Care homes and the NHS Standard
Contract
Alastair Hill
Senior Lead, NHS Standard Contract
NHS England
RCPA Seminar
20 November 2013
About NHS England
• An “arms-length body”
• Separate from Government and Department of Health
• Runs the NHS commissioning system
• Provides guidance and support to Clinical
Commissioning Groups
• Directly commissions primary care and specialised
services
• Works closely with regulators such as Monitor and
Care Quality Commission
2 NHS England | Presentation to RCPA Seminar 20 November 2013
Evolution of legally-binding NHS contracts
• Introduction of Foundation Trusts (acute services)
• Development of separate contracts for different
provider types:
mental health and learning disability
community; ambulance
care homes
• Introduction of increased choice and competition
• Move to the single NHS Standard Contract (2012/13)
3 NHS England | Presentation to RCPA Seminar 20 November 2013
Who uses the NHS Standard Contract?
Low volume,
high value
NHS Trusts and Foundation Trusts
High volume,
low value
Independent and voluntary sector
providers (hospitals, care homes, AQP,
patient transport providers, “enhanced
services” providers)
The NHS Standard Contract is not used for routine
primary care services
4 NHS England | Presentation to RCPA Seminar 20 November 2013
Why have a Standard Contract?
There are benefits in a standardised approach:
• one set of rules which everyone understands
• a level playing field for all types of provider
• economies of scale (contract production, legal
advice)
The Standard Contract is mandated for use by NHS
commissioners, and commissioners cannot vary the
nationally-set terms.
5 NHS England | Presentation to RCPA Seminar 20 November 2013
National and local elements
There are elements which are set nationally:
• boiler-plate legal clauses (payment, contract
management, dispute resolution, variation,
suspension, termination)
• national quality standards and reporting requirements
But much of the key detail is for local negotiation:
• service specifications
• local prices
• local quality standards and reporting requirements
6 NHS England | Presentation to RCPA Seminar 20 November 2013
“Tailoring” the Standard Contract
• This isn’t intended as a “one size fits all” approach
• The General Conditions are the same in all contracts
• But the content of the Service Conditions varies
depending on the specific services being
commissioned
• So standards or requirements that aren’t relevant don’t
apply
• This “tailoring” approach works best if the electronic
contract system (the eContract) is used
7 NHS England | Presentation to RCPA Seminar 20 November 2013
Updating the Contract for 2014/15
• Extensive engagement process, covering payment
systems, tariffs, incentives and the Standard Contract
•
•
•
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Direction of travel agreed
Main wording changes drafted
Improved eContract being developed
Publication of the final Contract and Technical
Guidance before Christmas
8 NHS England | Presentation to RCPA Seminar 20 November 2013
There will be changes for 2014/15
• The current three-part structure will remain, and many
clauses will see little alteration
• But there will be revised provisions, for example, to
implement recommendations from the Francis report
update the payment section to reflect the new
National Tariff system
adjust the sanctions that apply for poor performance
reflect new guidance on information governance and
staff pensions
9 NHS England | Presentation to RCPA Seminar 20 November 2013
What feedback did we get?
We need some
continuity –
please don’t rewrite the whole
Contract again!
The Contract
focusses too much
on acute services
10
We need to be
able to agree
contracts with a
longer duration
Some of the financial
sanctions in the contract
are unworkable or
disproportionate
There are provisions in
the contract which are
unreasonably
burdensome for small
providers
CQUIN can be a
problem for very
low-value
contracts
Commissioners don’t
pay us as quickly as
the Contract says they
should
The Contract is
overwhelming for small
providers – too long, too
complicated, not all relevant
How are we trying to make things better?
• Allow flexible longer-term contract duration
• Remove some of the disproportionate requirements on
small providers (emergency planning, carbon
reduction, counter-fraud, formulary, Prevent)
• Clarify which sanctions should apply and how they
operate (for example, Never Events)
• Commissioner discretion on low-value CQUIN
• Minimise nationally-mandated reporting requirements
• Try to resolve the late payment problem
11 NHS England | Presentation to RCPA Seminar 20 November 2013
Encourage wider use of the eContract
• Simple for providers – just log in and download the
proposed contract
• More work for commissioners – but the 14/15 version
will be easier to use
• Automatically produces a “tailored” PDF contract – so
all the clauses that don’t apply are filtered out
• Results in a shorter, clearer, more relevant contract –
which is what smaller providers say they want
12 NHS England | Presentation to RCPA Seminar 20 November 2013
The Contract in practice
• The contract gives both parties clarity – about the
service to be provided, the quality standards, the
price, the “rules” …
• But what really matters is having sensible, mature
working relationships between commissioner and
provider at local level
• If both behave in a reasonable, proportionate and
co-operative manner, they will probably not need
to rely on all the detailed provisions of the
Standard Contract
13 NHS England | Presentation to Foundation Trust Network 16 October 2013