Workshop F Managing the contract

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Workshop FManaging the contract
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New NHS Contract For 2008 and beyond

• Workshop F
• Managing the Contract

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Key Parts of Contract

• Clause 8 Review
• Clause 29 Information Requirements (Schedule 5)
• Clause 32 Performance
• Clause 33 Clinical Quality Review
• Schedule 3, Part 1, paragraph 9 C.difficile
• Schedule 3, Part 4 Quality Standards
• Part 4A Clinical Quality Performance Indicators
• Part 4B Performance Indicators
• Guidance particularly figures 1,2 3

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Partnership Co-operation

• The most successful contracts are managed through
  partnership co-operation win-win works.
• The contract management tools built into this
  contract are designed to encourage partnership
• The tools, in general, do not result directly in
  penalty but focus on remedy
• Knowledge and understanding of the contract is
  vital for both parties
• Effective contract management will rely on
• Relationships
• Information
• Communication internally and between parties
• Holistic solutions
• Report Review - React

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Case Study One

• The Provider is late in the delivery of a key
  monthly performance report
• The Provider has not told the Co-ordinating
  Commissioner that the report will be late
• The information is needed for the monthly review
• There is evidence that key Performance Indicators
  will be breached
• What do you do the manage the situation ?

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Case Study One - pointers

• Prior to resorting to the contract
• Provider and Co-ordinating Commissioner should
  co-operate so the Provider is remiss in not
  telling the Co-ordinating Commissioner
• If the Provider is able to issue a partial report
  that would help
• Using the contract
• This should only happen once the day-to-day
  working arrangements have failed to resolve the
  issue
• Clause 29 (Information) can be enacted
  flowchart, fig 1
• If a Commissioner is causing the delay the
  Provider is off the hook
• During negotiations
• It is key to have agreed the format, content and
  timeliness of all important information.
• Parties should be realistic in their expectations
• If a party cannot comply today with a reasonable
  request then a plan should be agreed to get the
  party to an acceptable position

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Case Study Two

• The New to Follow-up ratio in ENT is 17 compared
  with the planned level of 13
• The Provider agreed the ratio reeluctantly during
  the negotiations
• Achievement of the ratio relies on GPs
  undertaking some of the follow ups
• The Commissioners have plans which they are
  relying on in order that the ratio can be
  achieved
• The issue comes to light in the Monthly Service
  and Performance Review Meeting.
• How should this be managed?

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Case Study Two - pointers

• Prior to resorting to the contract
• Parties should check that they are delivering
  their commitments
• If the parties are complying with their
  commitments but the Provider is unable to reach
  the ratio for good clinical reasons then the
  ratio may be wrong and should be reviewed.
• A solution can be agreed without relying on the
  contract to manage it but to enable the next
  stages of the contract to kick in in the event of
  non-compliance it is sensible to use the
  Performance Notice.
• Resorting to the contract
• This should only happen once the day-to-day
  working arrangements have failed to resolve the
  issue subject to the above
• Clause 32 (General Performance Controls) can be
  enacted flowchart, fig 2
• If the other party is causing the breach then an
  Excusing Notice can be issued to mitigate against
  risk of consequence
• During negotiations
• The Providers reluctance to accept the ratio
  should have triggered a phased approach and a
  plan encompassing the relevant parts of the
  health economy (Provider, Commissioner, Referrer
  etc).
• The ratio should be set as a Performance
  Indicator in Schedule 3, Part 4B

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Linking contract management processes

• Different parts of the organisation will have
  different pressures and different demands on the
  contract
• It is unreasonable to expect one meeting to be
  able to embrace all issues
• Meetings should provide short notes to one
  another highlighting key actions and events for
  example
• The Clinical Quality Review meeting should supply
  minutes to the Monthly Service and Performance
  Review meeting and vice versa.
• Any sub-group that is working on improvements
  (e.g. information upload to SUS) should send a
  report to the Monthly Service and Performance
  Review meeting.
• In some instances it may be sensible to have a
  member of one meeting present at the other.
• For example a member of the Clinical Quality
  Review meeting may also be a standing member of
  the Monthly Service and Performance Review
  meeting
• Inviting relevant people to attend on an as
  required basis may be useful.

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Case Study Three

• The Provider has exceeded the agreed level of
  activity and the annual review is going to take
  place to determine whether the Provider should be
  paid or not for the activity.
• During the year the provider has requested
  Activity Management Plans to try to return
  activity to plan
• Not all Activity Management Plans have been
  complied with
• Not all Activity has been subject to an Activity
  Management Plan
• Some Activity came about through breached Prior
  Approval schemes
• The Commissioners have not complied with all
  their obligations
• What should happen?

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Case Study Three - pointers

• Prior to resorting to the contract
• In this instance the contract rules should apply
  but the final part of the process (not paying) is
  discretionary so the parties can agree other
  actions if they want
• Resorting to the contract
• Schedule 3, Part 1, Paragraph 6 can be enacted
  flowchart, fig 5
• The Provider may not be paid (at CCs discretion)
  where
• Prior Approval schemes have been breached
• The excess Activity was not subject to an
  Activity Management Plan
• The Provider has breached an Activity Management
  Plan
• The Provider must be paid where
• The excess activity was caused by a Commissioner
  not complying with its obligations
• During negotiations
• Both parties should make sure that they are
  confident that, together, they can deliver all of
  their obligations be it activity, ratios,
  performance indicators, UM schemes.
• If they cant deliver on day one then agree a
  plan to achieve it think win win

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Case Study Four

• The Provider is not going to achieve the 18 Week
  Referral-to-Treatment Target
• The Provider has not delivered all the Activity
  required (it has underperformed against the
  Activity Plan)
• The Commissioner has not managed all of its
  obligations and delayed discharge has resulted in
  some of the Providers under-performance
• The Provider has a capacity constraint but
  accepts that it has not done everything it can.
• What should happen?

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Case Study Four - pointers

• Schedule 3, Part 1, Paragraph 7 (flowchart, fig
  6) potentially mitigating the Provider from risk
  of fine CANNOT be enacted because the Provider
  has not exhausted its capacity to flex
• However the failure of the Co-ordinating
  Commissioner to perform in terms of delayed
  discharge does mitigate the Provider from some of
  the risk.
• The parties should plan together to achieve the
  target (which affects them both)
• In this instance the Provider has admitted it is
  failing and it is not all due to delayed
  discharge. The effect of delayed discharge
  should be analysed.
• If correcting it would prevent the 18w RTT breach
  then no action should be taken until the delayed
  discharge issue is rectified
• If correcting it would still leave the Provider
  in breach (albeit a lesser breach) the breach
  should be calculated and the Provider is at risk
  for the lesser amount.
• The Co-ordinating Commissioner should consider
  whether implementing the fine will benefit the
  health economy. In this instance the Provider
  seems honest and open if a decent plan to
  achieve 18 week RTT compliance is agreed the fine
  could be waived or stayed against compliance with
  the plan.
• During Negotiations
• Agree appropriate Capacity Review Criteria

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• Any group case studies to be considered ?