Download - NHS Central London Clinical Commissioning Group

Summary Sheet for Papers: Central London CCG Governing Body
Date
14 January 2015
Title of Paper
Clinical Lead
Expert Patient Programme – Delegated Decision for
appointment of Preferred Bidder
Kiran Chauhan, Deputy Managing Director, NHS Central London
Clinical Commissioning Group
Helena Stokes, NHS Central London Clinical Commissioning
Group
Kiran Chauhan, Deputy Managing Director, NHS Central London
Clinical Commissioning Group
Dr Krishan Aggarwal
Confidential
No
Presenter &
Organisation
Author
Responsible Director
The Governing Body Committee is asked to:
Agree to delegate the decision on a preferred bidder to Chair’s Action.
Summary of purpose and scope of report
We are requesting that Hammersmith & Fulham and West London CCGs delegate the
appointment of the preferred bidder to Central London CCG as the lead CCG in the
procurement. The Governing Body, in turn will seek to delegate this decision to Chair’s
Action to expedite the process.
The reason for this request is due to procurement timescales in order to achieve a service
start date of 1st April 2015. Due to technical errors some of the dates were pushed back
which put pressure on the available timescales.
Following the approval of the re-procurement of the Expert Patient Programme which
includes the Diabetes Champions and Diabetes User Group, the procurement is underway
and a preferred bidder is expected to be confirmed by Friday 16th January 2015.
The Expert Patient Programme is a peer-led structured education programme for patients
with a long term condition and the service transitioned to the CCGs on 1st April 2013. The
contract for the existing service ends on 31st March 2014, and drawing from engagement
and other considerations a case for re-procuring the service was approved by the Finance &
Performance Committee of the CCGs (dates confirmed below).
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Quality & Safety/ Patient Engagement/ Impact on patient services:
This was addresses in the original business case and but a high level summary in included
below.
Financial and resource implications
The contract is for three years with the option to extend for two additional 12 month
periods.
Affordability envelope per year, per CCG is:
Central London CCG - £112k per annum (EPP), £6k Diabetes User Group
Hammersmith & Fulham CCG - £105k per annum (EPP), £6k Diabetes User Group
West London CCG - £133k per annum (EPP), £6k Diabetes User Group
Contract includes Diabetes Champions which is funded by Public Health.
Equality / Human Rights / Privacy impact analysis
This was addresses in the original business case and but a high level summary in included
below.
Risk
There is a risk to the mobilisation of the new service if sign off is required of all the CCG
committees. The combined PQQ/ITT period was extended due to an issue with the upload
of the documentation which reduced the mobilisation period.
Supporting documents
Expert Patient Service Summary Report
Governance and reporting (list committees, groups, or other bodies that have discussed
the paper)
Committee name
Date discussed
Outcome
2
Expert Patient Service Summary Report
1. Introduction
This paper provides an overview of the recommendations for the re-commissioning of the Expert
Patient Programme (known locally as the Expert Patient Service) which were approved by the
Finance and Performance Committees of Central London, Hammersmith & Fulham and West London
CCGs on the following dates:
Finance and Performance
Committee (WLCCG)
27/05/2014
Approved
Finance and Performance
Committee (CLCCG)
28/05/2014
Approved
Finance and Performance
Committee (HFCCG)
25/08/2014
Approved
Throughout the process, from the recommendations to the evaluation panel, representation from
the following groups has been involved: patients, GPs, Public Health, procurement and CCG staff
including contract management, HR and finance.
The Expert Patient Programme (EPP) is a peer-led self-management course for people living with a
long-term condition. The course is based on a generic programme developed in the United States by
Stanford University called the chronic disease self-management programme (CDSMP)1. The EPP
recruits local people with lived experience of a long-term condition who undergo training to become
lay tutors. The course brings together local people with a range of long term conditions for six
weeks, with a weekly session of 2.5 hours. The course covers some of the key considerations for
living with a long term condition and one of the prime aims is to increase self-efficacy. The course
covers a range of topics such as:
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Overview of self-management and long term health conditions
Using your mind to manage symptoms
Getting a good night’s sleep
Making an action plan
Feedback and problem-solving
Dealing with difficult emotions
Physical activity and exercise
Preventing falls
Making decisions
Pain and fatigue management
Better breathing
http://patienteducation.stanford.edu/programs/cdsmp.html
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Healthy eating
Communications skills
Mediation usage
Making informed treatment decisions
Dealing with depression
Working with your healthcare professional and system
Future plans
The EPP was the subject of a Department of Health Expert Patients Taskforce. The resulting report2
highlighted the need and evidence to increase the role of self-management in the NHS and the EPP
was piloted in 2001-2004 and then mainstreamed in 2004-2007.
To inform the report Professor Julie Barlow of Coventry University undertook a review of the
evidence for self-management as a whole which showed benefits such as:
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Reduced severity of symptoms
Significant decrease in pain
Improved life control and activity
Improved resourcefulness and life satisfaction
There are different approaches to evaluating the impact of EPP such as increased self-efficacy,
quality-adjusted life-year (QALY), use of health services and broader impact through Social Return
on Investment3.
Examples of studies which looked to the use of EPP applied for different long term conditions
include Kennedy (2007) and Dost (2005) which collectively demonstrated:
 Greater levels of self-efficacy
 Significant increase in confidence levels that they would not let the condition
interfere with their lives
 Significant decrease in perceived intensity of symptoms
 Reduction in the use of health services
 Increased energy levels
 High probability that the intervention is cost effective
The service transferred from Public Health to the CCGs on 1st April 2013 and is due to be retendered.
The service is currently under a one-year extension via a tender waiver on the basis that the new
service is procured and in place on 1st April 2015. The service will be re-procured on an NHS
standard contract for three years with an option to extend for one year, plus one year.
To help inform the review of the current service and make its recommendations, the working group
considered existing engagement which had taken place to inform the CCGs’ Commissioning Plans for
2
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4006801
3
http://www.can-online.org.uk/uploads/editor/files/Invest/EPP_social_impact_report.pdf
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2014/15i. During this engagement, the following themes were predominantly raised in relation to
what was seen as either current priorities thinking about long term conditions or broader priorities
for the next 3-5 years:
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Increased access to the Expert Patient Programme
Increased access to peer support programmes delivered by people who understand the
context e.g. Expert Patient Programme, Community Champions, Health Trainers
Greater patient education and self-care programmes, including those focussed on long-term
conditions
Greater male motivation with their wellbeing
Include awareness of local services and expectations of services
Co-locating non-NHS services and NHS services
Increased knowledge of GPs of services such as Expert Patient Programme
The above engagement demonstrated clear support for the service and similar peer-led services to
enable local people to manage their long term conditions. It also indicated an opportunity to embed
the service into standard NHS pathways through comments such as increased referrals from GPs and
also co-locating services.
The service supports the following strategic objectives and statutory duties shared by the three
CCGs:
1. Empowering patients to take more control of their health and wellbeing4
2. NHS Outcomes Framework 2014/15, Domain 2, Enhancing Quality of Life for People with
Long-Term Conditions5
3. Duty to promote involvement of each patient, Health and Social Care Act 2012 Section 26 Each CCG must, whilst carrying out its functions, promote the involvement of patients, and
their carers and representatives, in decisions, which relate to the prevention or diagnosis of
illness in the patient, or their care or treatment.
2. Recommendations
The following recommendations were made by the working group which were approved by the
Finance and Performance Committees:
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Re-commission the service - feedback during engagement supported the need for this type
of service which currently is only recruited to via an outreach approach
Strengthen the number of referrals and its role within the standard care pathway – there
is a definite opportunity to introduce more referrals from primary care and look at how the
service can form part of care planning for patients newly diagnosed with a long term
condition or who are not confident in managing their condition. For example, each patient
4
CCG objectives taken from Board Assurance Framework
Taken from NHS Outcomes Framework 2014/15 at a glance – original available at
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/256457/At_a_glance_NHS_
OF.pdf
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undertakes a questionnaire at different stages during the course to understand their
confidence in different aspects that the course covers – this questionnaire could be
provided (with the patient’s permission) to the patient’s GP to enable them to build on this
within on-going care.
Ensure the reach of the service in terms of seldom heard groups is retained – the current
service has an outreach focus which is a strong approach in terms of ensuring that the
people who are most likely to benefit from the course do. While the future service should
seek to better embed itself within primary care and standard care pathways, it is crucial
that an outreach among local communities continues to help reach the most vulnerable and
those who may be less engaged with statutory services.
Improve overall access to the service – feedback suggested that there is the need to
introduce some courses delivered in target languages other than English as well as
introducing an online version of the course (which is being trialled locally outside this
procurement to understand interest and demand). The current course and materials are
not accessible to people with learning disabilities and therefore this will be introduced
during the course of the contract.
Introduce some targeted courses for underrepresented groups – for example while the
current provider performs well at recruiting people from deprived wards and BME
communities, there is a distinct low uptake of men.
Include follow on activity for graduating participants – the current service provider
demonstrated that activities to keep people engaged in the principals of the course led to a
sustained and/or increased level of self-efficacy therefore this is included within the new
service.
Support further development of self-care initiatives under the Better Care Fund which is
looking at other opportunities to embed self-management practices in patients and health
professionals. For example condition specific courses.
Introduce a part-block/part-activity payment schedule to incentivise recruitment and
referrals while providing stability for the service.
3. Expected Benefits
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Increase in patients with long-term conditions undertaking self-management
Increase in self-efficacy among patients with long terms conditions
Greater relationship between the EPP and local health services and professionals
GPs have a stronger awareness of their patient’s ability to self-manage which can be
supported in practice (i.e. through receiving the pre and post course questionnaires for their
patients who attend the EPP)
Reduced reliance on health services among patients with long term conditions, particularly
newly diagnosed patients
Reduction in use of unscheduled care among participants
Increase in number of men engaged in self-management
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4. Diabetes User Group and Diabetes Champions
While the above elements were not included in the original paper to the Finance and Performance
Committees, they were within the current contract as a contract variation for the financial year
2014/15.
The Diabetes Champions is a volunteer-led initiative to target local people with, or are at risk of,
developing Type 2 diabetes. The aim of the service is to help raise awareness of Type 2 diabetes and
risk factors, and help people make better lifestyle choices. This is Public Health funded.
The Diabetes User Group provides a targeted forum to ensure that the voices of the local population
contribute directly to the provision and development of local diabetes services. This is CCG funded
and transferred to the CCGs from Public Health in April 2013.
Funding for both services was confirmed separately and was included in the overall procurement
due to the close relationships between the aims and principles of the services e.g. utilising the
experience and passion of local people to improve the health of the broader population, specifically
those with long term conditions.
5. Procurement Timescales
Activity
Description
Dates
Issue advert & ITT
documentation
ITT documentation available to Bidders via
EU-Supply portal following expression of
interest
5th November 2014
Issue TUPE information
Contracting Authority publishes to Bidders
information received from current Provider of
Services regarding employees
5th November 2014
Bidder Briefing Event
Contracting Authority holds a Bidder Briefing
Event to ensure good understanding by
Bidders of the Service requirements and
Procurement process
Cancelled
Deadline for the receipt of
clarification questions from
Bidders
Deadline by which Bidders may request
clarification on the ITT documents
12th December
2014
ITT Submission DEADLINE
Deadline by when Bidders must have fully
compiled their Bids in the required format
and submitted via EU-Supply Portal
5pm, 19th
December 2014
ITT Bid evaluation stage
Period when Bids will be evaluated. During
5th – 8th January
this period. Bidders may be asked questions in December 2014
order to clarify information set out in their
Bids
Bidder presentation &
interview event
Dates when Bidders may be invited to
prepare for and deliver a presentation and
respond to interview questions as part of the
evaluation process of the Procurement.
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14th January 2015
Bidder initial notification
and standstill period
regarding Confirmation of a
Preferred Bidder(s)
The expected dates when Bidders will be
notified of the outcome of the evaluation and
observance of the recommended Standstill
Period
4th February 2015
Contract signature
The expected date for the signing of the
Contracts between the Contracting Authority
and the successful Provider
16th February 2015
Service mobilisation period
Period when the Preferred Bidder plans and
delivers mobilisation activities to prepare for
service commencement
16th February to
31st March 2015
Full service commencement Date when commencement of the new
Services expected
1st April 2015
Due to some technical errors, some of the dates were pushed back but we are still working towards
a service start date of 1st April 2015.
i
Feedback cited was captured during the following meetings or events:
 Healthwatch 19/09/13
 North Westminster Community Network 25/09/13
 BME Health Forum 30/09/13
 Behavioural Change World Café Event 02/10/13
 Tri-borough Older People’s Fair 11/10/13
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