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New Insourcing Framework Helps Cut NHS Waiting Lists

Phil Davies, July 2019

Image representing New Insourcing Framework Helps Cut NHS Waiting Lists

Phil Davies Article first published in the July/August edition of the National Health Executive.

With NHS trusts looking to meet growing patient demand and reduce waiting lists, Phil Davies, Procurement Director at NHS Shared Business Services (NHS SBS), explains how insourcing clinical services is one way NHS hospitals are treating patients more quickly.

Whilst NHS hospitals up and down the country are well used to providing an excellent standard of round-the-clock inpatient and emergency care, many day-to-day patient services are only currently available in - what would traditionally be considered - normal office hours. Operating theatres, imaging labs and outpatient clinics are some of the facilities that - at many NHS trusts - stand empty in an evening or at weekends.

But with an ever-increasing demand on patient services and NHS hospitals under real pressure to hit waiting list targets, many trusts are now looking to secure additional clinical capacity whilst making better use of their existing infrastructure.

Offering patients greater choice and flexibility is another reason why more and more NHS hospitals are looking to insource clinical services, as a safe and efficient way to provide high-quality care to a greater number of patients.

Insourcing - not to be confused with outsourcing - is where a third party provider of secondary care uses an NHS organisation's premises and equipment to deliver extra clinical capacity, outside of when they are normally in use. In most cases it is essentially an extension of a hospital's existing clinical service.

The NHS trust retains capacity planning in-house and ensures that patients are seen within the normal hospital environment and, in the majority of cases, by current NHS employees. These are clinical staff that will normally have their day job elsewhere in the NHS, who also carry out insourcing work outside of their standard NHS contract - in the same way that consultants might have private practice or nurses work via an agency.

Insourcing as a short to medium term solution means an NHS trust retains greater control - compared, for example, with referring patients to a private hospital to meet its 18 week targets - and all its normal practices and procedures are adhered to.  

In response to its growing popularity, NHS SBS launched the first ever specialist NHS insourcing framework in October last year. The framework, which will initially run until September 2020 (with the option to extend to 2022), aims to ensure that hospitals choosing to buy in extra clinical capacity have access to high-quality expertise and achieve best value for money. Indeed, insourced services provided via the framework offer savings of up to 20% compared with the normal tariff price. 

By having a framework like this in place, NHS trusts can be sure that a detailed OJEU (Official Journal of the European Union) compliant procurement exercise has already taken place, and that the successful suppliers are appropriate in terms of meeting all legislative requirements - saving them the time and money of running a formal tender process themselves. In other words, NHS hospitals are free to directly award contracts to suppliers on the framework without a complex tender process, or they may choose to run a mini-competition to further test quality and price.

Following our robust selection process, seven suppliers - offering a wide range of clinical specialities - were awarded a place on the new framework. The services provided cover more than 20 different clinical specialties, everything from anaesthetics to orthopaedics; audiology to vascular surgery; pain management to urology. This includes a multi-disciplinary consultant led service; triage and clinical assessment of patients; diagnostics and treatment; onward referrals or discharge; and follow up appointments as necessary.

A number of NHS trusts around the country have already used our framework to reduce waiting lists for patients. For example, having issued a capability assessment for its neurology requirements back in November 2018, one of the providers we work with, in the South West, identified the most suitable supplier for its needs and agreed a short term contract for extra clinical capacity. Having been impressed with the high-quality service provided, the Trust has since used the framework to access other services, such as cardiology and endoscopy, to ensure patients can be seen more quickly and conveniently.

And, earlier this year, another provider in the same region identified a requirement for extra clinical capacity for its endoscopy service. Instead of engaging directly with a supplier - which previously would have been common practice at many NHS hospitals - the Trust decided to use our new framework.

This was to ensure the Trust was legally protected (as suppliers are already signed up to framework terms and conditions); to guarantee full transparency of its requirements and supplier obligations (through the framework's Service Level Agreement); and to make sure the supplier had already met appropriate legislative requirements. After a competitive process, the hospital put a new contract in place under the framework, with the assurance that it is fully compliant and legally protected under the NHS standard terms and conditions.

The new insourcing clinical services framework is one of a number we have developed to better reflect the shifting NHS procurement landscape. As NHS trusts around the country explore new innovative ways to care for patients, our aim is to ensure they have easy access to the very best quality healthcare providers in the most cost-effective way possible.

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