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Market forces start to emerge

A loyalty to the NHS and having to ‘designate’ services to protect them from providers suddenly closing are emerging as key themes that will influence the new health market.

In a recent interview with Practical Commissioning, transition tsar Dame Barbara Hakin, said the majority of willing and able providers would be NHS but added ‘the most important thing is patient choice.’

Dr Hakin, added: ‘I don’t think there are any GPs that would want to deny their patients choices.’

The health bill makes provision for GP consortia to ‘designate’ services to protect them from providers pulling out of the market place or going bust.

At a Westminster Health Forum conference last week, Ernst and Young Partner, Andrea Longhi, previous director of commercial policy at the DH, said: ‘What happens when the first organisation, particularly an NHS one, goes into insolvency will be the test for me.’

At the same conference, Dr Richard Vautrey, deputy chair of the BMA’s GP committee, said he feared how Monitor would drive competition locally potentially preventing GPs working with their hospital.

Dr David Jenner, NHS Alliance senior policy adviser said Monitor would be a ‘fearsome beast’ with massive powers over the health service. He added that ‘designation’ was likely to involve a price premium but would ensure there was an obligation on the provider to continue to provide the service. ‘How it will be administrated I have no idea but for the sake of commissioners, there will have to be provision for AUP – Any Unwilling Provider – too.

Managing partner at Hempsons solicitors, Janice Barber, said the any willing provider model was ‘not being talked about anything like enough.’

She added: ‘If you’re a Foundation Trust, any willing provider should be causing you a great deal of anxiety at the moment.’

Middle class health tourism has also been identified as another potential driver of the health market.

Dr Richard Vautrey, deputy chair of the BMA’s GP committee, said the abolition of practice boundaries meant some patients would switch consortia to obtain certain services, for example IVF treatment.

‘It will be the middle classes that do that and the poorer people that lose out.’ He said.

He later added though that such ‘tourism’, might eventually result in national patterns being established as no consortia would offer certain services for fear of being inundated with new patients.

Dame Barbara Hakin