Primary Care Sheffield Limited & NHS South Yorkshire ICB Tele-dermatology USC Emergency Provision 2024/25

Concepts

• sheffield
• dermatology services
• dermatology image capture
• primary care sheffield limited
• usc emergency provision
• sheffield teaching hospitals nhs foundation trust
• sheffield teaching hospitals
• sheffield post
• primary care
• a comprehensive tele dermatology service

Location

Sheffield, South Yorkshire

Description

Tele-dermatology for Sheffield: An imaging service, for those GPs who are unable to take images to attach to urgent suspected skin cancer referrals, a service whereby a third party will capture the image on behalf of the GP and attach to the referral.

Total Quantity or Scope

The relevant authority, NHS South Yorkshire Integrated Care Board (SYICB) believe this award of a dermatology imaging contract, to Primary Care Sheffield Limited, is urgent.Following the regulations below from the Provider Selection Regime (PSR) the contract has been awarded under the Health Care Services Regulations 2023.Regulation 14(2)(a) of the Provider Selection Regime: The authority considers that the award must be made urgentlyThe authority considers that the award must be made urgently.Sheffield Teaching Hospitals 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 contract has been awarded for 6 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 by improving the quality of images sent with referrals; 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 discussions with primary care on the longer term approach to image capture and any resulting decisions to be undertaken in accordance with the relevant legislation and mobilised. The lifetime value of the contract will be £110,861.50 (total over the maximum available 12 month term).This is new service with a new provider.

Award Detail

Award Criteria

CPV Codes

• 85121282 - Dermatology services

Indicators

• Award on basis of price.

Legal Justification

This award has been made following the regulations stated below from the Provider Selection Regime.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 the Health Care Services Regulations 2023. For the avoidance of doubt, the provisions of the Public Contracts Regulations 2015 do not apply to this award.To ensure a tele-dermatology provision is effective good quality images are required to be taken and attached to referrals. Only 48 (of 74) practices in Sheffield are currently signed up to image capture to support tele-dermatology. Using Primary Care Sheffield Ltd (PCS) to provide additional capacity via the hubs for those practices not able to deliver image capture ensures that there is more short-term resource in the city to support primary care with image capture. Without an additional route for image capture any attempt to support FDS recovery through a tele-dermatology service will not be effective.PCS are the GP Federation in Sheffield. They hold a number of contracts for the provision if primary medical services within Sheffield and in addition are contracted to provide a number of at scale services across the city including Enhanced Access services on behalf of a number of Primary Care Networks and an Urgent Same Day Primary Care Service and Acute Respiratory Infection Service (USD) provided from a number of hub sites across the city. To maximise efficiency PCS already have the estate and digital infrastructure via the Enhanced Access service and USD to take the images and have previously delivered dermatoscopic imaging via Health Care Assistants when the model was trialled in 2018. PCS also have the management and operational infrastructure and experience necessary to mobilise such a service swiftly and safely. Using PCS avoids needing to scale up several services from scratch, at pace.Using the existing LCS and PCS (enhanced access/USD has locations accessible across the city) means we can support patients access services as close to home as possible. We are not requiring patients to travel in and out of one Sheffield location to have their images taken, which will reduce travel for patients and mitigate the emergency provision contributing to health inequalities through reducing travel costs / access barriers. PCS have access to interpreting services and a good understanding of patient demographics across Sheffield. Using existing hub locations also allows the service to be offered Monday to Saturday, thereby increasing accessibility for patients referred for photography.It is also possible to utilise other providers in the city through additional hubs. These can also be explored as additional options to increase accessibility for patients as part of this emergency provision and any resulting contracts will have notices published accordingly.The image capture forms part of the tele-dermatology pathway being urgently commissioned in Sheffield; which is required to mobilise at pace. The timescales required to undertake a competitive procurement for a tele-dermatology service (including giving consideration to image capture) and then mobilise a new provider will take in excess of 6 months. This 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 emergency provision the appropriate alternative process under the Provider Selection Regime will be applied.This decision was ratified at 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.