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Practices ‘could miss out on enhanced services’ as CCGs begin putting them out to AQP

Exclusive The first CCGs have begun putting local enhanced services out to tender through the ‘any qualified provider’ route, with GP leaders warning this could mean that practices will be ‘unable to compete for services they have always provided’.

CCGs in Essex said they are putting the local enhanced services – which are to be renamed ‘community service contracts’ from April 2014 – through the AQP route to avoid accusations of conflicts of interest that would arise were they to award contracts directly to practices.

Commissioners in other areas have also begun asking practices to complete onerous forms in order to be considered for LESs, despite local leaders pointing out that GPs have already provided the same information to different authorities, including the CCGs themselves.

GP leaders said that CCGs did not need to go down the AQP route and warned that the bureaucracy involved in tendering for services was ‘unnecessary’, yet the level of paperwork required could lead to practices missing out on services they currently provide.

From April, under new competition regulations, services will have to be put out to tender unless commissioners can prove that they can only be provided by a single provider.

The controversial AQP route requires providers to prove they meet NHS service quality requirements, prices and normal contractual obligations in order to be added to the list of qualified providers, from which patients can choose when they are referred to the service.

The professional bodies have warned that the AQP route would actually reduce choice, as the bureaucracy involved and the uncertain income would lead to practices shunning the services.

Until now, no CCG has said they are going to put enhanced services through AQP. But a statement sent to Pulse on behalf of Basildon and Brentwood, Thurrock, and Castle Point and Rochford CCGs revealed: ‘Given the potential conflict of interests  - CCGs with boards that are primarily made of GPs awarding contracts to primary care – it was considered that the AQP process was a fair and transparent way for commissioning these services long term. We are aware of the LMC’s position and we are in discussion with them.’

However, Dr Brian Balmer, chair of Essex LMC, said: ‘There is a real danger in this climate that some practices will not be able to compete for services they have always provided. We think this policy is complete rubbish. It looks like ambitious managers trying to make a name for themselves – but they don’t need to go down this route.’

Guidance from NHS England (then the NHS Commissioning Board) on local enhanced services issued in July 2012 stated that many services could be awarded without the need for tendering.

It said: ‘As now, for services for which there are no other possible providers, for instance because they require list-based primary medical care, or for services of a minimal value, CCGs will be able to commission services through single tender from GP practices.’

GPC deputy chair Dr Richard Vautrey said CCGs were concerned about legal challenges.

He said: ‘CCGs are doing this because they are fearful of legal challenges by private providers if they are not seen to be putting GPs under heavy scrutiny. If CCGs don’t go down this route they worry that other provider companies will threaten them with legal action.’

‘This is something that people have been fearful of. We have been thinking that more CCGs would go down the AQP route. But this involves a whole lot of bureaucracy, which has already been done as part of CCG processes. It’s simply unnecessary. Monitor has found that CCGs can use local commissioning arrangements to get the information they need.’

Pulse has also received a copy of a document sent by the Lancashire Commissioning Support Unit, which requires GPs and other potential providers to fill in what are known as ‘initial contract information’, covering safeguarding policy, serious untoward incidents, and insurance documentation. GPs in Lancashire also have to fill out ‘organisation crime profile’ forms which focus on violent incidents in the practice, bribery and fraud.

Mr Peter Higgins, chief executive of Lancashire and Cumbria consortium of LMCs said commissioners ‘are trying to be helpful’.

However, he added: ‘There is a fundamental issue here that needs to be taken up nationally. How many times do practices have to assure the same people that they fulfil their GMS/PMS contract, are CQC compliant, have a safeguarding policy and have a business continuity plan? It’s endless duplication.’

This follows Pulse’s report that practices are being burdened by extra paperwork to win certain local authority contracts for the provision of services including sexual health and long acting reversible contraception.