Community Anticoagulation Services - Bromley

Tender description

This is a Prior Information Notice. NHS South East London (NHS SEL ICB, hereafter referred to as "The Authority") invites Expressions of Interest (EoIs) and completion of a Market Engagement Questionnaire from all suitable providers, who are capable of delivering the required Community Anticoagulation services in Bromley or who wish to provide feedback on the Authority's proposals. NHS South East London - Bromley borough - has a community anticoagulation service which is currently delivered via 6 clinics and home visiting service. The service includes: • Initiation of anticoagulation treatment: both Direct Oral Anti-Coagulants (DOAC) and Warfarin (majority of new referrals are initiated on DOAC) • Around 22 new referrals per month, accepting from primary and secondary care • Monitoring of warfarin patients (700 under the service, around 1030 appointments per month) • Home visiting to housebound patients eligible for the community service (around 320 visits per month) • Undertaking measures to bring patients back into therapeutic INR range, however onward referral to secondary care is facilitated when necessary. • Undertaking switches between Direct Oral Anti-Coagulants (DOAC) as appropriate during initiation period. • Service delivered by pharmacist leads and Independent Prescribers (IPs). Clinical supervision is outsourced to a hospital-based consultant (not based in Bromley, but within SEL). This contract is due to expire on 31/03/2023 and NHS South East London is seeking expressions of interest and feedback on proposals from capable suppliers ahead of launching a procurement process to determine the service provider for the services from 01/04/2023. The annual contract value is expected to be between £320,000 and £370,000. This leaves a maximum 3-year contract value of £1,110,000 and a maximum 5-year contract value of £1,850,000. Lot 1: 5c Service - Requirements Our aim is to continue to ensure a comprehensive community anticoagulation service providing initiation of treatment and monitoring of warfarin patients in the community. This will serve patients aged 16 and over and registered with a Bromley GP. Referrals come from primary and secondary care. The accessibility of community setting locations and point of care testing in the current service has gained positive feedback from service users. Ensuring convenience and accessibility to Bromley patients is an important feature of the service. Home visiting to housebound patients (including care home / nursing home settings) from clinicians who can review and change treatments in person means everyone clinically eligible for the service receives a high-quality level of care and treatment. Ensuring a high-quality service to housebound patients is an important requirement. The minimum requirements of the service are to: • Provide swift, equitable and convenient access to care in a range of community-based locations across the borough and a domiciliary service; • Provide continuity of care for patients and minimal waiting times; • Treat patients with dignity and respect, and keep them fully informed and educated about their care so they are able to make decisions about their care in partnership with healthcare professionals; • Enhance the confidence and develop the skills of all Provider staff who have an interest in anticoagulation monitoring; • Provide a streamlined patient pathway through collaborative working with local primary, community and secondary care providers. The service will comprise: • Initiation of anticoagulation - DOAC (Direct Oral Anti-Coagulants) or Warfarin therapy; • Under NHS guidelines Edoxaban must be the first choice in DOAC treatment • Patients initiated on DOACs are discharged back to the care of their GP once treatment is stable. • On-going monitoring of INR (International Normalised Ratio) for the purposes of ensuring the Warfarin dose remains therapeutic. • The Provider shall employ Near Patient Testing (NPT) to determine patients' INR using the approved and appropriate equipment; • Review of DOAC management until patient's treatment is optimal and the patient can be discharged to the GP for long-term management; • Administration of Vitamin K where clinically appropriate • Testing and providing dosing advice to patients, including recording of this advice within the patents hand held record book (ie.Yellow Book) • Prescribing initial prescription(s) of Warfarin or DOAC. Note ongoing prescribing of Warfarin will be undertaken by the patients GP. • Thorough patient education, with information provided in line with the Accessible Information standards. • Domiciliary visits for housebound patients (including care home / nursing home settings) for initiation and management of anticoagulation therapy; • Systematic clinical data collection to allow a transparent analysis of cost benefits and patient satisfaction; • Service will integrate with the Bromley Referral Optimisation Protocol which guides GPs through set criteria to find the right referral form and service. • The service will be expected to be flexible and adapt in response to new or changing national or regional guidance on anticoagulation. Warfarin Monitoring Activity There has been a significant decline of 56% in the numbers of people on Warfarin in the community being monitored between 2018 and 2022 (with a corresponding decline in the number of "Warfarin follow up" appointments). This decline is mainly due to natural causes or people requesting switches of treatment to a DOAC. Almost all new referrals for anticoagulation treatment are initiated on a DOAC. Please see our activity assumptions for the contract term and finance information on the associated documentation. Interested providers will have to factor in how this decline in activity will be managed in terms of clinic space and staffing required to ensure the service is sustainable. The levels of other areas of activity such as new referrals, DOAC follow ups, and home visiting are not expected to decline significantly. We are offering a block contract to even out the revenue to support providers in their planning. Innovations and opportunities Managing switches of treatment in the community DOACs are the frontline treatment in anticoagulation and provide other benefits to patients by removing the need for regular blood tests and appointments. However, in Bromley switching treatment from Warfarin to DOACs currently requires referral to the hospital team. The community service currently refers around 60 patients a year to the hospital team to manage switches of treatment from Warfarin to DOAC. SEL ICB - Bromley is looking at the feasibility of managing switches from Warfarin to DOAC in the community. Is it possible to manage switches of treatment from Warfarin to DOAC in the community? What are the risks and mitigations given this would require (if added to the specification) a proactive review of the cohort, identification of suitable patients, engagement with patients, and the coordination of testing and switching of medication for individuals? Additional information: We are offering a three-year contract with an option for a two-year extension.