Consultant Connect & NHS South Yorkshire Integrated Care Board (SYICB) Tele-dermatology USC Emergency Provision 2024/25 (Ref: CC&SYICBTDUSCEP2024-25)

Concepts

• dermatology services
• sheffield
• urgent provision
• primary care
• dermatology image capture
• secondary care input
• the secondary care urgent suspected cancer
• sheffield teaching hospitals nhs foundation trust
• usc emergency provision
• the routine secondary care dermatology pathway

Location

Sheffield, South Yorkshire

Description

Tele-dermatology for Sheffield: A consultant triage provision for urgent suspected skin cancer referrals from primary care. The triage will result in; referral being sent to the secondary care urgent suspected cancer (USC) pathway, or, the referral being sent to the routine secondary care dermatology pathway, or, the referral being sent back to primary care with advice and guidance.

Total Quantity or Scope

The following has been prepared in accordance with regulation 14 of The Health Care Services (Provider Selection Regime) Regulations 2023 (PSR).The reasons why regulation 14 applied:Regulation 14(2)(a): The authority considers that the award must be made urgentlySTH have recently been under increasing national scrutiny as the worst performer in the country for the Faster Diagnosis Standard in skin cancer which is being correlated with them being the only provider without a comprehensive tele dermatology service. Tier 1 conversations have requested urgent action to recover this position. Some short term waiting list initiatives have been implemented to improve the position but this remains fragile due to ongoing capacity constraints and there still being insufficient capacity to match demand. There is well-recognised seasonal variation with skin cancer referrals leading to increased referrals over summer when the service is often most stretched for capacity. There are also concerns regarding waiting times for non-skin cancer conditions which have a serious quality of life implication. Awarding the teledermatology contract will allow consultant led triage of the urgent suspected cancers ensuring that the referrals into STHFT are limited to those definitely requiring secondary care input and releasing capacity to manage the whole PTL. Regulation 14(2)(b): The reason for the urgency was not foreseeable by and not attributable to the relevant authorityLess than 6 months ago STH were performing above the FDS target for skin and whilst performance declined during the winter it was not expected that this would drop as significantly below target as it did and continuing on a downward trajectory. A local incentivisation scheme was implemented to ensure dermatology image capture in primary care but this has not yielded the productivity gains that have been demonstrated by utilisation of a tele-dermatology provider.The reason for the poor performance is not attributable to SYICB but a result of combined demand and capacity pressures at STH. Regulation 14(2)(c): Delaying the award of the contract to satisfy the requirements of the other relevant PSR regulations would likely pose a risk to patient or public safetyThere is an immediate risk to patient safety due to delays in cancer diagnosis. The FDS is described by NHS England as being essential to ensure patients who are diagnosed with cancer can begin their treatment as soon as possible, and put those who are not diagnosed with cancer at ease sooner (see https://www.england.nhs.uk/cancer/faster-diagnosis/). The aim of this emergency tele-dermatology provision is to reduce the number of referrals on the USC skin pathway at STH (slowing demand) by ensuring only those genuine USCs are referred on the USC pathway and start their treatment as soon as possible.The lifetime value of the contract is not known however the amounts payable to the provider under the contract are:£3,600 one off set-up fee£42.50 per referral received by the Provider; it is anticipated that there are 405 Sheffield urgent suspected skin cancer referrals per month. The dates between which the contract provides for services to be provided6 months from 5th December 2024 with an option to extend on a rolling monthly basis for an additional 6 months (total contract term maximum of 12 months).Rolling extension will be used where:a) provision identifies a reduction in demand on the USC skin pathway in Sheffield; b) this reduction in demand is contributing to the skin Faster Diagnosis Standard (FDS) recovery at Sheffield Teaching Hospitals NHS Foundation Trust (STH); andc) if a provision is deemed as required in Sheffield post the initial 6 months, to allow time for any procurement and mobilisation to take place.A full procurement is likely to take in excess of 6 months and SYICB believe that urgent provision is needed at pace to sustain the recovery of the FDS.SYICB already commissions Consultant Connect (awarded under the Public Contracts Regulations 2015) for GPs to upload any dermatoscopic images and normal camera images for review (triage / diagnosis). Using Consultant Connect means that GPs are asked to use software for the emergency; provision that they are already familiar with meaning no additional information technology requirements are needed to mobilise an emergency provision at pace. In addition, Consultant Connect will not require any additional equipment to be made available to primary care to support an ‘emergency’ provision and can use the existing cameras and dermatoscopes. The timescales required to undertake a competitive procurement and then mobilise a new provider (in excess of 6 months) means that there would be a delay in recovering the cancer FDS position, which would pose a risk to patient safety through delayed diagnosis and treatment to cancer, as earlier described. If a decision is made that tele-dermatology is needed in Sheffield by SYICB post this the emergency provision the appropriate alternative process under the Provider Selection Regime will be applied.

Award Detail

Award Criteria

CPV Codes

• 85121282 - Dermatology services

Indicators

• Award on basis of price.

Legal Justification

8. The reasons why regulation 14 applied:Regulation 14(2)(a): The authority considers that the award must be made urgentlySTH have recently been under increasing national scrutiny as the worst performer in the country for the Faster Diagnosis Standard in skin cancer which is being correlated with them being the only provider without a comprehensive tele dermatology service. Tier 1 conversations have requested urgent action to recover this position. Some short term waiting list initiatives have been implemented to improve the position but this remains fragile due to ongoing capacity constraints and there still being insufficient capacity to match demand. There is well-recognised seasonal variation with skin cancer referrals leading to increased referrals over summer when the service is often most stretched for capacity. There are also concerns regarding waiting times for non-skin cancer conditions which have a serious quality of life implication. Awarding the teledermatology contract will allow consultant led triage of the urgent suspected cancers ensuring that the referrals into STHFT are limited to those definitely requiring secondary care input and releasing capacity to manage the whole PTL. Regulation 14(2)(b): The reason for the urgency was not foreseeable by and not attributable to the relevant authorityLess than 6 months ago STH were performing above the FDS target for skin and whilst performance declined during the winter it was not expected that this would drop as significantly below target as it did and continuing on a downward trajectory. A local incentivisation scheme was implemented to ensure dermatology image capture in primary care but this has not yielded the productivity gains that have been demonstrated by utilisation of a tele-dermatology provider.The reason for the poor performance is not attributable to SYICB but a result of combined demand and capacity pressures at STH. Regulation 14(2)(c): Delaying the award of the contract to satisfy the requirements of the other relevant PSR regulations would likely pose a risk to patient or public safetyThere is an immediate risk to patient safety due to delays in cancer diagnosis. The FDS is described by NHS England as being essential to ensure patients who are diagnosed with cancer can begin their treatment as soon as possible, and put those who are not diagnosed with cancer at ease sooner (see https://www.england.nhs.uk/cancer/faster-diagnosis/). The aim of this emergency tele-dermatology provision is to reduce the number of referrals on the USC skin pathway at STH (slowing demand) by ensuring only those genuine USCs are referred on the USC pathway and start their treatment as soon as possible.

Other Information

This is a Provider Selection Regime (PSR) confirmation of contract award . The contract has been awarded under regulation 14 ' Urgent award' of the Health Care Services (Provider Selection Regime) Regulations) 2023.This decision was ratified by Formal Executive Group. The decision makers present at this meeting were as follows:SY ICB Executive Place Director Rotherham/Deputy Chief Executive SY ICB Chief ExecutiveSY ICB Chief Medical Officer SY ICB Chief Nursing OfficerSY ICB Chief Finance OfficerNo conflicts of interest were identified.