A Cooperation and Competition Panel finding that a number of demand management initiatives are potentially illegal is a ‘hidden bomb' that could unseat GP commissioning, says a leading policy expert.
The interim report by the CCP into how the ‘any willing provider' model is working found some 70 PCTs suspected of already being in breach of its ‘principles and rules' through their demand management schemes including referral management centres, activity caps and restricting patient choice of provider.
Dr Shane Gordon, national co-lead of the NHS Alliance's GP commissioning federation and GP commissioning lead for NHS East of England, has already submitted a formal response to the CCP report arguing that if the finding is upheld it will be a licence for the ‘middle classes' to access a plethora of services, crippling GP commissioning budgets in the process.
Dr Gordon told Practical Commissioning: ‘If you take away referral management schemes, the restriction of procedures that can be provided then what levers has the GP commissioner got?
‘There is a potential Armageddon scenario where patients can choose anybody and they can offer anything they like and neither of those parties has any incentive to control their expenditure – and the GP commissioner becomes a bystander to this car crash.
‘All of these providers have to generate demand and they will whip up demand which will mean money going to them that should be spent on prevention and tackling health inequalities.
‘I went to a meeting recently and a large private provider said that if the any willing provider model is implemented they are quite happy to differentiate themselves from their competitors by offering rehabilitation in the Algarve to patients it gives knee replacements to.
‘The private sector is very clever at generating demand.
‘The new Atlas of Variation shows a four-fold variation, even allowing for age, need etc for some procedures.
‘If we're doing twice as many procedures as we need and then increase the number of providers who have staff to pay, the amount of activity will increase even further.'
The CCP report says the next stage of its study will focus on whether the PCTs' demand management actions would lead to benefits to patients and taxpayers which ‘should be weighed against any loss of patient choice or competition'.
Dr Gordon, said this was the ‘one ray of hope in that paper. But the fact that they're even contemplating this is extremely worrying.'
The final CCP report will be published in June.Dr Shane Gordon