Agenda Item 02.2 - NHS 111 OOH Update

The purpose of this paper is to update the Governing Body on the NHS 111 and
Out of Hours procurement process.
The paper also updates the Governing Body on the consultation process which has
started, as delegated by the Governing Body in November.
This paper is aligned to Strategic Aim 4 – Change Management and
Transformation, Strategic Aim 5 – Contracts Management and Performance and
Strategic Aim 7 – Governance.
3.1.1 The Governing Body approved the procurement to start with a Pre-Qualification
Tender which was released on 20th January 2015, following a bidder market event
on January 14th, attended by ten organisations.
3.1.2 At the market event, a number of suppliers, but not all reported that they felt that the
mobilisation period of 4 months was not sufficient and would place the current
providers in a more competitive position. The procurement paperwork has therefore
been updated to reflect that the CCG would allow a mobilisation to take up to a
maximum of six (6) months. This is a precautionary measure to reduce the risk of
an unsuccessful bidder challenging the procurement process.
3.1.3 The effect of the preferred bidder not being in a position to fully mobilise by 2nd
week on November 2015, would delay service launch until start of February 2016.
No service would be allowed to launch in the winter period.
3.1.4 The managerial effect of this is that the CCG will have to create a provision of
extending the current contracts for three months to end of January 2016 which may
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result in some additional costs. These cannot be fully assessed at this stage, but we
are in discussions with current providers around this, and ensuring continuity of
service for patients is what we are all working towards.
3.1.5 The scope of the procurement will exclude the three Royston practices as they will
join the East and North Herts CCG Herts procurement, who commission their
current services.
3.1.6 The procurement will also exclude the four Wisbech practices as agreed by the
Governing Body. They are working with the consortia of Norfolk CCGs. We are also
establishing engagement meetings with the PPGs in Wisbech so that they can feed
into the procurement. Due to the timescales of the Norfolk process, the paper with
recommended provider following the procurement evaluation process will be ready
no earlier than 3 March 2015, which is the date the Governing Body meets again in
public. Due to timing, therefore, we would recommend that the Wisbech LCG
Board reviews the outcome of the process and the recommended bidder. The
Governing Body would then delegate approval to the Lay Chair, Chief Clinical
Officer, Chief Operating Officer and Chief Finance Officer to approve the
3.1.7 The procurement will include the Oundle and Wansford Northamptonshire
practices, which currently use Peterborough based OOH services.
3.2.1 The structure to manage the process is already in place. It was agreed that the
Programme Board was established to oversee the NHS 111 and Out of Hours
Procurement. The Board has now met three times and draft service specifications
have been released to all members who have signed confidentiality and have no
conflict of interest.
3.2.2 The Programme Board will ensure overall linkages between the CCG, the LCGs,
Councils, Health Watch organisations in Cambridgeshire, Peterborough and
Northamptonshire, the Local System Resilience Groups (Urgent Care Boards), the
System Transformation Team, the OPACS mobilisation teams and bordering
Commissioners. The LCGs have nominated Clinical leads for specification
development on behalf of their boards.
3.2.3 In line with requests from the SRG and LCGs boards and due to the known and
potential conflicts of interest that exist, the Programme team would like to share the
specifications publically with the SRGs and LCG boards, once the PQQ has been
completed in mid-March. This will allow a short window for the SRGs and LCGs to
feed back to the procurement board. In advance of this review, we have requested
that the SRG’s and LCGs discuss what they would like to include in the
3.2.4 In line with the CCG Constitution’s Policy for Involvement of External Clinical
Advisors in Commissioning Decisions for Service Reconfiguration, the Programme
Board is will be appointing an Independent External Clinical Advisor to the
Programme Board to support the procurement from the ITT stage.
3.2.5 The oversight for the project will include the non-mandatory but best practice
assurance framework produced by NHS England for NHS 111 procurements.
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3.3.1 Following agreement by Cambridgeshire and Peterborough Scrutiny Committees, a
9 week public consultation started. The Consultation Document and Process was
signed off by the Lay Chair, Chief Clinical Officer and Lay Member for Patient and
Public Engagement in line with the delegated approval agreed by the Governing
Body at its last meeting.
3.3.2 Due to difficulties with distribution of information over the Christmas period, the
decision was taken to extend the consultation for an additional two weeks. This has
been widely publicised and additional meetings put in place after requests from the
public. We have also publicised the fact that there was a problem with the online
response form and this was rectified immediately.
3.3.3 The consultation now ends on Friday 6 March at 5pm. We are proposing to bring an
interim report for the first 9 weeks of the consultation period to the March Governing
Body meeting and will ask that the final updated version, including any new themes
and comments is considered by the Programme Board and the Patient Reference
Group, so that we can ensure that points are taken into account before we enter the
Invitation to Tender stage.
3.3.4 All responses will be reviewed for inclusion within the service specification the dates
of the public meetings are included and have been advertised and circulated to the
media, our stakeholder database, advertised in the press and via social media.
The 111 contract is operationally managed through the 111 Clinical Governance
Group. The Programme Board asked to be sighted on this. Short term measures
around the current service are made through that group for NHS 111 and through
the Contracting and Performance teams and Clinical Leads.
The Clinical Governance Group for 111 has highlighted the short term issues that
are being experienced as detailed below:
1. Driving up Emergency Department (ED) attendances by actual referrals from
111 to ED. A pilot scheme with a GP reviewing these is now in place and is
reducing dispositions to ED significantly.
2. Driving up Ambulance dispatches in Red 2 and Green 1-4 categories. A pilot
scheme has started with NHS 111 Clinical Advisors and East of England
Ambulance Trust paramedics in the call centre to start addressing Green
Ambulance dispatches from 111. Additionally a GP in the pilot scheme has
been trained in NHS Pathways to have the ability to review ED dispositions and
Green ambulances within the pathways system.
3. A mechanism for access to a GP for Care Homes and residential homes is now
in place and has been funded by NHS England.
4. Expanding the Directory of Services (DOS) to include more referral options has
been funded by NHS England and this work is on-going.
5. The Programme Team bid for monies to be involved with the second phase of
the National Pilots, but were unsuccessful and have a review with the National
Team at the start of February 2015.
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6. All this work is in line with a letter received from Dame Barbara Hakin, National
Director of Commissioning Operations at NHSE on 23 January about early
Clinical Input into the 111 Service.
The Governing Body is asked to note the potential mobilisation extension for the
The Governing Body is asked to support the work of the Programme Board and
support Clinical involvement with development of an outcome based specification
with common outcome measures. The specification to address the needs of each
LCG and their population demographics.
The Governing Body is asked to note the consultation currently underway and the
extension and agree the process for reviewing both the interim consultation
response on 3 March 2015 and the final response after 6 March 2015.
The Governing Body is asked to delegate approval for the Wisbech procurement
(as part of the Norfolk CCG) to the Lay Chair, Chief Clinical Officer, Chief Operating
Officer and Chief Finance Officer following review by the Wisbech LCG Board.
Jessica Bawden
Director of Corporate Affairs
29 January 2015
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