AGENDA ITEM

REPORT TO ADULTS’ HEALTH AND WELLBEING

JOINT COMMISSIONING GROUP

25 NOVEMBER 2014

REPORT OF TEES VALLEY PUBLIC HEALTH SHARED SERVICE CONTRACTS MANAGER

TEES INTEGRATED SEXUAL HEALTHSERVICE REVIEW AND RE-PROCUREMENT 2014-2015

SUMMARY

This paper provides the group with an overview of the process to be undertaken regarding the review and re-procurementofthe Tees Integrated Sexual Health Service.

It also details the governance arrangements for the review and re-procurement.

BACKGROUND

  1. In November 2010 a Teeswide integrated sexual health service was commissioned from Assura Stockton LLP (now Virgin Care Stockton LLP) for the duration of five years

to provide Level 1, 2 and 3 sexual health services including chlamydia screening. The contract began on 1st February 2011 and will end on 31st January 2016. The overall annual contract value awarded was £4.3million and a 20% cost saving was realised by commissioning a Teeswide integrated service i.e. shifting the model of delivery away from separate and distinct contraception services and genito-urinary medicine services with a number of different providers.

  1. From 1st April 2013 responsibility for commissioning different aspects of sexual health services was split across a number of commissioning bodies. The provision of open accessible sexual health services became a mandated responsibility for Local Authorities. This includes HIV prevention, sexual health promotion, open access genito-urinary medicine and contraception services for all age groups. NHS England commission HIV treatment and care, health services for prisoners, sexual assault referral centres and cervical screening. The Clinical Commissioning Groups (CCGs) commission community gynaecology, vasectomy, sterilisation and abortion services. Different aspects of psychosexual counselling are commissioned by local authorities and CCGs.
  1. Local Authorities have inherited the largest proportion of contract responsibility for sexual health services totalling £3.9m annually across Teesside. Despite the number of current commissioners,care is seamless to patients and Virgin Care continues to offer fully integrated services on behalf of seven commissioning organisations.
  1. The current service delivery model is a combination of hub and spoke, plus outreach work, and included in their subcontractors are general practices and pharmacies who offer a combination of long acting reversible contraception (LARC), emergency hormonal contraception (EHC) and chlamydia testing and treatment. The location of services is a mix of historic arrangements and new premises.
  1. As the current contract expiration date is 31stJanuary 2016, a full sexual health review will be undertaken with a view to re-tendering for an integrated sexual health service across Teesside, as agreed by the Tees Directors/ Assistant Directors of Public Health at the Tees Valley Public Health Governance Board (TVPHGB)in June 2014.
  1. On 7th November 2014, the TVPHGBprovisionally agreed a two month extension of the current sexual health contract for a further two months (1st February 2016 to 31st March 2016). This would align the new service contract to the financial year. Additional costs for a two month period would be £660,427.66 split across each local authority as detailed in table 1 below:

Table 1 – Addition costs for two month contract extension

Local Authority / Additional Costs
Middlesbrough BC / £183,897.98
Stockton-on-Tees BC / £202,025.28
Hartlepool BC / £113,397.80
Redcar & Cleveland BC / £161,106.60

The NHS Area Team has also agreed to this extension period, however, a decision is currently awaited from the two CCGs to support this before beginning negotiations with the service provider.

RECOMMENDATIONS

1. To note the programme of work described in this paper.

2. To note the governance arrangements for the service review and re-procurement as detailed in appendix 1.

3.To work with Local Authorities for Middlesbrough, Hartlepool and Redcar and Cleveland, to jointly commission an integrated sexual health service for Teesside.

DETAIL

1.AIMS AND OBJECTIVES: The aims and objectives of the sexual health service review and re-procurement are to:

  • Review the evidence base i.e. national guidance and best practice;
  • Review the current delivery of sexual health services in Teessidein terms of;
  • effectiveness and quality of the current service model
  • understanding and reviewing existing pathways
  • resource utilisation
  • inequalities in quality of care and access to services
  • costs and payment models
  • Conduct a full and comprehensive stakeholder consultation exercise to include, but not limited to;
  • service users
  • service staff
  • general practice (GP) and Local Medical Committee (LMC)
  • pharmacies and Local Pharmaceutical Committee (LPC)
  • voluntary and community sector (VCS)
  • Healthwatch
  • Consider information on sexual health needs provided by the Tees Sexual Health Needs Assessment 2014, Tees Joint Strategic needs Assessment (JSNA), the local Pharmaceutical Needs Assessment (PNA) 2014, together with national and regional sexual health reports;
  • Review contracting models and tariffs;
  • Analyse information and make recommendations on future service model;
  • Inform the re-procurement of integrated sexual health services.
  1. SCOPE: The current services commissioned from Virgin Care Stockton LLP and under review are detailed in table 2 below:

Table 2 – Commissioned Sexual Services and Commissioners

Commissioned Service / Provider / Current Contract End Date / Value
  • HIV prevention
  • Sexual health promotion
  • Open access genitourinary medicine
  • Open access contraception services for all age groups
  • Psychosexual counselling – medical
/ Middlesbrough BC
Stockton-on-Tees BC
Hartlepool BC
Redcar & Cleveland BC / 31stJan 2016
(31stMar2016) / £3,962,567
  • HIV treatment and care
  • Health services for prisoners
  • Sexual assault referral centres
  • Cervical screening
/ NHS Area Team / 31stJan 2016
(31stMar2016) / £87,227
  • Community gynaecology
  • Vasectomy
  • Sterilisation
  • Abortion services
  • Psychosexual counselling - psychosexual
/ South Tees Clinical Commissioning Group
Hartlepool and Stockton Clinical Commissioning Group / 31stJan 2016
(31stMar2016) / £257,737

3.CONTENT

  1. Review of evidence and best practice
  • Review national guidance, standards, national programme objectives and quality requirements from DH, PHE, BASHH, FRSH, MEDFASH, BHIVA etc.
  1. Effectiveness
  • Review contract compliance i.e. meeting key performance targets and quality outcomes
  • Audit of compliance against key clinical guidance and national standards
  • Review of clinical pathways
  1. Quality
  • Review of choice and access to services
  • Review of incidents, complaints and safeguarding issues
  • Review of training provision and CPD
  • Patient satisfaction and patient engagement
  1. Resource utilisation
  • Demand
  • referrals, walk-ins, appointments, DNAs
  • Backlog
  • analysis of waiting times
  • Activity
  • analysis of service activity 2013/14 compared to 2011/12
  • analysis and benchmarking of activity between local authorities and geographical areas within local authorities
  • analysis of utilisation by age, gender and deprivation
  • Capacity
  • review staffing model
  • estates
  1. Cost and payment models
  • Review of cost based on need and current service utilisation
  • Understand Out of Area utilisation in terms of activity and costs and risk to LAs
  • Review payment models
  1. Stakeholder consultation
  • Public consultation on current and future sexual health services in each local authority
  • Consultation with service staff
  • Consultation with stakeholders including, but not limited to, GPs, LMC, pharmacies, LPC, VCS and Healthwatch
  1. Health needs review
  • Description of epidemiology of STI and unwanted conceptions
  • Understanding of health needs by service users and stakeholders
  • Understanding of the needs for pharmaceutical services within Teesside
  1. Service model and current configuration
  • Description of service model and configuration

1

4.MILESTONES: Table 3 below details the main milestones and outline timeframe for the service review and re-procurement

Table 3: Service Review & Re-procurementMilestones and Timeline

Nov 14 / Dec 14 / Jan
15 / Feb 15 / Mar
15 / Apr
15 / May 15 / Jun
15 / Jul
15 / Aug
15 / Sep
15 / Oct
15 / Nov
15 / Dec
15 / Jan 16 / Feb 16 / Mar 16 / Apr 16
Service Review / Steering Group meetings
Evidence review
Review effectiveness and quality of service
Resource utilisation
Review costs, payment models and Out of Area activity
Stakeholder consultation
Health needs updates JSNA, PNA
Review contracting models and tariffs
Review current service model and configuration
Audit of assets liabilities (property. TUPE)
Progress Reports
Nov 14 / Dec 14 / Jan
15 / Feb 15 / Mar
15 / Apr
15 / May 15 / Jun
15 / Jul
15 / Aug
15 / Sep
15 / Oct
15 / Nov
15 / Dec
15 / Jan 16 / Feb 16 / Mar 16 / Apr 16
Re-procurement / Develop procurement strategy
Market engagement
Develop specification
Develop tender documentation
Place advert/ invite to tender
Receipt of tenders
Evaluate tenders
Advise successful bidder
Award contract
Mobilisation period
Implement contract

1

KEY ARES FOR CONSIDERATION

Stockton Borough Council (SBC) will act as the lead authority for the procurement process, consultation and legal advice required on behalf of the other three local authorities and meetings have taken place with identified staff to begin that process.

HEALTH & WELLBEING STRATEGIES

The sexual health service review will, at all times, remain closely aligned to the priorities set out in the four Health & Wellbeing Strategies in local authorities in Teesside.

LEGAL IMPLICATIONS

1. All decisions must be made in line with contractual obligations.

2. Any TUPE implications must be considered.

3. Stockton Borough Council procurement process with be adhered to.

4. Support for the project around procurement is being provided by the SBC procurement team.

5. Currently operating under an ‘implied’ contract therefore must manage a safe exit and working closely with SBC legal to deliver this.

6.The four Teeslocal authorities must agree the contract framework and risk share collaboration arrangements.

RISK ASSESSMENT

The joint commissioning arrangements in place include a risk share between the four local authorities. The contract value share and risk share will be reviewed as part of the service review process. Current risk share agreement as detailed in table 4 below:

Table 4 – Current risk share arrangements across Teesside

Local Authority / Risk Share
Middlesbrough BC / 28.09%
Stockton-on-Tees BC / 30.55%
Hartlepool BC / 16.97%
Redcar & Cleveland BC / 24.38%

CONSULTATION

Consultation will be a key part of the service review process and supported by the sexual health leads in each local authority.

MARKET ENGAGAEMENT

Market engagement will form part of the service review process. SBC will lead this process and will be advertised through the SBC ProContract system which will ensure a wide range of local andnational providers are made aware.

Name of Contact Officer: Jacky Booth

Post Title:Contracts Manager, Tees Valley Public Health

Shared Service

Telephone No: (01642) 745183

Email Address:

APPENDIX 1

TEES INTEGRATED SEXUAL HEALTH

SERVICE REVIEW AND RE-PROCUREMENT

GOVERNANCE ARRANGEMENTS

1.BACKGROUND

1.1In November 2010 a Teeswide integrated sexual health service was commissioned from Assura/Virgin Care for the duration of five years to provide Level 1, 2 and 3 sexual health services including chlamydia screening. The contract began on 1st February 2011 and will end on 31st January 2016. The overall annual contract value awarded was £4.3million and a 20% cost saving was realised by commissioning a Teeswide integrated service i.e. shifting the model of delivery away from separate and distinct CASH (contraception services) and GUM (genito-urinary medicine) services with a number of different providers.

1.2 From 1st April 2013 responsibility for commissioning different aspects of sexual health services was split across a number of commissioning bodies. The provision of open access sexual health services became a mandated responsibility for Local Authorities including open access genitourinary medicine and contraception services for all age groups, HIV prevention, and sexual health promotion. NHS England commissions sexual health services provided in general practice as part of the standard GMS contract, HIV treatment and care, health services for prisoners, military service personnel, sexual assault referral centres and cervical screening. The Clinical Commissioning Groups commission community gynaecology, vasectomy, sterilisation and abortion services. Different aspects of psychosexual counselling are commissioned by local authorities and CCGs.

1.3Local Authorities have inherited the largest proportion of contract responsibility for sexual health services totalling £3.9m annually across Teesside. Despite a number of commissioners now having responsibility for commissioning different aspects of sexual health services, care is seamless to patients and Virgin Care continues to offer fully integrated services on behalf of seven commissioning organisations.

1.4As the current contract expiration date is January 31st 2016, a full sexual health review will be undertaken with a view to re-tendering for an integrated sexual health service across Teesside, as agreed by the Tees Directors/ Assistant Directors of Public Health at the Tees Valley Public Health (TVPH) Governance Board in June 2014.

1.5The sexual health service review will, at all times, remain closely aligned to the priorities set out in the four Health & Wellbeing Strategies in local authorities in Teesside.

2.AIMS AND OBJECTIVES OF THE SEXUAL HEALTH SERVICE REVIEW

The aims of the review are:

2.1To review the model and the quality and effectiveness of the delivery of sexual health services in Teesside.

2.2To inform the re-procurement of sexual health services.

The objectives of the review are:

2.3 To review the evidence base i.e. national guidance, best practice and the current Tees Sexual Health Needs Assessment.

2.4 To review the current provision of sexual health services in Hartlepool, Stockton, Redcar & Cleveland and Middlesbrough in terms of:

  • Costs
  • Quality of the current delivery model
  • Activity
  • Inequalities and access
  • Variation within localities
  • Population need

2.5To conduct a full and comprehensive stakeholder consultation exercise to include but not limited to:

  • Local Medical Committee
  • Local Pharmaceutical Committee
  • General Practice
  • Pharmacies
  • Service users
  • Service staff

2.6 To present findings and recommendations to DPHs.

2.7To share the findings of the review with all stakeholders.

2.8 The service review will be led by Tees Valley Public Health Shared Service in collaboration with Local Authority Public Health Teams in particular with the identified sexual health leads.

3.AIMS AND OBJECTIVES OF THE RE-PROCUREMENT PROCESS

The aims of the re-procurement process are:

3.1 To commission open access sexual health services for the local authorities Teesside starting the 1st February 2016.

3.2To work with all commissioners to ensure integrated services for the local population.

The objectivesof the re-procurement process are:

3.3 To use the findings of the service review to inform the development of an integrated sexual health service specification for re-tendering purposes. The service specification to include but not limited to:

  • Service model
  • Elements of service included
  • Quality outcome indicators
  • Key performance indicators
  • Payment model
  • Risk share arrangements
  • Joint commissioning arrangements
  • Contracting model
  • Information requirements

3.4 To work collaboratively with other commissioners of sexual health service provision across Teesside (e.g. CCGs and AT) to develop seamless, integrated, shared care pathways across the whole patient journey.

3.5The re-procurement process will be led by the Tees Valley Public Health Shared Service in collaboration with the procurement team from Stockton Council as the lead procurement organisation. Stockton Council will also provide legal support on behalf of all local authorities in Teesside.

4. GOVERNANCE ARRANGEMENTS

4.1. Tees Valley Public Health Shared Service (TVPHSS)

Governance Board

  • The TVPHSS Governance Board oversees the commissioning of sexual health services for local authorities in Teesside.
  • Regular updates on the progress of the service review and re-procurement of sexual health services will be shared with the Governance Board.
  • The Governance Board will be the final decision maker on all recommendations.
  • Each Director of Public health will be responsible for reporting progress to their relevant local authority’s Health & Wellbeing Boards.
  • Membership of the group can be found in appendix 1.

4.2. Tees Sexual Health Service Review and Re-procurement Steering

Group

4.2.1Aims and Objectives

  • The steering group will be formed for the duration of the sexual health service review and re-procurement process
  • The steering group will agree the review and re-procurement timetable.
  • The steering group will provide expert advice and strategic oversight
  • The steering group will be responsible for maintaining focus and direction and ensuring that the work stays on track, according to the timetable.
  • The steering group will strive to resolve conflicts and make informed decisions regarding changes to scope and deliverables.
  • The steering group will provide support, direction and advice to the project manager and the working group.
  • The steering group will carry out when required, more specialised pieces of work to support the working group.
  • The steering group will report progress regularly to the TVPHSS Governance Board.
  • The steering group will support the implementation of all decisions of the TVPHSS Governance Board to ensure that a fit for purpose service model, aligned to consultation findings, is in place from the 1st February 2016.

4.2.2Leadership

  • The Tees Sexual Health Review and Re-procurement Steering Group will be chaired by Dr Tanja Braun, PH Consultant, TVPHSS.
  • The Deputy Chair of the Steering Group will be Jayne Herring, Contracts Manager, TVPHSS.
  • The Project Manager and lead for the sexual health review will be Jacky Booth, Contracts Manager, TVPHSS.
  • Membership of the group can be found in appendix 1.

4.2.3 Frequency of Meetings

  • Meetings will be held every 6 weeks for a period for three months and the frequency of meetings reviewed thereafter. Meetings will take place until the service review is completed.

4.2.4 Venue of Meetings

  • Board Room, Redheugh House, Teesdale South, Thornaby,

Stockton-on-Tees, TS17 6SG

4.2.5 Administration of Meetings

  • Administrative support will be provided by the TVPHSS.

4.3Tees Sexual Health Review and Re-procurement Working Group

4.3.1Aims and Objectives

  • The working group will be formed for the duration of the sexual health service review and re-procurement
  • The working group will be responsible for carrying out specific tasks of the review and re-procurement timetable as directed by the steering group and overseen by the project manager.
  • New members may be asked to join the working group as and when additional pieces of work have been identified.
  • The project manager will report progress to the Steering Group on a monthly basis.

4.3.2Leadership