Huge swathes of practice funding look set to be opened up to competition under new guidance that says only enhanced services of ‘limited value’ or where GPs are the ‘only capable providers’ should be commissioned directly from practices.
An official code of conduct from the NHS Commissioning Board on avoiding conflicts of interest in the NHS from 2013 urges CCGs to use AQP or full tendering for LESs as it adds ‘greater transparency and help reduce the scope for conflicts’.
Published today, the guidance also says that GPs on CCG boards will not be allowed to vote on commissioning LESs if they are potentially commissioning from their own practices.
All services currently commissioned as LESs – with the exception of public health services – will form part of CCGs baseline allocations from next April.
The guidance says CCGs will have to commission the services using the NHS standard contract rather than the GP contract, and must provide evidence that any proposed service ‘goes beyond the scope of the services provided by GP practices under their GP contract’, and that they have fully adhered to procurement rules.
It says CCGs must decide, subject to the proposed DH regulations on procurement and choice, ‘where it is appropriate to commission community-based services through competitive tender or an Any Qualified Provider (AQP) approach and where through single tender.’
But warns CCGs will only be able to avoid opening up services to the open market where GPs are ‘the only capable providers or where the service is of minimal value’.
It adds: ‘There may be circumstances where CCGs could reasonably commission services from GP practices on a single tender basis, i.e. where they are the only capable providers or where the service is of minimal value.’
In these cases, CCGs are advised to discuss the process with their local branch of the NHS Commissioning Board if they are in doubt.
The Board said the guidance would ‘enable CCGs and member practices to demonstrate that they are acting fairly and transparently’, but also ensure CCGs are not bound by over-prescriptive rules that risk stifling innovation or slowing down the services they wish to commission’.
GPs on CCG boards will not be permitted to commission LESs from their own practices, and will instead have to either refer the decision to the governing body and ‘exclude all GPs’ from voting , or co-opt individuals from a Health and Wellbeing Board on to the CCG Board to make the decisions.
In an interview with Pulse last week, Dame Barbara Hakin, national director of Commissioning Development at the NHS Commissioning Board Authority, said the code of conduct would be important for CCGs when determining potential conflicts of interest.
Dame Barbara said: ‘Where they want to commission a new service, it will be important that CCGs follow good procurement rules.
‘Where services could be provided by someone other than in registered list holder, then actually others ought to be given the opportunity to provide them, particularly if they are new services.’
‘This means, in the same way as PCTs do now, CCGs will be able to commission services exclusively from GP practices where they are the only possible providers, for instance because they are the registered list holder.’