The nuts and bolts of the any willing provider model
Editor Sue McNulty looks at the hot topic of the any willing provider contract
Editor Sue McNulty looks at the hot topic of the any willing provider contract.
What is the AWP model?
AWP is essentially a list of suitable providers patients can be referred to. Its raison d'etre is to create greater choice and competition in the health service
The beauty of AWP is that it encourages more providers into the local marketplace without them needing to go through a heavyweight tendering process.
The downside, if you like, for providers is there is no guarantee of the volume of work they will receive and it's down to them to market their service and draw in the punters.
To get on the list a provider has to be accredited by the PCT to ensure it meets national minimum quality criteria as set out by the Care Quality Commission.
Once on the AWP list you are entitled to go on Choose and Book.
The PCT is supposed to continually monitor the quality of accredited providers though anecdotal reports suggest PCTs could be more robust in this role. If concerns arise about a service, the PCT can serve notice for it to be removed from the list.
The guidance on AWP is not contained in a single document (see box below) but has evolved since 2006.
Why is AWP use set to grow?
The latest key Department of Health document on PBC, Clinical Commissioning: our vision for PBC, says (page 16): ‘World class commissioners will increasingly use any willing provider arrangements.' And on page 15 it says ‘robust governance has too often been mistaken to mean drawn-out approval processes or open tendering for all new services'.
Perhaps more of a lever for AWP though will be the opportunities it offers to save money if the service being provided is sufficiently different from the traditional hospital model, as the Payment by Results tariff does not necessarily apply.
The 2006 DH document, Practice-Based Commissioning: Practical Implementation (paragraph 3.45), says PbR only applies if a service is the ‘same as' an existing hospital service with its HRG hospital tariff ‘casemix' payment system. In other words, for PbR to apply, the alternative service must cover all the patient journey ‘parts' that would otherwise happen in a hospital – from diagnostics through to the discharge letter.
The 2006 guidance (par 3.40) says there should be open and transparent publication of prices and that they should be available to all PBC commissioners.
In these cash-lean times the AWP model also negates the need for a traditional procurement process, which itself can run into tens of thousands of pounds.
So what does have to be tendered?
The 2006 guidance (par 3.43) is very clear that a service should only undergo the traditional procurement process if an ‘unavoidable monopoly' is to be the outcome. It says: ‘This would be, for example, where the proposal seeks to move a whole service out of a local hospital without an equivalent service available within the PCT boundary.' FAQs on the PBC section of the DH website also give a concise answer saying the same thing.
Commissioners need to be mindful of the ‘Principles and Rules for Co-operation and Competition 2008', which say providers should be best placed to deliver the needs of their patients. So a commissioner who does not tender in any way – either traditional procurement or AWP – needs to demonstrate they have taken this decision with their eyes open in case an aggrieved provider later challenges them.
But my PCT says anything over the EU directive of £139,983 has to be tendered?
The May 2008 document PCT Procurement Guide for Health Services is the document you need to read on this one.
It repeatedly makes the point that clinical services come under part B of the EU public procurement directives and so, while some procurement rules apply, they are not subject to the full procurement rules regime (click on 'EU part A and part B' table on right of this page).
Somewhat frustratingly, par 3.6 says to comply with the requirement for transparency, non-discrimination and equality of treatment, ‘contracting authorities may wish to adopt approaches required for part A services'. It's easy to see why some PCTs have therefore adopted a heavy-handed approach.
To be fair, though, the same paragraph goes on to say that each contracting authority should take ‘proportionate and appropriate action to ensure a fair playing field among providers' and par 2.5 says ‘providers looking to supply a routine elective service, including those developed through PBC, tendering is not required, but in the interests of openness and non-discrimination, consideration ought to be given to advertising to ensure competition'.
The bottom line then is that advertising a new AWP service is important.
The Supply2Health website was created specifically for advertising part B health and social care services and a notice here would satisfy any advertising benchmarks as any serious alternative provider would be checking this website on a regular basis.
Notices of AWP awards should also be posted on the Supply2Health website.
How do I get on the list?
PCTs either run a managed or open list.
If they opt for the latter this means they will be prepared to accept proposals from providers at any time.
If they go for a managed process this means the PCTs award contracts at discrete moments in time for particular purposes.
Each PCT should have a policy document on AWP and it's obviously worth a read.
However, Christine O'Connor, chief executive of Catch On Group, says that in her experience the PCT having an open or managed list is largely irrelevant. She says: ‘A much bigger issue for providers is proving they are fit for purpose to get on the list. That's the hardest part to get through.
‘PCTs can limit the number who go on the AWP list but it's in their interests to
have a selection as not every provider will do everything.'
I've heard you can't use the AWP model if you're offering services to patients from outside your practice list
Mark Johnson, managing director of TPP Law, and Dr James Kingsland, NAPC president, both say there is nothing in the guidance to suggest this.
‘Once approved, a provider can provide services to any patient in the locality, regardless of whose patient list they are on,' says Mr Johnson.
Christine O'Connor, managing director of Catch On Group, one of the companies appointed by the DH to support PBC, agrees: ‘Patient list is irrelevant for this model and you can provide the service to any patient who chooses to come to you. The money follows the patient and you will be paid on footfall. That's what the "willing" word is getting at – the provider understands there is no guaranteed funding attached to this approach.'
Thanks to Catch On Group, TPP Law and NAPC president Dr James Kingsland for their help with this article
This article was shown to the relevant section of the DH to ensure accuracy
The any willing provider model encourages more providers into the local marketplace The any willing provider model encourages more providers into the local marketplace The relevant DH documents for AWP The relevant DH documents for AWP
- Health Reform in England – update and commissioning framework (par 3.1-3.15)
-Practice-based commissioning: practical implementation (section 3.34 onwards)
– NHS Operating Framework 2008/09
- PCT Procurement Guide for Health Services (updated version to be published autumn 2009)
– Clinical Commissioning: our vision for PBC
EU Directives - part A and part B