Abc Primary Care Trust (1)

Abc Primary Care Trust (1)

South Tyneside PCT Substance Misuse Commissioning Team Implementation of the NHS Standard Contract for Mental Health and Learning Disability Services

South Tyneside PCT Substance Misuse Commissioning

Commissioners Guide to the Implementation of Mental Health and Learning Disability Contract

PART 1

Outline Heads of Terms and Summary Briefing Overview

This briefing paper has been split into six parts as follows:

  • Page 2: Part 1, Introduction & Background to the Contract
  • Page 5 : Part 2,Outline of the Clauses
  • Page 30: Part 3, Outline of the Schedules
  • Page 36: Part 4, Partnership Section 75 Issues
  • Page 40: Part 5, Service Specification Example
  • Page 50: Part 6, Frequently Asked Questions

Introduction

The Department of Health has developed two new standard contracts which will be used on a mandatory basis by Primary Care Trusts (PCTs) from April 2009.

The standard contracts will be used for health and care services with any provider for new contracts commencing on or after 1 April 2009. There is one for general community based services and another for specialist mental health/learning disability or substance misuse services.

These will sit alongside the standard contract for acute hospital services and the primary care contracts. The contracts contain standard legal terms which cannot be changed and a service specification template for completion at a local level for each service. The standard legal terms are there to provide the basis for equal partnership working between all parties, and include for example review arrangements and dispute resolution procedures.

The standard contracts are not intended to be used for activity that would be moreappropriately funded through a grant process. Alongside the standard contracts we are reinforcing with PCTs the role of grant funding for organisations, particularly those providing lower level community based support. The National Audit Office Decision Support Tool can be used to support decision making on the most appropriate funding mechanism to use.

This paper sets out some of the thinking around the structure and content of the new standard NHS contract for communityservices across South Tyneside PCT area. It outlines each clause as a summary and also some questions / issues this may pose for Community Services. It is also envisaged that this paper may lead to further projects and recommendations being implemented particularly around some of the new requirements that Commissioners expect providers to adhere to.

This guide is a summary of the clauses and schedules(and details of what will be covered). Although the contract came into force on the 1st April 2009, however we are still very much in the developmental phase, and this guide represents findings so far. Further work beyond this paper will also be required.

Background and current situation

From April 2009 the Mental Health & Learning Disability Community Contract will be introduced on a one year basis to expire on 31st March 2010. This guidance will apply to the interim year agreements made by PCTs with all Providers of Mental Health and Learning Disability Services. The DH guidance describes that Substance misuse commissioning teams (previous DAT or DAAT) may also use the Mental Health and Learning Disability Contract however makes it clear that it is at the Commissioners discretion as depending on the type of Substance Misuse Service the standard Community Contract maybe more appropriate.

Where both the PCT and the Provider have a well developed contract in place and agree that their current contract arrangements would benefit from continuing until April 2010 then, subject to SHA approval, the parties can continue to contract under existing arrangements. PCTs will ensure that any extension to current contracting arrangements will not continue beyond 2010.

The contract is intended to cover the full range of mental health and learning disability services including services for:

  • Adults of working age
  • Older adults
  • Children and adolescents
  • Substance misuse
  • Learning disability
  • Forensic care

The Community and Mental Health Contracts have now been agreed and came into force with effect from 1st April 2009 and it is imperative that that South Tyneside PCT and its providers fully understand the contract in its entirety and its possible impact and effect to them.

The contract is very complex in places, so a clear understanding and training for managers and staff will be essential during initial rollout phase.

The framework for the contracts required the development of a standard contract applicable to:

  • Mental health services (including pathways relevant to the NHS learning disability services)
  • Community health services (including pathways relevant to the NHS learning disability services)
  • Ambulance services (including Patient Transport Service)

The three contracts, built around a common framework, will be for agreement between Primary Care Trusts and all types of provider organisation including NHS Trusts, NHS Foundation Trusts, and independent and third sector organisations.

Separate contract types will not be developed for different types of provider. A consistent contractual framework will ensure a fairer playing field

So why has this new contract been developed?

The new contracts are a tool to support commissioning at a local level by providing the basis of good practice when contracting with providers. It will also reduce the duplication and cost of legal and administrative costs at a local level.

Commissioners and the Department of Health hope that by implementing the new contract that it will allow:

  • Improved outcomes for patients
  • Give greater a patient experience, say and choice
  • National standards and national contracts giving consistency
  • Improved service delivery, performance & greater value for money
  • Allow a review of ALL existing services and systems (Strategic Reviews by Commissioners, New Service Specifications, Internal systems review, etc……..)
  • Implementation of new systems where appropriate and recommendations are made
  • Commissioning of new services or service redesign where appropriate and recommendations are made
  • Consistency across all contracts & services with improved care pathways
  • Ability to monitor performance much more closely
  • Further enhancing the World Class Commissioning agenda and Darzi recommendations

So what exactly does the newMental Health and Learning Disability Contract mean?

The contract provides an important tool for assuring accountability between Providers and Commissioners and for improving performance.

The new contract will mean changes to the way that we operate as outlined below:

  • One overarching contract that covers all services for 1 year only initially
  • Individual service specifications underpinning the contract
  • Greater competition between providers
  • Provide greater quality services and achieve better value for money
  • Commissioner / Provider split
  • Contractual obligations to Commissioners
  • Cultural changes
  • Service reviews and changes
  • Systems reviews and changes
  • Regular performance and contracts meetings
  • Provide commissioners with monthly reports and data
  • Accountability & Legal Obligations
  • Financial Penalties for breach of contract, poor performance.

1

NHS Standard Contract for Mental Health & Learning Disability Services Commissioners Guide (April2009)

South Tyneside PCT Substance Misuse Commissioning Team Implementation of the NHS Standard Contract for Mental Health and Learning Disability Services

PART 2

CountyDurham and Darlington Community Health Care Services NHS Standard Contract for Mental Health and Learning Disability Services

Outline Heads of Terms & Summary Briefing Overview

Contract Clauses

Clause / Brief Definition of Clause / Brief Explanation & Contractual Duties of the Provider Under this Contract Clause / Clause Links to Schedule
  1. Definitions And Interpretation
/ Providers have regard to the principles of interpretation set out in Schedule 1 apply. Also obliges the Parties to have regard to the NHS Core Principles. / Schedule 1 gives all standard terms used in the contract and there definition / meaning. You should know the definitions. / Schedule 1
  1. Commencement, Duration And Transition
/ Sets out when the Contract takes effect, when the Provider commences delivery of the Services, when the Contract expires, and how the Contract can be extended. / The standard duration will initially a 1 year contract. / None
  1. Co-ordination Commissioner & Associates
/ Sets out whether the commissioner acts on its own or in association with other commissioners. / There will be a range of flexibilities for coordinated commissioning and also individual provider-commissioner arrangements. Options are explored in Annex 1 & 2 in schedule 2 Part 1 / None
  1. Services
/ Sets out the Provider’s key obligations in relation to the provision of the Services to the Commissioners.
The contract will recognise the breadth and variation in delivery models of the services. The contract documentation will included a service specification template for completion by local commissioners in conjunction with providers to reflect the importance of local health economy. / Service specs will include the following:
  • Purpose
  • Scope
  • Service Delivery
  • Referral, Access & Acceptance Criteria
  • Discharge Process
  • Quality & Performance Standards
  • Activity / Plans
  • Patient Experience
  • Improving Patient Experience
  • Unplanned Admissions
  • Reducing Inequalities
  • Continual Service Improvement Plan
  • Contract Cost Details
There will also be requirements of patient booking and patient choice.
The provider must provide the services in accordance with:
  • The service specification, Schedule 2, Part 1
  • The Activity Plans; Schedule 3, Part 1, Annex 1
  • Quality Standards; Schedule 3 Parts 4a & 4b
  • The Law
/ Schedule 2 Part 1, Annex 2 & Annex 3
Schedule 3 Part 2
Schedule 2 & 3
4A.Safeguarding
Children &
Vulnerable Adults / This requires the provider to comply with the commissioner’s policy for safeguarding children and vulnerable adults which must be attached to or described in schedule 11. / All POVA docs / policies and all staff CRB checked and POVA aware and trained. / Schedule 11
  1. Services Environment and Equipment
/ Obliges the Provider to comply with the Law and with the Quality Standards in relation to the Services Environment and the Equipment. / The contract recognises the potential variation in service delivery settings including domiciliary care settings & provision and also the importance of a detailed risk assessment. / None
  1. Co-operation
/ Requires the Parties to co-operate to ensure the performance of the Services in the best interests of Patients. / (Also links to Clause 48 for Assignment and Sub-Contracting arrangements) / None
  1. Prices and Payment
/ Sets out how the Commissioners will pay the Provider.
In absence of a national tariff for the services this needs to accommodate local approaches. It will refer to a locally agreed baselineprice for each service covered by the contract that enables the provider to deliver the performance standards required by the contract. The provider may also make a reasonable margin, (in line with Monitor requirements for FTs). / As a minimum this price will be adjusted each year to take account of inflation, service changes, changes in required performance standards (either local or national) or baseline activity. Such adjustments will be made at the local agreed rate.
The contract will recognise the flexibility needed by providers. / Schedule 3, Part 1, Annex 3
Schedule 6
Schedule 11, Part 3
Schedule 11, Part 4
  1. Review
/ Obliges the Commissioner and the Provider to review at least monthly the performance of the Contract. / The requirement to formally meet monthly to look at the following for every service:-
  • Activity Plans
  • Annual Values
  • Section 75 arrangements
  • The schedules and compliance
  • Party Performance including any notices and warnings issued
  • Capacity Reviews in accordance with schedule 3
  • Compliance with Clause 16 Quality, 19 Clinical Governance, and 20 Managing Activity & Referrals
  • Performance Indicators
  • Complaints / Safety / Incidents
  • New Procedures or Treatments
  • Variation of agreement needed
  • Price and payment
They will also discuss the schedules for the next contract year:
  • Targets
  • 12 month outturn
  • Demand
  • Modernisation
  • Service Development Plans
  • Totality of services
  • Review Records
/ Schedule 6
Schedule 3
Schedule 2
  1. Consent
/ Obliges the Provider to operate a Patient consent policy in accordance with the Law and good clinical practice. / The provider MUST have a patient consent policy and evidence of this. / Schedule 3
Schedule 2
  1. Complaints
/ Obliges the Provider and the Commissioners to operate complaints procedures in accordance with the Law, and to disclose details of them to each other. It also obliges the Provider to implement learning from complaints. / The provider MUST have a Complaints Policy and evidence of this. / Schedule 2
Schedule 3
  1. Staff
/ Obliges the Provider to have sufficient Staff to ensure that the Services are provided in accordance with the Contract. It also sets out specific requirements in relation to Staff qualifications, indemnity insurance, regulatory registration, training, appraisal and professional leadership. /
  • Registration of staff where appropriate
  • Verification of Qualifications and Training and development
  • Indemnity Insurance
  • Appraisals
  • Leadership
/ Schedule 3
  1. Clinical Networks and Screening Programmes
/ Obliges the Provider to participate in any required Clinical Networks, to be agreed with the Commissioner and detailed in Service specification in Schedule 2. / This is service specific. We must participate where necessary in any Screening programmes or clinical networks. / None
  1. emergency & Critical care
/ Not Used / Not Used / Not Used
  1. Death of a Service User
/ Requires the Provider to have a policy detailing the procedures it will follow in the event of the death of a Service Userduring the delivery of services by the Provider. / The provider shall maintain and operate a policy that complies with Good Clinical Practice and the Law. / Schedule 3
  1. Serious Untoward Incident and Patient Safety Incident Reporting
/ Obliges the Parties to comply with the Serious Untoward Incident and Patient Safety Incident arrangements set out in Schedule 12. Has effect even after contract expiry. / The provider shall promptly send the commissioner any notice of serious incidents surrounding patients. / Schedule 12
Schedule 3
  1. Quality, Patient Safety and Quality Improvements
/ Specifies how the Provider is required to provide the Services, and provides a scheme for assuring the quality of Services. / The provider shall carry out the services in accordance with Law, Good clinical practices and good health and social care practices as follows:
  • The core standards / standards for better health
  • Recommendations from audits and serious incidents
  • NIHCE standards
  • Anything in the service specification
  • Quality standards
  • Carry out patient and carer experience surveys
  • Provider will publish 2 months before the end of the year a review of clinical activity to include:-
  • Compliance or failure to comply with the standards
  • Patient and carer complaints received
  • Any patient / carer surveys carried out
  • Staff satisfaction surveys carried out
/ Schedule 3, Part 1
Schedule 2 & 3
  1. Procedures And Protocols
/ Obliges the Provider to send to the Commissioner copies of Patient guides, or other written policies, procedures or protocols. / The commissioner can give 5 operational days notice to request the provider to provide ANY of its policies or procedures. / Schedule 3
  1. Transfer of Discharge from Care Obligations
/ Obliges the Provider to comply with Discharge and Transfer of Care Protocols, which are local agreements to be set out in the service specification at Schedule 2. / The contract will highlight the importance of the transfer of care protocols as part of the pathway approach to delivery of services as per the service specification. Care Transfer Plan is mandatory. / Schedule 2
  1. Clinical Governance, Transaction Records And Audit
/ Sets out provisions relating to clinical governance, the keeping of records, and rights to audit under the Contract. / The provider will comply with ALL of their duties under law to improve quality of clinical services for patients through integrated governance arrangements as set out in standards for better health.
  • Audit & Evaluation
  • Inspection
  • Investigation
  • Research
  • Commissioner requests
/ Schedule 3
Schedule 2
  1. Managing Activity and Referrals
/ Obliges the Parties to monitor and manage activity and referrals for the Services in accordance with Schedule 3 Part 1. / The provider shall monitor and manage activity and referrals in accordance with the schedule. / Schedule 3, Part 1
  1. Service User Health Records
/ Obliges the Provider to maintain and operate a policy for the effective management of Patient Health Records. It also sets out obligations on the use of records. / Clause recognises the provider held patient held and joint social care health records. / None
  1. Confidential Information Of The Parties
/ Sets out restrictions on the disclosure by the Parties of non-patient related confidential information. / Confidential information is owned by the party that discloses it and the party that receives it has no right to use it. / None
  1. Intellectual Property
/ Sets out how intellectual property relating to or arising from the Contract is to be handled by the Parties. / Except as set out expressly in this agreement no party shall acquire the IPR of any other party / None
  1. NHS Branding, Marketing and Promotion
/ Requires the Provider to comply with applicable guidance on NHS marketing, promotion and branding matters. / The provider shall comply with the requirements set out. NHS brand guidelines MUST be followed. / Schedule 8
  1. Pastoral and Spiritual Care
/ Requires care to take account of pastoral and spiritualneeds. / The provider shall take account of the spiritual and pastoral needs of ALL patients and liaise as appropriate with spiritual and pastoral authorities. / None
  1. Liability and Insurance
/ Sets out in what circumstances the Parties are required to indemnify each other for loss arising from negligence or breach of contract, and sets out their general obligations to insure. / The provider shall at its own cost have appropriate insurance policies having regard to their liabilities and obligations under this contract agreement. / None
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