Managing the backlog of demand for elective care has and will continue to rely on accessing capacity from the independent sector. To provide commissioners and trusts with a quick and simple route to contract and sub-contract acute elective care services, an innovative national framework – the Increasing Capacity Framework – was developed and launched in November 2020.
Successfully developing the framework required collaboration between national and acute procurement experts, with co-leadership and ongoing framework management provided by Arden & GEM’s experienced and proven team.
The challenge
As part of the response to the emerging coronavirus pandemic, in March 2020, all NHS hospitals were instructed to suspend non-urgent elective surgery to free up capacity to deal with expected COVID-19 admissions. This instruction, combined with subsequent pauses in routine care and a decrease in diagnostic activity across the health service, led to a significant backlog of patients whose care has been delayed.
The contribution that the independent sector could make to the COVID response was recognised early in the pandemic with NHS England and NHS Improvement securing additional resource through a national agreement with independent healthcare providers. To further harness the capacity of the independent sector to support service recovery, a sustainable procurement and contracting solution was needed which would minimise the administrative burden on local contracting authorities i.e. CCGs and NHS Trusts.
NHS England and NHS Improvement’s Independent Sector Coordination team sought specialist support to develop and launch an innovative national framework that would streamline and simplify the route to market.
Our approach
Arden & GEM’s procurement team had successfully delivered a range of regional and national procurement projects for NHS England over the past seven years. The CSU team was asked to work in partnership with the Procurement Directorate at Guy’s and St. Thomas’ NHS Foundation Trust to bring together national and acute expertise.
Procurement process
The blended NHS team worked at pace to design and deliver an OJEU compliant procurement process that included market engagement, stakeholder management, developing procurement documentation and an approach to assessment and evaluation. Arden & GEM operated robust project management principles to ensure the process was delivered, by all partners, to the strict timeline needed.
Supporting framework use
The framework was launched in November 2020 with resources available to support contracting authorities via a dedicated ICF portal, hosted on the Arden & GEM website.
The portal includes:
- A framework buying guide which provides an overview of how the ICF works
- An agreement of in scope services
- A list of providers and guidance on accessing a provider database
- Templates to draw down services including direct award, mini-competition and contract templates
- Useful information and contacts.
Identifying potential providers
With 90 providers successfully appointed to the framework, it was essential that users could easily identify providers that operated the right service in the right location and had capacity available. The ICF team worked in partnership with NHS data and analytics experts, AdviseInc, to build a Framework Provider Database that is searchable by service, geography and price. The provider database allows contracting authorities to quickly identify services in their area and informs decision-making about the call off process e.g. whether a direct award can be made.
Delivering value for money
Prior to the COVID-19 pandemic, there was a large discrepancy in the price paid for independent sector services under local contracting arrangements. In addition to stipulating that framework providers could not charge higher than national tariff, the ICF has also secured discounted services from many appointed providers, levelling the field and delivering value for money. While the ICF has been designed to reduce the administrative burden of contracting, its use is optional, enabling those commissioners who are already purchasing services at a lower tariff than the ICF to maintain their local arrangements.
Building in flexibility
The ICF, by necessity, was developed and implemented at pace to respond to the waiting list backlog created by the COVID-19 pandemic. Given this context, building in future flexibility was crucial. Through engagement with local commissioners and independent providers, Arden & GEM has devised a governance process that allows existing providers to add more capacity into the framework. This enables service offers to be moderated and adjusted in response to emerging trends. The ICF will also undergo a refresh in April 2022, when the framework will be reopened to allow additional providers to be appointed for the remainder of the framework term – until November 2024.
Framework management
To provide a dedicated resource for the ongoing management of the ICF – including coordinating the refresh, updating portal documentation and acting as a single point of correspondence for commissioner and provider queries – Arden & GEM appointed a framework manager. This resource will also develop and support the framework’s future roadmap including improving database functionality and working with providers to identify marketplace innovation.
The outcomes
The ICF provides commissioners and trusts with a streamlined route to contract and sub-contract acute elective care services. It enables the broad resource offered by the independent sector to be efficiently accessed through a nationally validated mechanism and at an appropriate price.
"The Increasing Capacity Framework for elective care is a national framework established by NHS England, through which NHS commissioners and Trusts may purchase clinical services from more than 90 providers, and has contributed significantly to our ability to treat more patients.
The Increasing Capacity Framework has provided a platform to work more efficiently and effectively with independent sector providers and NHS colleagues in order to buy elective care capacity swiftly and, in doing so, has enabled the independent sector to fully support the national work to alleviate long waiting patients as a result of the COVID-19 pandemic."
Victoria Pritchard – Deputy Director of Contracting – Specialised Services (National) and National Commercial Lead for Elective Recovery in the Independent Sector at NHS England and NHS Improvement