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CCGs ‘urging GPs to refer to NHS trusts’ against competition law

CCGs in some parts of England are urging GPs to refer patients to NHS hospitals ahead of private providers in an attempt to keep their local trusts viable, the head of a private provider has claimed.

Jill Watts, chief executive at Ramsay Healthcare, said CCGs in a ‘number of areas’ had been prioritising NHS trusts. This seems to be against the terms of the Health and Social Care Act, which says commissioners are not allowed to discriminate against certain types of providers.

The BMA chair told Pulse that, if Ms Watts’ claims were correct, the CCGs’ actions were ‘entirely appropriate’, but they were ‘on the face of it’ against the law.

Ms Watts made the claims at the Westminster Health Forum’s debate on choice and competition today. She said in a question and answer session she had seen some changes since April in terms of commissioners’ attitudes, including new people ‘who come with their own cultural beliefs, some positive, some less positive’.

She added: ‘What we have seen is different changes across the country. In some areas where we had almost adversarial relationships, and they didn’t want to use us at all, they are very keen to work with us now.

‘In another part of the country, where we have been providing very good service with excellent feedback, we have a lead commissioner who is very interested in protecting the local trust and has blatantly said “we will not work with you” has instructed GPs to direct all the work to the local trust.’

Ms Watts later told Pulse that there were a few commissioners across England who have prioritised NHS trusts over private providers.

Delegates at the forum discussed the implications around Section 75 of the Health and Social Care Act, which calls on commissioners to put contracts out to tender unless they can prove that the contracts can only be carried out by one provider.

It also includes a provision to prevent commissioners from discriminating in favour of certain types of providers – such as NHS trusts – but there is still uncertainty surrounding how this is applied in practice.

However, Dr Mark Porter, chair of BMA Council and a consultant anaesthetist in Coventry, told Pulse that the CCGs’ actions in promoting NHS trusts were ‘entirely appropriate’ to maintain NHS providers in the interests of patients.

He said: ‘What they are doing is entirely appropriate, but it appears on the face of it to be unlawful. This is another example of Government getting in the way of good decision-making.’

Dr Nigel Watson, chief executive of Wessex LMCs and chair of the GPC commissioning subcommittee, sympathised with the CCGs’ position.

He said: ‘It is a dangerous game if you are doing that. But I can also see there is still a number of block contracts and every patient that goes outside the block contract costs [CCGs] money.

‘They are sitting on fairly big deficits so they need to save money. What they cannot afford to do is for patients to exercise their choice to go around the country. They should not be doing it, but I can see what they are trying to point out.’

Ms Watts also predicted that there will be more challenges to CCGs’ procurement decisions because providers can go straight to an overview body, Monitor, instead of more expensive appeals processes.

She said: ‘Is there likely to be more cases going to Monitor? I could almost say yes. I think other providers have already taken cases there.

‘We have avoided taking it as the first line as we try and deal with it ourselves. But clearly where people behave right outside what the policy direction is, that is the only avenue.’