Withnell Health Centre GP practice


NHS Lancashire and South Cumbria Integrated Care Board (ICB) has produced a new process for procuring GP services, working closely with patients and communities.

The GP partnership at Withnell Health Centre was dissolved in December 2021 which meant the contractual arrangements for running the practice were no longer valid and required actions from commissioners.

In March 2024 the primary care commissioning committee approved a competitive procedure under the Provider Selection Regime to appoint a long-term provider for Withnell Health Centre. Based on consideration of all procurement routes and the associated published guidance, the committee believes that this is the option which will give the quickest route to securing the best outcome for Withnell Health Centre and its patients and staff. 

In May 2024, the committee agreed the procurement evaluation process for Withnell Health Centre which formally outlines how the decision regarding the future provider of services at the practice will be determined. The committee also agreed on the evaluation process and timeline which remains on track for concluding the process within the timescales set out in March 2023. The invitation to tender launched on 3 May 2024.


Working with the local community

Patients of Withnell Health Centre and representatives of the ICB for Lancashire and South Cumbria have met regularly since February 2023 to discuss a way forward for the procurement of the GP practice, which remains a legal requirement.

The unsatisfactory level of patient engagement during the previous procurement exercise in 2022 and the anger and anxiety this caused have been acknowledged. The ICB committed to working with the community to identify how patients at the practice can be involved in the process going forward and how they could contribute to any decisions made.  A process for this has now been agreed with Withnell patient steering group.  

The steering group met regularly with the ICB to support and advise. This group, together with the ICB representatives, has put in place collectively the best ways to reach out to other patients across the practice community to get their support, involvement, and feedback on developing and testing the new procurement process.

On the 28 May the ICB met with the steering group to seek feedback on the process for involving patients in the evaluation panel. As a result the group felt it has completed its agreed objectives and has now closed.  The ICB would like to express its gratitude to all of the volunteers who helped to design a procurement process for the people of Withnell, and primary care for Lancashire and South Cumbria moving forward. 

If you would like to be considered to take part in the evaluation process please click the blue button below, read through the information and then click the link to complete an online expression of interest form.

Patient and public involvement on the procurement evaluation panel

The procurement evaluation strategy (PES) - developed using feedback from patients and communities and the support of the Withnell Patient Steering Group - outlined the commitment of the ICB to include three patients/members of the public on the evaluation panel.

The full process in identifying the participants to support this procurement exercise is outlined below:

  • 29 May to 5 June 2024: Expressions of interest are submitted by members of the public to the ICB.
  • 6 June to 10 June 2024: Initial checks to be made by the ICB of those expressing an interest, including reviewing any previous correspondence by individuals or publicly available information
  • 6 June to 10 June 2024: All applications will be assessed by an independent lay member from the ICB who has had no involvement in the procurement to date.
  • Week commencing 10 June 2024: A final decision will then be made on the three participants selected. All applicants will be notified by email if they have been successful or not. Those who have been selected will be invited to attend training.

Three members of the public were successfully identified to support the evaluation process. We would like to thank everyone who expressed an interest in supporting this piece of work, unfortunately as there were a number of people who came forward, not everyone who did was able to take part.

The information in the blue box below outlines the method by which the evaluators were selected.

Download this information as a PDF

NHS Lancashire and South Cumbria Integrated Care Board (ICB) is the NHS organisation responsible for planning health services for its local population, which includes commissioning primary care services. Commissioning is the continual process of planning, agreeing and monitoring services.

NHS Lancashire and South Cumbria ICB has agreed a procurement process to secure the provision of general medical services at Withnell Health Centre through a competitive process.

NHS Lancashire and South Cumbria ICB is committed to putting the needs of people living in Lancashire and South Cumbria at the heart of all we do. There is a collective ambition to do this by working with residents and communities and our partners to co-produce and improve health and wellbeing services. To this end and in order to ensure a public voice within the procurement exercise, the ICB has committed to involving three members of public in the process who will score bids against specific questions as part of a group of subject matter experts. It is our intention that up to two of these people are current patients of Withnell Health Centre.

In order to participate in this exercise, we ask members of the public to express an interest in taking part which includes confirming they are able to take part in training and evaluation sessions, declaring any interests which may affect their ability to participate and signing a strict confidentiality agreement. These will then be reviewed before individuals are selected by a lay member representative who has had no involvement in the Withnell Health Centre procurement previously. 

The procurement evaluation process will take place throughout June, so anyone expressing an interest in taking part must be available throughout the whole month.

The full process in identifying the participants to support this procurement exercise is outlined below:

  • 29 May 2024 to 23:59pm on 5 June 2024: Expressions of interest are submitted by members of the public to the ICB.
  • 6 June 2024 to 10 June 2024: Initial checks to be made by the ICB of those expressing an interest, including reviewing any previous correspondence by individuals or publicly available information
  • 6 June 2024 to 10 June 2024: All applications will be assessed by an independent lay member from the ICB who has had no involvement in the procurement to date.
  • Week commencing 10 June 2024: A final decision will then be made on the three participants selected. All applicants will be notified by email if they have been successful or not. Those who have been selected will be invited to attend training.

The evaluation itself will require individuals to undertake training, followed by a period of individual evaluation where participants will complete a template. After this, evaluators will be required to attend at least one session to take part in moderation with the other evaluators.

Confidentiality and conflicts of interest during public procurement

In order to protect the integrity and safety of selected evaluators, the ICB will at no point identify the participants taking part in this exercise.

Individuals involved in the procurement are required to treat information (including but not restricted to bid documents, supplier evaluations, etc) with strict confidentiality, and not make any unauthorised disclosures of this information. Should confidentiality be breached, the individual who discloses information may be removed from the procurement exercise and the bid scoring process may need to be abandoned.

Any disclosed conflicts of interest will be assessed on a case-by-case basis. Individuals will only be excluded from carrying out the role where the identified conflict is considered to be material and cannot be mitigated or be reasonably dealt with in another way.

Examples of conflicts of interest may include, but are not restricted to:

  • If you are a current or previous employee of a company, or have a member of your family, your partner (married, civil partnership or not), your siblings, your children, or any close personal or professional relationships that are an employee of a company that is seeking to provide the service at Withnell Health Centre;
  • If you, or a member of your family/friends (as set out above), has a financial interest in a company that is seeking to provide the service at Withnell Health Centre;
  • If you, or a member of your family/friends (as set out above), has a financial relationship of any kind with a company seeking to provide the service at Withnell Health Centre.
  • If you have been involved in any fundraising activities, either financially or by association, established to in any way support any provider seeking to provide the service at Withnell Health Centre

This is a non-exhaustive list of examples and it is your responsibility to ensure that any and all actual, potential or perceived conflicts are disclosed prior to you being involved in the procurement.

If you are unsure whether your current or previous relationship or involvement with a company that is seeking to to provide the service at Withnell Health Centre constitutes a conflict of interest, you should include this on the expression of interest form and this will be reviewed as part of the process.

If conflicts of interest arise at any time during the exercise then you must make this known to the organisers of the procurement process.

Thank you for your interest in taking part in this exercise. If you wish to submit an expression of interest to be involved, please ensure you have carefully read the information above and then complete the form and declarations at https://www.smartsurvey.co.uk/s/O5HRGO/.

If you are unable to complete the online form, please contact contact the communications and engagement team, either by email at lscicb.communications@nhs.net or via ICB reception desk on 0300 3733550.


This page will continue to be kept updated with the latest news on the procurement process for Withnell Health Centre. 


Frequently asked questions

When was the procurement evaluation strategy approved

At the Primary Care Commissioning Committee on Wednesday 1 May 2024, the committee approved a procurement evaluation process for Withnell Health Centre, except for an amendment that will be made following the committee, which formally outlines how the decision regarding the future provider of services at the practice will be determined. The committee also agreed on the evaluation process and timeline which remains on track for concluding the process within the timescales set out in March 2023. As a result of the amendment to the PES, the invitation to tender launched on Friday 3 May 2024.

When was the market engagement exercise approved

On 14 April 2023, the ICB Primary Care Commissioning Committee approved a market engagement exercise to be carried out in October 2023 for Withnell Health Centre. This request for information is a standard procedure in a procurement process which is used to inform the most appropriate procurement option and the development of the service specification / service model. This is not a launch of a tender process. You can read the full paper for the committee here

When did public engagement take place and what did people say

A public engagement exercise was undertaken during September and October 2023 working closely with patients of Withnell Health Centre.

The engagement programme aims to support the procurement process and consisted of patients and public in the local area being asked to provide feedback on the service provided by Withnell Health Centre and to indicate what, if anything, could be improved about the service currently on offer. The engagement process is not intended to contribute to a decision about any potential procurement option. 

Patients have also been asked to identify what aspects of primary care provision they feel are most important to them.

The feedback from the patient engagement exercise is summarised in the evaluation report. The report is intended to be used to support the development of the service specification and to support the procurement process.

Download the final report here

Which procurement process was agreed at the Primary Care Commissioning Committee

The Primary Care Commissioning Committee, held on 14 March 2024, approved a competitive procedure under the Provider Selection Regime to appoint a long-term provider for Withnell Health Centre.

Based on consideration of all procurement routes and the associated published guidance, the committee believes that this is the option which will give the quickest route to securing the best outcome for Withnell Health Centre and its patients and staff.

What is a procurement evaluation strategy and how was the Withnell patient steering group involved?

NHS organisations are required to produce a Procurement Evaluation Strategy, or PES, following a decision to procure a service. The development and agreement of a PES is a critical part of the wider procurement process. The ICB has reviewed the current inherited PES and applied learning from recent procurement exercises. 

The Withnell patient steering group were directly involved in providing feedback on the previous PES used in the procurement in 2022. 

A new Procurement Evaluation Strategy was agreed at the Primary Care Commissioning Committee in October 2023. To read the papers visit this webpage

The review of PES is to ensure that it maximises the weighting towards bids that most demonstrate the key characteristics that lead to improved patient experience, satisfaction and outcomes. 

Patients can have a role in helping to define what some of those characteristics are for their local practice. This is determined through engaging and listening to what is important to local people in relation to the patient experience and satisfaction. Patient representatives will also have the opportunity to be involved in evaluation panels using this new approach. 

The new PES is intended to be used for all future primary care procurement process.  

Why was the most suitable provider option not proposed in the Primary Care Commissioning Committee in January?

In regard to the use of the most suitable provider process, we would like to assure that we have reviewed the new Provider Selection Regime guidance in detail and sought legal advice in how this can and must be applied. There is considerable detail in how this should be applied which NHS England has published on its website however this is untried and untested nationally.  

Our recent proposal for a competitive process was based on guidance relating to using the most suitable provider process which says there is a need to identify ‘all suitable providers’ and therefore potentially involves a significantly wider assessment of other potentially suitable and interested providers. The paper also describes the route as being, in many aspects, similar to the competitive procedure and would likely require an assessment of providers against criteria based on information the ICB would need to receive from both interested and suitable providers. 

The recent paper at the Primary Care Commissioning Committee described the competitive procedure as a timely option. This intended to recognise the concerns of patients, staff and the local community and provide an opportunity for a potentially quicker resolution within the timeframes we have set out whilst ensuring we follow due process for equity and fairness.

Why hasn’t the procurement criteria been made public?

The procurement criteria have not yet been agreed for the new procurement process for Withnell Health Centre. There are three different types of procurement process which are able to be used for a procurement process and this will need to be decided by the ICB Primary Care Commissioning Committee (PCCC) which are meetings held for the public to attend and observe. More information about this meeting is available on the ICB website:  https://www.lancashireandsouthcumbria.icb.nhs.uk/about-us/sub-committees/pccc

A paper was published on 7 September 2023 regarding an update on the procurement process to support Withnell Health Centre and to propose a market engagement exercise is undertaken. The outcome of which will be used to inform the type of procurement process which will be proposed for Withnell Health Centre and which will need approval from the ICB Primary Care Commissioning Committee before being implemented.  The paper will be considered at the PCCC next week where they are asked to endorse going out for market engagement. If a full procurement and tender exercise is the chosen option, a Procurement Evaluation Strategy will be developed and approved at the ICB Primary Care Commissioning Committee. Throughout the process there will be full transparency of decision making.

Is there a chance Dr Robinson can get the contract or is all this just a tick box exercise?

The ICB is undertaking a new procurement exercise and therefore this is a fair and transparent process which is required to provide a long-term provider for Withnell Health Centre.

Why have the results of the national GP survey for Withnell Health Centre not been used to inform decisions about the procurement process?

The national GP survey results are an important part of the engagement process; however, this does not ask questions which are designed to help support the development of the service specification or to support any potential scoring criteria which will be needed as part of a procurement process. When the results of engagement with Withnell Health Centre patients and public are reported back to the Primary Care Commissioning Committee, results of the national GP survey will also be included as important evidence to demonstrate patient satisfaction.

Why undertake a survey of patients when there is already a survey which demonstrates what patients think of the practice?

The national GP survey results are an important part of the engagement process however this does not ask questions which are designed to help support the development of the service specification or to support any potential scoring criteria which will be needed as part of a procurement process.

Is this a new process and what does this mean for any previous companies who were part of a procurement exercise for the practice?

This is a new process. It will be a fair and transparent process and the ICB is working with patients to ensure this continues throughout the process.

If a new GP comes, how long is the contract for? It’s no good for the patients if the GP is there for 12 months and then leaves?

This has not been confirmed but is likely to be 10 years plus an option to extend for five years

How many weeks are there before the tender closes? What is the process?

This information is not available yet as the procurement route has not formally been decided. Once a decision has been made information will be available on the process and timelines.

Has the tender specification been drafted and if so where can this be found?

No, the engagement work which is currently underway will contribute to the development of a new service specification to support a procurement process. This would need to be approved at a future Primary Care Commissioning Committee.

Why is the ICB not giving a ‘direct award’ to Dr Robinson?

No decision has yet been taken regarding the process for appointing a long-term provider for Withnell Health Centre.

At the Primary Care Commissioning Committee on 18 January 2024, a paper recommended a competitive procurement exercise to be undertaken, as this appears to be the only option available to the ICB under new procurement rules which only came into effect on 1 January 2024.

The paper describes that while the new ‘Provider Selection Regime (PSR)’ allows for contracts to be given on a ‘direct award’ basis, this is only under certain circumstances.  One of those circumstances is where ‘the proposed contracting arrangements are not changing considerably the existing contract’. 

A decision on the approach to be taken in relation to the procurement option was due to be made at the primary care commissioning committee meeting on 18 January, however the committee has agreed to defer a formal decision on the procurement route until further advice is sought.

The PSR, which is the national guidance we have to adhere to, was published on the 1 January 2024 and we are one of the first ICBs in the country to apply this. During the meeting, a few points were raised by committee members that we need to seek legal clarity on before going forward.

We know this isn’t an ideal situation, but we’d like to reassure the local population that we are still on track with the time frames that were originally set.

We remain committed to securing the best outcome for Withnell Health Centre and its patients within the legal guidance we are required and permitted to consider.

Securing high-quality services for our local population remains a priority for the ICB.

Why has the ICB opted to procure an APMS (alternative provider medical services) contract, rather than a GMS (general medical services) contract?

A general medical services (GMS) contract is a contract with no stated end date. Under a GMS contract, the holder is at liberty to add any third party on to the contract without the consent of the commissioner. For this reason, and on the advice of NHS England, we have been awarding alternative provider medical services contracts as a standard procedure since 2016, and it would not be equitable to change our process for one practice out of all the contracts we offer. 

There should be no impact on service delivery between GMS and APMS contracts. Under a GMS contract, future patient cohorts could have a more limited influence in commissioning and procurement decisions as there would be no end date to the contract.

It should be noted that the current contract held by Dr Robinson is an APMS contract.

The GP partnership at Withnell Health Centre was dissolved in December 2021 which meant the contractual arrangements for running the practice were no longer valid and required actions from commissioners.

The NHS rules governing GP contracts meant the practice therefore had to be put out to procurement. The contract went out to tender, during which ‘any willing provider’ can submit a bid to run the practice. This action was put in place by Chorley and South Ribble Clinical Commissioning Group (CCG), as the delegated responsible body by NHS England.

While the process was under way, Dr Robinson, as the sole remaining partner, continued to run the practice under an interim contract to ensure continuity of service and stability.

Prior to the start of the procurement process a survey was issued to some registered patients, asking for feedback on the practice and whether they were satisfied with the range of services provided. Although this helped in part to inform the procurement process, once the procurement process was under way, patients were not informed and were unaware that there was a potential change in the GP provider going forward.

On the 1 July 2022, due to new government legislation, CCGs ceased to exist, and the Integrated Care Board (ICB) was created, taking over responsibility from all eight CCGs in Lancashire and South Cumbria, including Chorley and South Ribble CCG.

An exercise was undertaken by the ICB inviting organisations to submit a tender for providing the service at Withnell Health Centre which were reviewed and scored by a multi professional panel, in line with national best practice. The conclusion of the tender evaluation process in December 2022 recommended that the ICB award the contract to SSP, a provider of GP services at multiple sites across the North West including in Lancs and South Cumbria. There was a great deal of concern from patients at the practice at this point when they learned of the outcome of the process and that Dr Robinson was not the preferred bidder.

This resulted in many patients campaigning and making representations against the decision considered by the ICB. Representations were made to the ICB pointing out that patients had not been informed and engagement had not been sufficient, therefore suggesting the process had not been followed in line with guidance and best practice.

In February 2023, the ICB undertook a detailed review of the procurement exercise and deemed that the patient engagement element was insufficient. The legal requirement remained, however, and the ICB still needs to put a long-term contract arrangement in place. The ICB agreed, as part of the next part of this process, to seek greater involvement from patients at the practice.

The ICB has reviewed how it makes decisions on primary care commissioning and, from June 2023, the Primary Care Commissioning Committee will meet monthly with members of the public able to observe.

The first meeting between a group of patients and the ICB has now taken place. The patient group agreed to work together to agree how they want to coordinate themselves and establish any groups to support the ongoing work and how they will involve the wider patient community of Withnell Health Centre. Further meetings with the ICB will scope what and how patients can influence the process going forward.

Lancashire and South Cumbria ICB performs due diligence on all providers it awards contracts to gain maximum confidence in the provider’s ability to perform the contract well

As a minimum, it carries out checks on:

  • Business standing
  • Financial standing
  • Criminal offences
  • Other acts which call into question the provider’s integrity and/or reliability

The ICB can carry out further due diligence as is necessary on its prospective awarded provider.

However, the selection of the awarded provider is the really key part.
 


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