NHS Purchasing and Supply Agency Procurement Guide - APMS

Procurement guide Alternative Provider Medical Services (APMS)

August 2005

Important: this guide is specific to APMS other generic information for PCTs on the procurement process is available in the TOPPM – including NHS-SID for pre- qualification and procurement support nww.pasa.nhs.uk/toppm

Feedback

The NHS Purchasing and Supply Agency welcomes feedback on their procurement guides. By receiving suggestions for improvement, comments on ease of use of the guides and any general comments, PASA are able to continually assess the content and format of the guides for any improvements. Please forward any comments that you may have to the contact detailed in this guide on page 6. This guide may be subject to updates following Wave 1 IPCCP

 Crown copyright, NHS Purchasing and Supply Agency NHS Purchasing and Supply Agency procurement guide - APMS

Contents

Section Heading Page 1.0 Introduction 4 1.1 Abbreviations 1.2 Other tools 1.3 Contact details 2.0 Background – policy context 7 3.0 The procurement process flowchart 8 3.1 Establishing the project team 3.2 Project plan, initial team meeting, TUPE 3.3 Project timetable 3.4 Implementation plan and key milestones 3.5 Compliance with standing financial orders and instructions 3.6 Contract management overview 4.0 Service requirements 17 5.0 Risk overview 18 5.1 Developing a risk register 5.2 Development of a risk matrix 5.3 Risk mitigation 5.4 Types of risks 6.0 EU issues 21 6.1 Compliance and tender process 6.2 EU requirements – sourcing suppliers 7.0 Evaluation criteria overview 24 8.0 Sourcing potential service providers 24 9.0 Invitation to submit a preliminary offer (ISPO) 26

10.0 Offer evaluations 34 10.1 Introduction 10.2 Evaluation criteria 10.3 Elements required by conditions of offer 10.4 Other elements required by draft contract 10.5 Elements with a direct bearing on offered contract price 10.6 Elements with an indirect bearing on the offered contract price 10.7 Abnormally low offers 10.8 Visits to service provider sites and presentations 10.9 Summary

11.0 Evaluation of preliminary offers 37 11.1 Project team pre-adjudication meeting 11.2 Preparation of the invitation to submit final offer documentation (ISFO) 11.3 Signing off draft ISFO 11.4 Issuing draft ISFO to preferred service provider 11.5 Tenderer to prepare and submit final offer

 Crown copyright, NHS Purchasing and Supply Agency – August 2005 2 NHS Purchasing and Supply Agency procurement guide - APMS

11.6 PCT evaluation 11.7 Final offer adjudication meeting 11.8 Concluding contracts with preferred offeror

12.0 Award of contract 40 12.1 Introduction 12.2 Ratification report 12.3 Notifying the successful service provider 13.0 Post award notification 41 13.1 Notifying unsuccessful offerors 13.2 Debriefing unsuccessful offerors 13.3 Contract documentation for unsuccessful offerors 13.4 OJEC award notification 13.5 Contract mobilisation and implementation 13.6 Statistical reports 14.0 Monitoring performance 44 15.0 Other resources 46 Appendices A Sample advertisement 48 B Sample pre qualification questionnaire 51 C Sample abbreviated output based specification 66 D Other Documents to be issued at ISPO & ISFO stages Document 1– covering letter 102 Document 2 – terms of Offer 104 Document 7 – form of Offer 108 E Contract acceptance letter 109 Contract rejection letter 110 F Outline model contract documents 111

1. Introduction

This procurement guide offers advice to Primary Care Trusts (PCTs) on the procurement of Alternative Provider Medical Services (APMS). Strategic Health Authorities (SHAs) and potential APMS providers will also find the document helpful.

This guide is applicable to single PCTs or consortia arrangements.1 It gives guidance on the procurement process, accessing potential providers, project managing procurement and post-procurement activities.

PCTs may also wish to take other procurement advice in relation to specific contracts, and should take their own legal advice.

Procurement is the process through which intending purchasers source supply from suitable providers, make a selection on the preferred provider and then formally enter into a contracting arrangement for the provision of services. Procurement is also the process whereby “open competition” is guaranteed and, where appropriate, the formal process of advertising invitations to bid is applied. There are specific rules around advertising that need to comply with the EU Directive 930/520/EEC.

The aim of any NHS procurement should be to secure desired service outputs and outcomes and good Value for Money (VfM). In planning for and entering into APMS contracts, PCTs should seek to balance flexibility with VfM.

APMS is a relatively new contracting route for PCTs. Although services may be provided by non-NHS providers, NHS patients treated under APMS arrangements will remain NHS patients. In procuring for services, PCTs will wish to ensure that a range of prospective providers can apply. A competitive tendering exercise does not require PCTs to contract with a provider using the APMS route. However, the PCT must ensure that all prospective providers are treated equally, and in accordance with EU rules.

1.1 Abbreviations used in this guide

Throughout this generic procurement guide, a number of names/documents are referred to in an abbreviated form. Below is a listing of these names/documents and the abbreviations used. Also included, where appropriate, is a link to the document by the way of a web link.

Alternative Provider Medical Services APMS The NHS Purchasing and Supply Agency also see NHSPASA http://www.pasa.nhs.uk/ The NHS Purchasing and Supply Agency PCT Operational Purchasing TOPPM Procedures Manual for use by NHS PCT staff. Any references in this document to the TOPPM also includes the OPPM, which is the NHS PASA version of the TOPPM for use by NHS PASA staff. (http://nww.pasa.nhs.uk/toppm ) Central Product Classification (Contracts classification system used in EU CPC

1 See the NHS Contractors’ Companion www.dh.gov.uk,and The Commissioning Friend www.pccacontracting.nhs.uk for more on consortia arrangements  Crown copyright, NHS Purchasing and Supply Agency – August 2005 4 NHS Purchasing and Supply Agency procurement guide - APMS

Services Directive 92/50/EEC to identify Priority and Residual Services) Common Procurement Vocabulary (More complex than the CPC, the CPV CPV is an EU contracts classification system, which the EC Commission has recommended contracting authorities should use when advertising contracts in OJEC). The purpose of using CPV codes in an OJEC advert is to assist potential tenderers searching through advertisements find the contracts appropriate to their business. Official Journal of the European Communities OJEC European Union EU The Transfer of Undertakings (Protection of Employment) Regulation 1981 TUPE Invitation to offer ITO Invitation to submit preliminary offer ISPO Invitation to submit final offer ISFO Pre-qualification questionnaire PQQ NHS PASA Supplier Information Database NHS-sid Freedom of Information Act 2000 FOIA Environmental Information Regulations EIR

1.2 Other Tools

To help PCTs in the procurement process, this guide also includes:-

 A flow chart of the necessary procurement steps (page 8)

 A suggested project timetable (page 13)

 A sample advertisement: Appendix A,

 A sample Pre-Qualification Questionnaire: Appendix B

 An abbreviated sample Output Based Specification (OBS): Appendix C This gives examples of requirements, which a PCT can build on to accommodate their particular need. Careful consideration should be given to the extent of the service that is specified.

 A sample Form of Offer: Appendix D

Further APMS guidance and a “model” APMS contract are available on www.nhsconfed.org. See also Appendix F APMS Directions and Department of Health guidance are on www.dh.gov.uk.

This website also contains general guidance on commissioning and contracting.

Both this guide and the offer document are periodically updated to reflect changing legislation, market trends etc. If you are working from a hard copy please ensure you have the latest version. Please see nww.pasa.doh.gov.uk/nhsforum/shared/pct/

Documents will also be amended to reflect feedback from stakeholders where the guide and offer document have been utilised.

If you wish to discuss any aspect of the documentation or any other issue relating to your procurement please contact the person named below. NHS PASA is not responsible for policy development for primary medical care - which is a Department of Health responsibility.

1.3 Contact details

Purchasing Faye Robinson, Category Manager, NHS Purchasing & Supply Agency Tel 01626 864698 Mobile 07710 645421 e-mail [email protected]

Policy development issues Donna Sidonio, Deputy Head of Services, Department of Health Tel 0113 25 45246 e-mail [email protected]

2 Background: Policy Context

APMS is a contracting route introduced in April 2004 alongside other primary medical care contracting routes - General Medical Services (GMS), Personal Medical Services (PMS) and Primary Care PCT Led Medical Services (PCTMS). Collectively, the four routes provide a strategic framework to enable PCTs to plan, commission and develop high quality primary medical services. Through these routes, PCTs have considerable flexibility to develop services which offer greater patient choice, improved capacity and access, provide services for a specific population, and develop innovative approaches to service delivery

APMS is a flexible contracting tool, which gives PCTs powers to contract for services from a range of providers and for a range of primary medical services. APMS cannot be used to contract for primary care pharmacy, dentistry or optometry services, which generally have to be commissioned by the PCT under the separate arrangements set out in the National Health Service Act 1977 (although, in some cases – e.g. dispensing - these services can be included in GMS/PMS/PCTMS and APMS contracts).

Under APMS, PCTs have powers to contract with:-

 Commercial providers  Voluntary sector providers  Mutual sector providers  Public service bodies  GMS/PMS practices, through a separate APMS contract.  NHS PCTs and NHS Foundation Trusts

APMS can be used to provide:-

 Essential services  Additional services where GMS/PMS practices opt-out  Enhanced services  Out of Hours services  A combination of any of the above

It is for the PCT to decide which contracting route – nGMS, PMS, APMS or PMS - is most appropriate for the services in question.

3 The procurement process - flowchart

Output Based Specification Appendix C & section 9.1 Outline business case (OBC)

Project team to establish project plan and agree sections 3.1 – 3.3 Project initiation timetable sections 3.1 – 3.3 document (PID)

Source service providers section 6.2 & 8

Draft ‘Invitation to Submit sections 9 Preliminary Offer’ (ISPO) Receive expressions section 8 of interest

Produce shortlist of potential service providers using sections 8 selection criteria. Notify unsuccessful companies.

Trust sign off ISPO and potential service provider list section 9.3

Trust Issue ISPO to potential service providers section 9.4

Tenderers prepare and section 9.5 submit ‘preliminary offers’

Trust evaluates and sections 11 Prepare ‘Invitation to scores preliminary offers sections 9 Submit Final Offer’ (ISFO) Trust shortlists preferred service provider and notifies section 11.1 unsuccessful companies

Trust sign off and issue ISFO to preferred service section 11.2-4 provider Full Business Case (FBC) Tenderer prepare and submit ‘final offer‘ section 115

Trust evaluate ‘final offer’ section 11.6

‘Final offer’ section 11.7 adjudication meeting

To include initial Trust conducts and section 11.8 negotiations, concludes contract with presentations and site preferred offeror visits with potential service providers Award of contract section 12 To include further negotiation and presentations Post award activity section 13

Contract starts –monitoring performance section 14

3.1 Establishing the project team

The following advice is given based on the assumption that a decision to engage in a competitive tender exercise has already been taken and that local stakeholders have been involved – eg Local Representative Committees, Patient and Public Involvement Forums, Local Authority Overview and Scrutiny Committee. PCTs are reminded of their legal duty to involve and consult the public when they are considering proposals for the way services are provided (section 11 Health and Social Care Act 2001).

The first stage is to establish/reconvene a committed project team that will carry through the exercise to a successful conclusion. This will involve significant time and commitment for some project team members and it is important that all the individuals concerned understand this requirement. There is benefit in the key members of the project team having knowledge of project management methodologies and roles to assist the process. The unavailability of one key team member can affect the progress of the project. Consideration should be given to the composition of the team to ensure that no conflicts of interest arise, particularly where an in-house PCTMS offer is also to be submitted.

Throughout the Offer process there is a necessity to conduct a variety of formal meetings. These will take the form of both internal and external meetings the latter involving contact with potential service providers. It can not be emphasised too strongly the importance of ensuring that all project team members attend these meetings in order to maintain joint ownership of the decisions taken and that appropriate records and minutes are made of any such meetings.

The composition of the team will vary in detail from project to project depending on the nature of the work to be carried out and type of service involved but it is possible to consider the generic constituents as follows:

The Project Sponsor This will normally be a representative of the relevant department commissioning the work and will, in all likelihood, be the budget holder. This is a crucial role as this is where the view on the relative operational competence of the Potential Service Providers is likely to come from which is clearly a principal factor in the award decision.

The Purchasing and Supplies Manager It is strongly recommended that a professional purchasing manager be included in the team to monitor the overall progress of the project as well as ensuring procedural and legal compliance.

The Finance Manager The project may be sponsored by the finance function and as such this discipline will be already represented but where this is not the case it is essential that a finance officer is included in the team to analyse the overall costs of the offers received. A whole life cost analysis is essential, not just a first year price comparison, and discounted cash flow techniques should also be used.

PCT Officers PCT officers who are responsible for writing the service specification should be represented on the team (but not if they were involved in supporting any in-house offer), plus associated staff groups and/or their representatives.  Crown copyright, NHS Purchasing and Supply Agency – August 2005 9 NHS Purchasing and Supply Agency procurement guide - APMS

Experts Where in-house expertise exists, professional, technical and clinical experts, as appropriate to the service being tendered, should be included e.g. financial, general management and personnel expertise and nominated stakeholders.

PCT Board Member The PCT should also consider the inclusion of an Executive PCT Board Member responsible for the services and/or a Non Executive Board Member who the PCT may wish to include for overall commercial/business advice. This may also prove useful in securing PCT board ratification on any subsequent award recommendation. This will be a local consideration for the PCT concerned.

Internal Auditors It would be helpful for the PCT's internal auditors to be involved in the offer process, as ultimately they will be responsible for confirming that the service meets its targets at the end of each year.

Outside Parties In certain circumstances where the project may have implications for a wider audience, consideration should be given to offer a place on the project team to representatives from other interested parties.

Project Manager It is vital that someone assumes the role of the project manager to lead and co-ordinate the project. This is often a role undertaken by the Project Sponsor or Board Member. The role is relinquished when the contract is signed and is assumed by the contracts manager.

Communications Lead It may be desirable to appoint someone with responsibility for communicating developments as appropriate – eg press releases, dealing with media enquiries.

If the PCT also intends to develop a PCTMS offer, at the same time that the project management team is being established there will be the need to establish a broadly similar team to support the PCTMS submission. The manager leading this submission will need input from other management functions to support various aspects of the offer's construction e.g. finance, human resources, users etc.

There needs to be a clear segregation between the project management team members involved with producing the service specification and managing the procurement process, and any individuals involved with producing and submitting any in-house offer.

If all the in-house expertise has been allocated to either the project team or in-house team, any skills deficit should be filled through the commissioning of external experts. Where no internal expertise exists at all, then as with the project team, external experts should be made available to support the in-house team. If this expertise is not available in-house, the PCT will need to consider contracting for these services. Information on how to carry out this process can be found in the service specific procurement guide ‘Use of External Consultants’. Consideration may need to be given in relation to value for money in the cost of employing external expertise against the value of the contract. In doing this a risk assessment will need to be made on the impact of not having this expertise available within the contracting process.

Legal advice The work undertaken in producing this guide and the associated Model Contract are designed to minimize the amount of legal advice required. That said, however, a PCT should seek legal advice where there is any uncertainty or unexpected risk that may transfer or reside with the PCT or where there are additional or enhanced services that may require the drafting of supplementary Terms & Conditions of Contract. See also the APMS “model” contract at Appendix F and www.nhsconfed.org

The Terms and Conditions of Contract will be the bedrock of the arrangement between the PCT and provider. It is not uncommon for providers to table their own set of Terms & conditions or table deletions or amended clauses when responding to an invitation to Offer (tender), it is important that legal advice is sought so that the possible transfer of risk to the PCT brought about these introductions, deletions and amendments are fully understood and evaluated.

The PCT will have appointed legal advisors but specialist legal help may be considered more appropriate. In the first instance the advice of the PCT Purchasing and Supplies Manager should be sought.

Contract Manager If during the later stages of the process it appears likely that a contract will be awarded then a Contract Manager will need to be recruited and in post at the time of contract award.

The role of the Contract Manager is to actively manage the contract that has been agreed to ensure compliance of the Provider with the agreed terms and address performance shortfalls that may arise. Key responsibilities of the contract manager could be the following:

 Staffing Is the PCT getting the full complement as tendered and is the skill mix as stated. What absences, if any, has the Service Provider been unable to cover.  Quality measures. These should be outcome based if at all possible, and ideally allow comparisons with other providers. There should be clear penalties for missing targets and clear remedial actions. This is something the Healthcare Commission will wish to see as part of the PCT’s commissioning strategy.  Aims of the Local Development Plan Are these being met.  Billing. Is the PCT being billed the correct amount, discrepancies etc

Depending on the size of contract this role could be added to an existing managers remit or the appointed project manager could continue to manage the contract.

The position commences when the contract is awarded.

3.2 Project plan

Once the project team and in-house team, where appropriate, have been assembled the project planning process can begin. The project plan will detail the procurement methodology and path necessary to market test the service.

3.2.1 Initial Project team meeting The main agenda item for the first meeting of the project team is to establish the terms of reference within which the project team will operate whilst managing the process. The terms of reference may include, but not necessarily limited to, the following:

 Appointment of Chair Person  Establish reporting procedures  Individual Project team members' role  Establish the legislation, guidelines and PCT policies and procedures within which the process is bound.  Determine procurement tender route and strategy to be established.  The desired outcome(s) of the process: this needs to include quality (ideally outcome) measures and ways to enforce them. The Healthcare Commission will inspect PCTs on the basis of commissioning processes  Establish procurement timetable.  Whether ‘Experts’ are required.  Expected cost of procurement process

In determining the Project plan a number of points need to be considered by the Project Team. These include;-

 What service or services are to be procured?  What are the desired outputs?  What are the cost parameters? (eg Estimate of the current cost of the service or similar service).  Likely contract period.  Current/ future market trends  Level of expert support available and/or required.  Future plans that may impact on the service requirement (i.e. PCT mergers, new buildings, PCT strategy for similar services, whether any additional services may subsequently be needed but are not required now and ensuring the bidder is aware of this)  VfM considerations  Overall cost envelope for the planned service.

In addition to meeting statutory requirements, the Offer process must be sufficiently robust and auditable to meet the PCTs own Standing Financial Instructions and Standing Orders. As part of the administrative process, notes or minutes of all meetings must be produced and retained on file in order to demonstrate an appropriate audit trail. In addition this process must be able to

meet the mandatory disclosure requirements of the Freedom of Information Act (FOIA) and the Environmental Information Regulations (EIR)

3.2.2 TUPE

In determining the extent and effect of the Transfer of Undertakings (Protection of Employment) Regulation 1981 (T.U.P.E.) the PCT will need the advice of their own legal advisors and human resource specialists.

Where it is decided that TUPE is likely to apply, the project plan will have to reflect the need to acquire existing staff profiles either from their own database or their existing service providers, where the service has been previously outsourced.

It should be noted that the compilation of this information could be both difficult and time consuming especially where third parties are involved. The PCT needs to allow sufficient time to ensure this data can be included in the Invitation to Offer.

Failure to provide this staffing information in a timely and accurate format will have implications as to the accuracy/reliability of any TUPE costs calculated by Potential Service Providers.

Further TUPE guidance is also contained in the “model” APMS contract please see Appendix F and also www.nhsconfed.org

3.3 Project timetable

The Project Timetable will reflect the activities resulting from the determination of the Project Plan. It is invariably the main driver within the offer process and as such should be realistically set from the outset in order to ensure that it is not subjected to continual change.

The project timetable underpins the project plan giving priority and cohesion to all elements of the process. The timetable additionally sets milestones to which all members of the team must work to ensure a successful and co-ordinated conclusion.

When the timetable is first being discussed it is important to remember that the timescales must reflect the chosen procurement path and be realistically achievable. Factors will include:-

 the scale of the project  whether the eventual provider is already established in the locality (eg as an entrepreneurial GMS/PMS practice), or will be relocating into the area (and possibly recruiting qualified staff, including from overseas)  Project Team member commitments, annual leave, bank holidays etc  Consultation/discussion with stakeholders  PCT and provider approval cycles

Not allowing sufficient time to carry out the procurement process may lead to not achieving the best results and benefits. It should be remembered that time scales can slip and the associated procurement process unfairly criticized.

The flowchart at the beginning of each of the procurement route outlines the various stages required for each of the tender route options to carry out the procurement.

Where the procurement process is governed by EU procurement rules, various stages within the procurement process have mandatory time periods that must be followed.

Details of time periods for this stage are included within the flowchart. Where the time period is not mandatory for a stage, a recommended time or estimated allowance has been included to assist the project team in calculating the total time required for completing the procurement process.

 Crown copyright, NHS Purchasing and Supply Agency – August 2005 14 NHS Purchasing and Supply Agency procurement guide – APMS

To be read in conjunction with Route 2 (Flowchart C)

Days required for each stage of the procurement process

Timescale Week 1 2 3 4 5 6 7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 Action 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 Project Team to establish project plan and agree timetable

Draft ‘OBS and other Invitation to Submit Preliminary Offer documentation (ISPO) Draft PQQ Draft Advert Source Service Providers

Receive expressions of interest

Shortlist of potential service providers

PCT sign off IPSO and potential service provider list

PCT issue IPSO to potential service providers

Tenderers prepare and submit preliminary offers

PCT evaluates and scores preliminary offers including presentations & site visits PCT shortlists preferred service provider

Negotiate & agree draft contract with preferred service provider ad prepare other ‘Invitation to submit final offer’ ISFO documents PCT sign off and issue ISFO to preferred service provider

Tenderer submits ‘final offer’

PCT evaluates ‘final offer’

Final offer adjudication meeting

PCT conducts and concludes contract with preferred offeror Award of contract

Post award activity

Contract starts

 Crown copyright, NHS Purchasing and Supply Agency July 2005 15 NHS Purchasing and Supply Agency procurement guide – APMS

3.4 Implementation plan and key milestones

The implementation plan and associated key milestones should be a separate document as this should be agreed and accepted by the supplier of the services. This document should also form part of the contract as supplier failure to meet any Key milestone may invoke contractual remedies

3.5 Compliance with PCT Standing Financial Orders (SFOs) and Standing Financial Instructions (SFIs)

In addition to the need to comply with EU public procurement regulations, a PCT must also fully comply with their own internal standing financial orders and standing financial instructions. These will include authority limits unique to an individual PCT and determine the authority regime for contract awards eg stages requiring board approval, or in some cases, approval from the Strategic Health Authority, delegation of duties etc.

It is imperative that the Project Manager is fully conversant with these documents to ensure appropriate timescales are incorporated into the project timetable and compliance at all stages of the procurement process.

3.6 The role of Contract management

The way a PCT manages its final contract will depend, to some degree, on the nature of the organisation and its needs.

At planning stage it is important to consider how contract management will take place, resources required and key service elements that need to be periodically performance managed and require regular reporting by the service provider. These will cover such areas as

 Staffing How will the PCT ensure it is gets the full complement as tendered and the skill mix as agreed. How will the service provider report vacancies?  Quality measures. These should be outcome based if at all possible, and ideally allow comparisons with other providers. How will penalties for missing targets and remedial actions be addressed. This is something the Healthcare Commission will wish to see as part of the PCT’s commissioning strategy.  Aims of the Local Development Plan How will these be met.  Billing. How will the PCT determine that they are being billed the correct amount.  Operational processes How will the PCT address operational shortfalls against agreed contract

4 Service requirements

A sample abbreviated Output based service specification is attached at appendix C page 59. This outlines to potential providers the scope and range of services which the PCT may require them to provide to a population.

It is important that the PCT spends time personalizing the specification to meet the needs and service requirements of the PCT. Time invested specifying the detailed requirements and aspirations of the PCT normally ensures a smoother procurement process.

5 Risk overview

This section address ways of identifying risk to the PCT and measures to mitigate risk identified during the procurement process. This is not intended to form part of the specification or the contract but may identify areas that will need to be addressed in the contract. In addition the relative exposure to risk between bids should form part of the evaluation.

Risk management is a structured approach to identifying, assessing and controlling risks that could emerge during the course of both the procurement and contract lifecycle. Its purpose is to support better decision making by a coherent approach to identifying inherent risks and their potential impact.

Efficient use of resources, improved project management and minimization of waste are some of the major benefits that can be gained from effective risk management.

PCT’s may already have a mechanism for assessing risks in place and therefore this project should be assessed in accordance with the existing risk profiling and established guidelines.

5.1 Developing a risk register

A risk register or log is a useful tool to identify, quantify and value the extent of risk associated. It can be used to identify the owner of the risk, the likelihood and impact on the procurement exercise.

A typical risk register/log should incorporate the following areas as a minimum:

Risk number (unique within register) Risk type Author (who raised it) Date identified Date last updated Description Likelihood Interdependencies with other sources of risk Expected impact Bearer of risk Countermeasures Risk status and risk action status (ie high, medium, low)

5.2 Development of a risk matrix

Once risks have been identified a simple risk matrix can be developed as below to plot the likely impact and possible consequences over a period of time.

Probable ie Medium High High 1:6 months

Possible ie Low Medium High 1:2 years

Unlikely Ie Low Low Medium 1:5 years

Low Medium High consequence consequence consequence Ie slippage and minor Ie misses target Ie Failure to find deviation etc date for contract Potential Provider, or start etc reach agreement on contractual terms etc

5.3 Risk mitigation

The treasury ‘green book’ provides detailed information on options to help manage risk.

These include:  Active risk management – including the identification of possible risks in advance, having processes in place to monitor and regular update risks, achieving the right balance of control, effective decision making  Early consultation – Identification at an early stage in order to minimise costs  Avoidance of irreversible decisions – allowing more time for investigation of alternative ways to minimise the risks  Pilot studies – acquiring information on risks that have been identified from other PCT’s that have gone through similar projects and sharing ways to minimise the risks  Design flexibility – ability to vary the contract and identification of costs in doing so  Precautionary principle – taking of precautionary action to mitigate a perceived risk – senior management must be engaged if this form of action is necessary

For further detailed advice on risk management within the public sector see www.hm-treasury.gov.uk/greenbook and www.ogc.gov.uk/sdtoolkit/reference/ogc_library/related/orange-book.pdf

5.4 Types of risks

The general types of risk that the project manager is likely to encounter for an APMS project encompass the following and need to assessed from the outset of the project:

Availability risk The risk that the quantum of the service provided is less than that required under a contract.

Business risk The risk that an organisation cannot meet its business imperatives.

Demand risk The risk that demand for a service does not match the levels planned, projected or assumed. As the demand for a service may be partially controllable by the public body concerned, the risk to the public sector may be less than that perceived by the private sector.

Design risk The risk that design cannot deliver the services at the required performance or quality standards.

Funding risk Where project delays or changes in scope occur as a result of the availability of funding.

Legislative risk The risk that changes in legislation increase costs.

Operational risk The risk that operating costs vary from budget, that performance standards slip or that service cannot be provided.

Policy risk The risk of changes of policy direction not involving legislation.

Procurement risk Where a contractor is engaged, risk can arise from the contract between the two parties, the capabilities of the contractor, and when a dispute occurs.

Reputational Risk. The risk that there, will be an undermining of customer/ media perception of the organisation’ s ability to fulfill its business requirements e.g. adverse publicity concerning an operational problem.

Volume risk The risk that actual usage of the service varies from the level forecast.

6 EU Issues

6.1 Compliance and tender process

Procurements for the provision of Alternative Provider Medical Services are not caught by the full weight of procedural rules as set out in the Public Services Contracts Regulations 1993. Alternative Provider Medical Services are classified as ‘specialised medical services’ and as such fall within CPC category 93122, a sub section of generic section 25 ‘ ‘health and social services’.

This classification means that the only procedural requirements that must be adhered to under the public procurement rules are:

 Adherence to the principals of equality of treatment, transparency, and non discrimination on the grounds of nationality  Adherence to the rules on EU standards  Placement of an award notice in the OJEU once the contract has been has been placed, assuming the value of the contract (aggregated over the full contract term, not per annum, exceeds the financial threshold. For this threshold see NHS PASA website nww.pasa.nhs.uk/purchasing/shared under European Tenders Residual Services Part B.

The thresholds for EU tendering are set in January and are fixed for a two year period. The current threshold for Residual Services part B was set in January 2004 and is £129,462 excluding VAT. This will be subject to review on the 31 December 2005.

The European Court of Justice has indicated that the principles of the EU Treaty require that all contract opportunities receive sufficient advertising to ensure open competition. This implies that restricting access to low value contract opportunities or residual services through ‘in-house’ or ‘approved’ supplier lists is in breach of EU Treaty principles.

The precise scope and form of the advertising required depends on the exact nature of the service in question and the extent to which the contract is likely to be of interest to purely regional, national or EU wide potential suppliers.

 route 1- Input based specification. Minimal negotiation  route 2 – Output based specification. Detailed negotiation

Experience has shown that when taking into account this type of service route 2 reflects the most appropriate process.

The PCT should actively consider the likely applicability of the TUPE regulations to any tendering exercise. This is more important where dedicated resources are present but

should be factored in to thoughts in all cases. Potential Service Providers should be furnished with sufficient information to allow them to reach an informed decision.

To summarize

EU services directive (EU/92/50/EEC) Category number CPC reference CPV reference classification

Residual service (part B) 25 93122 85147000-1

6.2 EU Requirements: Sourcing Suppliers

Whilst there is not a requirement to advertise the intent to market test under the EU legislation in the supplement to OJEC, the European Court of Justice has indicated that the principles of the EU Treaty require that all contract opportunities receive sufficient advertising to ensure open competition. This implies that restricting access to low value contract opportunities or residual services is in breach of the EU Treaty principles. If the PCT elects voluntarily to issue an OJEC notice for procurement, it is suggested that this is done before any other forms of advertising, though it is advisable that all adverts follow the OJEC notice.

The precise scope and form of the advertising required depends on the nature of the service in question and the extent to which the contract is of interest to purely regional, national or EU wide potential suppliers. A sample advert is at Appendix A.

Potential providers come from both the NHS and non-NHS sectors. The PCT should consider sourcing strategies that will encourage respondents from both. PCTs may wish to ensure that local stakeholders (eg LMCs, patient interest groups) have been involved in proposals to tender for services, and that the advertising and selection criteria do not preclude a potential range of applicants, ranging from entrepreneurial GP practices to large non-NHS providers.

It is good practice to ensure that all advertisements are in the same form, to ensure equality. All those expressing an interest in receiving a PQQ (see Appendix B) must receive one.

To source suppliers, there are a number of possibilities which PCTs may wish to consider. These are listed below:

 General health journals. For example, The Health Service Journal is a tried and tested forum for seeking expressions of interest in the provision of these services.  Specific trade journals. The PCT recruitment advertising contractor will be able to advise the appropriate professional journals to consider  Local/regional press – to enable potential local/regional providers to be aware of the opportunity to submit an expression of interest  Government specific journals. This could include ‘Contrax Weekly, or ‘Government Opportunities’.

APMS should be advertised in at least one local and one national publication to reduce the risk of legal challenge and to ensure competition. See Appendix A for a sample advertisement.

Selecting service providers from known service providers and/or trade directories/website is not recommended and may carry the risk of legal challenge.

The NHS Purchasing and Supply Agency has a national contract for Recruitment, Advertising and Publicity. Follow the link below for details: http://home.pasa.doh.gov.uk/professionalservices/shared/recruitmentadvertising/recruit ment.stm

7 Evaluation criteria overview

After the service has been advertised and offers received, the PCT will need to evaluate bids.

In common with all health related, and indeed most, services there is always an element of the intangible when assessing the bids. The generic services procurement guide gives detailed advice regarding evaluation methodology and the PCT should consider this when planning the process.

NB: It may be necessary to register using the link below to gain access to procurement guides. http://nww.pasa.nhs.uk/security/login.asp?redirect=/procguides/default.asp

Some Potential Service Providers may have demonstrated a track record in the provision of similar types of service, and financial stability, (NHS-SID & PQQ). Prior to invite, the focus should be on the details of the proposals.

The service plans of the PCT will dictate the particular evaluation criteria and any weighting apportioned but typically the following should be considered.

 The ability to meet the service requirement laid out in the OBS  Governance procedures  Meeting Standards for Better Health or National Minimum Standards, whichever is appropriate  How outcomes would be monitored  What audit procedures would apply  Internal performance assessments  Internal employment procedures  Assessment of risk of the proposals  Staffing. The ability to have sufficient personnel to meet the physical volume of work  Appropriate skill mix. It is not sufficient simply to have the required number of staff, there also has to be the right mix of qualifications to ensure the function is neither too light or top heavy in terms of medical /nursing/administrative expertise.  Access to additional/enhanced services. If this is part of the PCT requirements it will be interested in the Potential Service Providers solutions. If these are to be provided by a third party or parties these must also be considered. PCTS are required to follow the APMS Directions with regard to the circumstances for sub- contracting.  Service commitment. (references from PQQ stage)  Innovation, including the extent to which providers may be able to offer new/different approaches and solutions

 Cost. Bids from non-NHS providers are likely to include elements that may not apply to NHS providers (eg pensions; premises costs where appropriate) and need to be balanced against potential outputs.

8 Sourcing potential service providers

8.1 Introduction

The methodology recommended within this guide in drawing up a shortlist of potential service providers is influenced by good procurement practice.

The process will be determined by the tendering route to be followed and compliance with EU rules and PCT Standing Financial Instructions and Standing Financial Orders.

It is important at all stages that reasons for selection and de-selection of providers are recorded and placed on file. The EU advice given in section 8.2, below, is not a requirement for Residual Services, but can be applied as being good procurement practice. If an OJEC advertisement is used to source service providers for Residual Services, the PCT should state in the ‘Other Information’ section of the OJEC notice that the Notice is being placed for publicity purposes only.

8.2 EU advice for assessing potential service providers

8.2.1 Service provider pre-selection

EU rules allow the exclusion of service providers that do not meet certain economic, financial and technical requirements. The PCT may use these criteria in determining the shortlist criteria.

The PCT is free to set whatever selection standards it considers appropriate, provided they are proportionate to the contract, but the EU rules do prescribe the factors/information to which the PCT may have regard in determining whether individual service providers meet these standards.

Care must be taken to ensure that the shortlist criteria are not discriminatory and that they are relevant.

8.2.2 Examples of permitted evidence includes:

- Appropriate bankers’ statements - Financial accounts - Statements of turnover relevant to the product/service area concerned - Statements of previous relevant experience - Statements of average annual manpower

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 26 NHS Purchasing and Supply Agency procurement guide – APMS

Note that some of this information (and more) is available from NHS-SiD if the provider has populated the database.

The efficacy of the rules would be seriously undermined if the PCT were free to reject Offers or service providers on arbitrary grounds. Accordingly, the Services Directive specifies the grounds on which service providers may be automatically disqualified and also the information by reference to which PCT/health authority should determine the technical capacity of service providers from whom to invite Offers.

This Directive is permissive rather than prescriptive in terms of the information to which the PCT can have regard in assessing the financial standing of the service providers.

PCTs can also seek evidence of the service providers’ ‘ability’ (i.e. in terms of service delivery) that may allow more wide ranging questions to be posed.

8.2.3. Supporting Information: use of Prequalification Questionnaire (PQQ)

In all cases, prospective service providers will need to provide information upon which their suitability to be invited to Offer will be judged.

The use of a pre qualification short listing (PQQ) is highly recommended for this process and because there is a need to focus interested parties into providing specific information around their ability to deliver against Key Obligatory requirements.

A PQQ also minimizes cost and time, as it helps sift out unsuitable providers before a later stage in the process. The information requested must reflect the declared shortlist criteria and be relevant to the service against which it will be assessed.

Some of the information required for short-listing potential service providers from their expressions of interest may reside on the NHS Supplier Information Database (NHS-sid). NHS-sid is a web-based system for the communication and management of suppliers’ pre-qualification and/or tender support information for the NHS in England. Full details on the use of NHS-sid are available in the TOPPM.

NHSPASA has agreed with industry that all primary data required to be submitted as part of any tender should be made available electronically via NHS-sid and the responsibility for regular updates lies with the supplier. This avoids duplication and dramatically reduces suppliers tendering costs; therefore a PQQ should not request information that is currently up to date and available through the NHS-sid system. The information held on NHS-sid is indicated on the PQQ at appendix B.

The purpose of using a pre-qualification short listing, is:

 That it offers a formal way by which to summarize, on a like for like basis, information needed to assess the suitability of companies.  It provides a fair base against which a pass/fail system can be applied.

It is usual to evaluate the PQQ information on the basis of a pass/fail system against each of the sections. This evaluation, conducted either on an individual or group basis, would indicate whether the candidate moves forward to the next stage, or is deselected at this point. In essence, any section being marked as a fail would result in de-selection.

It may be appropriate when assessing returned PQQ information to use appropriate specialists to evaluate some sections e.g. finance and some fundamental primary requirements.

Appendix B shows example PQQ of information that could be requested. This listing is not exhaustive and consideration must be given to the type of contract being tendered.

It is important to note that some questions may not be applicable to all potential bidders (for example, small entrepreneurial GP practices may not be able to provide the same degree of detail as larger commercial or voluntary organisations).

All bidders must, however, provide all relevant information that applies to them.

8.2.4 Receiving Expressions of Interest from advert and the completed PQQ

With all procurement routes, a cut off date needs to be set, after which no further expressions of interest can be accepted.

It is not good practice to accept late bid submissions and run the risk of legal challenge. If the PCT decides to accept a late submission (ie if there are exceptional circumstances), the same must apply to any other late submission, but note that this can invite criticisms from those who submitted on time.

Any responses to the OJEC notice/advertisement from potential providers must be treated equally as all other responses.

Immediately following the cut off date for receiving expressions of interest, it is good practice to send an acknowledgement of receipt to all companies confirming receipt of their expression of interest.

8.2.5 Short listing of Potential Providers

The objective is to produce a pre-list of quality service providers who can provide the service. By spending time investigating the service provider’s credibility and experience it is possible to identify the most appropriate prospective service providers to be invited to offer.

When short-listing, consideration should be given to all potential providers, including smaller or new service providers and bids from known existing providers

A small/medium enterprise (SME) is defined by the Department of Trade and Industry, as a company that has a maximum of 200 employees. Considering small or new service providers may encourage competition, introduce new and innovative services/products and ensure that the market place is accessible to all service providers.

For further information on SME’s, see TOPPM.

8.2.6 Selection Process: criteria

The selection criteria must be meaningful in relation to the service in question and must not be open to challenge. This is based on the expectation that any decision needs to be justifiable in the event that a de-selected candidate should query the process. The selection criteria may include a degree of compliance in the case of Residual Services. The evaluating method employed for the short-listing of expressions of interest/PQQ stage is a pass/fail system.

It is important to understand that the decision to select/de-select any candidate, can only be based on information that is a matter of fact.

After the expressions of interest stage PQQ stage, the process moves to Invitation to Submit a Preliminary Offer (ISPO)

It is imperative to notify and de-brief the unsuccessful applicants. Further guidance concerning the basic principles of de-briefing can be found in section 13, (Post Award Activity).

9 Invitation to submit a preliminary offer (ISPO)

During the period when potential service providers are being sourced, work also needs to be carried out developing the Draft Invitation to Submit Preliminary Offer (ISPO.

9.1 Drafting of the Invitation to Submit Preliminary Offer (ISPO).

Output Based Specification (OBS)

The service specification (OBS i.e. OBS Output Based Specification) is at the core of the ‘Offer Process’. As a general principle, the OBS should focus on what should be achieved rather than how to achieve it. This should aim to encourage innovation and maximize cost effectiveness. Service specifications must include requirements across all dimensions of performance and incorporate any expected changes in activity levels over the contract term, taking account of national standards.

Where there are legislative requirements or other technical and environmental standards, and national policy standards, which must apply to the service, then these should be specified as a minimum standard in the specification.

It is essential to involve all interested parties when writing the service specification requirements. Where the service impacts upon the delivery of clinical services or on health, then clinicians need to be consulted and their ‘sign-off’ obtained.

Care must be taken to ensure that current process does not become enshrined in the specification rather than desired service requirements and outcomes, as this could lead to accusations of unfair competition in favor of any incumbent Service Provider.

Service specifications should also include details of what data will be required from the service provider and what performance standards will be applied to the service, including NHS and local performance management standards. Standards should be output based, and set challenging but realistic targets, which can be evaluated over the full contract term. These should be across all performance dimensions.

Clearly the PCT must guard against the specification simply becoming an unachievable ‘wish list’. Undertaking the consultation exercise within the overall objectives set by the PCT board will help. PCTs should set a resource envelope that is the expected budget available for that service, and transmit this to the stakeholders where this would be helpful. Without a budget it becomes virtually impossible to evaluate responses to the specification; either the desired quality standards are too costly in which case it becomes impossible to decide on what the trade-off between cost and quality should be, or the

minimum standard only is delivered at lowest cost, which may not meet the PCT or stakeholders objectives.

A partially completed OBS is included in Appendix C. Medical Technical and/or legal advice may need to be sought to assist with completion of this exercise.

Once the service specification and associated schedules have been completed they need to be encompassed within the overall Invitation to Offer documentation. At this point the final documentation should be considered and approved by the project team. A checklist of the documents that make up the ISPO can be found on the following pages

9. 2 Documentation required

When following the tendering route described in this guide two sets of documentation are required. The first set of documents is to reflect the requirements of the preliminary offer, followed by the second set of documents to reflect the final offer.

Below is a breakdown of the elements required to make up these two sets of Documents – sample documents are supplied within the appendices

Set 1 - The Invitation to Submit the Preliminary Offer (ISPO) Document consists of:

Doc A1 - Letter of Invitation to Submit Preliminary Offer (ISPO) - Formal invitation letter to organizations to submit preliminary offers in accordance with the invitation to offer. Doc B1 - Terms of Invitation to Submit Preliminary Offer (Terms of Offer) - Rules of engagement applicable in the submission of preliminary offers. Doc C1 - A Draft model Contract which will comprise of - Conditions of Contract - Any Supplementary conditions of Contract which the PCT has Drafted or had drafted. These are where additional conditions of contract are required to supplement the standard conditions - The partially completed Schedules to Contract. Within these - The Output Based Specification (OBS) at this stage without any response from the Supplier. Doc D1 - Form of Offer - The formal declaration that the Offer is made subject to the PCT’s Terms and Conditions of Contract. Doc E1 - Check list for documents to accompany the offer.

Set 2 - The Invitation to Submit the Final Offer (ISFO) Document Consists of:

Doc A2 - Letter of Invitation to Submit Final Offer (ISFO) - Formal invitation letter to service providers to submit final offers in accordance with the invitation to offer. Doc B2 - Terms of Invitation to Submit Final Offer - Rules of engagement applicable in the submission of final offers. Doc C2 - A complete AGREED Draft model Contract (EXCLUDING THE FINANCIAL COSTING SCHEDULE will comprise of Conditions of Contract

- Any Supplementary conditions of Contract which the PCT has Drafted or had drafted. These are where additional conditions of contract are required to supplement the standard conditions. If any AGREED amendments have been made to the Condition of Contract or the Supplementary Conditions of Contract then they would be included.

The completed Schedules to Contract (EXCLUDING THE FINANCIAL COSTING SCHEDULE). Within these schedules to contract the Output Based Specification (OBS) will reside but at this stage WITH the negotiated AGREED response from the Supplier

9. 3 Sign off the ISPO documentation, and the selected potential Service Provider expressions of interest

Once the ISPO has been produced and the potential service providers selected at this stage it is recommended that the project team/PCT formally sign off these documents.

9. 4 PCT Issue ISPO Documentation to Selected Potential Service Providers

Once the project team is satisfied with the ISPO, the PCT can issue the documents to the selected providers.

9. 5 Tenderers to Prepare and Submit Preliminary Offers

In the ISPO documentation, it must be clearly stated the latest date when completed preliminary offers are to be submitted to the PCT. Procedures for receiving and opening

offers will be determined by PCT Standing Orders and Standing Financial Instructions. The PCT will be responsible for the receipt, custody, security and opening of the offers.

10 Offer evaluations

10.1 Introduction

After the closing date for service providers to submit their completed Offers, copies of the Offer paperwork should be distributed to members of the panel to evaluate the elements of the offers that they are responsible for.

The choice of criteria that will apply to the evaluation of Offers must be stated in the Invitation to Offer documents. Good purchasing practice forbids PCTs to engage in ‘post offer negotiations’ with Potential Service Providers on fundamental aspects of their offer e.g. price.

Discussions aimed at clarifying or supplementing the contents of offers are permitted provided all service providers are treated equally. Further information on this procedure can be found in the http://nww.pasa.nhs.uk/toppm

10.2 Evaluation criteria

It is best practice to set and follow predetermined evaluation criteria. Offers are best evaluated when using formats that allow for analysis of each Offer against contract requirements. For the financial aspects, the analysis should reflect the total costs – (see Establishing the Project Team, the Finance Manager, Section, ‘6.C.3. (iii)’)

The following headings suggest how the evaluation may be broken down to facilitate analysis and comparability, although it is the responsibility of individual PCTs to determine the methods employed:

10.3 Elements required by Conditions of Offer

For example:  completion of Offer documentation  comments/amendments to terms & Conditions of Contracts and specification

10.4 Other elements required by Draft Contract (the schedules)

For example:  proposals for provision of labour  proposals for provision of non-labour elements  conformity with statutory requirements

 proposals for achieving and maintaining quality, meeting core standards and working towards developmental standards

See also the APMS “model” contract at Appendix F and www.nhsconfed.org

10.5 Elements with a direct bearing on the Offered contract price

For example : - total cost - breakdown of costs - breakdown of main points - staff input (worked hours for each area).

10.6 Elements with an indirect bearing on the Offered contract price

For example: - unscheduled work - contracted work of variable frequency - head office overheads

The technical/operational analysis should identify those Offers that meet the specification and the financial evaluation should identify those that are within the proposed operating budget.

10.7 Abnormally Low Offers (excluding below threshold offers)

If an offer for a contract is abnormally low (i.e. it appears to offer the bidder no reasonable chance of making a profit) a written explanation must be sought. This is important in the event that an abnormally low Offer is rejected. In considering the explanation, take account of issues that justify the Offer on objective grounds such as, economy of the method, technical solutions suggested or the exceptionally favourable conditions available to the Service Provider.

If an abnormally low Offer is rejected and the criteria for the award is the lowest price, then a report justifying this must be sent to the Office of Government Commerce for onward submission to the European Commission. Where such a report is generated, the PCT is advised to seek local legal advice.

10.8 Visits to service provider sites and presentations

As part of the offer evaluation and due diligence process it may be necessary to conduct formal inspections of sites from which or to which the Potential Service Provider currently supplies comparable services.

The project team may wish to agree areas on which they will make an assessment., perhaps through the use of a standard 'site visit' report pro-forma. Similar assessments can be applied to PCT scripted potential provider presentations

10.9 Summary

In summary, the evaluation process should provide an overall analysis, and, for each Offer identify:  Comprehensiveness/economic attractiveness of Offer  Omissions  Points that require clarification  Need for additional information/detail  Costs with an indirect bearing on Offer price (that have not been accounted for).

11 Evaluation of Preliminary Offers (ISPO)

Following the principles outlined in section10, the objective of this Offer evaluation will be for the project team to analyse the offers received and judge them against the agreed evaluation criteria.

This can be carried out using a weighted scoring system to evaluate each offer received PCTs need to think through how they are going to be able to distinguish good offers from bad and devise appropriate criteria and weightings to achieve the desired outcome, i.e. that the best offer will win the contract.

The criteria the PCT uses to assess preliminary offers should be the same as those it uses to assess final offers. At the stage when the PCT is devising its scoring matrix for assessment of preliminary offers it should also devise a scoring matrix for the assessment of the final offers.

The weightings of the criteria can be different at each stage, but the weightings to attach to criteria at final offer stage should be decided upon from the outset in order to head off any claims by Potential Service Providers that weightings were adopted to suit a particular outcome. The preliminary evaluation process may involve initial negotiations with each of the service providers, presentations, and site visits.

11.1 Project team undertake pre-adjudication meeting and choose preferred service provider)

On completion of the evaluation of preliminary Offers, the project team should meet in order that individual members of the team can present their specific evaluation findings to the rest of the team. The project team then need to agree the final preferred bidder (service provider).

It is not recommended that more than one preferred service provider is selected as it is assumed that the procurement route and evaluation stages should have produced one preferred service provider.

Following agreement of the preferred service provider, the unsuccessful applicants need to be notified. At this stage, it is not advisable to eliminate the other offers until the negotiations with the preferred Potential Service Provider have been concluded. If negotiations with the preferred Potential Service Provider do not reach a satisfactory conclusion, there is always the opportunity to then select the next best provider on your evaluation sheet to start negotiations with. It is necessary however to inform them that the PCT has chosen a preferred service provider and that in the event that the PCT is unable to reach agreement then they may be invited back into the procurement.

11.2 Preparation of the Invitation to Submit Final Offer (ISFO) documentation

The content for this documentation is detailed earlier in section 9.2 . Any variations from the original output based specification (OBS) and the providers response that are to be made following the evaluations, negotiations, site visits and presentations need to be detailed in the Draft Contract together with any changes to the other Schedules to Contract.

During this stage it will be necessary to meet with the Preferred Service Provider to discuss and agree in detail changes to the Draft Contract.

It should be recognised that the Draft Contract will now contain not only the OBS but also the preferred providers response to this specification together with fully completed schedules excluding the Costing Schedule.

It is normal to request a clear indication of the final costs at this stage so that the Full business case FBC can be submitted internally.

11.3 Signing Off Draft ISFO Documentation, and the short listed Potential Service Provider.

Once the ISFO has been produced in total , it is recommended that the project team/PCT formally sign off these documents.

11.4 Issuing draft ISFO documentation to preferred Service Provider

Once the project team is satisfied with the draft ISFO, the PCT can issue the documents to the selected service provider.

11.5 Potential Service Provider to prepare and submit Final Offer

In the ISFO documentation, it must be clearly stated the date when completed offers must be returned to the PCT.

Procedures for receiving and opening offers will be determined by PCT Standing Orders and Standing Financial Instructions. The PCT will be responsible for the receipt, custody, security and opening of the offer.

11.6 PCT Evaluate (ISFO)

Following receipt of the response to the ISFO it will necessary to check through the documentation and costs to ensure that there are no changes and that the final costs are acceptable.

11.7 Final Offer’ adjudication meeting

The ‘final offer’ adjudication meeting allows for the project team to determine their ‘final award’ recommendation.

11.8 PCT conducts and concludes contract with preferred Service Provider

The PCT seeks final agreement with the preferred service provider ready for ratification and signature. For further information on contract award documentation, see Section 13.3.

12 Award of Contract

12.1 Introduction

At the final Offer adjudication meeting, a report needs to be produced for ratification by the PCT, before the successful service provider is informed.

12.2 Ratification report

The final ratification report should be presented to the Chief Executive, or as determined by the PCT Standing Orders and Standing Financial Instructions, section the ‘Appropriate Authority’. The final award decision will normally be taken in accordance with the PCT’s Standing Orders with reference to the project teams evaluation and recommendation. The basis on which that final decision is taken should be recorded for the purposes of audit and management reviews. This will also provide the basis for debriefing unsuccessful Potential Service Providers.

Ratification report headings should include the following as a minimum:

 Introduction  Summary of process  Presentations and scores  Financial evaluation and ranking  Quality evaluation and ranking  Overall evaluation  Recommendation

12. 3 Notifying the successful Service Provider(s)

Once written confirmation of acceptance of the project team's recommendation has been received from the Appropriate Authority the preferred service provider can be notified. A sample award letter is contained in appendix E

Unsuccessful Potential Service Providers from the ISPO should not be notified at this stage. This is should not be done until final contracts have been agreed and signed as it enables discussions to be reopened in the event of failing to reach a satisfactory conclusion with the preferred service provider.

The PCT should ensure that written acceptance of the contract award is received from the successful Service Provider prior to notifying unsuccessful Potential Service Providers. (i.e. the contract is signed by both parties)

13 Post award activity

13.1 Notifying unsuccessful Potential Service Providers

Potential Service Providers that have been unsuccessful must be notified and given the opportunity of a debriefing. All Potential Service Providers are entitled to receive a formal debrief regarding the relative performance of their Offer. A sample rejection letter is contained at appendix E.

13.2 Debriefing unsuccessful Potential Service Providers

The opportunity for debriefing should be given to all Potential Service Providers and should be undertaken by at least two PCT authorised representatives.

Written notes must be kept of all debrief meetings. The reasons for the non-award should be drawn from the notes of the project team ratification report prior to the meeting. They could include any one or more of the following illustrative reasons: -

 Cost of service - general overview (not specific and infringing commercial in confidence information) of the financials relating specifically to their tender offer only  Ability to meet the service specification – this would deal with any service short falls in terms of operational practices, technology, staffing resource  Provision of adequate Quality Assurance plan – their ability to meet, maintain, and monitor the service to national standards, as a minimum  Acceptability of conditions of contract  Non-compliant offer

Telephone debriefs can be given but should be kept very basic, briefly highlighting the reason in terms of eg. ‘inability to meet the service specification’ or ‘ less economically advantageous than other offers’, but giving no specific detail.

A full debrief should be offered through a meeting. Notes of all debriefs should be kept on file, regardless of whether they are conducted face to face or over the telephone. Notes should include, whether telephone or face-to-face, date, those present, full details of conversation.

13.3 Contract documentation for successful Service Provider(s)

Formal contract documents should be drawn up for signature by the PCT if awarded to a commercial organization (see Appendix F ) or an appropriate Service Level Agreement if awarded in-house or to another NHS PCT. The Contract document should comprise :-

 Form of agreement document  Standard Conditions of Contract  Service Specification  Supplementary Conditions of Contract (if applicable)  Policies, Rules, Procedures and Standards  Quality Assurance and Contract Monitoring, 42including how services will meet core Standards (or National Minimum Standards), work towards developmental Standards, and how the PCT will judge this.  Contracted costs associated with the provision of service

Two copies of the contract should be bound and signed by the successful service provider and then the PCT. Each party should retain one copy.

This document should remain a ‘live’ document and be utilized for contract monitoring and review.

13.4 OJEC Award Notice

The official guidance states that “A contracting authority that has awarded a Residual Service contract shall, no later than 48 days after the award send to the ‘Official Journal’ an award notice”

This procedure is only applicable where the contract value is above the EU threshold for Residual services and applies regardless as to whether the PCT placed an original OJEU notice.

The local PCT Supplies Manager can assist in drafting and publishing this notice. Details of the contract award must be entered onto the notice, subject to the following:

 Any information specified in the ‘Contract Award Notice’ may be omitted in a particular case where to publish such information would impede law enforcement, would otherwise be contrary to public interest, would prejudice the legitimate commercial interest of any person or might prejudice fair competition between service providers. If the above is applicable the PCT may wish to consider the use of their legal advisors in drafting the document.  A contracting authority that has awarded a Residual Services contract, shall state in the contract award notice whether or not it agrees to its publication.

 Where a contracting authority decides not to award a public services contract, nor to seek offers in relation to another contract for the same purpose it shall inform the OJEU of that decision and shall, if so requested in writing by any services provider who submitted an offer or who applied to be included amongst the persons to be selected to Offer for or to negotiate the contract, inform him of the reasons for its decision.

13.5 Contract mobilisation and implementation

The PCT should put in place a series of contract mobilisation meetings with the successful service provider(s) in order to agree the actions to be taken to ensure a smooth implementation of the new contract. This will include operational and staffing arrangements as well as establishing the implementation timetable, and arrangements for monitoring and review.

If an In-house team is appointed, the agreed contract price becomes the budget for the period specified and if costs cannot be maintained the appropriateness of re-testing the market should be considered.

13.6 Statistical reports

PCT’s like all NHS Trusts are required to submit annual returns on contracts awarded above and below the financial thresholds. Therefore comprehensive records of all contracts awarded must be kept so that it can be provided on request.

The information required in the annual return is:-

 Value of Contract  Which procedure was used  Any services to be provided – Advertised as Priority Services  The nationality of the successful Service Provider  Public services contracts awarded as Residual Services

The Supplies Manager to the PCT should be able to assist with the collation and return of this information.

14 Monitoring Performance

The signing of contracts does not indicate the end of the contracting process. The future success of the contract will almost certainly centre around the quality of service received and how this relates to the specified service standard. To objectively measure this the PCT needs to put in place a robust ‘quality plan’ and determine the full responsibilities of the Contract Manager.

A ‘quality plan’ needs to clearly set out definitions for each of the following areas:

 The service standards to be achieved, based upon either the Standards for Better Health (NHS providers) or the National Minimum Standards (for independent providers).  How those service standards will be monitored  Who other than the Contract Manager will undertake any responsibilities in the monitoring of the contract  How quality and performance issues will be communicated between both parties  Requirements relating to remedying the shortfall  The liquidated damages for failing to remedy the shortfall. The use of the term ‘penalty clauses’ should not for legal reasons be used as it presupposes guilt. However the agreement of liquidated damages or method of calculation is permissible and is covered within the standard contract. It enables the PCT to claim where it can be proved that losses have occurred from poor performance.  National and local performance management requirements and targets: 44existing and new national targets are covered by Standards for Better Health, but would need to be set out as part of the contract for independent providers.  Providers should be given clear performance targets that fit with those for other providers of services in the PCT , and with the PCT’s overall strategy as set out in the LDP  Completion of regular reporting forms  A clear expectation of where services fit with Healthcare Commission requirements, including how services will meet core Standards (or National Minimum Standards), work towards developmental Standards, and how the PCT will judge this.  Managing any disputes  Action, including possible contract termination, in the event that services are not meeting requirements

Experience suggests that those contracts that are monitored in some detail by the PCT tend to be less prone to major problems in service quality, primarily due to the fact that service shortfalls are identified early and rectified before they become major issues.

The degree of PCT input into the monitoring process will be very much dependant on the extent to which internal resource is allocated. In some cases the PCT may chose to rely on the Service Providers ‘self monitoring’ their own performance and the PCT Contract Manager merely auditing and reviewing the outcomes.

Providers are likely to self-monitor their own outputs and performance, and PCTs will wish to agree with them how far such information should be shared in order to meet national and local performance measures and targets.

PCTs should also establish additional arrangements for review and monitoring, including regular meetings with providers.

PCTs will be expected to self-assess themselves, including all their commissioned services, against the core Standards for Better Health each year. The PCT will need to ensure that it has sufficient information on quality from all its commissioned services, including APMS, to assure itself that the Standards are being met. It will also be expected to monitor progress against the developmental Standards, and to demonstrate continuous improvement in both its provided and commissioned services.

It is important that the PCT recognises that the Contract MUST be managed and all changes to the Contract are agreed and recorded using the Change Control procedure as laid out in the Schedules to Contract see Appendix F

In developing a ‘quality plan’ PCTs should consider including the audit of other non- operational issues such as service variations, cost improvement plans etc.

15 Other resources

Other sources of information are available as follows:-

www.dh.gov.uk, includes general guidance on APMS, the APMS Directions, and The NHS Contractors’ Companion - which gives general guidance on PCT commissioning and contracting

www.pccacontracting.nhs.uk includes guidance on all primary care contracting routes, including The Commissioning Friend

www.nhsconfed.org information on APMS, including the APMS “model” contract and APMS guidance www.pasa.nhs.uk includes general guidance on purchasing procedures and many links to relevant sites

For further detailed advice on risk management within the public sector see www.hm-treasury.gov.uk/greenbook and www.ogc.gov.uk/sdtoolkit/reference/ogc_library/related/orange-book.pdf

APPENDICES

Appendices Page no A Sample advertisement 48 B Sample pre qualification questionnaire 51 C Sample abbreviated Output Based Specification 66 D Other Documents to be issued at ISPO & ISFO stages Document 1– covering letter 102 Document 2 – terms of Offer 104 Document 7 – form of Offer 108 E Contract acceptance letter 109 Contract rejection letter 110

Appendix A - sample advert (NOT AWARD NOTICE)

CONTRACTING AUTHORITY

Sample Primary Care PCT, Brick House,.Blue Business Park, Anytown, Plumshire, XY5 8AB UK. Telephone xxxxxxxxxxxx, Fax xxxxxxxxxxxxx,Electronic Mail [email protected] For the attention of A. Another (reference APMSxxxx) at the address above

OBJECTIVE OF THE CONTRACT

Provision of Primary Care Services within the geographical area covered by the Contracting Authority

Choice and Contestability

The PCT wishes to use this procurement as part of its strategy to introduce Choice and Contestability in primary care as a stimulus to increase efficiency and responsiveness of the primary care provision, as a whole to the PCT and will consider bids from the private, voluntary and not for profit sectors, together with bids from within the NHS and & GP Practice sector.

Vision

The PCT is looking for a completely modernised model of service that could include:

 User friendly and culturally sensitive primary medical services provided by a multidisciplinary workforce with extended skills, responsibilities and training

 Greater integration between primary, community and social services service provision

 An increase in the range of healthcare services provided in community settings

 Promotion of healthy living with close links with schools and local businesses aiming to tackle the underlying causes of ill health

 Provision of a number of enhanced primary care services across the PCT

Duration of The Contract.

To be agreed with any successful Bidder

It is anticipated that any award of Contract would be during this calendar year

Legal, Economic, Financial & Technical Information

Where applicable Parent Company or other guarantees may be required

Conditions for Participation

Any provider / supplier may be disqualified if they fail to provide the information requested. (where relevant to them) by the closing date shown below. In order to express an interest in participating in the procurement the candidates must initially follow the steps outlined below. (Expressions of interest from consortia will be accepted but each member of the consortia is required to satisfy the awarding Authority that it meets its minimum acceptance criteria.

1) Any provider / supplier from the voluntary or private sector should register on the electronic NHS Supplier Information Database (NHS-sid) at www.pasa.nhs.uk and submit NHS-sid profile for publication to the system.

2) Candidates wishing to be considered for this Contract must also complete all the relevant sections of the Pre-Qualification Questionnaire (PQQ) (reference APMSxxxx) and send this completed PQQ to A Another (reference APMSxxxx) Sample Primary Care PCT, Brick House,.Blue Business Park, Anytown, Plumshire, XY5 8AB UK. Fax xxxxxxxxxxxxx,Electronic Mail [email protected] For the attention of xxxxxxxx xxxxxr (reference APMSxxxx) at the address above by the closing date below.

This PQQ is available for download from the following website www.samplepct.nhs.uk or by written request to A. Another (preferably by e-mail)

OTHER INFORMATION

The information provided in NHS-sid and the Pre-Qualification Questionnaire will be used to evaluate responses and to draw up a short list of suppliers / providers.

Suppliers/Providers who are successful in being placed on this Short List will receive an Output Based Specification (OBS) This OBS will require a more detailed response from each Supplier/ Provider. Further detail on the evaluation process will be contained within this document.

It is the total responsibility of the Supplier /Provider to ensure that a completed PQQ has been received by the person named above at Sample PCT by the closing date specified below and that NHS-sid is populated with current data by the closing date specified below.

Where NHS-sid is unavailable, please contact the NHS-sid Helpdesk at [email protected] or telephone 0845 270 70 50.

The Authority is not bound to accept the lowest or any offer and reserves the right to accept an offer in whole or part.

Closing date for submission of the PQQ and population of data on to NHS-sid is

Xxxxday x xxxxxx 2005.

Appendix B - sample Pre Qualification Questionnaire

A PROPOSED AGREEMENT FOR THE PROVISION OF APMS SERVICES TO SAMPLE PRIMARY CARE PCT. PRE-QUALIFICATION QUESTIONNAIRE (PQQ)

Initial short-listing stage

Consortium Bids

Expressions of interest from consortia will be accepted. However, each member of the consortium will be evaluated individually, THEREFORE each member of the consortium should provide the information requested in this pre-qualification questionnaire.

Your Status as a Provider Please note that some of the questions will not relate to the Voluntary Sector, Partnerships, GP practices or PCT Service Provision Directorate. Under these circumstances bidders must provide all relevant information that applies to them and provide comprehensive information in section X.

Purpose of this Pre-Qualification Questionnaire

The information that you will provide in this PQQ will be used to evaluate you and it is therefore important that you complete every section accurately. References to “you” or “your” in this PQQ are to that business entity.

Some questions are scored and you will need to achieve a predetermined score in order to move on to the next stage.

The process of evaluation is:

1) Pre Qualification Questionnaire –suppliers must achieve pass mark.

Further information on the evaluation process will be provided to those who are short listed to receive the Preliminary Offer documents issued to them or

The responses from the referees you name will also be evaluated.

After the deadline for the receipt of PQQ responses, the Project Team will evaluate the individual responses based on the information provided. The potential providers who pass the PQQ evaluation stage will have Preliminary Offer documents issued to them or under certain circumstances Final Offer Documents Issued to them.

You are required to submit your PQQ response, by the deadline – 12 noon on xx XXXX 2005. One Paper Copy MUST be provided marked for the attention of :-

A. Another (reference APMSxxxx) Sample Primary Care PCT, Brick House,.Blue Business Park, Anytown, Plumshire, XY5 8AB UK. Fax xxxxxxxxxxxxx,Electronic Mail [email protected]

If you have registered on NHS-sid and the information is complete and current then all questions marked “***” are not required to be answered. Subject to your status as a Provider all other questions should be answered.

Section 1a: Company details section

1. i) Company Name: ii) Trading Name:

iii) Date company formed and incorporated:

iv) Company type: (ie Plc, partnership, sole trader, etc)

v) Address from where this contract would be managed:

vi) Telephone number:

vii) Web site address:

viii) Company registration number (where applicable):

ix) Previous company name(s), (if applicable)

Section 1b: *** Company details section (continued)

Indication of whether the following apply to this business or the business' directors or partners

Statements referring to the Public Procurement Public Services contracts Regulations 1993 (Si1993 No3228) Part IV; Regulation 14 Is bankrupt or is being wound up, whose affairs are being administered by the court, who has entered into an arrangement with creditors, who has suspended business activities, or who is in any similar position arising from national laws and regulations.

Is the subject of proceedings for a declaration of bankruptcy, for an order for compulsory winding-up or administration by the court or for an arrangement with creditors, or of any other similar proceedings under national laws and regulations.

Has been convicted of an offence concerning his professional conduct by a judgement which has the force of res judicata.

Has been guilty of grave professional misconduct proven by any means which the contracting authority can justify.

Has not fulfilled obligations relating to the payment of social security contributions in accordance with the legal provisions of the country in which he is established or with those of the country of the contracting authority.

Has not fulfilled obligations relating to the payment of taxes in accordance with the legal provisions of the country of the contracting authority.

Is guilty of serious misrepresentation in supplying or failing to supply the information that may be required under this Chapter.

Section 2: Contact information

2. i) Name of contact person responsible for completing this PQQ:

ii) Position in company of contact:

iii) Contact address:

iv) Contact telephone number:

v) Contact e-mail address:

Section 3: *** Associated companies section (where applicable)

3. i) Parent company name:

ii) Parent company address:

iii) Parent company web site address:

iv)* Relationship to parent company:

v) Names and address of any subsidiaries:

Section 4: Overview of services provided

4. i) Is the Provider already operating in this service area of this contract:

General description of Provider business activities that relate to this contract:

ii) *** Please indicate any geographical restrictions that may apply in providing this service:

Section 5: Financial

Insurance Details ***

5. *** Please provide the following extracts from your audited company accounts for the last three years (in £ sterling):

[year] [year] [year]

***Turnover

*** Profit / Loss on ordinary activities (gross):

***Net profit (before tax):

*** Net asset value:

*** Minimum / maximum value of contract that the supplier is willing to undertake:

*** Bankers contact name and address:

Permission to obtain banker’s reference: (Alternatively, you may provide as an attachment to this questionnaire a separate bankers reference from your banker regarding your company's current financial capability to undertake this contract):

Appropriate statements from banks and evidence of relevant professional risk indemnity insurance:

Insurance Overall Value per Expiry date Insurer Policy no. category: value per incident annum Professional indemnity

Employers liability

Public liability

Product liability

*** Past Contract Record Please provide examples of contracts awarded within the last 2 years where you feel this will support your offer of information. Where possible, these should be for the NHS, government departments, local authorities or other public bodies. This section should be used to summarise a small selection of past contracts, not every contract awarded.

Record (1) Customer contact

Forename: Surname: Email: Telephone: Organisation: Address: Town: County: Postcode: Country:

Brief description of work: Contract value: Contract start date:

Contract expiry date:

Contract is: current  completed  Public sector client: yes  no 

Record (2) Customer contact

Forename: Surname: Email: Telephone: Organisation: Address: Town: County: Postcode: Country:

Brief description of work:

Contract value: Contract start date: Contract expiry date: Contract is: current  completed  Public sector client?: yes  no

Section 6: Client references

6. Please provide details of the two NHS or public sector contracts currently held by your company that are of a similar size and nature to this contract. Permission is required to contact these clients for references.

Client 1 Type of contract (include type of services included):

Commencement date and expiry date of contract:

Client name: Client contact name: Contact address:

Contact telephone number: Contact fax number:

Permission to contact client:

Client 2 Type of contract (include type of services included):

Commencement date and expiry date of contract:

Client name: Client contact name: Contact address:

Contact telephone number: Contact fax number:

Permission to contact client:

7. Staff Details

Please provide details of staff members who will hold a key role in the execution and management of this Contract. Please include the names and responsibilities of at least one executive director or partner and members of your sales team.

Forename: Surname: Position: Contact telephone number: Contact email address: Does this staff record relate to an executive director/partner (tick box for yes)?  Responsibilities:

Relevant Qualifications:

Summary of relevant experience

Forename: Surname: Position: Contact telephone number: Contact email address: Does this staff record relate to an executive director/partner (tick box for yes)?  Responsibilities:

Forename: Surname: Position: Contact telephone number: Contact email address:

Does this staff record relate to an executive director/partner (tick box for yes)?  Responsibilities:

Summary of other Staff you employ or engage who are likely to be involved in the provision of the service. (indicate full / part time / agency)

Section 8: Quality assurance

8. ***Evidence of measures adopted for ensuring quality control such as accreditation to ISO 9002 or evidence of conformity to equivalent standards. Please include copies of any relevant certificates held.

9. Additional Details

If you wish to provide information about your current activity or business and cannot find an appropriate section in which to enter it you may include it here.

Appendix C

The Sample abbreviated Output Based Specification without the Suppliers (providers response)

Please note that much of the drafting of this sample OBS was undertaken by Suzanne Tytler of Hyndburn & Ribble Valley PCT and NHS PASA are grateful for her significant contribution to this procurement guide.

SAMPLE PRIMARY CARE PCT

OUTPUT-BASED SERVICE SPECIFICATION (OBS) FOR THE PROVISION OF ADDITIONAL PRIMARY CARE CAPACITY IN SAMPLE PCT

Note: This sample OBS has been designed to address issues which are specific to the PCT which drafted this document with the assistance of NHS PASA. Therefore it should be noted that PCTs using this as a guide to develop their own OBS will find that some topics are not relevant to them, or that there are additional issues which PCTs wish to include in their own OBS.

For example, in section 1.6 (Service Model) the two models described can and should be amended to reflect individual PCT requirements and are not designed to be prescriptive in any way.

This sample OBS relates to the provision of primary medical services. Other primary services (ie dentistry, pharmacy, optometry) generally have to be commissioned by the PCT under the separate arrangements set out in the National Health Service Act 1977.

Part A – Setting the scene

1 Introduction Sample Primary Care PCT (PCT) came into being on1st April 2002.

With a budget of almost £X million and employing Y staff, the PCT is responsible for providing a full range of Community Health Services to the people of Anytown, supporting the development and delivery of general practice and securing a full range of hospital services to meet local needs. It therefore brings together responsibilities for providing local services and commissioning (planning and procuring) specialty hospital services.

The PCT covers a population of approximately X over a large geographical area.

The purpose of the PCT can be summarized as:

“To improve the health and social well-being of local people through the provision and commissioning of high quality services and through partnership working, recognizing the diversity of local needs”

Sample PCT is one of a number of PCTs in the area and provides a range of services to these other PCTs as well as receiving services from them.

The PCTs have a close working relationship and have secured Teaching Primary Care Trust (tPCT) status and Local Improvement Finance PCT (LIFT) status for the area. However, potential Providers are asked to note that this OBS relates to services to be provided to the population of Sample PCT only.

1.1 Choice and Contestability The PCT wishes to use this procurement as part of its strategy to introduce Choice and Contestability in primary care as a stimulus to increase efficiency and responsiveness of the primary care provision, as a whole to the PCT.

1.2 Vision The PCT is looking for a completely modernized model of service that could include:

 User friendly and culturally sensitive primary medical services provided by a multidisciplinary workforce with extended skills, responsibilities and training  Greater integration between primary, community and social services service provision

 An increase in the range of healthcare services provided in community settings

 An academic primary care research facility working across the PCT

 Maximising the opportunities from the NHS LIFT programme

 Easier access to care resulting from enhancements in the use of information technology

 Working with a community pharmacy provider(s) to create a “flagship” community pharmacy serving the local population offering new methods of service delivery across primary and community care pathways. (Caution needs to be applied when including pharmacy services as APMS only applies to primary medical services. If the community pharmacy services are deemed as medical services they can be included

 A walk in facility/service serving any persons presenting for treatment and flexible opening times for services

 Providing a proactive and systematic approach to the care of people with long term conditions and support in maintaining healthy lifestyles **

 Promotion of healthy living with close links with schools and local businesses aiming to tackle the underlying causes of ill health

 Provision of a number of enhanced primary care services across the PCT

It should be noted that APMS contracts cannot be used for dentistry or pharmacy as these are non-primary medical services.

** potential providers should note that the terms “long term conditions” and “chronic disease management” are used interchangeably throughout this document.

Subsequently the vision for Sample PCT is based on a network of primary care services that can be described, as a ‘mixed economy’ of services will incorporate nine tiers of access:

 Level 1 – Prevention of ill health (health promotion & well being in the community)

 Level 2 – Services from people’s homes/self care and in the community

 Level 3 – Services from Primary care facilities opting to provide “basic” services

 Level 4 – Services from Primary care facilities opting to provide “enhanced” services  Level 5 – Locality based services that could be provided from Health & Social Care centres  Level 6 – Services that could be provided from a Community hospital site  Level 7 – Services that could be provided from a stand alone elective surgery centre

 Level 8 – Services needing the facilities of an acute district general hospital

 Level 9 - Specialist tertiary Care

This network approach envisages re-defining the role of primary (and secondary) care in terms of where acute and chronic conditions are managed. In addition, the impact of whole system commissioning will see a focus on re-designing services around the

patient’s journey. The implications of this approach may include; specialist GPs providing services to practices in appropriate specialties and the development of new models of managing emergency demand, incorporating increased use of primary care based resources.

The key to achieving the network vision is breaking down the barriers between professional groups, and developing real, integrated, multi-disciplinary teams in primary and community care. Therefore the intention is to build on bridges between primary, secondary and social care ensuring that patients move smoothly along tailored pathways with no discernable divide between the different elements of health and social care, providing a holistic service.

Services will be re shaped to meet the needs of the local population. Patients and clients, carers and families will be engaged in this process, in various ways. Involving the public in development and delivery of services will be an integral part of the vision. Involving patients and carers to a much greater degree in their own care will also be developed much further. This will encompass areas of prevention and treatment and will embrace the notion of patient empowerment. Patients will be encouraged and supported to take greater responsibility for their own health.

The vision is one that sees consistent, equitable, high quality, integrated, timely primary care services available to all sections of our community. It recognizes not only the importance of delivering effective care in general medical and community services but also that the care of people should be provided in community settings close to where people live and work. Services will be efficient, high quality and they will be delivered in appropriate settings. Taking into account levels of specialisation; some services will be delivered from central points to guarantee quality. Ensuring that people can access services equitably regardless of their language or disability will be achieved.

Services will particularly work towards identifying and accessing ‘hard to reach’ groups in the population. Care should be delivered in secondary care facilities only when absolutely necessary.

A central tenet of this vision will be a concentration on providing preventative advice and support in a health promoting, empowering way. There will be a focus on preventing as well as treating ill health, recognizing that good health is strongly determined by social, economic and environmental factors. Partnership linking to sources of support around exercise, smoking, family support, housing, benefits and many others will be a priority. The development of healthy settings in non-traditional health service areas such as schools and workplaces will be explored.

1.3 GP Retirement profile The five year retirement profile across the PCT indicates an increase in the number of GPs aged 55 years and over (i.e. eligible to retire) from X currently to Y by 200x. In addition, there are currently additional GP vacancies across the PCT.

In particular, the demographic changes of local primary care provision, which incorporates these vacant posts, and the approaching retirements of GPs previously outlined, present an important but nonetheless exciting challenge to future primary care provision.

1.4 Target population Potential Providers will recognise as they work through this OBS that target population to which services are provided, differs according to the nature of the service being described.

For example, the potential target population for Primary Medical Services could be in the region of approximately x patients in the first instance, with the scope for growth over time.

The walk in facility/service is expected to offer patients “open access” care which by its very nature means that this population cannot be differentiated.

In respect of the provision of services for patients with long term conditions, the target population will depend upon the service which potential Providers aim to deliver.

1.5 Current activity profile Potential Providers are advised, that current patterns of service delivery or profiles for the services contained in this OBS, are described below, where it has been possible to do so.

However, as some services are either providing a service where there are current gaps in provision or where the nature of the service is such that the patient flow is not limited to a “registered population” (e.g. walk in facility/service), the PCT merely indicates estimated target populations.

Providers should note that the requirements of this OBS anticipate a service model which will see care provision from one fixed building within the locality.

1.5.1 Primary Medical Services

The locality may potentially be able to identify a defined population in respect of provision of primary medical services.

1.6 Service levels Providers are advised that in response to this OBS, the PCT will accept responses that reflect services indicated in either Model 1 or Model 2 below. Providers are also referred to PART B (Requirements) for full details of each of the services indicated and also PART C (Rules for Respondents), for further information.

Model 1 Providers responding to Model 1 will need to demonstrate how they would provide the following services, as described in PART B (Requirements).  Primary Medical Services  Long Term Condition management

Model 2 Providers responding to Model 2 will need to demonstrate how they would provide the following services, as described in PART B (Requirements).

 Primary Medical Services  Long Term Condition management  walk in facility/service  Academic Unit

1.7 LIFT Status and Premises The local LIFT scheme is one of only 42 in the country and represents a step change in the quality of the primary care estate. NHS LIFT provides a flexible mechanism for translating health service plans into viable investment propositions.

1.8 Teaching PCT Status To support the workforce development agenda, the local PCTs were designated as a second wave Teaching Primary Care Trust (tPCT) from April 2002 and is one of only 30 tPCTs in the country. tPCTs were established in areas with poor health and particular problems with recruitment and retention.

Teaching PCT status will aim to:

 Develop links with local Higher Education Institutions (HEI) to develop academic training posts and teaching initiatives for local PCTs

 Facilitate Continuing Professional Development (CPD) and protected time for resources and opportunities for reflective practice and critical review for clinicians though tPCT status

 Develop initiatives to encourage primary care teams to work together to share valuable skills and resources and to keep up to date by participating in joint educational events

 Assist in increasing the number of learning and training practices and enhancing such practices to develop specialist training facilities for multi-disciplinary staff development across clinical and non-clinical groups

 Enable workforce planning and the development of new roles, at basic, intermediate and specialist levels, to support service improvement and provision

1.9 Spearhead PCT Status On November 16th 2004 the Government released the public health white paper “Choosing Health; making healthier choices easier”. This is the first major public health announcement since the publication of “Saving Lives: Our healthier nation” in July 1999. The proposals in Choosing Health are comprehensive and should be seen as evolutionary in nature.

The Government intends to take local action at national level, including limiting smoking in workplaces, advertising food to children, food labeling, limiting alcohol promotion, increasing physical activity, investing in sports, developing mass media campaigns, increased access to health information and so on.

These developments will support our local actions.

Sample PCT has been identified as one of the Spearhead group of local areas, by the Government, to be an early implementer of Choosing Health.

There is an expectation that the potential Provider, with the PCT and local authorities, will work closely to develop shared actions and targets of health inequalities. A delivery plan is expected early in 2005 when funding to support the activity will be announced.

2. Purpose of the OBS The PCT is inviting expressions of interest, with indicative costings, from potential Providers who understand our requirements and who are interested in taking forward this exciting opportunity to significantly re-design and enhance primary care provision within the catchment population.

In order to demonstrate fairness and equity, the services within this specification will be dependent on potential providers’ response to this OBS which will include the development of an appropriate service model and service specifications, incorporating relevant quality standards.

Expressions of interest from potential Providers which propose a joint venture for example with the service provision directorate of the Sample PCT, the local Teaching Trust, and GP practice(s) providers would be actively considered.

3. Background to the Requirement The Health and Social Care Act (2003) placed PCTs under a new duty of care to secure the provision of primary medical services. This took effect from 1st April 2004.

PCTs must therefore commission or provide primary medical services to “the extent that they consider it necessary to meet all reasonable requirements of their population”.

This enables PCTs the opportunity to think strategically and plan new and innovative ways of delivering services that are responsive to, and reflective of, local need.

This may assist in easing the workload on over-burdened GP practices, address need in areas of historic under-provision, enable re-provision of services where practices opt out and improve access in areas experiencing problems with the recruitment and retention of General Practitioners (GPs). The PCT has subsequently determined the need for the commissioning of additional capacity for primary medical services for a pre-determined population within the locality, to ensure that this population have:

 access to a comprehensive range of primary and community services  increased choice in where they are able to secure provision of primary and community medical services from  access to a range of enhanced services

3.1 Workforce issues One of the main aims of this development is to provide a genuine increase in clinical capacity and activity funded by the NHS. A central principle would be that staffing implications of this development do not disrupt existing services within the local health economy.

Potential Providers will be expected to demonstrate clearly how they would achieve workforce additionality requirements, provide the high quality services required, using suitably qualified and experienced staff and comply with the Departments of Health’s

Code of Practice for NHS employers involved in the international recruitment of healthcare professionals.

The recruitment and retention of staff within the NHS is a national problem. Across Sample PCT there has been an expansion of services that has led to staff shortages across all professions. This over the next few years may dramatically increase due to the projected retirement of all sections of the workforce in particular General Medical Practioners. The PCT has recognized this problem and is working pro-actively to improve the situation working closely with the tPCT.

The PCT has embraced the commitments to the Improving Working Lives (IWL) initiative, which ensures progressive employment practices are in place to attract and retain staff. In addition attained Investors in People (IIP) status reinforces the themes of valuing staff and ensuring facilities and opportunities are available for training and development.

The development of integrated care teams is seen as vital with regard to re-engineering the workforce which will provide exciting opportunities for health care professionals. For example it is envisaged that the role of the community pharmacist will continue to develop to include for example chronic disease management and health promotion. Another existing project is the delivery of Out of Hours care in an innovative and integrated manner.

The PCT is developing plans to further the close links with schools and community groups to ensure that NHS careers have an increased profile across the diverse local population.

4. Strategic Context There are a number of strategic “drivers” which will support the development and delivery of this OBS. These policies are interlinked and complimentary, and potential Providers will see common themes evident throughout these policies and the expected benefits of this OBS.

4.1 Shifting the Balance of Power within the NHS: Securing Delivery 2001 This sets the agenda for health services with new ways of working to devolve power to frontline staff and a new approach to involving patients and the public. PCTs are responsible for:

 improving the health of the local community with a strong focus on public health, community development, health promotion and partnership working;  securing provision of health services;  integration of health and social care;

 involving patients and the public in designing and delivering services.

4.2 Delivering the NHS Plan 2002 This outlines the government’s proposals to improve health services and health outcomes by:

 expanding capacity through increased numbers of clinical staff;  increasing the amount of community based healthcare via one-stop shops;  increasing use of IT for patient records and booking appointments;  increased choices for patients;  substantial use of private finance initiatives to extend the range and improve the quality of primary and community premises;  supporting staff with increased pay, more training opportunities and flexible working arrangements;

4.3 Improvement, Expansion & Reform: The Next 3 Years Priorities and Planning for 2003-2006 This identifies the national priorities and targets to be met by 2006. These include:

 improving access to GPs and reducing inpatient and outpatient waiting times;  increasing activity in primary and community settings;  targets on cancer, coronary heart disease, mental health, older people and children in care;  a reduction in death rates from cancer, coronary heart disease, including reductions in smoking rates;  increased numbers of GPs, nurses, therapists, health care assistants and mental health workers;  increased access and use of IT for communication, booking appointments, prescribing and record keeping.

4.4. A Better Quality of Life; A Strategy for Sustainable Development for the UK The aim of this document is to make the case for linking health improvement and sustainable development agendas. There are 4 key aims:

 social progress that meets the needs of everyone;  effective protection of the environment;  prudent use of natural resources;  maintaining high and stable levels of economic growth and employment

5. Expected benefits

The following benefits are expected from the implementation of this new innovation detailed in the OBS:

Draft note: PCTs should list below any of their expected benefits that should be reflective of their individual requirements and content of the OBS.

For example:  improved care for patients with Long Term Conditions (LTC), thereby actively contributing to the national target of a 5.52% reduction in bed days by 2008

 improved patient access to appropriate range of health care professionals,

 increased provision for a modern multidisciplinary workforce with extended skills, increased responsibility and training

 integrated solution to tackle both poor health and the determinants of poor health

6. Public Health in Sample PCT The following information is based on the most recent public health data set and includes demographic data from the 2001 census.

The locality has a relatively young population with X % of the population under the age of 15, with X % aged 65 or over. Thus Anytown has a greater proportion of young people than nationally (in England & Wales 18.9% of the population are under 15 years)

The target population within Anytown that this OBS is particularly concerned with, is XX % of ethnic heritage.

Using the Government’s Index of Multiple Deprivation, Anytown ranks as x most deprived local authority in England. This pattern is reflected in other indicators of social disadvantage, which have important influences on future health.

A further measure of deprivation that forms a useful indicator of the need for primary care and preventative services is the Jarman Index, which is based on 8 census variables and is often used as a proxy indicator for deprivation.

The national Jarman score is 0. Districts with a positive score are more deprived than those with a negative score.

Part of the PCT strategy to address this will involve investment in primary and community care. It also involves working with a range of local partnerships to improve environmental, social and economic conditions the locality.

The PCT expects that by meeting the service delivery requirements of this OBS, as detailed in PART B (Requirements) and PART C (Rules for Respondents), that potential Providers can work in partnership with the PCT and other agencies, to help address these problems.

6.1 Target areas On average the health of the local population is poor and age and sex standardised mortality ratios are worse than the national average and considerably worse than the national mortality rates.

This may be largely explained by a number of environmental and socio-economic factors, which have operated from historic periods and exist today.

Within the NHS Plan there are four major service specific areas with specific targets to be achieved by 2010.

 Cancers – reduce death rates in under 75 year olds by at least 20%  Coronary heart disease and stroke – reduce death rate in under 75 year olds by at least 40%  Accidents – reduce death rates by at lest 20% and serious injury by at least 10%  Mental illness – reduce death rate from suicide by at least 20%

As well as these national targets, there are a number of other public health issues which PCTs can identify themselves from their public health data which may require inter- agency working to secure the necessary health improvements for their local population.

Potential Providers should consider all of the national targets and local public health issues in their response to this OBS in order to meet the considerable challenges for the delivery of healthcare.

In doing so, potential Providers should note, that whilst they will not be expected to provide health intervention schemes themselves, they will be expected to demonstrate, via their response to this OBS, a mechanism for facilitating patient access to such intervention schemes, where it is required.

7. Disclaimer

Sample PCT has used reasonable endeavours in providing the information contained in this OBS at the time of issue and any changes to the specification will be notified as appropriate.

It should be noted that this document does not constitute a contract in any way and although it is the intention of the PCT to award and place a contract as a result of this procurement, the PCT is not bound to do so. As such, the PCT reserves the right to award or decline awarding a contract.

8. Confidentiality The information provided by the document is issued to Providers in confidence and should only be used for the purpose of this procurement.

The successful Provider will be required to sign a mutual confidentiality agreement upon award of a contract.

Part B – Requirements

9. Key considerations There are a number of key considerations that potential Providers are required to take into account in their response to the overall requirements of this OBS.

9.1 Environmental considerations Potential Providers are asked to describe how they will ensure that health and safety requirements will be met. Particular reference should be made to the disposal of clinical waste, Sharps, storage of medicines, aids & appliances and those substances which may be necessary to undertake minor surgery procedures as laid out in this OBS.

9.2 Information Technology The National Programme for IT is an essential element in delivering the NHS Plan. It will create a multi-billion pound information infrastructure, which will improve patient care by increasing the efficiency and effectiveness of clinicians and other NHS staff. It will do this by:

 creating an NHS Care Records Service to improve the sharing of consenting patients records across the NHS

 making it easier and faster for GPs and other primary care staff to book hospital appointments for patients

 providing a system for electronic transmission of prescriptions

 ensuring the IT infrastructure can meet NHS needs now and in the future.

Potential Providers are asked to demonstrate their ability to fully comply with NPfIT requirements and indicate the IM & T hardware and software which they will reasonably be expected to provide in order to meet the defined needs of this OBS.

Providers will be required to use a compliant GP system with the proven ability to support the required standards in the areas of security, information governance, Choose & Book, Electronic Transfer of Prescriptions and GP2GP functionality.

The Provider would need to liaise with the PCT and Local Service Provider (LSP) for their area to agree an implementation strategy.

For further information use www.npfit.nhs.uk

10. Core Requirements Potential Providers are requested to give details under each of the relevant headings below of how they propose to provide the output requirements, together with full details of any constraints that apply to meeting fully any of the stated requirements.

In addition, potential Providers are asked to indicate the level of requirement they expect to provide or alternative approaches against each heading and demonstrate value for money, consideration of possible HR implications and added value, wherever possible.

The absence of any information will be taken to indicate non-compliance, both current and future.

The core requirements are categorized as follows:

Obligatory An output requirement which the PCT considers to be essential and of particular importance and which may, as appropriate, (but will not necessarily) end up being treated as mandatory, which the Provider will be required to demonstrate they can fully satisfy Desirable An output requirement which the PCT considers to be of lesser importance and which may, as appropriate, (but will not necessarily) end up being treated as non- mandatory

10.1 Access It is a Planning and Priorities Planning Framework 2003-2006 target to ensure 100% of patients who wish to do so can see a primary healthcare professional within one working day and a GP within two working days by December 2004

Obligatory Providers are requested to provide details of how access to both GPs and healthcare professionals will be met and maintained in line with these requirements.

10.2 Primary Medical Services Following primary legislation and the introduction of the new national General Medical Services Contract (2003), Investing in General Practice, the provision of primary medical services has been categorized into Essential Services, Additional Services and Enhanced Services. The definitions of these services may change from time to time, subject to developments in national and local priorities, best practice and legislation requirements.

Providers should note that PART B, Section 13.7 (Management of the Contract) details how such changes would be made.

10.2.1 Essential Services Obligatory It is expected that Providers will be able to deliver all Essential Services as defined below.

i) management of patients who are ill or believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable

ii) general management of patients who are terminally ill

iii) management of chronic conditions in the manner determined by the healthcare professional in discussion with the patient

iv) Note summarization (patient records)

10.2.2 Additional Services Obligatory It is expected that Providers will be able to deliver all Additional Services as defined by the New GMS (GMS) Contract (2003) Investing in General Practice:

i) cervical screening

ii) contraceptive services

iii) vaccinations and immunisations

iv) child health surveillance

v) maternity services – excluding intra partum care (which will be an Enhanced Service

vi) minor surgery procedures of curettage, cautery, cryocautery of warts and verrucae, and other skin lesions

10.2.3 Directed Enhanced Services (DES) Desirable Providers are requested to indicate which of the following DES they may be able to provide. These services are as defined by the New GMS Contract (2003) Investing in General Practice:

i) improved access to general medical services

ii) childhood immunisations

iii) influenza immunisation for those in the 65 and over and other at-risk groups

iv) minor surgery

v) services to support staff in dealing with violent patients

10.2.4 Local Enhanced Services (LES) Desirable Providers are requested to indicate which of the following LES they may be able to provide and provide proposals as appropriate. These services are as defined by the New GMS Contract (2003) Investing in General Practice:

Draft note: PCTs should list below any of their LES for Provider consideration.

10.3 In Hours Home Visiting Service The criteria for determining when home visits are necessary should be set out in the practice leaflet. These criteria state that a practice will provide at the home of a registered or non-registered patient in its practice area, such services as the practice is contracted to provide during hours, which do not fall in the Out-Of-Hours (OOH) period when, in light of the patient’s medical condition, the doctor considers that such services are needed and would most appropriately be delivered by means of a home visit.

Obligatory Providers are asked to describe how they will provide this service to registered and non-registered patients as appropriate.

10.4 Out of Hours Service The out-of-hours period is defined as from 6.30 pm to 8.00 am on weekdays, and the whole of weekends, Bank Holidays and Public Holidays, and at other times as arranged between the PCT and Out of Hours provider.

Potential Providers should note that arrangements for Out of Hours provision in respect of this OBS will be by negotiation with the PCT and current Out of Hours provider. However, it is expected that existing arrangements will be extended to accommodate the requirements of this OBS.

10.5 Non-registered patients The responsibility for the provision of immediate/necessary/emergency treatment and treatment to temporary residents will be with the Provider.

Obligatory Providers are asked to describe how they will provide these services to patients.

10.6 Non-NHS work Under the new GMS contract rules, practices are be able to accept fees for non-NHS work in respect of providing organisations with a range of medical reports which are defined below.

Obligatory Providers are asked to describe how they aim to provide this range of services to patients.

i) examining (but not otherwise treating) a patient for the purpose of creating a report arising from a Road Traffic Accident or a criminal assault

ii) providing drugs and/or medical supplies, including travel kits, which a patient requires whilst he or she is abroad (this is in addition to existing provision in respect of travel vaccines)

iii) attending and examining (but not otherwise treating) a patient at the request of a commercial, educational or not-for-profit organisation for the purpose of creating a medical report or certificate

iv) attending and examining (but not otherwise treating) for the purpose of creating a medical report required in connection with an actual or potential claim for compensation against any public or private body that the patient and his or her legal advisers believe may have been responsible for some harm that the patient has suffered (whether it is permissible in law for practices to be able to levy this charge in addition to any charge that the practice is entitled to make under the Access to Medical Records Act will be examined)

v) examining (but not otherwise treating) a patient for the purpose of creating a report that offers and opinion as to whether a patient is fit to travel by air

10.7 Quality Frameworks In line with professional opinion and to reflect the ethos that higher quality care is most likely to be achieved through the use of incentives, the new GMS contract introduced a Quality and Outcomes Framework (QOF) based on the best available research evidence. This framework represents the first time any large health system in any country will systematically reward practices on the basis of the quality of care delivered to patients.

10.7.1 QOF Obligatory Potential providers are expected to work in partnership with the PCT, to agree a timetable against which they will agree their aspirations and subsequent work towards achievement of such aspirations, against the QOF, in line with other PCT practices.

10.8 Academic Unit (AU) There are two main reasons why recruitment and retention difficulties are experienced across the local health economy. One reason is related to the high socio-economic deprivation in the locality. This results in a population with high morbidity and mortality, especially from heart disease, diabetes and cancer. This perversely provides an excellent teaching base for healthcare professionals. The second reason is the absence of a locally based higher education provision.

There is strong local support for building a step change in the way health care professionals are trained across the local health economy and the concept of the AU has the potential to delivery this conceptual change.

The PCT in partnership with the tPCT has been successful in negotiating with the NPCRDC, a fully funded evaluation in their research programme for this initiative.

10.8.1 Research Obligatory Providers are asked to consider the concept of the AU and describe how they will maximise the opportunities afforded by this new Unit. Consideration should be given to how the relationships between the Provider, the PCT, the tPCT and the NPCRDC will be developed and maintained. Potential areas of conflict should also be identified along with suggested strategies to minimise such conflict.

10.8.2 Workforce Obligatory Providers are asked to describe how the desired additional capacity (clinical and non- clinical) could be facilitated by the development of the Unit. Providers should demonstrate how this will be achieved working in partnership with the tPCT and other local higher education partners where appropriate.

10.9 Walk in facilities/services Walk-in facilities/services in GP practice settings and health centres, provide advice and treatment for a range of clinical conditions as well as advice to prevent ill-health. They form an important component of patient choice in primary care.

It is envisaged that this overall scheme could incorporate a walk in facility/service approach whereby patients from other practices (or patients currently not registered with any practice) could access nurse or pharmacy led services without the need to book an appointment.

This would be particularly relevant where individuals who are not “registered” with the new service, present with those symptoms which are more traditionally associated with walk in centres, or where care is more appropriately delivered by other health care professionals.

For example, a nurse-led, Advice, Clinical Assessment and Treatment facility, which is available throughout the extended working day, can be offered to any individual as and when they present, and, new models of care for patients with long-term conditions could be delivered by pharmacist led teams.

Potential Providers are asked to demonstrate how they aim to develop and deliver the following Walk in facility/service through-out an extended working day, making explicit reference to working in partnership with other local providers and demonstrating workforce and training requirements.

The scope of services described is a combination of those services that were recently defined by the Department of Health (Department of Health 2003: Ambulatory Care Plus), and also those services that are particularly relevant to the health needs of the local population.

10.9.1 Access Obligatory

Providers are required to indicate how they will ensure patient access to healthcare advice, care and treatment during the following times, bearing in mind the Planning and Priorities Planning Framework 2003-2006 target as previously described and local Out Of Hours arrangements:

Monday – Sunday 8.00am until 10.00pm

Desirable Extended hours to this service can be considered as follows:

Monday – Friday 10.00pm until midnight Saturday, Sunday & Bank Holidays – 8.00pm until 10.00pm

10.9.2 Services Obligatory Potential Providers are asked to demonstrate how they will provide the following range of services, taking into consideration links with other local service providers and being mindful that these walk in centre services are not intended to replace local GP or hospital services but should complement them:

i) coughs, colds & ‘flu-like symptoms

ii) information on staying healthy, health promotion: diet, exercise

iii) information on local services

iv) skin complaints, including (but not limited to), rashes, sunburn, headlice, nappy rash, urticaria, scabies

v) cuts and bruises

vi) sore throat

vii) hayfever, bites & stings

viii) stomach ache, indigestion, constipation, vomiting & diarrhoea

ix) women’s health, e.g. thrush, menstrual advice

x) muscle and joint injuries – strains and sprains

xi) phlebotomy services *

xii) dressing care *

xi) suturing and suture removal *

xii) blood pressure monitoring

* particularly where local practices have no treatment room staff or facilities

Desirable

PCTs should list below any of their Desirable WIC criteria for Provider consideration

11. Long Term Conditions The PCT is committed to improving and developing services for those patients with long term conditions. The PCTs vision to achieve these improvements will aim to provide patients’ care closer to their home, support them in managing their conditions in a way which suits them and reduce the number of related emergency bed days (from 2003/04 baseline) by 5.52% by 2008. This may be done by reducing the number of admissions, reducing length of stay or a combination of both.

Draft note: PCTs should use their own local Long term condition strategy to determine which services or developments have the potential to be delivered by Providers and list these below.

12. Possible additions and variations to core requirements (obligatory & desirable) Providers may wish to comment on the following as possible variations to the core requirements.

12.1 Implementation Support The successful Provider may be required to support the launch of this new initiative by working with staff and patients groups to inform resulting changes to service delivery from that previously experienced.

12.2 Additional IM & T Support Providers will be required to consider any additional IM & T requirements, with particular reference to those necessary to meet national standards for service developments such as connection to N3 Catalogue services in respect of the Electronic Transfer of Prescriptions (ETP).

12.3 Terms of Service updates or amendments Providers should be mindful of a number of Terms of Service which still require clarification and/or amendment. Such areas currently outstanding include:

Emergency supply of medications Refusal of supply when appropriate Rounding to patient pack quantities Hours of opening Extended opening hours and out-of-hours

12.4 Training practice status/learning practice environment Consideration may be given to the future development of the practice to become a recognised training practice for both clinical and non-clinical staff.

12.5 Vaccinations during outbreak The PCT will liaise with the successful Provider in the event of an outbreak, to facilitate a vaccination programme as appropriate. Providers may wish to consider how this may be facilitated as part of this OBS.

12.6 Additional information and enhancements to scope In this section, respondents may provide additional information about their proposal and any further service enhancements which would or could be provided as part of the overall solution.

12.7 Management of the contract The PCT is committed to ensuring that the implementation of any contract awarded as a result of the procurement process is consistent with any relevant national guidance and the original intentions of this document. All changes to the contract will be undertaken using the Change Control Procedure, as laid out in the Schedules to the Contract.

Further details on the exact management arrangements that will apply to this OBS will be provided at a later date.

12.8 Requirements for service management There will be a requirement to manage the service elements of the contract to ensure that standards are and continue to be consistent with the best available evidence and data.

Whilst there will be a requirement to ensure provision of the range and depth of those services agreed with the successful provider, there will also be requirements to ensure adequate arrangements are in place to support service provision, such as human

resource management, premises management, financial management and IM & T support.

It will be necessary to comply with existing and any new recommendations from the National Institute for Clinical Excellence (NICE) and the publication of further National Service Frameworks (NSFs) and other relevant national and local public service documents.

Where new standards are recommended for introduction, this shall be facilitated via existing PCT Service Provider panels as previously indicated.

12.9 Requirements for patient/user liaison Section 11 of the Health and Social Care Act 2001 places a duty on strategic health authorities (SHAs), PCTs and NHS Trusts, to make arrangements to involve and consult patients and the public in planning services, developing and considering service changes and in decisions which affect how services operate. However, patient and public involvement is central to developing any organisation and NHS organisations in particular, should recognise the value of listening to and actively engaging with their constituent populations.

It is therefore a requirement on the successful Provider to develop effective mechanisms to actively engage with and consult with their population in relation to this new development, in partnership with the PCT and tPCT Team.

This will ensure the provision of services which are responsive to local need and will strengthen links across with the local health community to make long-term improvements to peoples’ health and well-being and engender PCT between health and care organisations and the public.

The PCT would welcome and support the establishment of a patent forum with the Provider in order to further engage patients and the local community.

12.10 Requirements for contract review meetings etc The PCT will meet with the Provider at least quarterly to review the provider’s performance against the contract.

The PCT envisages using its established contract review team to facilitate these meetings in order to ensure a consistent approach to contract management across all of its practitioners.

12.11 Monitoring, information and accountability

As well as formal contract review meetings, the PCT will agree with the Provider the following activities to support the monitoring of the contract and to agree the accountability requirements to the contract.

The Provider shall furnish the PCT such information requested by the PCT for the collation of national and/or local statistics and other such relevant information, as soon as reasonably practicable upon request.

The PCT will strive to avoid duplication requests for clinical and quality information wherever possible.

The PCT shall notify the Provider of any new or amended Regulations or Directions that relate to the Providers’ responsibilities or the PCTs’ responsibilities under this contract. The Provider and the PCT will then change or amend as appropriate, any terms of the contract as necessary. All changes to the contract will be undertaken using the Change Control Procedure, as laid out in the Schedules to the Contract.

The key clinical focus for all parties will be on the public health outcomes for the population served under this scheme.

The PCT shall endeavour to furnish the Provider with any information, access to facilities or access to other support necessary to the successful implementation and operation of the scheme, as is reasonably requested by the provider. The availability of such support will take into account the resources and overall priorities of the PCT.

13. Constraints Providers should detail fully any possible or likely constraints to their implementation of this scheme. Providers should be able to suggest ways in which these may be overcome or minimised. Such constraints may include the following (this list is not exhaustive but is merely suggestive of possible items for consideration).

 Interaction with other business activities

Possible TUPE requirements – potential Providers are advised that clarification on such requirements will be given in due course.

 Partnership working

14. Risk Transfer Providers are required to provide the following information in support of this scheme:

 Inventory of risks identified for this scheme

 An indication of which risks the Provider will have ownership of, risks that PCT will retain, and which risks the Provider wishes to share with the PCT

Part C Rules for respondents

16. Procurement process The proposed procurement process and any subsequent scheme implementation date, will follow the process and timetable outlined below. Potential Providers are invited to comment on their ability to meet these proposed timescales. Please note that the dates provided are for guidance only and the PCT will not be bound by these dates.

16.1 Procurement timetable TO BE INSERTED HERE

16.2 Implementation timetable TO BE AGREED WITH THE PREFERRED PROVIDER

16.3 Key dates Potential Providers should note the dates indicated on the procurement timetable, where their attendance may be required should they be successful in proceeding through the various stages of the procurement process.

16.4 Scripted demonstrations and provider presentations Short-listed Providers will be requested to provide a demonstration and presentation of their proposed solution in meeting the requirements of this OBS, in a script provided by the PCT.

16.5 Site visits Short-listed Providers will be requested to provide members of the evaluation panel with access to site(s) where the Provider delivers similar solutions, where appropriate.

17. Evaluation criteria and methodology High-level evaluation criteria will be made available to Providers for key stages of the procurement process.

18. Financial information from providers Providers must complete all information required in the Financial Schedule, as provided, when submitting responses.

19. Details of response required Potential Providers are asked to note and act upon, where appropriate, the content of this section of the OBS, which aims to give potential Providers information to aid their submission. It also acts as a checklist for potential suppliers to ensure that all relevant information is included as part of their submission.

In order to ensure transparency of process, fairness and equity, and to aid PCT comparison and evaluation of bids received, the PCT requires that potential Providers to layout their submissions in a standardised format.

Providers are required to give a point by point response to those items and services, as detailed in PART B, (Requirements) of this OBS. Additionally Providers are referred to PART C (Rules for Respondents) of this OBS s in order to describe their preferred approach to service provision, including project management arrangements, a project plan, suggested timetable to implementation, organisation details and staffing requirements, including TUPE arrangements where appropriate.

Part D Glossary of terms

Additional Services (in relation to primary medical services) These services relate to the provision of primary medical services and include:

i) cervical screening

ii) contraceptive services

iii) vaccinations and immunisations

iv) child health surveillance

v) maternity services excluding intra-partum care (which will be an enhanced service)

vi) those minor surgery procedures of curettage, cautery, cryocautery of wards and verrucae, and other skin lesions

AU Academic Unit. A Unit to provide training and research opportunities within a primary care setting.

Advanced Services These are new services arising from the new pharmacy framework due for implementation in 2005. These services are defined as requiring accreditation of the pharmacist providing the service and/or specific requirements to be met in regard to premises. These services include:

i) medicines use review

ii) prescription interventions

APMS Alterative providers of medical services. One of the four new contracting routes open to PCTs in order to secure the provision of primary medical services to its population. Providers may include, commercial organisations, not-for-profit organisations, the voluntary sector, NHS PCTs, other PCTs, foundation trusts; and practices.

CHD Coronary heart disease

COPD Chronic obstructive pulmonary disease

Directed Enhanced Services (in relation to primary medical services) These are services that relate to the provision of medical services and which are under national direction with national specifications and benchmark pricing which all PCTs must commission to cover their relevant population. These services include:

i) support services to staff and the public in respect of the care and treatment of patients who are violent

ii) improved access

iii) childhood vaccinations and immunisations

iv) influenza immunisations

v) quality of information preparation

vi) advanced minor surgery

Electronic Transfer of Prescriptions The electronic transfer of prescriptions from GP practices to pharmacies, will allow some of the new pharmacy contract Essential Services, such as repeat dispensing to be carried out more efficiently by using new advances in technology.

Enhanced Services (in relation to primary medical services) These are services that relate to the provision of medical services and include:

i) essential or additional services delivered to a higher specified standard, for example, extended minor surgery

ii) services not provided through essential or additional services. These might include more specialized services undertaken by GPs or nurses with special interests and allied health professionals and other services at the primary-secondary care interface. They may also include services addressing specific local health needs or requirements, and innovative services that are being piloted and evaluated.

Essential Services (in relation to primary medical services) These are services that relate to the provision of medical services and include:

i) management of patients who are ill or believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever possible

ii) general management of patients who are terminally ill

iii) management of chronic disease in the manner determined by the practice, in discussion with the patient

Essential Services (in relation to pharmacy services) These services are obligatory for all Service Providers and include:

i) dispensing of medicines

ii) repeat dispensing

iii) sign-posting

iv) public health: health promotion

v) support for patient self-care

vi) disposal of unwanted medicines

vii) clinical governance

Foundation Trusts NHS Foundation Trusts are a new type of NHS Hospital tailored to the needs of local populations and run by local managers, staff and members of the public. The Health and Social Care Act 2003 establishes NHS foundation trust as independent public benefit corporations modeled on co-operative and mutual traditions.

GMS General Medical Services One of the four contracting routes open to PCTs in order to secure the provision of primary medical services for its population. In this instance services are provided by primary care professionals (usually GPs or nurses) under a new nationally agreed contract.

GP General practitioner

LIFT Local Improvement Finance PCT.

Local Enhanced Services (in relation to primary medical service) These are enhanced services that are developed locally. The terms and conditions of these services will be discussed, negotiated and agreed locally between the PCT and potential practices, providers and with the involvement of the LMC.

LMC Local medical committee A statutory representative committee for general practitioners.

LTC Long term conditions Also known as chronic diseases. These are diseases which are treatable but for which there is no cure. Such diseases include, diabetes, heart failure, chronic obstructive pulmonary disease and asthma.

National Enhanced Services (in relation to primary medical services) These are enhanced services that have national specifications and benchmark pricing but are not directed. These include:

i) intra partum care ii) anticoagulation monitoring

iii) intra-uterine contraceptive device fitting

iv) more specialised drug and alcohol misuse services

v) more specialised sexual health services

vi) more specialised depression services

vii) multiple sclerosis services

viii) enhanced care of the terminally ill

ix) enhanced care of the homeless

x) enhanced services for people with learning disabilities

xi) immediate care

xii) first response care

xiii) minor injury services

NICE National Institute for Clinical Excellence Is a special health authority that promotes the best possible service and effective use of resources within the NHS. It sets clear national standards to improve the quality and consistency of NHS services throughout the country.

NPCRDC National Primary Care Research and Development Centre based at Manchester University;

NSFs National Service Frameworks. These are set national standards and define service models for different services or care groups

Out Of Hours This refers to: i) the period beginning at 6.30pm on any day from Monday to Thursday and ending at 8am on the following day;

ii) the period between 6.30pm on Friday and 8am on the following Monday; and

iii) Good Friday, Christmas Day and Bank Holidays;

OBS Output based service specification This outlines to potential providers the scope and range of services which the PCT may require them to provide to a population.

Patient Forum In England, established by Section 15 of the National Health Service Reform and Health Care Professions Act 2002, inter alia, to monitor and review the range and operation of services provided by, or under arrangements made by, the Primary Care PCT for which it is established

PMS Personal Medical Services One of the four new contracting routes open to PCTs in order to secure provision of primary medical services to its population. In this instance services are provided by

primary care professionals (usually GPs or Nurses) under a locally agreed contract with their PCT.

Primary Care Trust Primary Care Trusts bring together GP practices, nurses and allied health professionals within a geographical area and have a key role in the commissioning of services for patients

PCTMS Primary Care PCT Medical Services One of the four new contracting routes open to PCTs in order to secure the provision of primary medical services to its population. In this instance PCTs can provide these services themselves.

QOF Quality and outcomes framework This is a framework that supports the new GMS contract. The framework is designed to systematically reward practices on the basis of the quality of care delivered to patients. The framework consists of 4 domains that represent clinical disease areas, organizational aspects of general practice, additional services and patient experience.

SHA Strategic health authority

TPCT Teaching Primary Care PCT

TUPE The Transfer of Undertakings (Protection of Employment) Regulations 1981 (as amended) – commonly known as the TUPE Regulations – safeguard employees’ rights where businesses change hands between employers.

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 100 NHS Purchasing and Supply Agency procurement guide - APMS

Appendix D

Other Documents to be issued at ISPO & ISFO stages

Contents

Document 1 Covering Letter

Document 2 Terms of Offer

Document 7 Form of Offer

 Crown copyright, NHS Purchasing and Supply Agency Document 1

Covering invitation to offer letter

Note. PCT to enter details as indicated by the bold print.

Dear Sirs Re: Invitation to offer for the supply of Alternative Provider Medical Services (APMS) Offer reference number: [insert reference number] Period of contract: [insert date] to [insert date] Official Journal of the European Communities reference: [insert reference number if applicable or delete if not]

Offers are invited subject to the terms of this letter and also to the Terms of Offer (document no.2) for the supply, in accordance with the NHS Terms and Conditions of Contract for Alternative Provider Medical Services (APMS) (document no.3), Supplementary Conditions of Contract (document no.4) and Additional Supplementary Conditions of Contract (document no.4a), of the services detailed in the Specification (document no.5). [insert name of health authority or NHS PCT] does not bind itself to accept the lowest or any offer and reserves the right to accept an offer either in whole or in part, each item being for this purpose treated as offered separately. [insert name of health authority or NHS PCT] reserves the right to award contracts for the supply of the [insert details of services] described above and arising out of this procurement process to more than one supplier. This Invitation to Offer package comprises the following documents (if any of these documents are missing please contact me immediately): Document no.1 This covering letter Document no.2 Terms of Offer Document no.3 NHS Terms and Conditions of Contract for Alternative Provider Medical Services (APMS) Document no.4 Supplementary Conditions of Contract Document no.4a Additional Supplementary Conditions of Contract (if applicable) Document no.5 Specification Document no.6 Offer Schedule Document no.7 Form of Offer I would like to draw your attention to the following important points when completing and submitting your offer: 1. All offers must be written in English and, where applicable, in ink. 2. All offers must be submitted in accordance with the documentation provided herein. This must not be amended in any way.

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 102 3. All offers must be submitted in a plain sealed envelope bearing the address label enclosed. The envelope must not identify the name of your company. 4. The envelope containing your offer must be returned to the Offers Administrator at the address on the enclosed label no later than [insert time] on [insert date]. I must also draw your attention to the enclosed Form of Offer where all the requirements for completing and submitting an offer can be found. Failure to comply with these instructions may result in your offer being rejected. I hope that this clarifies matters, but please contact me if there is anything you wish to discuss. Yours faithfully

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 103 Document 2

Note. PCT to enter details as indicated by the bold print. Terms of Offer

1. Information and confidentiality 1.1 Information that is supplied to Offerors as part of the procurement exercise is supplied in good faith. However, Offerors must satisfy themselves as to the accuracy of such information and no responsibility is accepted for any loss or damage of whatever kind or howsoever caused arising from the use by the Offerors of such information, unless such information has been supplied fraudulently by [insert name of health authority or NHS PCT]. 1.2 All information supplied to offerors by [insert name of health authority or NHS PCT] in connection with this procurement exercise shall be regarded as confidential. By submitting an offer the offeror agrees to be bound by the obligation to preserve the confidentiality of all such information. 1.3 This invitation and its accompanying documents shall remain the property of [insert name of health authority or NHS PCT] and must be returned on demand.

2. Freedom of Information Act 2000

2.1 The Freedom of Information Act 2000 (FOIA) applies to [insert name of health authority or NHS PCT]. 2.2 Offerors should be aware of the [insert name of health authority or NHS PCT] obligations and responsibilities under the FOIA to disclose, on request, recorded information held by [insert name of health authority or NHS PCT]. Information provided by offerors in connection with this procurement exercise, or with any Contract that may be awarded as a result of this exercise, may therefore have to be disclosed by [insert name of health authority or NHS PCT] in response to such a request, unless [insert name of health authority or NHS PCT] decides that one of the statutory exemptions under the FOIA applies. The [insert name of health authority or NHS PCT] may also include certain information in the publication scheme which it maintains under the FOIA. 2.3 In certain circumstances, and in accordance with the Code of Practice issued under section 45 of the FOIA or the Environmental Information Regulations 2004, [insert name of health authority or NHS PCT] may consider it appropriate to ask offerors for their views as to the release of any information before a decision on how to respond to a request is made. In dealing with requests for information under the FOIA, [insert name of health authority or NHS PCT] must comply with a strict timetable and [insert name of health authority or NHS PCT] would,

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 104 therefore, expect a timely response to any such consultation within five working days. 2.4 If offerors provide any information to [insert name of health authority or NHS PCT] in connection with this procurement exercise, or with any Contract that may be awarded as a result of this exercise, which is confidential in nature and which an offeror wishes to be held in confidence, then offerors must clearly identify in their offer documentation the information to which offerors consider a duty of confidentiality applies. Offerors must give a clear indication which material is to be considered confidential and why you consider it to be so, along with the time period for which it will remain confidential in nature. The use of blanket protective markings such as “commercial in confidence” will no longer be appropriate. In addition, marking any material as “confidential” or equivalent should not be taken to mean that [insert name of health authority or NHS PCT] accepts any duty of confidentiality by virtue of such marking. Please note that even where an offeror has indicated that information is confidential, [insert name of health authority or NHS PCT] may be required to disclose it under the FOIA if a request is received.

2.5 [Insert name of health authority or NHS PCT] cannot accept that trivial information or information which by its very nature cannot be regarded as confidential should be subject to any obligation of confidence.

2.6 In certain circumstances where information has not been provided in confidence, [insert name of health authority or NHS PCT] may still wish to consult with offerors about the application of any other exemption such as that relating to disclosure that will prejudice the commercial interests of any party.

2.7 The decision as to which information will be disclosed is reserved to [insert name of health authority or NHS PCT], notwithstanding any consultation with you.

3. Prices 3.1 Prices must be stated in the Offer Schedule (document no.6) and must remain open for acceptance until [insert number] days from the closing date for the receipt of offers. 3.2 Prices must be firm (i.e. not subject to variation) for the period of the contract subject only to any variation provisions contained in the contract documents.

4. Offer documentation and submission 4.1 Offers may be submitted for all services or for selected items. 4.2 The services offered should be strictly in accordance with the Specification (document no.5). Alternative goods and/or services may be offered but all

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 105 differences between such items and the Specification must be indicated in detail in the Offer Schedule. 4.3 Offers must comprise: 4.3.1 • the Offer Schedule (document no.6) 4.3.2 • the Form of Offer (document no.7) 4.3.3 • a statement of prompt settlement discounts, if available 4.3.4 • details of the offeror’s ability, if any, to trade electronically 4.3.5 • confirmation that any information previously supplied to [insert name of health authority or NHS PCT] in connection with the offer is still accurate and is incorporated by reference into the offer. 4.4 The Form of Offer must be signed by an authorised signatory: in the case of a partnership, by a partner for and on behalf of the firm; in the case of a limited company, by an officer duly authorised, the designation of the officer being stated. 4.5 The Form of Offer and accompanying documents must be completed in full. Any offer may be rejected which: 4.5.1 • contains gaps, omissions or obvious errors; or 4.5.2 • contains amendments which have not been initialled by the authorised signatory; or 4.5.3 • is received after the closing time. 4.6 For help in completing the Form of Offer please contact [insert name and telephone number] for commercial queries and [insert name and telephone number] for technical queries. 4.7 Offers must be written in English and submitted in a plain sealed envelope which does not identify the offeror. The envelope should bear the address label enclosed herewith and arrive at that address no later than [insert time] on [insert date].

5. Contract award criteria 5.1 The contract will be awarded on the basis of the most economically advantageous offer judged on price, quality, delivery performance, risk and overall cost effectiveness. These factors are not listed in any particular order of importance.

6. Contract monitoring 6.1 [insert name of health authority or NHS PCT] is committed to helping improve the efficiency of contracted suppliers through sharing information on performance measurement. The criteria for measuring performance shall be agreed with the supplier/s and formally documented. It is possible that measurement criteria will develop during the term of the contract - this will also be documented following agreement with the supplier/s.

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 106 [insert / delete the following clause as appropriate 7. TUPE 7.1 The attention of offerors is drawn to the provisions of the European Acquired Rights Directive EC77/187 and TUPE (Transfer of Undertakings Protection of Employment Regulations). TUPE may apply to the transfer of the contract from the present supplier to the new one, giving the present supplier’s staff (and possibly also staff employed by any present sub-contractors) the right to transfer to the employment of the successful offeror on the same terms and conditions. The above does not apply to the self-employed. 7.2 Offerors are advised to form their own view on whether TUPE applies, obtaining their own legal advice as necessary. 7.3 To assist in this process [insert name of health authority or NHS PCT] is seeking workforce details from the present supplier. This information will be supplied to you on request on the basis that you treat it as strictly confidential; that you do not disclose it except to such people within your organisation, and to such extent, as is strictly necessary for the preparation of your offer; and that you do not use it for any other purpose. By requesting this information from [insert name of health authority or NHS PCT] you will be deemed to have agreed to abide by these obligations of confidentiality. 7.4 The successful supplier will be required to indemnify [insert name of health authority or NHS PCT] against all possible claims under TUPE. 7.5 It is a further requirement that the successful supplier will pass on all details of their own workforce towards the end of the contract period so that this information can be passed to other bona fide suppliers to enable them to assess their obligations under TUPE in the event of a subsequent transfer.]

[insert / delete the following clause as appropriate 8. Rebates/commissions 8.1 In any application of rebates and commissions, offerors will be treated fairly and equitably within their markets. Furthermore, agreement will be reached between both parties on the process for relating payments to contractual activity.]

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 107 DOCUMENT 7

Note. PCT to enter details as indicated by the bold print. Form of Offer

NHS Contract for Alternative Provider Medical Services (APMS) [insert name of offeror] (‘the Offeror’) of [insert address of offeror]

Agrees: 1.1 That this offer and any contracts arising from it shall be subject to the Terms of Offer, the NHS Terms and Conditions of Contract for Alternative Provider Medical Services (APMS) and Supplementary Conditions of Contract and all other terms (if any) issued with the Invitation to Offer; and 1.2 to supply the services in respect of which its offer is accepted (if any) to the exact quality, sort and price specified in the Offer Schedule in such quantities, to such extent and at such times and locations as ordered; and 1.3 that this offer is made in good faith and that the Offeror has not fixed or adjusted the amount of the offer by or in accordance with any agreement or arrangement with any other person. The Offeror certifies that it has not and undertakes that it will not: 1.3.1 • communicate to any person other than the person inviting these offers the amount or approximate amount of the offer, except where the disclosure, in confidence, of the approximate amount of the offer was necessary to obtain quotations required for the preparation of the offer, for insurance purposes or for a contract guarantee bond; 1.3.2 • enter into any arrangement or agreement with any other person that he or the other person(s) shall refrain from making an offer or as to the amount of any offer to be submitted.

Dated this [insert day] day of [insert month and year]

Name (print)

Signature

Title

The Form of Offer must be signed by an authorised signatory: in the case of a partnership, by a partner for and on behalf of the firm; in the case of a limited company, by an officer duly authorised, the designation of the officer being stated.

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 108 Appendix E Contract acceptance letter

Dear Sirs Re: Proposed contract for Alternative Provider Medical Services (APMS) Offer reference number: [insert reference number] Period of contract: [insert date] to [insert date] Official Journal of the European Union reference: [insert reference number if applicable or delete if not]

I am pleased to inform you that your offer included within the document with reference [insert reference number] dated [insert date] for the above services is acceptable and that your company has accordingly been awarded a contract. The contract schedule detailing the services you are contracted to supply is enclosed. This schedule is not variable without the prior written consent of [insert name of health authority or NHS PCT]. Your attention is drawn to the following terms in the Form of Offer which provide that: 1. The current NHS Terms and Conditions of Contract for Alternative Provider Medical Services (APMS) and other terms issued with the Invitation to Offer govern all contracts resulting from orders placed with your company. 2. The prices submitted and agreed to are firm for the period stated in the contract schedule and must not be disclosed to any party outside [insert name of health authority or NHS PCT] except with the agreement of [insert name of health authority or NHS PCT]. 3. The quantities stated are [insert either ‘fixed’ or ‘estimates only’]. 4. This contract is for the use of [insert name of health authority or NHS PCT] only. I would like to thank you for the time and effort spent in submitting your offer and I look forward to our working together to ensure that the contract is managed effectively. I should be grateful if you would acknowledge receipt of this letter by return. Yours faithfully

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 109 Appendix E Contract rejection letter

Dear Sirs Re: Proposed contract for Alternative Provider Medical Services (APMS) Offer reference number: [insert reference number] Period of contract: [insert date] to [insert date] Official Journal of the European Union reference: [insert reference number]

I regret to inform you that your offer reference [insert reference number] dated [insert date] for the above services has been unsuccessful. I would like to thank you for the time and effort spent in submitting your offer. Should you require a debriefing on the reasons why your offer was unsuccessful, please do not hesitate to contact me. Yours faithfully

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 110 Appendix F Outline model contract for Primary Medical Services

This outline model contract template was drafted by Bevan Brittan with the assistance of colleagues from the Department of Health and NHS PASA.

This is version 3/draft 8 28.4.2005.

It is imperative that you check www.nhsconfed.org. for the latest model contract information.

apms_contract_temp late.pdf

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 111 File ref:

Version Author/editor Notes Date published 19/04/05 Peter W Jones First version not released 28/06/05 Faye Robinson Second version not released 11/07/05 Faye Robinson Third version not released 23/08/05 Faye Robinson Final version released 26 August 2005

 Crown copyright, NHS Purchasing and Supply Agency - July 2005 112