GOVERNING BOARD

Date of Meeting 17 July 2019 Agenda Item No

9

Title

MCP Partnership Agreement and Update

Purpose of Paper

The purpose of this paper is to provide an update to the Governing Board with regards to national developments for integrated care contracts, and placing this within the context of Portsmouth Clinical Commissioning Group’s (CCG) commissioning intentions. The paper also seeks approval to extend current Multi-Specialty Community Provider (MCP) partnership arrangements within the city.

Recommendations/ Actions requested

The Governing Board is requested to consider the content of the report and agree to the following recommendations:

Continue to observe national developments in relation to the ICP

contract and await further learning and guidance to emerge from

vanguard CCGs before revisiting commissioning and procurement

intentions

Continue with existing MCP partnership arrangements in

Portsmouth by extending the MCP partnership agreement for a 12

month period.

Engagement Activities – Clinical, Stakeholder and Public/Patient

Engagement has previously been sought at: Clinical Strategy Committee; GP Commissioning Evenings; MCP Programme Board; and Primary Care Commissioning Committee. Views from the public have been taken into consideration from the Big Health Conversation and other patient and public engagement activities undertaken nationally and by the CCG.

Item previously considered at

Primary Care Commissioning Committee

MCP Programme Board

Potential Conflicts of Interests for Board Members

All Clinical Executive members of the Board have a potential indirect conflict of interest resulting from being partners at, or being employed by, GP practices in the city. Each GP practice is a member and shareholder of the Portsmouth Primary Care Alliance (PPCA) who is a member of the MCP partnership. Two members of the Clinical Executive also undertake clinical work for the PPCA.

Author Mark Compton, Deputy Director of Transformation

Sponsoring member Innes Richens, Chief of Health and Care Portsmouth

Date of Paper 05 July 2019

Portsmouth Multi-Specialty Community Provider: Considerations and Recommendations

1. Introduction

1.1. The purpose of this paper is to provide an update to the Governing Board with regards

to national developments for integrated care contracts, and placing this within the

context of Portsmouth Clinical Commissioning Group’s (CCG) commissioning

intentions. The paper also seeks approval to extend current Multi-Specialty Community

Provider (MCP) partnership arrangements within the city.

2. Background

2.1. Since 2017 the CCG has worked in partnership with the Portsmouth Primary Care

Alliance, Solent NHS Trust, and Portsmouth City Council (Adult Social Care), to

transform health and care in the city. This has been underpinned by an MCP

partnership agreement (which aligns to the ‘virtual MCP’ model described in the, NHS

Five Year Forward View).

2.2. In January 2018 the CCG’s Primary Care Commissioning Committee considered

procurement options in relation establishing an MCP contract in the city (a ‘partially-

integrated MCP’ model) for elements of primary and community care provision.

2.3. Due to the risks associated with pursuing an MCP contract at that time – risks centred

around the complexity and resource intensity of the procurement process, uncertainty

of GP practice buy-in, and a lack of learning and definitive path setting by national

vanguard MCPs – the Committee endorsed the recommendation to continue and

strengthen virtual MCP arrangements for a period of 12-18 months.

3. National Developments

3.1. Since the publication the of the original MCP contract by NHS England in 2016, two

further iterations of the contract have been published: the Accountable Care

Organisation (ACO) contract (2017); and the Integrated Care Partnership (ICP)

contract (2018).

3.2. Each iteration of the contract builds on the previous version and takes into account

learning and feedback gleaned from consultation exercises undertaken post

publication.

3.3. Due to issuing numerous revised contracts, resolving legal challenges lodged against

the use of these contracts, and undertaking formal consultations exercises, the advice

from NHS England has been for local commissioners to postpone any formal

procurements of these contracts.

3.4. Following the latest formal consultation on the ICP contract, NHS England and NHS

Improvement published its response in March 2019. Within this response NHS

England outlined that the ICP contract would be made available in a controlled and

incremental way, conditional on successful completion of the Integrated Support and

Assurance Process (ISAP). Initially this would be focussed on those commissioners

which had already taken steps towards using an ICP contract prior to the consultation.

4. Considerations for Portsmouth CCG

4.1. Since the CCG reviewed its procurement intentions for an MCP contract in 2017 there

has been further work conducted with MCP vanguard sites, and analysis of the impact

in moving to a formal MCP arrangement. The Strategy Unit has worked closely with

one MCP vanguard in particular, Dudley, to undertake an evaluation of their MCP

activities: “Evaluation of the Dudley New Care Models Programme – Strategic Level

Evaluation”.

4.2. This evaluation details the collaboration undertaken within Dudley to transform care

services and the outcomes of this work, which have proven largely successful.

However, in attempting to formally procure an MCP contract the evaluation highlights

the disruptive influence the procurement process has had on transformational

activities. The report concludes, “the procurement itself has proven a complex process

which has necessarily created short-term separations within a system which previously

was working as one partnership”.

4.3. Due to the ongoing complexity surrounding the use of the ICP contract, the uncertainty

of the impact on transformational activities to formally procure an ICP contract, and the

desire of the national team to only work with selected CCGs at this stage, it does not

seem credible for Portsmouth CCG to revisit its commissioning intentions and

procurement options for a formal integrated care contract at this moment in time.

4.4. Through the strengthening of ‘virtual MCP’ arrangements, and continued efforts of

MCP partners to improve provision of care within Portsmouth, transformational

activities have progressed well since the establishment of the Portsmouth MCP

partnership agreement.

4.5. However, the existing virtual MCP partnership agreement is at the point of requiring

extension to remain valid into 2019/20. A proposed extension of the current MCP

partnership agreement is detailed in Appendix A.

4.6. The CCG’s ‘ICP Contracting and Procurement Working Group’ has considered the

risks associated with the options currently available to the CCG in terms of continuing

and progressing integrated care, and has devised a set of recommendations that

enable Portsmouth to continue delivering transformation whilst mitigating potential

risks.

5. Recommendations

5.1. The Governing Board is requested to consider the content of this report and agree to

the following recommendations:

Continue to observe national developments in relation to the ICP contract and

await further learning and guidance to emerge from vanguard CCGs before

revisiting commissioning and procurement intentions.

Continue with existing MCP partnership arrangements in Portsmouth by extending

the MCP partnership agreement for a 12 month period.

6. Appendices

6.1. Appendix A – MCP Partnership Agreement 2019/20

Final Version for sign off

to extend to 2019/20

Portsmouth Multispecialty Community Provider (MCP) Programme

Partnership Agreement

Dated : 1 July 2019

Between:

Portsmouth Primary Care Alliance

Solent NHS Trust

NHS Portsmouth CCG

Portsmouth City Council Social Care

Signatories to this agreement:

PORTSMOUTH PRIMARY CARE ALLIANCE

Signature:

Date:

Name:

Designation:

SOLENT NHS TRUST

Signature:

Date:

Name:

Designation:

NHS PORTSMOUTH CCG

Signature:

Date:

Name:

Designation:

PORTSMOUTH CITY COUNCIL SOCIAL CARE

Signature:

Date:

Name:

Designation:

1. Purpose 1.1 The purpose of this document is to record that the CCG, PPCA, Solent and PCC (the

“participants”) are committed to working together to integrate primary, community and social care services in Portsmouth City (the “Partnership”).

2. Term and termination 2.1 This agreement commences on 1 July 2019 for a period of 1 year, which can be

extended by up to 12 months by mutual agreement of the participants, which will be recorded in writing and approved by the MCP Programme Board.

2.2 Any participant may cease its participation in the agreement by giving at least 3 months' notice in writing to the other parties. In such circumstances, the partners will agree a suitable exit management plan to manage the impact of any termination by one or more partners.

3. Variation

3.1 This agreement may only be varied by the mutual agreement of all participants, which will be recorded in writing and approved by the MCP Programme Board.

3.2 At the time of signing off this agreement, the participants acknowledge that there is likely to be a need to amend membership and focus in alignment with emerging Primary Care Networks and implementation of the NHS Long Term Plan.

4. Vision and Context 4.1 The Portsmouth Clinical Commissioning Group (CCG), Portsmouth Primary Care

Alliance (PPCA), Solent NHS Trust (Solent) and Portsmouth City Council (PCC) are committed to continued joint working across the system, in line with the Hampshire and Isle of Wight Sustainability and Transformation Plan (STP). There is a shared desire to build a strong primary and community care service which will be the foundation for the delivery of the Portsmouth Blueprint. The CCG believes this can best be achieved through a Multispecialty Community Provider (MCP) arrangement, building on the significant work already undertaken by the PPCA and Solent through their partnership. Ultimately it is envisaged this will form part of a wider PSEH ICP and so will adhere to the ICP principles.

4.2 The partners are committed to working together on the MCP programme, without

predetermining the final contractual vehicle. However, in the interests of transparency amongst partners, the CCG will continue to assess as appropriate options in relation to formal procurement of an MCP / ICP contract.

4.3 Work is on-going to confirm the detail behind the current outline for the MCP and ICP;

the development, testing, mobilisation and ultimate delivery and implementation of a

new service model will be a priority for all parties over the next 12-18 months, in accordance with the recently published long-term plan

5. Status of this Agreement 5.1 Nothing in this agreement supersedes existing service contracts; it works alongside

and in conjunction with existing service contracts and sets out how we will work together in a collaborative and integrated way to meet the objectives of the partnership.

5.2 Whilst there will be co-operation as to the service design, this will not restrict

commissioners obligations to comply with competition and procurement requirements, and does not preclude competition between parties in respect of service provision.

5.3 Any service changes agreed as a result of the partnership work will be actioned

through the normal NHS service contract process, which falls outside of this partnership agreement.

6. Objectives of the partnership 6.1 The participants will:

a) Develop and implement an agreed programme of change, in line with the principles of the Portsmouth Blueprint, which will:

improve access to services;

provide more integrated services outside of hospital; and

achieve savings across the Portsmouth system. b) Provide suitable resources (financial and people) to ensure the agreed programme

can be delivered.

c) Creating strength through partnership to support the out of hospital delivery, for the benefits of patients and public of Portsmouth City.

7. Principles of the partnership 7.1 We will:

a) work towards a shared vision of integrated service provision; b) commit to delivery of system outcomes in terms of clinical matters, patient

experience and achieving financial balance across the health system; c) commit to common processes, protocols and other system inputs; d) commit to work together and to make system decisions on a Best for Service basis;

e) take responsibility to make unanimous decisions on a Best for Service basis; f) always demonstrate the Service Users’ best interests are at the heart of our

activities; g) adopt an uncompromising commitment to trust, honesty, collaboration, innovation

and mutual support; h) establish an integrated collaborative team environment to encourage open, honest

and efficient sharing of information, subject to competition law compliance; i) to collectively identify, manage and mitigate all risks in performing our respective

obligations in this agreement; and j) co-produce with others, especially service users, families and carers, in designing and

delivering the Service.

8. Role of the Programme Board 8.1 The Programme Board has been established to bring together the partners for the

purpose of delivering the transformation of services. It will provide strategic direction to the Portsmouth MCP Programme; manage risk and steer the delivery of a programme of projects which aim to take forward the development of the Portsmouth MCP arrangement, so that it achieves the objectives set for it.

8.2 This Programme Board is not a forum for the management of service contract

performance.

9. Responsibilities of the Programme Board 9.1 The Programme Board will :-

set the overall objectives of the programme and of the individual projects, and will keep these under review;

determine the portfolio of projects which constitute the programme and the relative priority of these;

ensure alignment of all participants to the Portsmouth MCP programme vision and objectives, and those of the ICP;

promote and encourage commitment to the partnership principles and programme objectives amongst all participants;

agree the allocation of the resources to the projects and approve the project plans;

establish sub-groups as necessary, including delegating management of individual projects to project teams;

formulate, agree and ensure that implementation of strategies for achieving the programme objectives and the management of the programme;

discuss strategic issues and resolve challenges such that the programme objectives can be achieved;

respond to changes in the operating environment, including in respect of national policy or regulatory requirements, which impact upon the programme or any participants to the extent that they affect the participants' involvement in the programme;

agree policy as required;

agree performance outcomes/targets for the programme such that it achieves the programme objectives;

review the performance of the programme, holding the programme management team to account, and determine strategies to improve performance or rectify poor performance;

ensure that the programme management team identifies and manages the risks associated with the programme, integrating where necessary with the participants' own risk management arrangements;

generally ensure the continued effectiveness of the partnership, including by managing relationships between the participants and between the partnership and its stakeholders;

ensure that the partnership accounts to relevant regulators and other stakeholders through whatever means are required by such regulators or are determined by the programme board, including, to the extent relevant, integration with communications and accountability arrangements in place within the participants;

address any actual or potential conflicts of interests which arise for members of the programme board or within the partnership generally, in accordance with a protocol to be agreed between the participants (such protocol to be consistent with the participants' own arrangements in respect of declaration and conflicts of interests, and compliant with relevant statutory duties);

oversee the implementation of, and ensure the participants' compliance with, the partnership agreement;

review the governance arrangements for the programme at least annually

10. Status and Authority of the Programme Board 10.1 The programme board is established by the partnership, whose participants remain

sovereign organisations, to provide a financial and governance framework for the delivery of the Portsmouth MCP programme. The partnership is not a separate legal entity, and as such is unable to take decisions separately from the participants or bind its participants; nor can one or more participants 'overrule' any other participant on any matter (although all participants will be expected to comply with the terms of the partnership agreement).

10.2 The partnership agreement establishes the Portsmouth MCP programme board to

lead the partnership on behalf of the participants. As a result of the status of the partnership, the Programme Board is unable in law to bind any participant so it will function as a forum for discussion of issues with the aim of reaching consensus among the participants.

10.3 The programme board will function through engagement between its members so

that each participant makes a decision in respect of, and expresses its views about, each matter considered by the programme board. The decisions of the programme board will, therefore, be the decisions of the Participants, the mechanism for which shall be authority delegated by the Participants to their representatives on the programme board.

10.4 Each Participant shall delegate to its representative on the programme board such

authority as is agreed to be necessary in order for the programme board to function effectively in discharging the duties within these Terms of Reference. The Participants shall ensure that each of their representatives has equivalent delegated authority. Authority shall be recognised to the extent necessary in the Participants' own schemes of delegation be defined in writing and agreed by the Participants,

10.5 The Participants shall ensure that the programme board members understand the

status of the programme board and the limits of the authority delegated to them. 10.6 The participants will make every effort to reach consensus. Where a consensus is not

reached , then the Board will escalate the matter to the Portsmouth Blueprint Health and Care Executive, or the PSEH ICPBoard.

11. Measuring progress 11.1 Key performance indicators will be agreed by the Programme Board designed to

measure performance against the Objectives of the partnership set out in Paragraph 6.

11.2 These are set out in Appendix I to this agreement.

12. Membership of the Programme Board 12.1 The Portsmouth MCP Programme Board will consist of 2 senior representatives of

each of the participants. Normally these will be the following individuals, but deputies will be permitted.

Senior representative of PPCA – Rumi Chhapia; Director of PPCA

Senior representative of PPCA – Mark Stubbings; Director of PPCA

Senior representative of Solent – Sarah Austin; Director of Solent

Senior representative of Solent – Tim Trebble; Clinical Director

Senior representative of PCC – Angela Dryer; Director of Adult’s Services

Senior representative of PCC – Simon Nightingale; Head of Business Management and Partnerships

Senior representative of CCG – Mark Compton; Deputy Director of Transformation

Senior representative of CCG – Jo York; Director (New Models of Care) 12.2 Others may be co-opted as necessary to fulfill the objectives of the Programme

Board.

13. Standards of conduct for Programme Board members

13.1 Conflicts of Interests

13.1.1 The programme board will manage actual or potential conflicts of interests among its members (and those of the programme management team) in accordance with the national guidance issued by NHS England in June 2017. In particular:

The Programme Director will establish and maintain a register of interests of the members of the Programme Board and the Project Group;

Each Programme Board and Project Group meeting will have a standing agenda item to invite attendees to declare any significant interests that are not already included in the Programme’s register;

The Chair of each meeting will determine whether any member should be excluded from the discussion or decision on any item in light of a significant conflict of interest;

The Programme Director will undertake this function for the Programme Board Chair if the latter is involved in the conflict of interest.

13.2 Confidentiality 13.2.1 Information obtained during the business of the programme board must only be

used for the purpose it is intended. Particular sensitivity should be applied when considering financial, activity and performance data associated with individual services and institutions. The main purpose of sharing such information will be to inform new service models and such information should not be used for other purposes (e.g. performance management, securing competitive advantage in procurement).

13.2.2 Members of the programme board are expected to protect and maintain as

confidential any privileged or sensitive information divulged during the work of the partnership. Where items are deemed to be privileged or particularly sensitive in nature, these should be identified and agreed by the Chair. Such items should not be disclosed until such time as it has been agreed that this information can be released.

13.2.3 The Board will be sensitive to the requirements of procurement processes and will

put in place ways of working that ensure they operate ethical walls to avoid potential or perceived conflicts of interest.

14. Method of Operation 14.1 The Programme Board will be quorate when there is at least one representative of

each partnership participant. The Board will designate a Chair. The Board will meet monthly, or as it determines is necessary. Members should not be constrained in representing their views.

15. Governance 15.1 The Programme Board will report to the Portsmouth Blueprint Health and Care

Executive, and the ACS. Each participant will also account to their respective Boards to derive the delegated authority necessary to deliver the Programme. Each participant will utilise their own internal governance processes for the purpose of reporting and decision-making.

PSEH

ICP

Portsmouth MCP

Programme Board

Blueprint

HCE

Solent PPCA PCC CCG

Portsmouth MCP

Project Team