The NHS Commissioning Environment, A Guide for ion in the Third Sector

8/9/2019 The NHS Commissioning Environment, A Guide for ion in the Third Sector

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Titl The NHS commissioning environment: A guide fororganisations in the third sector

Auth The Department of Health; Third Sector Partnership Team

Publicatin dat March 2010

Tagt audinc National charities, third sector and social enterprise

volunteer-involving organisations; third sector and socialenterprise service providers; local community voluntarygroups, Voluntary Organisations/NDPBs, Trade Unions

Ciculatin list Voluntary Organisations/NDPBs Trade Unions

Dsciptin This guide aims to support third sector organisations andand social enterprises maximise their full potential incontributing to improved health and well-being servicesand outcomes for England, by describing key featuresof the NHS commissioning environment and highlightingthe potential roles and opportunities for the sector

Css nc N/A

Supsdd dcunts N/A

Actin quid N/A

Tiing N/A

Cntact dtails Howard ChapmanThird Sector Partnership TeamRoom 3E44, Quarry HouseQuarry Hill, LeedsLS2 7UE0113 254 5212

f rcipints us

Crown copyright 2010

First published March 2010

Produced by COI for the Department of Health

www.dh.gov.uk/publications
http://www.dh.gov.uk/publicationshttp://www.dh.gov.uk/publications


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fwd by thminist Stat

Ca Svics

As Minister of State for Care Services and with

responsibility for the third sector within health and social

care,I am well aware of the sectors substantial role in the delivery of high quality health and social care services.

Icontinue to be excited about the possibilities for thesectors contribution to tackling some of our biggest health challenges.

Third sector organisations have a strong track-record of

designing services based on strong insight into community and individual clients

needs, and are often better placed to respond flexibly to those needs. They are

often able to reach those vulnerable and hard to reach groups who may not be

in regular contact with statutory health and social care services.

Government reform recognises that by developing a broader range of service

providers, we can increase capacity, encourage innovation and improve userresponsiveness. However,Iappreciate there are challenges and barriers that canprevent the sector from achieving its full potential. In particular, if we are to

encourage third sector organisations to enter NHS markets, it is important that we

help the sector to better understand the developing commissioning environment,

which can seem complex and daunting.

Ihope that this guide will go some way to assist third sector organisations toachieve their potential by explaining, in a straightforward way, the NHS

commissioning environment including the commissioning cycles, and illustratingpotential roles and opportunities for the sector.

Phil Hope

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Cntnts

1. Intductin...................................................................................................4 2. Undstanding th stuctu th NHS........................................................5

2.1 Introduction...........................................................................................52.2 The organisational structure of the NHS.................................................62.3 Roles of organisations ............................................................................ 7

3. What is Cissining? ............................................................................123.1 The commissioning cycle ..................................................................... 123.2 What is commissioning? ...................................................................... 123.3 Who are the commissioners for the NHS?............................................16 3.4 Patient Public Involvement...................................................................193.5 The Compact.......................................................................................20

4. Hw t ngag and wk with cissins ............................................214.1 An overview of healthcare planning processes .....................................214.2 Points of engagement for thirdsector organisations.............................254.3 Collaboration and partnership working opportunities...........................27

5. Bcing a svic pvid t th NHS......................................................28 5.1 Tendering process and awarding contracts ...........................................285.2 Procurement policy .............................................................................. 285.3 Choice, Cooperation and Competition.................................................295.4 Grants as a funding route.....................................................................305.5 The procurement process..................................................................... 325.6 NHS contracts...................................................................................... 35

6. Cnclusin.......................................................................................................38

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1. Intductin

1.1 Thirdsectororganisationsand social enterprisesarekeypartnersindelivery

at everylevel andquarter acrossthehealth and social care system: contributingtothedevelopment andimplementationofpolicy and

services,helpingdriveinnovation andqualityimprovement; informingand contributingthroughthecycleof commissioningfor

healthand care services,helping understand users needs andexpectations; and

asprovidersofhealth and careservicesamongst anincreasinglydiverserangeformally commissionedbytheNHS andlocal authorities.

1.2 CommissioningofNHS servicesisincreasinglyfocusing onquality,greatercontrol,pathways of care,personalisation, andimprovingthe outcomesforindividuals.Thisisbeingachievedthroughgiving service users more choiceof services and

providers.

Two examples of

how

this

is

being achieved are:

thedevelopment ofpersonalhealthbudgetswhichgiveserviceusersthefreedomtodirectlychoose andpayfor care; and

theconcept of any willingproviderisbeing usedtocommissionpotentialproviderstogive service users choice andensurethatqualityisthe organisingprinciple ofhealthcaredelivery.

1.3 Thisguideaimstosupportthirdsectororganisationsand social enterprisesto makethe most ofthe opportunities available and maximisethe extenttowhichthey are ableto achievetheirfullpotentialin contributingtoimprovedhealthand wellbeing services and outcomesforthepopulation ofEngland.Itdoesthisbydescribingthekeyfeatures oftheNHScommissioning environment, along withkey stagesinthe commissioningcycles,highlightingthepotential roles and opportunitiesforthe sectorsetting outthekey stagesinbeing commissioned,inparticularfocusing on: understandinghowtheNHS commissioning environmentisstructured; howthirdsectororganisationsand social enterprisescanengagewith

NHScommissioners; and tenderingprocessesandfunding routesthattheNHS uses.

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2. Undstanding th stuctu th NHS

2.1 Intductin2.1.1 If the third sector and social enterprises are to work successfully with the

NHS, and the NHS is to benefit from the opportunities and benefits offered

by the third sector service delivery, it is key that there is mutual

understanding between NHS commissioners and third sector organisations.

There are ongoing initiatives to improve commissioners capability andunderstanding of the third sector. The aim of this guide is to help

organisations in the third sector to understand how the NHS works and

where the key opportunities for partnership working exist. This section

explains the way the NHS is structured, the planning process, and how

priorities are set. Finally, it focuses upon how to engage with

commissioners and, where appropriate, tender and contract for NHS

funded services.

2.1.2 The English health care system has four main features: The Government sets out policy and key priorities.

The health system is funded by the state through taxation.

The Government appoints the key regulators of services.

The Government allocates funds to local commissioners to supportproviders of health care services.

2.1.3 One of the main reasons this guide is being produced is that the last of

these is changing. The ability of patients to choose means that the provider

market for health is diversifying. Other sectors are becoming approved

providers of services, contracted to provide services through an increasingly

sophisticated process of procurement by PCTs.

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Structure of the NHS today

Department of Health

Funding

Accountability

Referrals

Contracts

10 Strategic HealthAuthorities

152 primary care trusts

Specialistservices

Hospitalservices

Out of hospitalservices

Communityservices

Primary careservices

GPs

Providers

The NHS commissioning environment: a guide for organisations in the third sector

2.2 Th ganisatinal stuctu th NHS2.2.1 In very simple terms the NHS is structured to plan and deliver services as

set out below:

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Understanding the structure of the NHS

2.2.2 To fully explain the main structures, the diagram below illustrates the

nature of the relationships between the various elements of the NHS

system, including regulators:

2.3 rls ganisatinsThis next section explains in detail the roles of each type of organisation

in this structure.

Dpatnt Halth (DH)

2.3.1 The DH has the overall responsibility for health and social care policy

for England. The role of the DH is to set overall policy, guidance and

frameworks designed to create the conditions for improvement and

innovation in the delivery of health and social care, to benefit staff,

patients and the public by:

setting national standards;

shaping the direction of health and social care services;

promoting health and wellbeing; and reducing health inequalities.

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DH Third Sector Partner Induction 5 May 2009


2.3.2. The DH does not deliver health and social care services to the public

directly. Instead it works with a variety of delivery partners, principally

within the health and social care system, which includes the NHS, local

government, DHs arms length bodies, and independent private and third

sector organisations. More information about the DH can be found at

www.dh.gov.uk

Statgic Halth Authitis (SHAs)

2.3.3 Strategic Health Authorities provide the key link between the DH and

the local NHS. The role of the 10 SHAs is to provide strategic leadership

for a large geographical area at regional level and monitor the performanceof local PCT areas, including local NHS Trusts, to ensure that local health

systems operate effectively and collaboratively. Of particular relevance

to this guide, SHAs have a lead role in assuring PCTs commissioning

competencies and are responsible for PCT commissioning development

programmes.

rginal planning

SHAs are mainly coterminous, and work closely with the Government

Offices for the Regions. At a regional level the SHAs need to be aware ofthe other demands on government and work with several regional

partners. These are set out below:

Regional landscapeRegional Association Public Healthof Directors of Adult ObservatoriesDH Regional

Social ServicesTeam

StrategicCommission Health AuthorityCare Quality

Regional SelectImprovement and

Regionaland Grand

Efficiency CommitteesPartnership

RegionalGovernment Assembly

Office (replacement organisation in allregions except London)

Regional DevelopmentLocal

Government Agency UniversitiesAssociation

Regional Ministersregional body

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SHAs work with the Regional Improvement and Efficiency Partnerships

on issues of joint concern, with the Government Offices and the Joint

Improvement Partnerships (JIPs) whose membership include key regional

figures from the DH social care team and Directors of Adult and Childrens

services as well as key third sector representation.

Some joint commissioning may take place at a regional level where the

people needing services are small in number and have relatively specialist

requirements. This regional commissioning level can provide focus on

common outcomes and give greater efficiency to provision. Regional

structures do vary.

Piay ca tusts

2.3.4 Most primary care trusts (PCTs) have the same geographic boundaries as

local authorities. PCTs have three main functions:

to engage with their local population to improve health and wellbeing;

to commission a comprehensive and equitable range of high quality,responsive and efficient services, within allocated resources, across all

health service sectors; and

to directly provide services, for example many PCTs currently providedistrict nursing and health visiting services and some also provide some

specialist services such as community dentistry.

PCTs must have in place separate internal management arrangements

for their provider arms, ensuring that they are treated in the same

manner as any other provider. In February 2010 the Department of

Health issued guidance (Transforming Community Services: The

assurance and approvals process for PCT-provided community

services), which required PCTs to develop, agree and implementproposals for the future organisational structure of their current PCT-

provided community services. Options include integration with other

community-based providers, which could include third sector providers,

as well as setting up new social enterprises under the Right to Request

scheme (see below).

Pvids

2.3.5 There are a number of types of organisations that provide NHS-funded

care. Traditionally, most services have been delivered by PCTs themselves,

and NHS Trusts which are accountable to SHAs and usually provide either

acute hospital, mental health or ambulance services. Increasingly, NHS

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Trusts are becoming NHS Foundation Trusts; these have a greater degree

of autonomy than NHS Trusts and and are regulated by Monitor (see

below).

2.3.6 Most primary care services have traditionally been delivered by General

Practitioners, either as independent practitioners or working in partnership

with other GPs within a practice. GPs also have a role in commissioning

services as practice based commissioners; this is explained in more detail in

the section focusing on Strategic Commissioning.

2.3.7 The diversity of providers is expanding. Already some services in some

areas are delivered by non-NHS providers, and also by local authorities.NHS staff working in PCT-provided community services have also been

given the Right to Request to develop a business case for the transfer of

the services they provide into a social enterprise which will diversify future

supply further. Any services which are transferred under this arrangement

will be market tested after the expiry of the initial contract.

rgulatsCa Quality Cissin

2.3.8 Until recently the quality of NHS services was monitored by the Health

Care Commission (HCC), the Commission for Social Care Inspection (CSCI)

and the Mental Health Act Commission. From April 2009 they merged into

one organisation, the Care Quality Commission (CQC), which regulates

the quality of both health and adult social care. Health and social care

providers including, for the first time, NHS providers are required to

register with the new regulator in order to provide services that fall under

the scope of regulated activity. The registration requirements that all

providers, including the third sector, must meet are consistent across both

health and adult social care. Regulation is focused on essential levels of

safety and quality of services to ensure that patients, users and vulnerable

groups are protected.

In addition, the CQC carry out a periodic review of PCTs, NHS providers

and local authorities (previously known as the Annual Health Check) and

Performance assessment of Local Authorities. For more information go to

www.cqc.org.uk.

mnit2.3.9 NHS foundation trusts provide over half of all NHS hospital and mental

health services. Foundation Trusts are monitored by an independent

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regulator Monitor to ensure that they are well managed and financially

strong. There are three main strands to Monitors work:

determining whether NHS trusts are ready to become NHS FoundationTrusts;

ensuring that NHS Foundation Trusts comply with the conditions theyhave signed up to that they are well-led and financially robust; and

supporting NHS Foundation Trust development.

Audit Cissin

2.3.10 The Audit Commission audits NHS trusts, PCTs and strategic healthauthorities to review the quality of their financial management systems.

They also publish independent reports which highlight risks and good

practice to improve the quality of financial management in the health

service and encourage continual improvement in public services including

in the field of public health and health inequalities.

Cphnsiv Aa Assssnts (CAA)

2.3.11 The Audit Commission has developed tailored frameworks for CAA for

council areas, which will include the role and contribution of PCTs. The

frameworks pull together a range of information in an objective and

comparable way to reach an overall judgement on a councils performance.

The CAA framework document, published on 10 February 2009, set out

how CAA will be delivered from April 2009. CAA reflects the new era of

public sector partnership working. This new assessment framework will

provide a snapshot of how effectively local partnerships are working

together to deliver local peoples priorities.

CAA has been developed and will be delivered jointly by the main public

sector inspectorates. The partner inspectorates are:

Audit Commission

CQC

HM Inspectorate of Constabulary

HM Inspectorate of Prisons

HM Inspectorate of Probation, and

Ofsted.

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3. What is cissining?

3.1 Th cissining cycl

3.2 What is cissining?

3.2.1 There are many definitions but the four main components are:

Identifying need What do we need?

Identifying demand How much do we need?

Shaping the market Who can do it and how?

Holding the market to account Monitor, adjust and review

3.2.2 The key principles for commissioning as set out by the Office of the Third

Sector are:

Understand the needs of those using the service.

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What is commissioning?

Consult provider organisations when setting priorities.

Put outcomes for users at the heart of the process.

Map the fullest practical range of providers.

Consider investing in the provider base.

Ensure contract processes are transparent and fair.

Ensure long-term contracts and risk sharing.

Seek feedback to review effectiveness of the commissioning process.

3.2.3 The processes and broad timetables for commissioning within the NHS are: Strategic Commissioning:

needs assessment (spring and summer);

decommissioning decisions (summer and early autumn);

priority setting (autumn);

defining the service programmes required (on-going).

Funding/Procurement and Contracting (see the PCT ProcurementGuide, www.dh.gov.uk/en/Publicationsandstatistics/Publications/

PublicationsPolicyAndGuidance/DH_113745):

shape the structure of supply (ongoing)

grant funding awards (winter and spring)

procurement and contracting (winter)

Monitoring, Performance Management Review

contract settlement and review (monthly)

performance assessment (monthly)

Wld Class Cissining

3.2.4 The Department of Health has developed a vision for NHS commissioning

which outlines what it means to be world class commissioners within the NHS

at a local level, and how world class commissioning will impact population

health and wellbeing. See www.dh.gov.uk/en/managingyourorganisation/

commissioning/worldclasscommissioning/index.htm

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In suay:3.2.5 World class commissioning aims to

deliver better health and wellbeing for all, so that:

people will live healthier and longer lives; and

health inequalities will be dramatically reduced.

deliver better care for all:

services will be evidence-based and of the best quality; and

people will have choice and control over the services that they use,so services become more personalised.

deliver better value for all:

investment decisions will be made in an informed and consideredway, ensuring that improvements are delivered within available

resources; and

PCTs will work with others to optimise effective care.

WCC assuanc syst3.2.6 The world class commissioning assurance system gives appropriate

frameworks for assessing a PCTs current capability and identifying future

development requirements for world class commissioning, and to ensure

that health outcomes are improving. Therefore, it also gives the third sector

a useful understanding of what they can expect from local commissioners.

Cptncis

3.2.7 World class commissioning competencies describe the knowledge, skills,

behaviours, and characteristics that commissioners will need to reach world

class status.

3.2.8 In summary, world class commissioners will:

locally lead the NHS;

work with community partners;

engage with public and patients;

collaborate with clinicians;

manage knowledge and assess needs;

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prioritise investment of all spend;

stimulate the market;

promote improvement and innovation;

secure procurement skills;

manage the local health system; and

efficiency and effectiveness of spend.

3.2.9 The full vision and other information is available at www.dh.gov.uk/en/

Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm

3.2.10 Third sector organisations can help commissioners to achieve these

competencies, particularly in relation to working with community partners,

engaging the public and patients, assessing need, stimulating the market

and promoting improvement and innovation.

Suppt and dvlpnt awk

3.2.11 A support and development framework exists to give commissioners accessto the tools they need to drive improvements in commissioning practice,

either by sharing services and good practice, developing internal resources,

or buying in external expertise, for example through the Framework for

procuring External Support for Commissioners (FESC). FESC provides PCTs

with easy access to a framework of expert suppliers who can support them

in undertaking their commissioning functions. FESC assists commissioners

by:

providing easy access to a framework of organisations, offering a range

of skills and experience, that have been through a robust pre-qualification process by the Department;

saving time in undertaking procurement activities with easy access tooptimum value for money solutions;

minimising the range of organisations offering resources, which willreduce the legal and cost implications that can be encountered when

seeking to procure external support; and

adopting more innovative and efficient approaches to commissioning.

There is the potential for third sector organisations to become involved in

supporting PCTs as commissioners (for example, in contributing to needs

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assessment or service design and specification), helping them to become

world class commissioners either directly or in partnership with a FESC

provider.

3.3 Wh a th cissins th NHS?3.3.1. The commissioners of NHS services are principally practice based

commissioners and PCTs. This section sets out their roles in more detail

and also the roles of other key commissioning organisations.

Pactic basd cissining

3.3.2 A practised based commissioning (PBC) group often comprises GPs, but it

can also include other primary care professionals such as nurses,

pharmacists and optometrists, amongst others. Individual practices may

become a PBC, they may also form an alliance/consortium or a cluster with

other practices in their local area.

3.3.3 PBCs develop commissioning plans for their communities and patients, and

working closely with PCTs and secondary care clinicians, decide how best

to meet the needs of their patients to achieve the best clinical, health and

wellbeing outcomes. They also play a key supporting role to PCTs byproviding valuable feedback on provider performance.

3.3.4 PCTs are the budget holders, and therefore take the lead in actually buying

services including tendering and placing contracts. They have overall

accountability for healthcare commissioning; however, practice based

commissioning is crucial at all stages of the commissioning process, to

inform each PCTs purchasing decisions.

3.3.5 More information can be found at: www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Practice-basedcommissioning

Piay ca tusts

3.3.6 PCTs are responsible for working with PBCs and local authorities to engage

with their local population to assess needs, commissioning health care

services to meet those needs, and improve health and wellbeing outcomes.

3.3.7 They normally take the lead in procuring and placing contracts with

providers to reflect those commissioning needs. PCTs can enter intopartnerships with local authorities who may take the lead in procurement

and contracting for services (see below for joint commissioning).

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3.3.8 PCTs may also work together and collaborate to commission services via

Specialist Commissioning Groups (SPGs) to agree strategic commissioning

approaches for specialist services that are organised across larger

geographical areas. Local cancer networks are an example of this. A single

PCT may then take the lead in contracting for services on behalf of the

SPG to meet the aims of the joint commissioning plan.

Lcal authitis

3.3.9 Local authorities are responsible for commissioning social care for their

population.

3.3.10 Local authorities and PCTs work as key partners in Local Strategic

Partnerships (LSPs). LSPs are non-statutory, multi-agency partnerships that

match local authority boundaries. They are charged with bringing together

different sectors of the community public, private, community and the

third sector to work together more effectively in instigating and

developing new initiatives that improve the main areas of performance laid

out in the PSAs and the Local Area Agreement targets (see below). Most

LSP structures deal with the local issues relating to earning, learning,

community safety and health. Each Local Authority should have a

dedicated structure for its LSP and a website detailing its local structure

and targets. In most areas, third sector organisations are already involved

in the LSP, which reflects the local Compact agreement. Individual

organisations may wish to consider their own links with the LSPs and

how they can influence them effectively.

3.3.11 Some services may form legal partnerships with PCTs to commission and/

or provide services jointly. The framework provided by the National Health

Service Act 2006 means money can be pooled between health bodies and

health-related local authority services, functions can be delegated andresources and management structures can be integrated.

The arrangements allow commissioning for existing or new services, as wellas the development of provider arrangements, to be joined up. They were

previously referred to as Section 31 Health Act flexibilities, and cover:

lead commissioning (where a commissioner takes the lead on behalf ofthe other);

integrated provision (where health and social care staff work together,sometimes this is via a Care Trust); and

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pooled budgets (where budgets are merged for specific issues, e.g.learning disability services).

3.3.12 In England, Section 31 of the Health Act 1999 has been replaced by

Section 75 of the National Health Service Act 2006, which has consolidated

NHS legislation. The new provision is in exactly the same terms, and

existing Section 31 arrangements will continue as if made under the new

powers.

Any new partnership arrangements should refer to the new powers underSection 75, rather than to Section 31. Similarly, previous grant

arrangements known as Section 28A

and Section 28 BB have changed asresult of the NHS Act 2006, and are now known as Section 256 and 76

respectively.

3.3.13 Further information can be found at www.dh.gov.uk/en/Healthcare/

IntegratedCare/Healthact1999partnershiparrangements/index.htm

Childns Tusts

3.3.24 Childrens Trusts bring together all local services for children and young

people, to focus on improving outcomes. They do not necessarily manageservices directly, but focus on ensuring that services are commissioned and

organised in a cohesive and coherent manner. Their commissioning plans

are normally procured and contracted by both PCTs and local authorities.

3.3.25 Arrangements which allow local authorities and primary care trusts to pool

childrens budgets or integrate the provision of childrens services are

known as Section 10 agreements.

Lad pvids3.3.26 PCTs may choose to contract with a lead provider to deliver certain types

of care; the lead provider may then sub-contract elements of this care to

other providers. Both NHS trusts and NHS foundation trusts could be lead

providers of care. Equally, third sector or independent sector providers

could also undertake this role. Where this arrangement is in place, lead

providers are responsible for ensuring that the main requirements of their

contract with the commissioner in relation to quality and governance are

reflected in any sub-contract.

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3.4 Patint Public InvlvntLcal Invlvnt Ntwks (LINks)

3.4.1 The Local Government and Public Involvement in Health Act 2007 placed

a duty on local authorities with social services responsibilities to arrange for

a LINk to be established in their area (from 1 April 2008). This same

legislation abolished the previous system of Patient Forums.

3.4.2 Local authorities contract with a Host organisation that is then responsible

for setting up and supporting the LINk. LINks are independent networks of

individuals, organisations, groups and associations, and have been set up

to:

cover all publicly funded health and adult social care services in thelocal authority area;

promote and support the involvement of people in the commissioning,provision and scrutiny of local services, thereby providing communities

with a mechanism to monitor and review local health and social care;

actively canvass every section of the community for their views andexperiences of local care services;

make those views known to those responsible for commissioning,providing, managing and scrutinising services.

3.4.3 Under the legislation LINks can:

make recommendations for improvements and expect a response withina specific timescale;

enter certain premises and view the care being provided; and

refer matters to the local Overview and Scrutiny Committee and expecta response within a specific timescale.

3.4.4 Anyone can get involved in a LINk from individuals (e.g. carers, service

users, community leaders) to groups and organisations (e.g. charities,

faith groups, Black and Minority Ethnic (BME) organisations, user-led

organisations, tenant groups and youth councils) in a variety of ways

to suit their needs.

ovviw and Scutiny Citts3.4.5 Each local authority has a Health Overview and Scrutiny Committee; these

were established by the Health and Social Care Act in 2001 to monitor

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local health services and it must be consulted on major local service

changes.

3.5 Th Cpact3.5.1 Established in 1998, the Compact is an agreement between Government

and the voluntary and community sector in England. It recognises the vital

role that the sector has in society, working alongside the state and the

private sector, and the values, principles and commitments it shares with

Government. The Compact provides the framework for how both parties

should work together, with overarching principles and commitments that

each side will undertake in order to ensure productive partnership working.It is built on trust, mutual goodwill and the belief that working together

will produce better outcomes than working in isolation.

3.5.2 The Compact is not statutory guidance, its authority derives from the fact

that it is signed up to by government and the sector. The Compact applies

to central government departments, including Government Offices for the

Regions, and executive non-departmental public bodies that have a

relationship with the third sector organisations.

3.5.3 A national level, the Compact Partnership consists of the Office of the

Third Sector, based in the Cabinet Office, which represents the interests of

government, and Compact Voice, which represents the interests of the

third sector. The Commission for the Compact is an independent body

responsible for overseeing the Compact.

3.5.4 All English local authority areas are covered by a Local Compact. These

compacts, along with regional compacts that support them, provide a

jointly agreed framework of principles to guide the working relationship

between local authorities, primary care trusts and other public bodies andthe third sector in the area, with the aim of deriving mutual, purposeful

and positive benefit. Local Compacts cover all aspects of relations across

the whole range of third sector organisations in the local area. They are

based on the national Compact, but are tailored to take into account

differences between areas.

3.5.5 A key Compact principle, especially at local level, is that service delivery

and voluntary and community activity are equally important. Therefore,

contracts and grants (and other support) should be kept in balance.

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4. Hw t ngag and wkwith cissins

4.1 An vviw halthca planning pcsss4.1.1 In many ways the heart of the commissioning cycle is what used to be

called a planning process. The planning process starts with the

determination of key goals, and aims to make the best use of available

resources. All budgets are finite and therefore it is essential to know the

limit of resources available to the planning organisations of the NHS andthen determine the priorities for investment. The process for setting out

the national priorities and the financial resources available to the NHS is

the responsibility of government. The local NHS responds to national

priorities by developing a plan to deliver improvement. Increasingly the

focus is for the local NHS to establish and address priorities at a local level

within its geographic boundary. Central to this is the Joint Strategic Needs

Assessment (JSNA) which is led by primary care trusts (PCTs) and local

authorities.

Cphnsiv Spnding rviw (CSr)

4.1.2 The CSR is a process which started in 1997, under the current Government,

and covers a three-year period which sets out fixed expenditure limits for

each government department, including Health. The CSR process also sets

out the key improvements in public services to be made in the three-year

period for which the expenditure limit has been set. The Governments

priorities are set out in Public Service Agreements (PSAs). The PSAs for

the current period are set out at www.hm-treasury.gov.uk/pbr_csr07_

psaindex.htm. The current PSAs are reflected in the Operating Frameworkof the NHS.

4.1.3 The NHS is funded through general taxation. Funding for government

departments is determined through Spending Reviews. The Treasury

announced three years of funding for the NHS as part of the last

Comprehensive Spending Review (CSR) in October 2007. The CSR also

sets out the key priorities for the funding as part of the Departments

Public Service Agreements (PSAs). The current CSR period runs from

2008/09 to 2010/11. A key aim of the Spending Review process, has beento allow organisations to develop longer term financial plans. This includes

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the ability to award longer term contracts to providers and grants to third

sector organisations.

4.1.4 The Government priorities are set out in the PSAs. Where appropriate the

Department cascades these to the NHS though the priorities set out in the

NHS Operating Framework and its Vital Signs indicators. The indicators

clearly distinguish the national must dos from those areas where local

organisations need to set their priorities based on local needs. The

operating framework for the NHS in England 2010/11, which sets out

current priorities for the NHS along with performance management

arrangements, is available at: www.dh.gov.uk/en/Publicationsandstatistics/

Publications/PublicationsPolicyAndGuidance/DH_110107. This keypublication sets out the issues which PCTs are required to address and is

therefore ssntial ading cunt and ptntial pvids.

4.1.5 Along with the Operating Framework, the DH issues financial allocations

to PCTs to fund local services.

Natinal plicy

4.1.6 National policy is set out by the DH at various times of the year and

includes major strategies or statements about organisational changes and

technical guidance on a variety of NHS issues. The DH website provides

information about new documents and new consultations (www.dh.gov.

uk). Organisations such as the National Institute for Health and Clinical

Excellence (www.NICE.org.uk), the Kings Fund (www.kingsfund.org.uk)

and the NHS Confederation (www.nhsconfed.org) produce useful analyses

of the papers issued.

Piitis and planning

4.1.7 The following annual planning processes and documents are key

to understanding the priorities at both national and local levels. Their

development also gives the potential for third sector organisations to

influence commissioning priorities and receive early notice of tendering

opportunities.

Lcal iplntatin

4.1.8 In most places the detailed plan for each PCT is worked on during the

summer and autumn. During that period there should be openengagement with users and user groups in order to review current services

and to help produce the plans for future service configuration. A Joint

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How to engage and work with commissioners

Strategic Needs Assessment (JSNA) is now required for each local authority

and PCT area to frame its commissioning plans; this is described in more

detail below. Between October and December most PCTs prioritise their

planned spending for the year to come, and start to consider how to work

with the providers across all sectors. The period between January and

March is when contracts and other forms of agreement with providers are

finalised. A final plan is agreed by the board of each PCT either in March

of every year or as soon as possible in the new financial year.

PCTs are required to produce five-year Strategic Commissioning plans

which should also be aligned with information from the JSNA (see 4.1.17).

Lcal Aa Agnts (LAAs)

4.1.9 LAAs set out the priorities for each Local Strategic Partnership (LSP) area to

achieve. They are agreed between central government and each LSP

through the Government Offices for the Regions. There are 188 National

Indicators in total, on which progress in each LSP area is reported. Many of

these relate to health and social care, but others relate to community

safety, education and other matters that contribute to improved

communities. Of these 188 national indicators, each LSP will have agreed

35 as key priorities for action (LAA targets), although progress against any

of the 188 could contribute to the Comprehensive Area Assessment (CAA)

by the Audit Commission, Care Quality Commission (CQC) and other

inspectorates of how well the LSP is improving outcomes for local people

in the area. New initiatives and proposals developed by any organisation

should ideally show how the services on offer will contribute to the

achievement of LAA targets.

4.1.10 The NHS has two sets of indicators against which performance is managed

and monitored. These are set out in the NHS Operating Framework asExisting Commitments and Vital Signs. Some of these are specific to the

NHS, while other health and wellbeing indicators require working in

partnership with local authorities. These indicators can help potential

providers to frame discussions and proposals in ways that assist

commissioners to achieve their priorities.

Dict Public Halth pt

4.1.11 Each PCT has a Director of Public Health (DPH). Some are shared with

other NHS organisations but all should be appointments agreed with the

local authority.

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4.1.12 Each DPH produces a report on an annual basis. The report sets out an

assessment of the health of the population for a specific geographic area

and makes recommendations as to how health can be improved in that

area.

4.1.13 It is important to note that the report is independent, in as much as the

report does not have to be formally sanctioned by a local authority or a

PCT board. It is a statement of the independent professional view of the

DPH.

4.1.14 The report should provide health planners with a good basis for producing

local action plans and should be taken account of within the JSNA. It istherefore also useful for the third sector to understand the key priorities of

the Director of Public Health, as this will have an influence upon

commissioning decisions.

Jint Statgic Nds Assssnt (JSNA)

4.1.15 The Local Government and Public Involvement in Health Act 2007 requires

local authorities and health bodies to produce a JSNA of the health and

wellbeing of their local community. This became a duty in April 2008.

JSNA guidance is available at: www.dh.gov.uk/en/Publicationsandstatistics/

Publications/PublicationsPolicyAndGuidance/dh_081097.

4.1.16 The JSNA has been referred to as the story of the community and uses

data regarding population, health, housing, social care and other

prominent areas of possible concern to help paint a picture of both current

and future needs. It may also describe the historical context for the

assessment. It will help communities to understand themselves and

contribute to the setting of priorities through the various planning

mechanisms described here. It is expected that the priorities described in

the JSNA will reflect the outcomes that communities wish for and shape

the final commissioning plans of PCTs and local authorities.

4.1.17 The JSNA should provide the basis for framing key commissioning decisions

to ensure that they meet the identified needs of local people. Third sector

organisations can offer a vital role in engaging and representing the needs

of the population as part of this assessment process.

Pactic basd cissining plans

4.1.18 Each practice based commissioner (PBC) will have a developed process to

produce a commissioning plan for its registered population. This gives PBCs

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the opportunity to suggest alterations to the PCTs current plans in respect

of the services which the PCT purchases. Through these plans there are

opportunities to deliver new, innovative and local improvements. Practice

based commissioning does not mean that practices themselves purchase

healthcare; this is a duty of the PCT.

4.1.19 Plans at a PBC level could give smaller providers an opportunity to work in

a particular area of PCT commissioning and often provides opportunities

for small-scale innovative approaches.

Pvid tust businss plans

4.1.20 NHS trusts and foundation trusts may provide an opportunity for a range

of providers to work in partnership. Trusts produce an annual business plan

setting out their priorities and the key actions they want to take in order to

achieve those plans. In developing these plans, trusts may well be willing

to work with a range of providers in the development and implementation

of their plans. There is no fixed national timetable for the production of the

plans, but mainly they will be expected to be complete before the end of

each calendar year.

4.2 Pints ngagnt thid sct ganisatinsGt t knw yu lcal cissins

4.2.1 For third sector organisations looking to engage and work with NHS

commissioners as a partner or provider, the same tips apply as with any

sector. The key to successful supply is to know your partner and the

market, and understand your partners or potential customers needs and

priorities. Developing a relationship with commissioners can help

organisations shape their potential services and identify future

opportunities for joint working.

4.2.2 It is important to remember that there is a distinct difference between

collaboration and cooperation with commissioners and others to shape the

commissioning plans for services, and competition when a formal tendering

process commences. Third sector organisations will have a legitimate

interest in both stages, but they are distinct. All parties need to ensure that

the first stage provides equal opportunities for all appropriate interests to

play a part. Involvement in this initial stage should not then lead to an

assumption that a competitive tender process is not required, or that thecompetitive tender process is different for any potential legitimate bidder.

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4.2.3 It may also be important for third sector organisations to acknowledge the

differences there may be between their campaigning and advocacy roles

and their roles as potential providers of services. A clear distinction

between these roles will need to be made when working with

commissioners, unless specifically contracted to undertake a particular role,

for instance in an advocacy capacity.

4.2.4 There is already a clear duty, provided by legislation, requiring PCTs to

involve third sector organisations in developing the JSNA. If this is not

happening, organisations should establish how they can participate and

add value to the process.

4.2.5 All PCTs, trusts and local authorities have websites which give information

about their structures, their local plans and how to contact them. In

particular, it is worth looking at board agendas and papers to identify their

priorities in relation to commissioning; this may also identify the lead

individuals within key statutory organisations.

4.2.6 The most appropriate contact for any issue will depend upon specific

circumstances and may vary slightly at a local level, as commissioners do

not necessarily have exactly the same organisational structures.

4.2.7 If the proposed service is basd aund a paticula and sall cunity,

it may be most appropriate and beneficial to discuss it firstly with practice

based commissioners (GP practices). PCTs will have the information about

local PBCs.

4.2.8 If the service is of a spcialist natu a paticula clint gup, enquire

who in the PCT leads for commissioning specialist services.

4.2.9 If the service is focusing on gnal halth ptin, advic suppt it

may be most appropriate to contact the Public Health Directorate.

establish th nd

4.2.10 Is the proposed service one that the NHS currently buys? If it is an existing

service, are there plans to go to competitive tender? If so, when will this

happen?

Ds th ppsal t th cissins nds?4.2.11 Proposals should fit with the identified strategic needs assessment,

priorities and commissioning plan of the commissioner. In addition, your

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proposal should be adabl, vidncd basd and where possible

demonstrate asuabl utcs. Successful proposals will probably

recognise the key partners in care delivery and linkages to other services to

ensure that svic uss a supptd and ca dlivy is salss.

Can th vidnc bas and cptnc th ppsd svicb dnstatd bustly?

4.2.12 Commissioners are held to account for spending public money, and while

they will be interested in new and innovative services, commissioning a

new, untested service without a strong evidence base represents a higher

degree of risk. Equally a new provider will need to give assurance that it isa safe and competent organisation. Providers therefore need to supply

robust evidence on a regular basis that they are fit for purpose, and as far

as possible demonstrate that their proposal will deliver a safe, effective and

value for money service which meets the identified needs.

4.3 Cllabatin and patnship wking pptunitis4.3.1 It may be useful to link up with other organisations with similar interests to

consider collaboration, and to participate in Strategic Commissioning

processes and/or service provision opportunities. Being a member of a localnetwork or providers forum may also provide a channel for regular

communication with commissioners. The local infrastructure organisations

can provide information about local networks and forums, and may also

offer opportunities to engage with local commissioners.

4.3.2 Consortia or partnership arrangements when tendering for services may

increase the potential opportunities for third sector organisations. Further

information and advice can be found in Working in a consortium, available

at: www.cabinetoffice.gov.uk/media/107235/consortium%20guide%20final.pdf

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5. Bcing a svic pvidt th NHS

5.1 Tnding pcss and awading cntacts5.1.1 This section gives an outline of the principles of procurement and how

providers of health care are selected where competitive tendering is used.

It then goes on to explain the different forms of contracts which the NHS

may use.

5.2 Pcunt plicy5.2.1 The PCT Procurement Guide for Health Services supports NHS

commissioners in deciding whether and how to procure health services

through formal tendering and market-testing exercises. The Guide is

intended to complement and build upon wider system management

initiatives and the world class commissioning programme. It is one of

several system management tools and guidance documents announced in

Annex C of The operating framework for the NHS in England 2008/09.

The Principles and Rules for Cooperation and Competition (PRCC) (Annex

D) set out the expected behaviours and processes for procurement, and for

cooperation and competition between providers. Principle 3 of the PRCC

requires PCTs to follow the guidelines set out in the PCT Procurement

Guide.

5.2.2 It is wth nting that NHS cissins d nt ncssaily hav t us

al xtnal pcunt pcsss all svics. Halth ca is

usually classiid as Pat B und eU pcunt law, which ans that

a cptitiv tnd aangnt is nt quid t awad a cntact halth ca. The Guide and the Principles will therefore be applied and

considered by commissioners in each individual circumstance, both when

procuring services, and working with existing providers, to give them the

opportunity to improve or redesign services.

5.2.3 The full guide can be found at www.dh.gov.uk/en/

Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/

DH_113745

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Becoming a service provider to the NHS

5.3 Chic, Cpatin and Cptitin5.3.1 Good procurement systems within the NHS will be characterised by the

proactive and effective use of:

chic on the part of patients between providers of clinical services,settings and models of care;

cptitin between providers for, and in, the healthcare market;

gvnanc arrangements in place in contracting organisations;

cntacts between NHS contracting organisations and providers;

statgic patnships; and

inatin for patients and referrers to enable them to make informedchoices.

Such systems will enable commissioners to secure the best services for the

people they serve, and supply benchmarks against which providers and

clinicians can measure themselves.

5.3.2 The Framework for Managing Choice, Cooperation and Competition

supports these outcomes by:

providing a statement of the bnits ctivly anaging chicand cptitin;

stating the c pincipls by which choice and competition should bemanaged;

ensuring that patints a d gnuin chics and have theinformation to make informed decisions;

defining ls and spnsibilitis anaging chic andcptitin;

outlining the role and development of the independent C-patinand Cptitin Panl; and

setting out how we propose to build the capability t anag chicand cptitin and hold organisations to account through appropriate

assuanc chaniss.

5.3.3 The full framework can be found at www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/

DH_084779

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C-patin and Cptitin Panl (CCP)

5.3.4 An independent national Co-operation and Competition Panel has been setup to advise the DH and consider complaints about alleged breaches of the

principles and rules, for example, from potential providers or bidders who

are dissatisfied with procurement processes. The CCP may consider four

types of cases:

merger inquiries

conduct inquiries

procurement dispute appeals

advertising and misleading information dispute panels

Merger inquiries and conduct inquiries may be considered directly by the

CCP. However, procurement and advertising disputes will only be

considered on appeal from a strategic health authority. The CCP may also

investigate and report on non-case specific competition issues referred to it

by the DH or by Monitor. More information about the referral process can

be found at www.ccpanel.org.uk/referrals-to-ccp/index.html

5.4 Gants as a unding ut5.4.1 PCTs may consider the use of grant funding to support or contribute to

some third sector activities. This is distinguished from services which are

purchased, where a full contract will be more appropriate.

5.4.2 There is a recognised need for both grant funding and contracts to support

a sustainable third sector, including social enterprises. Funding can have

different purposes, and there may be a benefit to maintaining a mix of

grant funding (such as to support the Joint Strategic Needs Assessment)alongside the increasing opportunities to contract for the delivery of public

services. Where third sector and social enterprise providers are acting as

publicly funded service providers on behalf of the NHS, it is appropriate to

have a legal contractual agreement in place, which shares risk and provides

a framework for performance.

5.4.3 The main determinants of the form of the financial relationship are the

purpose of funding and the nature of the intended outcomes. The decision

on which funding mechanism to use should be based on a combination of

these factors:

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Purpose:

Pcunt: used to acquire goods, works or services in line with theGovernments policy of value for money the optimum combination

of whole-life cost and quality (or fitness for purpose) to meet the users

requirement normally achieved through competition; or

Gant: used to fund an activity of a recipient because that activity is inbroad alignment with the Governments objectives. There is a

continuum of uses of grant, although grants in general are subject to a

more detailed level of control than grant-in-aid. At one end of the

continuum, commissioners may wish to give money to a third sector

organisation because it wishes to offer financial support for specifiedaspects of the organisations expenditure. At the other, a commissioner

may wish to give a grant return for which the organisation must deliver

services as specified by the commissioner.

Other issues include:

what level of control is appropriate;

the state of the market; and

the specificity of the outcomes which the funder intends and theindicators available for qualitative and quantitative measurement of

these intended outcomes.

5.4.4 There is, however, an ongoing role for strategic or capacity building

funding, including general grants to assist with the costs of developing and

running an organisation where the objectives of the organisation align with

and contribute to the PCT or local authority responsibilities for health and

social care.

5.4.5 There is also a role for specific grants to enable an organisation to carry

out a particular project. Specific grants are also appropriate for financial

support in an area of work, designed and proposed by the third sector

organisation, that supports activities aligned with the Governments wider

objectives, for example hospice care.

5.4.6 Th Natinal Audit oics Successful Commissioning Guideshuld b

usd by cissins and thid sct pvids t assist in th

dtinatin th st apppiat unding ut. This can b undat www.na.g.uk/succssulcissining

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It should be noted that the awarding of grants may still be on a

competitive basis. In addition, both funders and third sector organisations

need to be mindful of state aid issues when awarding grants.

5.5 Th pcunt pcssAdvtising NHS pcunts

5.5.1 It is now mandatory for all commissioners in the NHS to use the

Supply2Health portal for all healthcare service procurements. NHS

Supply2Health is an online resource that advertises opportunities to

provide Part B clinical services commissioned by the NHS in England.

The website also has details of contracts that have been awarded.

5.5.2 Supply2Health can be found at: www.supply2health.nhs.uk

Ky stags a al pcunt pcss

5.5.3 Competitive procurement approaches can vary and may be via an

invitation to tender, an invitation to negotiate or an any willing provider

route. If a service does go through a formal procurement process, the

key stages may include:

planning

affordability modelling

service specifications

key programme milestones

business case

Official Journal of the European Union (OJEU) advert

bidder expressions of interest (EOIs)

memorandum of information (MOI) and pre-qualification questionnaire(PQQ) issued

bidder information events

PQQ responses

bidder long list agreed and approved

invitation to tender (ITT) award of contract mobilisation

contract management.

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5.5.4 A procurement roadmap for community services has been developed to

support both commissioners and providers in explaining the potential

options when undertaking a competitive tender, and provides model

templates for each stage. This can be found at: www.pasa.nhs.uk/NR/

exeres/EE4ED689-03B5-4564-8070-B72E91B8376E.htm

Intnal itnss pups

5.5.5 Any organisation which is seeking to tender for the delivery of public

services must first of all ensure that it has a robust internal structure and

management arrangements which make it fit for purpose to do business

with the NHS. There are a number of resources which are available tosupport organisations in assessing their fitness for purpose. This guide is

intended to sit alongside these; however, there are two issues which an

organisation planning to provide NHS care may wish to take into account:

any relevant potential requirements of the pre-qualifying questionnaire(PQQ) within a tendering process; if an organisation does not meet

these, the tender cannot proceed beyond this stage of the process; and

the potential requirement to register with a regulator.

extnal quality assuanc gistatin

5.5.6 Many of the activities which are commissioned by the NHS are required to

be registered with a regulator. The role of the regulators and the

development of the Care Quality Commission is explained earlier in this

guide; the transitional arrangements for providers are summarised below.

5.5.7 All providers who are already registered under the Care Standards Act

2000 will be transferred across to a full registration system under the

Health and Social Care Act 2008 in 2010/11. Providers who set up new

services that fall within the scope of current registration systems will be

able to continue to apply under the current system in the run up to the

introduction of the new system. Any new providers making an application

from 1 July 2010 will do so against the requirements set under the Health

and Social Care Act 2008.

Picing

5.5.8 The flexibility in how much providers can charge will depend on which

services they are providing and the tendering process. It is important toremember that price alone will not determine the outcome of a tendering

process, and that other factors are also taken into account when assessing

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each bid for the value for money it offers. The three main factors are

efficiency, economy and effectiveness.

Natinal tai

5.5.9 A national tariff for mainly acute based care is in place for the NHS under

the principles of Payment by Results (PbR). The main aim of PbR is to

ensure that competition is based upon quality and not price. Key objectives

are to:

support patient choice and encourage hospitals to respond to patientpreferences;

encourage commissioners to arrange provision of effective care in themost appropriate settings;

reward hospitals for the work they do;

increase transparency of hospital funding; and

impose a sharper budget discipline on hospitals.

5.5.10 The national prices are based upon health resource groups, which group

together similar treatments and costs in relation to each patient spell. Thereare separate tariffs for elective and emergency care, and a market forces

factor to compensate for unavoidable regional cost differences. A national

tariff ensures that there is a fair playing field in pricing for providers,

regardless of sector, and will be extended in the future to include mental

health services. Pilots are under way to explore the potential of developing

a good practice structure for setting a local tariff for community health

services.

Nn-tai pics5.5.11 All other prices are determined locally via procurement and contracting to

reflect the direct and indirect costs of providing services, including the

potential to agree a reasonable margin for the provider.

full Cst rcvy

5.5.12 DH policy requires PCTs to adopt procurement practices that are fair and

open. This means that they must be neutral between different types of

providers and transparent with regard to pricing. This should minimise

transaction costs, and allow providers to frame realistic economic tenders.

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Such an approach therefore reflects the need to ensure that there is the

potential for full cost recovery. It reflects the principles of full cost recovery

as set out by the National Audit Office, which can be found at:

www.nao.org.uk/publications/0607/full_cost_recovery.aspx

5.5.13 Organisations seeking to tender need to ensure that they calculate their

full cost recovery proportionate to the size of contract being tendered for,

and may include a contribution to surplus. They should then decide the

extent to which they wish to include these elements in any proposed price

in the context of a competitive tender.

5.5.14 Tenders will have a value for money assessment. This can includeconsideration of the social value added through the design of the service,

such as employing local people, contributing to community infrastructure,

access to additional services not funded through statutory sources and

reinvestment of surplus for community benefit.

Any Willing Pvid dls

5.5.15 The Any Willing Provider procurement option allows PCT to procure one

or more potential providers for the same service, at a consistent price. This

is a framework approach where level of income which each provider

receives will be directly related to the number of referrals or episode of

care, with patient choice driving competition to improve quality.

5.6 NHS cntacts5.6.1 There are different standard contracts which PCTs may use to contract for

services; a summary of the options and their key features is set out below.

It is mandatory for PCTs to use these standard national contracts for all

NHS contracted activities:

Acut, ntal halth and cunity halth ca svics

5.6.2 The contract is for use with all sectors; it provides a fair playing field

between all providers, and aims to encourage innovation and increase the

efficiency and quality of services. The contract has been written to ensure

that, regardless of the financial value, the standards and requirements for

any provider supplying NHS-funded care are the same.

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5.6.3 The contract also places responsibilities upon commissioners to ensure

that there are appropriate market management behaviours regardless

of contract size. There are four types of contract, for

acute/secondary care

mental health, including learning disabilities

community services

ambulance services.

5.6.4 These contracts are all structured with various sections. One section

contains the standard legal components and nationally set standards.Another identifies standard issues where locally determined targets should

be agreed, and the third section is for local determination between the

PCT and service provider. The standardised approach is intended to reduce

the administrative burden for providers and commissioners. The contract

can be used for more than one service and if the range of services

increases, these can be added to the existing contract rather than requiring

another separate agreement. Commissioners also have the option to use

coordinated commissioning arrangements, which means that a single

contract canbe agreedfor servicesthat areprovidedto morethan onePCT.5.6.5 The normal duration of a contract should be three years; however, the

contract can be agreed for either a longer or shorter period if appropriate,

with agreement from the relevant SHA. This acknowledges the

Governments commitment to longer term funding for the third sector.

5.6.6 Payment is normally monthly. However, to reflect the principles of the

Compact (see Chapter 3) for smaller organisations where the contract value

is less than 130,000 per annumand

the provider organisation has fewerthan 50 whole time equivalent staff, prepayment can be agreed at a

local level.

Copies of the NHS standard contracts and further information,

including an email helpline, can be found at: www.dh.gov.uk/en/

Managingyourorganisation/Commissioning/Systemmanagement/

DH_085048

Piay dical svics cntacts

5.6.7 The majority of primary medical services contracts require the provisionof the full range of essential services to a registered list of patients. It is

important to note that while GPs are the only professionals qualified to

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deliver the full range of essential services to patients, the use of skill mix

will play an important part in effective service delivery.

5.6.8 Essential services form the core level of service that patients would expect

their GP to provide. These services are described in legislation to secure a

uniform basis across all primary medical services contracting routes. These

legal requirements are not subject to local negotiation (although there may

be some matters of local interpretation), thus ensuring that all patients

receive a consistent level of provision.

5.6.9. Where a potential primary medical services contractor is required to hold a

registered list of patients, and consequently to provide the full range ofessential services, there are three possible contracting routes which will be

determined by the commissioner. These are:

general medical services (GMS) contract;

personal medical services (PMS) agreement; or

alternative provider medical services (APMS) contract.

5.6.10 A single contractor may hold a variety of contract types with a variety of

commissioners. For example, an existing GMS contractor might also holdan APMS contract with a second PCT.

5.6.11 For more information about primary care contracts see

www.primarycarecontracting.nhs.uk/uploads/medical/pcc_provider_

guide__nov_06_final.pdf

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6. Cnclusin

6.1 We hope that this guide is helpful to third sector organisations. While it is

intended to give an overview rather than a detailed compendium of policy,

the key aim is to improve understanding of NHS commissioning, and how

to work with commissioners. This is a live document which we will review

from time to time to take account of policy developments. We would

therefore welcome feedback on areas which could be improved or where

additional information would be helpful in future editions.

If you have any comments please email us [email protected]

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mailto:[email protected]:[email protected]:[email protected]


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The NHS Commissioning Environment, A Guide for ion in the Third Sector

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