commissioning, disinvestment and contracting manual v… · commissioning and contracting manual 14...

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

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


14 july 2010

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


14 july 2010

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’



START UP


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.


14 july 2010

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


14 july 2010

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.


14 july 2010

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.

http://nhsmkproject.mkhe.nhs.uk/pwa


14 july 2010

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


14 july 2010

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


14 july 2010

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.



START UP


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.


14 july 2010

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.


14 july 2010

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.


14 july 2010

1.2 Activities

Workforce impact assessment

Testing evidence base

Cost Benefit analysis

Test fit with strategic priorities

Quality testing; quality criteria


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


14 july 2010

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]


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


Clinical engagement

Consider IT Systems and data requirements

Map of Medicine pathways

Undertake Equality Impact Assessment


14 july 2010

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,


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.


14 july 2010

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


Phase 3 Procurement


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


14 july 2010

3.2 Products

Tender Document in accordance with procurement strategy

Selection Criteria (from business case)

Feedback to bidders


Workforce planning


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.


14 july 2010

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


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


14 july 2010

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.