QUESTIONS & ANSWERS

Audiology Market Warming/Listening Event 12th January 2017

Questions from providers to commissioners

1 What are the complex audiology exclusions? These are the Department of Health national exclusions and will be published in full in the tender documents. 2. Is the £1M projected opportunity based on research and forecast activity? Yes, the CCG has reviewed historical patterns of delivery over three years; the CCG is in the process of overlaying the new model of care to assess the forecast accuracy of the revised pathway and ensure that the cost basis is reliable. 3. It is dangerous to base calculations for activity on hospital data as there may be quirks which scew the information. Historic activity will not match the new pathway. This is a valid observation acknowledged by NWS CCG. There are limitations to how a forecast mthodolgy may be applied when future care pathways will be different. Recognition will further be given to projected local demographic change and population growth. 4. What is the age range of patients to be included within the service? Aged 18 years and above. 5. Is there any mention of impacted wax removal or ear suction procedures in the tariffs? There are certain conditions that it is anticipated will be eliminated by the triage process that takes place prior to enacting a referral. NWS CCG is also exploring co-located services in order to enable treatments to be delivered concurrently preventing delay and failed appointments. 6. Action on Hearing Loss have supported providers through the delivery of a range of follow- up care options using volunteers. This can be provided across a number of locations or providers. The CCG welcomes providers proposing innovative service models to deliver more efficient, accessible and effective care proposals for the benefit of the patient and often, in turn, achieving better economic value. We would encourage providers to work with the voluntary sector and third sector. A provider enquired of Action on Hearing Loss as to whether or not providers were required to pay for this service arrangement The representative from Action on Hearing Loss advised that “yes” the arrangement was a paid for one. 7. Are you seeking a single provider or multiple providers? This will depend on how the procurement is let and the model of delivery proposed by the bidder. The CCG is keen to hear provider feedback about the options of letting a single contract across the entire CCG geography or separating the procurement into 3 x separate lots seeking a provider for each of the three localities within the region. 8. How will you address the matter of patient choice? We recognise that patient choice is a requirement. Potentially by going to the market in 3 Lots will secure more than one provider and offer greater patient choice. The need to ensure patient choice would prevent the CCG however, from commissioning Lots on the basis of a securing a named provider for all patients registered with practices in the locality they serve. Exclusivity of this nature could not be afforded. The CCG welcomes feedback about the scale and scope of the geographic service provision that the procurement should seek to secure. 9. Why are you not pursuing an AQP tender approach? NWS CCG has reviewed this option and listened to feedback from across the country. This has been varied, some commissioners report that the outcomes have been positive whilst others less so. Some report concern about the loss of control over the volumes of service provision that can occur. . 10 What you have said above sounds at odds with the Commissioning Framework. . Commissioners managing the first round of Audiology AQP contracts may have found variations in practice but the system now works very well. MONITOR reports the quality of services to be very good. This is a valid observation. The commissioner has every intention to ensure that services are delivered in line with the Commissioning Framework as can be evidenced through the service specification. The contract model has been considered in line with the performance and quality requirements, the commissioners resources and budget, alongside feedback and leanings.

In preparing this programme of work the commissioner undertook research by engaging with many commissioners who had already undertaken a procurement of this nature, , feedback and leanings were considered and incorporated in the proposals for discussion today...

NWS CCG notes these observations and this event was intended to generate feedback from providers. We intend to consider all feedback when finalising the route to market for this opportunity. It is vital to get your feedback which will influence our thinking.

We are keen to use the national commissioning model as we recognise it provides quality benefits and improvements. One of the considerations for seeking a single or lot level procurement is the ability to engage our providers in the emerging alliance construct and the strategic development of STP models and ways of working. 11 Regarding the STP model are you having conversations with other partners? . Yes, in all areas of our work we are in discussion with partners. 12 Can you realistically make changes to your tender as a consequence of our feedback within . eight days? Yes, this is our intention. Significant preparatory work has been undertaken to ensure we can adhere to our timelines. The programme team are used to working to compressed timelines and delivering at pace. 13 Do not be frightened at the prospect of managing numerous AQP contracts. There is a . willingness from those present to help you meet your budgets. Thank you. All feedback will be considered and inform our final decisions. 14 What are the plans concerning the legacy provider and patients currently in the system? . This is one of the most difficult aspects of the process. We are keen to know what has worked well for you previously. There are two aspects requiring careful consideration and finalisation - the clinical delivery and transition of incomplete cases and any waiting list; as well as the financial mechanism that will detail payments related to incomplete pathways delivered at entrance and exit. Stephen Hepworth, Acting Commercial Director, Ashford & St Peter’s NHS Foundation Trust confirmed that there was no waiting list held by the incumbent at this time.. 15 Please note that GPs do not support discharge at three years as this requires primary care . management and potential re-referral. Yes, that is understood. We held our Clinical Executive yesterday and this matter was raised. The model will be amended accordingly to reflect feedback. 16 If you pursue a sole provider model or Lot based contracts what is the likelihood of TUPE . transfer? The likelihood is high; again this information will be published with the tender information. 17 There are six or seven types of hearing aid used across the provider landscape . There may . be software issues for legacy patients possessing an aid that a new provider cannot support. Thank you for highlighting this, this will be addressed in the tender documentation.

Please submit any further questions or observations to Contract.Reporting @nwsurreyccg.nhs.uk