nhs england london region imos market event · • both primary and secondary care referrals for...
TRANSCRIPT
NHS England London Region
IMOS Market Event
September 2016
Introductions
Pepe Shirlaw
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Introductions
• Donal Markey: Regional Lead, Dental, Optometry & Pharmacy Primary
Care Commissioning (London)
• Pepe Shirlaw: Chair of London Local Dental Professional Network
• Mervlyn Clarke: Senior Commissioning Manager Dental, Optometry &
Pharmacy
• Claire Robertson: Consultant in Dental Public Health
• Divyash Patel: Dental Advisor London Region/Clinical Lead, Office of the
Chief Dental Officer
• Caillin Redican: Chair of IMOS Working Group
• David Singleton: Senior Procurement Manager
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Agenda
o Welcome and Introductions
o Current IMOS arrangement / Background
o Patient Engagement results
o Recommendation
o PDS Agreements / RMS / KPIs, Pricing Mechanism
o Accreditation/ clinical specification
o The Procurement Process
o Procurement Opportunities
o Questions and Answers
o Next Steps/Close4
Needs Assessment & Patient and
Public Survey feedback
Claire Robertson
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Findings of IMOS Scoping
• No information available on normative need for level 2, only demand
• 18 of London boroughs have current arrangements in place for management of
IMOS
• Huge inequities in access to IMOS across London:
Wide variation in coverage by existing IMOS – some boroughs with
numerous providers, others with none.
Some current services accept referrals for patients living in more than one
borough, others have referrals from single borough residents only
Wide variation in levels of IMOS activity – historical commissioning by
PCTs
Wide variation in commissioning arrangements - PDS, GDS & unit costs
• Range of referral processes and criteria with only 5 existing referral management
services in London across 14 boroughs
Findings of IMOS Scoping (2)
• Both primary and secondary care referrals for level 2 cases
• 17 secondary care providers of oral surgery across London
• Total secondary care oral surgery spend = £38,525,990
• Secondary care oral surgery spend ranges from provider to provider
• Lower Threshold - £716,000 Upper Threshold - £8,799,240
• Cases coded differently and as a result incur different costs: Based on consultant
led service.
Treatment
function name
WF01B
First Attendance
- Single
Professional
WF02B
First Attendance -
Multi
Professional
WF01A
Follow Up
Attendance -
Single
Professional
WF02A
Follow Up
Attendance -
Multi
Professional
Oral Surgery 119 185 75 128
Estimate of lower levels of IMOS /borough• Estimated the minimum activity required / borough to meet demand made on
basis of historical activity for a given population – i.e. existing levels of activity
• Minimum estimate modelling has not included level 2 cases currently going
into secondary care by direct referral – therefore likely to be only a starting
position
• Any activity removed from secondary care will need to be re-commissioned
within a primary care contract – additional commissioning will be required as
commissioning moves forward
• Future additional activity will be commissioned as part of this current
procurement process, as part of transformational programme
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Patient and public engagement• Patient engagement events and both online and paper surveys have been
undertaken
• Opportunistic questionnaires completed in the waiting rooms of primary &
secondary care
• Mixed methodology, a snap shot over 3 weeks in August: sampling frames:
a) targeted
Patients receiving IMOS treatment in primary care identified by BSA
Patients receiving IMOS in secondary care identified before treatment by
the Provider
b) non targeted
Survey link tweeted on NHS England (London Region)
Twitter page
Surveys in primary care waiting rooms
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Outcomes of patient and public surveyMost important factors to patients when receiving an appointment:
• Timing of appointment most important to patients with waiting time slightly less
• Distance to appointment relatively not such a major factor to patients
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Patient Practitioner
Outcomes of patient and public surveyIn addition to Monday to Friday 9am – 5pm, when would patients prefer the service
to be available?
• Both patients and profession identified Saturdays as most desirable with
weekday evenings also, but slightly lesser extent
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Patient Practitioner
Outcomes of patient and public survey• Length of time patients and practitioners feel it is acceptable for a patient to wait
for treatment after the point of their referral
• Treatment in four weeks and under would be acceptable, but patients would
prefer earlier
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Outcomes of patient and public survey• Actual length of time between referral and treatment.
• Patients reported an increased waiting time for treatment in secondary care in
comparison to primary care.
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Outcomes of patient and public survey• Amount of patients given a choice in the location for delivery of treatment
• 59% of patients were given a choice of location
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Outcomes of patient and public survey
• Timing of appointment most important factor to patients - Saturdays and week
day evenings preferred
• Waiting time for appointment also important to patients who felt the wait should
be no more than four weeks - currently a high proportion of patients waiting
longer than this.
• Patient choice for location of treatment of concern – patients wish to understand
their options
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Summary of key findings:
The Commissioning Model
Commissioning Team
NHS England
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CURRENT IMOS PROVISION
• 56 Contracts
• Different contractual agreements;
• Based of legacy commissioning arrangements;
• Different sizes, values and access arrangements;
• In 23 boroughs;
Borough No Borough No Borough No Borough No
Bexley 4 Greenwich 5 Ken & Ch 0 Southwark 4
Brent 1 Ham & Ful 0 Kingston 0 Sutton 1
Bromley 6 Haringey 2 Lambeth 2 Tower H 2
Camden 2 Harrow 0 Lewisham 3 Waltham F 1
City &
Hackney
0 Havering 2 Merton 0 Wandsworth 3
Croydon 4 Hillingdon 0 Newham 0 Westminster 0
Ealing 4 Hounslow 4 Redbridge 0 Barnet 2
Enfield 2 Islington 1 Richmond 1 Barking &
Dagenham
0
Existing Provider Services
Scoping exercise
• Collation of information from current contracts;
• Steering Group
• Patient/public engagement
• Provider Engagement
AIMS AND COMMISSIONING INTENTIONS
• The aim :
• Raising quality standards
• Promoting consistency and equity across London for both patients and
providers
• To improve access & flexibility to patients;
• To commission a service that is fit for purpose
• To use a standard contract
• To have a standard service specification
• Standardise monitoring and management
• To have a standard pricing structure
Service proposal by “Lots”
1.891.89
2
1.131.
Barnet
LE: 1130
3390 UDA’s
20 cases
Bromley
LE: 990
UDA’s 2,969
20 cases
LSL North/South
LE: 2841
8522 UDA’s
60 cases
Greenwich & Bexley
LE:1528
4585 UDA’s
30 casesKingston &
Richmond
LE: 1118
3355 UDA’s
20 cases
Cam&Isl
LE: 1459
4376 UDA’s
30 cases
C&Hack
Le: 821
2463 UDA’s
15 cases
Enfield
LE: 958
2875 UDA’s
20 cases
Haringey
LE: 818
2453 UDA’s
15 cases
H&F &KC
LE:1094
3283 UDA’s
20 Cases
Westminster
LE: 751
2253 UDA’s
15 cases
Hillingdon
LE: 877
2631
UDA’s
20 cases
Havering, Barking
& Dagenham
LE:1307
3921 UDA’s
25 cases
Waltham Forest &
Redbridge
LE: 1669
5007 UDA’s
30 cases
Brent & Harrow
LE: 1729
5188 UDA’s
30 cases
Ealing &
Hounslow
LE:1860
5579 UDA’s
40 cases
Proposed Service• 17 contracts “Lots”;
• Sessions – 3-8 sessions per week depending on different geographical area or population;
• At this point, referral will be from ‘Dentist to Dentist’;
• Monetary value for each CoT will the same;
• Each contract will have an additional 2% for assess and reject;
• Each contract will have monetary value allocated for OPG X-rays;
Accreditation/The clinical specification
Divyash Patel
Dental Advisor London Region
24
Aim of Presentation to describe:
• Service delivery
• Performer Competencies
• Accreditation process for level 2 performers
• Equipment and Practice visits
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Service delivery
• The specification requires the Provider to deliver Level 2 OS services
• London residents registered with NHS England (London Region)
• Referred by general and specialist dental practitioners, hospital specialists, community and salaried dental services
• Treated under local anaesthesia
• Delivered by performer accredited to undertake OS work at the competency level 2 or Oral Surgery Specialist
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The range of procedures be performed under this
Level 2 agreement include:
• Surgical removal of uncomplicated third molars involving bone removal
• Surgical removal of buried roots and fractured or residual root fragments
• Management and surgical removal of uncomplicated ectopic teeth (including supernumerary teeth)
• Management and surgical exposure of teeth to include bonding of orthodontic bracket or chain
• Surgical endodontics
• Minor soft tissue surgery to remove apparent non-suspicious lesions27
Competency framework
• Performers who are on the Oral Surgery specialist list
• Accredited performers who undertake OS work at competency level 2
Formal qualification
Experience based
National Working Group
• Supportive and enable the development of general practitioners
• Process and accreditation should be robust to ensure patient safety but not overly onerous
• Not sit in isolation to specialty training pathways
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Principles
History
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Accreditation Process
• Assessment by panel
Consultant, Commissioner, DPA ,LDC
Separate process:
New level 2 performers
Existing accredited performers (DWSI)
In conjunction with procurement, close to identified preferred bidders
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Existing accredited performers (DWSI)
• CV stating all professional experience relevant to training and clinical work
• Structured reference from a senior colleague within the same IMOS centre or from other practice or organisation(s)
• Logbook of procedures carried out over the last 12 months with provision of case notes and x-rays for cases for assessment by accreditation panel
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Competency framework for new level 2 performers
• Evidence of training posts in oral surgery or oral and maxillofacial surgery
• Testimonials and structured references from trainers and consultants
• Case log books
• Evidence of CPD specific to Oral Surgery
• Evidence of Audit and/or publications in the field of Oral Surgery
• Evidence of any academic diploma or masters courses in Oral surgery
• Relevant teaching experience 36
Premises & Facilities/Equipment
• Assessed by Practice visit
• After preferred bidders identified
• Focus on equipment specific to OS
• Information Technology
• Compliance with Resuscitation Council Guidelines
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• Appropriate surgical equipment and instruments/disposable items
• Orthopantomograph (OPG)
• Chair
• Operating light
• High volume aspiration
• Reception and waiting room
• Adequate staffing levels
• Car parking and/or pick up facilities
• Pre and post-operative instructions, consent and medical history
forms
• Wheel chair access
• Emergency equipment and drugs38
Process of referrals/referral
forms/RMS
Caillin Redican
Chair of IMOS Working Group
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The Procurement Process
David Singleton – Procurement Lead
47
What Procurement Process will be used?
o We will be using The Restricted Route (Advert, EOI, with PQQ and ITT)
o Advert – Advertising the procurement
o EOI – Expression of Interest
o PQQ – Prequalification Questionnaire
o ITT – Invitation to Tender
o Our decision has considered the amount of bidders interested
o Our decision has considered Commissioners time to evaluate responses
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Key Features of the Process
Advert:
o The advert, will be published w/c 26th September 2016 on Contracts Finder
https://www.gov.uk/contracts-finder
Expression of Interest and Prequalification Questionnaire:
o The EOI and PQQ stage is only accessible via the tendering portal w/c 26th
September 2016
https://procontract.due-north.com/register
Invitation to Tender:
o The ITT is only accessible via the tendering portal
o This stage is specifically about how you will deliver the service.
https://procontract.due-north.com/register
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Key Features of the Process cont.
Awarding Process:
o Is about governance of a fair and open process and the effectiveness of a
decision.
o Unsuccessful bidders will receive a detailed debrief report
Standstill Period
o As best practice there will be a standstill period of 10 calendar days
Mobilisation
o Contract preparation and signature
o Preparing to start service provision
o Staff TUPE including pensions
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Key Features of the Process cont.
Clarification and Communication Process
o You must use the clarification question template that is provided as part of the
tender documentation to ask any questions during the procurement.
o You will need to complete the template and upload it as an attachment to a
message on the e-tendering portal. Clarifications will not be answered any other
way.
o You must adhere to the deadline for clarification questions. This allows us as
commissioners to process your questions and respond to you and it allows you
time to assimilate the answers into your bid as required.
o Anonymised clarification questions and the answers provided will be published to
all Bidders via the e-tendering portal.51
Procuring Compliance for IMOS
o Compliance with:
o Public Contract Regulations 2015
o National Health Service (Procurement, Patient Choice and Competition)
Regulations 2013
o Open, fair and transparent process
o Opens up competition to the market
o Need to ensure the best possible service is procured for our patients
o Value for Money for taxpayers
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E-Procurement Portal
o All major procurements are conducted online using:
https://procontract.due-north.com/register
o We advertise all procurements on Contracts Finder and OJEU
o https://www.gov.uk/contracts-finder
o http://www.ojeu.com/
o If you are interested in participating in any NHS England tender process, it would
be good to register on both as soon as possible.
o NHS England London region uses the Due North procurement portal and if you
wish to bid for projects with us – so must you!
o All the links and instruction can be found as part of the Contracts finder advert
along with how to register.53
Patient and Profession Surveys
o Patient surveys were undertaken as outlined by our Clinical experts earlier.
o The Commissioning model is supported by our Clinical experts on the project
team
o Themes arising from Patient feedback will be included in the MOIs at ITT stage.
o The Profession was also surveyed in the lead up to this process.
o Bidders will need to take patient feedback into account when preparing their bids
in order to stand a chance of achieving maximum scores.
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Timetable (subject to operational change)
Milestone Date
PIN published to OJEU
Market Event24th February 2016
6th, 8th and 10th September 2016
Advert and PQQ published w/c 26th September 2016
Deadline for receipt of completed PQQs 31st October 2016
ITT issued to those that have passed the PQQ 1st February 2017
Deadline for receipt of ITT bids 28th February 2017
Award Approval by NHS England Board w/c 15th May 2017
Contract award and start of mobilisation 2nd June 2017
Contract start date: 1st September 2017
Service start date: 1st September 2017
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Tips for Submitting Your Bid
Bullets
o If there are bullet points in a question use them as headers to help write your
response.
Clarity
o Waffle is your enemy. Evaluators will switch off if you prevaricate and
procrastinate, which will affect your score.
o Ensure you answer the question that is asked, read the question fully.
Format
o Keep to the correct format.
o Ensure each attachment is labelled with the correct reference number.
o Upload your response/ attachments in the requested format.
Plan
o Ensure you leave enough time to upload your submission on the e-tendering
portal.56
Tips for Submitting Your Bid cont.
Checklist of Documents
o Sounds simple but many bids have failed because people have forgotten to
upload all the correct documentation – there will be a document checklist, use it.
Words
o Read the signpost words in the questions - Describe, Give detail, Explain, Briefly
Describe, Attach.
Word Limits
o Take notice of the word limits; the more words, the more detail expected.
o When copying from WORD, spaces and page breaks take up your word count.
Ask Questions
o Don’t be afraid to ask questions to clarify your understanding.
Complacency
o Do not assume that the evaluators will have prior knowledge of your organisation
or past experience.
o Demonstrate in your answer that you have understood, and are able to expertly
address, that question’s subject matter.57
Panel Q&A
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Next Steps
We will send you:
o A copy of the presentation
o A copy of the FAQs prepared from this meeting
o Information regarding bid preparation support and learning opportunities
Key dates:
o Advert & PQQ published w/c 26th September 2016
o Submit completed PQQs by 31st October 2016
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