Exclusive GP commissioners have put three quarters of all new contracts out to competition since taking over in April, potentially opening up huge swathes of the health service to take-over by the private sector.
Figures obtained by Pulse reveal that 63% of the contracts offered by CCGs since April were put to full competitive tender and 9% out to Any Qualified Provider.
The figures are the first to show the effect of the controversial section 75 regulations on the procurement of new services by CCGs since they came into force in April.
They show that despite assurances from ministers that the regulations would not force CCGs to use competition for services, commissioners are extensively using market forces to shape their procurement decisions.
These data were from 65 contracts offered by 63 CCGs since April and was obtained under the Freedom of Information Act. They reveal that contracts worth millions – and in some cases billions – of pounds have been put out to competition in the past few months.
Of these 41 (63%) were put out to competitive tender, six to AQP and 18 (28%) of contracts were offered to service providers without being put out to competition.
However, few of these were directly healthcare related, and included contracts such as archiving and records management, training projects and estates management.
Cambridgeshire and Peterborough CCG earlier this year said it was running a procurement process worth between £700m and £1.1bn over five years to provide care services for elderly patients, in a move branded the ‘most audacious sell-off to date’ by Labour.
Barnet CCG said it was tendering a children’s speech and language therapy service for £5.9m over three years, while Luton CCG tendered an ‘improving access to psychological therapies’ service for £3m over three years.
Tameside and Glossop CCG has put a diabetes service out to tender, worth £3m over three years. Meanwhile, Wakefield CCG is tendering for an asylum seeker health service worth £750k.
When asked whether they had awarded contracts without putting it out to competition, many CCGs – including Cambridgeshire and Peterborough – answered: ‘This would be contrary to the section 75 regulations.’
How section 75 has affected CCG procurement
Number of contracts offered: 65
Number put out to full competitive tender – 41 (63%)
Number of contracts offered via AQP – 6 (9%)
Number of contracts offered without being put out to full tender or via AQP – 18 (28%)
Source: Information provided by 63 CCGs under the Freedom of Information Act
Critics of the Government’s section 75 regulations say they compel CCGs to put services out to competition unless they can prove there is only a single possible provider, but the Government said that alterations to the regulations in March would put it ‘beyond doubt’ that commissioners were in charge of when to use the market.
Regulations issued by NHS England in May failed to include the promised Government opt-out to preserve the integration of services when awarding contracts for local services to GPs.
Dr Richard Vautrey, deputy chair of the GPC, said GP commissioners were worried about not falling foul of competition law and being challenged by large corporations over their decisions.
He said: ‘I think CCGs are worried about competition law and are very anxious not to fall foul of that, which may well be driving that particular pattern of behavior.
‘It would be helpful to know how much the tendering process is actually costing and whether CCGs are getting value for money, and whether they end up with a fragmented service rather than the joined-up service and integrated model, which is what the Government favours.’
Dr Nigel Watson, chair of the GPCs commissioning subcommittee, said there was a lot of confusion over what the rules are in this area.
He said: ‘There’s still lots of confusion, but CCGs need to be bold and commission effectively. Competitive tendering is costly and does not always achieve the best service.’
But Dr Steve Kell, co-chair of the NHS Clinical Commissioners leadership group and chair of Bassetlaw CCG, said the findings showed evidence that CCG leaders were ‘getting on and designing new services’.
He said: ‘Where we develop new services, it is entirely appropriate that we tender so we get the best services and the best value for money.’
But he added: ‘We need all of the [procurement] options and it is really important we look at the need for integration of services and… the proportionate time and effort spent by CCGs on smaller contracts.’