Lewisham High Intensity User Service

This is a prior information notice of an upcoming procurement for the Lewisham High Intensity User service to be delivered under an NHS Standard contract arrangement. South East London Integrated Care Board (NHS South East London) will soon be undertaking a procurement process to select a service provider to deliver a High intensity User (HIU) Service that will provide high quality, collaborative multidisciplinary support for patients that are high users of urgent care services. The SEL ICB is currently developing the draft service requirements which is being informed by service user and stakeholder feedback. SEL ICB wish to request market feedback from potentially interested providers to inform the upcoming procurement process. The service contributes to the delivery of the NHS Long Term plan by reducing demand in Urgent and Emergency Care and aims to deliver positive outcomes and benefits for both patients and the health care system. In order to assist the Commissioners with testing its assumptions and proposed service requirements, a market engagement questionnaire (MEQ) has been published to explore the market's feedback on the following areas: • Outline of service requirements and KPI's • timescales for procurement and mobilisation of the new contract • proposed contract duration and financial model. Although, this pre-market engagement does not form any part of the formal procurement process, it will inform how the new service is commissioned. Information gained from this exercise will be used to inform the final service specification and expected outcomes from the procurement process. Background In 2019/20, the NHS operational planning and contracting guidance set out that all health systems in England must implement a high intensity use service. Lewisham has had a high intensity user service in place since 2018 supporting a caseload of approximately 120 patients per annum offering both clinical and non-clinical support to patients that are identified as high users of emergency services in Lewisham. The service has evolved over time in response to both the Covid19 Pandemic and varying patient need increasing its caseload from 100 in 2018 to 120 in 2022 with plans for this to increase to up to 140 in the new specification. Outline The service will operate under an NHS Standard contract for delivery of a community based High Intensity User (HIU) service that offers a one-to-one coaching approach, targeting people who use healthcare more than expected specifically targeting high users of 999, NHS111, A&E and hospital admissions supporting the most vulnerable patients in community to flourish, whilst making the best use of available resources. The service will contribute to the wider High Intensity User Programme and is designed to take a multi-disciplinary approach to proactive case management, support prescribing priorities and deliver both routine and urgent care 'in-hours'. This HIU team will consist of a mixed workforce of both medical and non-medical staff who will work collaboratively with key services and stakeholders to support, manage, and treat a patient's health and social needs. Monthly Multi-disciplinary meetings with key service providers and stakeholders will be held to review patient cases, the service activity dashboard, and patient outcomes. The service holds an annual baseline caseload of approximately 120 patients which is reviewed and refreshed on a quarterly basis to proactively identify any patients that are at risk of becoming a high user of urgent care services. Robust quantitative (KPIs) and qualitative (patient experience/case studies) is required and critical for determining the success of the service resulting in both benefits and positive outcomes for patients whilst contributing to the reduction of demand on urgent care services. Patient Cohort The service will support approximately 120-140 patients per annum who frequently attend or are at risk of multiple A&E attendances/ admissions or contact London Ambulance Service (LAS) services. Patients are identified by the acute provider and LAS. Inclusion Criteria: HIU of A&E/ 999 services aged 18+ registered with a Lewisham GP Exclusion Criteria; Patients with sickle cell disease, age above 70, children under age 18, care home patients etc or not registered with a Lewisham GP. Aims and objectives The aims of the service are to: • Effectively manage, co-ordinate and signpost frequent attenders at A&E • Reduce frequent attenders' activity on A&E department. • Effectively manage and co-ordinate the chaotic and demanding nature of the patient group through the use of multi-agency support and the voluntary sector • To provide support to identified patients linking to end of life pathways where appropriate. The objectives of the service are to: • Identify those at greatest risk of multiple attendances and admissions at A&E services. • Proactively manage a dynamic rolling cohort of High Intensity Users, using a truly personalised approach • To provide support to ensure patients are empowered to take ownership of their health and well-being, linked with primary care whilst decreasing their dependency upon A&E services. • Refer to/utilise existing community and admission avoidance services. • Provide a service driven by quality with positive, measurable outcomes. • Improve communication and partnership working between those involved in patient care. • To implement a patient centred and holistic approach to care, facilitating appropriate clinical treatments as well as solutions to underlying issues (including social care). • Work closely with the acute provider and London ambulance Service (LAS) ensure approaches to patient care are coordinated. • Empower patients to self-manage to enable discharge and to support the transition from negative to positive contributors of society. Key outcomes • To reduce (avoidable) attendances to A&E department • To reduce (avoidable) admissions to A&E department • Provide high quality and personalised interventions. • Promote self-care and health and well-being of patients (health coaching) • Minimise inappropriate use of resources. Please complete the MS Forms Market Engagement Questionnaire, LINK - https://forms.office.com/e/Tv73YkPDim Contract Duration The contract will have an initial term of 3 years (36 months), followed by an optional extension of 2 years (24 months) at the discretion of the commissioner. If all available extension is taken up in full the contract will have a maximum duration of 5 years (60 months). Contract value The indicative contract value is approximately £170k per annum equating to a maximum contract value of £850k (£510k + £340k). The purpose of this PIN is to inform the market of a possible procurement. In issuing this PIN and engaging with the market, the Authority is not committing to carrying out any procurement. The services in the scope of this procurement fall within Schedule 3 to the Public Contracts Regulations 2015 ("the Regulations") which are not subject to the full regime of the Regulations, but is instead governed by the "Light Touch Regime" contained within Chapter 3, Section 7 of the Regulations (Regulations 74 to 77).