1

London Medical Locum Framework Agreement Contract Ref. No: GP- 000017

User Guide October 2012 – version 1.2 Contents Introduction....................................................................................... page 2 Background...................................................................................... page 2 Scope of the new framework........................................................... page 2 Benefits of the new framework......................................................... page 3 Management of the new framework................................................ page 3 Risks of using non-framework agencies........................................... page 5 Pricing and Discounts....................................................................... page 5 Implementing the new framework within your trust.......................... page 6

Stage 1: Establish your existing position.............................. page 7 Stage 2: Select suppliers...................................................... page 7 Stage 3: Consider your approach......................................... page 9 Stage 4: Communication...................................................... page 10 Stage 5: Service Level Agreements (SLAs)........................ page 11 Stage 6: Eliminate any non-framework use......................... page 11 Stage 7: Good practice......................................................... page 12 Stage 8: Monitoring agencies............................................... page 14

Working together with other London trusts....................................... page 14 Complaints procedure...................................................................... page 15 Frequently Asked Questions............................................................ page 16 Contacts........................................................................................... page 19 Appendix 1: List of Framework Agencies and contact details.......... page 20 Appendix 2: List of Job Profiles........................................................ page 22 Appendix 3: Agency Worker Placement Checklist........................... page 25 Appendix 4: Migration support.......................................................... page 26

2

Introduction This user guide is intended to provide information about the new regional framework agreement for medical locums (contract ref: GP-000017), and guidance for how to use it. The new London framework is in place from 1st May 2012 for a period of two years (with the option to extend it for a further 2 x 12 months). It is available for use by all London NHS trusts and any other public sector organisation within the London region. Background Traditionally, Trusts within London have made use of the national framework for medical locums provided by the NHS Purchasing and Supply Agency (PaSA) and now Government Procurement Service. The current national framework is due to expire in June 31st 2012. A number of issues and considerations have now led London Trusts to believe that the creation of a framework procured and owned within London is now the optimum approach for the benefit of London. The new regional medical locum framework will build on the recent success of the regional agency nursing framework which now provides access to around 90% of agency nurses within the London region and savings of £8m per annum compared to the previous Government Procurement Service framework. The London Procurement Programme (LPP) have established the new framework agreement in partnership with St George’s Healthcare NHS Trust, who are ‘hosting’ the new framework. Scope of the new framework The new London framework agreement is for the supply of Medical Locums and Locum General Practitioners. A list of professional specialities and job families covered by the Framework Agreement is included at Annex 2. What are the benefits of the new framework?

Reduced costs – costs will be reduced in terms of the hourly pay rate, supplier commission fee and the uplifts for unsociable hours. Discounts are also available; for electronic trading, prompt payment, long-term placements and volume of business level discounts. Trusts may also appoint a supplier as a Tier 1 supplier which enable Trusts to make further savings against a supplier’s standard commission rates.

Reduced clinical risk – using the framework provides assurance that agencies are contractually obliged to provide medical locums that meet the requirements of the NHS T+C’s, which include DH and NHS Employers’ guidelines

NHS LA compliant – Use of framework agencies and the Agency Worker Placement Checklist is supported by the NHS Litigation Authority. NHS LA audit outcomes determine the level of fees paid to them by your trust

3

Improved framework management – LPP will be overseeing the framework and providing regular updates to stakeholders to help implement the framework, as well as assisting with regional SLAs if required

Legally compliant – using the regional framework allows trusts to access better rates in a legally compliant way, in line with EU regulations. It also provides trusts with a compliant route to call off suppliers

London focused – having a regional framework allows for better strategic management of suppliers and better engagement with stakeholders, ensuring that London trusts’ specific needs are met. London Trusts are well placed to work together to manage the medical locum market

Audits – one of the key benefits of using framework agencies for the supply of medical locums is the security of knowing the audit team inspects them. The audit team ensures that NHS Employers’ quality and code of practice standards are maintained and that framework agencies and their temporary workforce are compliant with all national guidelines for occupational health and identification security. This includes validation of qualifications and Criminal Records Bureau checks. Whilst the framework seeks to provide value for money for the NHS; patient safety and clinical governance are high priority drivers not only for the construction of the framework but also the ongoing review of framework agencies’ adherence to these standards. NHS bodies that use non-framework agencies will run the risk of allowing temporary staff into their organisation without this protection and reassurance. This, in turn, could seriously affect patient safety and clinical governance requirements.

Pricing and Management Information (MI) will continue to available through MyLPP, which allows Trusts to access pricing (including pay rate, supplier commission fee and discounts available) and also provides spend data and reports for your own Trust. Guidance on how to access and use MyLPP is available online: www.lpp.nhs.uk Audit of the new framework will be undertaken by LPP and results of the audit will be shared with Trusts on the LPP website.

The audit team’s fundamental objective is to ensure that all workers supplied to the NHS are of high quality and do not present a risk to patient safety. Set out below are some of the areas audited to ensure that the framework agencies are compliant with the contract:

recruitment procedures

immigration rules and regulations

fitness to work and immunisation

professional qualifications

training

criminal records disclosures (CRB checks) The audit team has close links with strategic stakeholders in this area including:

NHS Employers

NHS Counter Fraud Services (NHSCFS)

General Medical Council (GMC)

4

NHS Litigation Authority (NHSLA) Regular audits will continue for awarded agencies during the lifetime of this agreement. The ongoing review of suppliers will focus on the following areas:

NHS employment check standards

policies and procedures

contract price

invoices and timesheets Within the audit process the team review individual files of agency workers to make sure that suppliers can demonstrate that individuals undergo a CRB check, are trained in life support, have the right to work in the UK and meet occupational health and regulatory body registration check requirements. It is possible that individual agency workers could be suspended from being used without the entire agency being suspended. Where there is significant non-compliance, an agency will be required to prepare a plan to improve compliance, a meeting will typically take place with the supplier 10 days after the initial audit and a follow up audit will be undertaken six weeks after the first notification of non compliance. LPP and the audit team will work to help agencies improve their compliance. The audit team will continue to carrying out emergency/spot check audits as part of the ongoing supplier review, where the NHS raises concerns or where whistle blowing occurs. Invoice auditing will continue to form part of the new agreement and the team will continue to work closely with NHSCFS to ensure best practice timesheets and invoices are implemented to mitigate against instances of fraud. Role of LPP LPP will manage and administrate the framework including the following areas:

- Strategic supplier relationship management - Collaborative regional initiatives - Managing the stakeholder networks including LSG and Category Board - Analysis of Management Information and other relevant data - Working together with the audit team to drive compliance - Dealing with operational and strategic issues arising during the lifetime of the

framework - Point of contact for London trusts and all framework stakeholders

A central Management Charge of 0.75% on the invoice amount (excluding VAT) will be incurred when using the new framework agreement. This is partially intended to cover the costs of managing and administrating the framework, including audit and the use of the MyLPP Management Information system. Where a trust is a member of the London Procurement Programme then any surplus that is recovered in the management charge will be netted off against LPP fees due in the same financial year.

5

What are the risks of using non-framework agencies? Non-framework agencies will only continue to exist if the NHS continues to give them business. They all had the opportunity to be on the framework but have made a business decision not to participate. London trusts can only ensure compliant medical locums at fair prices by working together and only using the agencies and pay rates within the framework.

Increased costs for all – if one trusts uses a non-framework agency, not only will they pay higher rates, but ALL trusts will feel the impact, as other agency medical locums start to demand increased rates

Severe clinical risk - no assurance that workers meet DH and NHS Employers requirements, such as CRB, references and immunisation. This can pose a direct risk to patient safety and may also lead to legal costs

No audit – agencies are not audited by the national team and there is no assurance to check they are providing safe, compliant medical locums

Legal risk - non-framework agencies may not have sufficient insurance and liability cover

Risk of placement fees – if you use an medical locum from a non-framework agency who then works at the trust through a different agency, the trust is likely to be charged very high ‘placement’ fees or ‘introduction’ fees by the non-framework agency. If you only use framework agencies, fees like this can be easily avoided by observing the notice periods laid out in the framework agreement

Non-compliance – using non-framework agencies does not comply with EU law for public sector organisations, unless the trust carries out their own compliant procurement process which would be lengthy and costly

Pricing and Discounts Pricing and discounts for each agency can be accessed online through the MyLPP system. More information on this system is available at www.lpp.nhs.uk MyLPP is a pricing and reporting tool. It combines the benefits of providing access to the full range of framework supplier pricing, discounts and supplementary charges with supplier ranking reports, bespoke spend reports for your trust and a cost analysis tool. The system is easy to use with a clear layout; we highly recommend that trusts gain access to MyLPP to help achieve the full benefits of this new framework. Total price is made up of a number of elements in the regional framework agreement:

1. Hourly pay rate to medical locum (this varies per job sector and pay band) 2. WTR (Working Time Regulation) supplement which is a set amount added on as a

percentage of the hourly pay rate 3. ENIC (Employers’ National Insurance Contribution) which is a set amount added on

as a percentage of the hourly pay rate 4. Supplier commission fee (this is a fixed flat rate per job sector and pay band; it is

not a percentage) The tender process for this framework agreement was structured in order to encourage agencies to offer competitive, fair market rates. Due to the high pay rates offered by some

6

agencies some locums may see a reduction in their hourly pay from their previous rates, depending on which agency they are with. It is important to note that if ALL London trusts commit to the new framework prices, locums will have to accept these pay rates, which represent a fair market rate for London. Only by working together will London trusts get the best value from the new framework. It is also hoped that more locums will be attracted into bank or substantive roles. Following consultation with London trusts, the option for an escalation procedure (i.e. increasing pay rates above the agreed framework rates) has not been included in the regional framework. It was agreed that agencies too readily make use of an escalation procedure to unnecessarily inflate pay rates. Pay rates in the London framework are fixed, with an option for an annual review in April 2011. It will be stressed to framework agencies that escalation of pay is not permissible, but trusts must flag any instance of this to LPP. Framework agencies have also had the opportunity to offer a range of discounts to trusts. Where offered, these discounts will be deductible from the supplier commission fee only, rather than from the total charge rate:

Long-term placement discount (for placements over 4 weeks)

Prompt payment discount (0-3 days, 4-7 days, 8-14 days, 15-30 days)

E-trading discounts (booking via web application, use of electronic timesheets, electronic invoicing)

Tier 1 commission (where a Trust has an SLA in place with a Supplier for a period of time for a number of families, for which it pays a Tier 1 commission rate rather than a standard commission rate)

Volume of business level (VBL) discounts: VBL discounts are available at the following levels of spend:

Volume Business Level

12 months annual anticipated value of business excluding VAT (£)

1 up to and including £100,000

2 £100,000.01 and up to and including £500,000

3 £500,000.01 and up to and including £2,000,000

4 £2,000,000.01 and up to and including £7,000,000

5 £7,000,000.01 and up to and including £12,000,000

6 £12,000,000.01 and up to and including £13,500,000

7 £13,501,001

Implementing the new framework within your trust It is vital that everybody in your trust who may be required to book medical locums is aware of this agreement and has access to a complete list of framework agencies and contact details. Once a decision has been made regarding which supplier(s) to work with, it is essential that this is communicated to all relevant people in your trust. In the event that the preferred agencies are unable to supply, other framework agencies should always be approached, rather than any non-framework agencies.

7

In order to successfully implement the new framework agreement within your organisation, you may wish to consider the following recommendations: Stage 1: Establish your existing position 1. Establish a project leader

If possible, appoint a project leader to manage the implementation of the framework. The project leader will be the main link between agency bookers, agencies, the LPP stakeholder group and any other NHS trusts. The project leader needs to have sufficient seniority or senior management support, in order to bring about any necessary changes within the trust. 2. Consider current agencies

- Review the list of framework agencies and check if the agencies you are using now

are on the list.

- Check if there are any SLAs or interim arrangements in place with current agencies. It is understood that any current arrangements with agencies should have been made on an ‘interim’ basis only, in anticipation of the new framework. However, check if this is the case and make sure your trust is not tied in to any other arrangements when the new framework comes in to effect.

3. Analyse current usage

- Which types and bands of medical locums are most used at your Trust?

- What percentage of temporary roles are currently filled through the staff bank? - What rates are you currently paying? Consider both the supplier commission fee

and the medical locum hourly pay rate. Compare the hourly pay rates you previously paid with the new framework pay rates. Are medical locums at your trust likely to be taking a pay cut under the new framework? If so, this may affect the way you communicate about the new framework. Ensure the relevant people at your trust are aware of this. However, be assured that if all London Trusts continue to commit to these new pay rates, medical locums will accept these new rates.

Stage 2: Select Suppliers A full list of London framework suppliers and their contact details is available in Appendix 1. The new framework agreement is a ‘direct call off’ framework, which means it is unlikely that further competitions will be required in order to select suppliers. Further competitions, or mini competitions, are only permissible if there is a specific requirement which is not already covered within the terms of the framework agreement. A tool has been developed which allows trusts to select suppliers in a compliant way; according to scoring information from the tender process. Trusts will be able to weight the different scores within permissible weighting ranges, according to their particular requirements. Please see the LPP website for the call-off tool and all relevant details. www.lpp.nhs.uk

8

Although this type of call off process is not a new legal requirement, it has not been widely adhered to in the past. It is important to bear in mind now, that you will need to consider all agencies on the new framework in a fair and transparent way, before deciding who to work with. The selection criteria will include price (pay rates, supplier commission fee, discounts) and the number of compliant locums that the agency has registered (in the relevant job roles). It is recommended that as a Trust, you keep written notes to back up your decision-making process with regards to your choice of supplier(s). For further information on legislation regarding supplier call-off, please follow this link: http://www.ogc.gov.uk/documents/OGC_Guidance_on_Framework_AgreementsSept_08.pdf

9

Stage 3: Consider your approach Depending on your current position and which suppliers you select, you may wish to adopt different approaches. Consider which of the following applies to your trust:

You currently use an

agency which is on

both the national and regional

frameworks

You currently use an

agency which is on the

national framework but not on the regional

framework

You currently use a

non-framework agency

You wish to continue

with the same agency

through the regional framework

You wish to move to

a different agency

which is on the regional framework

You wish to move to

a different agency

which is on the regional framework

You wish to move to

a different agency

which is on the regional framework

Contact the agency and confirm in writing that all future bookings will be made under the new regional framework; contract reference

GP000017.

Ensure the regional framework prices are

adopted as from 1st May, and no higher or lower

rates are agreed.

You will need to justify and document your

reasoning for continuing with the same agency,

and show that you have considered all other

agencies on the regional framework in a fair and

transparent way.

Stop using the non-framework agency as

soon as possible i.e. do not make any new

bookings through them and do not renew existing bookings.

Check the non-

framework agency’s T+C’s to find out notice periods in order to avoid placement fees if medical

locums migrate to the new framework agency.

Subject to any required notice periods, inform

medical locums and staff that from 1st May the

Trust will only be using agencies on the regional

framework.

If medical locums are migrating to a new

agency, they will need all the relevant

paperwork to be in

place including a new CRB check, in order to

be compliant.

See also Stage 6 and

‘migration support’ in Appendix 4.

If you have an SLA with

the agency, you will need to give them 3

months notice that you will be terminating this agreement, unless you have already given this notice or it is an interim

SLA.

If medical locums are migrating to a new

agency, they will need all the relevant

paperwork to be in place including a new

CRB check, in order to

be compliant.

If you have an SLA with

the agency, you will need to give them 3

months notice that you will be terminating this agreement, unless you have already given this notice or it is an interim

SLA.

If medical locums are

migrating to a new agency, they will

need all the relevant paperwork to be in

place including a new

CRB check, in order to be compliant.

10

Stage 4: Communication Communicate your decision with internal staff. Clear communication is essential to ensure that all those who may book medical locums are aware of the new regional framework and the agencies they should use. This is especially important in Trusts where locums are not booked centrally but through individual departments. You may wish to communicate the following to all bookers as well as medical locums themselves, to ensure they are aware of the new framework:

- All medical locums will be booked through the regional framework (contract reference GP-000017) as from 1st May 2012.

- The Trust is committed to only using agencies and prices in the new framework from this date

- Advise which agency/agencies you have chosen to work with, if applicable - It is expected that some medical locums may be facing a reduction in pay rates,

depending on which agency they are with. However the Trust is committed to only paying these rates and no increases (i.e. ‘escalated rates’) will be permissible

- Medical locums are invited to join the staff bank - In the current challenging financial climate faced by the NHS, changes must be

made in regards to agency staffing spend - This is a fully supported London-wide initiative

Bookers will need to be aware of the following, as a minimum:

- The contract reference for the framework to use when making each booking (GP-000017).

- Why only framework agencies should be used - Who the framework agencies are and their contact details - What types of medical locum each agency supplies - Which agencies they should use first. Are there any SLAs in place at the NHS Trust

and what has been agreed within the SLA - What they should do if the priority agencies are unable to supply - What they should do if no framework agency is able to supply. There should be a

high level authorisation procedure before anyone is permitted to use a non framework agency.

- Who should they go to for advice regarding medical locum agencies. Who is the project leader for medical locum usage.

It may not always be practical to quote the contract reference (GP-000017) with each booking that is made. Where this is the case it is recommended that trusts have an agreement in writing with each framework agency they use, where by the framework agency accepts that any booking made from that authority, to fulfil a requirement for medical locums is assumed to be made under the framework agreement terms and conditions of the contract. You may also wish to promote the framework using posters or email alerts within the trust. Suppliers may also need to communicate with their medical locums and undertake some work to manage the transition into the new pricing structure. The more London trusts show they are committed to the new framework and prices, the more agencies will do to support it. Trusts are advised to communicate with suppliers to confirm their commitment to the new framework and reiterate that no escalated pay rates will be considered.

11

Stage 5: Consider Service Level Agreements (SLAs) What is an SLA? An SLA is a written agreement between a Trust and an agency which sets out the way in which the agency and Trust will work together under the framework agreement, in order to get the best value from the framework and meet specific Trust requirements. Trusts may choose to sign an SLA with one or several agencies; and may also choose to sign SLAs for the supply of particular groups of staff. By consolidating spend Trusts may maximise volume of business (VBL) discounts. An SLA is intended to:

meet regular local and/or regional agency medical locum staffing requirements

augment any of the service provision requirements set out in the framework agreement

agree discounts on supplier commission fee to reflect on-going or continued business

The typical duration of any SLA is one year. It may be for the same or a shorter duration than the overall duration of the framework agreement i.e. up to but no longer than three years. Permitted content of an SLA can be found in Schedule 6 of the Terms and Conditions of Contract (T+Cs). The T+Cs, as well as a template SLA document, are available on the LPP website: www.lpp.nhs.uk For details of any regional SLAs for medical locums, or for further advice on how to set up an SLA for your trust, please contact LPP. Opportunities for collaboration (e.g. regional SLAs) will be discussed via the LPP stakeholder group. SLAs are highly recommended as best practice, and provide an effective means to manage supplier relationships and access the full range of discounts available. An SLA also provides a mechanism to monitor fill rates, set out requirements such as use of the Agency Worker Placement Checklist, and manage expectations regarding agency service. Stage 6: Eliminate any non-framework use Eliminating the use of non framework agencies requires planning. Senior management/director level support is also essential as is full involvement of all key stakeholders within the trust.

Agency staff will typically go to where the work is. If a Trust continues to book staff through a non framework agency, there is no incentive for agency workers to migrate to framework agencies or to a Trust’s staff bank. When London Trusts commit to only use the agencies on the new regional framework agreement, medical locums will have to work at those agencies and at the agreed framework rates in order to work. Strategies that have worked well at some NHS trusts have been:

- set a date e.g. in two months the Trust will stop using all non framework agencies

12

- publish the date within the Trust to ensure that everyone is aware e.g. on posters confirming that from that date only framework agencies will be used and that if agency workers wish to continue working at the trust they will need to join the bank or a framework agency

- where possible, a dedicated project team should be established at the trust, to

oversee the process

- obtain a copy of the non-framework agency’s terms and conditions, and check the relevant notice periods to avoid any placement fees

- work with framework agencies to ensure that they will focus their recruitment activities to support your timescales for migration

- the framework agency will need to ensure all the relevant paperwork is in place for

the medical locum that is migrating, including CRB checks. These cannot be transferred from one agency to another so allow sufficient time for the checks to be done and all the paperwork to be put in place with the new agency

- if the non-framework agency has a ‘sister’ company on the regional framework,

contact them and tell them you will only accept bookings from the framework arm

- eliminate the use of non-framework agencies gradually e.g. one department or hospital at a time over say a two month period

- work with neighbouring London Trusts to ensure that activities are co-ordinated in

the same geographical area. It does not help if your trust bans the use of an expensive non framework agency if the neighbouring trust is continuing to use them

- seek support from the trust Finance Director, e.g. ‘from x date, any invoices

submitted by x non-framework agency will NOT be paid’

- once the date is reached - stick to it. Any exceptions should require Director level authorisation

Trusts can seek additional assurance that bookings have been made under the framework by ensuring that the timesheet details are being provided as outlined within the framework agreement terms and conditions (Annex 3 of the T+C’s).

- If they are not, consider how you could move away from those agencies i.e. if

possible, stop using those agencies now or reduce usage with them as much as you can. Ensure all bookers are aware not to make any further new bookings with other agencies but to direct all new bookings to agencies on the regional framework.

Stage 7: Good practice Promote the Agency Worker Placement Checklist The Agency Worker Placement Checklist can be found in Appendix 3. Please ensure all those booking agency staff are requesting this from agencies and checking it once received.

13

In the national framework, suppliers are obliged to provide Trusts with a completed Agency Worker Placement Checklist only if the trust requests it. In the new London framework, suppliers are obliged to provide the Checklist unless the Trust opts out. The Agency Worker Placement Checklist is very important as it can be provided as evidence that the trust itself is checking each agency worker’s compliance. This evidence is a requirement of the NHS Litigation Authority, who are auditing trusts individually. The Checklist also acts as an incentive for agencies to ensure their medical locums are compliant. Use of non-compliant medical locums can be a serious clinical risk to trusts and it is vital that compliance is carefully checked for every agency worker. A tick-box has been added to the top of the Agency Worker Placement Checklist, which is to be ticked only if the worked is fully compliant. This is intended to make checking quicker and easier for Trusts. Review agency booking procedures

In order to ensure your Trust has strong controls around the medical locum booking process, you may wish to consider reviewing your booking process. Things you may wish to consider may include:

- Are medical locums booked centrally, or more widely across the Trust e.g. by different departments? Would a central booking process be more efficient and is this workable for your Trust?

- Ensure all bookers are aware of new framework, and that they will need to only book medical locums through those agencies

- Ensure bookers are aware they should not use non-framework agencies, and consider establishing an approval process for situations where framework agencies may be unable to supply (i.e. a senior Trust member must be consulted)

- Could the Trust benefit from implementing an e-rostering system or staff bank in order to try and reduce agency usage and enhance controls?

The key to effective management of temporary staffing is an understanding of what the drivers are that influence demand for temporary staff and actions can be taken to control them. Many Trusts use electronic rostering systems successfully to monitor vacancies; sickness rates, annual leave patterns etc. Once the factors affecting demand are understood, action can be taken to control it.

Careful continual monitoring of agency booking patterns and spend is also key. Strict booking protocols are required alongside effective workforce planning within the Trust to ensure that bookings are controlled and made according to genuine need. Ensure the Trust is represented on the stakeholder group

The LPP Stakeholder Group for Medical Locums is the forum for London Trusts to work together regarding all medical locum matters. If you would like to be added to the stakeholder group, or check who is currently on the group from your trust, please contact mick.corti@lpp.nhs.uk. Stakeholders will receive communications and updates about the framework, and invitations to meetings. It is important that all London Trusts who use medical locums are represented at a senior level, to ensure the framework is successful and Trusts have the opportunity to discuss issues and join collaborative initiatives. Stakeholders should then feed back all relevant information to others in their Trust.

14

Stage 8: Monitor agencies Where an SLA has been established with one or more awarded agencies, Trusts are strongly encouraged to conduct individual regular performance management review meetings with each agency to monitor and assess their performance of:

- obligations under the agreement - compliance with the national framework agreement conditions and special terms (if

any) negotiated - provision of medical locums through the SLA

Suggested information that should be obtained from each awarded agency includes but is not limited to:

- number of booking requests and lead time to booking - number of bookings made per sector, band, job profile and shift type - number and percentage of agency’s cover of booking requests (fill rate) - number and percentage of any subcontractor’s cover of booking requests, as

appropriate - number and percentage of unfilled bookings by the agency and any sub-contractor,

as appropriate - number of cancellations by the agency - per job sector, band and job profile - number of cancellations by the trust - per job sector, band and job profile - number of cancellations by medical locums - agency’s compliance with the percentage fill rate agreed (if any) - complaint monitoring and analysis - any information generated by the agency’s quality assurance system, as may

reasonably be required by the trust from time to time Working together with other London trusts Only by working together will London trusts get the best value from the new framework. The LPP medical locum stakeholder group is the forum for exploring collaborative opportunities. If you would like to join the stakeholder group or check who is currently representing your trust, please contact mick.corti@lpp.nhs.uk By collectively committing to only use the medical locum agencies and pay rates within the framework agreement, London Trusts can gain control of the medical locum market in the region. As has been noted many times, the use of non-framework agencies needs to be eliminated across London in order to control costs and ensure only safe, compliant medical locums are used. The new regional framework aims to support Trusts by delivering significant cost improvement while maintaining national compliance standards; however this can only be achieved if all trusts only use the regional framework agencies and pay rates. An in-depth consultation process was followed with Trusts in order to establish competitive market rates for medical locums. Only if all Trusts agree to the framework rates will medical locums accept these pay rates in order to work. However if some Trusts continue to use off-framework agencies or accept higher pay rates, this will have an impact for all other London Trusts as medical locums begin to demand higher pay. The new regional framework gives London Trusts a real chance to work together to regain control of the medical locum market. This is particularly important given the serious

15

financial challenges the NHS is facing; not only do we need to put more emphasis on controlling costs; we also need to ensure substantive staff are retained rather than being encouraged into agency work by high pay rates. In addition to this, London Trusts need to put collective pressure on agencies to conform to compliance standards. If all Trusts refuse to accept bookings where the medical locum put forward is not 100% compliant, agencies will have to ‘up their game’ and put more effort into ensuring workers are compliant, in order to generate business. The Agency Worker Placement Checklist is an important tool in enabling this. Complaints Procedure Any complaint about the provision of the services should be raised, in the first instance, through to the supplier and attempts should be made to resolve the issue between both parties, using the processes laid out in the framework agreement Terms and Conditions of Contract, Clauses 11 (Complaints procedure) and 12 (Dispute Resolution Procedure and Mediation). Where there is a serious breach of compliance by an individual agency worker, the agency should be notified immediately. Where there is evidence of any malpractice by the agency worker the agency will have a procedure in place for reporting and monitoring complaints with the relevant professional and regulatory body. The agency has a responsibility for monitoring and following up such complaints with the relevant professional and regulatory body until an outcome is reached. They will also discuss with the authority whether an Alert Notice needs to be issued and co-operate with any action required. The NHS body or other participating authority can also report instances of malpractice by an individual agency worker directly through to the NMC who are the UK professional and regulatory body responsible for protecting the public through setting and maintaining the standards of professional training, and the performance and conduct of the medical locums they regulate. For some professions covered under this medical locum agreement the NHS body or other participating authority can also report instances of malpractice by an individual agency worker directly through to the HPC who are the regulatory body responsible for protecting the public through setting and maintaining the standards of professional training, and the performance and conduct of the clinicians they regulate.

Please see link for the postal address of the: GMC (General Medical Council) GDC (General Dental Council)

www.gmc-uk.org www.gdc-uk.org

Where any instances of this nature occur, the LPP agency staffing team should also be informed. It may also be necessary to undertake an audit with the agency.

16

Frequently asked questions (FAQs) My preferred agency is not one of the medical locum framework agreement suppliers - does this mean we can't use the regional framework to source medical locums from this supplier?

The regional framework includes a wide range of medical locum agencies, and is designed to cover the majority of medical locum requirements. Therefore, trusts should not have any requirement to use any agency outside of this agreement. If you have a current contract with a non-framework agency, check the cancellation terms and conditions and start the process of engagement with framework agencies. If you require help and/or support in this engagement process please contact the LPP team.

I have a contract already with an agency but want to switch to the regional framework. What should I do?

You should talk to your current supplier as soon as possible. If they are on the framework, they should be amenable to you switching over but this needs to be discussed in detail and help/support can be provided by the LPP team. If your current agency is not listed on the regional framework, you may have to see out your current contract, depending on the contract and the agency’s terms and conditions. You should be able to switch agencies successfully as long as you observe any notice periods that may be in place, to avoid placement fees. For advice on eliminating use of non-framework agencies, please see page 11-12 of this pack.

How long does the regional framework agreement last for? The framework has been awarded for a period of two years, commencing from 1st May 2012 and ending on 2nd May 2014. There is an option to extend the agreement for a further 2 x 12 months after this expiry date.

If I become unhappy with the framework agency I choose, what can I do?

You can change your chosen framework agency by giving three months notice if you have an SLA. Without an SLA there is no notice period required. However you should ensure you select a new agency through a fair and transparent process. We advise discussing any issues with your agency or the LPP team before taking this step, as it may provide the agency with an opportunity to resolve issues to your satisfaction. If you terminate an agreement with a supplier you will need to justify and document your reasons for doing so.

How does LPP monitor its participating framework agencies to ensure they meet quality and clinical risk requirements? Each framework agency is audited by the national audit team on a regular basis, or ad-hoc/emergency basis if deemed necessary. The audit team monitor each participating framework agency; ensuring full adherence to core operational policies and procedures detailed within the conditions of contract, to which each framework agency has agreed to supply into the NHS against. The LPP team will take action against participating agencies who fail to meet or comply with these requirements. Action may include temporary suspension to exclusion from the framework agreement.

17

The LPP team will also focus on the support and management of suppliers for the duration of this agreement, to promote desired quality and compliance standards.

If I have a medical locum who I wish to take on as a permanent employee, what should I do?

This framework has been put in place to provide temporary workers and it is not intended as a recruitment mechanism. There may be isolated instances when a temporary worker responds to advertisements and is subsequently to be employed by the Trust. In these cases a placement fee may be payable if notice has not been given (please see the terms and conditions for when this will apply). If Trusts provide framework agencies with four weeks’ notice then they will normally waive the placement fee charge (please see the T+C’s for this notice period/placement fee waiver).

How can I find out the full pricing information on the medical locum agreement?

Pricing information is available from MyLPP. You can obtain the latest rate information, as well as customise search patterns for specific job types, retrieve sales data, and run bespoke reports against framework spend. More information on MyLPP is available at www.lpp.nhs.uk. Is the pricing in the new framework flexible? Pricing has been pre-agreed with agencies for this framework agreement and is not flexible. Prices have been freely submitted by agencies and the framework aims to provide pricing that is fair and competitive in the current market. There is an option for an annual price review to allow for any standard uplift in line with Agenda for Change recommendations. Any price review and subsequent uplift can only be agreed by the LPP team and will be communicated to all suppliers and Trusts as and when appropriate. Framework agencies cannot uplift pricing of their own accord; and any such instances should be reported to LPP. Can non-framework agencies supply workers through framework agencies?

The framework agreement does not allow for this supply route. The framework offers a number of vendors for each job family so there is enough capacity and coverage within the framework.

18

Can we use workers supplied through a non-framework associated “sister” company of a framework agency?

The framework agreement does not allow for this supply route. Supply taken from this source will potentially expose you to commercial and clinical risk, alongside other issues that cannot be regulated. Even if an agency says they have a sister company or associated company that is on the framework, only the agencies and trading names on the London framework agreement list are on the framework. Can I view/download a copy of the service level agreement (SLA) and/or terms and conditions of contract?

The SLA template and T+C’s can be found on the LPP website: www.lpp.nhs.uk Will the Government Procurement Service national medical locum framework remain in place? The existing Government Procurement Service Framework for medical locums expires in June 2012 and a replacement is expected to be in place by this date. The procurement of the regional framework has been designed to minimise the wide variations in pricing seen in the national Framework that can create inflationary pressures for Trusts. In addition to this, a rigorous and innovative procurement process has been used to establish competitive pricing and discounts from suppliers. As a result it is expected that better value for money will be achieved through use of the regional Framework and it is expected that the national Framework will cease to exist for the London region once the regional framework has been in place for a period of time. For benefits of the London medical locum framework, please see page 3 of this pack. Why do we need to call off suppliers using the tool provided – we already know which framework agencies we want to work with? Although it may not have always been clear, the need to call off suppliers in a compliant way, via a fair and transparent process, has always been there. This is a requirement of EU law for public sector organisations, to ensure all businesses have an equal chance to supply under a Framework. It is ultimately a trust decision whether they wish to adhere to this or not – however if you cannot justify your decision-making process when challenged, you may face the risk of legal challenge by another framework agency who has lost out. The framework tender has been structured with this in mind, and trusts should be able to make a decision regarding who to work with based on price as well as the number of compliant medical locums that the agency has registered. Please see page 12 of this pack for further information and visit www.lpp.nhs.uk for details of selection criteria.

Where can I find out further information on the medical locum agreement?

Information on the regional medical locum framework agreement is available on the LPP website: www.lpp.nhs.uk

19

Contacts

If you have any queries, please contact the LPP Agency & Temporary Staffing team: Mick Corti (Workstream Lead) 020 7716 5620 mick.corti@lpp.nhs.uk

20

Appendix 1 – Framework Agencies and contact details

Agency Name Main Organisation Phone Number Website

A24 Group (Ambition Recruitment Services) 0871 8733 333 www.a24group.com

Accident & Emergency 0207 456 1456 wwww.accident-emergency.co.uk

Agenda Recruitment Ltd 01992 501515 www.agendarecruitment.co.uk

Arrows 020 7803 1730 www.arrowsgrouphealthcare.com

Athona Limited 01277 217777 www.athona.com

Blue Cross Locums Limited 0208 551 1001 www.bluecrosslocums.com

Capital Care 0208 801 2929 www.capitalcareservices.com

Care Recruitment Specialists 01274733227

Career online 0208 553 0005 www.locumdirect.com

Corrigan's door 0208 994 6862 www.corrigansdoor.co.uk

Clinical Employment Services 0845 257 1313 www.ces-locums.com

Doctors on Call 0208 231 0570 www.doctorsoncalluk.com

DRC Locums 01908 545999 www.drclocums.com

Evergood Associates Ltd 017630271515 www.evergoodassociates.co.uk

First Medical 01908 821025 wwww.first-medical.co.uk

Fresh Medical 01908397460 www.freshmedical.com

GDN (National locums) 01908 686800 www.nationallocums.co.uk

Holt Doctors Skipton 0845 508 1491 www.holtdoctors.co.uk

Interact Medical (Reality HR Consulting) 01908 357722 www.interactmedical.co.uk

I D Medical 0845 130 9331 www.id-medical.com

Locumcheck 02032397454 www.locumcheck.co.uk

Locum Placement Group 020 8262 4222 www.locumplacementgroup.co.uk

Locumlinx 01908 207 100 www.locumlinx.com

Maxxima t/a Labmed 020 7749 8282 www.maxxima-group.co.uk

Medacs Healthcare 01756703000 www.medacs.com

Medsol 01604 605 999 www.locumpages.com

Medical Professional 0845 122 0415 www.nursing-personnel.co.uk

Medicare First 020 7407 1122 www.medicarefirst.co.uk

Medics Pro Limited 0208 911 9232 www.medicspro.com

Medicure 020 8453 1325 www.medi-cure.com

Medilink 0208 221 4652 www.medilinkconsulting.co.uk

Medpro Limited 01322222207 www.medpro.info

Merco Recruitment 02089473077 www.merco.co.uk

MSI Group 02079404300 www.msirecruitmentgroup.com

My Locum Limited 0208 518 4336 www.mylocum.com

Nationwide Locum Services Limited 0845 650 7018 www.nationwidelocumservices.co.uk

NHS Professionals 01923 690 565 www.nhsprofessionals.nhs.uk

NISI 0116 2257556 www.nisistaffing.co.uk

No 1 Recruitment 01708 388233 www.number1recruitment.co.uk

Pro Medical Personnel Limited 01277 212 797 www.promedical.co.uk

Provide Medical 01908 524850 www.providemedical.com

Psychiatry People 0207 456 1273 www.psychiatrypeople.co.uk

Pulse Healthcare (London) 01992 474 900 www.pulsestaffing.co.uk

21

Agency Name Main Organisation Phone Number Web site

Ranstad 0207 932 6222 www.randstadcare.co.uk

R.I.G. Locums 0800 690 6044 www.riglocums.com

Reed Specialist Recruitment 0207 632 5763 www.reed.co.uk

RMR Ltd 020 8989 5577 www.rmrrecruitment.co.uk

S A Cohen & Co t/a dr-locums 02074987999 www.drlocums.com

Serving the Nation 0208 961 6600 www.servingthenation.com

Supply Care Medical 0203 137 5023 www.supplycaremedical.co.uk

Surgi-call 01908440111 www.surgi-call.co.uk

Swiftcall Medical Limited 020 8989 6699 www.swiftcallmedical.com

Team 24 0845 370 2424 www.team24.co.uk

Templar Company Limited 01624 827110 www.templarsmedical.com

Thames Medics 08450 613 613 www.hcldoctors.com

The Anaethetists Agency 0800 830 930 www.theanaethetistsagency.com

The Consultants Agency Ltd 0121 624 7737 www.consultantsagency.com

The Locum Agency 0333 9000 998 www.tlagroup.co.uk

The Locum Consultancy 0845 279 9788 www.thelocumconsultancy.com

The Pario Group t/a Locum Practice 0208 10 40 100 www.thelocumpractice.com

The Pathology Group 02074561450 www.pathologygroup.co.uk

TIG Consultancy 0190876022 www.tigconsultancy.com

Total Assist Recruitment 01708 388 000 www.totalassist.co.uk

Triple West Medical 08450740614 www.triplewestmedical.com

Your World Recruitment 020 7220 0811 www.yourworldmedical.com

22

Appendix 2: List of Job Profiles

Speciality Grade

A+E Associate Specialist

A+E Clinical Assistant

A+E Consultant

A+E FY1 (PrHO)

A+E FY2 (SHO)

A+E Hospital Practitioner

A+E ST1

A+E ST2

A+E ST3 (Spr)

A+E Staff Grade

A+E GP

Anaesthetics Associate Specialist

Anaesthetics Clinical Assistant

Anaesthetics Consultant

Anaesthetics FY1 (PrHO)

Anaesthetics FY2 (SHO)

Anaesthetics Hospital Practitioner

Anaesthetics ST1

Anaesthetics ST2

Anaesthetics ST3 (Spr)

Anaesthetics Staff Grade

Anaesthetics GP

Dental Associate Specialist

Dental Clinical Assistant

Dental Consultant

Dental FY1 (PrHO)

Dental FY2 (SHO)

Dental Hospital Practitioner

Dental ST1

Dental ST2

Dental ST3 (Spr)

Dental Staff Grade

Dental GP

Obstetrics & Gynaecology Associate Specialist

Obstetrics & Gynaecology Clinical Assistant

Obstetrics & Gynaecology Consultant

Obstetrics & Gynaecology FY1 (PrHO)

Obstetrics & Gynaecology FY2 (SHO)

Obstetrics & Gynaecology Hospital Practitioner

Obstetrics & Gynaecology ST1

Obstetrics & Gynaecology ST2

Obstetrics & Gynaecology ST3 (Spr)

Obstetrics & Gynaecology Staff Grade

Obstetrics & Gynaecology GP

23

Specialty Grade

General Medical Associate Specialist

General Medical Clinical Assistant

General Medical Consultant

General Medical FY1 (PrHO)

General Medical FY2 (SHO)

General Medical Hospital Practitioner

General Medical ST1

General Medical ST2

General Medical ST3 (Spr)

General Medical Staff Grade

General Medical GP

Paediatrics Associate Specialist

Paediatrics Clinical Assistant

Paediatrics Consultant

Paediatrics FY1 (PrHO)

Paediatrics FY2 (SHO)

Paediatrics Hospital Practitioner

Paediatrics ST1

Paediatrics ST2

Paediatrics ST3 (Spr)

Paediatrics Staff Grade

Paediatrics GP

Pathology Associate Specialist

Pathology Clinical Assistant

Pathology Consultant

Pathology FY1 (PrHO)

Pathology FY2 (SHO)

Pathology Hospital Practitioner

Pathology ST1

Pathology ST2

Pathology ST3 (Spr)

Pathology Staff Grade

Pathology GP

Psychiatry Associate Specialist

Psychiatry Clinical Assistant

Psychiatry Consultant

Psychiatry FY1 (PrHO)

Psychiatry FY2 (SHO)

Psychiatry Hospital Practitioner

Psychiatry ST1

Psychiatry ST2

Psychiatry ST3 (Spr)

Psychiatry Staff Grade

Psychiatry GP

24

Specialty Grade

Radiology Associate Specialist

Radiology Clinical Assistant

Radiology Consultant

Radiology FY1 (PrHO)

Radiology FY2 (SHO)

Radiology Hospital Practitioner

Radiology ST1

Radiology ST2

Radiology ST3 (Spr)

Radiology Staff Grade

Radiology GP

Surgical Associate Specialist

Surgical Clinical Assistant

Surgical Consultant

Surgical FY1 (PrHO)

Surgical FY2 (SHO)

Surgical Hospital Practitioner

Surgical ST1

Surgical ST2

Surgical ST3 (Spr)

Surgical Staff Grade

Surgical GP

General Practitioner General Practitioner

25

Appendix 3: Agency Worker Placement Checklist Agency Worker Placement Checklist for the supply of medical locums

Worker is confirmed as fully compliant (tick box)

Authority name (location)

Authority reference no. (if provided)

000000000000

Reason for Booking (if provided)

Job Profile Title Band 6 EPP? Yes / No / N/A

Placement date from

DD/MM/YYYY Placement date to

DD/MM/YYYY

Proposed working pattern

Shift times Total number of hours booked

000

Hourly Pay Rate incl. any adjustments, as appropriate

£00.00 Total hourly charge excl. VAT £00.00

Hourly Agency fee £00.00 VAT (as appropriate) £00.00

Travel and/or Other disbursements

As agreed with the Authority

Accommodation required As agreed with the Authority

Agency Worker’s full name John Doe Smith

Previously worked at the Authority as above?

Yes / No Available for full placement period?

Yes / No* (*see below)

Recent photograph attached

Yes / No

Verified ID United Kingdom Passport Attached Yes / No

Nationality and Immigration status (Right to Work in UK)

Not applicable (as above) Attached Yes / No

Relevant Professional and Regularly Body registration (as appropriate) GCD / HPC / NMC

Relevant Professional and Regularly Body registration number (as appropriate) 0000000

Relevant Professional and Regularly Body registration last checked (as appropriate)

DD/MM/YYYY

Enhanced CRB disclosure no. 000000000000 Date CRB issued DD/MM/YYYY

Enhanced CRB disclosure name of employer

Name of employer that obtained enhanced CRB disclosure

Regulated Activities status checked date

DD/MM/YYYY

Certificate of Fitness for Employment issued by

Name of OH Service Provider Date issued DD/MM/YYYY

Competent in oral and written English

Yes / No Two references attached Yes / No Alert notification?

Subject / Not subject

Other information as

required by the Authority

The above named Agency Worker has been submitted by the Supplier for consideration in the provision of the Services i) in response to a request from the Authorised Officer of the Authority; ii) has undergone all of the necessary and appropriate pre-employment screening checks as required by the NHS Conditions of Contract for the supply of agency workers to ensure their compliance prior to supply and iii) shall be charged in accordance with the Contract Price set out in Appendix 2 to the Framework Agreement.

Name Position

Signature Date DD/MM/YYYY

26

Appendix 4: Migration Support

These tools are provided to assist with the process of migration from non-framework agencies to agencies on

the regional framework.

Please also see ‘Stage 6: Eliminating any non-framework use’ for further advice.

Legal advice regarding the avoidance of placement fees from non-framework agencies:

AgencyfeesGuidance.pdf

Suggested migration plan for managing the migration process: