Delivering Substance Misuse
Services in a New and
Emerging LandscapeRecommissioning approaches and intentions
South Gloucestershire Drug & Alcohol Action Team
(DAAT)
Welcome and
introductionsHouse keeping, format of morning and
introduction of the Recommissioning
Working Group
Suite of Key Documents
• Commissioning intentions paper
• Pre-engagement consultation report and feedback
• Adults, Housing & Public Health Committee
approval
• Service user feedback analysis
• Substance Misuse Needs Assessment and JSNA
Support Pack
• Joint Strategic Assessment for Crime & Disorder
• Performance scorecards and pilot profiles
• TUPE briefing
Recommissioning Working Group• Matt Wills – Programme Lead & Lead commissioner
• Rosie Collins – SHIP Operational and Shared Care Lead
– (provider liaison outside of recommissioning team)
• Nasrul Ismail – Performance and Commissioning and
Lead for the ProContract
• Jacqui Offer – Specialist Public Health Manager
• Dr Neil Kerfoot and Dr Greg Clarke – Lead GPs
• Christopher Johnson – Solicitor, Legal Services
• Nicola Lewton – Corporate Procurement Manager
• Andy Hichens – CAH Commissioning Hub
• Peter Heffernan– Corporate Consultation
Wider Engagement Partners
• The Care Forum
• CVS South Gloucestershire (CVS/VCSE)
• Office for the Police & Crime Commissioner
• NHS England
• Public Health England (PHE)
• Clinical Commissioning Group (CCG)
• Safe & Strong Communities
• Avon & Somerset Constabulary
• Wider Public Health representatives
• Wrapped around the urban fringe of Bristol
• 53,000 hectare area, making us one of the largest unified local authorities
• 60% of population live in urban fringe suburbs
• Numerous small villages and market towns
• Shared borders with priority authority
• Large commercial centres
• Largest custody suite in Avon & Somerset
Geography of South Gloucestershire
• Wrapped around the urban fringe of Bristol
• 53,000 hectare area, making us one of the largest unified local authorities
• 60% of population live in urban fringe suburbs
• Numerous small villages and market towns
Geography
Key features of South
Gloucestershire
• Location for University of West of England
• Several high value added industries, 46th least deprived local authority in England
• Six priority neighbourhoods across the area
• Economic activity rate above national average
Substance Misuse in South Gloucestershire
• Accessibility issues and housing shortages
• Priority around alcohol, NPS (legal highs) and
opioid analgesics prescribing
• Shared care philosophy and pharmacy
engagement
• Integrated clinical and psychosocial model
• Value for Money - Every £1 spent on substance
misuse in South Gloucestershire will derive an
£8.34 saving in crime reduction and increased
health and wellbeing
What has shaped our decision-making?
• Outcomes of Government Comprehensive
Spending Review
• National Public Health Grant reductions
• Local Authority Savings Plan
• Transfer of responsibilities to Public Health
• More devolved responsibilities
• NHSE, Clinical Commissioning Group and
NOMS reductions
• Department of Health and PHE Directives
Public Health Grant Reductions & Council Savings Plan
Year Public Health Grant
Allocation
Reduction Management Plan
2014/15 £2,500,000 None None
2015/16 £2,300,000 £200,000 In year cost savings, use of
reserves, reduction of
facilitation budgets.
Removal of payment by
results levy. Ending of pilots
and non-essential
commissioned services
2016/17 £2,150,000 £150,000 Variation of contracts with
providers in contract period.
Ceasing innovation and
grant process. Reduction of
facilitation budgets
2017/18 £2,000,000 £150,000 Adjustment of
recommissioning envelope,
full recommissioning, and
service redesign
New landscape of commissioning
• Localism Act 2011
• Transfer of PCT responsibilities
• Change of direction for health & crime
services
• Brave commissioning
• Effective critical analysis
• Robust needs assessments
• Pooling of budgets
• Collaborative relationships
Questions:
• What has altered the landscape of
commissioning?
• What are the new priorities for commissioners?
• What is the impact for providers?
• What are the gaps & unmet need?
• What are the impacts of Payment by Results &
Value For Money?
• Impact/benefit for service users?
How Will We Procure?
• Seek Adult, Housing & Public Health Committee approval
• Assemble a Recommissioning Working Group
• Work within European Union/SGC framework (Light
Touch/Restricted)
• Use the E-Tendering platform (ProContract)
• Ensure a comprehensive consultation window
• 12 month process to allow appropriate process
• Clarity, transparency, openness, fairness, and maximising
opportunity
Commissioning model: IPC joint model for public care
Recommissioning Timeline
• Consultation Period – 4th April – 26th June
• PQQ Stage – 19th July – 17th August
• Notification of PQQ Outcome – 7th
September
• Successful PQQ Providers Meeting – 21st
September
• ITT Stage – 27th September – 31st October
• Evaluation, Moderation, and Committee
Approval – 1st November – 20th December
• Notification of Award – 21st December
• Standstill Period – 21st December – 11th
January 2017
• Contract Finalisation – 12th January 2017 –
31st March 2017
Supplying the
South West Portalhttps://www.supplyingthesouthwest.org.uk/
All communication, questions and tender
submissions will be done through this route
without exception
TUPE
• Currently services are delivered by a number of
external providers all of whom have been notified
of the procurement process
• Although as the commissioning body South
Gloucestershire cannot declare TUPE applies, it
would suggest that under the current regulations
in some cases it may
• All providers have been requested to ensure
TUPE information is prepared and ready to be
submitted as part of the re-procurement process
Solution-focused Outcomes
Clinical Interventions
• Right time, right person, and right treatment
• Patients need to feel they are in a seamless service
• Needs-led intervention, allowing safe clinical decision
making
• More integrated approaches
• Structured expectations early and regular reviews
• Choice of clinical intervention linked with need and best
health outcomes, and NICE compliant
• Bio-psycho-social modelling
• Empowering and improving confidence in GPs
Examples of Barriers to Recovery
• Last 15 years – developed a primary clinically-led
service
• Get them on, keep them on, keep them safe
• Structuring expectations
• Working, earning, living….why take me off my
methadone?
• One size does not fit all
• Poly drug use
What is our direction
of travel?
Where Do We Want to Be?
• More investment in brief interventions and preventative services
• Better validation of the health and cost benefits
• Access to a primary care located package of recovery focused clinical and psychosocial interventions
• More integration of secondary specialist drug services
• Care planned engagement will dictate treatment need (thresholds)
• Understanding the population profile and delivering needs-led services
• Structuring and embedding expectations regarding clinical interventions
• Stepped care approaches
• BBV interventions and harm reduction services
• Continuity of care upon release
• Better use of local hubs and pharmacies
Where Are We Heading?
• Engagement of OCUs & non OCUs
• Clinical interventions - recovery focused
• Bio-psychosocial modelling and strong key working
• Integrated pathways & services, including IOMU
• Conversant with different performance metrics for national and local requirements
• Proactive performance management of the services
• Robust data recording systems are robust and compliant
• Effective and measurable outcomes and can we implement effective payment by results?
• Effective Primary Care Integration
Selection of Consultation Feedback
Trading Standards should be included in
the considerations for the new model.
The new landscape of substance misuse now
dictates that we need to be proactive towards
emerging trends of which NPS and alcohol is
prevalent. We already ensure that our
colleagues in the Trading Standards Department
are included and would be highlighted as
significant stakeholders.
We will continue to ensure that the department
is fully included in the suggested model and
clear working protocols remain in place.
To ensure Equalities and Equalities Impact
Assessments are included as part of the
commissioning as well as the service
model
Equalities & EIA will be completed as part of the re-
commissioning process as well as included on the
PQQ and ITT tendering documents. All potential
providers will be expected to ensure that this is in
place as part of the contractual responsibilities.
To ensure the Local Compact is more
specifically included within the
commissioning and service delivery
Yes, we agree. We will ensure that the Local
Compact is more specifically included and
identified. CVS South Gloucestershire has been
involved in the re-commissioning process and we
rely on them to advise us on the best practices
within COMPACT during the process.
Substance Misuse
Treatment Model
Rosie CollinsSpecialist Health Improvement
Practitioner – Substance Misuse
Shared Care Vision
• The current shared care model and wider
treatment system
• Why does shared care work in South
Gloucestershire?
• Issues for the future
Proposed future model
• Expansion of shared care
• Continuation of effective unstructured
alcohol services
• Consultation with GPs
Performance
Management
Nasrul IsmailPerformance & Commissioning
Officer
Current Case Mix – Structured Treatment YTD
Opiate , 53%
Non-opiate , 18%
Alcohol, 21%
Alcohol and Non-opiate,
8%
Current Case Mix – Non-structured
Treatment and Pilot Projects
Performance Wishlist
• Linking with services that are
considered priorities for the
Director of Public Health,
Health & Wellbeing Board,
and Safer & Strong
Communities
• Linking with Public Health
Outcome Framework (PHOF)
• Proactive management of
performance by the service
providers
• Better data recording for ‘pain’ areas, such as
dual diagnosis and the number of service users
starting Hepatitis B vaccinations
• Improving poor transfer from the prison treatment
and criminal justice system into the community
setting
• Improving transition pathways from young people
into adult services
Managing Performance
• Quarterly performance monitoring based on the
national and local performance indicators
• Reported through performance scorecards
• Half-year reviews
• Annual Needs Assessment and Payment by
Results (PbR)
• Managing underperformance
Remote and Smarter Working
• Using mobile devices within the GP surgeries to
access GP software, such as EMIS, appointment
management systems, and case management
systems
• Providers will need to ensure remote work as
part of their bid
• Consideration of ownership and management of
the implementation, communications, IT
infrastructures, and information governance
Jacqui Offer
Specialist Public Health
Manager
Wider Public Health Agenda
• Emerging Public Health priority regarding alcohol
• Alcohol Stakeholders’ Group subgroup function
• How this fits with the wider substance misuse
agenda?
• Substance Misuse Needs Assessment
• Whilst alcohol is a priority area, we recognise poly
drug use with alcohol as a common substance
• Joint working with the Clinical Commissioning
Group
Embedding Wider Public Health Initiatives
• Expanding primary care to deliver wider Public
Health objectives including smoking cessation,
sexual health, and mental health
• Linking with pharmacies to deliver Healthy Living
Pharmacy accreditation and signposting
• Using key engagement points to Make Every
Contact Count (MECC)
• Mobilising the Health Champion workforce
• Using resources available eg Books on Prescription
Steve Spiers
Public Health Programme Lead
– Mental Health & Emotional
Wellbeing
Linking Mental Health With Substance
Misuse
• Do we build a joint approach around referrals
and community interventions?
• The wellbeing college helps develop protective
factors for all risky behaviours so easily links to
substance misuse?
• Can we link commissioning to ensure
sustainability?
Comfort Break
What are we looking for…• Effective relocation of current SMS to a primary care setting
• Supporting GPs and building trusted relationships
• Embedding specialist services across the system as opposed to discrete
• Maximising entry, effective retention & successful exits
• Appropriate support mechanisms for transition & rapid re-capture
• Maximising the use of IBA, brief interventions and education and preventative approaches
• Effective & measurable recovery outcomes throughout the entirety of the treatment journey
• Pathways supporting sustained abstinence
• Continued engagement and retention of CJ clients and OCU’s as a primary cohort linked to crime and health
Tender Lots
• Lot 1 – Engagement
• Lot 2 – Integrated Primary Care Service (including Single Point of Contact)
• Lot 3 – Community Reintegration
• Excluded: Residential Rehabilitation, Pharmacy IBA, OST element of shared care, Opioid Analgesics Dependency Pilot Project (ending June 2018), and service user advocacy
Lot 1
Engagement and
Primary
Intervention
Engagement and Primary Intervention
• Lot 1 is building from the effective early interventions
and brief advice model delivered so far
• It will need to focus on up and coming trends and
engaging with the hardest to reach groups
• Its primary aim will be:
– Structuring expectation, moving service users
towards care planned interventions
–Delivering brief interventions to reduce the costs
associated with secondary care
–Working with a transitional aim
Key areas of delivery
• Harm reduction and management of the Needle
Exchange (community and pharmacy) and BBV
services
• Managing criminal justice client transfers from
court, custody suites, and prisons
• Leading innovations with emerging drugs such
as NPS and steroids
• Delivering Alcohol IBA services in primary and
secondary care
• Delivering Naloxone programmes
• Working with YPDAS regarding seamless
transition from young people into adult treatment
services
• Assisting community partners in developing
themselves as effective points of information
• Supporting our vision of Healthy Living
Pharmacies
Lot 2
Integrated Primary
Care Service
(including SPOC)
Single Point of Contact• This service will offer a rapid triage assessment,
meet all required targets, and refer service users to
the appropriate services
• To operate as the single point of contact between
Monday and Friday, 09:00am – 17:00pm. Out of
office hours can be agreed
• Attend to ad hoc data requests from the
commissioners
• Moving away from data inputting to data monitoring
• The need for a dedicated data analyst ring-fenced to
South Gloucestershire work only
Case Management System
• The case management system will be chosen
and managed by the service provider
• It must comply with NDTMS core dataset
upgrades and must have the ability to submit
agreed data directly into DAMS
• The service provider will be expected to train all
users of the system and make appropriate
investments into the case management system
• Compliance with the current dataset
• Maintain accurate information
• Capable of generating requested data in a timely
manner
• Data sharing protocols
• Safe haven of data as part of the contingency
plan
Integrated Primary Care Service
•Shared care vision
•Expansion of primary care
•Increased number of shared
care workers
Integrated Primary Care Service
• Consultation so far
• GPs
–Key points
–Concerns or issues raised
• Space
• Cost
• IT and information governance
• Further considerations
Lot 3Throughcare
Services
Housing
• To support people to achieve long-term positive housing outcomes and to promote independence
• To address the barriers for service users’ ability to access and sustain suitable accommodations and to assess if people develop a range of life skills
• To oversee the management of Access Scheme (previously known as the Deposit Bond Scheme)
Peer support
• To provide additional help to service users in
achieving their recovery goals
• To lead in the recruitment, comprehensive
training, line-management supervision, and on-
going support of peer support workers
• To ensure that peer support workers are given
opportunities to work across services as
appropriate and have choices in a variety of roles
that promote development and visible recovery
Employment
• To facilitate access to education, employment, training, and volunteering in order to build upon the service users’ recovery capital
• To forge strong links with statutory and non-
statutory providers, such as JobCentre Plus,
local work programme providers, and further
education establishments
• To work with service users who successfully gain
employment (paid and unpaid) to sustain their
ongoing employment and recovery
What about the
money?Trying to maximise effectiveness
with reduced budgets
Potential Funding Envelopes
• We have not yet finalised the funding elements as we are
still finalising the PHG and elements of provision which
will be included, but what we do know:
– PHG for 2017/18 will be approximately £2,000,000
– We have made the necessary cuts in line with the CSR
and CSP of 21% so currently have met all the
necessary reduction targets
– We are anticipating that by making these advanced
reductions at the start of the process there will be
minimal alterations
– PHG and CSP continues to be challenged for the next
few years so may alter total SMS PHG
Indicative Percentages of the SMS PHG
• Lot 1 – 10%
• Lot 2 – 41%
• Lot 3 – 7.4%
• GP services including Public Health Contract
(previously known as LES) – 8.4%
• Pharmacy services (including LES & IBA) – 3%
• Residential rehabilitation including inpatient
16.2%
• Other ad hoc services – 14%
Any questions?