Attain and Thurrock CCG source IAPT services through Structured Dialogue approach

Working closely with Attain, Thurrock CCG have successfully overcome challenges in sourcing Improving Access to Psychological Therapies (IAPT) services and appointed a provider for these services through utilising a Structured Dialogue approach.

Both within Thurrock CCG and nationally, a successful IAPT service is a key factor in the delivery of an integrated Primary Care Mental Health model. It will enhance the support GPs require to manage people presenting with common mental health problems and where clinical assessments allow people being discharged from secondary care. Thurrock’s five year strategy aims to reduce the inequalities of outcomes for people with mental health problems as well as delivering “Parity of Esteem” with physical health.

Following two previously unsuccessful procurements to identify a provider that would deliver IAPT and develop a Recovery College model within Thurrock, a single award waiver had been approved aligned to the CCG’s SFIs.

Of the two traditional procurement processes, the first was a restricted process commencing in December 2014. It was cancelled in April 2015 in order to enable commissioners to redefine the service specification to meet the needs in Thurrock.

A new open procurement was subsequently advertised on the national website in May 2015. This process did not identify a successful provider within the set financial envelope.

The CCG still sought to identify a competent provider from what appeared to be a limited market place.

Alongside Thurrock CCG’s commissioner for mental health, Attain recently led a procedure to engage with clinical leads, service users and wider community stakeholders to ensure a transparent and robust process was followed to both identify and appoint a suitable/competent/capable provider for these services.

This was undertaken by providing the commercial support to design and deliver a structured dialogue process.

Structured dialogue process modelA Structured Dialogue process is built on the treaty principles of EU regulations:

  • Transparency – contract procedures must be transparent and contract
  • Equal treatment and non-discrimination – potential suppliers must be treated equally
  • Proportionality – procurement procedures and decisions must be proportionate
  • Mutual recognition – giving equal validity to qualifications and standards from other Member States, where appropriate.

The initial steps saw a thorough analysis of the national IAPT market place, including:

  • Identification of providers who currently deliver these services to CCGs with mental health prevalence and demographics in the same range as Thurrock.
  • Review of HSCIC national performance data.

A high level of due diligence was executed throughout and gave the benefit of increased of interaction between commissioner and providers.

Dialogue sessions were developed and planned by Attain and provided a robust audit trail. Pre-qualification was assessed on a pass or fail basis, which saw successful providers being invited to a face to face dialogue session. It was here that the critical delivery factors for the service were assessed in an open yet structured format. All evaluation material utilised throughout were published to all bidders.

The process overview and outcomes have been relayed to Monitor for advice and endorsement. This has led to further discussion to highlight the process as an example of good practice in innovating to ensure competition requirements can be met in a fair manner when procurement may not be the right choice. This is based on the guidance by Monitor in relation to the Procurement, Patient Choice and Competition Regulations 2013.

Allowing the CCG to move forward with implementing and mobilising this key service within a set financial budget, the project was delivered within challenging timescales. It has provided a far more engaged process which allowed for a proactive review of the existing market place and concluded with the appointment of a high quality provider and extremely satisfied community.

Benefits of a Structured Dialogue approach include the following:

  • The process can be classified under “Integration” and therefore not subject to a full procurement
  • Providing equality is maintained Commissioning organisations are free to discuss anything with potential providers
  • Genuine benefits to patients can be clearly identified and implemented within service delivery
  • Checks and Balances (Pre-Qualification Questionnaire elements) will still be carried out as per traditional Procurements
  • Cost savings and efficiencies can still be effectively realised
  • Named existing Providers of required services can be identified as being part of the solution (e.g. Mind for Thurrock IAPT)
  • Timelines will need be to be proportionate but can be dictated by the Commissioners.

Structured Dialogue can be a sound and robust method to source a provider when traditional procurement has been unsuccessful or not appropriate. The below examples could potentially be suitable for a Structured Dialogue approach:

  • Where “Integration” of services are being undertaken with genuine benefits to patients and can include innovation
  • Where incumbent providers are invited only for Integration of services
  • Following an open advertisement through Contracts Finder (CF) so any interest parties can take part in Structured Dialogue rather than Competitive Dialogue
  • Where a procurement has not provided a suitable provider, leading to a proactive search for a provider that fully meets all requirements
  • Where there is genuinely only one single supplier that can provide the required integrated service.


“It has been great having Attain colleagues working with Thurrock CCG, assisting to deliver our commercial requirements. Recently they have supported a Structured Dialogue process to identify an IAPT and Recovery College provider, after previous failed attempts to competitively secure a provider. This process was innovative and engaging whilst demonstrating transparency and robustness. The objectives of the our strategic plans for mental health were met in true partnership with the lead commissioner and the new provider.”

Mandy Ansell, Chief Operating Officer, Thurrock CCG


Please contact Attain should you wish to explore situations where a structured dialogue might be relevant or preferable or should you wish to get a better understanding of the benefits of a structured dialogue over a traditional procurement route.