Excellent healthcare – locally delivered Market information event Pulmonary rehabilitation service Bexley

Alison Taylor Integrated Care Project Manager

Clinical Outcomes Excellent clinical evidence for the benefits of pulmonary rehabilitation: – Reducing readmissions – Improving health related quality of life – Substantially below the NICE threshold for cost effectiveness at £ per Quality adjusted Life Year In Bexley we want to commission a service which – Improves patient’s quality of life – Reduces the need for patients to access any secondary care to manage their respiratory condition for at least a year after PR – Provides excellent patient value 3

Aims of Procurement VALUE: Great patient outcomes at lower cost per patient 4 Successful patient outcomes Increased volumes

Our provider will be: Patient focused Outcomes focused Flexible Responsive Competitive Multi- disciplinary 5

Local context 28 GP practices Population 232,000 Population growing and ageing Estimated that less than half of those living with COPD in the borough have been diagnosed with it. Large sector of population would benefit from PR (2.5% x 232,000 = 5,800) 6

Scope of service Available to all patients registered at a Bexley GP who have a chronic respiratory condition resulting in disabling breathlessness (MRC = 3 or above) Referral from GPs, respiratory nurses or secondary care ~110 patients completed the course in BCCG want to expand the service Currently no waiting list Need to manage future demand as huge population eligible for service 7

Service requirements Assessment Course Exercise Education Evaluation 8 Course must be offered in at least 2 locations – patient choice and convenience

Outcomes information Three Indicators CAT 2 point improvement 6MD 10% improvement HAD scores 2 point improvement for those scoring 10+ Longer term outcomes assessment Questionnaire to patients to assess health related quality of life for the year post PR 9

Payment Model Aims to incentivise provider to expand service to max no of patients ensure those who enrol complete the course to realise the potential benefits focus on patient outcomes CCG pays provider for A)each patient who completes the course - all inclusive cost, assumed VAT recoverable B) annual bonus for achievement of patient outcomes Payment is capped at an annual level of £61,000 10

Payment Model 2 Provider invoices CCG quarterly for each patient who has COMPLETED course – Completion = attendance at >50% sessions and initial and final assessments Bidders must state price per patient who completes the course No other costs/ invoices to be paid Bonus of up to 15% of total invoiced 5% for each outcome target achieved 11 Thresholds for payment of bonus

Example Total budget per year £61,000 Provider charges £330 per patient completing the course 160 patients complete the course in the year CCG pays £52,800 for course completions (capped at £53,000 pa) Bonus of 5% for achievement of each outcome Provider achieves all 3 outcome indicators 15% bonus = £7,920 Total payment = £60,720 12

Additional performance information required Basic activity numbers: No. of patients referred to service No. of patients assessed by PR team No. of patients signing up to PR course No. of patients completing PR course No. of carers attending 2 or more sessions Other KPIs % patients completing the course % patients referred attending PR within 9 weeks of referral % patients who have personalised exercise programme 13

Additional Investment With 50% additional budget Course content Impact on outcomes Impact on patient numbers Innovations 14 Possible opportunity to invest more in successful service over time

Judith Hughes Head of Procurement and Contracting

Procurement Timeline Open tender 16 Procurement stageDate Advert issued on S2H (ITT documents available to download from Delta) 1 st April 2014 Clarification questionsUntil 29 th April 2014 Tender deadline7 th May 2014 (at 14.00) Award recommendation to BCCG Governing Body 29 th May 2014 Preferred/Unsuccessful Bidder notification 2 nd June 2014 Mobilisation and transitionUntil 14 th July New service begins14 th July

Concerns? Barriers to tender? Questions? Questions??