GP Payments Calculation Service

1. GP Payments Calculation Service Opening address Kemi Adenubi – Programme Director (GPIT)

2. Introducing the Organisation

3. Introducing the Presenting Team

4. More Information… • For the Question & Answer session later submit a Bidder Question Form – one question per form • Book a one to one supplier meeting at the Registration Desk • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: GPPCS.Procurement@nhs.net

5. GP Payments Calculation Service Policy Overview Richard Armstrong - Deputy Director Primary Medical Care and SRO 2nd November 2010

6. Background – the current situation • Primary Medical Care • Primary Care consists of medical, dentistry and eye-care services • Most patient contact in the NHS is through Primary Medical Care via their General Practitioner • GPs are private contractors • DH negotiates main ‘GMS’ contract with General Practitioners Committee (GPC) of the BMA and has the responsibility to improve the commissioning and quality of, and access to, primary care • PCTs currently hold contracts with practices • GP remuneration • Approx £8bn paid to approx 8,300 GP practices • 15% (over £1.12bn) of which relate to quality outcomes for patients under the Quality Outcomes Framework

7. Background – the current situation (2) • Quality Outcomes Framework • Incentive and reward scheme for GPs for the quality of care they provide to their patients • Most practices (99%) participate and achieve highly • GPs like the QOF • DH seeking to reduce process based indicators and move focus to outcome based indicators • QMAS • Payments for the QOF are currently calculated by QMAS • GPs like QMAS (and trust information supplied via QMAS) • QMAS only calculates payments for the QOF

8. Government Policy – some key points • White Paper and Commissioning consultation • Govt White Paper ‘Equity and Excellence: Liberating the NHS’ published July 2010 • Government consultation document: ’Liberating the NHS: Commissioning for Patients’ published July 2010 • Contain four key themes • Putting patients first • Shared decision making – “No decision about me, without me” • NHS Information revolution • Improving quality and healthcare outcomes • Quality Standards, developed by NICE, will inform the commissioning of all NHS care and payment systems • Payment should reflect outcomes not activity • Money follows the patient and reflects quality 2nd November 2010

9. Government Policy – some key points (2) • Increase autonomy and accountability • Devolve power and responsibility for commissioning services to GPs and groups of GPs working in consortia • Establish NHS Commissioning Board to lead on achieving health outcomes and quality improvement • Cutting bureaucracy and improve efficiency • Release £20bn of efficiency savings • reduce management costs by more than 45% over next four years 2nd November 2010

10. Implications of Government Policy • Organisation changes • Reduced role for DH and creation of NHS Commissioning Board to: • provide national leadership for quality improvement • hold Consortia to account for outcomes and financial performance • Allocate and account for NHS resources • Hold contracts with individual GP Practices for Primary Medical Services • Abolish PCTs (and SHAs) and create GP Consortia • GP Consortia hold commissioning budgets to commission the majority of NHS Services on behalf of patients • Shift decision making as close as possible to patients • Every GP practice will be a member of a consortium

11. Implications of Government Policy (2) Accountability and Rewards NHSCB accountable to Secretary of State.. Managing overall commissioning revenue limit Delivering improvements against health outcomes NHSCB in turn holds GP Consortia to account NHS Outcomes Framework National set of outcome goals determined by SoS NHSCB held to account through achievement against Outcome Framework 11

12. Implications of Government Policy (3) Commissioning Outcomes Framework Translated from NHS Outcomes Framework A proportion of GP practice income is to be linked to the overall outcomes that practices achieve collaboratively through their role in commissioning consortium Reform of QOF to focus more on health outcomes so that it better reflects individual practices’ contribution to patient health care 12

13. Implications of Government Policy (4) When will it happen 2012 – majority of reform come into effect NHS Outcomes Framework fully implemented NHS Commissioning Board fully established Formal establishment of GP Consortia Commissioning Board makes allocations to Consortia for 13/14 year 2013 PCTs and SHAs abolished Consortium in place12/13 year and fully in operational by 2013/14 13

14. Meeting the Policy Need A new system is required to meet this policy need: • Continue to calculate the QOF with a greater focus on health outcomes achieved (including for individual patients or groups of patients) • Calculate performance of GP Consortia against the Commissioning Outcomes Framework • Is likely to require a wider set of data than at present • Ability to recognise GP practice contribution to the COF • Rewards made to GP Consortia not individual GP practices • Commissioning Outcome Framework will develop over time as will changes to QOF – therefore greater need for flexibility in introduction of new/changed indicators • Support more complex commissioning arrangements – for example there is no longer a straightforward relationship between one commissioning organisation and the GP practice • Support payments forany other commissioned service where the data is available in GP Clinical Systems

15. What’s important to us • Generic calculating and reporting tool that is not payment specific • Configurable and flexible to be able to meet future needs • Changes to be made quickly, easily and cheaply • Calculate accurately • Service operates as we expect it to • Provides value for money with no surprises • Implemented in readiness for the 13/14 year but preferably for the 12/13 year

16. More Information… • For the Question & Answer session later submit a Bidder Question Form – one question per form • Book a one to one supplier meeting at the Registration Desk • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: GPPCS.Procurement@nhs.net

17. GP Payments Calculation Service GPPCS Service Requirements David Arthur – DH Business Assurance Martin Warden – QMAS and GPPCS Programme Manager 2nd November 2010

18. Project Background • History of Project • SRO vision of a flexible calculating and reporting tool • Project initiated in 2008 • High Level Requirements developed with input from end-users and key stakeholders • NHS CFH formally managed project from 2009 • Detailed requirements gathering activities from summer 2009 to summer 2010 • Outline Business Case developed and ready for Ministerial approval in March 2010 • Election May 2010 • Government proposals published • SoS approval • Cabinet Office and HMT approval • Revision of requirements to reflect Government’s proposals • Key stakeholders have been involved throughout • NHS CFH • End Users of system – GP practice managers, PCT commissioners, GPs • NHS Information Centre, NHS E, NICE and Project Sponsor • External Assurance has been provided by a Project Assurance Group • Representation from General Practitioners Committee • Royal College of General Practitioners • Joint GP IT Committee

19. What are we buying? • We are buying a managed service consisting of: • A calculating and reporting system • a modular and configurable solution that calculates payments accurately and is quickly and cheaply adapted to meet changing business needs • Development capability • to extend the system quickly to account for changes outside of current assumptions and in doing so ensure that the new capability is re-usable

20. What are we buying? (2) • Implementation and ongoing service delivery • to ensure that the service is implemented seamlessly into the business, including data transfer, and with consideration for the new business environment • to make changes to the following aspects of the system as instructed by the Authority: organisation structure, commissioning arrangements and payments and ensure that they are tested appropriately • Support and Training • helpdesk staffed by knowledgeable people who can swiftly resolve issues and provide informed help and guidance to users • provide initial training, primarily electronically, that is appropriate and cost effective so that users can use the system competently and with confidence • ongoing training that is kept up to date and prepares new users to the same standard as during initial implementation

21. GP Practices NHS Commissioning Board GP Consortia GP Systems Agree participation Setup Performance Schemes with both GP Practices and GP Consortia Setup and Manage Performance Schemes with GP Practices Other information sources Payment notifications Payments WEB INTERFACE Service Provider Set-up Services/Schemes Data extract or provision Data query and extract GPPCS System Organisation data Organisation data Scheme participation data NHS Payments Agencies Menu Record participation in Services NHS Information Centre Analyse and format data • Calculate • Achievement and Payments Approve/Adjust Participation and Achievement • Report • Achievement and Payments GPES EXETER ‘BOXES’ Make Payment INTERFACE Payment notifications Aggregated achievement data INTERFACE Organisation Data Service Data Store System Ref. Table Proposed Future State – GPPCS system shown in blue

22. 1a. NHSCB setup Performance Schemes for GP Consortia and GP practices GP Practices NHS Commissioning Board GP Consortia GP Systems 1b. GP Consortia set-up Performance Schemes with GP practices Agree participation Setup Performance Schemes with both GP Practices and GP Consortia Setup and Manage Performance Schemes with GP Practices 2a. Participation in Schemes is recorded through the menu on the web interface 3a. GPs record clinical care on their systems and non-clinical data through the web interface 1c. Service Provider sets up Schemes in system. Organisation data is passed to GPPCS 3b. GP Consortia and/or NHSCB record certain outcomes through the web interface Other information sources Payments Payment notifications WEB INTERFACE Service Provider Set-up Services/Schemes 2b. GPPCS informs the NHS IC of the Performance Schemes that GP Consortia and GP practices participating in. Data extract or provision Data query and extract GPPCS System Organisation data Organisation data Scheme participation data NHS Payments Agencies Menu Record participation in Services NHS Information Centre Analyse and format data • Calculate • Achievement and Payments • Approve/Adjust • Participation and Achievement • Report • Achievement GPES EXETER ‘BOXES’ 4. GPES extracts achievement data from GP systems and other sources, and aggregates it before sending to the calculating system. Make Payment 5. The system calculates achievement/payments that are approved/adjusted through the web interface where necessary INTERFACE 7. Exeter makes payments and sends payment notifications. Payment notifications Aggregated achievement data INTERFACE 6. Reports are produced when required and payment notifications/adjustments are sent to the relevant Exeter system Organisation Data Service Data Store System Ref. Table Proposed Future State – GPPCS system shown in blue

23. GPPCS – Characteristics Characteristics The aim is to bring to life GPPCS from a technical perspective in terms of its size and scope The aim is also to demonstrate that GPPCS is not necessarily a hugely complex technical challenge though challenges clearly do exist. The GPPCS Application It’s a Calculation and Reporting application – Other systems capture the inputs and perform payment transactions Does not necessarily need a healthcare technology solution Calculating and reporting performance against indicators is not a new concept - existing QMAS concepts, knowledge and experience will be retained and built on There is no patient identifiable data - complexities around managing patient data do not arise here 23 12 March, 2014

24. GPPCS – Characteristics (2) The Data Store GPPCS data held centrally – one data centre, no local data stores to manage Interfaces to External Systems Message based interface to NHAIS for sending payment notifications, receiving GP Practice details & payment reference data Data interface from GP Clinical Systems – either the proposed message based interface from the GP Extraction Service (GPES) or direct from GP clinical systems One way upload of organisational data from the proposed Organisational Data Service The messaging interfaces that feed data to GPPCS will be weekly or monthly and low volume 24 12 March, 2014

25. GPPCS – Characteristics (3) Users and Volumes Stable user numbers. Approx 40,000 registered users of system comprising of staff from 8800 GP Practices, 500+ GP Consortia, NHS Commissioning Board and DH. Core hours are 8:00 AM to 18:00 PM Mon-Fri Primary activity of the user base is checking their progress against QOF/COF outcomes on monthly basis and the outcome of the financial year end calculation Average number of users on QMAS is 80-100 measured over an hour Peak 2500 users per hour during April, May, June with users checking end of year calculations 25 12 March, 2014

26. GPPCS – Technical Challenges The payment calculation needs to be accurate The calculations are complex but well understood Technical solution needs to be flexible - examples Can introduce a new set of QOF indicators without software changes Can change Read Codes configuration without software changes Add a new calculation that uses existing inputs and outputs without needing a full regression test QMAS and GPPCS Test phase to check GPPCS against QMAS end of year calculation is key QMAS transition – data migration/parallel running 26 12 March, 2014

27. GPPCS Service – Implementation Milestones Business process is based on end of year financial year Live Service Implementation Live service could start as late as end Sept 2012 for fy 12/13 for QOF and COF For GPPCS service implemented after end Sept 2012 then the live service will start for fy13/14 27 12 March, 2014

28. More Information… • For the Question & Answer session later submit a Bidder Question Form – one question per form • Book a one to one supplier meeting at the Registration Desk • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: GPPCS.Procurement@nhs.net

29. GP Payments Calculation Service End User View Dr Ian Trimble GP and Professional Executive Committee Chair, NHS Nottingham City PCT 2nd November 2010

30. User Perspective Quality matters Brief History of Quality Schemes Practical User issues 30

31. Quality matters • Drivers for systematic quality schemes: • Evolving research / evidence base • Wide observed inter-practice variation • Implementation quantifiable (for some conditions) • Emerging evidence re QOF: • Has had some impact, but ?sustained • May not address holistic care / continuity of care • Need to avoid gaming / perverse incentives • Some lessons learned: • Need to align with NICE guidance • Systems need to be intuitive / easy to use • More flexibility required (year-on-year, and locally) • Future policy direction • Quality / outcome measures imperative • Commissioning quality framework • More local schemes likely

32. Brief History • 1990 Contract • Cervical cytology • Immunisation • 2000 ‘Quality in Primary Care’ schemes • Ad hoc implementation • Wide variation • 2004 ‘New GMS’ – QOF / QMAS • Successful implementation • Inflexible: monolithic system, no local flexibility • 2010 GPPCS

33. 2002 version • Simple • Based on NSFs • Utilised MIQUEST • Labour intensive • Informed QOF

34. 2002 version Small number of targets

35. 2002 version Variable weights

36. 2002 version Flexible targets

37. 2002 version Total score should improve over time

38. QOF / QMAS • Much more detailed • Very structured • Defined ‘business rules’ • Automated data collection • User feedback mid-year • Adjustable end-year results • www.qmasweb.scot.nhs.uk/training

39. User expectations – GP practice • Intuitive • Wide variation in practice staff capabilities • Interface must be intuitive and easy to use: log-in, inputs • Improved benchmarking, reporting tools • Good support • Training, guidance, and Helpdesk readily available • Transparent • System should collect data with minimal user input • Quick and accurate • Reliable • Outputs should be directly comparable with practice IT outputs • System should be on-line at all times • Available • Available almost all year, with more frequent updates if possible • System should provide feedback early in year to allow remedial action

40. User expectations – PCT contract manager • Intuitive • Wide range of skills at PCO level also • Well supported • Training materials up to date and readily available to PCT staff and practices • Reliable • Quick and accurate, with smooth transition from existing QMAS • Adjustable • Allow for manual adjustment of practice input values following audit / challenge • Flexible • Allow for local QOF / Enhanced Service calculation • Accessible • Allow for local reporting of performance • Better comparative reports – ability to download all PCT data

41. More Information… • For the Question & Answer session later submit a Bidder Question Form – one question per form • Book a one to one supplier meeting at the Registration Desk • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: GPPCS.Procurement@nhs.net

42. GP Payments Calculation Service Procurement: “How will we deliver this deal...?” Matt James – Director of Procurement Michael Entwistle – Commercial Manager & Procurement Lead

43. How Will We Deliver this Deal…? • Commercial Principles • Procurement Timetable • PQQ Guidance

44. OGC Commercial Principles - Contract

45. Commercial Principles - Flexibility ?

46. Commercial Principles - Financial

47. Procurement Process & Proposed Timeline 47

48. PQQ Guidance

49. More Information… • For the Question & Answer session later submit a Bidder Question Form – one question per form • Book a one to one supplier meeting at the Registration Desk • After the event, if you wish to raise any PQQ clarification queries, please use the project email account only: GPPCS.Procurement@nhs.net

50. Q & A ?