CSS CLINICAL REFERENCE GROUP CONTRACT MANAGEMENT SERVICE 21 st February 2012 Thomas Wilson NHS T&G

1. CSS CLINICAL REFERENCE GROUP CONTRACT MANAGEMENT SERVICE 21st February 2012 Thomas WilsonNHS T&G

2. Objective today is to talk through contract management products • develop a better understanding of your needs and concerns • get challenge/support for proposals outlined

3. Principles I • Contract management means different things to different PCTs/CCGs – so need to be clear about basics. • Total Provider Management rather than a narrow “contract management” service • Quality • Cost • Delivery (and new management TLAs: TPM 4 QCD)

4. Principles II • CCGs express concerns about loss of control • CCGs hold the legal authority and responsibility to make decisions • CSS Provider Management Service only ever provide advice to make those decisions – never overrule CCG decision making.

5. Principles III • Commissioners often have no realistic alternative but to contract with the providers they already have • Management of the overall relationship is therefore key; not continual referral to contractual clauses and threats of market testing over single issue • But... if you want aggressive free market contract management we can do that!

6. To focus on managing providers you need: Single contract team per provider Not a contract team per CCG

7. Contracted providers are stratified by CCGs • significant providers: actively managed • material providers: routinely monitored • smaller providers: minimal maintenance

8. Stratification is based on clinical, financial, performance and reputational risk

10. Five products make up the Provider Management Service: • Contract drafting • Consortium governance • Contract Management • Decommissioning • Other Contract Advice

11. Product 1: Contract Drafting – Sad enough to read: Nerdy enough to understand Standard NHS contract needs 44 local sections completing • Totally for a new contract from a procurement exercise • revised annually each year as part of the contracting round The end product is • a completed contract for signature by the authorising officer for each CCCG and provider • a signed copy stored securely & an electronic copy per CCG

12. Product 2: Consortium Governance I - monopoly v monopsony The CSS offer is predicated on the notion of commissioners acting in unison via their commissioning consortium. Commissioners need a mechanism to agree their commissioning activities and relationship with a provider. This is done through the formal consortium agreement that is embedded within the standard NHS contract at Section C Part 9.

13. Product 2: Consortium Governance II - monopoly v monopsony The key output is Consortium decisions, made by the constituent CCGs, are properly audited and fed into the CCG governance processes: • Drafting and formalising the consortium agreement • Administration of consortium meetings • Agreement on a documented annual negotiation plan • “Dispute resolution service”: decision making power of consortium lies wholly with the CCGs, the CSS Team is there to facilitate decision making in an efficient manner but not to override or influence the decisions

14. Product 3: Contract Management – velvet gloves and iron fists At its simplest this means the management of contracted providers to deliver CCG commissioning intentions • quality (safety, experience & effectiveness) • cost (affordability of provider to health economy budget) • delivery of performance targets (NHS Standard Contracts, NHS Operating Framework, NHS Constitution, Health & Social Care Act 2006)

15. Product 3: Contract Management – velvet gloves and iron fists Quality monitoring • the creation with CCG clinicians of local quality indicators (KPIs and CQUINs) • monitoring and reporting of indicators and progressing “quality challenges” to the provider: • narrow contract measures • wider monitoring of quality indicators of providers e.g. CQC Quality Risk Profiles, NHS Information Centre SHMI reports, Monitor compliance etc and patient experience data e.g. complaints monitoring • on site inspections and audits • management of SUIs

16. Product 3: Contract Management – “it’s the economy stupid” Lack of financial control is biggest risk to delivery of CCG commissioning plans. Key risk lies with largest providers. The key outputs are: • Finance reconciliation of accounts from provider including any necessary and agreed financial challenges to accounts being presented by providers for payment • Finance and activity reporting – analysing provider activity and referral activity and providing reports in a format agreed by the CCG at consortium, CCG and practice level

17. Product 3: Contract Management – “that which is not measured is not managed” Performance monitoring • the creation with CCG clinicians of local performance indicators (KPIs and CQUINs) • monitoring and reporting of indicators and progressing “performance challenges” with the provider: • dedicated performance and BI staff spending • 25% of time on collection, analysis and reporting • 50% of time on short term performance intervention • 25% of time on medium term performance intervention • often need to link with service redesign teams

18. Product 3: Contract Management • Finance, performance and quality issues are governed in the contract at Section E Clause 46 (Review) and Clause 47 (Contract Management) • monthly review meeting with significant providers will be chaired by the CCG and with high levels of clinical input from CCG members • the performance management regime that results in Contract Queries, Joint Investigations , Remedial Action Plans, imposition of fines and notifications to regulators and any dispute resolution

19. Product 4: De-Commissioning CCGs plan to change services and providers that are no longer needed to be part of the commissioning landscape to serve the CCG population. De-commissioning carries more risk than commissioning. Key outputs: • notice and exit management • public and stakeholder engagement

20. Product 5: Other Contract Advice The two key outputs are: • Maintenance of a contracts database to allow robust market analysis to take place – what is spent, with whom and to what effect? • Ad hoc expert advice sourced from within CSS or from other expert contract management sources such as lawyers, Department of Health, Primary Care Contracting etc

21. Next steps • Feedback – now during Q&A or email tom.wilson1@nhs.net • Revised service specification drafted to go in Outline Business Case for end of February