Complex service mobilisation and the key steps to success

You’ve done it; you’ve come to the end of a long and complex procurement process or worked collectively in an existing system to agree a new model of care and how this will be delivered to local populations. It is time now to bring that new model of care to life and start delivering outcomes for people using services.

Lucy Cole, Manager at Attain talks about complex service mobilisation and the key steps to success.

What is mobilisation?

Mobilisation covers the period between the award of a new contract to the commencement of that contract and service. This is a critical period which is fundamental to successful implementation of a new service and sets the tone for effective, long standing relationships across a system.

This is a joint effort between commissioners and providers to develop a partnership and to bring a model described on paper (in a specification and bid) to life as a functioning service.

The fundamentals

There are some fundamental principles to apply when approaching a service mobilisation of any size and complexity, these are:

Strong programme management

  • Agree and implement joint governance structures and processes across commissioners and providers
  • Define and implement work streams, identify leads, scope and responsibilities
  • Develop joint plans and shared risks to be agreed across commissioners and providers
  • Identify a dedicated resource to manage the day to day relationship whose targeted role is to unblock issues and identify solutions rapidly

Facilitation and relationship management – good working relationships are the key to delivering a mutually beneficial contract; the commissioners achieving better outcomes for their population and the provider delivering effective, sustainable care.  This relationship should also act as a catalyst for change within the local system. Implementing new models of care will only add further challenge; changing the relationship between commissioner and provider, with providers responsible for delivering outcomes and capitated budgets and commissioners relinquishing some responsibilities. Having a devoted, skilled individual (or team) will act as the conduit between all parties and maintain relationships and momentum between commissioners, providers (new and incumbent) and other key stakeholders.

Contract development – it is important that time is invested in the development of all contract particulars to form a comprehensive contract covering the new model of care detailing development plans (e.g. SDIP and DQIP), core KPIs and incentive schemes. The move to outcomes based incentive schemes is an iterative process and requires a clear plan to develop measurement processes which often are not pre-existing and to establish a baseline. This will often be phased, progressively moving away from traditional KPIs and measures to new outcomes as the service and new methods of measurement are embedded.  A comprehensive contract will ensure both parties have absolute clarity on what has been commissioned, and the services to be provided.

Communications and engagement – have a comprehensive plan, engage clinical and professional leadership in the development and delivery of this plan, and update stakeholders little and often using as many channels as possible.

Transition to business as usual – ensure the structures are in place to manage the new model of care through regular, meaningful reporting and contractual mechanisms to guarantee a smooth, planned transition from mobilisation phase to business as usual. If the model of care is new, the method of governance, assurance and management should reflect this.

Application of these fundamentals will give you the framework to undertake a successful mobilisation programme.

Top tips

  • Beware procurement fatigue – a complex procurement or equivalent process working with existing providers can be intensive, long and often exhausting. There is a danger that momentum can be lost at this crucial stage. Don’t let it! Mobilisation is the next (crucial) stage of the process.
  • Plan ahead – look ahead early; build enough time into your project plan for mobilisation.  There is a lot to be done, such as, staff transfers, training, setting up new systems to name but a few. Be prepared and understand the level of resource, support and commitment required to deliver this phase of activity.
  • Know your services – longstanding contracts and services often evolve without adequate reflection within contracts and service descriptions. Providers and commissioners need to work together closely to ensure that the understanding of the service line and actual delivery to people using services are aligned and that there is no risk  of gaps in service delivery or finance.
  • Don’t leave it until mobilisation – there is often temptation to leave specific developments until the mobilisation phase for discussion and agreement (e.g. final KPIs, detail of incentive schemes). Do as much as possible in the design phase – trying to reach consensus whilst trying to mobilise a new service can risk compromising the original vision for the model of care.
  • It’s a marathon not a sprint – the ambition, scale and pace of design and delivery of new service models has increased rapidly and this ascendency is set to continue. In many systems this involves moving from a very traditional, long-standing models of care focused on tasks and episodes of care, to something very different including outcomes based approaches, capitated budgets and innovative models of risk share. This transition will not happen overnight. Clarify the objectives within the initial phase of mobilisation and agree this across the system. Use the governance structures to hold detailed discussions on how the transition to the vision of the full new care model will be realised in a safe and effective way, using contractual mechanisms such as Service Development and Improvement Plans (SDIP) to capture these activities and milestones.

Mobilisation – the next challenge

With the release of the NHS Planning Guidance 2016/17–2020/21 and systems working together to produce Sustainability and Transformation Plans (STPs) the focus over the next few months will be to articulate local and regional journeys to new and sustainable models of care. Ideas such as capitation, integration, MCPs and ACOs will feature heavily. Alongside articulating the ‘what’, systems will need to be prepared for the ‘how’; mobilising new, complex and ambitious models of care will be the focus of health and social care systems for the next five years.

Case study

Following a competitive dialogue process to procure a lead provider for Care Closer to Home services the two commissioning CCGs required support to mobilise the new contract following an extended standstill period resulting in constrained 10 week mobilisation period. The contract was awarded for five years with the option to extend for a further two years.

Attain worked with the CCGs and the new lead provider to establish a joint governance structure and apply the fundamentals outlined (strong programme management, facilitation and relationship management, contract development, communications and engagement and a smooth transition to business as usual arrangements) through a dedicated delivery lead. The delivery lead facilitated discussions and brokered agreements between the commissioners and providers, working closely with key stakeholders across the system, to ensure the service was mobilised and the contract commenced on the required date.

In the restricted timescales, the following outputs were delivered and outcomes achieved:

  • Comprehensive contract completed and signed before contract commencement
  • Implementation of key identified functions by identified dates – with priority areas implemented for contract go live
  • Created the foundation of partnership working to carry through into business as usual contract management
  • Defined contract and quality management structure and processes for long-term management
  • Jointly agreed transformational priorities with timelines for implementation
  • Stakeholders fully briefed to understand and utilise new service.

Attain is working with health and care systems across the country to support the design and mobilisation of new care models. If you would like to learn more about how Attain can assist you in the mobilisation of new care models, please contact Gareth Hartley, Director Service Transformation or Chris Walker, Director Commercial.