NHS England London Region

IMOS Market Event

September 2016

Introductions

Pepe Shirlaw

2

Introductions

• Donal Markey: Regional Lead, Dental, Optometry & Pharmacy Primary

Care Commissioning (London)

• Pepe Shirlaw: Chair of London Local Dental Professional Network

• Mervlyn Clarke: Senior Commissioning Manager Dental, Optometry &

Pharmacy

• Claire Robertson: Consultant in Dental Public Health

• Divyash Patel: Dental Advisor London Region/Clinical Lead, Office of the

Chief Dental Officer

• Caillin Redican: Chair of IMOS Working Group

• David Singleton: Senior Procurement Manager

3

Agenda

o Welcome and Introductions

o Current IMOS arrangement / Background

o Patient Engagement results

o Recommendation

o PDS Agreements / RMS / KPIs, Pricing Mechanism

o Accreditation/ clinical specification

o The Procurement Process

o Procurement Opportunities

o Questions and Answers

o Next Steps/Close4

Needs Assessment & Patient and

Public Survey feedback

Claire Robertson

5

Findings of IMOS Scoping

• No information available on normative need for level 2, only demand

• 18 of London boroughs have current arrangements in place for management of

IMOS

• Huge inequities in access to IMOS across London:

Wide variation in coverage by existing IMOS – some boroughs with

numerous providers, others with none.

Some current services accept referrals for patients living in more than one

borough, others have referrals from single borough residents only

Wide variation in levels of IMOS activity – historical commissioning by

PCTs

Wide variation in commissioning arrangements - PDS, GDS & unit costs

• Range of referral processes and criteria with only 5 existing referral management

services in London across 14 boroughs

Findings of IMOS Scoping (2)

• Both primary and secondary care referrals for level 2 cases

• 17 secondary care providers of oral surgery across London

• Total secondary care oral surgery spend = £38,525,990

• Secondary care oral surgery spend ranges from provider to provider

• Lower Threshold - £716,000 Upper Threshold - £8,799,240

• Cases coded differently and as a result incur different costs: Based on consultant

led service.

Treatment

function name

WF01B

First Attendance

- Single

Professional

WF02B

First Attendance -

Multi

Professional

WF01A

Follow Up

Attendance -

Single

Professional

WF02A

Follow Up

Attendance -

Multi

Professional

Oral Surgery 119 185 75 128

Estimate of lower levels of IMOS /borough• Estimated the minimum activity required / borough to meet demand made on

basis of historical activity for a given population – i.e. existing levels of activity

• Minimum estimate modelling has not included level 2 cases currently going

into secondary care by direct referral – therefore likely to be only a starting

position

• Any activity removed from secondary care will need to be re-commissioned

within a primary care contract – additional commissioning will be required as

commissioning moves forward

• Future additional activity will be commissioned as part of this current

procurement process, as part of transformational programme

8

Patient and public engagement• Patient engagement events and both online and paper surveys have been

undertaken

• Opportunistic questionnaires completed in the waiting rooms of primary &

secondary care

• Mixed methodology, a snap shot over 3 weeks in August: sampling frames:

a) targeted

Patients receiving IMOS treatment in primary care identified by BSA

Patients receiving IMOS in secondary care identified before treatment by

the Provider

b) non targeted

Survey link tweeted on NHS England (London Region)

Twitter page

Surveys in primary care waiting rooms

9

Outcomes of patient and public surveyMost important factors to patients when receiving an appointment:

• Timing of appointment most important to patients with waiting time slightly less

• Distance to appointment relatively not such a major factor to patients

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Patient Practitioner

Outcomes of patient and public surveyIn addition to Monday to Friday 9am – 5pm, when would patients prefer the service

to be available?

• Both patients and profession identified Saturdays as most desirable with

weekday evenings also, but slightly lesser extent

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Patient Practitioner

Outcomes of patient and public survey• Length of time patients and practitioners feel it is acceptable for a patient to wait

for treatment after the point of their referral

• Treatment in four weeks and under would be acceptable, but patients would

prefer earlier

12

Outcomes of patient and public survey• Actual length of time between referral and treatment.

• Patients reported an increased waiting time for treatment in secondary care in

comparison to primary care.

13

Outcomes of patient and public survey• Amount of patients given a choice in the location for delivery of treatment

• 59% of patients were given a choice of location

14

Outcomes of patient and public survey

• Timing of appointment most important factor to patients - Saturdays and week

day evenings preferred

• Waiting time for appointment also important to patients who felt the wait should

be no more than four weeks - currently a high proportion of patients waiting

longer than this.

• Patient choice for location of treatment of concern – patients wish to understand

their options

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Summary of key findings:

The Commissioning Model

Commissioning Team

NHS England

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CURRENT IMOS PROVISION

• 56 Contracts

• Different contractual agreements;

• Based of legacy commissioning arrangements;

• Different sizes, values and access arrangements;

• In 23 boroughs;

Borough No Borough No Borough No Borough No

Bexley 4 Greenwich 5 Ken & Ch 0 Southwark 4

Brent 1 Ham & Ful 0 Kingston 0 Sutton 1

Bromley 6 Haringey 2 Lambeth 2 Tower H 2

Camden 2 Harrow 0 Lewisham 3 Waltham F 1

City &

Hackney

0 Havering 2 Merton 0 Wandsworth 3

Croydon 4 Hillingdon 0 Newham 0 Westminster 0

Ealing 4 Hounslow 4 Redbridge 0 Barnet 2

Enfield 2 Islington 1 Richmond 1 Barking &

Dagenham

0

Existing Provider Services

Scoping exercise

• Collation of information from current contracts;

• Steering Group

• Patient/public engagement

• Provider Engagement

AIMS AND COMMISSIONING INTENTIONS

• The aim :

• Raising quality standards

• Promoting consistency and equity across London for both patients and

providers

• To improve access & flexibility to patients;

• To commission a service that is fit for purpose

• To use a standard contract

• To have a standard service specification

• Standardise monitoring and management

• To have a standard pricing structure

Service proposal by “Lots”

1.891.89

2

1.131.

Barnet

LE: 1130

3390 UDA’s

20 cases

Bromley

LE: 990

UDA’s 2,969

20 cases

LSL North/South

LE: 2841

8522 UDA’s

60 cases

Greenwich & Bexley

LE:1528

4585 UDA’s

30 casesKingston &

Richmond

LE: 1118

3355 UDA’s

20 cases

Cam&Isl

LE: 1459

4376 UDA’s

30 cases

C&Hack

Le: 821

2463 UDA’s

15 cases

Enfield

LE: 958

2875 UDA’s

20 cases

Haringey

LE: 818

2453 UDA’s

15 cases

H&F &KC

LE:1094

3283 UDA’s

20 Cases

Westminster

LE: 751

2253 UDA’s

15 cases

Hillingdon

LE: 877

2631

UDA’s

20 cases

Havering, Barking

& Dagenham

LE:1307

3921 UDA’s

25 cases

Waltham Forest &

Redbridge

LE: 1669

5007 UDA’s

30 cases

Brent & Harrow

LE: 1729

5188 UDA’s

30 cases

Ealing &

Hounslow

LE:1860

5579 UDA’s

40 cases

Proposed Service• 17 contracts “Lots”;

• Sessions – 3-8 sessions per week depending on different geographical area or population;

• At this point, referral will be from ‘Dentist to Dentist’;

• Monetary value for each CoT will the same;

• Each contract will have an additional 2% for assess and reject;

• Each contract will have monetary value allocated for OPG X-rays;

Accreditation/The clinical specification

Divyash Patel

Dental Advisor London Region

24

Aim of Presentation to describe:

• Service delivery

• Performer Competencies

• Accreditation process for level 2 performers

• Equipment and Practice visits

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Service delivery

• The specification requires the Provider to deliver Level 2 OS services

• London residents registered with NHS England (London Region)

• Referred by general and specialist dental practitioners, hospital specialists, community and salaried dental services

• Treated under local anaesthesia

• Delivered by performer accredited to undertake OS work at the competency level 2 or Oral Surgery Specialist

26

The range of procedures be performed under this

Level 2 agreement include:

• Surgical removal of uncomplicated third molars involving bone removal

• Surgical removal of buried roots and fractured or residual root fragments

• Management and surgical removal of uncomplicated ectopic teeth (including supernumerary teeth)

• Management and surgical exposure of teeth to include bonding of orthodontic bracket or chain

• Surgical endodontics

• Minor soft tissue surgery to remove apparent non-suspicious lesions27

Competency framework

• Performers who are on the Oral Surgery specialist list

• Accredited performers who undertake OS work at competency level 2

Formal qualification

Experience based

National Working Group

• Supportive and enable the development of general practitioners

• Process and accreditation should be robust to ensure patient safety but not overly onerous

• Not sit in isolation to specialty training pathways

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Principles

History

32

33

Accreditation Process

• Assessment by panel

Consultant, Commissioner, DPA ,LDC

Separate process:

New level 2 performers

Existing accredited performers (DWSI)

In conjunction with procurement, close to identified preferred bidders

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Existing accredited performers (DWSI)

• CV stating all professional experience relevant to training and clinical work

• Structured reference from a senior colleague within the same IMOS centre or from other practice or organisation(s)

• Logbook of procedures carried out over the last 12 months with provision of case notes and x-rays for cases for assessment by accreditation panel

35

Competency framework for new level 2 performers

• Evidence of training posts in oral surgery or oral and maxillofacial surgery

• Testimonials and structured references from trainers and consultants

• Case log books

• Evidence of CPD specific to Oral Surgery

• Evidence of Audit and/or publications in the field of Oral Surgery

• Evidence of any academic diploma or masters courses in Oral surgery

• Relevant teaching experience 36

Premises & Facilities/Equipment

• Assessed by Practice visit

• After preferred bidders identified

• Focus on equipment specific to OS

• Information Technology

• Compliance with Resuscitation Council Guidelines

37

• Appropriate surgical equipment and instruments/disposable items

• Orthopantomograph (OPG)

• Chair

• Operating light

• High volume aspiration

• Reception and waiting room

• Adequate staffing levels

• Car parking and/or pick up facilities

• Pre and post-operative instructions, consent and medical history

forms

• Wheel chair access

• Emergency equipment and drugs38

Process of referrals/referral

forms/RMS

Caillin Redican

Chair of IMOS Working Group

39

The Procurement Process

David Singleton – Procurement Lead

47

What Procurement Process will be used?

o We will be using The Restricted Route (Advert, EOI, with PQQ and ITT)

o Advert – Advertising the procurement

o EOI – Expression of Interest

o PQQ – Prequalification Questionnaire

o ITT – Invitation to Tender

o Our decision has considered the amount of bidders interested

o Our decision has considered Commissioners time to evaluate responses

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Key Features of the Process

Advert:

o The advert, will be published w/c 26th September 2016 on Contracts Finder

https://www.gov.uk/contracts-finder

Expression of Interest and Prequalification Questionnaire:

o The EOI and PQQ stage is only accessible via the tendering portal w/c 26th

September 2016

https://procontract.due-north.com/register

Invitation to Tender:

o The ITT is only accessible via the tendering portal

o This stage is specifically about how you will deliver the service.

https://procontract.due-north.com/register

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Key Features of the Process cont.

Awarding Process:

o Is about governance of a fair and open process and the effectiveness of a

decision.

o Unsuccessful bidders will receive a detailed debrief report

Standstill Period

o As best practice there will be a standstill period of 10 calendar days

Mobilisation

o Contract preparation and signature

o Preparing to start service provision

o Staff TUPE including pensions

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Key Features of the Process cont.

Clarification and Communication Process

o You must use the clarification question template that is provided as part of the

tender documentation to ask any questions during the procurement.

o You will need to complete the template and upload it as an attachment to a

message on the e-tendering portal. Clarifications will not be answered any other

way.

o You must adhere to the deadline for clarification questions. This allows us as

commissioners to process your questions and respond to you and it allows you

time to assimilate the answers into your bid as required.

o Anonymised clarification questions and the answers provided will be published to

all Bidders via the e-tendering portal.51

Procuring Compliance for IMOS

o Compliance with:

o Public Contract Regulations 2015

o National Health Service (Procurement, Patient Choice and Competition)

Regulations 2013

o Open, fair and transparent process

o Opens up competition to the market

o Need to ensure the best possible service is procured for our patients

o Value for Money for taxpayers

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E-Procurement Portal

o All major procurements are conducted online using:

https://procontract.due-north.com/register

o We advertise all procurements on Contracts Finder and OJEU

o https://www.gov.uk/contracts-finder

o http://www.ojeu.com/

o If you are interested in participating in any NHS England tender process, it would

be good to register on both as soon as possible.

o NHS England London region uses the Due North procurement portal and if you

wish to bid for projects with us – so must you!

o All the links and instruction can be found as part of the Contracts finder advert

along with how to register.53

Patient and Profession Surveys

o Patient surveys were undertaken as outlined by our Clinical experts earlier.

o The Commissioning model is supported by our Clinical experts on the project

team

o Themes arising from Patient feedback will be included in the MOIs at ITT stage.

o The Profession was also surveyed in the lead up to this process.

o Bidders will need to take patient feedback into account when preparing their bids

in order to stand a chance of achieving maximum scores.

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Timetable (subject to operational change)

Milestone Date

PIN published to OJEU

Market Event24th February 2016

6th, 8th and 10th September 2016

Advert and PQQ published w/c 26th September 2016

Deadline for receipt of completed PQQs 31st October 2016

ITT issued to those that have passed the PQQ 1st February 2017

Deadline for receipt of ITT bids 28th February 2017

Award Approval by NHS England Board w/c 15th May 2017

Contract award and start of mobilisation 2nd June 2017

Contract start date: 1st September 2017

Service start date: 1st September 2017

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Tips for Submitting Your Bid

Bullets

o If there are bullet points in a question use them as headers to help write your

response.

Clarity

o Waffle is your enemy. Evaluators will switch off if you prevaricate and

procrastinate, which will affect your score.

o Ensure you answer the question that is asked, read the question fully.

Format

o Keep to the correct format.

o Ensure each attachment is labelled with the correct reference number.

o Upload your response/ attachments in the requested format.

Plan

o Ensure you leave enough time to upload your submission on the e-tendering

portal.56

Tips for Submitting Your Bid cont.

Checklist of Documents

o Sounds simple but many bids have failed because people have forgotten to

upload all the correct documentation – there will be a document checklist, use it.

Words

o Read the signpost words in the questions - Describe, Give detail, Explain, Briefly

Describe, Attach.

Word Limits

o Take notice of the word limits; the more words, the more detail expected.

o When copying from WORD, spaces and page breaks take up your word count.

Ask Questions

o Don’t be afraid to ask questions to clarify your understanding.

Complacency

o Do not assume that the evaluators will have prior knowledge of your organisation

or past experience.

o Demonstrate in your answer that you have understood, and are able to expertly

address, that question’s subject matter.57

Panel Q&A

58

Next Steps

We will send you:

o A copy of the presentation

o A copy of the FAQs prepared from this meeting

o Information regarding bid preparation support and learning opportunities

Key dates:

o Advert & PQQ published w/c 26th September 2016

o Submit completed PQQs by 31st October 2016

59