Question and Answer and Amendment Matrix
NEL Community Musculoskeletal Physiotherapy Service
Number / Date / Section / Amendment
1 / 29/09/14 / Specification Section 7 Quality & Performance Indicators / In light of the questions posed regarding the Pre and Post Client Reported Outcome Measure we have reviewed the KPIs and amended them to reflect our minimum position on the PROM measure, as follows:
•100% of clients to be offered a Client Reported Outcome Measure (PROM) pre-treatment questionnaire during their initial assessment. It is expected that there will be at least a completion rate of 90%.
•Work towards achieving 90% of clients completing a Client Reported Outcome Measure (PROM) post-treatment questionnaire prior to discharge that have completed a pre outcome questionnaire. This will be benchmarked against local performance of other MSK providers and reviewed annually.
Questions and Responses
Number / Date / Question raised / Commissioner Response
01. / 05/09/14 / "Assessment and treatment in a client’s home will occur when the client is unable to attend for assessment due to their level of disability."
- Could you advise on the tariff for domiciliary visits please? / There is no additional tariff for home visits, it is expected that this will fall within the given prices in the financial section.
02. / 09/09/14 / I have been unable to find any word/character limit relating to the response document. Can you confirm that our responses are not restricted to certain limits please? / We have not set limits on the number of words for responses. Tenderers should consider their response appropriate to the relevant question.
03. / 09/09/14 / Could you confirm the number of IAs and Follow Up home visits that were undertaken in the past 12 months please? / There are several current contracts for Community MSK. In the main home visits are not a specific requirement. The number of home visits are small, with no more than one home visit a month. In the last year, it is estimated that a total of 12 home visits have been provided.
It is expected that having a community MSK service will support patients to access the service even further. Therefore while we would not expect the number to increase.
04. / 11/09/14 / What is the criteria for the two tiers proposed? / The Community MSK service being tendered will be for all GP referrals to MSK provision. Complex MSK will be all consultant referrals to MSK Provision.
05. / 11/09/14 / The specification suggests providers will need to also perform a domicillary service. Is the CCG proposing to disband the current community physiotherapy team at DPOW? / No, the Community Physiotherapy Team will remain operational. It is proposed that the majority of MSK patients will be seen within community based MSK clinics, the specification offers the opportunity for patients to be seen within their own home if they are prevented from attending the clinic due to their level of disability. This is to ensure equity of access. It is thought that these would be rare, however essential to ensure provision of care to meet need. As answered in a previous question raised, there have been very few home visits to meet current MSK patients’ needs, in total about 12 in the last year.
06. / 11.09.14 / How will the average of 3.5 sessions fit with the NICE guidelines of 8 sessions for the treatment of LBP when evidence shows the majority of GP referrals will be for LBP? / The number of follow up sessions will always be based on clinical decision making, the actual number provided will therefore be based on need. Using activity data for the last year the local average number of follow up sessions provided is less than 3.
07. / 11.09.14 / How is the CCG justifying the proposed tariff as it is significantly below the 2009 figures published by the DOH for MSK AQP? / As part of the Commissioning process we have undertaken research on current MSK provision, we have then benchmarked ourselves against those current figures. In addition to this, we have utilised local figures currently being spent on MSK GP referral community provision and the volumes of patients being seen and the number of sessions being delivered. It should also be noted that complex MSK provision will remain outside of this specification.
08. / 11.09.14 / The claw back of monies for exceeding an average of 3.5 sessions is currently proposed to be monthly. As fluctuations are statistically inevitable in short time frames should this not be annualised? / It is proposed to be quarterly as stated in the specification ” If the average ratio of follow up appointments to initial assessments in any reporting quarter exceeds 3.5, NELCCG will claw back the cost of the excess from subsequent payments”.
09. / 11.09.14 / The Specification mentions onward referral into the pain service, will AHP's be able to refer into this service? / No, the current system of referral will remain the same, access to the pain management service will be via a GP referral.
10. / 11.09.14 / Can you please confirm if the group sessions can be held if there are under 7 patients? For instance if 4-5 patients are deemed suitable can this session be held? / The specification identifies that the minimum number of participants for a group will need to be 7.
11. / 15.09.14 / Whilst we appreciate that as with all framework contracts there are no guaranteed or indicative volumes for individual providers, however can you please provide the total activity for previous years in respect of: Initial assessments, follow up appointments , group sessions / Current annual activity estimates are as follows:-
Initial Assessments: 4205
Follow Up Appointments: 7418
Group Sessions: 249
12 / 19.09.14 / Reference question 2.16 you ask for a tender price and value to date to be completed; please can you clarify what you mean by a ‘tender price’? / The tender price relates to the total value of the contracts listed.
13 / 23.09.14 / "100% of clients to complete a Client Reported Outcome Measure (PROM) pre-treatment questionnaire during their initial assessment - Work towards achieving 100% of clients completing a Client Reported Outcome Measure (PROM) post-treatment questionnaire prior to discharge" This clause states that 100% of patients are to complete PROMS pre and post treatment. This will be extremely difficult to achieve as not all patients will agree to complete PROMS. Other NHS contracts have requested that 100% of patients are "offered" PROMS pre and post treatment and then set a % for acceptance - would this not be a more manageable performance indicator? / The reason the clause states 100% for a pre-treatment questionnaire is because it was felt that this should be completed during the initial assessment and therefore wouldn’t be negotiable as its part of the assessment. In terms of post treatment, we accept that not all patients will choose/ not be able to finish the course of treatment and therefore may not attend their final visit/ session and complete the post treatment questionnaire at discharge, hence we stated that the provider should work towards 100%.
In light of the questions posed regarding the Pre and Post Client Reported Outcome Measure we have reviewed the KPIs and amended them to reflect our minimum position on the PROM measure, as follows:
•100% of clients to be offered a Client Reported Outcome Measure (PROM) pre-treatment questionnaire during their initial assessment. It is expected that there will be at least a completion rate of 90%.
•Work towards achieving 90% of clients completing a Client Reported Outcome Measure (PROM) post-treatment questionnaire prior to discharge that have completed a pre outcome questionnaire. This will be benchmarked against local performance of other MSK providers and reviewed annually.
14 / 29.09.14 / Discharge letters- will a summary within the boundaries given- on System 1, be acceptable / YES. Although where a client requests a copy, this should also be sent directly to the client.
15 / 29.09.14 / Clients with deteriorating neurological conditions- can these patients be seen if their presenting problem is MSK / All clients with a presenting MSK need that is appropriate for delivery via this specification (Via GP referral) can be seen
16 / 29.09.14 / Please clarify whether or not Group Work sessions will count towards a client's total number of Follow-Up sessions, when determining: a) their total number of Follow-Up sessions (not to exceed 5); and b) the quarterly monitoring ratio of 3.5 / a)Yes
b)Yes
17 / 01.10.14 / Do we have the agreement of the CCG that we can tentatively start t approach clinics within the CCG boundaries, to check for available space, in the event of us being accredited? / Potential providers can contact Practices directly but should ensure they speak to either the Building Manager or the person responsible for the building.
18 / 01.10.14 / At 3.5, there is a requirement to enclose audited financial statements. Our company is exempt an audit, on the grounds of its size. As such, although we are able to submit the relevant financial statements, there is no audit report pertaining to these. Would this preclude us from participating in this tender? / Being exempt from having to audit your accounts will not preclude you from participating in the MSK tender.
If you submit an application please provide your accounts as they stand, but be aware that we may seek further clarification relating to them.
19 / 09.10.14 / Can the CCG supply and exclusion criteria eg patients that should be referred directly to the community physiotherapy team and those that should be seen under this contract? / The clients who would be excluded from this specification are those who are referred into MSK services via a consultant or other AHP professional and those who require physiotherapy input where their main presenting condition is not an MSK condition.
20 / 09.10.14 / Are we to be given access to the integrated community equipment store for patients in need of home adaptation or walking aids? / Physiotherapists from successful Providers on the MSK Provider Framework will be able to complete an Equipment Prescription utilising their professional competencies to source equipment from the Integrated Community Equipment Store subject to clients meeting the eligibility criteria as determined by the Therapist.
In terms of access to home adaptation, if a therapist wishes to make a referral for a Home Adaptation, this could be made if they had evidenced the appropriate Competency Framework required by all referring therapists.
21 / 09.10.14 / Will any safety equipment/procedures be provided by the CCG for lone workers attending clients homes as they do in the community team at the hospital? / No, all Providers will have to develop their own procedures for lone working
22 / 09.10.14 / As the service specification calls for experienced physiotherapists to conduct the work how will this impact on the role of technical instructors who currently do home visits? / Technical Instructors in other community physiotherapy services will not be affected.
23 / 10.10.14 / Can you confirm that for question 3.9 and 2.10, the contract values you have requested are for the period from the start of the contract up to date? Or do you require annual values for each contract? / The question requires you to confirm totalcontract values for the contracts you currently carry out. These may be an anticipated total contract value.