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Commissioning dilemma – the need to declare a market

A dermatology GPSI works at your practice and has always provided services to your practice and several neighbours. Can you continue this arrangement under the commissioning plans, or does do you need to declare a market under any willing provider? Dr Shane Gordon advises.

Ensuring competition in the provision of services is a big plank of the proposed reforms. Monitor will be given new powers (similar to the Office of Fair Trading) to ensure adequately competitive markets and will effectively be able to force commissioners to introduce competition if providers feel excluded. This might mean that you need to have more than one choice of Dermatology service available to your patients. Given that this is a GPwSI service it is likely that patients already have a choice locally, between the GPwSI and the local hospital.

Three aspects of this arrangement might be called into question. Firstly, have you as a commissioner conducted the procurement of the service in a transparent way which avoids clear conflicts of interest? Have you taken steps to declare any financial interest in the GPwSI service, for example if it brings income into your practice? Did you exclude yourself from the processes of letting the contract and setting the price? Secondly, was the market opened up to other providers of Dermatology services? One way to do this might be by using an Any Willing Provider contract under which any suitable provider can offer services under a tariff arrangement. That would mean that the providers only get paid if they successfully attract patients into their service. Secondly, are you as the referrer making patients aware of the available choices? Ensuring that your providers are listed under Choose and Book and on NHS Choices would allow patients to see the range of services available and make more informed choices.

Creating a competitive marketplace for providers will become an important role for GP Commissioners. Providers will do well if they meet the needs of both patients and referrers.

Dr Shane Gordon is GP Commissioning Lead for NHS East of England, national Co-Lead of the NHS Alliance’s GP Commissioning Federation, and chief executive of the North East Essex GP Commissioning Group

Dr Shane Gordon