NHS SOUTH OF TYNE AND WEAR

SUBSTANCE MISUSE COMMISSIONING TEAMS

CONTRACT & PERFORMANCE MANAGEMENT POLICY 2009

DRAFT VERSION

JUNE 2009

LIST OF CONTENTS

Introduction / Content
Section 1 / NHS SOTW Approach to Contract Management
Section 2 / The importance of the Contract Service Specification as the basis for Contract Management and Review
Section 3 / How the Contract will be monitored
Section 4 / Type and Frequency of Contract Management for Providers
Section 5 / Contract Management Meetings
Section 6 / Contract Management Visits
Section 7 / Performance Monitoring Procedures
Section 8 / Quality Assessment Framework (QAF) and Continuous Improvement
Section 9 / Service User Involvement in Contract Management
Section 10 / Re-shaping the Market and Supporting Providers to Rise to the Challenge
Section 11 / Dealing with Poor Performance under the Contract
Section 12 / Options Appraisal Meetings
Section 13 / Extension of Contracts
Section 14 / End of Contract Procedures and Options Appraisal Meetings
Section 15 / Contract Management Outcomes and the Administration of the service budgets
Section 16 / Data Protection and Contract Management
Section 17 / Dispute Resolution, & Complaints Procedure and Contract Management
Section 18 / Review of Contract Management Procedures
Appendices:
Appendix A / Service Specification Summary Guide
Appendix B / Request for Variation to Contract Form
Appendix C / Contract Management Meeting Agenda template
Appendix D / Improvement Plan
Appendix E / Quality Assessment Framework (QAF) Self- Assessment Summary
Appendix F / Contracts Team Provider Workbook Log and Improvement Plan DatabaseScreen Shot
Appendix G / Performance Notices
Appendix H / Feedback Form

Introduction:

This contract management handbook for providers has been written to improve understanding of NHS South of Tyne and Wear (NHS SOTW) Substance Misuse Commissioning Team (SMCT) new approach to managing the service level contracts at an operational level.

It follows the Provider Consultation event in June 2009 in which providers were asked how they would like to see NHS SOTW develop its approach to service specifications, contract management and procurement. NHS SOTW has considered all the responses received and has wherever possible taken on board the views and concerns of providers. It has formulated its approach after balancing the needs of providers with the treatment plan objectives outlined in Section 1. It is recognised that the Substance Misuse nationally is in a period of transition and this handbook therefore seeks to set out contract management procedures that will enable providers to operate with confidence within the Local Area funding environment.

In order to make the handbook accessible the document has been written in a question and answer format, which it is hoped, will help providers to better understand the approach taken and the processes that are being introduced.

Please note that nothing in this handbook is intended to detract from the applicability of the terms and conditions of the NHS SOTW contract including those outlined in the service specification and schedules.

A full list of ALL aspects of the management of the Contracts is outlined below and will be available to providers from the NHS SOTW. These include: -

  • Community Contract with Schedules including Service Specification
  • NHS SOTW Treatment Plan
  • Providers Guide to Community Contracts
  • Contract Teams Provider Workbook,Provider Log and Improvement Plan Excel System
  • Contract Management and Performance Policy
  • NHS SOTW Service User Involvement Strategy
  • Commissioning Policy and Decommissioning Policy
  • Procurement Policy
  • Value for Money Policy
  • QAF and Guidance

There has been a deliberate attempt to reduce the amount of overlap in these documents wherever possible whilst establishing the links between the various work cycles operating within the Substance Misuse Services.

However there are areas where an understanding of the overall Commissioning, Procurement and Contract Management framework will aide understanding. Providers are therefore encouraged to be familiar with the contents of all documents in order to become familiar with all the factors that might impact on the provision of services.

Queries regarding the contents of this handbook and general feedback are welcome. Please feel free to contact the NHS SOTW or complete the feedback form at the end of the handbook.

1Section 1: NHS SOTW Substance Misuse Commissioning Teams Approach to Contract Management

1.1The NHS SOTW Team has developed the Contract Management procedures outlined in this handbook to support its overall objectives for Substance Misuse Services in NHS SOTW. In terms of Contract Management this includes the following objectives: -

  • Integration with the Commissioning and Procurement processes for Substance Misuse Services to facilitate forward planning, gap analysis, and market analysis and re-procurement decisions
  • The delivery of Value for Money in the efficient, effective and economic use of resources
  • The funding of eligible support in line with National Treatment Agency funding conditions
  • The ability to demonstrate transparency and fairness in decision making to all partners and stakeholders
  • The effective management of risk
  • Improved accountability to the PCT, NTA and Joint Commissioning Group at both strategic and operational level
  • The development of a responsive Contract Management function that facilitates effective risk management, early intervention and a partnership approach to improving services
  • The delivery of evidence based Contract Management in order to eliminate bias
  • The development of Outcome based contracting wherever possible to allow flexibility and encourage innovative service delivery
  • The involvement of service users in the Contract Management process to ensure that services continue to meet needs
  • The delivery of continuous improvement in both the monitoring of contracts and the quality of services offered to service users
  • The development of a healthy Substance Misuse Services market in NHS SOTW area including supporting the development of the third sector

Progress towards these objectives will be the basis on which NHS SOTW evaluates the success of its Contract Management approach.

1.2How Contract Management fits into the overall management of the Substance Misuse Commissioning?

1.2.1Contract Management is a distinct cyclical process within the wider Commissioning, Procurement and Contract Management Cycle. For the purpose of clarification:

  • The flow chart on page 7 illustrates the place of Contract Management within the wider Commissioning, Procurement and Contract Management cyclical process
  • The flow chart on page 8 illustrates the various stages within the Contract Management cyclical process and how it is envisaged that this will lead to continuous improvement
  • What is the role of the Contract Manager within Contract Management?
  • The role of the Contract Manager will be to ensure that services meet the overall objectives for the Substance Misuse Services as outlined above. As such the Contract Manager will work in partnership with providers to drive continuous improvement and improved value for money at operational level. At the same time the Contract Manager will undertake a strategic role in order to review and improve the effectiveness of the NHS SOTW Services as a whole and will be the primary agent in integrating contract management within the commissioning and procurement cycles.
  • What is the role of the Provider’s Contract Manager within Contract Management?
  • It is envisaged that the Provider’s Contract Manager will work in partnership with the NHS SOTWContract Manager to deliver continuous improvement and improved value for money within the contract. This approach will hopefully generate additional benefits including improved prospects in terms of retaining business and facilitating future growth

FLOW CHART: COMMISSIONING, PROCUREMENT AND CONTRACT MANAGEMENT CYCLE

FLOW CHART: THE CONTRACT MANAGEMENT CYCLE AND CONTIUOUS IMPROVEMENT

2Section 2: The Importance of the Contract Service Specification as the basis of Contract Management and Review

The Contract Service Specification will become the primary focus for Contract Management and Review of all NHS SOTW contracts in NHS SOTW.

2.1What will the Service Specification Include?

2.1.1It is intended that by mid 2009 all NHS SOTW Contracts will include a Service Specification, which will highlight the following: -

  • Purpose
  • Scope
  • Service Delivery
  • Referral, Access and Acceptance Criteria
  • Discharge Process
  • Quality Standards
  • Patient Experience
  • Improving Patient Experience
  • Reducing Inequalities
  • Performance Monitoring
  • Review Details and Cost of Service
  • Activity Plans

Explanation of terms:

  • PURPOSE - A clear statement of the primary purpose of the service and details of what will be provided
  • SCOPE - This section sets out clearly what the service does
  • SERVICE DELIVERY - This section sets out the detailed requirements the supplier is to meet (Mandatory)
  • REFERRALS, ACCESS and ACCEPTANCE CRITERIA - This should make clear how patients will be identified, assessed (if appropriate) and accepted to the service. Acceptance should be based on types of need and / or patient
  • DISCHARGE PROCESS – The intention of this section is to make clear what the service’s exit plan with a patient is and when this would be reached
  • QUALITY STANDARDS - Each service specification will include service specific standards that as a minimum reflect nationally mandated quality standards. The service specific standards should encompass the total service from acceptance to discharge or transfer
  • PATIENT EXPERIENCE - A patient and carer experience survey is conducted annually across all services
  • IMPROVING PATIENT EXPERIENCE - This section sets out improvements to patient experiences
  • REDUCING INEQUALITIES - Relevant areas for improvement within the commissioner’s strategic plan and targets should be identified
  • PERFORMANCE MONITORING - Key measures of baseline service activity to be measured
  • CONTRACT DETAILS and COST OF SERVICE - Basis of the service
  • ACTIVITY PLANS – Measures of activity

In practical terms the above are all included in the Service Specification to form the basis of Contract Management and to be recorded in the Contract Management File. Within this approach we will be able to move towards the minimisation of inputs, outputs and targets wherever possible and a growing reliance on the use of lead outcomes to drive performance monitoring.

2.2When will New Service Specification be introduced?

2.2.1It is recognised that the transition to outcome-focused Contract Management will require a considerable investment of resources for the team and will therefore take some time to implement.

2.2.2For that reason it is intended to introduce this new approach on a phased basis between 2009 and 2010

  • From mid 2009 onwards all newly commissioned Services in NHS SOTW will have a service specification that reflects the new approach.
  • From 1st July 2009 all NHS SOTW contracts, where it is intended to issue Community based contracts, will also have a service specification that reflects the new approach. This first phase includes those services that currently have interim contracts but are scheduled to move to community contracts in line with our procurement strategy. These include the majority of services that cater for socially excluded, drug and/or alcohol dependency, and those service users with complex needs.
  • Existing services that are likely to be substantially affected by a sector wide strategic review in NHS SOTW; by major structural changes to the funding and/or re-configuration of services before 2010, are unlikely to be issued with a community contract before 2009. However it is possible that a new service specification may be agreed to ensure closer fit with the new funding environment when any interim contract is renewed. The agreement of a new service specification in this second phase will be determined by the contract manager.
  • How will the new Service Specification be introduced?
  • The Team will work collaboratively with all those providers awarded community contracts to negotiate and agree an appropriate Service Specification. The Specification will include all the minimum inputs, outputs, targets and outcomes on which the service provider will be asked to provide measure of performance or methodology throughout the Contract Management process. The level, extent and frequency of monitoring for each service will vary depending on a risk assessment, which is covered elsewhere in this handbook.
  • What is the legal status of the Service Specification?
  • The Service Specification is an integral part of the contract and does not detract from the main body of the Contract terms and conditions: It is intended to clarify and enhance understanding of the overall purpose of the service and enable a more focused approach to Contract Management.
  • Can the Service Specification be varied?
  • The Service Specification can be varied by mutual agreement. Any required changes in the Service Specification would be agreed as part of a Contract Variation procedure as outlined in the main body of the Contract’s terms and conditions. A copy of the standard contract variation form is attached at appendix B.
  • Does there always need to be mutual agreement before the Service Specification can be varied?
  • There are several circumstances in which a service specification can be changed by the team without the agreement of the provider.
  • These are: -
  • Legislative requirement
  • A change in the specification that, in the opinion of the NHS SOTWManager is essential in order to adequately safeguard the Health and Safety of service users.

An automatic presumption of the provider’s agreement to a deemed variation in these circumstances is contained within the main terms and conditions of the contract. These are outlined in more detail in the main body of the community contract.

2.7Can the measure of performance or methodology be altered without changing the Service Specification?

2.7.1Themeasure of performance or methodology required by the Contract Manager can be altered without the need for a contract variation. The agreement of measure of performance or methodology methods will be negotiated between the contract manager and the provider’s Contract Manager at the award of contract stage. However it will be implicitly understood that the type and extent of evidence required may vary throughout the life of the contract.

2.8What should a provider do if they are unhappy about a proposed change to the Service Specification?

2.8.1It is anticipated that the contract manager and the provider’s contract manager will have discussed any proposed change in depth before a variation to the contract is formally proposed in writing.

2.8.2If, following discussions, the provider’s contract manager is not prepared to agree to the change they are within their right to refuse to sign the contract variation. However the contract manager will need to evaluate to what extent the service will continue to meet the needs of service users, deliver value for money and meet the overall objectives of the NHS SOTW Drug and Alcohol programme if a change to the service is not agreed.

2.9What should a provider do if they are unhappy about a proposed change to the type or extent of measure of performance or methodology required by the Contract Manager?

2.9.1If, following notification of the proposed change to the evidencing requirements, a provider’s contract manager still does not agree with the proposed change they can use the appeals procedure outlined in Section 17.

2.10Further Information on the new Service Specification

2.10.1A copy of the Service Specification Pro-Forma is attached at appendix B.

2.10.2It is recommended that all providers’ representatives involved in delivery of the contract familiarise themselves with the Service Specification for the Contract and, in particular, any new Service Specification agreed for their service in order to ensure that sufficient focus and resources are directed at achieving the primary objectives of the contract.

3Section 3: How the Contract will be monitored

3.1NHS SOTW will monitor contract performance for most Substance Misuse contracts in two key areas throughout the life of the contract.

3.1.1These are: -

  • Value for Money
  • Contract Compliance based on the service specification
  • These are explained in more detail below.
  • This approach to Contract Management applies to all services with a Community Contract
  1. Value For Money
  2. NHS SOTW will monitor Value for Money throughout the life of the contract in order to ensure that both the team and providers remain focused on the efficient and effective use of NHS SOTWfunds.
  3. NHS SOTW believes that Value for Money is about achieving the optimum balance between relatively low costs, high productivity and successful outcomes and not simply about the cost of a service. The team does not therefore intend to use financial data, eg benchmarking information, in isolation as a means of determining the value attached to the contract.
  4. Value for Money assessments can be a valuable tool in reviewing the contract and can provide a point of reference for both parties in discussing issues of quality and cost.
  5. Value for Money will be reviewed regularly as part of the Contract Management process and where necessary, the Contract Manager will feedback any issues arising to the provider’s Contract Manager.
  6. Regular reviews of value for money for each service will support the identification of any areas for improvement and may form part of improvement plans.
  7. In 2009 NHS SOTW Teams intend to introduce a new value for money methodology, using the data collected from providers during contract negotiations, which will enable the contract manager to undertake a comprehensive value for money analysis of any individual service. Further Information on the value for money methodology will be made available to providers as soon as possible.

3.3Contract Compliance

3.3.1NHS SOTW will monitor contract compliance in the following areas: -

  • Service Delivery
  • Performance Management Returns
  • Quality Assessment Framework (QAF)
  • Service User Involvement
  • Financial and Administrative Compliance
  • Strategic Engagement
  • Lead Outcomes

NB. See illustrated flow chart on page 15

3.4CONTRACT COMPLIANCE MONITORING

3.5