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Practices who fail to offer choice to face crackdown from CCGs following Monitor ruling

Practices and GP commissioners have been warned by the competition watchdog that they must offer patients a choice of secondary care providers after it found against two CCGs for failing to publicise that care was being offered by a private provider.

A report by Monitor found that the NHS Blackpool CCG and NHS Fylde and Wyre CCG in Lancashire had not ensured that GPs were offering patients adequate choice of provider for their first outpatient appointment.

It followed a complaint from Spire Healthcare that the CCGs had asked GPs to direct patients away from the Spire Fylde Coast Hospital, towards the Blackpool Victoria Cross, although this complaint was dismissed.

Monitor does not regulate practices themselves, but it has warned that other CCGs must ensure that they and their practices look to the ruling to identify whether their own operations may be causing a similar breach of regulations.

But GP leaders have said that most patients are concerned with good care rather than being offered choice, while the chief clinical officer of NHS Blackpool CCG has said that Monitor made the ruling without consulting any GPs.

The watchdog’s report states: ‘Under the relevant rules, commissioners must take proactive steps to ensure that patients are being offered a choice of provider when they require an elective referral (whether by their GP, dentist or optometrist) for a first outpatient appointment with a consultant or consultant-led team (Standing Rule 39).’

It criticised the two CCGs for failing to ensure that GPs were offering this choice.

The report stated: ‘We found that the commissioners had not ensured that GPs had offered this choice to patients. We therefore found that the CCGs did not comply with their obligations under Standing Rule 39.’

NHS Fylde and Wyre CCG has since introduced an enhanced service for practices to offer patients choice, as well as a patient survey, and is publicising the choice policy on its website.

Monitor says the ‘proposed contractual arrangements with GPs could help Fylde and Wyre CCG meet its obligation to ensure patients are offered choice and that patient choice is publicised and promoted’.

However, it also raised concerns that only 80% of patients needed to be offered choice to trigger the enhanced service payments, and that the voluntary scheme’s impact would depend on GP uptake.

Catherine Davies, executive director of co-operation and competition at Monitor, said: ‘Patients have legal rights to make choices about aspects of their NHS care and commissioners have an important job to do making sure that patients are offered a choice by their GPs.

‘Commissioners in other parts of the country will no doubt want to see what lessons they can learn from this case about how to make sure patients are offered a choice and how to promote and publicise those choices.’

But Dr Nigel Watson, chief executive of Wessex LMC and former chair of the GPC commissioning subcommittee, told Pulse that choice was not a priority for GPs.

He said: ‘GPs are, as individuals, required to do the best for their patients. My experience is that patients don’t necessarily want choice, they want to go to where best fits their needs. That’s part of the GP’s job as the patient’s advocate, but I think the vast majority of GPs, where applicable, will offer choice.

‘We just need to move away from pointless tick box exercises and I think all patients know there’s choice. For GPs, if you live in the middle of Southampton and there’s one hospital, then it’s likely you’ll be referred to that one hospital. Where I work I’ve got the choice of three, so I’ll ask “which one of these three do you want to go to”? But I think it’s a battle and an issue that’s a non-issue really, but it blows up where someone complains.’

Dr Amanda Doyle, chief clinical officer for NHS Blackpool CCG and co-chair of the NHS Clinical Commissioners Board, said: ‘We recognise that Monitor did not find enough evidence that we promoted choice in GP surgeries or on the home page of our website. We will be looking to implement their recommendations in this regard.

‘It is somewhat concerning, however, that in their search for evidence to demonstrate whether choice was promoted and offered in GP surgeries, not a single GP, practice manager or patient was spoken to by the investigating team, nor was a single practice visited. Placing the burden of proof on CCGs in this way causes unacceptable pressures in terms of both cost and administrative capacity.’

Liz Cousins, hospital director at Spire Fylde Coast Hospital, said: ‘We look forward continuing to work in partnership with Blackpool CCG and Fylde and Wyre CCG to provide NHS patients with the high-quality care and choice that they expect.’