Have you got a tariff  voice? Mine is quiet, mutters away to me and usually includes the following phrases ‘but I thought that' or ‘yet the health bill says' or ‘no, that can't be right..'

Following the quiet voice there's sometimes  a loud headline that follows it. For example:  the originaI bill said there would be a ‘maximum tariff' , so when I read Sir David Nicholson's letter in February saying that would not be the case  my little voice was saying ‘but the health bill definitely says maximum tariff..'

 I tweeted the relevant section of the health bill (103 for anyone interested) to see what others thought.

Loud headline follows saying  health bill being partially amended – first time a partial amendment of bill since Mineral Workings Act of 1951 (again, anyone interested?)  - with most  notable u-turn being Lansley saying there will not be competition on price.

At a King's Fund breakfast briefing in June the private sector loudly said they were not happy about this change to the bill.  Jill Watts, Ramsay Health CEO said she was ‘deeply disappointed' at the health bill as only a third of NHS services were currently available under national or local tariff.

Then, out of the blue a DH diktat was issued telling PCTs to identify three mental health or community services to be provided under AQP by April 2012. I phoned some senior GP commissioners to get a reaction and got a diplomatic ‘ didn't know anything about that Sue' and a ‘I didn't know they were going to do that'. My quiet voice muttered – ‘you'd think they would know…'

Pulse headline that follows last month‘DH reviews "bonkers'"rules enforcing competition when commissioning community services.

The ‘bonkers' line was provided by Dr Mike Dixon, NHS Alliance chair and the story explained how the NAPC and NHS Alliance are ‘engaged' in talks with the DH about the rollout of the policy.

Last month I stumbled upon some new DH guidance on AQP. I was looking for something else on the DH site when I came across it.  This guidance says GP commissioners will have to negotiate with providers to set local prices for services not covered by national tariff.

My little voice is saying ‘but there's not supposed to be competition on price'….will there be a headline to follow?

The other side of the coin of course is that there are a notable number of GP commissioners who are willing to stand up and bravely ‘come out' as it were and say ‘competition on price is a good thing'.

One GP provider I was speaking to the other day bemoaned having to put up the prices for the outpatient service he provides to be in line with the local tariff. Putting prices up? It does seem a bit mad.

And finally, there are some GP commissioners who just don't seem to have grasped that you can't undercut the national tariff. At a recent conference, one GP said they had saved money by providing a service below the tariff. I heard that little voice again, But hold on, it wasn't mine. It was coming from the CCG manager sitting next to me -  ‘you're not supposed to' she was muttering to herself..