It is intended that a National Commissioning Body (NCB) will be responsible for managing the national catalogue, the national tariff, the national contract for the national loan equipment home delivery service, demand forecasting and the prescription clearing house.

Category Management & Supply Chain Group: It is intended that the Category Management & Supply Chain Group will provide an integrated, national solution managing our national catalogue, national tariff, demand forecasting requirements and the contract for the national home delivery service for the large items of equipment (beds, lifts, hoists) that will still be loan equipment.

The Programme, in conjunction with key stakeholders, is currently appraising options including:

• Key existing stores could be utilised as regional distribution centres
• New contracts, either local or regional, could be let
• Exisitng private sector national distribution networks culd be utilised

Our option appraisal exercise includes discussions with a variety of stakeholders and interested parties one of which is NHS Supply Chain provided by DHL, a leading international supply chain provider. NHS Supply Chain has a national contract with the Department of Health until 2016.

There has been no decision yet on the final option.

1. National Contracts and Supplier Relationship Management: The Category Management & Supply Chain Group will develop a specification for the national loan equipment home delivery service. The successful provider will be managed by the NCB and it is intended that there will be a collaborative approach to service delivery to ensure a quality, best value offering to users and local authority/health partnerships.

2. Retail Market Management: There will be a requirement for the first 2 - 3 years of the retail market model to work closely with retailers to ensure that retailer capacity remains in line with the national roll out plan. The Category Management & Supply Chain Group will mnagae the relationship with national retailers particulalry and will develop reporting feedback mechanisms with all retailers.

3. National Catalogue: A national catalogue has been prepared incorporating the most common items of equipment issued through community equipment stores in England. The TCEWS Programme involved occupational therapists and specialist nurses in the preparation of the national catalogue. Generic specifications, meeting clinical need, have been developed to ensure the widest range of equipment items are available in the retail marketplace. The catalogue is now being reviewed and signed off by professional bodies.

The catalogue is divided into Aids to Daily Living, provided through prescriptions redeemed at retail outlets, and loan equipment home delivery items, colloquially called ‘Big Kit' or ‘Complex Equipment.' Some items may appear in both parts of the catalogue.

Each local authority and health partnership will be able to tailor the catalogue to reflect the range of products they will provide within their locality. The national catalogue will reflect the full range of commonly offered equipment through out England.

There will still be special one off or bespoke items that will continue to be sourced locally. The Category Management & Supply Chain Group will review the items purchased nationally and consider additions to the national catalogue as required.

It is intended that the national catalogue will be reviewed regularly through an independent procust review panel and the process will involve users and their carers/personal assistants, practitioners and third sector organisations specialising in product evaluation, such as Ricability, Disabled Living Foundation, the College of OT's, NAEP Special Interest Groups, individual Experts.

4. National Tariff: A national tariff will support the national catalogue. It is intended that one price will be set across England for each product on the catalogue. The Category Management & Supply Chain Group will be commencing a market price benchmarking exercise in April to set the tariff price for these items. It is intended that the tariff will be created by averaging the lower quartile of benchmarked wholesale prices for each item and adding a small element of retail profit (retailer margin).

There will be a tariff for

• Each piece of equipment
• Delivery
• Installation
• Specialist fitting of equipment

The tariff will be signed off through the national Commissioning structure and it is intended that the tariff is in place for the end of June 2008. The national tariff will initially reflect Aids for Daily Living.

In addition retailers will receive a prescription handling fee per prescription raised in addition to the tariff for the cost of equipment.

5. Demand Forecasting: It is vital that there is robust information nationally to understand the historic and potential demand for community equipment.

Local commissioners will complete a new annual national standard Demand Forecasting Tool. The information will be forwarded to the National Commissioning Body.

The Demand Forecasting tool will contain the following information:

• Local population data
• Local joint health and social care demand for equipment
• Local actual spend

Prescription Clearing House: It is currently estimated that around 3 million prescriptions for Aids to Daily Living will be issued annually. Prescriptions can be redeemed at any accredited retailer, not just accredited retailers in the locality of the issuing local authority/NHS partnership.

Retailers will be required to send fulfilled prescriptions to a national prescription clearing house before they will be paid for the community equipment they have issued.

1. Processes: The prescription clearing house will receive prescriptions and enter the details into their system. It is intended that this will be through optical scanning systems but a manual process may be operated initially.

From the key information contained within the prescription the value of equipment issued by each retailer will be checked and the reimbursement calculated. It is intended that the prescription clearing house will be able to pay retailers and charge local authority/NHS partnerships but local authority/NHS partnerships could choose to receive collated information and handle payments to retailers direct from their own systems.

2. Management Information: There are key pieces of information contained within the prescription and the prescription clearing house will be able to generate a variety of reports to enable local authorities and their NHS partners to manage their local budgets.

Who could undertake the role of the National Commissioning Body?

The Transforming Community Equipment programme is in discussions with existing public sector organisations who provide similar services. We are working closely with the NHS Business Services Authority (NHSBSA) who currently manage the national Prescription Pricing Division (PPD) handling all the drug prescriptions, payments to pharmacists and charges to Primary Care Trusts for England. NHSBSA also manage NHS Supply Chain provided by DHL, a leading international supply chain provider. NHS Supply Chain (NHSSC) provide a national warehousing and distribution service for medical and general products to NHS premises across England. They are currently developing home delivery services for items such as incontinence and renal products. NHSSC currently have Category Management & Supply Chain Groups with expertise in the majority of the product areas we require.

Products

Whilst we talk about a retail model it consists of different components. These are dependent on the most appropriate supply chain for the different types of product. We have broken products into three main areas: aids to daily living: loan equipment (Products to support care in a home setting) and bespoke equipment

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Aids to Daily Living: Below are examples of products that will be available through retail outlets. This equipment will be owned by the user.

This is an example of the range of equipment that will be available in the ‘High Street' as the retail market matures

Loan Equipment Home Delivery Service: This is the equipment for users with complex needs and equipment to support their carers/personal assistants. A national contract is envisaged for loan equipment and home delivery, collection, decontamination and recycling for the items not included in the retail market model such as beds and mattresses. It is envisaged that one national logistics provider will provide this service and meet a next day delivery performance level. Equipment for hospital discharge will be part of this arrangement. There will be an option of a premium rate service (2 hour delivery time for 82% of post codes or 3 hour delivery for 95% of post codes within England) for items to be fast tracked. Below are examples of products that will be available through the loan equipment home delivery service. This equipment will be loaned to the user.

This is an example of the range of equipment that will be available for home delivery. We are still reviewing children's equipment.

Bespoke or Special Equipment: There will still be items that the service views as bespoke (or special) in that it is uniquely constructed for an individual. The challenge is to consider the unique requirements that define the best supply chain route. This equipment will most likely be loaned to the user.

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Recycling: Recycling will be an important aspect of the retail model.

1. Manufacturers: Manufacturers of community equipment products should be encouraged to develop products constructed from components made of recyclable materials. Many products appear to be over engineered for the domestic market as much of this equipment has been specified for use in institutional settings and we required longevity. We also think minimal packaging materials should also be explored.

2. Community Equipment Stores: Our practice has been to reuse equipment many times so it has had to withstand a number of decontamination processes. This has an environmental impact in itself through road traffic use, consumption of energy resources and waste water discharges.

The model supports the continued reuse of mechanical/electrical equipment colloquially referred to as ‘Big Kit.' This includes beds, lifts and hoists as described in the section on Products.

Part of the implementation process involves costing out the current refurbishment service to understand the true cost of reusing products per local authority and health partnership. Local implementation teams have an opportunity to discuss the provision of recycling and waste disposal information for inclusion in their local communications about the changes to the service.

3. Users and their Carers/Personal Assistants: Aids to daily living products will now be owned by the user. The national standard for information includes advice on thoughtful equipment disposal which can be linked with local authority information on recycling.