The Co-operation and Competition Panel (CCP) has given the go-ahead for foundation trusts to take over general practices, provided they implement a number of measures to overcome potential conflicts of interests.
It follows a CCP review of a Transforming Community Services merger in Warwickshire which will see the George Elliot Hospital NHS Trust take over three local practices that were previously run by the PCT. George Elliot Hospital NHS trust is not a foundation trust but the CCP said the case would be applicable to other cases involving foundation trusts that it had been asked to look at.
The case has obvious potential conflict of interests for the GPs involved as they will be both gatekeepers and employees of the main local provider of acute services.
The assurances, accepted by health secretary Andrew Lansley, include:
– Internal and external signs at the premises making it clear to patients the premises is owned by the trust
– A leaflet given to patients to read in the waiting areas of the GP practice explaining it is now owned by the foundation trust
– GP training on NHS Choices and Choose and Book
– Tracking of referral patterns from the practices
– The option of allowing the PCT to appoint a ‘choice adviser’ funded by the FT if the PCT feels this is necessary
The CCP has said the assurances are likely to be sufficient to address any potential adverse effects on patient choice and competition that might arise from other mergers taking place as part of the Transforming Community Services reforms.
Despite the assurances, in a statement the CCP said: ‘We continue to be concerned that there is the potential for a conflict of interest to arise in these circumstances and suggest that this is a potential issue for Monitor or the NHS Commissioning Board to consider in future, once they have been established.
NHS Alliance chair, Dr Mike Dixon, said the CCP’s recommendations were something of a ‘landmark’.
‘It’s very interesting the CCP have allowed this and it will make a lot of other foundation trusts think about whether to take over their front line outlets.
‘It creates a very large monopoly that’s secondary care centred. We’re all for bringing primary and secondary care together but not in the context of foundation trusts. It’s this secondary care pull that we’re trying to get away from.’
The CCP currently has an advisory role to the DH, secretary of state and Monitor.
Once the new competition regime is implemented and Monitor becomes the economic regulator it will have powers to enforce compliance and prevent anti-competitive behaviour.
At least six similar cases involving major local providers looking to take over general practices have been referred to the CCP including:
– The transfer of PMS/APMS contracts by NHS Salford with Royal Salford NHS FT
– The transfer of PMS/APMS contracts by NHS South Tees to South Tees NHS FT
– The transfer of PMS/APMS contracts by NHS Sheffield to Sheffield Health and Social Care Trust
– The transfer of PMS/APMS contracts by NHS County Durham and Darlington to County Durham and Darlington Foundation Trust
– The transfer of PMS/APMS contracts by NHS South of Tyne and Wear to South Tyneside NHS Foundation Trust
– The transfer of PMS/APMS contracts by NHS Oxfordshire to Oxfordshire and Buckinghamshire Mental Health Foundation Trust.
The Warwickshire case’s recommendations will apply to these and the CCPsaid it will not investigate the other cases individually.
In 2009 the CCP looked into the merger of a practice in Sunderland with City Hospitals Sunderland NHS Foundation Trust when it became one of the Government’s integrated care pilots.
At the time, the NHS Alliance said the scheme would create problems by enabling the foundation trust to refer to itself.
The CCP said it was confident appropriate measures were in place to ensure GPs at the practice referred appropriately and that there were enough alternative local practices patients could register with if they wished to attend a surgery not linked with the foundation trust.