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COMMISSIONING, DISINVESTMENT AND CONTRACTING
MANUAL
Evaluation of Initial
ProposalDevelopment Procurement Contract Monitoring
START UP
The Four Pipeline Phases
The Pipeline
For use in (area) NHS Milton Keynes
For use by (staff groups) All staff
Document Owner: Pam Tresise, Head of Corporate Affairs
Document Status: Approved
Version Date Author Reason 2 August 2010 Pam Tresise / Sue Lacey-
Bryant Final edit
Version Date Approved Last Review Next Review Approved by Author/
Contact Person
1 July 2010 EMT
Sue Lacey-
Bryant, Pam
Tresise & Andy
Peedle
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 2
Contents Page
INTRODUCTION
Purpose: the commissioning and contracting pipeline
A single process
Programme and project management
Commissioning for quality
Features
Applying the process to the appropriate level
Parallel working
Organisational values
4
4
4
6
7
7
8
8
8
START UP
REQUESTS FOR A COMMISSIONING CHANGE (START UP)
Requesting a change in commissioning
A single route for requests
Review
Decision point
Activities
Products
Ending start up
9
10
10
10
10
10
11
11
PHASE 1
1.1
1.2
1.3
1.4
EVALUATION OF INITIAL PROPOSAL
Decision points
Activities
Products from Phase 1
Ending Phase 1
12
12
13
13
13
PHASE 2
2.1
2.2
2.3
DEVELOPMENT
Decision points
Activities
Products from Phase 2
14
14
14
14
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 3
2.4
2.5
Ending Phase 2
Scalability
15
15
PHASE 3
3.1
3.2
3.3
PROCUREMENT AND DELIVERY
Activities
Products
Ending Phase 3
16
16
16
17
PHASE 4
4.1
4.2
4.3
4.4
4.5
CONTRACT MANAGEMENT
Decision points
Activities
Products
Transition management
Post project review
18
18
18
19
19
19
19
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 4
Our Chief Executive Officer, Dr. Nicholas Hicks spearheads the organisations beliefs that collectively
we manage the commissioning of health services on behalf of local taxpayers in order to provide
safe, high quality healthcare, and improve health and reduce inequalities.
We are keen to work with partners across the health economy. This document sets out our ways of
working and with a view to transparency links to PDFs of the templates we use through our working
processes.
Purpose: the commissioning and contracting pipeline This manual describes how we manage the journey we experience when commissioning and
contracting. In particular it sets out the phases of work (‘Pipeline’ Fig 1.0) through which requests for
changes in the services currently being commissioned are steered. Clearly defined processes and
standardised documentation support a shared understanding so that we can effectively navigate /
steer a proposed commissioning change through to delivery / implementation.
Fig1.0 the ‘Pipeline’
Evaluation of Initial
ProposalDevelopment Procurement Contract Monitoring
START UP
The Four Pipeline Phases
The Pipeline
The manual:
Offers a transparent, simple and well understood framework
Evidences commitment to streamlining ways of working to enable implementation of the Strategic Operating Plans
Is a live and dynamic resource, which is regularly updated
Ensures robust consideration and evaluation of the need for change, thorough development of proposals, timely decision-making, efficient tendering and contracting to deliver the change, on to subsequent monitoring of its delivery and impact.
Not least, the manual makes explicit the underlying principles and values to which we are
committed. Focused on improving the quality of healthcare, we are committed to an evidence-based
approach to commissioning, and to engaging patients and the public, clinicians and commissioners in
strategic planning and service design.
A single process NHS Milton Keynes has a single ‘commissioning pipeline’ for all requests, suggestions and directives
for commissioning change. Each phase has associated activities that allow the proposal to be moved
along. Decision points are made explicit, and the governance arrangements for each phase of the
pipeline are described so that a focus on strategic priorities is maintained.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 5
This consistent approach ensures that, whatever the stimulus for change, the same rigour is applied
to evaluating the organisation’s response to the request, that processes are well understood and
that organisational resources are used to good effect (and not wasted on working up proposals that
ultimately are non-runners).
The phases broadly sit within the wider Commissioning Cycle which is seen as ‘best practice’ for
commissioning organisations.
We are moving towards commissioning via Capitation Outcomes Based Incentivised Contracts
(COBIC) which will demonstrate a commitment to commissioning for outcomes (quality) rather than
simply outputs (activity). The processes align with the South Central Collaborative Operating Model
(COM) for strategic sourcing. The Trust is keen to work collaboratively and to engage effectively with
the Commissioning Enablement Service (CES), and committed to making good use of data and
analytical tools along the pipeline.
Programme Pre-
Start
Planning Transition and
Business as Usual Delivery
Project Start : Project Close
Phase 1 Decision
Points
Programme adopts proposal
Programmeauthorises project
Phase 2 Decision Points
Programme approve documents
PEC approve clinical pathway
Project approved
Phase 4 Decision
Points
Payment approved
Phase 3 Decision Points
STAKEHOLDER ENGAGEMENT IN ALL PHASES: Clinicians / Public and Patients/ Primary
Care / Providers
Phase 1.
Evaluation of
Initial Proposal:
Establishing its
contribution to
QIPP (Quality,
Innovation,
Productivity,
Prevention)
Phase 4.
Contact
Management:
Ensuring the
right outcomes
Phase 2. Development:
The project phase – all the work done after an item
is recognised as a priority prior to implementation
Phase 3. Procurement:
Delivery Phase
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 6
Programme and project management The Strategic Delivery model of programme and project management will be applied throughout the
pipeline. The purpose of the Programme Boards is to deliver our strategic goals and all work is,
therefore, aligned to the strategy through the Programme Boards. The Programme Board is
responsible for identifying and delivering measurable benefits.
The Programme Board governance arrangements are set out in the diagram below
BOARD
Chair: Malcolm Brighton
Strategy
EXECUTIVE TEAM
Chair: Dr Nick Hicks
Managing the Business
Delivery and
Performance
PEC
Chair: Dr Tina Kenny
Clinical Leadership and
Engagement
BUSINESS CHANGE
FORUM
Chair: Graham Ball
Operational Management
Programme 3
Programme 4
Programme 2
Programme 1
Delivering
Capability
Project
Project
Project
Project
Project
Project
Project
Project
Project
Project
Board Assurance
Pay and Remuneration Committee
Audit Committee
Risk and Quality Committee
Gateway Reviews
Service Reform Group
Chair: Dr Nick Hicks
Provider Leadership &
Engagement
Stra
teg
ic S
en
ior S
up
plie
r
Str
ate
gic
Se
nio
r U
se
r
Sub-Committees of the Board
Programme Boards Aligning Executive Decision Making
LINK:MK
Chair: John Needham
User & Public
Engagement
Turnaround Board
Chair: Non Executive
Director
Portfolio Office
Director: Graham Ball
Prioritisation of
Resources
Key Stakeholders
Scrutiny
Further information about the Strategic Delivery Model is set out in the programme governance
manual.
The NHS Milton Keynes Project Approach is applied throughout the pipeline:
The Programme Board is responsible for monitoring delivery of the project
‘Management by exception’ is used to ensure that the project does not overburden management structures
The Project Owner is the key link to the Programme Board for the appointed project manager.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 7
The project manager ‘runs’ the project and reports to the Project Owner regularly, and should any exception occur
The Project Owner is responsible for assessing whether new intelligence calls into question the project’s original mandate, in which case the Owner must refer back to the Programme Board to consider whether to raise an exception report to the Executive Team
Templates for common project management documents are available on the project server at http://nhsmkproject.mkhe.nhs.uk/pwa
For advice and guidance on how to use the project server and for commonly used templates please
contact the Portfolio Office, tel. 01908 278693.
A training document is available
Pdf versions of the common templates used in the phases of the pipeline are available for
information. These are not working documents; all work should be carried out within the project
server as this will enable a transparent organisational view of current programme and projects
progress and delivery.
Commissioning for quality Services must be commissioned to achieve high quality care for all by delivering on promptness,
safety, effectiveness, efficiency and consideration, and reflect Care Quality Commission Standards
for the registration of providers. We are committed to evidence based practice, public and patient
engagement and clinical engagement.
Features The processes within the pipeline exhibit the following key features:
They are straightforward, easy to understand and ‘lean’ (avoiding waste, adding value)
Meaningful public and patient engagement is central to transformational commissioning.
The pipeline is ‘stage gated’ with explicit decision points, any of which may result in a proposal being rejected or progressed.
Standardisation: the manual is accompanied by templates
Working practice: the manual links to more detailed protocols e.g. on service review and redesign, Map of Medicine (MoM), managing conflicts of interest, workforce planning, procurement and contract monitoring
Transparency: those submitting making proposals will be able to see why the decision has been made
Locally agreed quality criteria are used to support the evaluation and approval of the any proposal for service change and the accompanying business case
Matrix working: effective team-working within multidisciplinary teams is crucial. Leadership will
change and the level of involvement of individuals varies at different points along the pipeline. Good
communication and strong team-working skills are critical.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 8
Applying the process to the appropriate level Adoption of a single pipeline for all requests for commissioning change does not mean that our
processes should be applied to the same extent and in the same way in all cases. Each phase of the
pipeline is important - right up to the point when enough has been done to allow confident decision
making and smooth transition to the next step. Managers are expected to adopt a response
proportionate to the request for change. Over-work and rework are both wasteful.
Parallel Working Changing service may involve one workstream to decommission while another commissions the new
service. Each workstream will work through the pipeline as parallel pieces of work rather than one.
The Programme Board will need to oversee the interdependencies between the two workstreams to
ensure commissioning and decommissioning is coordinated with provider services
Organisational values Our values are embodied in a set of four test statements that reflect core public sector
responsibilities; to provide the best possible services and to ensure that the public get value for their
taxes:
Organisational - ‘we are agents of the public and buy services on their behalf – we buy high
quality safe care for the people of Milton Keynes’
Quality and safety - ‘we are happy to personally use the services that we buy’ and ‘we are
happy to recommend these services to our friends and family’
Efficiency – ‘if this was our own money we would be confident and happy with the way it is
being used’
Work Ethics - ‘we are a small workforce with a budget of over £300 million, and therefore
everyone in the organisation has a critical role to play
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 9
Adopting a whole system approach to quality improvement, we established several channels
through which good ideas can be raised for consideration. The manual makes the governance for
each route explicit. To optimise the process they all feed into and then flow through a single defined
pipeline.
The diagram below outlines what are the key drivers locally that may promote the need for
commissioning change and where across the local health economy they may come from.
Strategic Goal
Health
Inequalitites
Strategic Goal
Urgent Care
Strategic Goal
Patient Safety
Strategic Goal
Vulnerable People
Strategic Goal
Major Killers
Technological
Developments
Changes to Local
Landscape
Project Brief/
Service
Development
Opportunity (SDO)
Programme 1 Programme 2 Programme 3 Programme 4Delivering
Capability
Drivers for Change
Programme Board
Joint
Commissioning
Stakeholder
Groups
Joint Planning
Groups and LITshealth:mk Providers
Using our quality methods:
Evidenced based (inc. Map of Medicine)
Clinician involvement
Public and patient engagement
Source of Request
Turnaround Board PEC
Approvals
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 10
Requesting a change in commissioning The principal sources from which requests for commissioning change, either commissioning a new
service, disinvestment or change in service, may emerge are depicted above. These may be:
Internal - implementing planned strategy via Programme Boards
External to the organisation – in response to emerging policy or guidance, to developing clinical capabilities or to public feedback, or changes to the profile of local provider.
Meaningful engagement and effective market development are integral to effective commissioning.
Conflicts of interest must be recognised and managed appropriately, in line with our policy.
A Start-up Pathway Redesign checklist is available to support this early stage of the work
A single route for requests All requests for commissioning change must initially be directed to the relevant Programme Board
and if unclear consult the Executive Team. To ensure effective implementation of efficiency and
improvement opportunities, plans to renew any contracts relevant to the work-streams of these
strategic Boards must also be submitted to the Programme Board .
Review A (green) Service Development Opportunity Form, a completed Financial Appraisal and Risk
Assessment form is submitted to the Programme Board for the Programme Board to undertake a
first pass review based on the overall strategic direction and objectives of its agreed work
programme and corporate priorities for transformation and change.
Service review must incorporate a review of medicines management and it is essential to ‘get
medicines use right’ within service specifications.
Decision point The Programme Board may agree to progress the proposal into Phase 1 of the commissioning
pipeline for detailed evaluation, or reject it with a full reason why or seeking further information or
because it does not demonstrate how it meets our strategic goals or priorities.
Evaluation of Initial
ProposalDevelopment Procurement Contract Monitoring
START UP
The Four Pipeline Phases
The Pipeline
The stages of commissioning are depicted as a pipeline for convenience. In practice it should be
viewed as a circular process whereby contract monitoring leads to service review and further needs
assessment.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 11
Activities Needs Analysis
Review current service provision These two then feed into completion of SDO and project risk assessment form
Manage conflict of interest identifying stakeholders and potential providers
Review of medicines management
Review Map of Medicine
Undertake preliminary Equality Impact Assessment.
Products
Strategic Development Opportunity (SDO)
Financial Summary Form
Project Risk Assessment form which determines the level of risk associated with the request.
These documents capture enough information to allow the Programme Board to judge whether the
proposal should be progressed.
A Start-up Pathway Redesign checklist is available to support this early stage of the work.
Project management templates to support ‘Start-up’ are held on our project server
Ending Start Up ‘Start-up’ ends in one of two ways:
The Programme Board gives the go-ahead and nominates a project lead to work up the proposal for a more complete review in phase 1
Requests that do not fit with the strategic intent of NHS Milton Keynes to be rejected. Key documents to support this review include the latest Strategic Plan, Operating Plan and Commissioning Intentions.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 12
Milton Keynes Commissioning Pipeline
Start Up
De
cis
ion
s /
Go
ve
rna
nce
Info
rma
tio
nP
roce
sse
s
Service
Development
Opportunity or
project brief
Programme
adopts
proposal
Develops OBC as
Part of PID
Yes
Report to
originator
No
Programme
reviews PID
against criteria
and prioritise
Programme tests
and
recommends
project to
Turnaround
Board
Project Initiated
Report to
originator
No
Report to
originator
‘progressing’
PID sent to PEC
for clinical review
Feedback/Advice
Phase 1 Evaluation of initial proposal
NHS MK Project Approach (PROGRAMME PRE-START)
Stakeholder
Engagement
Start health
market analysis
Identify project
team members
Asse
ss a
nd
ma
na
ge
co
nflic
t o
f in
tere
sts
Yes
Turnaround
Board
authorises
project
Phase 1 starts with the development of Project Initiation Documents (PID) by the nominated project lead. The PID incorporates an Outline Business Case (OBC). The Programme Board reviews the OBC and seeks advice from Professional Executive Committee (PEC) before authorising a new project, and agreeing its start date. Where an approved project incorporates a pilot project, it is essential that procurement rules are followed to avoid legal challenge This phase is ‘fed’ by the (green) Service Development Opportunity Form (SDO) and Financial
Appraisal together with the Risk Assessment Form.
A Phase 1 pathway redesign checklist is available,
1.1 Decision points
Programme Board reviews the PID against criteria and prioritises the proposal
Programme Board recommends for project start, or rejects proposal.
PEC reviews PID and advises Programme Board on route of travel and clinical safety
Business Change Forum (BCF) reviews PID to ensure that the OBC is robust and all relevant teams are aware of the project
Project authorised by Turnaround Board Criteria: 1. Cost savings 2. Patient safety 3. System reform
Within these consider the following; strategic fit, QIPP, priority, evidence-base, capability,
capacity engagement and acceptability, scalability, constraints, risk.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 13
1.2 Activities
Workforce impact assessment
Testing evidence base
Cost Benefit analysis
Test fit with strategic priorities
Quality testing; quality criteria
Public and patient engagement
Clinical engagement and clinical decision making within the commissioning cycle
Refer to the ‘medicines in commissioning toolkit’
Review Map of Medicine
Consider information requirements
Equality impact assessment
1.3 Products from Phase 1
A detailed Project Initiation Document (PID); to include the Outline Business Case, Equality Impact Assessment
Advice from PEC to the Programme Board
Report to originator on the status of the request – i.e. progressing (approved at Phase 1) or not progressing (rejected)
Communications plan
Inclusion of the new project in the NHS Milton Keynes database of work in progress
Project management templates to support Phase 1 are held on the project server
A Phase 1 Pathway Redesign checklist is available to support this stage of the work
1.4 .Ending Phase 1
This phase ends in one of two ways:
The proposal is approved. A commissioning project is initiated, a project manager appointed
Programme Board does not support the proposal and this is reported back to the originator with the rationale for the Board’s decision
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 14
The outcome of this phase is a decision on the full business case.
(Phase 1) Phase 2 – Development Stage [NHS Milton Keynes Project Approach – Project Start]
Milton Keynes Commissioning Pipeline
De
cis
ion
s/ G
ove
rna
nce
Info
rma
tio
nP
roce
sse
s
Workforce PlanProject initiation
document
Service
Specification
Market
Management
Full Business Case
Pprogramme
sends Service
Specification and
Clinical Pathway
to PEC
PEC approve
clinical
pathway
Programme
prepares for
documents for
approval with
Project Owner
Report to
Programme
Project within
delegated
limits?
Turnaround Board
approves project
ready for
procurement/
disinvestment
no
yes yes
yes
Move to
procurement/
disinvestment
Delegated
Authority
Approval
no
yes
yes
Report to
Programme
no
A Phase 2 Pathway Redesign checklist is available to support the preparation of the full proposal
2.1 Decision points
Approval or rejection of full business case by the appropriate body – working in accordance with NHS Milton Keynes Delegated Limits (Programme Board, Executive Team or Board).
The clinical pathway and service specifications must be approved by PEC
2.2 Activities
Some activities in this phase will overlap chronologically with work being conducted for phase 3
activities:
Provider / market analysis
Exploring Investment & divestment opportunities and potential for outsourcing
Developing the service vision / blueprints
Exploring the implications for the workforce
Collating intelligence to inform planning – concerns, complaints, incidents, reports – favourable or otherwise
Develop full Service Specification ready for PEC approval
Public and patient engagement
Clinical engagement
Consider IT Systems and data requirements
Map of Medicine pathways
Undertake Equality Impact Assessment
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 15
2.3 Products from Phase 2
The main product is the Full Business Case on which the decision as to whether to progress to
tendering and procurement is based
Terms of reference
Stakeholder analysis leading to a stakeholder map
Business case
IT system requirements
Workforce template
Service blue-print
Full Service Specification inc. minimum datasets (MDS) and additional data requirements
Localised MoM pathways
Market management plan
Description of the procurement route
Equality Impact Assessment
A Phase 2 Pathway Redesign Checklist is available to support the preparation of the full
proposal,
Project management templates to support Phase 2 are held on the project server
For project management, structure and leadership see section 1.3 Programme and project
management
2.4 Ending Phase 2
This phase ends in a decision on the Full Business Case by the delegated authority (Programme
Board, Executive team or our Board in line with Delegated Limits):
The full business case is approved and the project is progressed to phase 3 of the pipeline
The clinical pathway and service specifications must be approved by PEC
Programme Board rejects the full business case in the light of gathered intelligence
Decisions are reported back to the originator with the rationale for the Board’s decision
2.5 Scalability
For significant, radical, ‘cross service’ changes extensive work is required in this phase. For a
small change affecting a single department in a single service phase 2 may require relatively
small pieces of work involving a small group of people.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 16
This phase is led by the relevant Director who creates a Procurement Panel (PP) to deliver the
procurement function. It stands down at the end of the phase. Its work is guided by agreed
clinical services procurement principles
This phase is ‘fed’ by the Full Business Case, as approved, including:
The stakeholder map
IT system requirements
The communications engagement plan
The outline business case
The workforce template
The service blue-print
Service Specification including minimum datasets (MDS) and additional data requirements
Localised MoM pathways
Market management plan
Equality Impact Assessment
Phase 3 Procurement
Milton Keynes Commissioning Pipeline
Phase 2
De
cis
ion
s /
Go
ve
rna
nce
Info
rma
tio
nP
roce
sse
s
Procurement
process
commences
Preferred provider
selectedFinalise contract
Report to
Programme
Sign contract Project end
NHS MK Project Approach – DELIVERY to PROJECT END
Phases 2 and 3, whilst discrete, may overlap chronologically so that elements of development
and procurement are run in parallel.
A Phase 3 Pathway redesign checklist is available to support the planning and implementation of
change in pathways
3.1 Activities
Procurement – note, where an approved project incorporates a pilot project, it is essential that procurement rules are followed to avoid legal challenge
Change management
Contract with providers / shape structure of supply
The CES Procurement Transactions Service may come into play in this phase.Consider
equality issues
Consider workforce issues
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 17
3.2 Products
Tender Document in accordance with procurement strategy
Selection Criteria (from business case)
Feedback to bidders
Equality Impact Assessment
Workforce planning
Project management templates to support Phase 3 are held on the project server
A Phase 3 Pathway Redesign Checklist is available to support the planning and implementation
of change in pathways,
3.3 Ending Phase 3
Phase three ends with selection of the preferred provider and the signing of an agreed contract.
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 18
This phase is led by the relevant contracting team
This phase is ‘fed’ by
The Full Business Case from Phase 2 ( particularly relevant are the Service Specification
and Service Specific data set)
Tender document from Phase 3
Phase 4 Contract Management
Milton Keynes Commissioning Pipeline
Phase 3
De
cis
ion
s /
Go
ve
rna
nce
Info
rma
tio
nP
roce
sse
s
Invoice receivedInvoice validation
Delivery checked
against invoice
Review
Quality review /
Contract
monitoring /
Performance
management
Payment
approvalNo
Payment made
Yes
Programme Management – Transition Management and Business as Usual
A Phase 4 Pathway Redesign checklist is available to prompt review of the changes delivered, plus
targeted intervention, as needed.
4.1 Decision points
Key decision points are contract monitoring and performance management against quality
standards prior to payment.
4.2 Activities
Contracting
Contract Monitoring
Quality monitoring
Focused intervention when necessary
Post project review
Patient experience monitoring
Managing demand and ensure appropriate access to care
Workforce planning – the contract may specify workforce requirements that must be met
4.3 Products
Invoice management
Contract quality management
Post Project review
COMMISSIONING AND CONTRACTING MANUAL
14 july 2010 Page 19
Project management templates to support Phase 4 are held on the project server. These will
include:
Contract template
Service specific data set
Post-project review guidance
Formal guidance on the procedures for the contract monitoring process is available to staff
A Phase 4 Pathway Redesign Checklist is available to prompt review of the changes delivered,
plus targeted intervention, as needed.
Staffing standards and skills issues are addressed in key questions on the workforce in contract
monitoring.
4.4 Transition management
Ownership of responsibility for managing the change as an outcome of the project into business
as usual lies with the Business Change Manager
4.5 Post project review
Post project review is managed by the portfolio office. This is an important step as it enables
continual learning and improvement of commissioning processes.
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