musculoskeletal integrated clinical assessment and

Find out more online:

www.worcestershire.nhs.uk

Musculoskeletal Integrated Clinical Assessment and Treatment (ICAT)

Services – Information for Prospective Bidders

26th February 2010



Agenda

• Introductions and welcome• Driver for procurement • Cluster scheme overviews Wyre Forest, Redditch and Bromsgrove and

South Worcestershire Clusters• Procurement Process• Refreshments • Questions and Answers• Close

Presenter

Presentation Notes

Jonathan



Membership of Panel

•• Simon Hairsnape Simon Hairsnape –– Director of Delivery Director of Delivery –– NHSWNHSW•• Chris Emerson Chris Emerson –– Head of Acute Commissioning & Deputy Director of Delivery Head of Acute Commissioning & Deputy Director of Delivery --NHSW NHSW •• Heather MacDonald Heather MacDonald –– Cluster Commissioning Manager Cluster Commissioning Manager –– Wyre Forest PBCCWyre Forest PBCC•• Andrea Cudd Andrea Cudd –– Cluster Commissioning Manager Cluster Commissioning Manager –– Redditch and Bromsgrove PBCCRedditch and Bromsgrove PBCC•• Adrian Giles Adrian Giles –– Project Manager Project Manager –– South Worcester PBCCSouth Worcester PBCC•• Dr Dr RupenRupen KulkarniKulkarni –– GP Redditch and GP Redditch and BromsrgoveBromsrgove PBCCPBCC•• Dr Simon Gates Dr Simon Gates –– GP GP –– Wyre Forest PBCCWyre Forest PBCC•• Dr Anthony Kelly Dr Anthony Kelly –– GP GP –– South Worcester PBCCSouth Worcester PBCC•• Glyn Wise Glyn Wise –– HPC Procurement AdvisorHPC Procurement Advisor

Presenter

Presentation Notes

Jonathan



Simon HairsnapeDirector of Delivery NHSW



Introduction

● Welcome and introduction to NHS Worcestershire;● Preparing for future challenges;● Maximising investment and enhancing Primary Care services;● NHSW team approach to the future.



Driver for Procurement

Chris EmersonHead of Acute Commissioning & Deputy Director of Delivery NHSW



Rate of first OPA by PBC Cluster 08/09



Additional rationale

● Elective & DC admissions 5th highest in region;● Elective & DC admission rate rising faster in Worcestershire than nationally and

regionally;● OPA 3rd highest in region; ● OPA 1st attendance 2nd highest in region;● OPA 1st attendance rate rising faster in Worcestershire than nationally and regionally;



NHSW response to the ‘Orthopaedic Challenge’

● Commissioning Guidelines for the Management of Orthopaedic Conditions in Primary Care – implementation date April 2010 and inclusion within each of the Clusters MSK ICATS Service Specifications;

● The 3 main Cluster areas are fully supported by NHS Worcestershire to procure MSK ICATS;

● Acute Commissioning Portfolio relating to orthopaedic activity will reflect reductions in orthopaedics from 2010/11;

● Primary Care Services including mainstream outpatient physiotherapy to be enhanced;● Referrals into Secondary Care orthopaedics will only be accepted following treatment

and assessment via MSK ICATS (pending implementation, exceptions apply).



MSK ICATS in Worcestershire – A Generic Overview

Dr Simon GatesGP - Wyre Forest PBCC



MSK ICATS in Worcestershire – A Generic Overview

● Why do we need an ICATS service?● Equitable triage, assessment and treatment, adhering to the Commissioning

Guidelines for the Management of Orthopaedic Conditions in Primary Care;● Integration: primary care / physiotherapy / secondary care / orthotics / podiatry ● Minimum duplication of workload;● 3 clusters - 3 solutions;● Patient focused service.



MSK ICATS – anticipated, measurable outcomes

● High patient satisfaction, based on results of a patient survey;● Adherence to: Commissioning Guidelines for the Management of Orthopaedic

Conditions in Primary Care;● Delivery of a range of teaching and training, including feedback on individual

referrals;● Anticipated conversion rates will form part of the KPI’s and agreed via

individual Service Specifications.



Wyre Forest Cluster



Wyre Forest PBC Cluster



Wyre Forest PBC Cluster Summary

•13 practices;

• 68 GPs;

•Population of approx 110,000.



Orthopaedic referralsOrthopaedic referrals

Attendance Type ActivityElective 2,548 NonElective 563 Unclassified 3 OP 16,887 Grand Total 20,001

Attendance Type OP Referral Group ActivityOP A&E 575

Allied Health Professional 9 Consultant 834 GP 3,046 Other 1,151 Self 44 (blank) 32

Grand Total 5,691

All referrals from Wyre Forest in 2008/09All referrals from Wyre Forest in 2008/09

PbR, 1st OP PbR, 1st OP referrals onlyreferrals only



Orthopaedic 1Orthopaedic 1stst : FU rate: FU rate

●● 11stst : FU rate for Wyre Forest 2008/09 is approximately 1 : 2 (PbR : FU rate for Wyre Forest 2008/09 is approximately 1 : 2 (PbR activity only)activity only)

Attendance Type TypeMid ActivityOP 1st 5,691

FU 11,147Procs 1

Grand Total 16,839



The WF MSK ICATS Service Flowchart

GPPatient

presents with MSK problem

Education sessions

with Primary Care

ICATS

Triage of Referrals Direct

Listing

Secondary Care

Routine Physiotherap

y

Pain

Pathway

Diagnostics/ Investigations /

Injections/ treatment plan

Option to self refer

Discharge

On 1st

Presentation

Red Flags

Orthopaedic Consultant

Sessions

Informed decision making

Primary care ICATS Secondary care

Shoulder

Hip

Knee

Elbow & Lower Arm

Carpal Tunnel

Foot & Ankle

Pathway s

Routine Podiatry

Routine Orthotics



Where?

● Within the Wyre Forest area;

● Appropriate premises.



Vision for the MSK ICATS service

● 3-5 yr plan;● Close relationship between ICATS provider and cluster commissioning

group;● Provider to be able to tailor service in year to meet needs of cluster..



What we don’t want

● Providers to bid low and then re negotiate;

● Providers to be dogmatic in dealing with commissioners.



Key Aspects of Service

● Close links with primary care;● Close links to secondary care;● Extended scope physiotherapists supported by consultants;● Extended scope physiotherapists to be capable of joint injections;● Decision Making Support tools to be used;● Back and spinal excluded.



Redditch and Bromsgrove PBC Cluster

Andrea CuddCluster Commissioning Manager RBPBCC




Presenter

Presentation Notes

Alan




Basic Demography There are in excess of 170,000 registered patients within the 23 practices in the Redditch & Bromsgrove PBC Cluster, accounting for nearly a third (30%) of the registered patient population of Worcestershire;A high percentage of patients reside in the 2 separate towns of Redditch and Bromsgrove but a significant minority are found along the Western end of the M42 motorway and in rural settings around the 2 towns and to the south of nearby city Birmingham.



Orthopaedic referrals

AttendType TotalElective 2915NonElective 1124OP 27463Grand Total 31502

AttendType Referrer TotalOP A&E 2492

Allied Health Professional 19Consultant 942GP 4750Other 115Self 157(blank) 25

OP Total 8500

All activity from Redditch & Bromsgrove in 2008/09

PbR New outpatients only



The RBPBCC MSK ICATS Flowchart

ICATS MSK Services required – patient registered accordingly (day 2 – 7)

Pain Services Referral (day 21 – 28)Secondary Care Referral (day 21 – 28)

GP – Patient Referral

Physiotherapy required – ESP physiotherapy via MSK ICATS OR referral to RBPBCC Musculoskeletal Out Patient

Physiotherapy Services (day 2 – 7)

Podiatry required – referral to ICATS Podiatry Services or mainstream Podiatry

Services (day 2 – 7) +/- OP sessions (2 av, 4 max; day 21 – 28)

MSK ICATS in house management (day 21 – 28)

MSK ICATS – Specialist Orthopaedic/ESP MSK ICATS triage (day 0 – 2)

OP physiotherapy sessions (3av,6 max)( Day 21-28) Urgent within 7 days

Discharge to GP

Referral to sec care via ICATS

Orthotics

Diagnosis

Investigations/scans

Injections

Treatment Plan

Discharge to GP

Reviews – max 2 – 3 Rheumatology

Review

Intervention/surgery

Discharge to GP

Discharge to GP

Back Pain - acute back pain clinic Alexandra Hospital. Chronic Back pain –

ROH clinic.



Where?

● MSK ICATS should be delivered from a Primary Care location within the Bromsgrove and a Primary Care location within the Redditch area as a minimum;

● The identification of premises will be at the discretion of each of the bidders and should feature within any ITT submission.



Vision for the MSK ICATS Service

● An integrated service, providing the patient and the referrer with accurate assessment, diagnosis and primary care treatment to appropriately manage patients with musculoskeletal conditions;

● A service which includes patient education to support them in the management their own condition;

● A service which supports referring GPs by managing patients in a Primary Care setting and realises efficiencies (in line with indicative GP referral targets);

● A service which complements existing commissioning arrangements and builds crucial links with Secondary Care;

● A service which builds confidence in all Stakeholders and evolves beyond the life of the pilot phase.




● Robust marketing plans to ensure slick implementation across the 23 practices within Redditch and Bromsgrove with emphasis on partnership working and engaging local GPs;

● MSK ICATS to be delivered by Orthopaedic specialists and ESP’s;● MSK ICATS to be delivered in line with Commissioning Guidelines with KPI’s identified

within the Service Specification;● MSK ICATS Provider to work with RBPBCC should in-year changes to the Service

Specification be required to optimise service implementation and secure its future;● Back and spinal included at present.



South Worcester PBC Clusters

Adrian GilesSouth Worcester Clusters Project Manager



South Worcestershire – Where we are



South Worcestershire PBC Cluster

Basic Demography There are in excess of 200,000 registered patients within the 21 practices in the South Worcestershire PBC Cluster. It is the largest PBC cluster representing 35% of the total population of Worcestershire and is divided into 4 distinct locality sub clusters:● Droitwich● Worcester City 4● Worcester City 5● Malvern Hills & Pershore



SW all orthopaedic activity 08/09



SW PbR Orthopaedic OPFA 08/09



The SWCC MSK ICATS proposed patient flow

Confidential

SWCC ICATS

Electronic Triage

Orthopaedic Consultant

Patient presents to GP with musculoskeletal pain.

GP completes Electronic ICATS Referral stating preference of secondary care provider

Physiotherapy

Podiatry

Specialist Pain Management

Minor Surgery (1y care)

Red Flag?

Yes

No

Orthotics Service

OPS Knee, Shoulder & Spinal

New Episode of Acute Musculoskeletal Pain

Suitable For Physiotherapy?No

Yes

Presenter

Presentation Notes

Change words!

ICATS Electronic Triage (Day 0-2)

Physiotherapy Face To Face Assessment

(Day 2 -5)

DefinableLesion

Physical Treatment(Day 5 – 14)

OPSSpinal, Shoulder & Knee

(Day 5 – 28)

Treatment (Maximum of 5

Sessions)

Secondary Care Orthopaedic Dept.

DefinableLesion

Not Suitable For

Physiotherapy

Discharge

Functional Rehabilitation Programme including CBT

(Day 21 – 28)

Is patient suitable For Physical Treatment

?

Specialist Pain

(Day 2–56)

Minor Surgery

(Day 2–28)

Podiatry Service

(Day 2–56)

Orthotics Service

(Day 2–56)

Discharge

Yes

No

All patients discharged from ICATS will be given a management plan.

These patients will be allowed to self- refer directly back to ICATS Triage Service should condition deteriorate.

OPS

Proposed ICATS Physiotherapy /Pain Management Treatment Algorithm



Where?

● MSK ICATS to be delivered from a Primary Care location within South Worcestershire;

● The identification of premises will be at the discretion of each of the bidders and should feature within any ITT submission.



Vision for the MSK ICATS Service

● An Extended Scope Practitioner led service that will:● Provide quick, accurate assessment, diagnosis and treatment to appropriately

manage patients with musculoskeletal conditions;● Include patient education and support to help patients manage their own

condition;● Support referring GPs by managing patients in line with indicative GP referral

targets;● Complement existing treatment pathways;● Utilise current resources and skills in primary and secondary care settings.




● Overall philosophy: you tell us;● Strong yet subtle marketing of service to ensure implementation across the 21

practices within South Worcestershire;● MSK ICATS to be delivered in line with existing Commissioning Guidelines.

KPIs to be identified within the Service Specification;● MSK ICATS Provider to work with SWCC during first year to optimise patient

experience and treatment outcomes and to refine service where necessary; ● Back and spinal pathway is included at present.



Procurement Process Overview

Glyn Wise Healthcare Purchasing Consortium (HPC)



Procurement Process - Overview

• The procurement process has already started;

• Advertisements have already been placed on Supply2Health and local web sites;

• Further information will be available through the NHS Worcestershire Internet site;

• The procurement will be managed using Bravo (e-procurement system);

• Registration on BRAVO for this procurement represents an Expression of Interest.

Presenter

Presentation Notes

Glyn



Procurement Process - Pre Qualifying Questionnaire (PQQ)

• The Pre-Qualifying Questionnaire (PQQ) can be downloaded by all Potential Bidders from the BRAVO web site (www.hpc.bravosolution.co.uk);

• Completed responses must be submitted by 5 March 2010 using BRAVO;

• The PQQ will be used to evaluate the potential bidders’ capability, capacity and eligibility to deliver the required services;

• The PQQ is the Selection part of the procurement process.

Presenter

Presentation Notes

Glyn

http://www.hpc.bravosolution.co.uk/



Procurement Process - Invitation to Tender (ITT)

•• A shortlist of Pre-Qualified Bidders will be invited to tender;

• The ITT will be issued electronically via Bravo and responses will need to be submitted by 30 April 2010;

• The ITT examines the Bidder’s proposed solution and not the Bidder;

• The ITT is the Award part of the procurement process;

• The ITT will include the criteria on which the contract will be awarded and the contractual arrangements that will apply;

• ITT submissions will be evaluated with a view to being able to appoint a Recommended Bidder.

Presenter

Presentation Notes

Glyn



Contractual Process

• Based on the standard contract for Community Services;

• Contract duration is 1 year plus an option to extend for a further year;

• The contract will be available with the ITT, for bidders to review before they submit their bids;

• There will be three “Lots” – Bidders may bid for one, two or three Lots. It is intended that up to three contracts will be awarded;

• It will be an ITT, not an Invitation to Negotiate (ITN). Responses will be open for NHS Worcestershire to accept.

Presenter

Presentation Notes

glyn



Key Milestones

•• Advertisements - published;

• Pre Qualification Questionnaires (PQQ) – to be submitted by 5th March 2010;

• Deadline for submission of Invitation To Tender (ITT) responses is 30th April 2010;

• Contract award planned - 14th June 2010;

• Service commencement – 1st October 2010;

Presenter

Presentation Notes

Glyn



Key Points to Note

•• Will be an open, fair and transparent process to ensure that all potential providers have an equal opportunity to bid;

• Web-based Procurement;

• Bidders can bid for one or more “lots”;

• All information on NHS Worcestershire Website:–http://www.worcestershire.nhs.uk/mskicats.aspx

• Bids and Correspondence via e-Bravo:-https://hpc.bravosolution.co.uk/web/login.shtml

Presenter

Presentation Notes

glyn

http://www.worcestershire.nhs.uk/mskicats.aspx

https://hpc.bravosolution.co.uk/web/login.shtml



Questions and answers…

This presentation will be available shortly from the MSK ICATS website www.worcestershire.nhs.uk/mskicats.aspx

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