The Cooperation and Competition Panel has published its interim findings into primary care trusts’ use of the 'any willing provider' policy for elective care in the NHS.
Its initial conclusions indicate that there have been more than a few teething problems in making sure that commissioners are compliant with the NHS’s competition rules, which aim to give patients real choice over their care.
The findings contained in the interim report reveal that up to 70 primary care trusts have been engaging in behaviour which is 'inconsistent' with the NHS’s own principles and rules for competition. PCTs, and in some cases Strategic Health Authorities, are alleged to have restricted patient choice through a number of methods. Among the anti-competitive charges aimed at PCTs are allegations that GPs were given explicit directions to use specific services for their patients and the range of services which independent providers could offer was being constrained.
While independent sector healthcare providers anticipated some ‘bedding in’ issues during the transition from national to locally held contracts with PCTs, the cases highlighted in the report indicate that PCT behaviour has gone far beyond this.
The report’s initial findings leave little doubt that if such practices continue then patient choice will be adversely affected, at least in the short term. But there is also the worrying possibility of longer-term damage if independent providers lose confidence and start to back away from the NHS market.
The government has acted swiftly in response to the CCP’s report and has announced it will extend the current national contracts until June to provide more time for the transition to be sorted out. This will also allow time for the CCP to complete its report and, one hopes, come up with a way forward that protects patient choice and the any willing provider principle. This will go some way to resolve the immediate issue, but there are bigger factors at play, most notably the need to establish the ground rules for 2013, when GP-led commissioners take over from PCTs, and Monitor takes up the reins as an independent regulator.
The government’s NHS reforms aim to give patients the freedom to seek out and use the healthcare providers offering the best care. Under those reforms, the any willing provider policy will be applicable to a much wider range of services, not just elective care. Given the policy will be wide-ranging, there must be strong safeguards in place to hold GP commissioners accountable for protecting patient choice - as well as securing value for £80 billion of taxpayers’ money.
In the political arguments about the reforms it is easy to lose sight of the fact that the use of competition, tailored to the specific circumstances of healthcare, and rigorous application of procurement best practice, will be key weapons on the side of patients and those responsible for public funds, not the threat which is sometimes suggested.
The government is rightly committed to giving patients greater choice and independent sector providers have already played a significant role over the past decade in turning choice into a reality for NHS patients. This latest turn of events shows how important it is to have a competition regulator to keep the process going in the right direction.
David Worskett is director of the NHS Confederation’s NHS Partners Network
