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NHS COMMISSIONING BOARD2013/14 NHS STANDARD CONTRACTPARTICULARS (Service Specification)

SCHEDULE 2 – THE SERVICES

OUTLINE SERVICE SPECIFICATION

A. Service Specifications

Service Specification No.

OCSOL

Service Oldham Community Services Outline Specification

Commissioner Lead NHS Oldham Clinical Commissioning Group

Provider Lead

Period 3 years from commencement

Date of Review 1/4/13

This is one of two documents that constitute the specification. This document should be read in conjunction with the individual service specification for the community service in question.

1. Population Needs

1.1 National/local context and evidence base

Oldham is a large town in Greater Manchester, England. It lies amid the Pennines on elevated ground between the rivers Irk and Medlock, 5.3 miles (8.5 km) south-southeast of Rochdale, and 6.9 miles (11.1 km) northeast of the city of Manchester. Oldham is surrounded by several smaller towns that together form the Metropolitan Borough of Oldham, of which Oldham is the administrative centre.

1.1.1 Strategic Context and Underpinning Commissioner Requirements

NHS Oldham CCG has taken a deliberate and strategic decision to fundamentally change the way in which Community Services will be required to contribute to the ongoing health and wellbeing of our local population. We (CCG) feel we need to re-specify the contribution required from all professional clinical services contained within the macro title of Community Services. The reason for this is influenced by a number of very important factors that all potential providers and/or interested parties will need to understand and seriously consider before responding to the PQQ offer.

Our vision for Integrated Care (will be shared upon request) requires providers of services to be much more closely focused on the contribution of effective care planning and care delivery for individual patients, particularly those most vulnerable citizens such as the Frail Elderly and those living with Long Terms conditions who require ongoing and dedicated ‘year of care’ support. The CCG feels that this is best provided when professional services come together at a sub population level, i.e. the one size fits all traditional community service offer will not meet our patient requirement. The level of integration will be required at ‘Primary Care Medical

DRAFT 5/72013 Particulars 2013/14 NHS STANDARD CONTRACT

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http://en.wikipedia.org/wiki/Metropolitan_Borough_of_Oldham

http://en.wikipedia.org/wiki/Metropolitan_Borough_of_Oldham

http://en.wikipedia.org/wiki/Manchester

http://en.wikipedia.org/wiki/Rochdale

http://en.wikipedia.org/wiki/River_Medlock

http://en.wikipedia.org/wiki/River_Irk

http://en.wikipedia.org/wiki/Pennines

http://en.wikipedia.org/wiki/Greater_Manchester


Home’ (PCMH) level. This is a term to describe the leadership of clinical decisions, the organising of care delivery and the regulation of provider quality and contribution at CCG Member and/or Cluster Member level. In other words, there will be a key and fundamental relationship between the Community Services Providers(s) and the local GP Practice CCG Membership. This level is likely to be at around 30k population levels. The CCG members working together at that level will direct the inputs of commissioned services to ensure coherence with the particular needs of that community. While we appreciate that community needs can be common, we also know that in other ways there is a major difference between parts of the Oldham Borough. These will have to understood and catered for, working with GP Practices and Social Care Teams.

The ability to effectively control and coordinate care contributions, particularly for urgent care and rapid response demands will be a key measure for all providers within this exercise. Our CCG Clinical Directors, Cluster Clinical Leads and General Membership have developed this new way of working and fully expect commissioned suppliers to be able to integrated their services and solutions, and add further innovation to our thinking, via a whole team delivery model, based around the ‘PCMH’.

NHS Oldham CCG is working closely with our colleagues at Oldham Metropolitan Council (OMBC) to ensure alignment and coherence on Public Sector Reform, in order to ensure we harness and harvest the maximum contribution and value from jointly commissioned programmes. OMBC fully support our vision for services at PCHM level.

The CCG would urge all interested parties to carefully review the detail contained in the material provided and we draw particular attention to the areas that describe the specific service lines and requirements for them. Finally, the CCG is constantly seeking to encourage partnerships, collaborations and joint ventures if they can demonstrate innovative delivery and drive improvements in standards, quality and value. With this in mind, the CCG would encourage larger organisations to consider working with smaller, niche/specialist organisations in order to offer a federated approach to delivery, where this could enhance knowledge and skills and further drive value and improvements in the quality of care.

1.1.2 Oldham’s Current Population

See the Oldham Public Health Annual Report 2012-13; Jobs, Homes & Friends (NHS Oldham & Oldham Council, 2012) for further details.

NHS Oldham Clinical Commissioning Group’s GP registered population size as at 1 April 2013 was 241,412.

The estimated population for the Oldham borough based on the 2011 Census is 224,900 people. The population is made up of 223,200 people living in households and 1,700 people living in communal establishments. A communal establishment is an establishment that provides managed residential accommodation, such as student or sheltered accommodation.

Oldham’s latest population structure by age band compared to the population structure of England can be seen in figure 1. Females make up over half (51%) of Oldham’s population and this is comparable to Greater Manchester, North West and national figures.


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Oldham has a higher proportion of younger people compared to England anda lower proportion of older people for both males and females. In Oldham under 16s make up 22.4% of the population compared with 18.9% nationally. People aged 75 and over make up 6.5% of Oldham’s population compared with 7.8% of England’s population.

Figure 1: Oldham 2011 Population estimates based on census 2011 results

1.1.3 Ethnicity in Oldham’s Population

The size of Oldham’s minority ethnic population has increased from 13.9% in 2001 to 22.5% in 2011, a significantly greater change than nationally.

The largest minority ethnic group in Oldham is Pakistani (10.1%) followed by Bangladeshi (7.3%), both groups making up a higher proportion of Oldham’s population than nationally (2.1% and 0.8% respectively). By contrast Indian (0.7%), Black (1.2%) and mixed heritage (1.8%) groups are relatively under- represented in Oldham compared to national figures.

1.1.4 Health, Wellbeing and Illness in Oldham

Life expectancy estimates the average number of years that someone will live from birth. It is a reflection of the prevailing conditions that have an impact on health for the whole population at that time. Figure 2 tells us that males in Oldham will live for 75.7 years compared to 77 years for males in the North West and 78.6 years for England. Females will live for 80.5 years in Oldham compared to 81.1 years for females in the North West and 82.6 years for England.


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Figure 2: Life Expectancy Trends

Increases in life expectancy can be seen in Oldham, regionally and nationally. The gap in life expectancy for females between Oldham (80.5), the North West (81.1) and England (82.6) is gradually narrowing. However Oldham still has the 19th worst life expectancy for females out of the 324 local authorities ranked in England.

For males in Oldham life expectancy has been increasing but not at the same rate as in the North West and England, meaning that the gap in life expectancy between Oldham (75.7) and the regional (77) and national average (78.6) has increased. Oldham also has the 16th worst life expectancy for males of the 324 local authorities in England.

Ward level life expectancy for 2007 to 2011 (figure 5) also demonstrates inequalities in Oldham as there is an 11.9 year difference between males living in Coldhurst, the worst-off ward in Oldham, and those in Saddleworth North, the second best off ward in Oldham. For females there is a gap of 10.8 years between females in Alexandra and Crompton.

1.1.5 Challenges to health in Oldham

In Oldham the main diseases contributing to premature mortality (deaths in people aged under 75) in 2011 for both males and females are cancer (40% and 46%) and cardiovascular disease (26% and 22% respectively).


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Figure 3: Main causes of death in Oldham 2009-11

The two main cancers contributing to premature cancer deaths (2009-11) for males in Oldham are lung cancer (29%) and colorectal cancer (10%). Lung cancer is also the biggest cause of cancer deaths for females in Oldham (32%) followed by breast cancer (18%).

For males in Oldham the rate of premature deaths from cancer has been increasing since 2005-07, so the gap between Oldham and England’s death rates has increased. At 2008-10 the death rate for cancers in males aged under 75 in Oldham was 151 per 100,000 compared to 137 for the North West and 122 for England.

The opposite has been the case for female under 75 cancer deaths, with mortality rates dropping since 2005-07 and the gap with England narrowing. The rate for Oldham females at 2008-10 was 122 per 100,000, which was higher than the North West (110 per 100,000) and England rate (99 per 100,000).

Coronary heart disease and stroke are the two main contributors to cardiovascular deaths for both males and females in Oldham. Deaths from coronary heart disease make up 68% of male deaths from cardiovascular disease and 51% of female deaths whereas stroke contributes 16% for males and 28% for females.

The rates of male and female premature cardiovascular disease mortality have been decreasing over the last 10 years and the gap with England has narrowed. The death rate for males aged under 75 in Oldham in 2008-10 was 129 per 100,000, which is higher than the North West (115) and England rate (95). The rate for females in Oldham was 56 per 100,000, which is also higher than the North West (52) and England rate (41).

Respiratory disease is the third biggest contributor to premature deaths in Oldham. Whilst death rates for England and the North West have stayed fairly constant for males and females since 2005-07, Oldham has seen an increase in rates. The gap between Oldham


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and England’s death rates for males was decreasing but the 2008-10 rate has seen an increase since the previous year. Oldham’s death rate for males (20 per 100,000) is higher than the North West (17) and England (13). The female death rate for respiratory disease in under 75s in Oldham (18 per 100,000) is also higher than the North West (15) and England (10).

So the main diseases related to a shortened lifespan in Oldham are cancers, heart disease and stroke and respiratory illness. Digestive diseases, particularly those associated with alcohol consumption, have also been rising.

1.1.6 Secondary Care Providers

Pennine Acute Hospitals NHS Trust is the largest secondary care provider for NHS Oldham CCG with the Royal Oldham Hospital acting as the primary hospital, offering a full range of general and acute outpatient and inpatient services.

Tameside NHS Foundation Trust is another large secondary care provider and is the hospital of choice for many of Oldham’s registered patients that live over the Tameside borough border (generally registered with Pennine Medical Practice, Mossley).

The Christie NHS Foundation Trust provide the majority of tertiary cancer services for Oldham patients.

Central Manchester NHS Foundation Trust provide the majority of tertiary children’s services of Oldham patients.

1.1.7 Principles for Community Services

The general principles that NHS Oldham Clinical Commissioning Group has adopted in relation to its commissioning of community services are:

1. Providers must work as part of the integrated model of care (i.e. integrated efficient pathways involving general practice, social care and secondary care providers) to achieve the best outcomes for patients.

2. To ensure that patients who can be managed within the community receive their care in this setting with the effective provision of community services supporting early discharge back to community care from secondary care settings as soon as possible.

3. Providers to work effectively within the Alliance Partnership for urgent care and LTC,

4. Providers will adhere to the agreed CCG Effective Use of Resources (EUR) Policy.

5. Community services will be configured to support the development of the primary care medical home (i.e. GP practices) as the cornerstone for effective LTC management. Providers will work closely through the practice based clusters to redesign pathways and service provision.

Figure 4 below illustrates the set-change that NHS Oldham CCG wish to achieve by managing patients with long term conditions more effectively.


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Figure 4: Long Term Conditions – A Typical Year of Car

1.1.8 Community Contract Segmentation

The community contract has been segmented into six lots, including;

1. Core Community Services2. Specialist Elective Community Services3. Continence Service4. Intermediate Care5. Respiratory Community Service6. End of Life Community Service

A market and service based approach has been taken to determine these. Bidders are able to tender for all lots.

All services within a specific lot must be delivered by one primary provider; submissions made for individual services will not be accepted. NHS Oldham CCG would like to offer the opportunity to deliver services to both large scale organisations wishing to tender for the entirety of the service, and also to smaller, more niche organisations wishing to tender for specific elements

Organisations wishing to supply the entirety of service would be expected to offer smaller organisations the opportunity to partner deliver under a federated model. The CCG wishes to encourage innovative solutions. For those applying for individual lots only, the requirement for partnership working to ensure fully integrated care will be expected to demonstrate how they will work in partnership with other providers.


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Potential providers are asked to consider the services included in each lot and ensure they can deliver each of these services before submitting a PQQ response.

See Appendix B for Finance and Activity Information.

The Community service provider (lot1) will establish 4 care planning teams (1 team per 2 clusters), 8 care delivery teams (1 team per cluster), and a single response team across the Borough, working in collaboration with a Primary Care delivery partner, in line with the approach outlined below (see figure 5), to inform the content of the teams at cluster level, specific to the needs of the population. See the Integrated Health Teams service specification for further details. It is anticipated that all community services would be established to support the CCG cluster based model.

Figure 5: Approach to commissioning community services through the CCG clusters

The Primary Care delivery partner function will be undertaken by the community service provider - this role should be clearly defined as to the individual staff members responsible and articulated by bidders throughout the evaluation process.

There is a clear expectation that the Primary Care delivery partner will provider clinical expertise in relation to how assets are provided and utilised effectively across the CCG – working in conjunction with the CCG clusters.

1.1.9 Health & Social Care Partnership Working

OMBC and NHS Oldham share the vision of an integrated commissioning hub, which aims “to deliver improved outcomes for citizens through ensuring that commissioning services are influenced, shaped, and delivered as appropriate by a range of delivery partners including citizens and communities”. Part of this vision is to take a system wide perspective on health and social care services.

Both organisations have made progress towards realising the vision of the integrated commissioning hub outlined in the ‘Integrated Hub in Oldham’; there are jointly funded posts, a transitions forum, which regularly considers strategic issues relevant to both organisations, and a number of operational projects and pilots.


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As part of further developing the relationship between the two organisations, OMBC and NHS Oldham have taken the opportunity to update their governance arrangement. Changes range from the strategic (e.g. governance) to the operational (e.g. integrated Continuing Care/Continuing Health Care Team).

The current strategic issues with managing the population’s health, improving outcomes, avoiding premature deaths, enhancing quality and ensuring sustainable services for their future, will not be addressed if the current healthcare system does not change. Improved health needs assessment and strategic planning have demonstrated the scale of the challenge faced in the management of long term conditions, and the financial implications of treating patients in hospital when their admission could have been prevented by earlier intervention or treatment closer to home.

Coupled with reduced funding anticipated across Oldham, operating in the current way is not viable. As we have already described, the population of Oldham is continually growing and people are living longer but with more unhealthy lifestyles, meaning that people are continuing to become ill and need expensive hospital treatment.

The current system means that hospitals are at the centre of much of the borough’s healthcare, be it for outpatient visits, consultant or specialist appointments and inpatient stays. Patients themselves have informed commissioners, healthcare providers and clinicians that they want their healthcare to be managed differently. We have found this out through a comprehensive programme of engagement, not just with clinicians but with patients and the general public too. We believe that the development of an integrated care system provides the right solution to help tackle the challenges ahead.

1.1.10 Our Vision

As described above, the demand for health and care services is growing, associated with the increasing number of patients living with long-term conditions. The burden of chronic conditions is growing, with almost a third of the population living with one or more chronic long-term conditions.

Greater integration of health and social care is needed to mitigate the impact of fragmented health and social care provision on patient experience. Patients can often experience gaps in service provision, poor transition between care settings and professionals, and failures in communication within current service provision.

There is much evidence in terms of patient experience and clinical outcomes of delivering care at or closer to home. The Department of Health’s Whole System Demonstrator study reported a 24% reduction in elective admissions, a 14% reduction in bed days, a 21% reduction in non-elective admissions, a 45% reduction in mortality and a fall of 15% in A&E visits. A 2012 study found that a third of older patients admitted to hospital as an emergency had no need to be in a hospital bed. This is not just costly, but often increases clinical and psychological risks and gives patients and carers a poorer experience.

Although this specification relates only to health services, there is an expectation that the service provider will work in partnership with the social care team, to deliver a truly integrated service. It is expected this service will be supported through a single point of access for all referrals (urgent and non-urgent) to the community service provider. The Health and Social Care Act places a duty on providers to work more closely to address these issues. Given the financial challenges facing the public sector, not only is a responsive coordinated service needed, but also one that is sustainable, shifting the emphasis onto prevention to effectively manage demand.

Emphasis in Oldham is being placed on fostering a more person-centred approach to care, taking a holistic view of an individual’s needs and personalising the way care is delivered to them to help them live as independently as possible. This means providing a greater choice of services at a time and place most convenient to them.


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The Oldham Care Vortex

NHS Oldham CCG intends to change the balance of healthcare in Oldham so that patients receive care closer to home, where that is the right place for them. We will do this by working with clinicians from all settings to support integration, patients and the public to embrace the self-care agenda. We will encourage innovation and the use of new technologies to trial new ways of working to meet patients’ needs.

The Oldham Care Vortex places primary care at the centre of patient care and describes a way of transforming our thinking to move away from institutional care, with a move towards a managed system of service transformation. This places greater emphasis (including investment) on managing an increasing amount of activity within communities, closer to the patient. The model recognises international research and world-class managed care modelling and has guided the thinking, service modelling and service investment profiling in Oldham.

Figure 6: The Oldham Care Vortex Model

The Oldham Care Vortex Model (2013)The Current & Emerging Landscape for Service Integration

Acute and Tertiary

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Healthier Together

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Opportunities for Integrated Care Threats for Integrated CareResources & Investments

Managed Care

Coordinated Care

Developing cluster based integrated health and social health care teams, based on the health needs of the local population, with the appropriate specialist and response services in place to support the long-term conditions agenda, is the priority for the CCG, to reduce emergency admissions, improve patient experience, and ultimately address the potential years of life lost from conditions considered amenable to health care. Continuity of care will be assured through ensuring that the GP and the practice remain at the centre of commissioning and provision for the patient in their community. This service will support the proactive management of patients within the patient centered medical home, by more holistic management of patients with a care-coordinator identified by the practice. It was also ensure quick response patients in crisis, particularly those nearing the end of their life. The


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service will be required to adopt approaches which embed shared decision making, support the effective use of medication and utilise technologies such as telehealth and telecare.

The Long Term Conditions programme in Oldham seeks to improve the quality and effectiveness of holistic care of people with multiple long-term conditions across the health and social care economy. This includes patients in nursing and residential homes. The tripartite approach to the management of LTCs includes:

• The iterative development and implementation of a risk stratification tool in primary care and an urgent care dashboard, to enable practices to identify their patients currently accessing secondary care services, or at risk of admission to hospital (including end of life patients).

• The development and implementation of Local Integrated Health Teams to coordinate and facilitate health and social care for patients with long term conditions. The patients GP will be central to the creation and functioning of integrated generic care teams, which will be based around a locality (GP practice or neighbourhood) and will provide joined up and personalised services. These generic teams will pull in specialist services when necessary, but treat a patient holistically, regardless of their condition(s). Each patient (and their carer) will have a key worker within this team who coordinates their care and acts as the single main point of contact, with the rapid response team as the failsafe.

• Embedding the behavioural change required for a strategic approach to self-care in primary care, using defined products (i.e. shared decision making tools) with patients to facilitate increased autonomy and collaborative personalised care planning between clinicians, social care professionals and patients.

Core community health services will provide:

The infrastructure to support rapid action from the urgent care dashboard (daily information provided to practices with regard to their patients who have attended A&E or have been admitted) and quick adoption of the risk stratification tool, commencing with the top 5% of patients initially, then working down the register quickly after this.

The infrastructure to deliver the services traditionally provided by the district nurse and community matron functions.

The response facility for those patients getting into crisis, when their named coordinator in not available, or for those patients who present at an urgent care facility without a care plan in place but are suitable for management by community services to reduce the potential of hospital admission.

The intention of the local LTC programme is to reduce non-elective admissions for defined conditions, by 20% by 2014/15, and support the wider integration agenda moving care closer to home, in line with the Healthier Together vision over the next five years.

Effective management of long-term conditions by Primary Care, supported by the wider community health and social care teams, will be a key contributor to the CCG delivering its triple aim objectives. To support this new model of care delivery, will require Primary Care to operate in a different way. The CCG feel the best way to approach this is to align an 'EQALS ' scheme to support new ways of working. In past years this would have been issued to GP practices as a locally enhanced service (LES); as this contracting route is not open to CCGs it will be issued to practices as a standard NHS contract with a three-year term that has provisions for renegotiation each year. EQALS will contain in phase 1, 4 components included within a standard national 3 year NHS contract.


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Phase 1

The initial phase will encompass the following areas:

Component 1: Holistic management of long term conditions Component 2: Dementia care planning Component 3: End of life care planning Component 4: Implementing a cost effective repeat prescribing system to minimise

waste without compromising patient access to medication

Phase 2

Phase 2 will include indicators to be selected, following prioritisation with members, patients, Clinical Directors and Governing Body members during the summer of 2013.

The Managed Care Model

NHS Oldham CCG has described a service model that enables patients registered with a GP, diagnosed with a long term condition, or experiencing sudden onset or illness or an acute medical need, to be supported and cared for and managed in the most clinically appropriate environment, wherever possible within the community.

Access to all services will be controlled by a single point of access within the community service provider, which will ensure patients are treated in the most appropriate component part of the system. The single point of access will be staffed by a multi-disciplinary team (MDT) of health and social care professionals, to ensure consistency of assessment protocols, and to ensure detailed understanding of each component of the urgent care system. The selected service provider will be able to describe how they can integrate with other providers and social services to provide a holistic response to the patient.

The following principles are embedded within the managed care model:

Personalising care and putting patients and /or their carers in charge Having a generic patient pathway, recognising inter-relationships between diseases Having a collaborative care plan, including what to do in a crisis, is the central

component to all care, a true collaboration between the patient with a long term condition, family and carers

The Primary Care Medical Home is the central organisational focus – skills and expertise that the patient requires will be made available here

The development of a care passport using the patients health record and care plan Population risk stratification for risk of disease, morbidity and hospitalisation

underpins the strategy Long term prevention is essential to achieve long term outcomes

The cluster based approach

Practice based cluster groups, are our foundation in Oldham, for creating a high performing CCG. Themes regularly debated by clusters are:

• The development of the integrated health and social health care teams supporting the Long Term Conditions agenda. Each cluster requires a different composition of its multidisciplinary team, based on the health needs of the population. The make up of that team needs to be driven by the clusters. Service utilisation at ward level within the JSNA highlights the differing needs of populations within Oldham

• A focus on the quality improvement agenda within primary care, using the assurance framework as a tool

• Innovation - Generating good ideas to influence the commissioning agenda• Looking at best practice from other clusters and assessing their application locally• Communication – understanding what’s going on within the CCG and wider


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• Improving data quality within primary care• Hot topics e.g. supporting CQC registration

It is anticipated that community service provider will support the development of these entities by organising services around the practice clusters.

Children’s and Young People’s Services

Work has commenced to establish an integrated children’s service to provide community health, social care and educational provision for children, young people and their families. This greater integration is needed to mitigate the impact of fragmented health and social care provision for this cohort of patients with often gaps experienced in service provision. There can often be poor transition between care settings and professionals, and failure in communication within the existing service provision. To support the integrated health and social care teams that will be required to deliver this vision, there will be a dedicated integrated core assessment and response team for children. These services will agree holistic management of care for a child and young person from a broader health and social care provision perspective to foster a more person-centred approach and higher quality outcomes.

Service providers will be expected to provide expert, invaluable advice and support to children, young people and their families to give every child the best start in life. This is crucial to reducing health inequalities across the life course. The health and social care teams will be important in promoting the health and wellbeing of all children and young people reducing inequalities through targeted intervention, as and when need is identified, and on an on-going basis for more complex or vulnerable and disadvantaged children and families. Successive reviews have demonstrated the economic and social value of prevention and early intervention and the intention of this service is to promote the prevention and self-care agenda, ensuring that patients and their carers at the heart of any decisions made.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely

Domain 2 Enhancing quality of life for people with long-term conditions

Domain 3 Helping people to recover from episodes of ill-health or following injury

Domain 4 Ensuring people have a positive experience of careDomain 5 Treating and caring for people in safe environment and

protecting them from avoidable harm

See the individual service specification.

2.2 Local defined outcomes


3. Scope


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3.1 Aims and objectives of service


3.2 Service description/care pathway

Interpreters will be used where indicated along with information in other languages, if appropriate.


3.3 Population covered

Patients registered with a GP of the NHS Oldham Clinical Commissioning Group. The provider should make arrangements to ensure patients living outside the borough receive the specified service.

For those Oldham residents registered with a non-Oldham GP, the provider and commissioner will work together to ensure the services are funded by the appropriate commissioner.

Also see the individual service specification.

3.4 Any acceptance and exclusion criteria and thresholds


3.5 Interdependence with other services/providers

The successful integration of community services to achieve efficient pathways and positive patient experiences will be a key determinant in the commissioner’s appraisal of service provider performance.

See the Referral Management Protocol (appendix A).


4. Applicable Service Standards

4.1 Applicable national standards (eg NICE)


4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges)


4.3 Applicable local standards

General

The provider will not undertake any commercially focused or direct marketing of its services to patients, or GPs and other authorised referrers, without the explicit consent of NHS Oldham CCG.


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Where Any Qualified Provider (AQP) contracts are in place that cover the provision of a service to Oldham patients, the provider will not enter into sub-contracting arrangements to provide such services on terms that materially differ to those within the AQP contract.

Providers will be able to demonstrate that they promote healthy lifestyles to patients and make reasonable efforts to enable their staff and wider families to live healthy lifestyles (i.e. live by example).

Following the publication of Healthcare for All (2008), the CQC developed a number of essential standards that healthcare providers need to meet in order to assure a minimum standard of care to be offered to people with learning disabilities. Providers will need to ensure that they fully meet the needs of patients with learning disabilities through reasonable adjustment to their service and have standardised local systems to identify this issue. An individual’s capacity and consent needs to be inherent in the system to ensure the patient’s journey is successful and providers will need to confirm and provide evidence to support these standards.

To provide education and training to patient groups and health professionals on issues relating to the individual service specifications.

The provider must adhere to the Referral Management Protocol (appendix A) to avoid financial penalties being imposed.

The provider must adhere to the requirements relating to the location of services (see section 6).

The provider will undertake a bi-annual patient experience survey, elements of which will be determined by NHS Oldham CCG to enable benchmarking and trend analysis.

IT

The provider must submit Community Data Sets (see Health and Social Care Information Centre - http://www.hscic.gov.uk/comminfodataset.

The provider must ensure it transmits correspondence with GP’s, and other referrers where relevant, via the integrated electronic messaging service ‘Docman’.

The provider must list its scheduled care services on the national referral system (i.e. Choose and Book) with directly bookable appointments.

Also see the individual service specification.

4.3.1 Key Performance Indicators

KPIs are under review and may form part of the bidder evaluation process at the ITT stage.

The following KPIs are additional to those within the individual service specification.

KPI (title) Description Threshold Method of Measurement

Consequence of Breach

IT/Business Intelligence


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1. Integrated messaging

Compliance with the integrated electronic messaging service for transmitting correspondence with GPs

100%

Monthly provider performance report

As per NHS standard contract arrangements

2. Timely submission of CDS

Dataset to be submitted to the submission dates identified by the HSCIC

<=2 days after the HSCIC submission date

Submission date to SUS/SFTP site

A contract query will be raised if submissions continue to be late. Failure to resolve the issue will result in a remedial action plan.Non-submission of the CDS dataset will result in non-payment of invoices.

Access3. Urgent same day referral

Service users requiring urgent care must be seen on the same day (Urgent same day referral)

95% Monthly provider performance return


4. High risk within 3 days

Patient assessment and verbal response to referrer within 3 days



5. High risk within 7 days

Patient assessment and verbal response to referrer within 7 days



6. High risk patient reports

Report returned to the patient's care coordinator (if applicable) and GP within 2 working days of the patient’s assessment



7. Urgent scheduled referral (i.e. non emergency)

First appointment within 2 weeks

95% CDS As per NHS standard contract arrangements


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8. Routine referral

First appointment within 6 weeks

100% CDS

9. Breach patients

No. of patients waiting in excess of 6 weeks for a first appointment at month end (split by referral priority)

0 Monthly provider performance return


DNA rates % of booked appointments not attended

<10%

Reducing Inequalities

Referral figures to reflect ethnic composition in Oldham

TBC

Relationships10. Practice/Cluster MDT Attendance

An appropriate service representative (i.e. clinician with relevant case load) will attend practice/cluster MDT meetings (if applicable)

See individual service specification

Monthly provider performance return


Patient Experience

11. Patient survey

Bi-annual patient survey performance (detail TBC)

TBC TBC


Safety

12. Infection Control

Numerator:Percentage of staff that have completed mandatory infection control trainingDenominator: Number of staff in service.

95%




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13. Mandatory safeguarding training requirements

Numerator: Percentage of staff that have completed mandatory safeguarding training at levels commensurate with roles and responsibilities (levels 1, 2 and 3)Denominator: Total number of staff in service

95%



4.3.2 Indicative Activity Plan

See Finance and Activity Information (appendix B).

Indicative activity plans will be set via a modeling exercise during the first several months of service operation. NHS Oldham CCG will determine indicative activity plans based upon; (amongst other indicators) historic activity levels, activity and waiting time information, and population benchmarking. The provider will assist in this exercise by sharing information as required. The provider is expected to manage existing demand for the service in the manner described within the service specification.

Service providers are expected to radically different models of care, some resulting in decreasing activity due to less duplication; some resulting in more activity as a result of deflected hospital admissions, therefore current levels of activity can only be used as indicative levels of provision for current service models.

5. Applicable quality requirements and CQUIN goals

5.1 Applicable quality requirements (See Schedule 4 Parts A-D)


5.2 Applicable CQUIN goals (See Schedule 4 Part E)


6. Location of Provider Premises

Where there is available capacity, the following premises must be utilised by the provider, use of alternative accommodation can only be allowed with the explicit agreement of the commissioner:

Integrated Care CentreNew Radcliffe StreetOldham


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OL1 1NL

Glodwick Primary Care Centre137 Glodwick RoadOldhamOL4 1YN

Failsworth Primary Care Resource CentreAshton Road WestFailsworthManchesterM35 0AD

Moorside Medical Centre681 Ripponden RoadMoorsideOldhamOL1 4JU

Royton Health Wellbeing CentrePark StreetRoytonOldhamOL2 6QW

Werneth Primary Care CentreFeatherstall Road SouthOldhamOl9 7AY

Chadderton South Health CentreEaves LaneChaddertonOldhamOL8 8RG

Chadderton Town Health CentreMiddleton RoadChaddertonOldhamOL9 0LH

Crompton Health CentreHigh StreetShawOldhamOL2 8ST

Uppermill Health CentreSmithy LaneUppermillOldhamOL3 6AH

Delph Surgery – new build not available UNTIL around MARCH/APRIL 2014Garside StreetDelph


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OldhamOL3 5DW

Chew Vale Clinic6-8 Chew ValeGreenfieldOldhamOL3 7EQ

St Chad’s CentreLime Green ParadeLimehurstOldhamOL8 3HH

Egerton House11 Rock StreetOldhamOL1 3US

Ellen House (office accommodation only)Waddington StreetOldhamOL9 6EE

Block 4 Southlink (office accommodation only)Southlink Business ParkHamilton RoadOldhamOL4 1DP

There will also be an expectation that the provider works within General Practices where appropriate. Some services have a base within the Royal Oldham Hospital and the Intermediate Care service is based at Butler Green House.

Figure 7: NHS Property Services Premises in Oldham


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There will be the need to enter in to a licence or lease agreement dependent upon the nature of occupation. The main terms and conditions of such occupational agreements will be available upon request. In addition, a service charge will be levied to cover the costs of such items as consumables, telephone, use of multi-functional copying machines, franking and all other costs not reflected in the occupational agreement. All service providers occupying premises reflected in this contract document must attend an induction and adhere to policies, procedures and any statutory requirements of the commissioner, the landlord or their appointed agents.

See Finance and Activity Information (appendix B) for indicative premises costs associated with service lines.

7. Individual Service User Placement

N/a

8. Prices

See Appendix B (Finance and Activity Information) in the ‘Oldham Community Services Outline Service Specification’.

Basis of Contract Unit of Measurement

Price Thresholds Expected Annual Contract Value

Block Arrangement/Cost

and Volume


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Arrangement/National Tariff/Non-Tariff Price________*Quality Payment

Maximum potential penalties

Total

9. Appendices

A Referral Management Protocol

B Finance and Activity Information

10. References

Wikipedia (2013) Oldham. Available at: http://en.wikipedia.org/wiki/Oldham [accessed 25 June 2013]

NHS Oldham & Oldham Council (2012) Oldham Public Health Annual Report 2012-13; Jobs, Homes & Friends, available at:http://www.oldhamccg.nhs.uk/Portals/0/Docs/BoardPapers/April2013/AI%207.6(i)%20Public%20Health%20Annual%20Report%202012%2013%20FINAL.pdf [accessed 24 June 2013)

NHS Trafford (2012) Outline Commissioning Specification for Trafford Community Services, filed: /Volumes/data$/System Reform/Community services specs/Working Drafts Summer 2013 [accessed 24 June 2013]

NHS Oldham (2009) Transforming Community Services Strategy, filed: smb://file1.oldham.nhs.uk/data$/System Reform/Transforming Community Services (TCS) Reviewed JT/Strategy 2009/Full Documentv4doc.pdf [accessed 24 June 2013]

NHS Oldham (2012) Commissioning Intentions, filed:smb://file1.oldham.nhs.uk/data$/System Reform/CCG submitted evidence for wave 1 application/2012-13 IP and Commissioning Intentions 2013-14/commissioning intentions.doc [accessed 24 June 2013]

NHS Oldham (2012) Health & Social Care Partnership Governance Proposal, filed: smb://file1.oldham.nhs.uk/data$/System Reform/CCG submitted evidence for wave 1 application/List of Collaborative commissioning/Collaborative working OMBC.pdf [accessed 24 June 2013]


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http://www.oldhamccg.nhs.uk/Portals/0/Docs/BoardPapers/April2013/AI%207.6(i)%20Public%20Health%20Annual%20Report%202012%2013%20FINAL.pdf

http://www.oldhamccg.nhs.uk/Portals/0/Docs/BoardPapers/April2013/AI%207.6(i)%20Public%20Health%20Annual%20Report%202012%2013%20FINAL.pdf

http://en.wikipedia.org/wiki/Oldham

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