PROCURING TO ENSURE LOCAL NEEDS ARE MET

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PROCURING TO ENSURE LOCAL NEEDS ARE MET

• William Jones
• Assistant Director of Commissioning
• Derbyshire County PCT

• Dr Sarah Chilvers
• Chief Executive
• ChilversMcCrea Healthcare

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OBJECTIVES

• PCT Perspective -
• Introduce Creswell Langwith
• History the story so far
• Summary of Procurement
• Contract Negotiation
• Problems
• Lessons
• Provider Perspective
• Introduce ChilversMcCrea Healthcare
• History
• Contract/Lease
• Media
• Recruitment
• Lessons Learnt

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Creswell and Langwith
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Creswell Langwith
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CRESWELL PRIMARY CARE CENTRE

• HISTORY CHAPTER 1
• Spring 2003 - Retirement of Senior Partner and
  dissolution of Practice 8,000 Patients
• PCT managed Practice and advertised
• September 2003 - Nurse led PMS
• Spring 2004 - Independent External Review
• Summer 2004 complaints to Healthcare Commission
• Breach of PMS Contract
• Termination October 2005
• District of Bolsover Spearhead status
• PCT MANAGED PRACTICE

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CHAPTER 2

• November 2005 Advertised again
• 50 Expressions of Interest
• December 2005 Interviews
• United Health Europe preferred provider
• Local Resident, Patient and Parish Councillor
  take PCT to Judicial Review
• August 2006 Judge found PCT breached duty under
  Section 11 HSC Act 2001
• STILL PCT MANAGED PRACTICE

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CHAPTER 3

• September 2006 PPIF Chaired two public meetings
• Public Consultation on selection criteria
• 1st October - new Derbyshire County PCT
• November - PCT Board agree selection criteria and
  tender process
• December advertise, 15 January 2007 closing
  date
• 2nd February Interviews
• 14 February Board approve ChilversMcCrea
  Healthcare preferred provider
• 1st October PCT MANAGED PRACTICE!

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CHAPTER 4

• 15 October 2007
• ChilversMcCrea Healthcare PROVIDER
• TO
• DERBYSHIRE COUNTY PCT
• NO LONGER A PCT MANAGED PRACTICE

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SUMMARY OF PROCUREMENT 1

• Consult on selection criteria
• - Full involvement of PPIF
• - Write to all patients on list
• - Involve County, District and Parish Councils
• Board approve criteria tendering process
• Advertise BMJ Pulse
• - Expressions of interest (x25)
• - Complete information sheet
• Information Pack
• - Specification for service
• - Competencies
• - Business Case pro-forma

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SUMMARY OF PROCUREMENT 2

• Question Answer Forum
• Full Business Cases (x9)
• Shortlist
• - Panel of 12
• - Patient representatives
• - PCT Non Executive Directors
• - Score against criteria
• Interview (x6)
• - Panel of 9 (including 3 patient reps)
• - Score against criteria
• Board approve preferred provider subject to
  references

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REFERENCES

• Very important
• Not easy to get
• Verbal easier than written
• ChilversMcCrea Healthcare chased them up
• Some LMCs had strong views
• Interesting views

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CONTRACT NEGOTIATIONS

• Value based on PCT average cost per head
• Growth linked to realistic targets
• - Extended opening
• - Clinician recruitment
• - Establish patient groups
• Investment in notes summarisation
• Agreed to principal of penalties for poor
  performance
• All sorted May 2007 BUT

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..PREMISES

• This is where the delays started
• Length of lease and APMS contract
• PCT to underwrite
• Value and District Valuer reviews
• Lenders authority
• Asbestos survey
• Condition survey

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LESSONS

• Assume that s11 applies if any doubt
• Communicate regularly brief PPIF, OSC, Councils
• Keep the patients informed
• Document everything
• Handle the Politics
• Start work on premises as early as possible
• Get to know provider early, develop relationships
• Do not underestimate complexities and time
• Essential high calibre contract lead at PCT
• Keep staff and Unions well briefed
• HANG ON IN THERE!
• And I will now hand over to Dr Sarah Chilvers

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Company overview

• An NHS General Practice Company
• Urgent Care Centres
• Keeping people well at home using telemonitoring

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Company overview

• Acquire General Practices
• Partner with GPs and others to run General
  Practices
• Wide range of specialist services
• Practice based commissioning

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Summary of Service Provision

• 30 GP practices
• 3 WiCs
• Specialist services
• Over 300 people employed
• Support services include
• Finance
• HR
• Legal
• Clinical Governance
• IT

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History of Procurement Process

• Went for the contract in November 2005 we
  withdrew.
• Prior to applying again had to consider
  carefully whether we could stomach the publicity.
• Applied again when re-advertised given
  preferred provider status

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Legal Complications

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Recruitment problems

• Lack of full information from the landlords
  meant that we set dates and then had to keep
  moving them.
• We would recruit doctors and then have to stand
  them down.
• Lost a lot of good people who could not afford
  to wait around.
• People in Australia had heard of
  Creswell/Langwith!

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Media

• We worked hard with Patient Groups who were very
  well organised.
• Experienced a lot of unpleasantness from the
  media (Financial Times).
• LMCs were hostile.

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Lessons learnt

• Need to have as much information as possible
  about the premises and the Practice at the
  outset.
• Develop close relationship with PCT and work
  together to get problems solved.
• Know the landlord personally and not just
  through his solicitor.
• In most circumstances it is more convenient for
  the PCT to take a lease and offer a service
  occupancy to the Provider.