involvement, corporate communications, marketing and campaign services, patient experience services, media relations and reputation management. The CCGs only commission communications, all engagement activity is provided in-house. Also, CCGs have elements of communications in-house and commission specific pieces of work on an ad-hoc basis. Extend the current core and ad-hoc arrangements with Arden Gem and complete a more detailed piece of work on the option to bring the service in-house to simplify elements of the service and enhance the current engagement function. The review will also include a review of the Emergency Preparedness Resilience & Response arrangements across Nottinghamshire County. 4.2 Collaborative Contract Management The service provides contract negotiation, management and compliance services focusing on the key providers whose contracts operate across multiple organisations and where leverage and efficiencies can be realised at scale. Services are offered in partnership with CCGs as an end to end solution through the contract management lifecycle from negotiation to execution, compliance and renewal of existing contracts. This currently includes Non -Emergency Patient Transport, Home Oxygen and IVF. Extend the current contract with Arden Gem and invite bids via the Lead Provider Framework. 4.3 Clinical/Non-Clinical Procurement The service includes procurement and contract development for clinical services commissioned by the CCG. It is delivered under the broad headings of procurement, market management, AQP, education, advice and consultancy and transition management. The non-clinical procurement service ensures that non-commissioning spend is delivered in accordance with corporate policies and public sector procurement regulations and provides access to a range of framework agreements. Both services deliver a broad range of projects within an agreed annual work plan plus in year ad-hoc requests. Complex projects that are not part of the core offer are delivered on a pay as you go basis. Decommission the Arden Gem core service and invite bids via Lead Provider Framework for a retained provider on a pay as you go project by project basis. 4.4 Human Resources
The HR Service provides a transactional recruitment process and HR advice and support through HR Business Partners. The detailed service offer by HR Business Partners provides a range of human resources services to assist the CCGs to meet public sector duties and legal obligations. Arden GEM s workforce team ensure CCGs manage, analyse and utilise staff data; recruit and retain staff; manage employee contracts; manage employee relations and wellbeing; develop and manage policies and procedures and manage staff health and safety. The service also includes Occupational Health Services. Invite Bids via the Lead Provider Framework. 4.5 supports CCGs to become high performing organisations through focussing upon people development, talent management, leadership, management and board development, individual and team development. Corporate Development, corporate skills, culture development, staff engagement, vision, values and brand. The service is delivered through a number of agreed days per annum. The OD service currently includes the development of the CCG OD plan and also delivery of events and workshops to meet the objectives of the OD plan. The CCGs also access OD development opportunities through the East Midlands Leadership Academy. Decommission the current service and commission OD events on a pay as you go basis. 5.0 Additional Commissioning Support Services In addition to the core CSU services, the CCGs also commission retrospective CHC reviews from Arden Gem and data information services from the Yorkshire and Humber CSU. Continuing Healthcare Retrospective Reviews The review of retrospective CHC cases is now very high profile and CCGs are being closely monitored by NHS England. All reviews are due to be completed by the end of March 2016. If cases have commenced prior to 31 March 2016 Arden Gem will continue until the cases have been closed. Data Management Services The Nottinghamshire County CCGs also procure data processing services from the Yorkshire & Humber CSU. The Yorkshire & Humber CSU is not part of the LPF and the North of England CSU has been identified as the stability partner to take over the services. Data services can only be commissioned from accredited DSCRO s (Data Services for Commissioners Regional Offices). On the basis that that only HSCIS (Health & Social Care Information Centre) staff can handle personal identifiable data NHS England have confirmed that the existing agreement can continue without the need to procure via the LPF. The expectation is that DCSRO services will become part of the HSCIS at some point in the future with services provided nationally.