Agenda item

The Cabinet Member for Health, Social Care, and Well-Being considered the report which requested the implementation of Contract Standing (CSO) 16.02 and 10.02.1 (b) to approve an extension of contract to Central and North West London NHS Foundation Trust (“CNWL”), for the delivery of the North Central London (NCL) Genito-Urinary Medicine (GUM), Sexual Health Reproductive Services (SRH), additionally, routine Pre-Exposure Prophylaxis (PrEP) commissioning which was transferred from NHS to local authorities in October 2020 and appended to this contract via cabinet approval in February 2021.

The report also proposed that contracts were extended in accordance with the terms of the contract and approval in the original Cabinet award report for 3 concurrent years from 1st April 2022 – 31st March 2025.

In response to a question about changes to health services across North Central London, it was noted that there had been and were expected to be a number of changes as a result of the Covid-19 pandemic and the introduction of Integrated Care Systems (ICS). It was noted that there were a number of ways to access services, including online, through pharmacies, and through clinics. It was explained that, although a number of people would prefer online services, it was important to ensure that GUM clinics were available as they were often the most appropriate setting for complex or harder to treat cases and for cases with potential safeguarding considerations. It was highlighted that it would be important to ensure that services continued to be available and delivered in North Central London.

The Cabinet Member enquired whether there were differing outcomes for people who accessed services using different mediums, such as online services. It was explained that, in many cases, the different options allowed people to use the service that best suited them. It was noted that officers were conscious of monitoring any differences in outcomes for service users.

The Cabinet Member RESOLVED

To approve the extension of contracts in respect of the provision delivered by the North Central London (NCL) partnership for Genito-Urinary Medicine (GUM), Sexual Health Reproductive Services (SRH) and routine Pre-Exposure Prophylaxis (PrEP) commissioning in accordance with Contract Standing Order (CSO) 16.02 and 10.02.01 (b), from 1 April 2022 – 31 March 2025 to CNWL as follows:

(i)            Lot 1a - GUM services, for a period of 3 years from 1 April 2022- 31 March 2025 at an estimated total cost of £4,824,219 for the 3-year extension period. The maximum total estimated cost of the contract, inclusive of the initial 5-year contract is therefore £12,787,991 over 8 years.

(ii)          Lot 1b - SRH services, for a period of 3 years from 1 April 2022 – 31 March 2025 at an estimated total cost of £155,001 for the 3-year extension period. The maximum total estimated cost of the contract, inclusive of the initial 5-year contract is therefore £413,336 over 8 years.

(iii)         Routine Pre-Exposure Prophylaxis (PrEP) commissioning – for a period of 3 years from 1 April 2022 – 31 March 2025 at an estimated cost of £627,000 (£209,000 per annum).

The estimated annual grant allocation to LB Haringey for PrEP commissioning is £418,000 (based on 2021-22 allocation). It is anticipated that 50% of the annual budget expenditure (£209k) will be spent through CNWL as the commissioned sexual health provider for NCL. Whilst the remainder will cover the cost of residents who access the service from other providers across London and Home Counties.

The total value of the contracts for the 3-year extension period to 31 March 2025 is therefore £5,606,220.

The total value over the life of the contracts is £13,828,327.

Reasons for decision

The NCL Integrated Sexual Health (NCLISH) services are provided by Central and North-West London NHS Foundation Trust (CNWL).

The Haringey - Genito-Urinary Medicine (GUM) contract – lot 1a, for clinic-based services commenced on 3 July 2017, in partnership with Barnet, Camden & Islington for a period of five (5) years (with an option to extend for a further 3 year on year extensions.

The NCL services have been very successful with over 18,000 Haringey residents accessing the service since launch in 2017. Residents benefit from the local authorities pooling their funds and expertise to have a modern, well-staffed service. Haringey has realised savings, some of which have been reinvested in more local services like the Healthy Living Pharmacy (HLP) programme, pan-London sexual health online services, dedicated young people sexual health testing, treatment and women’s contraceptive services and a dedicated community-based outreach sexual health promotion STI and HIV testing service aimed at engaging with and supporting residents from groups and communities most impacted by sexual ill health.

The transfer from NHS to local authorities of routine Pre-Exposure Prophylaxis (PrEP) as a standard treatment commissioned by local authorities in October 2020 has also been welcomed. Local Authorities are best placed to ensure equity of access, and this fits well with Haringey’s strategy to reduce late diagnosis of HIV and London’s ambition to end new infections in the capital by 2030.

Furthermore, because of health concerns, confinement measures and service closures adopted in the wake of the Covid-19 crisis, which caused severe disruption to the core provision of the service alongside other local and regional services that are inter-connected as part of the wider sexual health services landscape. The extension period will allow NCL-commissioners, rest of London (RoL) commissioners (as part of the London sexual health transformation programme (LSHTP) and trust providers (through representation via the Clinical Advisory Group) sufficient time to:

·         Review existing service models, due to operational and service delivery challenges experienced during covid-19 lockdown.

·         Review best practices implemented during the pandemic to meet those challenges.

·         Understand the long-term impact the pandemic has had on how residents will re-engage with in-clinic sexual health services.

·         Use the opportunity to apply some of the learning garnered through the council’s recovery renewal exercise, to help the council, to better understand how communities disproportionately impacted by the Covid-19 pandemic are accessing sexual health and wellbeing services.

·         Allow NCL commissioners and LSHTP to work with sexual health providers to review and re-model current service provision and tariffs as it is clear that a return to ‘business as usual’ due to the impact of the pandemic on operational and service sustainability is unlikely long-term. The extension period will also provide commissioners the opportunity to better understand the changing service landscape and allow time to develop a new service model that is able to evolve and support increased complexities presented by service users when accessing services i.e., safeguarding concerns, sexual assault, drugs and alcohol and learning disabilities as an example.

The contracts are monitored on quarterly basis including submission of activity data e.g. 21/22 data showed a total of 12,250 attendances comprising clinic and telephone consultations, of which:

·         9,822 were for STI testing and treatment

·         1,877 was for contraceptive support

Alternative options considered

This is a mandated open access service. Service transformation has already realised significant savings and transferred the previous sexual health services into an integrated system across the NCL sector. This is an activity and tariff-based contract, and therefore charges are ultimately based on levels of activity. Due to the complex nature of the cross-charging arrangements, this service is part of the London Sexual Health Programme (LSHP).

The Memorandum of Understanding (MOU) for the LSHP strategic board sets out that partners agree to a number of areas of working together “collaboratively regarding the Integrated Sexual Health Tariff (ISHT). As part of the LSHP, it is required that services use a standardised contract format agreed by all Boroughs as part of the governance of the transformation. This ensures that all the clinics are governed under a similar set of terms and conditions, as a result, any changes made to the contract need to be made in agreement with colleagues across London, in accordance to the contract clause.

The Chair of Overview and Scrutiny has been informed that it was impracticable to give 28 days’ notice of the decision. A timely decision is required to ensure that a contract is in place by 1 April 2022. The pre-election will be in place from 21 March 2022; therefore, normal Cabinet functions will be suspended/limited during this period.

Given the above, it is not practicable to comply with the 28-day notice requirement in Part Four, Section D, Rule 13 of the constitution. This is set out in Part Four, Section D, Rule 16, of the Constitution.