Public Health England
Sexual Health Teesside is collaboratively commissioned by the 4 Tees local authorities, 2 clinical commissioning groups and NHS England. The prime provider works to one contract, signed by all 7 commissioners, which has a strong focus on prevention and is supported by a collaborative commissioning agreement.
Teesside first commissioned an integrated sexual health service (SHS) in 2011. In 2013, as a result of the new division of commissioning responsibilities, the primary care trust contract was divided into separate commissioning lines for each of the 7 new commissioners.
Recognising that separate commissioning could result in multiple providers and a fragmented system, and in view of the significant cross-local authority border flow of people using SHSs, the commissioners decided to collaborate to ensure continued delivery of an integrated service across Teesside.
In 2016, the service was re-commissioned and the contract awarded to one prime provider, which in turn subcontracts to primary care and voluntary sector providers.
The prime provider is jointly commissioned and works to one contract signed by all 7 commissioners, supported by a collaborative commissioning agreement between all parties.
The contract has a strong focus on prevention and includes an innovative series of Service Outcome Related Payment (SORP) objectives, which rewards delivery against specific strategic prevention outcomes.
The prime provider delivers SHSs from 4 hubs (one in each borough) and several spoke clinics in the community, as well as through outreach sessions. The prime provider has subcontracts with a number of GP practices, as well as pharmacies across Teesside to deliver some services including:
- chlamydia screening
- emergency hormonal contraception
- a C-card scheme providing free condoms to young people
It also has further subcontracts with voluntary sector organisations.
What was involved
The collaborative re-commissioning of Teesside SHSs had the following objectives:
- to commission a high quality, integrated and seamless SHS across Teesside with better access and more choice for the local population
- to commission collaboratively across the whole system to prioritise prevention, education and training, and services for young people
- to develop a highly trained and flexible sexual health workforce, able to move between boroughs and offer more targeted outreach sessions to different population groups
- to centralise and coordinate contact management, patient records and partner notification across Teesside
- to avoid the need for cross-charging between the 4 boroughs for residents using SHSs across local authority boundaries
- to make a 7.4% efficiency on saving on SHS expenditure
The commissioning of an integrated service offers a number of benefits to the commissioners.
With large numbers of people using SHSs outside their borough of resident, the 4 local authorities avoid the need for mutual cross-charging, saving administrative costs. Further efficiencies and a better service for the local population are provided by centralised functions such as contact management, patient records and partner notification systems.
The inclusion of SORPs in the contract was an innovation to incentivise preventative work and has enabled a greater focus on improving the sexual health of young people.
Appointing a single contract manager, who worked equally to the requirements of all collaborative partners, was also beneficial as it ensured that communication among and between commissioners and provider is streamlined and consistent.
The new SHS delivers on a vision for the whole population of Teesside. Pathways are designed to be seamless, and users have a choice of appointments or walk-in clinics on an open-access basis across the 4 boroughs.
A full range of services is offered, including STI testing and treatment, and outreach services are delivered in schools, colleges and other settings for young people. Additionally, online services including STI self-sampling kits have recently been introduced.
The Directors of Public Health across Teesside provided strong leadership and governance of the procurement process. Together with the support of a team with a clear mandate and resources to take this forward, effective collaborative commissioning could be carried out.
Jacky Booth, Contract Manager for Public Health South Tees, said:
We wanted to work together with commissioning partners for a whole system approach, where we would look at the population as a whole and the prevention agenda.
Working collaboratively, commissioners have managed to procure an integrated SHS for potentially 9 more years.
For further information, contact Jacky_Booth@middlesbrough.gov.uk.