Dos and don'ts of procurement

The Dos and Don'ts of Procurement

The dos and don'ts are part of the IMPRESS full paper Commissioning a community COPD service: Lessons for the NHS based on a case study in Somerset PCT. Click here for the full document. They have been expanded in light of a second story, Community Services - a second case study, October 2009.

They should also be read in the light of the latest guidance from the NHS Chief Executive on the NHS as preferrred provider. October 2009 - quoted here.

Commissioners

Support, if in existence, or establish, a clinical network to guide the development of a needs assessment, service specification and care pathways
Involve local patients actively and continuously
Consider if a competitive procurement process is the most cost-effective and sustainable way of improving care or if a continuous improvement programme could be developed
If it is, consider the readiness of the local NHS to enter a fair competition and discuss locally what support might be available if needed
Consider the impact on integration and on NHS sustainability if the contract is won by a non-NHS provider
Ensure you have expert primary and secondary care advice for adjudication of bidders
Ensure that responsibility for keeping the service up-to-date with best practice is built into the specification
Consider whether you wish bidders to bid for the provision of audit, research, education and training of primary and community care professionals
Consider inclusion of incentives to reward best practice
Have benchmark data for evaluation and some manageable but important evaluation criteria such as continuity of care for patients, equity of access across practices and localities, hospital utilisation, unscheduled care.
Make it clear to clinicians who the commissioners are – there is potential for confusion if the same people who were employed by the PCT are no longer commissioners but on the PCT provider side, or if GPs who were in one role are now leading practice-based commissioning.
Consider any unintended consequences such as what happens to the residual costs of providing an acute medicine service and therefore the total costs of the system if investment is removed from a local trust.
There is an important role to verify that the proposals are clinically safe and within guidelines so consider how this is achieved (e.g. PbC leads and neighbouring specialists) and be clear on their roles.

NHS clinicians

Get involved in any local clinical network and actively work together with colleagues across primary and secondary care to consider how care could be improved. Use resources such as tdata he BTS referral criteria to assist in these conversations.
Plan for how you and your colleagues will listen to patients and engage them in not just self-management but also in service design, information provision and service evaluation
Campaign for investment in respiratory care, demonstrating how it can meet commissioners’ aims such as reduction in avoidable hospital admissions, and care closer to patients’ homes.
Maintain relationships with colleagues but be sure you know what their role is now, and who the decision-makers: who is a PCT commissioner, who is in the PCT provider organisation, who is a practice-based commissioner and who is a GP with an interest in providing services (and note that it is possible to be both a practice-based commissioner and a GP provider).

Successful bidding teams will include senior managers and clinicians working closely together.

Acute providers

When horizon scanning, ensure you look across borders for partners/competitors and make no assumptions about your likelihood of success or the calibre of your competitors. Community providers may be newer organisations than acute trusts, but they will have turnovers in the region of £50 million plus, and employ over 1000 staff. Also, if you are approached by a community provider to provide consultant input, price it fairly and avoid restrictions on availability.

Community providers

You have the potential to work very effectively in new markets. Commissioners want clinical engagement and responsive providers. Community organisations tend to be less hierarchical and have less of a management/clinician division: exploit this to be an effective bidding team.

Bidders

Appreciate the value of good personal relationships particularly between providers and commissioners: build them if they do not exist; nurture them if they do.
Be business ready. NHS providers have huge opportunities to know their market, by undertaking proactive customer research: this is not the same as thinking you know what patients want because clinicians see patients in clinic and on the ward. If the feedback is positive, build on it. If the feedback offers criticism, learn from it and make changes – commissioners will do their own research and know what patients think.
Familiarise yourselves with the process, particularly the scoring system, timelines and adjudication process.
Get help early from people who have the appropriate skills sets in budgeting, data analysis, scenario planning, social marketing, presentations, and make connections with key stakeholders
Having read the specification, decide whether it is appropriate to bid – does it fit with your organisation’s strategy? Do you have the resources to bid? What are the risks of not bidding, or not winning? Do you have the resources to deliver the service?
If you bid, respond to the specification as it is written in the final documents; seek clarification using the formal processes
Try to start by thinking “out of the box”, without being restricted by knowing how things are done now or the implications for the use of NHS assets.
Think about not just the written submission but any other adjudication processes such as an interview. Who should attend? For what reason? Imagine what your competitors might do

Have you balanced the team to match the adjudication panel in terms of experience, knowledge of the patch, patient advocacy, gender and age and styles? Do you have a mindset of “we know best” or “let’s do our best to sell our services and our personal capability”? These comments are equally relevant during a competitive dialogue.

See also advice to providers from Sharon Haggerty, this is her presentation to the Summer 2009 BTS meeting.
Consider the distinctions between evidence and knowledge. Bidders should stress their expertise is not just in knowing the evidence-base of what works, which all providers can access easily, but also in their wider knowledge base eg of know-about (problems), know-why (the root cause of behaviours), know-how (to interpret policy and guidelines into practice locally) and know-who (who are the local stakeholders to engage) (ref: Prof Huw Davies, NIHR SDO)

23 October 2009