Establishing urgent treatment centres in East Kent

When the four CCGs covering East Kent needed to procure urgent treatment centres to cover nine localities, Arden & GEM’s procurement team was tasked with delivering a complex and innovative procurement programme that would bring together a range of organisations in collaborative arrangements.

Through close partnership working between the CCGs and CSU, extensive engagement with the market, and designing a responsive and transparent procurement strategy, providers have been successfully appointed in each locality. The five-year contract will ensure that local urgent treatment centres are able to relieve pressure on A&E services, while harnessing economies of scale, enabling patients to quickly and easily get the care they need.

The challenge

With estimates suggesting that up to 3 million people who attend A&E each year could have their needs addressed elsewhere within the health care system, urgent treatment centres (UTCs) offer the opportunity to relieve pressure on A&E and enable patients to quickly and easily get the care they need. NHS England and NHS Improvement pledged to see UTCs fully integrated into local systems by autumn 2020.

The CCGs in East Kent – NHS Ashford, NHS Canterbury and Coastal, NHS South Kent and NHS Thanet – wanted to achieve these benefits across their localities by establishing nine UTCs. The CCGs had historically worked in an independent and autonomous manner but procuring and establishing UTCs would require a collaborative approach and culture to be developed.

With a remote geography leading to a fragmented marketplace, the procurement would need to engage both internal stakeholders and potential providers to devise an innovative strategy that would result in bidders with the necessary capability and capacity.

Our approach

Arden & GEM provides procurement support and advice to CCGs in Kent and Medway, as part of the local Lead Provider Framework solution, and was tasked with working in partnership with East Kent CCGs to design and deliver the procurement.

Market engagement
The CSU supported a wide-reaching market intelligence gathering process which evidenced that there would be no one provider with the necessary capacity and capability to meet the 27 UTC minimum standards across each of the nine identified localities.

With the prospect of collaboration likely, a two-month period of pre-procurement engagement was initiated which included:

• The issuing of a Prior Information Notice (PIN) which elicited interest from 12 organisations
• One to one meetings with each interested provider to explore their capability, capacity and collaborative appetite.

This process provided the opportunity to explore the draft specification with prospective bidders, including out of area providers, with the aim of determining the best procurement strategy to deliver the right solution for the service.
It also helped to establish relationships between commissioners and providers that would benefit future dialogue.

Managing risk and organisational equity
Following the initial period of engagement, the CSU led the commissioner through the potential collaborative bidder forms available including a lead provider model, joint venture model, sub contractual model and consortiums. Analysis of these models, combined with an exploration of the region’s historical contracting experience, confirmed that the most beneficial option would be a joint venture.

To minimise the risk to the commissioner, deliver the service requirements, effect true collaboration and ensure organisational equity for all parties, a joint venture agreement (JVA) was commissioned by the CCG to be included as part of the procurement.

The service background, procurement strategy and JVA were presented in a workshop, attended by a wide range of interested organisations, to guide prospective bidders through the process in an open and transparent manner.

Tailoring the process
A two-stage process was designed, with time built in to encourage dialogue, which recognised that a different approach would be needed for each of the nine localities. Following the first PQQ/SQ stage, for five localities there was just one bid received which enabled direct awards to be made to the providers, subject to the appropriate due diligence.

For the remaining four localities, which covered the larger acute sites, two lots were determined to enable economies of scale to be achieved. Bidders were subject to an evaluation and clarification process, which included unforeseen scenarios, before submitting final responses.

The outcomes

This complex and collaborative procurement process has successfully appointed providers, through a five-year contract worth £60 million, to deliver GP-led urgent treatment centres in nine localities within East Kent.

While no out of area providers were included in the successful joint ventures, the comprehensive approach to market engagement and instilling a collaborative culture enabled successful bidders to assimilate knowledge from providers in other areas.

Through effective partnership working between commissioning and procurement teams, underpinned by appropriate governance, an innovative solution was found in a fragmented marketplace which will ensure equitable urgent care coverage throughout the area.

The contract commenced in April 2020 and immediately provided COVID-19 resilience capacity to A&E. The slower than anticipated uptake in service, due to the pandemic, has enabled the whole system to begin developing an integrated approach to urgent care, of which UTCs are a key delivery component.