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- Definitions And Interpretation
- Commencement, Duration And Transition
- Co-ordination Commissioner & Associates
- Services
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
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 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
- Services Environment and Equipment
- Co-operation
- Prices and Payment
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
- Review
- 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
- Targets
- 12 month outturn
- Demand
- Modernisation
- Service Development Plans
- Totality of services
- Review Records
Schedule 3
Schedule 2
- Consent
Schedule 2
- Complaints
Schedule 3
- Staff
- Registration of staff where appropriate
- Verification of Qualifications and Training and development
- Indemnity Insurance
- Appraisals
- Leadership
- Clinical Networks and Screening Programmes
- emergency & Critical care
- Death of a Service User
- Serious Untoward Incident and Patient Safety Incident Reporting
Schedule 3
- Quality, Patient Safety and Quality Improvements
- 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 2 & 3
- Procedures And Protocols
- Transfer of Discharge from Care Obligations
- Clinical Governance, Transaction Records And Audit
- Audit & Evaluation
- Inspection
- Investigation
- Research
- Commissioner requests
Schedule 2
- Managing Activity and Referrals
- Service User Health Records
- Confidential Information Of The Parties
- Intellectual Property
- NHS Branding, Marketing and Promotion
- Pastoral and Spiritual Care
- Liability and Insurance