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Independents' Day

More CCGs putting enhanced services out to competition

Exclusive GP practices face more competition for their local enhanced services, with rising numbers of CCGs using a full tender or Any Qualified Provider (AQP) when commissioning enhanced services, new data obtained by Pulse has revealed.

An FOI to 109 CCGs and 82 local authorities found that around one in five CCGs are using the ‘AQP’ route or putting services out to competition, compared with only 8% in 2013/14, when CCGs first began commissioning enhanced services.

It also revealed that one CCG had put all its enhanced services out to AQP since 2013/14.

However, the actual proportion of the value of the services being put out to competition remains fairly low.

GP leaders said that CCGs need to be more confident about not putting services out to costly and ‘onerous’ procurement processes.

CCGs and local authorities took responsibility for commissioning local enhanced services in April 2013, and were told that they would no longer be able to give them straight to GP practices.

The NHS reforms stated that services would have to be put out to competition unless it could be proved that there was only ‘a single potential provider’, leading to fears that GP practices would have to go through long and costly processes to provide enhanced services.

Pulse’s survey has revealed that more CCGs and local authorities are putting services out to tender, or through the AQP route.

In total, around 7% of all enhanced services funding by local authorities and CCGs was going to AQP and competition.

One CCG – NHS North Kirklees CCG – told Pulse it had put all its enhanced services out to AQP in 2013 under three-year contracts.

Elsewhere, NHS Nottingham City CCG, NHS Warwickshire North CCG and NHS East and North Hertfordshire CCG all put more than 50% of services to competition or AQP.

Dr Chaand Nagpaul, chair of the GPC, said that they had been long opposed to the ‘unnecessary competitive procurement of services that are sensibly provided by GP practices, which incurs huge bureaucracy and takes GPs and staff away from caring for patients’.

He added: ‘The tendering process is onerous, goes into disproportionate detail and requires huge amounts on info from practices.

‘CCGs need to be more confident of rules, so that they do not feel they have to put services out to tender.’

However, Dr James Kingsland, president of the National Association of Primary Care and an adviser to the Department of Health when it was devising the Any Willing Provider process, said he was happy to see more CCGs using AQP.

He said: ‘AQP was a way of reducing bureaucracy and costs. The idea was that if you were good enough, you would get services, but you weren’t guaranteed volume.

‘It should have been the norm by now anyway. The tendering process is complex and very costly, and ends up with a monopoly provider. AQP was a way of moving away from that.’

Readers' comments (9)

  • and then they wonder why practices are non profitable and closing. Arses and elbows.

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  • "‘It should have been the norm by now anyway. The tendering process is complex and very costly, and ends up with a monopoly provider. AQP was a way of moving away from that.’"

    Instead, the tendering process is compex, very costly, and ends up with many providers cherry-picking the easy cases.

    Well done!

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  • QOF will be scrapped completely eventually and all those targets will be converted to enhanced services which will then be put out for tender. This will be the end of General Practice.

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  • It's the privatization agenda coming into play for those who had doubts whether CCGs were 'our' organisation. This was what was meant by 'co-commissioning' with NHSE right from the outset and it was clear that the weaker partner or co-commissioner, which the CCGs are, will have no say when offering contracts for DES/LES and would have to play NHSEs game of tendering.
    Pity though as money essential for GPs to stay afloat is being channelled away from Contract holders. There was a decent way to do it- get the costing right and offer it to anybody willing to do it without the need to tender. But then again, that would be too transparent and inconvenient. GPs don't have the resources to tender as my colleague above has put it, so they won't even attempt a tender.

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  • these cheap aqp services will go burst one day like some icats and ccg would not know what to do. they say patient should be cared near home. aqp may be 15 miles away. who will pay for travel?? we will loose skills. when problems , then they will pass buck to gps

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  • The days of protected monopolies are over, unless you are NHSE that is. GPs need to go private or at least diversify and start using their skills to build up their footprint in the private sector. GPs also should not ideally be co-operataing and training up noctors to replace them.

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  • i'm not sure if we as GPs can stem the tide, but we can certainly be great at what we do and make general practice the only logical choice to deliver these services. Which seems more productive than just complaining about it all.

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  • Vinci Ho

    (1) How is one going to define 'good enough'? Is a patient's own GP knowing him or her well counted as better? Yes , you can argue enhanced service does not need to base on a GP's list .
    (2) The complex , bureaucratic tendering process was meant to monopolise one AQP including GP to deliver ultimately the service in question . To have multiple AQPs to deliver the same service , in theory, sounds politically pretty but the actual reward to provide the service will be spread so thin that any small AQP (including GP) will not be able to survive.
    (3) Bottom line is CCGs are squeezed from all sides: GP shortage means some enhanced services cannot be delivered by default . And the HSCB is forcing CCGs to go down the road of procurement with less and less freedom
    The biggest question is do you really believe that more procurement of services can really improve quality?
    Something necessary? Another white elephant ?

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  • We are a GP federation and run services under AQP contracts. They are dead easy to bid for and once you have done one a lot of the material is the same. They are also much easier to run.

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