title of paper update on contract negotiations yes€¦ · the paper will provide an update on the...

Date Wednesday, 11 November

2015

Presenter Leroy Cordle, Associate Director Contracts, NHS Central London CCG Author Leroy Cordle, Associate Director Contracts, NHS Central London CCG Responsible Director Matthew Bazeley, Managing Director NHS Central London CCG Clinical Lead Dr Neville Purssell, GB Chair and Clinical Lead

Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so

The Governing Body is asked to: Note the contents of the paper

Summary of purpose and scope of report The paper will provide an update on the 2016/17 contract negotiations which will be based on national timetable for concluding the negotiations by the end of March 2016. The report also considers a paper to the Commissioning Delivery Group on 22nd October, which seeks to gain support from the NW London Collaborative and also references the Formal Notification of Contractual Changes to the CLCH contract issues on 30th September 2015.

Quality & Safety/ Patient Engagement/ Impact on patient services: The contract negotiations will be clinically led to ensure our clinicians contribute to provide assurance that the CCGS’ commissioning requirements and being met and consider the impact on quality and safety of services.

Finance, resources and QIPP None at this stage

Equality / Human Rights / Privacy impact analysis None undertaken for this report

Risk Mitigating actions None perceived at this time N/A

Supporting documents Approach To 2016-17 Contract Round Update

Governance and reporting (list committees, groups, other bodies in your CCG or other CCGs that have discussed the paper) Committee name Date discussed Outcome Commissioning Delivery Group 22nd October 2015 For noting

Title of paper Update on Contract Negotiations

Paper: # to be added by each CCG

Introduction

The 2015/16 NHS Standard Contract Negotiations is mandated by NHS England and follows the formal notification of contractual changes issued to providers on the 30th September 2015. For the NW London Collaboration of CCGs, the 2015/16 process will be managed as a collaborative effort to ensure there is rationalisation where possible and consistency where appropriate to facilitate the delivery of the wider NW London strategic commissioning plans. NHS Central London CCG is the Lead Commissioner for Central London Community Healthcare NHS Trust Community contract and the coordinating commissioner for Guys and St Thomas’ NHS Foundation Trust, King College Hospital NHS Foundation Trust and University College London Hospital NHS Foundation Trust and therefore represent and takes a lead on the negotiations or liaise with lead commissioner or CSU on behalf of other NW London CCGs during the contract negotiations.

Copies of the Formal Contract Notice of changes to Central London Healthcare NHS Trust (CLCH) contract and Update on Approach to 2016/17 Contract Round to the Commissioning Delivery Group are included below for reference.

Proposed deliverables During 2016/17 contract negotiations, commissioners will be required to negotiate mainly a ‘block’ contract which will deliver significant strategic change in our contracting models which have been clearly articulated in the our notice letters issued to providers at the end of September. Key deliverables will focus on commissioning for outcomes based on capitated budgets which require joint accountability for the outcomes and costs between providers. Since our current contracting models do not support this change, there is a requirement for shared understanding of the scale of change required. For this reason, a collaborative approach to the contract negotiations will be fundamental to a successful outcome for commissioners and seen as the best way forward to ensure a consistent delivery of the changes commissioners expect to implement from 1st April 2016.

Progress to date

From a NHS Central London CCG perspective, our contracts team aim to commence formal negotiations with CLCH in mid-November with a signed contract by the end of March 2016 or in accordance with national timetable which is subject to change due to a potential delay to 16/17 tariff or other national guidance. This timescale may be impacted by publication of national contract and other contracting guidance. However, to ensure flexibility and to keep pace with the anticipated changes to programme milestones, we have set our plans to commence formal contract negotiation with scheduled events and key contractual activities in mid-November with a completion date in accordance with national and local timetable.

Paper: # to be added by each CCG

The contract negotiations will be underpinned by robust governance arrangements, which will outline clear lines of accountability between commissioners and Trust Officers/representatives and will also include milestones that will align our strategic commissioning requirements to the wider NW London transformation agenda to ensure we follow a consistent approach to reaching agreement with provider on each of the contract schedules. Regarding the much broader NW London plans, the contracts team have aligned their plans to consider the CWHHE contracting round programme which includes a series of events and key activities covering key sections of the contract including Quality/CQUINs and Information requirements. This will allow subject matter experts and work stream leads to outline the key areas which have been endorsed by the NW London Collaborative in a coordinated fashion, to will lessen the ambiguity and provide consistent interpretation and approach to the delivery of these key areas of the contract. Conclusion This paper provides a brief update to the 2016/17 contract negotiations between NW London CCGs and providers. The context of the paper outlines the change required to our contracting models which will support major strategic change from 1st April 2016 and beyond. Key success factors will require the successful negotiation of contracts with the required changes to support our direction of travel, and within our affordability envelope that will optimise quality outcomes for NW London service users.

Leroy Cordle Associate Director of Contracts, NHS Central London CCG 26th October 2015 Following this report:

a. CDG Update on Approach to 2016/17 Contract Round b. Formal Notice of Contract Changes to CLCH Contract for 2016/17 issued to CLCH

North West London collaboration of

clinical commissioning groups

1

Commissioning Delivery Group – 22nd October 2015

Approach To 2016-17 Contract Round Update As At 21st October 2015

Author: Andrew Burgess - Interim Director of Contracts, Performance & Procurement, BI & IT

Purpose

To update the Board upon progress and key outstanding issues relating to the development of an approach to the contracting round embracing our proposed new models of care for 2016-17 and beyond Key Recommendations

The Commissioning Delivery Group are asked to note the;

(1) Content included in the 30th September provider contract notification letters (section 1) (2) Proposed key deliverables and timelines during the course of the next month in developing

an approach (section 2) Including specific consideration as to the how we most effectively engage with providers on development and implementation of the approach

Executive Summary

An approach to the NWL contract round for 2016-17 and beyond is being developed which implements the intent articulated as part of our 30th September provider contract notification letters (section 1) and which:

- Continues to target achievement of key NWL strategic objectives whilst at the same time is consistent with national policy

- Incorporates the shared WSIC vision, design principles and programme objectives - Proposes one or more applicable contractual models for 2016-17 which also formally defines

(possibly in the form of the proposed Alliance agreement template included in Appendix 3) the interrelationships with the NWL CCG early adopter models and ACP formations appropriate to the various differing stages of development across NWL

- Targets key outcomes and strategic direction consistency and goal congruence between the various 16-17 provider contracts and the transitional (shadow) capitation models

- Most effectively engages with applicable providers and key stakeholders - Adheres to EU and national procurement guidance and legislation

(1) Content included in the 30th September provider contract notification letters

“While the letter below covers the standard areas that would be expected under an NHS PbR contract, we wish to signal our intention to contract differently for 2016/17. There is significant financial instability within providers at present, which unaddressed will risk the stability of trusts and the quality of services to patients. As commissioners we wish to work with trusts to reduce the level of risk in the system, and to change the way in which we do business to enable us to achieve our

2

joint strategic ambitions as set out in Shaping a Healthier Future and through the Whole Systems Integrated Care programme.

We believe that high quality, integrated services can best be delivered by accountable care partnerships which have developed appropriate models of care for their population; which are commissioned to deliver clear outcomes for the different segments of the population; which share accountability for achieving those outcomes and which share financial risks and benefits through a capitated budget.

We do not believe that it is possible to move directly from a PbR environment to a whole population capitated budget across an ACP. We wish to achieve the latter by April 2018 at the latest, in line with our 5 year strategy. We therefore wish to explore with you the potential to move to an alternative contracting approach for the next two years, based on the following:

• A 2 year contract (16/17 and 17/18) • Mainly block based, though with opportunities to earn additional income through:

o Achievement against a small number of outcome measures, at least one of which would be defined across multiple providers to measure system wide achievement

o underspending against shadow capitated budgets • a joint review of opportunities to reduce or eliminate aspects of the in year contracting

processes that add limited value, thereby freeing up trust and CCG resource to work jointly together to understand activity and cost information and to create capacity to move to shadow capitation monitoring

• Clear accountability for the delivery of national performance metrics and key quality standards.

We are keen to begin early discussions with you to explore whether there is appetite for doing business in a new way as set out above”

(2) Proposed key deliverables and timelines during the course of the next month in developing an approach

At the 26th November 2015 CDG, approval will be targeted for proposals regarding; - Applicable contractual models and risk and reward mechanisms - The scope and coverage of transitional capitated patient cohorts, allocation of initially

proposed budgets, development of timelines relating to reporting and proposed link with 16-17 contracts

- Outcome measures and potential strategic use of CQUIN as a WSIC transformational enabler - Roadmap for development of ACP’s and proposed approach to provider engagement

3

Regarding contractual format and the various interrelationships, the slides

below depict one potential solution, already envisaged by the WSIC work thus far.

4

Enablers for this include;

- Re-commencement of the WSIC Steering group will re-commence (and WSIC Finance & Activity group will continue)

- The intersection of WHYSE and WSIC being formally considered and a business case will be prepared regarding on-going plans

- Financial forecast outturns, local adjustments relevant to 2016-17, 2016-17 national tariff and planning assumptions information which will be incorporated into modelling as and when available

Regarding provider engagement, some engagement has already been undertaken via:

- The provider network working group - WSIC programme executive - Leadership summits - Local discussions at Early Adopter/shadow ACP meetings.

This engagement thus far has primarily been with Director leads rather than Chief Executive level attendance. Specific consideration and thoughts are welcomed from CDG colleagues as to;

(i) How we most effectively engage with providers on the development and implementation of the approach, including the cultivation, mobilisation and formation of ACP’s (The potential options range from a combination of individual provider meetings and a series of workshops to informal, non-committal market engagement)

(ii) What our approach might be if certain key providers are opposed to the approach and what our approach might be in persuading and leveraging their active participation?

Chairs: Dr Ruth O’Hare, NHS Central London CCG CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham,

Hounslow and Ealing Clinical Commissioning Groups

Dr Fiona Butler, NHS West London CCG Dr Tim Spicer, NHS Hammersmith & Fulham CCG Dr Nicola Burbidge. NHS Hounslow CCG

Dr Mohini Parmar, NHS Ealing CCG Chief Officer: Clare Parker

Sent by Email Only 15 Marylebone Road

London NW1 5JD

Tel: 0203 350 4177

Email: [email protected]

30th September 2015

Dear James

FORMAL CONTRACT NOTICE OF CHANGES TO CENTRAL LONDON COMMUNITY

HEALTHCARE NHS TRUST CONTRACT

On behalf of NHS Central London CCG in its role as the Co-ordinating Commissioner, this letter is

to give formal notice of intended changes to the service being commissioned from Central London

Community Healthcare NHS Trust (CLCH) in relation to the NHS Standard Contract for 2016/17.

Please note that this letter includes standard requirements by the North West London

Collaboration of Clinical Commissioning Groups, however we appreciate that not all of the content

applies to every provider (including community providers).

The letter outlines the contracting intentions of the North West London CCGs for 2016/17 and

includes decommissioning notices plus coding and counting changes as applicable for the

contract. It also includes appendices which summarise individual NWL CCG intentions. For the

purposes of contract notice notification, the Appendix form part of the contractual notice and

inclusion of an item in the Appendix should be construed as if it were included in the main body of

the letter. Any de-commissioning notices that have already been served remain in force unless

otherwise notified.

One exception to the standard content is where we want to signal to CLCH in particular that there

are a number of developments which are on-going where we are not yet able to give notice of

specific contractual change but we would expect both commissioner and provider to be responsive

and use the contract to effect any such changes. These include our intentions for CIS, WSIC, the

outcome of the Baker Tilly review and linked to that relating to CLCH FT application and the long

term commissioning and contracting implications for CLCH in the context of our new models of

care.

Community Independence Service

With our Local Authority partners, we are yet to decide on our approach to commissioning CIS

services and will give notice of any proposed changes within the next two months.

James Reilly

Chief Executive

Central London Community Healthcare NHS Trust

7th Floor

64 Victoria Street

London SW1E 6QP





Review of Community Services

Following the receipt of the final report, we intend to use that as the basis for improvement in

services and ways of working. Specifically, we will use the review to identify any commissioning or

contractual requirements and given it is a collaborative report, we expect any changes to be

implemented from 1st April 2016 which could include decommissioning of services.

Whole System Integrated Care across Central London, West London and Hammersmith and

Fulham CCGs

The development of Whole System models across the NWL collaborative will have significant

impact on the way we commission services, particularly Community nursing and the primary care

interface between GP practices and community nursing services. The different whole system

models will impact on community services activity for example we anticipate decommissioning of

community nursing activity from the main contract and re-commissioning as part of these models of

care.

Additional NHS West London Requirements

NHS West London CCG will review the Baker Tilly Audit when finalised, and this will inform

commissioning decisions for 16/17.

Commissioners are yet to decide the full approach to commissioning CIS services and will indicate

our intentions within the next 2 months. Specifically West London CCG is currently undertaking an

audit of older adults services across West London. This is inclusive of the ICHT Older Adults

Rapid Access Service, Chelsea and Westminster Older Adults Service, CIS and CLCH Community

Provision and the wider WL Whole Systems service. The intention of this is to identify any

duplication resulting from historical commissioning decisions, and to amend the volume/range of

services if duplication is identified. This may affect any provider, and standard notice of change

would be applied.

Within Whole Systems, West London CCG welcomes the involvement of CLCH in our evolving

model, and wishes to restate our intent to invest in the initial pump-priming of the Whole System

over 65 years model of care, and from this, to evolve the baseline service from CLCH and other

providers, into our new model of care.

Long Term Commissioning and Contracting Implications for CLCH

We recently wrote to you on the subject of your FT application. In that letter, we explained that we

do not believe that the foundation trust model for a community provider will help us to achieve the

best operating model for integrated services. We want to establish how care can be provided most

effectively and efficiently and, consequently, determine the best operating model and

organisational form for community providers. When we have established this, there will be also an

impact on the contractual model which we also expect to change to help deliver our long term

ambitions for community services as part of our new models of care.





Out of Hospital Services: Delivering population coverage of high quality and consistent enhanced services in primary care settings

The Out of Hospital Services is a portfolio of 19 services that are being rolled out across CWHHE.

This programme of work will deliver:

a) A shift in care settings from hospitals into primary care

b) Increased quality of care through consistent service specifications delivered across all

CWHHE GP practices and increased quality in monitoring processes

c) Improved equity of access to services for patients, ensuring appointments for the 19 services

are available for all patients by March 2016. Appointments will be closer to home and

delivered at the registered GP practice or a neighbouring practice

d) Supporting the development of Whole Systems Integrated Care through the delivery of

services buy GP Provider Organisations that support network and locality based service

delivery.

e) Capitalising on the SystmOne roll out through the development and implementation of

SystmOne templates that are aligned with the service specification. This also supports the

robust and consistent collection of service provision data.

In 16/17 the focus will be on ensuring quality of services meets national standards, population

coverage has been achieved, outcomes from the service implementation review have been

implemented and a process is in place for new out of hospital services to be commissioned.

We will ensure that the commissioning and contracting arrangements are in place for all these

services, including decommissioning existing services where appropriate. The services include:

a) Ambulatory Blood Pressure Monitoring

b) Anticoagulation Level 1 – Monitoring

c) Anticoagulation Level 1 and 2 – Initiation and Monitoring

d) Case finding, Care planning & Care management

e) Complex wound care

f) Coordinate My Care

g) Diabetes (Level 1)

h) Diabetes (Level 2)

i) ECG

j) High Risk of Diabetes

k) Homeless

l) Management of Complex Common Mental Health problems

m) Near Patient Monitoring

n) Phlebotomy

o) Ring Pessary

p) Serious Mental Illness - Transfer of Care

q) Simple wound care

r) Spirometry

s) Extended Hours





In addition to the formal notification of variations and terminations, the letter outlines the overall

NWL CCG collaboration proposed approach to the contracting round for and potentially beyond

2016/17. National and London guidance has yet to be issued for 2016/17 and we will need to

jointly review our 2016/17 plans in the context of this guidance when it is available.

We are also aware that there are likely to be issues from a Trust perspective that you will wish to

address through the contracting round. It would be helpful if these could be articulated at high level

in writing to us and we would also welcome an early discussion on these issues, noting that any

issues requiring notice should have been communicated to us by the end of September in order to

be considered for 1st April 2016 implementation.

Strategic Objectives For 2016/17 and Beyond

All eight NWL’s Clinical Commissioning Groups and partner organisations continue to work

collaboratively to successfully plan and implement a transformation of the healthcare system that

will dramatically improve care and health outcomes for over two million people.

Our vision is to deliver care which is:

a) Personalised – Enabling people to manage their own care themselves and to offer the best

treatment to them. This ensures care is unique.

b) Localised – Localising services where possible, allowing for a wider variety of services

closer to home. This ensures care is convenient.

c) Integrated – Delivering care that considers all the aspects of a person’s health and is

coordinated across all the services involved. This ensures care is efficient.

d) Centralised – Centralising services where necessary for specific conditions ensuring greater

access to specialist support. This ensures care is better.

Our vision is centred on the needs of the NWL population, developed from the patient views on

their requirements of healthcare. These views then formed as the ambitions of our strategy and

vision for the healthcare transformation in North West London. We are already delivering this

transformation through the Shaping a Healthier Future (SaHF) portfolio. This work will continue

during 2016/17 through local activity within the individual boroughs and within the following major

programmes being run on a pan – NWL level, including Acute reconfiguration, Primary Care

transformation, Whole Systems integrated care and Mental Health Transformation.

Acute Reconfiguration: Improved hospitals delivering better care 7 days a week, and ensuring

there are more services available closer to home.

We have recognised the changes in population demographics and lifestyles, and, as such, are

changing the way we organise our hospitals and community health services. By making these

changes, we can ensure that the highest standards of care are met; that our hospitals have the

specialist doctors and facilities in place to deal with your specialist needs round-the-clock, and out-

of-hospital services are on hand to treat your everyday health needs as quickly and conveniently

as possible, either closer to or within your own home. Acute Reconfiguration aim to deliver:





a) A major shift in care from within a hospital setting to an out-of-hospital setting so more

people are treated closer to their homes;

b) The concentration of acute hospital services in order to develop centres of excellence which

are able to achieve higher clinical standards and provide a more economic approach to the

delivery of care.

In 16/17 the focus will be to:

a) Deliver a revised Implementation Business Case for approval by the NHS and HM

Government, allowing for capital investments to be made to transform NHS estates in NWL;

b) The delivery of the transition of inpatient paediatric services from Ealing Hospital by June 30,

as agreed by Ealing CCG Governing Body (on behalf of all other Governing Bodies in NWL)

on May 20 this year;

c) Planning for the transition of other services from Ealing and Charing Cross Hospitals as we

continue to transform these sites to their future state.

Primary Care Transformation: Placing Primary Care at the heart of whole system working, and

improving access to GP services.

Primary Care, and in particular General Practice, is at the centre of the NWL vision. However, the

model of general practice that has served Londoners well in the past is now under unprecedented

strain. There are significant challenges that must be addressed, including increasing demand and

projected shortages in workforce. Patients’ needs are changing and the systems that are currently

in place need to evolve to ensure that they are still fit for purpose in light of this change.

The implementation of Shaping a Healthier Future (SaHF) will deliver a vision where patients can

benefit from:

a) Improved health outcomes, equity of access, reduced inequalities and better patient

experience;

b) Services that are joined up, coordinated and easy to use;

c) More services available, closer to homes;

d) High quality out-of-hospital care;

e) More local patient and public involvement in developing services, with a greater focus on

prevention, staying healthy and patient empowerment.

This will then enables us to provide accessible, coordinated and proactive care, as set out in the

London-wide Strategic Commissioning Framework. To ensure the vision is successfully realised

and these benefits become tangible and sustainable, the model of Primary Care needs to be

transformed so that it can become the strong and sustainable for Whole Systems Integrated Care

(WSIC).





As we move through this year, our priority areas in 16/17 are as follows:

a) Approving the new model of primary care through the joint co-commissioning committees in

common and implementing this across NWL and ensuring that this is a fundamental part of

an integrated care offer for patients:

b) Working to ensure that all necessary enablers are in place to support the new model of care

rollout (including workforce, technology and contracts);

c) Putting the right support in place to nurture and grow GP federations so they are able to

deliver sustainability in the long term as part of Accountable Care Partnerships (ACPs);

d) Progressing with the primary care estates strategy that takes into account the development

of out of hospital hubs across NWL. Currently, 19 sites are in the pipeline. Once delivered

these will provide significant additional space to deliver primary and integrated care.

Whole Systems Integrated Care: Coordinating care across commissioning bodies and provider,

centred around the patient.

Across NWL we are approaching year three of a five year journey towards delivering the Whole

Systems Integrated Care (WSIC) vision.

The characteristics of WSIC (outcome-based models of care, accountable care partnerships,

capitated payments and system-wide risk and reward sharing) have been reinforced through

national policy as articulated by the “Five Year Forward View”.

Substantial progress has been made during 15/16 which we will build on and accelerate during

16/17, agreeing a three-year transition towards:

a) Jointly commissioned population level outcomes that span health and wellbeing;

b) Accountable care partnerships (ACPs) delivering co-produced models of care and managing

the clinical and financial risk for their registered populations;

During 16/17 early adopters will continue to:

a) Roll out, review and refine new models of care that reflect the WSIC vision of person-centred

care, supporting people to direct the care they need in their homes and local communities:

b) Embed new ways of working, culture and behaviours to underpin the system changes

required;

c) Develop joint governance across commissioners and providers

d) Embed co-production throughout ways of working;

e) Share learning and best practice across and beyond NWL.

To support transition during 16/17 commissioners will:

a) Engage formally with the development of ACP boards;

b) Work collaboratively with providers to set a clear roadmap for transition to 18/19;





c) Shape an approach to system assurance that ensures WSIC provides the best quality and

best value care for the population of NWL;

d) Adopt a ‘wrap around’ approach to the relevant contracts, enabling providers to jointly

reallocate existing workforce to the new models of care within an agreed funding envelope

e) Produce shadow population-level capitated budgets;

f) Introduce discrete elements of real risk share where appropriate to support transformation of

care delivery;

Mental Health Transformation: Improving mental and physical health through integrated

services. NWL is committed to collaborating with key partners to co-produce a mental health and

wellbeing strategy which will improve outcomes and value.

Across the system we have agreed to ensure that there is:

a) Support for people who have experienced mental health problems to live well in the

community;

b) Promotion of recovery, resilience and deliver excellent health and social care outcomes

including employment, housing and education;

c) Development of new high quality services in the community, focusing on community based

support rather than inpatient care so that people can stay closer to home;

d) Services that provide urgent help and care which are available 24 hours a day 7 days a week

for people who experience or are close to experiencing crisis.

As part of our commissioning intentions we would want providers to be proactively involved in

transformation work and in implementing the outputs of transformation work. Specifically in

2016/17 we want to focus on:

a) Implementation of new urgent care pathways and compliance with national target waiting

times;

b) Implementation of Future in Mind, the national strategy for children and young people to

respond to local needs;

c) Work with local specialist Mental Health and Learning Disabilities providers to implement

local pathways to enable people to be cared for within NWL;

d) Work collaboratively to implement the emerging outputs of the Like Minded strategy.

London Commissioning Arrangements

London CCGs have agreed to continue with the various Coordinating Commissioner arrangements

currently in place, for 2016/17 contracts. CCG commissioners will agree a Consortium Agreement,

which will set out governance arrangements, and the respective roles and responsibilities of the

Coordinating Commissioner and Associate CCGs for 2016/17.





Quality and Safety Standards

Quality, which encompasses patient safety, health outcomes and patient experience, and

Safeguarding will and must remain central to all aspects of the contract in the coming year. All

services commissioned by NWL CCGs must comply with the current legislation, multi-agency and

NHS assurance systems covering safeguarding children and adults. Core to contract monitoring,

will be to the requirement to ensure that providers, through a culture of learning, have robust and

aligned mechanisms to report, monitor and improve quality of services. This will be achieved by a

number of approaches including clinical visits and monthly Clinical Quality Group

meetings. Aligned to CQG reporting, the Quality schedule will ensure consistency across NWL

commissioned providers. We expect to see a strong focus from providers on Sepsis and

antimicrobial stewardship which we will be supporting providers to implement, the national rollout

of Friends and Family Test across all services and mortality (including specialty level mortality

rates), in conjunction with the TDA.

Providers will be required to comply with the current London multiagency policy and procedures to

safeguard adults from abuse and with the requirements of the Mental Capacity Act (including the

Deprivation of Liberty Safeguards). It is expected that Services be compliant with the Care Act

2014 following implementation in April 2015. They will also be required to implement the Prevent

agenda that requires all healthcare organisations to work in partnership to contribute to the

prevention of terrorism by safeguarding and protecting vulnerable individuals who may be at a

greater risk of radicalisation. We also expect to work closely with our providers to implement key

areas of strategic change and development as per Shaping a Healthy Future; Better Care Fund

and Five Year Forward View initiatives.

CQUIN

We expect to reflect both National and London guidance on CQUINs in our contract, utilising where

possible local flexibilities, as we have done in previous years, to secure a mutually acceptable but

challenging agreement around CQUIN that reflects National, London and local clinical

commissioning priorities and which supports achievement of our NWLCCG strategic objectives. In

reviewing CQUIN proposals we will need to jointly identify those CQUIN targets that should

appropriately move from being incentivised through CQUIN to core standards as part of the

2016/17 contract, as well as identify new priorities for CQUIN development for 2016/17.

Commissioners will be developing their proposed local CQUIN priorities and plans for discussion

with providers at an early stage of the contract negotiations and we welcome proposals from

providers which are aligned to achievement of our strategic objectives and CCG priorities as part of

this process.

Information Management and Technology

Our objectives include further develop its established Information Technology integration

programme as defined in its commissioning intentions in place since 2012/13 and delivered to date

via IT CQUINs to achieve one of three levels of systems development. The objective is to build on

existing programmes of work from previous years and incorporate technical delivery and clinical

utilisation within core contractual frameworks.





In line with the NW London Whole Systems Integrated Care programme and the establishment of

an integrated data warehouse to support the objectives of this programme the CCG will seek to

formalise the information flows from trusts to further this work and develop an operational solution

that will benefit patient care across organisational boundaries. This will be reliant on trusts

implementing systems and processes for populating the data warehouse at higher frequency rates

than at present and effectively utilising the outputs of this common solution. This will mean

extension of existing contractual information schedules and information delivery mechanisms.

To align trust individual development plans with regional (NW London wide) Information

Technology and Management programmes across all trusts and local authorities in order to deliver

the objectives of the National Information Board and London wide healthcare informatics

development programmes. This would first be the establishment of a combined digital roadmap

during the remainder of 2015/16.

From 2016/17 there will be on-going governance and strategic coordination framework and the

expectation that the trust will be a formal active stakeholder within that governance framework with

senior executive representation. This is in order to coordinate the development of the digital

maturity of Trusts within NW London through monitoring and implementation of national digital

maturity frameworks as issued by NHS England. This will include particular focus on applying the

maturity model such as that of the NHS e-referrals service to establish improved utilisation of

national strategic IT systems as well as local systems in line with the NW London Digital Roadmap

as developed during 2015/16.

Patient Transport Services (PTS)

In NWL a range of commissioning and funding arrangements including consistent Key

Performance Indicators for contract monitoring have been developed to address the key current

patient experience issues resulting in missed appointments, delayed discharge and an impact on

bed management in trusts. The following Commissioning Intentions are required for

implementation in contracts by April 2016:

a) Quarterly data submission and performance monitoring against PTS KPI’s

b) Implementation and monitoring of NWL wide PTS Quality Standards.

111

During 2016/17, NWL CCGs will continue the whole systems review of all services delivering

urgent and emergency care services being inclusive of NHS 111, GP OOHs, Urgent care centres,

mental health services, community services, secondary care, social services (where applicable)

and new models of care in federated networks for all patients registered with local GPs. Current

contracts for NHS 111 services are due to expire over the next year.

We aim to commission a safe, high quality integrated urgent care whole system which will align the

NHS 111 service to the other urgent care services.





The new service will support our vision to deliver care closer to home, provide for a single point of

access and monitor the availability and provision of services for the needs of our local patient. All

the parties involved in the delivery of the new system will ensure that they actively work with the

commissioner to:

a) Keep the Directory of Service fully up to date

b) Maximise the utilisation of the summary care record and locally determined electronic health

care record

c) Maximise the utilisation of MiDOS

d) Ensure full compliance of the national standards for the electronic transmission of information

and interoperability

e) Undertake participation in full clinical "end to end" patient journey experience reviews

f) Participate in patient experience feedback of the whole patient journey

g) Work with the commissioner to develop outcomes based measures regarding urgent care

centres changes occurring during 2016/17, we would particularly draw your attention to

potential contractual changes for UCCs in Hillingdon (due to expire 30/09/2016), Hounslow

(due to expire 31/01/2017) and Harrow (due to expire 31/03/2017) and Ealing UCC’s contract

is also due to expire in July 2016.

Cancer

The Five-year Cancer Commissioning Strategy for London was launched in February 2014. The

strategy was developed collaboratively by NHS England with significant input from cancer

clinicians, representatives from the Integrated Cancer Systems (London Cancer and London

Cancer Alliance) linking into the clinical pathway groups, CCG clinical commissioners as well as

commissioners from Public Health England and NHS England. These commissioning intentions will

support the delivery of cancer waiting times across London. They include the changes to services

required to meet the new NICE suspected cancer guideline (2015). This will enable GPs to have

direct access to a greater range of diagnostic tests to support them to identify which patients need

to be referred under the two week standard. Improvements to pathways are also included (e.g.

Straight to test in Lower GI) which will support sustainable achievement of the targets. All services

will also be commissioned against timed tumour level pathways

The approach taken for 2016/17 is to refine and build on last year’s commissioning intentions, with

a limited number of additional requirements. The commissioning intentions for 2016/17 are

outlined below, this is supported by a detailed document list of requirements.

Earlier detection of cancer

GP direct access to a wider range of diagnostics in line with NICE Suspected Cancer Guidelines:

Recognition and Referral (2015), including:

a) Chest x-ray (same day chest x-ray for high suspicion of cancer)

b) Non-obstetric ultrasound





c) Gastroscopy

d) MRI for specific patient cohort to improve early detection of brain cancer

e) CT scan of abdomen to improve early detection of pancreatic cancer

Additionally;

a) GP straight to test access to flexible sigmoidoscopy/colonoscopy via a diagnostic triage

service that will assign the most appropriate diagnostic test.

b) In order to promote the earlier diagnosis of ovarian cancer, services will be commissioned to

support US and CA125 concurrently

c) In order to support the reduction of the risk of delayed diagnosis, all commissioned services

will be required to formally report A&E, Urgent care centres and inpatient chest x-rays (CxR)

and implementation of National Patient Safety Alert 16/2007

d) JAG accreditation for endoscopy services and implementation of lower GI surveillance

guidelines

e) Endobronchical US (EBUS) services are commissioned to an agreed service specification

and tariff.

Reducing variation in secondary care

a) All services will participate in national cancer peer review or other assurance programme

defined by commissioners. All cancer MDT’s are quorate for 95% of meetings and individual

core members attend 66% of meetings (in order to support improved MDT decision making)

b) Lung cancer – including requirement to follow a best practice timed pathway, a thoracic

surgeon present at all MDTs, CT prior to first OPA, CT scan prior to bronchoscopy and

Clinical nurse specialist present at diagnosis

c) Breast cancer – including requirement to follow a best practice timed pathway, that an

individual surgeon has a caseload of 50 per annum, each service provides a one stop triple

assessment service, the service is delivered through the 23-hour stay model, that patients

have access to immediate reconstruction and that 70% of new patients are followed up

through a stratified pathway of supported self-management

d) Prostate cancer – including to follow a best practice timed pathway, requirement that an MRI

is performed pre-TRUS Bx for a given cohort, 40% of new patients are followed up through a

stratified pathway of supported self-management, use of multi parametric MRI (dependent on

outcome of current trial)

e) Colorectal cancer – including requirement that to follow a best practice timed pathway, all

surgeons are completing the required minimum numbers of 20 cases with curative intent per

annum, each MDT completes a minimum of 60 cases with curative intent per annum,

enhanced recovery programme embedded, all suitable patients to be offered laparoscopic

surgery and resection rates to match the England average and the age of referral for low risk,

but not no risk of cancer lowered to 45

f) Providers to agree and implement service consolidation plans





g) Services will be commissioned to provide pathways for the management of treatment related

fertility issues (NICE Guidance 2013)

h) Services will be commissioned for the management of those with a family history of

moderate risk breast cancer to a Pan London specification (NICE Guidance 2013)

i) Services for the provision of Metastatic spinal cord compression will be commissioned in line

with NICE QS56 (Feb 2014).

j) CNS and AHPs in cancer MDTs will attend advanced communications training and Level 2

psychological assessment skills training, and will have access to on-going psychological

support supervision.

k) Services required to follow NICE guidance on smoking cessation

Living with and beyond cancer - recovery package (NCSI)

a) All cancer services commissioned to deliver the recovery package (holistic needs

assessments and care plans, treatment summaries; health and well-being events) within a

specified time-frame

b) Services will have pathways in place to manage some of the consequences of anti-cancer

treatment specifically: the management of GI late effects, lymphedema, psychological and

physical sexual related problems. psychological support (reference CI 15) and managing

hormonal symptoms

It is the intention that the commissioning intentions were signed off by the Pan London Cancer

Commissioning Board on 29th September 2015.

Liaison Psychiatry Service

As you are aware from previous dialogue regarding Liaison Psychiatry Services, it is a continued

requirement for 2016/17 that the Liaison Psychiatry Service in mainstream acute ward settings (not

A&E) is fully funded through the PbR Tariff as part of a comprehensive in-patient Liaison

Psychiatry Service, to ensure the safety and appropriate referral of these patients to the relevant

service.

The provision of any additional physical care required due to a patient’s mental health is included

in the Admitted Patient Care PbR Tariff, although the treatment of their mental health condition is

not and the patients would need to be referred to a mental health provider in the normal way

through the Liaison Psychiatry Service. In addition, if an Acute Trust is caring for a patient with a

mental health comorbidity /complication (e.g. dementia) then whilst the Trust may sub-contract the

care from a specialist mental health provider the Trust will continue to be funded for this through

the complications /comorbidities tariff.





Medicines Management

As previously advised, NWL Trusts will be expected to be implementing the CCG proposal to

supply a prescription at all outpatient attendances requiring a new medicines or change in

medicine from April 2016. We hope to work collaboratively with you in order to implement a

solution which incentivises and unlocks savings and system benefits. For drugs excluded from

national tariff, NWL CCGs will only pay actual acquisition costs of drugs and will therefore require a

review of historic arrangements in place for sharing benefits, funding any on-cost and/or homecare

charges and charges made by some Trusts through SLAM for tariff medicines. These excluded

drugs are expected to be charged through SLAM with adherence to a minimum dataset that should

be agreed in line with that required by NHS England. NWL CCGs are looking to secure an

electronic information management system for drugs excluded from tariff and will require Trusts to

use this tool for funding requests in line with an agreed implementation plan.

Trusts should work with the commissioner when contracts are negotiated for the procurement or

supply of items such as continence or stoma devices, glucose monitoring devices or feeds which

may require on-going prescription in primary care.

a) The Hillingdon Hospital only: Charges for drugs excluded from tariff should be included as

baseline contract activity and provide report via SLAM for CCG validation.

b) West Middlesex University Hospital: Charges for drugs funded by NHS England should

be removed from CCG SLAM reporting

c) Chelsea and Westminster Hospital: Funding requests for initiation and continuation of

drugs excluded from tariff must be submitted to NWL CCGs as per the requirements of the

medicines schedule. The CCGs will no longer offer any leeway in 2016/17 for legacy

patients.

Information Provision

NWL CCGs continue to develop a strategy of standardised format for data submission by its

providers via the contract information schedules. This benefits both providers and commissioners

in terms of driving up data quality and enabling automation at both ends of the process leading to

efficiencies and better use of resources, greater intelligence, better commissioning decisions and

better outcomes for patients in North West London. Whilst progress has been made to achieve this

objective in 2015/16, there remains inconsistency in the format and timeliness of data submissions

across providers with both activity and performance areas. The movement to payment on SUS

data remains a key CCG commissioning intention in 2016/17, significant work has been

undertaken by providers and commissioners over the past 12 months to better understand the

SUS / SLAM variances in order to rectify them. It is now intended that agreement will be reached

for 2016/17 to move to payment based on SUS data from Month 1 and to work towards full

alignment of SUS and SLAM data.

The timelines for 2016/17 documentation will be confirmed shortly. The CCGs initially intend to

produce draft information schedules by the end of October to be agreed by Providers by the end of

the year. Providers will also be invited to a series of workshops in November 2015 to review the

proposed 2016/17 schedules and to clarify any points or issues.





Metrics

The NHS must demonstrate that it is making the most effective use it can of public money to

deliver quality healthcare. NWL CCG’s have traditionally used a number of high-level indicators of

efficiency that identify potential areas for improvement. Their purpose is to enable commissioners

and providers to identify variations in local and national performance areas where productivity or

efficiency might be improved in their organisation through benchmarking against peer

organisations. NWL CCG’s will look to ensure standardisation in the application of the metrics

across all providers and will work jointly with providers to create new metrics which will reflect the

changing strategic landscape of the local health economy.

Cross Border Arrangements

The Provider is reminded that NWL CCGs GP practice boundaries may extend beyond the Local

Authority boundaries, however, remain responsible for commissioning services to ensure the

healthcare needs of their registered populations are met irrespective of their place of residence.

Therefore, under the contractual arrangements for the provision of community healthcare services,

the NWL CCGs will expect the provider to provide care in accordance with ‘Who Pays’ guidance

and the terms outlined in the NHS Standard contract in relation to ensuring no treatment is refused

or delayed due to uncertainty or ambiguity relating to cross border concerns by any provider.

2016/17 Detailed Timetable

We will issue in due course a detailed timetable for 2016/17, which will build on both national and

London requirements and local requirements. The intention is to adhere to a consistent timetable

related to key milestones across London with the end objective of securing signed contracts by 31st

March 2016 at the latest, or earlier as may be required by national guidance.

Yours Sincerely

Clare Parker

Chief Officer

Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs

CC: Matthew Bazeley, Managing Director NHS Central London CCG, Coordinating Commissioner

Louise Proctor, Managing Director NHS West London CCG

Janet Cree, Managing Director NHS Hammersmith and Fulham CCG

Dr Ruth O’Hare, Chair NHS Central London CCG

Dr Fiona Butler, Chair NHS West London CCG

Dr Tim Spicer, Chair NHS Hammersmith and Fulham CCG

Andrew Burgess, Interim Director of Contracts, Performance and Procurement

Leroy Cordle Associate Director of Contracts, NHS Central London CCG





Table 1: Impact of Key services changes – CLCH Contract The following table summarises the changes that will apply to Central London Community Healthcare NHS Trust for the 2015/16 contract.

Service Area Contracting Intention Change Required Anticipated date

POD Impacted

Activity Impact

NHS Central London, West London and Hammersmith and Fulham CCGs

Wheel chairs: Assessment and prescribing service

Decommission from 30th June 2016

Termination– Wheelchair Assessment and prescribing

31st July 2016 N/A N/a

Children’s: Speech and language therapy (three boroughs)

Decommission from end of September 2016

Termination – Speech and Language Therapy Children

30th September

2016 N/A 64,706

Tissue Viability New service – Development of a single specification for CL, WL and H&F

Increased activity – Expansion of CL and WL Tissue Viability service based on new service specification

1st April 2016 N/A

NHS Central London CCG

Wound care Decommission £12.5K of wound care activity

Reduction of activity related to Complex wound care : demarcation and disaggregation of wound care based on clinical review of complex wound care service

31st March 2016 N/A N/A

Interpreting Decommissioning Termination – Interpreting and translation reprovision as new service model – QPP element

31st March 2016 All N/A

Phlebotomy Decommissioning

Termination of Phlebotomy 31st March 2016 All 14,347





Service Area Contracting Intention Change Required Anticipated date

POD Impacted

Activity Impact

NHS West London CCG

Community Nursing Following our co-design process, to decommission, refocus and recommission proportion of service into the Whole Systems model of care (or through development of a wrap-around concept)

District Nursing/Care Managers or wider community nursing services in part reallocated, to reflect and deliver the new WL Whole Systems model and contract,

From June 2016, and scale to be evaluated as Whole System pilot model evolves.

N/A TBC

Wound Care Decommission £12.5K of wound care activity

Reduction of activity related to Complex wound care : demarcation and disaggregation of wound care based on clinical review of complex wound care service

31st March 2016 N/A TBC

Interpreting Services Decommission Interpreting Services Termination of Interpreting and translations

31st March 2016 N/A TBC

St Charles UCC Contract ends 19th May 2016. Likely to be extended for a short

period while urgent care review is underway.

19th May 2916 N/A

NHS Hammersmith and Fulham CCG

Community Respiratory Decommissioning Termination of service 31st March 2016 OP First

and Follow-up

6,700

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