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NHS LPP’s Clinical Digital Solutions (CDS) team enables quality digital and interoperable healthcare solutions, representing bespoke projects at a national level. The Health and Social Care Applications Dynamic Purchasing System (DPS) facilitates approved digital solutions which support efficient healthcare, avoid hospital admissions and promote prevention/self-care.
To reduce variation, support consistency and raise standards, NHS LPP partnered with Organisation for the Review of Care and Health Applications (ORCHA), adopting their existing evaluation process reducing duplication. Apps have become key in supporting those at high risk, to stay home, during the Covid19 pandemic. Providers can now instantly access multiple pre-approved, or propose new Apps.
Digital solutions are at the centre of the evolution of the NHS as it continues to drive for operational efficiency underpinning improvements in patient care and health outcomes. NHS LPP’s solutions align to NHSX’s digital transformation agenda, the NHS Long Term Plan and the London Digital and Imaging strategies.
NHS LPP’s CDS team works in partnership with all relevant national and regional NHS policymakers: NHSD/NHSX, NHSE/NHSI, the London CIO Council and ‘One London’, to observe and accelerate national strategy and avoid duplicated effort.
Partnering with ORCHA, a digital health Application (App) evaluation/advisor organisation who support the evaluation process for the NHS Apps Library has meant signficant efficiency savings.
The NHS and wider public sector were experiencing a huge surge in the demand for wellbeing and/or condition-specific Apps to meet health and social care needs; supporting patients and staff alike. During the Covid19 pandemic, providers and commissioners now need to urgently adopt these as part of their toolkit for treating patients faster and more efficiently. They need a fast, compliant route to market for proven Apps which have already undergone clinical review.
The DPS removes the need for individual organisations to evaluate Apps, removing risks to both patients and care providers, reducing the burden on clinicians and improving productivity. The ORCHA evaluation ensures consistent standards, in a potentially high risk area. ORCHA’s review looked at 260 aspects of each App. Full details can be found at: https://www.orcha.co.uk/our-solution/the-orcha-review/.
There is no other framework currently available and, whilst multiple Apps already exist and are in use, their development has been supplier led, with little or no rigour or clinical governance.
Advanced procurement delivery
A DPS is a flexible tool, to which new suppliers and innovation can be added during the life of the arrangement. NHS LPP engaged suppliers and providers, in order to deter direct supplier marketing of unapproved Apps and help providers understand the risks.
Each App will go through the ORCHA evaluation process. ORCHA’s programme covers Apps to address all conditions currently considered appropriate to this technology by the NHS and social care sector. The DPS covers 24 condition categories each containing several sub-categories that are specific to a condition for example anxiety or bi-polar disorder. Now the DPS is live, any future categories needing to be added can be advertised through OJEU via an addendum to the existing OJEU advert.
A supplier can only take part in a further competition if they have been awarded a place on the DPS for a given Category/Sub-Category. Suppliers who have already passed the selection questionnaire (SQ) stage will only have to demonstrate that any new App meets the minimum required technical criteria of the ORCHA review process, thereby saving time and effort for suppliers too.
The DPS will be accessible to collaborative groups of any nature, with the option to either nominate a lead contracting authority or to hold their own individual call off contracts with a shared pricing model.
As standards evolve, NHS LPP may require a more in depth review process than ORCHA. In May 2020 new legislation required applicable Apps to gain CE Mark certification. Any that don’t hold this will now be automatically removed until they have successfully undergone the ORCHA recall process.
Bidder Evaluation Methodology
Suppliers’ professional capabilities are assessed at SQ stage, requiring a pass to be awarded on to the DPS. The SQ evaluation was undertaken in accordance with the Public Contracts Regulations 2015, http://www.legislation.gov.uk/uksi/2015/102/contents/ made including:
- A completeness and compliance check;
- An assessment of the selection questions including economic and financial capability;
- An Evaluation of the Technical Questions and Professional Ability.
Stimulating the market to innovate
When NHS Digital successfully launched the NHS Apps Library of Digital Health Tools in April 2017, we began work with suppliers to understand this market. Local workshops with NHS LPP acute provider members took place to identify further needs.
Supplier Webex discussions, complementing ORCHA’s already significant market engagement, informed and encouraged any new App development through this route, rather than engaging directly with clinicians. Suppliers have responded well, they see this as a streamlined route to take robust products to market and an opportunity for them to innovate collaboratively.
Challenges and solutions
Managing a vast array of stakeholders from multiple clinical specialisms has necessitated challenging engagement and buy-in from existing clinical forums. Creating a safe, regulated mechanism to enable the NHS to address capacity issues via a modern, sustainable, combined care model, in an increasingly uncontrolled market, has successfully been achieved.
Outcomes, benefits and successes to date
Apps can help keep people out of hospital.
It is too early to have data on uptake but there have already been awards. However, what is really important is regulating this new market early and enabling adoption of digital solutions.
At launch in late 2019, 30 suppliers were awarded. Multiple new rounds since then have included new suppliers and Apps. It now provides access to over 144 approved Apps.
User feedback and potential for future use is highly positive:-
- NHS England have used the DPS to award a contract to support patients with Type 1 – Diabetes. This award was in response to COVID-19 and provides all patients diagnosed with Type 1 – Diabetes in England with access to an app to help them manage their condition and reduce the risk of admittance to hospital during the current pandemic.
- Dorset CCG have used the DPS to procure apps for chronic obstructive pulmonary disease, high blood pressure, diabetes and asthma. This award was in response to COVID-19 to help patients suffering with these conditions to better manage their condition and reduce their risk of admittance to hospital during the current pandemic.
- The Royal Marsden NHS Foundation Trust, London has demonstrated confidence in the new DPS as the vehicle of choice for procuring Apps which will also undergo the additional clinical scrutiny of the Cancer Network. We have been to its Apps Clinical Advisory Group (CAG), a clinical network extending beyond London aiming to enhance care for cancer patients in terms of wellbeing, palliative care and mental health.
- IAPT (Improving Access to Psychological Therapies) intend to use Apps to support and improve mental health care, in relation to currently unachievable digital cognitive behavioural therapy targets.
- Public Health England are going through a process to explore its use for social care users.
- The Ministry of Defence are planning to use the Mental Health element of the App.
- The London CIO Council, The Healthy London Partnership (HLP) and Health Innovation Network (HIN) have all worked enthusiastically with us throughout the development of the DPS.
Formal user feedback mechanisms are now being designed to understand impact and actual value.
Autonomous monitoring and self-care means that fewer physical appointments, or faster appointments using prior information, can be expected and less clinical time spent. Current engagement with NHSX is working on how to evaluate actual clinical hours which could be saved and establishing validation and accreditation criteria for clinical outcomes from healthcare Apps.
Spreading the benefit and promoting replication
NHS LPP has presented at national conferences (eg. HETT 2019) and jointly with ORCHA at NHSE’s Clinical Entrepreneur Programme events in order to spread awareness. Needs were initially identified by our CCG membership network, who wanted routes to market for clinically assured, low cost Apps which could improve health outcomes. Subsequent discussions with multiple acute providers explored cancer and diabetes management Apps, who are now reviewing care models for acute, chronic and long term conditions.
We are now confident that we will automatically become the App store of choice for the NHS. With our partners, ‘Procurement in Partnership’ (PiP), the national collaboration between NHS procurement hubs, we could easily open this up to all of the public sector through our established relationship with Crown Commercial Solutions (CCS) to communicate available Apps across all public services.
We will continue to collaborate with Public Health England, Healthy London Partnership (HLP) and Health Innovation Network (HIN). We have aligned to our own strategic objectives as well as those of the NHS Long Term Plan, working with STPs. Our current focus is on engaging emerging Primary Care Networks (PCNs), Accountable Care Organisations (ACOs) and Integrated Care Systems (ICSs). Specialist trusts/centres of excellence are currently being targeted to understand further, specific requirements and ensure awareness of this route.
Work on communicating the DPS is expected to attract interest from the whole spectrum of health and social care. Many of their requirements will already have been included in the ORCHA App review process, or can easily be added. This is a new market, testing usability and measuring user numbers will be critical. Digital Apps provide good data for efficient review and analysis, as well as evaluating clinical efficacy, to understand effectiveness and evolve solutions as necessary, which is equally key to success.
Downloads: Attachment 1 OBR process | Attachment 2 Empowering Patients | Attachement 3 Empowering patients through an Integrated HE | Attachement 4 Learning to Ride the Lion | Attachment 5 LPP Article
Finalist : 2020 HCSA Procurement Consultancy Award and Winner : 2020 HCSA Procurement Consultancy Award
Name: Trish Hardy
Job Title: NHS Consultancy PMO
Organisation: NHS London procurement Partnership
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