Tendering – How low do you go? Claire Lemer. My Roles.

Tendering – How low do you go?

Claire Lemer

My Roles

The Commissioning Process

PHASE 2:Procuring services

PHASE 1: Strategic planning

PHASE 3:Monitoring

and evaluation

Assessing need

Reviewing service provisions

Deciding priorities

Designing services

Shaping structure of supply

Planning capacity and managing demand

Supporting patient choice

Managing performance

Seeking public and patient views

Why Tender?

• To introduce new providers• To encourage efficiency in the system• To drive innovation• To ensure value for money

Alternatives to tendering

• Negotiated altered pricing plans• Reconfiguration• Bringing in external management– Private e.g. Just management– Public e.g. Opth at BGH is by RFH

Tendering for the market...

Publically available slides by Charlie Davie Neurologist

Publically available slides by Charlie Davie Neurologist

Publically available slides by Charlie Davie Neurologist

Publically available slides by Charlie Davie Neurologist

The Big Picture

The Slightly smaller picture

• New buildings• Requirement to meet financial targets• Articulation of vision and mission• Increasing focus on Quality of Care – Francis

Report• Increasing focus on patient satisfaction• Increasing competition from external providers• Uncertainty whilst wider changes enfold

The Local Picture

The Tender ProcessAdvertisement of Intended Tender

Intention To Tender

Short-listing of ITTs

Full Tender

Short-listing of Full Tenders

Interviews

Decision announced

Appeals

DRSS- Nationally

• National screening programme v.v. specific rules:– Proportion to invite to screen– Proportion to be screened– Exemptions– Training of screeners

• Computerised programmes linking GP records to computer system

Screening Pathway

Result not possible

Patient identified as Diabetic from GP

records

Patient invited to screening

Patient screened by photography

Patient screened using slit lamp

Photograph reviewed

Screen result given to patient, GP and

entered into recordPatient advised

Locally• NMUH provided DRSS for approximately 50,000 pa• Grew organically• Started before the national screening programme• Covered Enfield and Haringey• Camden and Islington Programme suspended• NMUH took over C+I for 1 year• Tender for 5 areas including Barnet• Barnet had their own service provided by GPs – very

high standard• E+H not quite meeting national targets in 18 months

prior to tender

How would you go about preparing the proposal?

A False Start..

ITT• Short document• Focused on organisational

ability to deliver• Will ask about insurance,

previous history• Limited information about

planned option• Often no cost indication• Accompanying this will be a

service specification asking identifying what the commissioners want

What we did locally..• Disconnect confusing governance lines• Improve our local performance• Prove ourselves capable of managing a bigger programme• Build links with commissioning team• Build information about competitors• Get the exec on side• Decide if we would join a consortia• Create a tender team:

– Exec– Lead for DRSS– Programme heads– HR– Finance

Full Tender -The Proposal

• Very formulaic, strict word counts• Opening page often about costs• May even expect a bottom line figure

What we did locally..• Map out staff we had • Map out staff that we would need to employ• Identify what our preferred model of delivery was

– Lower banded staff doing work?– Outsourcing reviewing– Numbers of sites– Involvement of opticians– Same day results?

• Map staffing onto this preferred model• Identify the key areas of concern:

– Prisons, Mental Health– Hard to reach groups

• How low could we go...– Was NMUH prepared to subsidise the bid?– Where there any bits of the service that were not included in the bid?– What were the knock on effects of loosing the service?

• The “brainwave”

The Interview

• Panel of commissioners• 15 mins to present and answer questions• Limited number of people able to present

Interview Team

• Practiced the pitch• Identified who to take• Practised potential questions• Spent time guessing who the panel was

Then the fun really begins – delivery..