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Nicholson awards NHS England ‘five out of ten’ for first-year performance

The chief executive of NHS England has admitted that its direct commissioning duties – which include holding the GP contract – has been a ‘weakness’, awarding it ‘five out of ten’ for its first-year performance.

Sir David Nicholson also said that the competition environment was the ‘worst of all worlds’ is his keynote address at the Commissioning Live conference in London – his last appearance before stepping down on March 29.

He explained that competition had been intended as a tool for commissioners to improve services for patients but that ‘between the regulation and legislation, we’ve lost it’.

Sir David said that CCGs had deserved ‘eight out of ten’ for their start, but warned that his own organisation had failed to focus on ‘direct commissioning’, which includes primary care services.

He said: ‘NHS England’s weakness has been our own direct commissioning. We spent quite a lot of time thinking about setting up CCGs and organising that, I don’t think we quite put the same amount of discipline in organising our own direct commissioning.

‘Part of the downside of how commissioning is organised at the moment is the split between primary care and other services commissioned at the local level.’

‘[So I’d give NHS England] about five out of ten I think, they’ve made a decent start but the potential is all there.’

Sir David also said NHS England needed to support commissioners in understanding the competition rules – which were the ‘worst of all worlds’.

He said: ‘NHS England as an organisation, needs to stand behind you to make it happen. I’m hopeful that we can do that, because I think the place that we’re in at the moment, is the worst of all worlds and it is stymieing our ability to improve some of our services for patients.’

‘That’s what I think – but I’m finishing on Thursday.’

Sir David revealed that NHS England was working with Monitor to address the lack of guidance for CCGs on when services – including current local enhanced services – should be put out to tender.

He said: ‘Competition wasn’t invented by the 2012 [Health and Social Care Act], it was there before. The attempt in the HSCA was to give us a local health based competition regulator, to avoid being sucked into a big national and European debate around competition.’

‘The intent behind it always was that competition is a tool available to commissioners to improve services for their patients. That was the absolute intent behind it. But somehow between that intent, the regulation and the legislation, we’ve lost it.’

Sir David stressed that competition should only be used to for improving care, and not because of fears of the external regulator or legal advice which invariably says ‘to be safe you have to compete’.

He said: ‘We’ve been struggling manfully – womanfully – with Monitor to get a simple set of rules that everyone can understand.’