Health secretary Andrew Lansley has insisted CCGs will not be forced to use competition if it does not best suit the needs of their population.
Speaking at yesterday's joint NHS Alliance and NAPC Clinical Commissioning Coalition conference for CCG leaders, Mr Lansley said the legislation was ‘absolutely clear' on how competition should be used.
‘Competition and cooperation are tools. The legislation doesn't change the rules on competition in the NHS at all. It just means Monitor administers them – that's it.
‘The Competition and Cooperation Panel forms part of Monitor. They actually technically will be applying the same rules in the future as have been applied in the past.
‘What that means is that if you go out to competition you have to do it in a way that's fair. But before that issue of going out to competition, you can make a decision about what shape of services you're looking for. So if you were to say we require for our purposes in our geographical area and are not looking to go out to competition you don't have to.'
He said CCGs could also state they wanted a ‘end to end' service for a particular disease, for example diabetes. ‘Nobody is going to come along and say I'm going to force you to unbundle one bit of it, say the community bit.'
He added: ‘Monitor can't wander in and say you must apply competition to your commissioning activity. Their job is to ensure that when you use competition, it happens fairly.'
Earlier at the conference, David Bennett chairman of Monitor had explained how there was still a large amount of work to do to interpret the Act.
‘Although we now have an Act, the bill has been passed and it is in that sense fixed. But we still have a huge amount of work to do to work out what it really means.'
He added ‘ the exact extent' of how the Competition Act and EU law, which existed before the health bill, would be applied to commissioning groups was ‘unclear'.
Further detail on procurement practices to which CCGs must adhere will be set out in secondary legislation and regulations later this year and are currently being worked on by the Department of Health.
Dr Brian Fisher, NHS Alliance network lead for Public and Patient involvement called for greater clarity on the issue of competition.
‘I found Andrew Lansley's response very laissez-faire and said it's really up to CCGs to decide on whether they tender something out or not. But I actually spoke to David Bennett after his talk and he said that wasn't the case. He said it was the case that someone like Virgin could challenge the decision that a CCG had taken and go to Monitor. So I am really quite confused now and it would be very helpful to clarify it as it's going to be a very big issue.'
NAPC chair, Dr Charles Alessi said: ‘My understanding is exactly as Andrew Lansley described - that it is up to commissioners to decide whether to invoke competition or not.
‘Should a commissioner completely ignore a inequality that exists in their local population and do something without the appropriate processes and without a audit trail of why they're not invoking competition then clearly Monitor would be involved.'