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CCGs 'urging GPs to refer to NHS trusts' against competition law

CCGs in some parts of England are urging GPs to refer patients to NHS hospitals ahead of private providers in an attempt to keep their local trusts viable, the head of a private provider has claimed.

Jill Watts, chief executive at Ramsay Healthcare, said CCGs in a ‘number of areas’ had been prioritising NHS trusts. This seems to be against the terms of the Health and Social Care Act, which says commissioners are not allowed to discriminate against certain types of providers.

The BMA chair told Pulse that, if Ms Watts’ claims were correct, the CCGs’ actions were ‘entirely appropriate’, but they were ‘on the face of it’ against the law.

Ms Watts made the claims at the Westminster Health Forum’s debate on choice and competition today. She said in a question and answer session she had seen some changes since April in terms of commissioners’ attitudes, including new people ‘who come with their own cultural beliefs, some positive, some less positive’.

She added: ‘What we have seen is different changes across the country. In some areas where we had almost adversarial relationships, and they didn’t want to use us at all, they are very keen to work with us now.

‘In another part of the country, where we have been providing very good service with excellent feedback, we have a lead commissioner who is very interested in protecting the local trust and has blatantly said “we will not work with you” has instructed GPs to direct all the work to the local trust.’

Ms Watts later told Pulse that there were a few commissioners across England who have prioritised NHS trusts over private providers.

Delegates at the forum discussed the implications around Section 75 of the Health and Social Care Act, which calls on commissioners to put contracts out to tender unless they can prove that the contracts can only be carried out by one provider.

It also includes a provision to prevent commissioners from discriminating in favour of certain types of providers – such as NHS trusts – but there is still uncertainty surrounding how this is applied in practice.

However, Dr Mark Porter, chair of BMA Council and a consultant anaesthetist in Coventry, told Pulse that the CCGs’ actions in promoting NHS trusts were ‘entirely appropriate’ to maintain NHS providers in the interests of patients.

He said: ‘What they are doing is entirely appropriate, but it appears on the face of it to be unlawful. This is another example of Government getting in the way of good decision-making.’

Dr Nigel Watson, chief executive of Wessex LMCs and chair of the GPC commissioning subcommittee, sympathised with the CCGs’ position.

He said: ‘It is a dangerous game if you are doing that. But I can also see there is still a number of block contracts and every patient that goes outside the block contract costs [CCGs] money.

‘They are sitting on fairly big deficits so they need to save money. What they cannot afford to do is for patients to exercise their choice to go around the country. They should not be doing it, but I can see what they are trying to point out.’

Ms Watts also predicted that there will be more challenges to CCGs’ procurement decisions because providers can go straight to an overview body, Monitor, instead of more expensive appeals processes.

She said: ‘Is there likely to be more cases going to Monitor? I could almost say yes. I think other providers have already taken cases there.

‘We have avoided taking it as the first line as we try and deal with it ourselves. But clearly where people behave right outside what the policy direction is, that is the only avenue.’

Readers' comments (12)

  • I have two words regarding competition law...if you don't like private providers ....nhs trusts are failing everywhere thanks to "competition"...i congratulate these CCGs, I wish my CCG had the balls to do the right thing also and protect my local NHS trusts from completely falling apart too.

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  • Vinci Ho

    When more people are prepared to break a law laid down solely by the government , what does that tell you about the law and the government ?

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  • Anon 4:50pm

    Perhaps a better question is why cant your local NHS trust compete with the other providers?

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  • Anon 5:21. without taking you the noddy school of business which you may need, Private organizations which cherry pick cases, do not undertake serious research and don't teach vs NHS organizations that do. Umm guess why one costs more!

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  • Perhaps a better question is why cant your local NHS trust compete with the other providers?

    It's a rather obvious answer. They have to take all-comers, and can't cherry pick the easy (and cheap) cases. It has always been the fact that some parts of a hospital subsidise other parts, and that difficult cases are balanced with easy ones.

    Pursuing this agenda will result in fragmented services and no big shiny buildings to send people when they are sick.

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  • I hope a CCG does go to court against Monitor's action on competition. I think it remains to be seen if the Health and Social Care act is actually enforceable when subjected to legal tests. It would be catastrophic for the NHS if CCGs or trusts went down on mass and I doubt any private provider would be able to pick up the pieces without becoming a zombie company. Some very interesting legal arguments could be developed such as what happens when legislation causes conflict with other statutory duties, like providing basic healthcare for example...

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  • but, Jill Watts, chief executive at Ramsay Healthcare, would say that, wouldn't she. If by making these comments, she puts doubt in just one CCG or one GP practice, that's more patients and more profits for Ramsey Healthcare - and less financial contribution to maintaining an NHS that can cope. If/when, it all collapses, I’m sure organisations like Ramsey Healthcare and their shareholders will be laughing all the way to the bank.

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  • One of my patients took a huge PE after a hip op in the lcal private hospital and needed an urgent transfer - over to the local NHS trust - guess running an ICU unit has extra costs that the private sector dont wish to bear.

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  • It's interesting because commissioning is about the best interests of the patient and it is clear that letting an NHS trust fail would not support that ethos. It would be fascinating to see a proper legal challenge about this however the consequences of a decision going against a CCG are unthinkable!

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  • The general public have been treated like idiots. Resistance to these legally-enforced changes need to be confronted. The markets will not work in healthcare, the private sector are only being semi-nice now because they don't have overall power, but just wait until they get the full reins. Collaboration with competition is an oxymoron. Repeal the Act, sack the government and take a stand.

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