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GPs will be hit by legislation requiring CCGs to use competition, warns GPC

GPs will be forced to waste time and money defending their practice resources from competition under proposed legislation for the NHS that will require CCGs to put all services out to tender ‘as a default’, warns the GPC.

The claims come after the Government published its draft regulations for CCG procurement, giving Monitor new wide-ranging powers to reprimand CCGs that have not ‘considered the full range of options’ before commissioning services.

The GPC has branded the secondary legislation, titled ‘Procurement, Patient Choice and Competition’, a betrayal of Government promises that CCGs should be able to use competition only when it served ‘patient’s interests’.

It also said that they would have a large impact on GP practices, bidding for new local enhanced services, or defending existing services when they are put out to Any Qualified Provider.

The draft regulations do make one concession, that CCG procurement arrangements ‘must not include any restrictions on competition that are not necessary to achieve intended outcomes which are beneficial for patients’.

But GPC negotiator Dr Chaand Nagpaul said this ‘slight provision’ would still require CCGs to justify when they decided not to use competition and meant using AQP would be the norm for commissioning services.

He said: ‘These regulations are placing a compulsion on CCGs to use competition by default, with exceptions to this occuring in defined instances. I think that reneges on the commitment given by Government to CCGs at the passing of the bill.

‘An ideological requirement for competition will be bureaucratic and will force CCGs to commission with the private sector. The last thing CCGs need is to be spending all of their time putting out every service to tender. There is a huge bureaucracy and expense involved in processing tenders.

‘It will affect GPs because the last thing we want is for CCGs to be incurring expense, delay of going through tendering processes, but also we don’t want GPs as providers to be putting unnecessary time and expense into tendering for services either.’

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Writing to CCGs in February 2012, Mr Lansley said: ‘It is a fundamental principle of the bill that you as commissioners, not the Secretary of State and not regulators, should decide when and how competition should be used to serve your patients’ interests. The healthcare regulator, Monitor, would not have the power to force you to put services out to competition.’

CCGs will now have to publish details of all procurement decisions, after the Department of Health declined to implement a suggested minimum value of £10,000 before publication was required. This data will be open for scrutiny by Monitor and may also be collected in a central database, after the DH tasked Monitor to look into how best to put a suggestion from the private companies’ representative group, NHS Partners’ Network, into practice.

Monitor and the NHS Commissioning Board will now draft additional guidance to commissioners on how best to comply with regulations, to be drafted and consulted on in coming months. Dr Nagpaul said that it is vital that the regulations, which will apply to all local services including LESs going forwards, does not create huge bureaucracy with CCGs wasting money on tenders.

The DH said in its response: ‘Given the current fiscal situation, the NHS is facing one of the tightest funding settlements in its history. We therefore need to ensure that commissioners operate within a framework of rules so that they secure the best clinical services for patients and deliver best value.’

The consultation on competition regulation, entitled ‘Securing Best Value for NHS Patients’ ran from August to October last year and saw over 80 responses. This included submissions from the BMA and the RCGP as well as private companies such as Virgin Care and Weight Watchers.

Pulse Live: 30 April - 1 May, Birmingham

Pulse Live

Richard Apps, partner at RSM Tenon accountants, will be presenting a session on ‘Maximising your income and keeping an eye on your cashflow’ at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers.

Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.

To find out more and book your place, please click here.

Readers' comments (8)

  • Cue the Private Sector to come and cherry pick those QOF areas easily done cheaply by employed nurses. eg diabetic monitoring, COPD checks, asthma checks etc etc etc.

    GPs will lose that income and the Government will claim it as a great thing because it will free up more time for GPs to what they do best ie see ill patients.

    Why would any young doctor want to be a GP in the UK?

    Why would any doctor want to take on being a partner with all the c**p it brings with it, CQC, QOF, fighting to be paid for services etc etc?

    Pay off your debts and retire asap!

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  • Peter Swinyard

    Another tragic example of the loss sustained by the NHS when Andrew Lansley was kicked out in the reshuffle. Whatever you think of his health act (be polite now!), he at least understood the NHS and general practice and would not have allowed this ghastly secondary legislation to come to pass. One can only suspect that the lobbying from the big guns of private industry is heard loud and clear in the corridors of power and this secondary legislation is despicable and unaccountable. It must be fought.

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  • I assume from the comments made that GPs think they should be protected from competition. Tenders to bid under AQP are so heavily weighted in favour of the status quo (GPs do, after all, have the systems already in place whereas anyone bidding does so from a standing start) so I belive the only GPs with anything to worry about are those that are not doing the job properly in the first place.
    By the way, GPs have no qualms about "extending their services" into other areas such as pharmacy etc, on the basis of "increasing patient choice" - and yes, I am a Pharmacist

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  • It will affect the practice by hitting the non GP clinician. Currently my PN and HCA do alot of the basic QoF check. If there are problem they'll let me know. They also do non QoF but helpful services along side their QoF work - ECGs, urine dips, pill checks, advice on glucosemeter, some practice organizations, taking blood etc etc. If the private sector is to Cherry pick easy QoF areas, we will probably not be able to afford to have current set of nurses/HCAs. And along side their jobloss, other non QoF work they have been providing will be lost too as they are non profitable (and some are non essential under GMS contract) and unsustainable in the currant climate.

    The DoH really need to look at practice service as whole.

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  • GPs using their medical skills managing the NHS rather than treating illness....will never happen.......

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  • Too expensive to do this bureacracy when it cost the PCT, but now that CCGs get a fixed amount from the public purse for their admin, isn't it right and proper that they should have extra bureacracy forced on them to pay out of their own pocket?

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  • More privitisation to kill the NHS. Just more and more a direct attack, rather than some sneaky back-door dealings.

    Be great for my choice as an NHS patient isn't between a range of highly skilled GPs, but between lowest possible bidder private providers that won't know what to do when something outside the box comes up.

    While I may not always agree with some of the views of those in Primary Care, I know everyone involved works damn hard for the good of patients, unlike private sector.

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  • I do not think we need to fear the private sector at all. The NHS exists in its current form because doctors used to and a few still do very long hours for peanuts. Work out take home pay per consultation today - it will be between £2 -£ 4. If the private sector can provide this cheaper - good luck to them. What will happen is that health and safety will appear to doctor's workloads and prices will go up. That is why patients go bankrupt in the USA from medical bills. As an older GP, I really do not want expensive private sector.

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