Tendering – How low do you go?
Claire Lemer
My Roles
The Commissioning Process
PHASE 2:Procuring services
PHASE 1: Strategic planning
PHASE 3:Monitoring
and evaluation
Assessing need
Reviewing service provisions
Deciding priorities
Designing services
Shaping structure of supply
Planning capacity and managing demand
Supporting patient choice
Managing performance
Seeking public and patient views
Why Tender?
• To introduce new providers• To encourage efficiency in the system• To drive innovation• To ensure value for money
Alternatives to tendering
• Negotiated altered pricing plans• Reconfiguration• Bringing in external management– Private e.g. Just management– Public e.g. Opth at BGH is by RFH
Tendering for the market...
Publically available slides by Charlie Davie Neurologist
Publically available slides by Charlie Davie Neurologist
Publically available slides by Charlie Davie Neurologist
Publically available slides by Charlie Davie Neurologist
The Big Picture
The Slightly smaller picture
• New buildings• Requirement to meet financial targets• Articulation of vision and mission• Increasing focus on Quality of Care – Francis
Report• Increasing focus on patient satisfaction• Increasing competition from external providers• Uncertainty whilst wider changes enfold
The Local Picture
The Tender ProcessAdvertisement of Intended Tender
Intention To Tender
Short-listing of ITTs
Full Tender
Short-listing of Full Tenders
Interviews
Decision announced
Appeals
DRSS- Nationally
• National screening programme v.v. specific rules:– Proportion to invite to screen– Proportion to be screened– Exemptions– Training of screeners
• Computerised programmes linking GP records to computer system
Screening Pathway
Result not possible
Patient identified as Diabetic from GP
records
Patient invited to screening
Patient screened by photography
Patient screened using slit lamp
Photograph reviewed
Screen result given to patient, GP and
entered into recordPatient advised
Locally• NMUH provided DRSS for approximately 50,000 pa• Grew organically• Started before the national screening programme• Covered Enfield and Haringey• Camden and Islington Programme suspended• NMUH took over C+I for 1 year• Tender for 5 areas including Barnet• Barnet had their own service provided by GPs – very
high standard• E+H not quite meeting national targets in 18 months
prior to tender
How would you go about preparing the proposal?
A False Start..
ITT• Short document• Focused on organisational
ability to deliver• Will ask about insurance,
previous history• Limited information about
planned option• Often no cost indication• Accompanying this will be a
service specification asking identifying what the commissioners want
What we did locally..• Disconnect confusing governance lines• Improve our local performance• Prove ourselves capable of managing a bigger programme• Build links with commissioning team• Build information about competitors• Get the exec on side• Decide if we would join a consortia• Create a tender team:
– Exec– Lead for DRSS– Programme heads– HR– Finance
Full Tender -The Proposal
• Very formulaic, strict word counts• Opening page often about costs• May even expect a bottom line figure
What we did locally..• Map out staff we had • Map out staff that we would need to employ• Identify what our preferred model of delivery was
– Lower banded staff doing work?– Outsourcing reviewing– Numbers of sites– Involvement of opticians– Same day results?
• Map staffing onto this preferred model• Identify the key areas of concern:
– Prisons, Mental Health– Hard to reach groups
• How low could we go...– Was NMUH prepared to subsidise the bid?– Where there any bits of the service that were not included in the bid?– What were the knock on effects of loosing the service?
• The “brainwave”
The Interview
• Panel of commissioners• 15 mins to present and answer questions• Limited number of people able to present
Interview Team
• Practiced the pitch• Identified who to take• Practised potential questions• Spent time guessing who the panel was
Then the fun really begins – delivery..