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Independents' Day

GPs 'will walk' if ministers do not reword competition rules, says commissioning leader

Exclusive The Government must change the wording of its rules over the use of competition, or risk GPs deserting the entire clinical commissioning process, says the leader of the organisation representing CCGs.

Speaking to Pulse, Dr Michael Dixon, interim president of NHS Clinical Commissioners, said the rules risked forcing commissioners through expensive procurement processes and opened them up to expensive legal claims.

He added that this would mean some ‘would walk’ as the whole clinical commissioning project had been ‘a complete waste of time.’

NHS Clinical Commissioners, the independent organisation representing CCGs, says the wording of the new competition rules set out last week may have a ‘chilling effect’ on CCGs, who need freedom to decide whether to use competition or not.

The new rules, contained in section 75 of the Health and Social Care Act, have reignited the debate over the use of competition and private providers in the NHS.

Today BMA chair Dr Mark Porter called for a Parliamentary debate on the issue of competition in the NHS and the GPC warned earlier this week that GPs will have to waste time and money protecting their services if they are put out to competitive tender.

Speaking to Pulse, Dr Michael Dixon, interim president of NHSCC, said: ‘The danger about the current wording of section 75 is that it seems to put a duty upon the commissioner to go for competition with all contracts that are made.

‘We don’t want to get CCGs bogged down in protracted processes. The aim of clinical commissioning was to innovate to redesign, to try and ensure that we do more outside of hospital and in primary care. Now, if that is their aim and they start getting bogged down in matters of issues of whether or not they are being competitive, that is going to take their eye off the ball.

‘Unless the commissioner is king, the system is going to fall down. And worse still, the clinicians will walk and feel the whole thing has been a complete waste of time.’

He further warned that CCGs may have to defend claims from private companies for not having put service procurement out to tender, which they cannot afford.

He said: ‘It is going to make everyone watching their back and a whole industry of people who challenge things back and forth as to whether they have been sufficiently competitive or not, and opens the window to providers to challenge the CCGs, who with their £25 management allowance are not going to be in a position to go through the complexity of all of this.’

It comes as health minister Lord Howe rebuffed claims that the Department of Health is driving a privatisation agenda, which is why it has ‘always said that competition in the NHS should never be pursued as an end in itself, but only where this is in the interests of patients’.

Dr Dixon said: ‘I welcome those words from Lord Howe, who I think is very much recognising the issues here, but what I would say is that we must get the wording right. It is secondary legislation after all. It must read as what it means.’


Readers' comments (10)

  • Who really believed that Commissioners were ever going to be king??I always felt we were mere pawns in a much bigger game of winner takes all. Section 75 just confirms my thoughts all along that the only reason for this whole restructing is to allow the destruction of the NHS. Glad I'm out of it across the Atlantic.

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  • Are these new regulations going to spply to all hospital services as well? There's nothing in the wording to say they don't? Our contracts expire at end of March every year - does that mean CCGs will have to go to public tender for everything currently done by their local DGH or face competitive challenges? That's a huge procurement exercise!

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  • I was part of the process which developed the Principles and Rules for Co-operation and Competition under the previous government. The PRCC made it perfectly possible for commissioners to not tender where it was inappropriate. It worked. Having just read the new regulations, commissioners still have options, and I can't see any material change here from the existing rules. This looks less like a Tory plot, more like DH lawyers serving up yesterday's fayre under a new name on today's menu.

    In practice, private providers do not lightly resort to legal challenges to procurement processes. Most private providers of healthcare services have just one customer - the NHS - and are very wary indeed about being seen as trouble-makers. Challenges to date have tended to occur where commissioners have explicitly or clearly excluded non-NHS providers for reasons other than achieving best services for patients and best value for tax payers - typically, that they just believe that they should favour the NHS. Circle Health's challenge to the PCTs in Bath are a case in point.

    The Act and these regulations are very clearly aimed at curbing the cultural disposition to favour NHS provision, but that is not the same as favouring non-NHS providers.

    The whole point of competition is to give commissioners options to procure in the best interests of patients and to give them leverage (the threat of loss of position) over incumbent providers. It does not mean everything has to go to the private sector.

    And on that note, I find some of Dr Michael Dixon's sentiments to be rather troubling. The commissioner must not be king. The patient must be king, and commissioners must not forget it.

    I do not underestimate how much work commissioning involves for those now burdened with it (often reluctantly), but if there is privilege as well as privation to be had from the process then it is surely in knowing that one has done the very best possible job for patients.

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  • What I think the headline should read is GP's worried about breakup of cosy cartels. The act doesnt stop the change in where care is provided. What it stops is GP's on CCG Boards just deciding to give the work to GP's without any challenge or checking that GP provision represents best value for the patient. That doesnt seem unreasonable to me unless GP's fear they dont represent best value.

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  • Commentators seem hell bent to denigrate the value GPs bring to Commissioning. I remember when this whole process was foisted onto GPs that we, the GPs, had called for better control in managing our destiny and the health care system in our locality. To be accused of cronyism in deploying services is defamatory and does not help the debate. Section 75 is, pure and simple, a means to sideline the power of GP Commissioners. This is contrary to the spirit of the Health and Social Care Act. Patients are voters but they cannot ever have the breadth of knowledge and experience a healthcare professional brings to commissioning, particularly the GPs. To place patients on the throne of control of local services is a hostage to the integrity of the NHS in each and every locality.

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  • Peter Bennett | 27 February 2013 10:50pm I always felt we were mere pawns in a much bigger game of winner takes all.


    More like prawns I think. Just crazy to have taken this on!

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  • As Matt James points out, the Section 75 regulations don't change the current legal position. CCGs are already obliged to consider open procurement under EU law.

    Whilst most of the CCGs I work with on a daily basis understand the procurement requirements, and are not particularly phased by them, there are some clinical commissioners who think they can simply hand contracts for services to their mates - these are the ones that will be upset by the S.75 regulations.

    I have no doubt that clinical commissioning will work - but clinicians need to understand that they have to comply with the law (including EU law) and this means doing things in a fair, open and transparent manner. My advice to them is get yourselves some good procurement and commissioning staff - don;t try and do this yourselves.

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  • Wake-up . The agenda is privatisation of the health service and shifting blame away from the politicians to dump it on the poor suckers who have to drink from this poison chalice . If the real intent was to increase clinical imput to rationalising service - more GP's culd be put on the board of PCTs without the upheaval .

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  • Quelle surprise! It was Dr Dixon and his small but vociferous group of entrepreneurial GPs and self-appointed experts who managed to persuade Lansley and Co to introduce the disastrous NHS Bill in the first place, despite the massive opposition from the medical and other health care professions. They knew best, and they chose not to listen to the many wiser heads in the medical profession, the Royal Colleges, and the representatives of virtually all other official healthcare bodies and professionals.
    Now, things are beginning to unravel and it is all blowing up in his face. What is happening is precisely what we all predicted and, alas, this is just the tip of the iceberg as regards the disastrous effects that the introduction of the NHS Bill will have on patient care, team working, clinical linkages, multidisciplinary, multi agency care etc. Dr Dixon and his acolytes chose to ignore a fundamental lesson: never, ever, get into bed with politicians. Not only that: many of them were also having breakfast at Downing Street.
    I heard Dr Dixon's performance on this morning’s Today Programme and what he appeared to be arguing for could almost all have been provided from within the previous PCT framework, with very few modifications.
    Dr Dixon and his supporters (we know who they are: many of them feature in these columns where they have spent the last few years peddling their nonsense in addition to their written contributions to the Daily Telegraph et al) share a huge responsibility for the tsunami that is about to overwhelm healthcare in this country. Sure, there are many major problems within the NHS, but this was not the way to cure them. How on earth are the new arrangements enshrined in the latest massive reorganization of the Heath Service going to address and clear up the mess left by North Stafford and which, by all accounts, still prevail in a number of other hospitals and health care settings within the country?

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  • With reference to your comments David Lewis around patient involvement and patients are "just voters and can never have the breadth of knowledge..." I find your commentary very old school. Patients should be able to help shape the NHS and you may think they are just voters but they are your paymasters as well and certainly have a stake in how you provide health care to them. One of the problems with the current NHS is attitude crafted like this where the few and alleged knowledgeable determine direction without switching on their "emotional intelligent chip". Quite honestly and adding to the debate of the utopia of joining up health and social care where many seemed to have failed, the commissioners could do with seeing some bright lights to hold onto instead of the same old centric opinions. Do G.P's have an inferiority complex in light of your views?

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