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Local authority keeps all public health LESs with local GPs



A local authority in London has decided to allow GPs to retain all public health enhanced services without them being put out to tender, as LMCs lobby other councils to follow suit.

Brent Council has said that GPs must register with the local authority to provide the services, but it has assured practices that services will not be put out to full tender or to the ‘any qualified provider’ (AQP) process.

Local leaders have described Brent’s decision as ‘reasonable’, and have called on commissioners across the capital to implement similar processes.

Councils and CCGs were allowed to carry over LESs for one year after the health and social care reforms were introduced in April 2013, but the enhanced services will have to be recontracted as community service contracts from April this year.

As part of the reforms, local authorities were given responsibility for public health enhanced services and guidance issued by the Department of Health encouraged councils to use competitive procurement processes to appoint providers.

An investigation by Pulse last year revealed that local authorities and CCGs were already putting enhanced services out to tender through a fear that they will face legal challenges from other providers under section 75 of the Health and Social Care Act, which compels commissioners to put services out to competition unless they can prove there is only one possible provider.

But, while many CCGs have said they will not be putting enhanced services out for competitive procurement, Brent Council is the first local authority to do so.

Brent’s director of public health Dr Melanie Smith, a medical doctor with a public health specialism, said the council was convinced by the ‘strong public health argument’ for keeping the contracts with GPs as these provide ‘easy access’ to services like health checks and smoking cessation.

She said: ‘There are strong public health arguments for ensuring as easy access as possible to these services which include health checks and smoking cessation. We therefore are creating a qualified providers’ list which all local GP practices are able to apply to join. Any practice which meets the required criteria will be eligible to provide health checks, smoking cessation, IUCD fitting and chlamydia screening.’

The qualified providers’ list will only be open to GP practices, she added.

Dr Smith said that while the council regulations required all providers to be registered, they consciously tried to keep unnecessary bureaucracy to a minimum.

She said: ‘Brent Council inherited a number of public health LESs from the NHS. As the LES contractual route is not open to councils from 2014/5, we needed to move to a council-specific services contract in line with usual council processes.’

‘Practices apply electronically to the qualified provider list via a service qualification questionnaire. We have actively tried to minimise bureaucracy while ensuring we comply with the council’s contract standing orders and the Public Contract Regulations 2006. The creation of the qualified provider’s list is solely for LESs and does not include the wider public health services that transferred to the council, which will be re-procured in due course complying with good procurement practice.’

Dr Tony Grewal, Brent LMC secretary and medical director for Londonwide LMCs, welcomed the decision.

He said: ‘The director of public health [in Brent] is actually very reasonable and has invoked a clause in the competition regulations which allows the enhanced services to be exempt from any competition. The council has said that all suppliers of services have to be accredited but it’s a self-assessment accreditation and, although a bit tedious, these are things that all GPs are doing anyway for things like CQC and performers’ lists.’

However, he added: ‘My problem is that across London each council is doing things completely differently. This is one of the more sensible ones, but there are 27 of them and they are all doing something different. It is problematic [from the LMCs’ perspective] in terms of getting things negotiated. It is a lot of work but I think it is necessary because enhanced services are important for GPs both as income streams and patient services.’

‘At the moment I have not seen anyone putting it all out to competition and we are putting it to them quite strongly that using GPs, as registered list providers, makes a lot more sense. We have also pointed out to them the relevant regulations and necessary guidance that allows them to do that.’