STP commissioning meeting Tuesday 5th June, Brighouse – Commissioners don’t know where the hell they’re heading

West Yorkshire and Harrogate Sustainability and Transformation Plan/Partnership/Health and Care Partnership/ Integrated Care System has more names than you can shake a stick at – but it is an Accountable Care Duck.

Its Joint Clinical Commissioning Committee is meeting in public Tuesday 5th June, 11am-1pm at Kirkdale Room, Junction 25 Conference and Meeting Venue, Kirkdale House, Armytage Road, Brighouse, HD6 1QF

CK999 will be there to ask some questions.

The Agenda is here.

New Integrated Urgent Care Service

One of the decisions the meeting is recommended to make is to extend the current West Yorkshire Urgent Care contract with Local Care Direct until March 2020 and in the meantime to “enter into market engagement on service redesign” in order to re-procure the services from 2020.

The Commissioners are faffing around because they don’t know what the hell they are moving towards.

Here is the paper: Out of Hours primary medical care services

Although the title of the paper is ‘Out of Hours Primary Medical Care Services’,  it spends most of the document talking about a new Integrated Urgent Care and Core Clinical Advisory Services contract.

This is based on a specification from NHS England. Discussed at the March 2018 meeting, the Integrated Urgent Care and Core Clinical Advisory Services contract is to cover the whole of Yorkshire and the Humber – 3 Sustainability and Transformation Partnerships.

The March 2018 meeting agreed to instruct the Yorkshire and Humber Joint Strategic Commissioning Board to start a competitive procurement process to award the new contract. The consultancy group Attain – which  was paid £378K to set up the West Yorkshire and Harrogate STP – has been involved in preparations for this. The contract is to be awarded in time for it to start in April 2019.

NHS England has told Clinical Commissioning Groups that the new Integrated Urgent Care and Core Clinical Advisory Services have to increase collaboration between providers of urgent and emergency care services, including NHS 111, ambulance providers, urgent treatment centres, GP out of hours, GP primary care services, emergency dentists and others.

The Yorkshire and Humber new Integrated Urgent Care and Core Clinical Advisory Services will still have NHS 111/999. Patients who call NHS 111 in need of clinical advice will receive it from one of many services that CCGs and NHS England have commissioned across the region. Whoever has the NHS 111 contract has to be able to route the right calls to a network of clinical teams who will consult and complete without passing the caller on or referring them to another clinician at an A&E or elsewhere.

In 10 days in January 2018, the Prior Information Notice about the new Integrated Urgent Care and Core Clinical Advisory Services attracted 7 service providers who said they were interested in bidding to provide the service. This included organisations which are currently offering NHS111 or urgent care services.

Greater Huddersfield Clinical Commissioning Group, as the lead commissioner, have started the process of competitively procuring these Integrated Urgent Care and Core Clinical Advisory Services.

But the contract for West Yorkshire Urgent Care, which basically provides specialist out of hours GP care and Leeds Minor Injuries Units, will not be part of this Integrated Urgent Care and Core Clinical Advisory Services contract – although the Joint Clinical Commissioning Committee recognise that West Yorkshire Urgent Care, including out of hours GP services, need to be integrated with the Integrated Urgent Care and Core Clinical Advisory Services. Duh.

The current contract for West Yorkshire Urgent Care is currently held by Local Care Direct, a social enterprise company, on a subcontract from Yorkshire Ambulance Service, which holds the NHS111 contract which West Yorkshire Urgent Care is part of.

This West Yorkshire Urgent Care contract was due to expire in March 2018 and there was no provision to extend it. However as the West Yorkshire commissioners are not ready to “go to market” to re-procure West Yorkshire Urgent Care with a new contract, they have made an arrangement to extend it until March 2019, with an optional 6 months extension,As the paper for the meeting makes clear, the reason for this is that the Joint Clinical Commissioning Committee don’t have a clue about how the new West Yorkshire Urgent Care services would operate.

At the March 2018 meeting, Christine Hyde of N Kirklees Support the NHS asked where the evidence from the West Yorkshire Urgent and Emergency Care Vanguard is in the urgent and emergency care proposals.

Carol McKenna, Chief officer of Greater Huddersfield and N Kirklees Clinical Commissioning Groups,  replied,

“That’s a well made point. We need to use the evidence.”

But there’s no mention of it in the paper for the Tuesday 5th June meeting.

An Independent Review has told the Joint Clinical Commissioning Committee the future West Yorkshire Urgent Care services would have to be different from the current ones. But the West Yorkshire Commissioners can’t agree among themselves about:

  • how to deliver extended/improved access to GP care (ie evening and weekend opening),
  • how to develop and set up urgent treatment centres and
  • how they would operate out of hours.

They’re not sure if they want to commission these services on a West Yorkshire or Sustainability and Transformation Partnership basis after 2020 – but agree they should collaborate up until then and the paper recommends that they extend the current West Yorkshire Urgent Care contract until then.

The paper then says clearly that GP Out Of Hours services are a core part of the Integrated Urgent Care provision, and that at the moment – with the exception of the Local Care Direct West Yorkshire Urgent Care out of hours service that is subcontracted from Yorkshire Ambulance Services’ NHS111 – GP Out Of Hours services are contracted by individual Clinical Commissioning Groups, who do not want this to change.

Section 6 lays it on the line about why West Yorkshire clinical commissioners are not ready to “embark on a procurement process” for the new West Yorkshire Urgent Care services. Basically, they are clueless; GP services are in a state of chaos and they have no idea how the new Integrated Urgent Care model will affect GP services.

This is how the paper for the Committee puts it:

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