Winning Tenders

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Winning Tenders

• A Practical Guide

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Programme

• Contract considerations
• Uncertainty and innovation
• Legal status and procurement
• Provider concerns
• Procurement process
• Consultation and conflict of interest
• Payment mechanisms
• Organisational capabilities
• Being paid

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How Have Things Changed?Context

• Major NHS reconfiguration
• PCTs and PbC clusters are commissioning
• PCTs are contracting
• Contestability means that practices can no longer
  rely on historic patient flows for their future
  income
• For practices to prosper in the new healthcare
  market they will need to
• Become more outward looking in their planning
• Seek to engage with new opportunities
• Adapt their ways of working to meet changing
  needs and expectations
• Develop enhanced skills in planning, marketing
  and finance

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In with the new
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How Have Things Changed? NHS Drivers for Change

• The 10 year NHS Plan 1997
• The NHS Improvement Plan 2000 Ten years of
  reform
• Shifting the Balance of Power 2001
• The two Wanless reports
• The best way of funding healthcare
• The fully engaged public health scenario Our
  Health, Our Care, Our Say
• - A government belief in flexible markets and
  the Choice agenda

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How Have Things Changed? Key Themes

• Efficiency, Efficiency, Efficiency!
• Outcome driven
• New roles and new ways of working
• Quality of service, not number crunching
• Patient and Public Involvement
• Increased accountability
• Plurality of provider private partnerships
• Patient Choice

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What Changes Will Patients See?

• Standards
• Inspection
• Independent providers
• NHS Foundation Trusts
• Flexible Workforce
• An end to waiting
• Choosing Health

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What Changes Will Patients See? And theres more!

• New GMS contract
• New pharmacy, optometrist and dental contracts
• Choose and Book -Fair for all, personal to you
• Payment by results - National tariffs
• Plurality and diversity of provision
• Practice based Commissioning

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Who Else Is Involved?PCTs Can Contract for
Additional Services With

• Commercial organisations
• Voluntary / Charitable organisations
• Mutual providers
• Public Bodies
• GMS PMS practices through a separate contract

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What Are Others Doing?Competitors

• With a specialist team of experienced
  professionals assigned to the new APMS
  initiative, (Private Provider) is happy to
  exchange ideas and explore options with PCTs. We
  have a pipeline of doctors at PCTs disposal and
  are adept at using the skills of advanced nurse
  practitioners, special interest GPs, pharmacists
  and healthcare assistants to provide a
  multi-practitioner approach to developing our
  services. We are experienced in designing and
  building new healthcare facilities. We can offer
  diagnostics emergency avoidance schemes
  intermediate care rehab services long-term
  conditions management and, of course,
  out-of-hours and in-hours primary care.

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What Are Others Doing?Competitors

• The strengths that (Private Provider) can
  demonstrate speak volumes about how we aim to
  fulfil APMS contracts
• We pride ourselves on the closeness, quality and
  longevity of the relationships we build up with
  partner organisations
• Our key focus is finding and delivering
  solutions to wide-ranging problems, as
  demonstrated in our contracts to build and run
  ISTCs
• We have an excellent reputation for service
  provision and for delivering on budget and on
  time

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What Is A Tender?

• In simple terms, a tender is an offer to do
  work issued by one party to one or more others

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What Do We Need To Consider? Considerations for
Contracts

• The exact service to be provided
• The length of contract
• Performance monitoring, quality control and
  governance arrangements
• Payment schedules and pricing structures
• Employment issues, including protection of
  employment and pensions
• Provision of premises and equipment
• Provision of information and contract monitoring
• Warranties

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What Do They Expect Of Us?Uncertainty

• PbC clusters are specifying services and
  preparing for tenders
• PCTs may neither need nor want to specify the
  type of contract at the start of the process
• The same services could be provided under PMS,
  GMS or APMS
• The choice of contract may be not be determined
  by the PCT but by the contracting party

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Do They Want New Ideas?Encouraging Innovation

• A PCT/PbC cluster may not have an idea of what
  the service will look like at the start of the
  tender process
• It may have identified a particular problem or
  service need and then be looking for creative
  ideas or solutions to solve it
• This type of approach may help encourage more
  innovative solutions

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Whats the Legal Status?Contracts

• Section 16CC (2)(b) of the NHS Act 1977
• Directions from the Secretary of State, currently
  the Alternative Provider Medical Services (no 2)
  Directions 2004
• Provisions from the National Health Service
  (Personal Medical Services Contracts) Regulations
  2004

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Will the Process Be Fair?EU Procurement Directive

• EU Treaty means PCTs have obligations of
  transparency and fairness in tendering processes
• The only formal requirement is to publish a
  contract award notice following the award of the
  contract much more will be expected

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Will the Process Be Fair?Conflicts Of Interest

• Conflicts of interest are particularly likely if
• There is potential for the tendered services to
  be provided directly by the PCT
• GPs in the PCT area are potential bidders for the
  services
• GPs could lose their enhanced services to the
  proposed scheme
• All potential conflicts of interest must be
  disclosed

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Will the Process Be Fair?Experience

• Does the PCT have tendering experience?
• Does the PbC cluster have tendering experience?
• Who is advising them?

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What Should Worry Us?Potential Provider Concerns

• Repetitive pre-tender quality vetting
• Endless discussions that progress nowhere
• An over-bureaucratic process
• Lengthy private discussions resulting in a
  competitive tender open to others
• A fix with only one bidder considered
• Risk of losing intellectual capital when
  discussions put into the public domain and shared
  with others
• Process disproportionate to the value ofthe
  contract
• Competitors using loss leaders

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What Types Of Tenders Are There?Types of
Procurement Process

• Model A Competition against specification
• Model B Competition against specification with
  variant bids encouraged
• Model C Competition to act as a partner in
  developing and providing a service
• Model D Responding to a direct approach
• Source NHS Confederation

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Tender Applications

• Selection criteria and the parameters of the
  tender document should be clearly stated in the
  procurement pack
• Contact details and methods of obtaining further
  information should be stated
• Other sources of information may include
• Freedom of Information Act
• Annual report and accounts
• Public Health report
• Local Authority information
• Doctor Foster ..

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Are We Up To It?Initial Questions

• What are the gaps in our skills and knowledge of
  planning and tendering?
• What additional help will we require during the
  tender process?
• What analytical and planning techniques are
  required?
• Who will have to be involved?
• Do we have the organisational capability?

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What Comes Before Form Filling?Engaging in the
Process

• Completing tender documentation is not about
  filling in the boxes with words the PCT wants to
  read
• It is about proving you have undertaken all the
  essential preparatory work to ensure successful
  implementation
• The documentation is the final evidence of that
  process
• Proving you have the experience

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What Sort of Organisation Are We? Your
Competitive Strategy

• Cost Leadership
• Having the lowest costs by being efficient and
  having economies of scale
• Differentiation
• Creating a unique service by packaging or quality
• Focus
• Concentrating in a limited field of activity

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What Are Our Capabilities?Your Capability Profile

• Is your current organisation capable of winning,
  sustaining and retaining the contract?
• Resources available
• Services provided
• Systems used
• Organisation structure
• Quality of outcomes
• Financial returns
• Proven track record

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What Are Our Capabilities?Organisation

• Current facilities
• Where are the bottlenecks?
• Analysis of staffing
• Qualities
• Skills
• Adaptation to change
• Analysis of financial performance

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What Are Our Capabilities? Expectations

• Employees
• Job satisfaction
• Pay
• Working arrangements
• Patients
• Quality
• Access
• National and local Associations
• Purchasers

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What Do We Want To Achieve?Generating Ideas

• Time is needed to articulate and discuss
  perceptions of patient need
• Avoid solutionism generating solutions
  without fully forming the problem
• You need an insight into the thinking of the PCT

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What Does the PCT Want?Using Marketing in the NHS

• A coherent and objective read that
• Responds to patient need
• Responds to Ministers needs
• Responds to targets
• Responds to White Papers
• Demonstrates value for money
• Shows innovation
• Ticks some boxes!
• Answers the question!!!

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How Do We Write The Tender?Putting it on Paper

• Clear
• Concise
• Accurate
• Factual
• Evidence based
• Business-like
• Specific to the audience
• With impact

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What About the Money?Costing of Services

• Basic pay
• Allowances and enhancements
• National Insurance and pension contributions
• Additions for long-term sickness and maternity
  leave
• Uniforms, vehicles, mobile phones etc
• Equipment, materials, premises costs
• Management and administration
• Costs of gathering data, analysing it and
  reporting upon performance

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How Do We Get Paid?Payment Mechanism

• Method
• Fixed price
• Performance-related
• Volume-related
• Other measure?
• Incentives for high-quality performance
• Access to financial information, or an
  open-book accounting system
• Price variation mechanism for changes to services

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Where Do I Find Out More?Further Information

• NHS PASA will be issuing a procurement pack and
  contract commentary on the NHS PASA website
  www.pasa.nhs.uk
• www.healthskills.co.uk
• www.lmcs.info