NHS England is looking to establish a framework agreement to provide Participating Authorities with a route to access relevant goods, services and/or technological solutions to supplement the core capabilities of STPs with more advanced innovations and solutions to deliver meaningful, transformational change for patients as envisaged by the 5 Year Forward View. Requirements include:

— Infrastructure: encompassing EPR and place-based digitalization, local health and care record solutions (incl. strategy, implementation support and infrastructure); and ICT infrastructure support and strategic services (incl. Primary Care IT support and cyber-security),

— Insight: informatics, analytics and digital tools to support system planning, assurance and evaluation, care coordination and management and risk and impactable models,

— Impact and Intervention: transformation and change support, patient empowerment and activation; system assurance support and medicines optimisation support.

The scope of this Lot will include the provision of advice and support on the development and implementation of all aspects of digitizing care records including Electronic Patient Records and provision of clinical systems, hardware, and associated support services.

This Lot will run to a different timetable to the other Lots under this Framework Agreement. Further information on the detailed requirements and timetable for procurement will follow.

Suppliers with a potential interest in this Lot should register for updates at:

— https://nhsengland.bravosolution.co.uk/web/login.html

This Lot may be further divided into lots/sub-lots to be confirmed.

Provision of services to measure, benchmark, model against and support the system to manage quality, cost and clinical outcomes (both analytics and other multidisciplinary skills to provide additional necessary capacity), including but not limited to:

• Provider relationship management and supply chain support.

• Financial and quality measurement and assurance.

• Provider modernisation and transformation.

Full details can be found in the ITT.

Provision of expert medicines management and optimisation support to develop, implement and deliver a strategy to deliver improved outcomes from medicines. The services encompass:

• Engagement with patients and the public to better understand how local services can support patients to get more from their medicines.

• Improving commissioner understanding of the systems around medication use and procurement as well as the value from the investment in medicines through communications and education.

• Working with patients to improve adherence: an improved experience of medicine taking for patients, securing greater value for money from medicines expenditure. This includes disease and therapeutic management programmes that involve outreach and education to high risk or high cost patients.

• Improving medication safety including a demonstrable reduction in harm from medication errors.

• Engagement across the system to improve governance and utilisation of medicines and reduce medication waste and variation in practice (including community pharmacy, care homes, hospital trusts, the Pharmaceutical Industry and others).

• More effective use of non-GP personnel e.g. pharmacists. Particularly enhancing the multi-disciplinary team by commissioning and utilising the best skill mix including community pharmacists.

• Clinical programmes including: prescribing efficiently through switching to biosimilar alternatives; reduction in inappropriate polypharmacy; improving safety, e.g. flagging of potential adverse effects from prescribed combinations of pharmaceuticals; improve Formulary Management: standardised formulary and dosing, tiered formularies; medicines reconciliation and transfer of care.

• Work with physicians to improve drug therapy: relationship building, prescriber enablement and education programmes to initiate behaviour change e.g. the prescribing of drugs with low clinical value, prescribing to counter antimicrobial resistance.

• Integrate and analyse data in new ways: utilisation of data at population and patient level to identify the risk of incorrect / incomplete medication use and undertake a targeted intervention/ enablement programme.

• Effective use and integration of a range of data sources to identify real world efficiencies, quality improvements and outcomes in the way medicines are used locally and nationally to identify value and best practice.

• Supporting prescribers at point of care through tools, technology, data and information e.g. decision support and population health analytics.

• Reporting and analytics on outcomes delivered through the use of medicines.

• Support alignment of incentives and contracts to drive the optimal use of medicines both in primary and secondary care e.g. prescribing incentive schemes including risk and gain share.

• Integration of medicines management and optimisation into the wider system for clinical support and managing total cost of care.

• Business intelligence and data visualisation to identify trends and variance as well as to identify opportunities for medicines optimisation and to track provider performance.

• Working with the pharmaceutical industry including primary and secondary care rebate schemes.

Provision of advice and support on the development and implementation of a Local Health and Care Record solution infrastructure and surrounding governance including but not limited to:

— Strategy development: Working with the ACS to develop their local technology architecture and implementation strategy for interoperability and information exchanges including but not limited to governance (including IG advice to ensure all data flows have clearly defined purposes and legal bases), user-centric solution design, making the case for change, engaging key stakeholders, identifying and supporting the commissioner to secure funding, identifying key barriers and designing solutions (for example aligning local processes and adhering to national standards), identifying and mitigating key risks and opportunities, supporting data quality improvement (including but not limited to targeted data quality performance reporting, outreach, education, training and other engagement and support to ensure good data quality practice is applied) and providing a detailed plan for transformation and change.

— Implementation support: Provision of a project management office and dedicated support to ensure that the new Local Health and Care Record infrastructure is implemented effectively. Support includes but is not limited to:

— — supporting and training users,

— — change management (including culture change and business transformation),

— — information governance support (including but not limited to supporting creation and operation of IG policies,

— — capturing and mapping all information assets ensuring GDPR requirements for processing activities are covered; definition of the purposes of data use,

— — Privacy/Data Protection Impact Assessment,

— — creation of data processing agreements, information sharing agreements, and Fair-Processing/Privacy Notices,

— — IG governance and compliance advice and assurance,

— — support for the design, implementation, and maintenance of organizational, process and technical controls that ensure data security and confidentiality), monitoring utilization and identifying opportunities for further improvement, benefits management and realization, call management of services and systems that would have a direct link to the implementation support structure including but not limited to:

— — — third-party suppliers,

— — — NHS care providers,

— — — private care organizations,

— — — local and national infrastructure (N3, CoIN / HSCN), and,

— — — local access services and local care response.

Provision of infrastructure services as an appropriate and secure collection of software, cloud services and/or hardware to enable near real-time integration, exchange and storage of patient data as part of a Local Health and Care Record and which provides appropriate read/write access to patient data by actors across a local economy across multiple organizations and EPR solutions in line with overarching architectural standards as defined by NHS England and NHS Digital.

A Local Health and Care Record will consist of a set of technical capabilities with the precise makeup being determined by each ACS/STP in line with national strategy.

The precise specification and means of delivery of a Local Health and Care Record that maintains patient security and provides linkages to an individual’s data held in other Local Health Care Records in something that will evolve with our pilot sites, so we are open to propositions that use approaches not fully captured in the characteristics below. The specification will evolve with learning from the pilot sites.

The main characteristics of a Local Health and Care Record infrastructure are that they will:

— be designed around user needs,

— enable the delivery of local, longitudinal care records for the delivery of integrated care,

— be interoperable so that information can be shared securely (in line with information governance and cyber-security requirements) as patients move across boundaries,

— support directly and/or enable a comprehensive block and incremental feed to dedicated solutions to support multiple individual patient care management, local population health management and de-identified feeds to non-patient care solutions such as business management and clinical research, and,

— provide data for national purposes such as statutory functions and for accessing data held nationally for wider regional use in a standard format agreed across the regions/nationally where appropriate.

The services of a Local Health and Care Record infrastructure must include:

— shared health and care record,

— accommodation to make information available to non-exchange-capable-providers,

— open APIs,

— master citizen index,

— record location,

— local event management,

— national event management,

— access to Local Health and Care Record,

— federation broker,

— authorization service,

— information sharing agreement,

— terminology and code sets,

— meta-data definitions,

— directory of services,

— cross STP data distribution,

— De-id,

— Re-id,

— audit,

— data landing,

— Personal Health Record (PHR) data exchange,

— patient accounts,

— caseload management and workflow,

— structured medications data.

Full details can be found in the ITT.

Provision of ICT infrastructure, strategic ICT support services and ICT outsourcing, including in a Primary Care setting, in line with GP IT best practice and market developments and relevant national guidance (such as the latest GP IT Operating Model, Securing Excellence in GP IT Services and associated CCG Practice Agreement requirements) and other best practice including but not limited to:

— ICT Infrastructure: Provision/sourcing of IT infrastructure including but not limited to network services (including Wi-Fi, HSCN, overlay services such as site to site connections, network monitoring and filtration services,), telephony, IT equipment and specialist advice on commissioning/decommissioning IT systems and aligning / sharing infrastructure.

— Management of infrastructure: Managed IT estates services (n.b. IT assets purchased with NHS capital (e.g. for GP IT) will be retained by the NHS but may be managed by the supplier) including asset management and software licensing support for systems and associated software (e.g. antivirus, encryption etc.), version control and patch management, provision of desktop support/service desk, managed data hosting (including storage and server management), management of third-party providers and integration of third-party goods and services, print management and remote access to the clinical record solutions, including mobile device management.

— IT Systems functionality: Sourcing/provision and ongoing support of IT systems on behalf of the commissioner including but not limited to:

— — NHS Mail,

— — system integration and interoperability,

— — implementation and support of software solutions,

— — remote access solutions and access control and administration,

— — mobile applications development, and,

— — electronic messaging for direct patient communication.

— Support services: Provision of Primary Care Enabling Services for General Practice, Registration Authority (RA) administration and management, NHS Mail Administration, Clinical Safety Officer Support and provision of specialist Information Governance advice and support to ensure that commissioners and providers are advised on how data can be compliantly stored, managed and used in line with the IG Toolkit Level 2 (or equivalent) and the General Data Protection Regulations, National Strategic System Implementation Services (including deployment and implementation support, project and change management support, clinical systems training and systems optimization support), support to improve data quality including delivery of training to improve coding (including in a primary care setting), management of third-party providers and integration of third-party goods and services.

— — cyber-security support: Provision of support to ensure systems are secure and patient data is protected including but not limited to:

— — identification of cyber-security threats,

— — regular penetration testing,

— — disaster recovery and business continuity support services,

— — supporting/implementing critical actions related to CareCERT alerts,

— — supporting/acting on recommendations from cyber security assessments,

— — support the checking of supplier certification (in line with the Department of Health’s Data Security, and,

— — Protection Requirements) and supporting the management and mitigation of cyber-security risks.

— IT Optimisation, Strategy, and Transformation: Provision of expertise and PMO support to develop and implement local IT Strategies (such as Local Digital Roadmaps), supporting Sustainability and Transformation Partnership (STP) working including but not limited to:

— — providing expert advice on strategy design,

— — development,

— — market development,

— — benefits testing and realization,

— — national and international best practice,

— — information governance,

— — national policy advice,

— — regulations and standards,

— — infrastructure and system architecture design, and,

— — barriers and solutions.

Provision of informatics and analytics and digital tools to support whole system planning, strategy development, management, assurance and evaluation (cost, quality, clinical outcomes) including but not limited to:

— actuarial analysis and intervention modeling,

— supporting system financial management, quality, and outcomes measurement (including clinical outcomes),

— planning and evaluation need assessment and opportunity analysis, and,

— research tools.

Full details can be found in the ITT.

Provision of informatics, analytics and digital tools to support care coordination services including but not limited to:

— risk stratification and impactable modeling for early intervention and preventive care:

— — development of predictive risk models tools, algorithms, and analytics capability that can be used to identify the most impactable patients taking into account the wider determinants of health including but not limited to risk modeling of triple fail events over different time periods (e.g. for prediction of unplanned hospital admission over the next 12 months);

risk of developing a bed sore in the next 6 weeks),

— — stratifying populations by allocating risk scores to individuals,

— — impactable modelling to determine the likelihood that a particular patient will benefit from different preventive care interventions (approaches to impactable modelling might include prioritising high-risk patients with a high weighted gap score, one or more ambulatory care sensitive conditions, a high ratio of illness vs complexity and/or data-driven approaches (e.g. using machine learning to predict which patients will benefit most from different preventive interventions),

— — provision of a rules engine to determine eligibility for different preventive interventions based on predicted risk, predicted impactable, undertaking an impact assessment to determine the risk of false positive and false negative results, financial impact assessment (to calculate the return on investment) and equality impact assessment (to ensure that the preventive approach will not inadvertently exacerbate health inequalities).

— Supporting systems for the development of individual care coordination and management: Provision of insight to support how care is managed in near real time. Services include but are not limited to systems and applications which utilise, or extensions to, electronic patient record systems/health information exchanges to flag potential interventions (including through the use of risk algorithms and predictive modelling) and to trigger alerts, analytics to identify optimal patient pathways and flag them to providers of care, analysis and continuous improvement of support tools to evaluate their utilisation, efficacy and impact, flagging of packages of care where the outcomes appear to be suboptimal, capacity management and predictive modelling to plan for and manage surges in demand, robust use of economic models to optimise decision making.

— Services to support clinicians to make faster and better interventions at the point of care with a patient: Development and deployment of services that utilize patient data to support clinical decision making in real time, embedded in clinician workflows. Services include but are not limited to systems and applications which utilize, or are extensions to, electronic patient record systems/health information exchanges to flag potential interventions (including through the use of risk algorithms and predictive modelling) and to trigger alerts when a patient’s condition worsens/is about to worsen, analytics to identify optimal patient pathways and flag them to providers of care and analysis and continuous improvement of support tools to evaluate their utilisation, efficacy, value, and impact.

Provision of a range of expert advice, analysis, transformational and change management capability to design and build the necessary infrastructure for an ACS / STP function effectively. Services include but are not limited to:

• Patient pathway optimisation and care model design.

• Specialist advice on organisational redesign, governance and payment and contract reform.

• Communications and engagement.

• Workforce and leadership development support including but not limited to:

— Transformational workforce planning,

— Workforce development,

— System leadership development,

— System leadership support.

• Scaling innovation.

• Primary Care at scale support.

Full details can be found in the ITT.

Provision of services to support the implementation of shared decision making, self-care programmes (including social prescribing and innovative technologies and associated wrap around support), and personal health budgets & integrated personal commissioning through sharing information with care providers remotely to enable the activation and empowerment of individuals to more effectively manage their own health, care and wellbeing. These products and services will enable people to live with greater independence, confidence and safety, and in many cases reduce the need for unplanned care.

• Support for implementing shared decision making.

• Support for implementing self-care programmes (including social prescribing and innovative digital and remote technologies and e-consultations).

• Identification of patients for intervention.

• Advisory services participation.

• Implementation services.

• Patient portals.

Support for implementing Personal Health Budgets and Integrated Personalised Commissioning support - Services include but are not limited to:

• IT solutions to support integrated personal commissioning and Personal Health Budgets.

• Care planning.

• System redesign.

• Implementation support and management.

Full details can be found in the ITT.

Provision of services to support smooth transition into, through, out of and between organisations (including by provision of command centres) in a local health system ensuring patients are treated in the most appropriate setting and minimising the amount of time patients wait before transitioning between care settings. Whilst analytical services are an important enabler, these services are intended to provide practical day-to-day support to ACS / STP in mapping, forecasting, managing and ultimately shaping and redirecting patient flows, necessitating different infrastructure, organisational collaboration, skills and tools.

Services include but are not limited to:

• Alignment and co-ordination of transfer of care.

• Integrated discharge planning.

• Forecasting demand and patient flows in the short term across different care settings.

• Forecasting underlying demand in the medium to long term.

• Advice on / provision of a patient level care co-ordination function.

• Coordination of care provision within and between organisations.

Full details can be found in the ITT.