Oxfordshire Clinical Commissioning Group Contracting to support integration for mental health and older people Oxfordshire CCG’s approach to contracting for outcomes

Oxfordshire Clinical Commissioning Group This presentation  What do we mean by an outcomes based contract?  Our approach to procurement  Developing the contract and contract negotiation

Oxfordshire Clinical Commissioning Group What do we mean by an outcomes based contract?  One contract incentivised to deliver outcomes  One contract that incorporates all of the services and investment needed to deliver those outcomes  One plan for the patient across all of the different providers  One system of clinical governance and accountability  One database linked into national datasets Delivery of outcomes…but not at the expense of quality  Uses PbR clustering and coding to monitor activity  Outcomes linked to the delivery of recovery and well being  Contract length that supports transformational ambition-5+2

Oxfordshire Clinical Commissioning Group Approach to procurement (1)  Know your market and your organisation  January 2013 Phase 1 market analysis included option appraisal as to how providers might be chosen  November 2013 Phase 2 had included more market analysis and determined two options  Proceed with current providers via a service review exercise  Proceed to competitive procurement

Oxfordshire Clinical Commissioning Group 5 Commercial Overview 5.7 OPTIONS FOR ROUTES TO CONTRACT State of Market (number of providers) Few many Complexity of service Degree of Integration required Commissioning structure optionsCommissioning route options Full competitionSimpleLimitedRange of providers competitively procuredITT or Framework Full competitionComplexFullConsortia competitively procuredCompetitive dialogue No competitionSimpleLimited / FullDevelopment of the market No competitionComplexLimitedSingle providerSingle action tender with strong partnering & incentivisation No competitionComplexFullLead provider with back to back subcontract arrangements Single action tender with strong partnering & incentivisation Diligence on subcontractors Some competition in specific service areas but with one dominant (lead) provider ComplexFullLead provider with competition for subcontracts Or Specialist integrator with back to back arrangements to dominant provider and sub contract providers. Single action tender for lead with strong partnering & incentivisation Competitive Dialogue for subcontractors Or As above with Competitive Dialogue for integrator Some competition in specific service areas with several dominant (key) providers ComplexFullLead provider with competition for subcontracts Or Specialist integrator with back to back arrangements to key providers and sub contract providers Competitive dialogue for lead provider role Single action tender for key providers with strong partnering & incentivisation Competitive Dialogue for subcontractors Or As above with Competitive Dialogue for integrator

Oxfordshire Clinical Commissioning Group 5 Commercial Overview There are pros and cons for each Commissioning structure and when assessing the optimal one these should be taken into account to understand which Pros and Cons have a material bearing on the situation and which Cons can be mitigated. The key Pros and Cons are set out below, but are assessed on a scheme level in each service section. 5.8GENERIC PROS AND CONS OF EACH CONTRACTING ROUTE Potential commissioning structure ProsConsOther considerations Range of providers competitively procured Competition in the market can drive quality and VfM Risk of poor integrationIntegration risk held by the Commissioner Consortia competitively procured Competition in the market can drive quality and VfM Some risk of lack of integration requires strong governance Contract awarded to Single provider Enables development of partnering collaborative approach No contestability or pressure to drive quality Quality may be sub-optimal in non core areas Lead provider with back to back subcontracting arrangements Specific services are provided by speciality providers Integrator risk with provider Limited contestability or pressure to drive quality Risk of compounding of required profit Back to back arrangements with step in rights may be required Lead provider with competition for subcontracts Specific services are provided by speciality providers Some competition for specific services Integrator risk with provider Limited contestability or pressure to drive quality for lead provider Risk of compounding of required profit Specialist integrator with back to back arrangements to key and sub contract providers Potentially some element of competition Requires strong contractual arrangements whereby risk is transferred to the providers and the integrators can effect change

Oxfordshire Clinical Commissioning Group Approach to procurement (2)  January 2014 Gateway review and increased emphasis on integration within system  February 2014 Decision to work with current providers  June 2014 Issued invitations to participate in most capable provider assessment

Oxfordshire Clinical Commissioning Group Most Capable Provider Process  Assessment of  Provider engagement and demonstration of appetite  Acceptance of key principles  Capability  Invitation issued with assessment criteria and providers given 40 working days to submit written proposal  Evaluation

Oxfordshire Clinical Commissioning Group Developing the contract and contract negotiation: Developing the Contract:  National standard contract  MCP provider submission used to inform the development of the contract  Prime Contractor model v’s Allied Contract  Exercise national flexibilities where appropriate to your approach e.g. local variations, local modifications & local prices  Secure legal support

Oxfordshire Clinical Commissioning Group Developing the contract and contract negotiation Contract negotiation:  Clearly define the negotiation timetable  Set out requirements/expectations of the negotiation meetings and roles of attendees  Ensure sufficient administration support to accurately capture agreements/actions with clear deadlines  Schedule enough time to prepare for negotiations and pre-meets – over estimate  Issue a full contract in advance of commencing negotiations  Make use of technical sub-group meetings to inform negotiation meetings

Oxfordshire Clinical Commissioning Group Contacts  OBC Programme Lead:  Catherine Mountford  Head of Contracting and Procurement  Hannah Mills

Oxfordshire Clinical Commissioning Group Outcomes and metrics for mental health OutcomeProposed metric People will live longerMortality rate of people with SMI People will improve functioningRecovery star; progress through PbR clusters; effective discharge Timely access to supportEmergency response: 2 hours Carers will feel supportedSurveyed on case review People will have a meaningful rolePeople in paid work, structured volunteering and structured education People will have stable accommodationPeople in settled home, including on supported housing pathway People will have better physical healthReduced used of urgent care pathway; “normal” BMI; smoking reduction