Commissioning and System Management
NHS Contract for Community Services
Third Sector Learning Event
Welcome & Introduction
Melinda Letts OBE
Commissioning and System Management
Strategic context for the
Standard NHS Contracts
Anthony Kealy – Contract Development Lead
Why do we need new contracts?
Commissioning and System Management
• To strengthen commissioning
• To improve NHS business processes
• To strengthen accountability and improve performance
3
‘Failure of Commissioning’
Commissioning and System Management
NHS has ‘commissioned’ for over a decade, but …
•
‘Command & control’ model has consistently reinforced the ‘provider line’
•
Commissioners have lacked robust levers
•
Not all available levers have been used
•
Inadequate regulatory regime
•
Low investment in developing commissioners
•
Highly variable & fragmented practice
•
Lack of legitimacy (linked to ‘voice’ & patient /public engagement)
•
Very limited range of providers
4
Commissioning and System Management
Re-launching commissioning
–
Commissioning Framework (July 06)
–
Third Sector Commissioning Task Force –
(July 06)
–
Practice-Based Commissioning Guidance
(November 06)
–
Interim New NHS Contract (December 06)
–
Commissioning Framework for Health &
Well-being (March 07)
–
A Vision for World Class Commissioning
(December 07)
–
New standard acute contract (December 07)
–
New standard community, mental health &
ambulance contracts (December 08)
5
A new approach to contracting
•
The need for new NHS contracts was introduced with in the
Commissioning and System Management
Commissioning Framework, July 2006
•
This was reinforced by the Third Sector ‘No excuses…’ report
•
Contracts becomes the main tool for achieving accountability and
improving performance in a system with more autonomous providers
•
The final version of the acute contract was published with the 08/09
Operating Framework
•
New contracts are now being developed for
– Ambulance
– Community
– Mental Health
6
Structure of the Contract
Commissioning and System Management
Nationally Applicable
Standard Terms
1.
2.
3.
‘Must have’ elements for
local negotiation
1.
2.
3.
4.
5.
6.
Elements for local
agreement
1.
2.
3.
Are set centrally
Can be changed generically only through the NHS Operating
Framework
Could be considered as “Standard NHS Terms and Conditions”
Are contractual or legal requirements
Are defined centrally
Require local detail so local agreement is necessary
Provide flexibility within a framework
Co-ordinating Commissioner defines consortium rules (by
agreement)
Must be completed to make contract executable
Are locally defined, with no national or legal requirement
Must be internally consistent and not ‘trump’ required elements
Could cover any issues, but typically might cover care
pathways, treatment protocols, quality standards
7
Commissioning and System Management
Main features
•
A standard – not a model contract
•
A new model of co-ordinated contracting
•
Activity planning and review
•
Demand management requirements
•
National and locally-agreed quality standards
•
Requirements on information flows and provision
•
Dispute resolution arrangements
•
Contractual Control mechanisms.
•
Sanctions and / or incentives for performance on a small number of
priority issues
•
Locally-defined service specifications
8
Stakeholder Principles
Commissioning and System Management
The contract should:
•
Reflect vision, long term planning and change
•
Recognise the community interest
•
Provide clarity on commitments that need to made to stakeholders
•
Clarify and define respective roles and responsibilities
•
Recognise that open information is required from both parties to manage
the contract
•
Underpin a relationship between equals
•
Understand mutual dependency and benefit of the parties in aiming for a
partnership approach
•
Support co-operation and collaborative behaviours that benefit both
parties and cement the positive relationship between them.
•
Be based on terms that are deliverable in practice
9
Commissioning and System Management
Expected behaviours
•
Find and support win-win solutions
•
Achieve appropriate risk sharing, and sharing of any benefits that are
realised by mutual effort
•
Maintain mature, regular dialogue within a professional code of conduct
•
Ensure flexibility where there are genuine problems in delivery
•
Provide incentives as well as penalties
•
Recognise investment required to achieve requirements over a
reasonable time period
•
Support providers to change their service offer over time in relation to
changes brought about through patient choices
•
Maintain honesty and transparency – across both parties and with
patients and the public
10
Project management
Commissioning and System Management
Mark Britnell
Stakeholder
Reference Group
Contract National
Steering Group
DH Contract
Project Support
Group
Mental Health
Project Group
Ambulance
Project Group
Community
Services
Project Group
Task
Sub-Groups
Task
Sub-Groups
Task
Sub-Groups
11
Commissioning and System Management
Developing a new Standard NHS Contract for
Community Services
- Overview of scope and structure
Tracy Cannell
System Management and New Enterprise Directorate
Aims, Strategic Links and Potential Barriers
of Community Services Contract
Commissioning and System Management
Strategic Links
Next Stage Review including
Primary & Community
Services Strategy
Aims
Flexibly support innovative
commissioning approaches
Improve care outcomes,
System Management
3rd sector & SE Programme
Wider programme re.
community services
development
Links to CQC re standard
setting, monitoring and
response to failure.
Catalyst to maximise quality
and productivity
Potential Barriers
Wide scope of coverage
Cross-departmental approach
for Section 75 agreements
Joint approach to be agreed with
DCSF re. childrens’ services,
Legal agreements already in
place with non-NHS bodies may
delay implementation
Support both joint
commissioning & pathway
based care
Develop benchmarking.
Current lack of standards/
targets in relation to quality and
activity
Community MDS not in place,
metrics not yet available for
majority of services
13
Scope of community services contract
Commissioning and System Management
1
In-Patient Care
Includes
Rehabilitative and
palliative care in
community hospitals,
hospices, nursing or
residential homes
2
Out-Patient care
Includes therapy
services such as
physiotherapy and
podiatry as well as
district nurse clinics.
3
Community dropin
Includes specialist
services such as
family planning &
health visiting
4
Domiciliary Care
Includes home visits
by district nursing,
occupational
therapy, community
midwifery and health
visiting.
Community Services
14
Potential Contract Routes for Community
Services (1 of 2)
Commissioning and System Management
Option 1
Commissioner
Benefit: Reflects most
common current practice
with commissioner
contracting on an
organisational basis with
each provider therefore easy
to implement
Option 2
Commissioner
Lead provider for geographical area
Benefit: Could reflect PBC or
local approach with Local
Authority with one provider
accountable to
commissioner
15
Potential Contract Routes for Community Services (2 of 2)
Option 3
Commissioner
Commissioning and System Management
Strong Commissioning
Benefit: Commissioner /
provider split is maintained, and
commissioner retains full
control of commissioning care
SINGLE CARE PATHWAY
Option 4
Commissioner
Lead provider
Benefit: One provider retains
clinical and financial
responsibility for the patient, as
well as accountability to the
commissioner
SINGLE CARE PATHWAY
16
Structure of community services contract
Commissioning and System Management
1
Heads of Terms
Standard section
containing nationally
mandated approach
with no local
variation
Contains standard
legal requirements
National core
standards applicable
to all community
services, e.g. this
could include HCAI
targets, minimum
data collection
requirements
2
Core
Requirements
Nationally identified
issues but local
targets, e.g. Could
include stretch
targets for
performance
information and
quality standards.
3
Local Issues
For local
determination
4
Supporting
Guidance
To include guidance
re. liabilities
Service specification
template to support
locally determined
commissioning
Community Services Contract
17
Commissioning and System Management
Performance and quality issues
being considered for inclusion
•
Patient held records
•
Patient based use of NHS number
•
Use of national MDS (to be developed)
•
Assessment & care plan
•
Diagnosis & Treatment codes
•
Outcomes
•
Communication between professional/services
•
Infection control
•
Choice/convenience - appointment times, transport and location
•
Waiting times – 18 weeks, 1st & follow up, referrals
•
Patient satisfaction
•
Patient information re service
18
Commissioning and System Management
Key Policy Issues to address
•
The role of sanctions and incentives
•
Minimum information requirements and flows
•
Mandatory performance and quality requirements
•
Anticipating outcome of community metrics work and development of
tariffs
•
Compact Compliance e.g. Flexible payment arrangements
•
Transition and adoption requirements for very small providers
•
Relationship with primary care contracts
19
Commissioning and System Management
Key timescales & milestones
March
- Collation of current best practice completed
April
- Outline heads of terms available
- Stakeholder workshops
- Initial testing with stakeholders commences
June
- Identification of test sites & initial workshops
- 3rd Sector Learning Event
September
- Test sites complete Final Report
October
- Impact assessment processes
Nov
- Contract published & Transitional guidance issued,
Dec
- Implementation support programme
Feb 2009
- Contracts agreed and signed
20
Further Information
Commissioning and System Management
• Tracy.Cannell@dh.gsi.gov.uk
Monthly Bulletin available via ‘The Week’
(www.dh.gov.uk/en/managingyourorganis
ation/commissioning/DH_085048)
Commissioning and System Management
Performance and quality issues
being considered for inclusion
•
Patient held records
•
Patient based use of NHS number
•
Use of national MDS (to be developed)
•
Assessment & care plan
•
Diagnosis & Treatment codes
•
Outcomes
•
Communication between professional/services
•
Infection control
•
Choice/convenience - appointment times, transport and location
•
Waiting times – 18 weeks, 1st & follow up, referrals
•
Patient satisfaction
•
Patient information re service
22
Commissioning and System Management
Workshop Discussions
•
Each group to consider how the contract can provide a sound approach
and clarity for both commissioners and providers re. responsibility and
accountability, performance management, risk management
•
Identify any barriers/enablers/vital links
•
Consider what support will be required to implement the contract
•
And also specifically:
– Performance Management
– Contract Terms
– Service Specification
– Quality Standards
– Flexibility
23
Commissioning and System Management
Workshop Topics
Group 1- Performance Management
•
What are the key performance measures
that should be incorporated into the
contract as a baseline platform?
•
Are/should these be duplicated by
regulation?
•
What measures should have incentives
or penalties attached?
Group 4 – Quality Standards
•
What are the key generic standards that
should be incorporated into the contract as a
baseline platform?
•
Are/should these be duplicated by
regulation?
•
What standards should have incentives or
penalties attached?
Group 2 – Contract Terms
•
Are the generic heads of terms
appropriate in both its scope and detail?
•
Can/should we scale the documentation
according to contract value?
•
Should block contracts be permitted? Is
there sufficient understanding in the use
of contracts vs grants?
•
What if any variation or flexibility be given
to the contract duration and notice
periods?
Group 5 – Flexibility of Contract
Is the contract appropriately structured to
support both commissioners and providers of:•
Differing Organisations
•
Care pathways
•
Umbrella or lead provider arrangements
•
Section 75 arrangements
•
Co-ordinated commissioner arrangements
Group 3 - Service Specification
•
Will the proposed specification guidance
be sufficient to support local
commissioning?
•
Is it structured appropriately?
•
What supplementary guidance would be
helpful?
If not how should this be changed and/or what’s
missing?