Agenda item - Whitehawk Alternative Provider Medical Services (APMS) Contract

13.1    This item was presented by Adam Doyle, Chief Executive; and by Amy Galea, Chief Integration and Primary Care Officer, NHS Sussex Integrated Care Board (ICB). Lola Banjoko, ICB Deputy Chief Integration    and Primary Care Officer, was also in attendance.

13.2    Mr Doyle told members that, some years ago, there had been a good deal of fragility in the Brighton & Hove primary care system. In response          to this, commissioners had instituted 3 Alternative Provider Medical      Services (APMS) contracts, at Arch GP practice, Brighton Station, and at Whitehawk. APMS contracts do require regular review to ensure that       they continue to deliver value for money and a quality service in terms           of both the primary care map for Brighton & Hove and for Sussex as a whole. The Brighton practices are the only practices in Sussex holding          APMS contracts.

13.3    Amy Galea told the committee that the Whitehawk APMS contract        includes a standard NHS general practice contract element plus a         deprivation premium. The current Whitehawk contract was let in April         2018 for a period of 5 years. The contract has been under review for some time, and in April 2023 was extended for an additional     year to           give more time to agree future arrangements. As part of           discussions, the current provider, Wellsbourne Health Community   Interest Company (Wellsbourne), was offered a new contract but      declined to accept this within the funding envelope available. Subsequently, the ICB published a Prior Information Notice (PIN)    indicating to the market that it was minded to proceed to tender at a stated value. There was market interest in this, and the ICB began the   tender process.

13.4    The tender process was paused when it became evident that there was         a discrepancy between the contract value and the current staffing costs       submitted by Wellsbourne. During the pause, all bidders were made          aware of the potential for the contract to generate income in additional      to the core contract value, via Quality Outcome Framework (QOF) and     Locally Commissioned Services (LCS) payments.

13.5    The tender process was resumed, and in March 2025 the ICB     announced its intention to award the contract to a different provider.       Wellsbourne challenged this decision on 2 occasions, citing perceived          flaws in the procurement process. After the ICB reiterated its intention to           award, Wellbourne asked for review by the Independent Patient           Choice and Procurement Panel (the panel). This was agreed,         and the panel investigated Wellsbourne’s complaints, publishing its   advisory report in July. The panel report’s main recommendation was        that the ICB should suspend the tender and re-start it from the Invitation   To Tender (ITT) stage. The ICB has subsequently announced that it will   commission a wide-ranging external review of the tender process. The           ICB has also extended the current APMS contract by an additional 12         months.

13.6    Mr Doyle told members that the review report will be published,     potentially with some redactions of commercially sensitive information.         The report will initially be presented to the ICB’s Audit Committee and           will also be shared with NHS England. The review will include all aspects        of the tender process, including all the issues highlighted by the panel           report. It will also look at engagement. Once the report has been      published, the ICB will need to consider its next steps.

13.7    The Chair asked why there wasn’t more exploration of a direct award to        the current provider, particularly given how deeply embedded    Wellsbourne is in the local community. Ms Galea responded that it was         not possible to go into detail about the ICB’s conversations with         Wellsbourne. However, the ICB does have a duty to provide value for           money, and it should be noted that there was interest from the market in           the contract at its advertised value.

13.8    The Chair asked whether a direct award was still a potential outcome    here? Mr Doyle replied that he did not wish to pre-empt the review       findings. However, there will be a number of options open to the ICB and   this includes direct award.

13.9    Cllr Evans noted that there has been lots of praise for the work that       Wellsbourne has done, including in the past from the ICB. However, in          a short period of time, a decision was made to go to competitive tender.           It remains unclear what happened here. Mr Doyle acknowledged that    Wellsbourne did very constructive work on the Integrated Community   Team (ICT) programme, as did many localities across Sussex. Mr Doyle is seeking clarification on what occurred in terms of any offer of a direct        award, but his current understanding is that Wellsbourne declined an    offer because of the level of funding proposed.

13.10  Cllr Evans noted that the situation where APMS contracts are regularly reviewed, but General Medical Services (GMS) contracts are not, is           unsatisfactory. The committee should consider lobbying for APMS to be          brought in line with GMS in this respect to help provide stability.

13.11  Cllr De Oliveira asked for the timeline of the review. Mr Doyle replied that    the review provider will be announced in the next week. The review is    expected to take 10-12 weeks, with a report published in early 2026.

13.12  Cllr De Oliveira asked a question about the pre-tender engagement. Ms     Galea replied that this was focused on an online survey asking people         to recount their experiences of receiving services. The survey was open          to everyone in the area, reflecting the fact that Wellsbourne provides           services for local residents who are not necessarily registered at the      practice. In addition to the online survey, there were 4 in-person       meetings, plus specific engagement with local voluntary and community        sector organisations. 56 survey responses were received. Cllr De      Oliveira queried whether a digitally led approach to engagement was the           best choice for Whitehawk where many people are digitally excluded. Mr         Doyle responded by acknowledging that there has been some negative         community feedback regarding engagement. The ICB will look very   closely at what the review has to say on the engagement process, and           will learn the appropriate lessons. Ms Galea added that it was important          to recognise that the ICB regularly collects community feedback on the         services it commissions: the data from the specific Whitehawk survey           forms only part of the data it used to inform its thinking around the APMS           contract.

13.13  Cllr Fishleigh (attending as a guest) asked whether it was possible to just        abandon the tender. Mr Doyle replied that this was a possible outcome,        but the ICB would need to be assured that this was the best course of action, and will need to wait for the review to report before making        any decision           about the future of the tender.

13.14  Cllr Fishleigh asked how patient satisfaction was assessed for other   bidders to the contract. Mr Doyle replied that there was a process for     capturing this information as part of the tender bid evaluation. The review     will look at how robust this was.

13.15  Geoffrey Bowden (Healthwatch) explained the role that Healthwatch Brighton & Hove has played in the bid evaluation process. Ms Galea confirmed to the committee that the review will look closely at the        processes adopted in terms of the evaluation of bids.

13.16  Cllr Hogan noted her disappointment that the review process had not yet           begun. Mr Doyle acknowledged this but stressed that it was important that due process was followed. To be of value the review needs to be          both rigorous and independent and these arrangements do take time to       agree.

13.17  Cllr De Oliveira asked whether the review report would include extracts       from the minutes of the bid evaluation meetings. Mr Doyle replied that    he  is committed to do everything possible to be transparent, but some          material may be commercially sensitive.

13.18  Cllr Hill asked about reported statements made by Wellsbourne. Ms     Galea  replied that she was not in a position to speak for Wellsbourne. She noted that procurement rules do restrict what bidders for a   contract can say in public.

13.19  Cllr Hill asked a question about some providers purportedly lacking access to details of Locally Commissioned Services. Ms Galea responded that there may not have been total clarity about this in the          tender documents. However, the successful bidder for a contract of this         type would be expected to have a good understanding of how to access           information.

13.20  Cllr Hill asked about details of a question in the Invitation To Tender     documents relating to bidders communicating with patients. Ms Galea replied that the ICB believe that they followed good practice here.        However, the panel report has queried this, so this will be one of the     areas that the review will focus on.

13.21  Cllr Evans noted that it is not uncommon for some larger bidders for    contracts to be expert making pitches, but sometimes less       expert at       actually delivering services. Cllr Evans also noted that having only 56 responses to the online survey is disappointing when there         are     more than 8000 people on Wellsbourne’s patient list.

13.22  Cllr Evans asked why there was the APMS contract has only a minimum       weighting for social value. Mr Doyle responded that it is important to look      at the contract weighting in the round: the social value element is low,           but there is a high rating for health inequalities which addresses similar    issues. This is an area that the review will focus on.

13.23  Cllr De Oliveira asked whether the ICB would apologise to the local    community for its mistakes in the tender. Mr Doyle replied that he was committed to ensuring that the investigation of the tender is both swift   and thorough. This is important for local people. He would be happy to        apologise for flaws in the tender process if the review requires this.

13.24  Cllr Simon commented on the poor response to the engagement survey           and queried whether the ICB had involved community groups to assist       with outreach and how many people had been involved in the in-person           engagement sessions. She also asked what the data from the survey     had been used for. Ms Galea responded that community groups had      been involved and that the survey data was used to inform the contract      specifications, for example in terms of the weighting in the contract for    health inequalities. Ms Galea agreed to provide details of the number of       people attending in-person sessions.

13.25  The Chair asked whether a full chronology of the tender process would         be included in the review report. Mr Doyle confirmed that it would be.

13.26  Cllr Mackey asked a question about whether the principles of the Marmot     review had informed the contract specifications. Mr Doyle replied that        the contract specification did indeed focus on health inequalities in line           with Marmot principles.

13.27  Cllr Parrott asked whether the ICB was committed to re-engaging with          the local community, and said that Councillors would be happy to assist      with this. Mr Doyle replied by saying that it was clear that there was a      need to have an open conversation with the local community. He           welcomed the offer to co-design this with Councillors.

13.28  There was discussion of whether the lead reviewer could be invited to a         future HOSC meeting when the review is discussed. It was agreed that       attendees should potentially include Mr Doyle, the lead reviewer and a         representative of NHS England.

13.29  Cllr Evans asked why the ICB would not apologise now rather than    waiting for the completion of the review, as it is clear from the panel           report that significant mistakes were made. Mr Doyle replied that there           are various views on the panel’s recommendations. This is why it is so        important to have an external review which looks at the whole tender           process.

13.30  The Chair thanked the presenters for their contributions.

13.31  RESOLVED – that the report be noted.