East Kent Wet Age-Related Macular Degeneration Service

Background: NICE Technology Appraisals (TA) for the use of intravitreally injected medication have had a significant impact on the treatment of macular disease associated with the development of choroidal neovascularisation (CNV). These conditions are Wet Age-related Macular Degeneration (WAMD) and Myopic Degeneration with CNV (Myopia CNV). Not only have these previously untreatable or poorly responsive disease states now become amenable to treatment but they also now require lifelong monitoring.

NICE have approved the use of both Ranibizumab and Aflibercept for treating WAMD and Ranibizumab for treating Myopia CNV Currently all treatment and monitoring of these 2 macular conditions is delivered by acute services, all patients experiencing symptoms or signs of either of condition are required to attend an acute service site for assessment and initiation of a loading dose of 3 intravitreal injections each one month apart. Subsequently every 4-5 weeks they must re-attend for monitoring and decision as to whether they require further injections. If an injection is deemed necessary they must attend the acute site for this – if not they continue to re-attend the acute site every 4-5 weeks for further monitoring indefinitely. However it has been demonstrated that there is now potential to safely repatriate these patients back to receive treatment and monitoring in primary/community care through appropriate commissioning. This will allow already overburdened acute services to concentrate on treating the other more complex indications for intravitreal therapy such as macular oedema due to diabetes or retinal vein occlusion as well providing a more cost-effective service closer to home for patients.

Requirements: To provide a Consultant Ophthalmologist led service for the diagnosis, treatment and monitoring of WAMD and Myopia CNV. It should be delivered at sites distributed throughout East Kent in locations convenient for patients and utilizing the skill set of local Ophthalmologists, Optometrists, General Practitioners with a Special Interest,(GPwSI) Nurses, Eye Care Liaison Officer (ECLO) and Ophthalmic Technicians.

The service must comply with relevant National Institute for Health and Care Excellence (NICE) and Royal College of Ophthalmology (RCO) Guidelines. As new drugs become available the service can utilize these following NICE guidance or Commissioner directive. The new pathway is expected to follow a community-based two-tier system, with providers designated as Tier 1 or 2 dependent on level of involvement in the pathway.

The role of each Tier is as follows:

Tier 1 : New Patients - Patient assessment and treatment initiation Tier 2 : Follow-up Patients - Monitoring and treatment continuation

Providers will provide Tier 1 or Tier 2 only or both.

Providers must make an Eye Care Liaison Officer (ECLO) available to patients at the point of care.

Additional information: To ensure operation in a fair and controlled manner, the Commissioner will conduct the procurement using a web-based system – sometimes referred to as an eSourcing portal. This is the only route through which the Commissioner will communicate with bidders and accept completed bids. Bidders who express an interest will be notified automatically of events throughout the procurement process. Bidders can use the system to access the tender documents and other material for procurements in which they have expressed an interest. The eSourcing portal is a third party service operated by BravoSolution. Bidders who encounter problems registering on the eSourcing portal should contact the BravoSolution help desk by email at [email protected] or by telephone on UK number 0800 368 4850. The help desk is available Monday to Friday from 8.00 am to 6.00 pm UK time. Bidders will be able to use the eSourcing portal to register their interest, to download the procurement documents, and to upload their completed bids. How to register A bidder who wishes to participate in a procurement but who has not already registered with the eSourcing portal, must register as follows: 1. Browse to the eSourcing Portal: https://commercialsolutions.bravosolution.co.uk 2. Click the link ‘Click here to register’ 3. Accept the terms and conditions by clicking ‘Continue’ 4. Enter the correct business and user details 5. Note the username chosen and click ‘Save’ when complete The bidder will shortly receive an email with a unique password (please keep this secure). Bidders who require any further assistance on the eSourcing portal should use the online help, or contact the BravoSolution help desk as above. To express an interest in this procurement, a provider must: 1. Browse to the eSourcing portal: 2. https:// commercialsolutions.bravosolution.co.uk 3. Login using their username/password 4. Click the link ‘Open Access PQQs’ (these are Pre-Qualification Questionnaires open to any registered provider) 5. Click the link for specific procurement PQQ to access the content. This project is identified on the Bravo portal by the title: NHS East Kent Wet AMD Service

6. Click the button ‘Express Interest’ in the box ‘Actions’ on the left-hand side of the page. This will move the PQQ into the ‘My PQQs’ page.

7. Click on the PQQ code, and access any attachments by clicking the link ‘Settings and Buyer Attachments’ in the box ‘Actions’

8. Choose to ‘Reply’ or ‘Reject’ (please give a reason if rejecting)

9. Optionally use the ‘Messages’ function to communicate with the Commissioner and seek any clarification

10. Note the deadline for completion, then follow the instructions onscreen

Bidders who require any further assistance on the eSourcing portal should use the online help, or contact the BravoSolution help desk as above.