Contracts Transition Workshop Newbury and Leeds

CONTRACTS TRANSITION WORKSHOP – NEWBURY AND LEEDS QUESTIONS AND RESPONSES

Questions Response

For immunisation and ante- natal screening that is delivered in The latest guidance commissioning services is at hospital settings, is it the http://www.commissioningboard.nhs.uk/files/2012/07/fs-ccg-respon.pdf intention to transfer the commissioning and contractual responsibilities to CCGs?

Does the description of Sexual Assault Referral Centres that are being transferred to NHSCB include independent Sexual Violence Advisors?

Could you provide a definitive description of Public Health services associated with Service Users who are currently in prisons?

Could you definitively describe the content of HIV treatment and care that will be transferred to NHSCB eg Liverpool PCT has a community HIV Nurse – will this resource be funded from the NHSCB or the Local Authority?

Can you provide advice where all the elements of Mental Health will be transferred to under the new arrangements?

We understand that specialist inpatient services for Substance Misuse will be transferred to Public Health and hence the Local Authority – can you

Page 1 of 11 Questions Response confirm this?

Can you confirm where Dental Primary and Secondary services including maxillofacial services are to be transferred to?

Is there a definitive list of services that will be commissioned by the respective new commissioning bodies?

I would be most grateful The Board has confirmed the future commissioning if you could let me know arrangements in a fact sheet at (if this has now been decided/confirmed) as to http://www.commissioningboard.nhs.uk/files/2012/03/fact- the future commissioning enhanced-serv.pdf bodies of the ES’s. Where does the future In summary DESs transfer to the Board but the funding commissioning for LESs is being devolved to CCGs and Local responsibility for Authorities to support local investment decisions. Enhanced Services lie? PCTs will need to agree with CCGs which LES’s (excluding public health as described below) to extend to 2013/14 and CCGs will manage those on behalf of the Board but paid from CCGs own budgets.

Local authorities will be responsible for most health improvement services as described at: http://healthandcare.dh.gov.uk/public-health-system/ and will have similar discussions with PCTs around the transfer of public health LESs.

Sharing of contract The local authorities will become responsible for information with Local commissioning some services that are currently Authority colleagues in commissioned by PCTs. It would not be unreasonable for relation to Public Health them to be made aware of the contents of contracts transfer. Can we share relating to the PH services they will be taking over. details from Data capture tool given their “commercial in confidence” nature? Does an information sharing protocol need to be signed and does this provide us with any cover?

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Enhanced Services – The Board has confirmed the future commissioning PCTs are due to submit arrangements in a fact sheet at: the Collection of Analysis of PCT Revenue http://www.commissioningboard.nhs.uk/files/2012/03/fact- Resource Limit for New enhanced-serv.pdf Commissioning arrangements in July. In summary DESs transfer to the Board but the funding The guidance for the for LESs is being devolved to CCGs and Local collection states at 4.1.3 Authorities to support local investment decisions. (b) that LES’s that are non-public health will be PCTs will need to agree with CCGs which LES’s transferring to CCGs. Is (excluding public health as described below) to extend to this the final and 2013/14 and CCGs will manage those on behalf of the definitive position from Board but paid from CCGs own budgets. the DH and can we move forward on this basis? Local authorities will be responsible for most health improvement services as described at: http://healthandcare.dh.gov.uk/public-health-system/ and will have similar discussions with PCTs around the transfer of public health LESs.

The guidance in 4.1.3 (b) is specifically referring to the treatment of expenditure in relation to completing the template for the baseline expenditure exercise. This information will then be used to assist in the mapping of resources to the new commissioning architecture.

Which body will be The commissioning of PET CT services will fall under responsible for nationally specialised commissioning and therefore the NHSCB. procured PET CT schemes? Which body will be Almost all the ISTC contracts were passed to the relevant responsible for managing PCT to manage in 2007. These contracts will transfer to Phase 2 ISTC contracts? the NHSCB under the transfer schemes arrangements.

After y/e who pays The issue of legacy liabilities is being considered by the liabilities on contracts if Transition Executive Forum (TEF). The Operating accrued in PCT Framework for the NHS in England 2012/13 states that Accounts eg QoF? CCGs will not be responsible for resolving PCT legacy debt that arose prior to 2011/12.

How will we deal with The who pays guidance is in the process of being non-elective NCA work? updated to reflect the new system architecture and responsibilities. This is anticipated to be available from the Board in the autumn. Any revision to the management responsibility for NCA will be set out in the revised document.

Corporate PCT (non- The transfer schemes cover all PCT/SHA property, clinical) Contracts – will liabilities and staff. they be part of the

Page 3 of 11 Questions Response transfer orders?

Scenario The PCT is required to use the NHS Standard Contract - NHS body about for secondary and community services and the relevant to sign 3 year primary care contracts set out in regulation. contract for service that will Where the LA is a lead commissioner for a service and transfer to LA the PCT is an associate (under a Section 75 agreement) - LA wants NHS then the LA is free to use the contract of its choosing body to use its which may include the NHS standard contract or their contract format own contract. - NHS body want to use NHS standard contract Any advice?

Do we need contracts for All providers of NHS funded care should have a formal exception/ad hoc contract in place. It is contrary to advice for NHS patients individual patient to be placed with, or referred to providers where there are treatments undertaken no contracts in place. by private providers who There is guidance covering NCA activity based on patient do not hold NHS choice. standard contracts?

Will dispensing services Yes but the funding for services contracted as local quality schemes (DSQS) enhanced services is being devolved to CCGs. PCTs and be part of the NHSCB's CCGs will agree which LES should be extended into functions? 2013/14 and CCGs will manage these on behalf of the Board. Tacit knowledge tool: I The Tacit knowledge tool is an important document and am currently recording all is aimed at a supportive document to assist the new the contact commissioning organisations. There is no fixed advice names/details of primary what should be included. It is suggested that you care providers. For a big consider the type of information you would like to have if organisation such as you were the receiving organisation and then include that Boots (ophthalmic), we detail. might have one contract but many addresses. Are we supposed to list Boots Head Office (i.e. one address) or every site (multiple addresses)?

Where a Primary Care We are planning to set out guidance to assist with contract has been set up ‘splitting’ contracts. For the contracts transition it is as a ‘block’ payment suggested that you look at the proportion of activity that contract against a list of was envisaged to be part of that block contract. services how can/should the contract be split – PH/NHSCB?

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The OOH primary care contracts took 6% of the CCGs will be responsible for all OOH provision except respective GMS contract where retained as part of the core GP contracts as funding when GPs commissioned by the Board. The funding for this – the opted out of OOH current value of all separate contracts for OOHs in CCGs services and the contract area will form part of their commissioning budget. terms were taken out of the GPs contracts. How The funds for primary medical services commissioned by will this be accounted for the Board will continue to include the notional 6% for in terms of OOH contract OOH service retained by GP practices as part of their funds for CCGs versus core GP contract. Only when they opt out will the funding the opted out GP pass to CCGs (matching the transfer of commissioning contracts with the responsibility). Board?

Will QoF funds be split QOF funds will not be split at a contract level as it up to go with PH contract continues to be a primary medical services payment element? incentive scheme to be managed by the NHS CB. Nationally 15% of the current value of QOF will be recognised as the responsibility of public health england reflecting the current indicators supporting public health areas.

Payments for doctors Custody suite health care is an NHSCB function. attending custody suites Adoption and fostering reports will fall within (CCG/LA) to section patients and remit. for adoption/fostering reports who is responsible for these post 1 Apr 13?

New NHS Standard Work has already started on this, publication of the Contract Documentation Mandate is expected in October 2012 and NHS ’NHS for 13/14: When will this operational or business assumption plans’ at the end of be available- will there Nov 2012. The contract will reflect the requirements and be a fixed duration of 3 it is anticipated that the contract will be published during years or 1 year? Jan 2013 with contract variations to follow. The duration of the contract has yet to be agreed.

Is the standard NHS The NHS Standard contract may be used by Local contract mandated for Authorities but it is not mandated. Local Authorities from Where the LA is a party to the commissioner contract, 2013/2014? the consortium agreement entered into will be legally binding.

Does the transfer Yes. The scope of the transfer schemes is set out in the scheme cover all Health and Social Care Act 2012 at section 300. contracts?

What about section 75? CCGs will be able to enter into partnerships agreements with local authorities.

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Where a S75 does not terminate on 31 March 2013 this will be transferred to the appropriate CCG(s) under the Transfer Scheme arrangements.

Can we terminate those Any contract can be terminated but in doing so the contracts where we have commissioner may incur termination costs, where set out no documentation? in the contract, or if there is no contract, by the court.

Advice should be sought where PCTs are planning to terminate any contract.

Continuity: What The service under the existing contracts will transfer. LA's happens where Local take on the responsibility for managing the contracts Authorities have plans to services and may use the terms of the contract to change change services that are or amend the services as set out in the agreement. not compatible with current contract?

How should you There are a number of options that PCTs may wish to approach a unwritten/lost consider contract?  Ask provider if they have a copy.  Where no signed contract exists, consider setting out and agreeing with the provider the scope of the current arrangement, the services and the amount paid.  There is an issue as to how long the letter says the agreement is for, suggestion to say will run for 12 months then will be reviewed.  There is a risk of a procurement challenge as the PCT is effectively offering a new contract.

What happens if contract It is anticipated that there will be a requirement that all not signed by 1st April contracts for 2013/14 should be signed prior to 1 April 2013? 2013 to allow the Transfer Scheme to be put in place.

Negotiations with providers will be led by CCGs supported by PCTs and these negotiations and discussions can commence well before the standard contract is published.

If the PCT signs the It will not be necessary for a CCG to sign alongside the contract on 31 March PCT as the PCT remains the legal entity up to the 2013 will the CCG Leads 31March 2013. need to countersign or However, CCG's must lead all contract negotiations. The would a contract contract will transfer to the CCG on 1st April 2013 under variation be needed on the Transfer Scheme. 1st April?

Where there is no signed It is suggested that the PCT might wish to write to the contract but both parties provider on the basis of the assumed start date for the

Page 6 of 11 Questions Response have schedules which contract with the provider responding only if there is include a disagreement on the commencement date. commencement date can this be taken as the service commencement date?

Who decides who the In the first instance, the PCTs will decide. However it is future commissioner recommended that any decisions should involve the should be for each relevant future commissioners. contract/element of the contract?

5 year community Derogation is required on all procurements beyond 31 contracts - What if CCG March 2013 to ensure CCG buy in. wishes to terminate? Variations to contract terms once the contact has been signed, will require the agreement of both parties.

Both before and after contract transfer the parties should follow the processes set out in the contract.

In the NHS Standard Contract there are provisions that allow either party to terminate the agreement on giving 12 months’ notice.

Will there be any DH There is no central budget for any legal costs the PCTs funding for potential legal may incur. costs?

Co-ordination and Further guidance will be published on the shift phase of splitting of contract the contract transition in the autumn. values/£ - Plan - Actual + Relationship to allocations?

Does Finance 'number' At this stage, it is not thought necessary for the Transfer need to be on transfer Scheme information to include any financial detail. order? The resource allocation process is running in parallel to the contracts transition processes.

Further advice on transfer orders will be circulated.

How does the current This baseline expenditure exercise is independent of the baseline setting exercise Clinical Service Contract Transition work, which is being link with the financial performed primarily to ensure the safe and effective element in the data transfer of clinical service contracts to new contracting capture tool? Risk of authorities by April 2013. Where the information and having 2 different intelligence produced from the Clinical Service Contract sources of financial Transition exercise can be used to enhance the baseline

Page 7 of 11 Questions Response information. expenditure exercise this will be considered by the Programme Board 5-10% of detail that can't Block payment contract arrangements may present a be reconciled in block challenge. Where there is a lack of clarity, block contracts contract - What do we will need to be disaggregated to ensure there is sufficient do? clarity on which services are transferring to each commissioner from April 2013. Financial Reconciliation The financial reconciliation template was a tool intended at end of June and to support PCTs and SHAs in gaining assurance of the September, what % financial values attributed to clinical contracts. There is correct is expected? not a correct or expected reconciliation percentage. The level of financial reconciliation needed to provide assurance is for local determination What happens to Allocation of PFI cost? This will be clarified in due course

Can you provide The risk belongs to the PCT and they need to review this guidance on assessing for themselves. Consistency across the PCT is not financial risk - required. consistency of approach across PCTS?

What are we reconciling PCTs need to provide assurance that the clinical service to? contracts included in the contract transition exercise represent the value of clinical service contract expenditure for their organisation. The choice of accounting period for reconciliation should not dilute the level of assurance provided. i.e. if there is a material change in expenditure between 2011/12 and 2012/13 it would be prudent to use the most recent financial information. Will there be some Further advice sought. wording/letter from DH to LA's clarifying the details regarding the ring fencing of PH funds?

How does Finance The issue of legacy liabilities is being considered by the reconciliation work at the Transition Executive Forum (TEF). The Operating end of contract (March Framework for the NHS in England 2012/13 states that 2013)? CCGs will not be responsible for resolving PCT legacy debt that arose prior to 2011/12. How do we notify the DH Guidance on the Transfer Scheme arrangements will of contracts let between take this into account. 1 Oct 12 and 31 March 13 so that they can be included in the transfer order?

How are CCGs CCGs should have worked out their commissioning preparing? intentions from June 2012. The DH team regularly reminds CCGs of the need to prepare. CCGs should be

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sitting alongside commissioners now.

Where DES'S have been All Enhanced Services need to be listed in the data turned into LES's capture tool and transfers need to be reconciled with the because they have been new commissioning arrangements confirmed by the added to or otherwise Board. See: amended e.g. minor surgery with additional http://www.commissioningboard.nhs.uk/files/2012/03/fact- procedures; flu with enhanced-serv.pdf pregnant woman. How should these be In summary DESs transfer to the Board but the funding handled? for LESs is being devolved to CCGs and Local Authorities to support local investment decisions.

PCTs will need to agree with CCGs which LES’s (excluding public health as described below) to extend to 2013/14 and CCGs will manage these on behalf of the Board but paid from CCGs own budgets.

Services that are shown Services included in baseline funding of PMS contracts on the finance schedule will be the responsibility of and managed by the NHS of PMS contracts as commissioning board. Therefore it does not matter that enhanced services but there is no end date. are funded through PMS development funds in pilot contract and the Lockhart's contract obliges their continuation- there is no end date?

Learning Disability Advice being sought assets paid for by the NHS but owned by the LA but which must be used for health funded patients. How should these be accounted for? Will there be a 'tool' or No there will not be a tool. Output of stabilisation will be process to complete for what is required to support the Transfer Schemes. stabilisation similar to the DCT for the stocktake? What does a good A good contract has a clear service description/service contract look like? specification, there are appropriate quality and information requirements, the financial envelope adds up, there is an accurate record of service changes and

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challenges and it is signed by both parties.

CCGs - Will there be a CCGs are considering their approach to commissioning lead CCG and and contracting. Whilst it is not mandated many CCGs associates? are looking at a coordinated commissioning and contracting model.

If CCGs were to work Not necessarily. It would be up to the CCGs to decide. together, would the co- ordinating CCG be the largest commissioner of that provider?

What happens to This will be confirmed. CQUINS next year 2013? Please could there be The necessary provisions to amend the previous further clarity around the legislation to reflect the new system requirements have process of transition for been made. From April 2013 local authorities will those services that are responsible for commissioning public health services expected to fall within the from a range of providers. commissioning responsibility of Local Authorities – mainly public health and sexual health services. Our understanding is that Local Authorities are currently unable to hold contracts for health services so it would be helpful to know if this has changed through the NHS Act.

I assume that the The Transfer Schemes process is set out in the Health workshop will address and Social Care Act 2012 at section 300. This statutory what needs to be done to transfer arrangement sets aside the need to have assign contracts that do ‘assignment or novation clauses’ in existing contracts. not include clauses that allow the contract to be assigned – mainly primary care contracts. It would be helpful if there could be a clear understanding of what we need to do to ‘shift’ these contracts; what we should be doing now; timescales; and what we do if a contractor starts being awkward?

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Provider Engagement Have requested advice. Letters to all Primary care providers – is there a national approach, standard letter/ terms or is it for local PCT/cluster to address?

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