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GP commissioners given green light to sidestep competition process for well-performing services

GPs have been given a boost in their bid to hold on to enhanced service income after the healthcare regulator told CCGs they can avoid putting services out to competitive tender if providers are already meeting the needs of patients.

Speaking at the Commissioning Live conference yesterday, David Furness, a competition adviser at Monitor, said CCGs should continue services that are ‘working well’ without putting them out to a full tender process or via the ‘Any Qualified Provider’ route.

GP commissioners have expressed concern about competition rules, with some CCGs putting all existing enhanced services out to tender for fear of legal challenges from other potential providers.  

GP leaders welcomed the comments from Monitor, and said they could help prevent practices from having to complete vast amounts of paperwork associated with competition processes and potentially losing enhanced services income.

Under Section 75 of the Health and Social Care Act, commissioners are compelled to put a service out to competition unless they can prove there is only one potential provider.

Providers who feel that the CCG has not adhered to the regulations have the option of appealing to Monitor.

However, Mr Furness’s comments to delegates in London suggested that CCGs would have a strong case to roll over enhanced services contracts if the current provision is benefitting patients.

He said: ‘If you’ve got a service line that is working well, you might have the opportunity to extend the contract, or you might want to renew it.’

He gave the example of a community dermatology provider that is working well, while other services are causing problems. He said: ‘You might want to go through a process that says, do we think this service can be improved? Does it still meet the need? If the answer is no, it can’t be improved, it still meets the need,  then that certainly would be situation in which you’re not required to go run a competitive process.’

Mr Furness emphasised this was a matter of local judgement.

He said: ‘I’m reluctant to say “okay services x, y and z you don’t have to” partly because, as I hope I’ve made clear, it’s actually about making judgement in local circumstances, so without knowing yours I don’t feel I can’t go further than that.’

‘But we certainly don’t go around CCGs saying you must run competitive process in every single instance.’

The comments followed a speech by the outgoing chief executive of NHS England, Sir David Nicholson, who said it was currently developing guidance for commissioners on the competition rules alongside Monitor.

Sir David also said the current state of competition regulation was ‘the worst of all worlds’.

Dr Peter Swinyard, chair of the Family Doctor Association, said of Monitor’s line: ‘It’s immensely welcome, we’ve had so much hassle. We’ve been providing enhanced services in various fields for so many years, and suddenly people have been saying… “we’re a bit worried about doing it in case we fall foul of Monitor”… and they haven’t actually got the cojones just to get on with it.`

Dr Andrew Mimnagh, a GP in Sefton, Merseyside, said: ‘From a providers perspective, there’s no doubt that formal procurement is massively complex, and massively time consuming and effectively neutralised out all but the most organised service or federated providers.’

‘This is a more welcome stance, from the points of view of existing small practices being able to contribute to clinical development as a provider.’