GP commissioners will have to negotiate with providers to set local prices for services not covered by national tariff under new Department of Health arrangements for Any Qualified Provider.
Developing the price outside of national tariff is the responsibility of the commissioners and will provide opportunity for the providers to influence the price, guidance on the DH website reveals.
Among the new information is that before running an AQP opportunity, commissioners must have engaged the market and determined the appropriate service specification, pathway, referral protocols and outcomes.
But commissioners must bear in mind that setting the price too high or too low will have consequences on how much choice, innovation and cost savings can be brought to bear, the guidance warns.
Prices should be fixed for the period of the contract and allow for them to be amended each year, otherwise alterations would be a “material change”requiring a new AQP opportunity to be advertised.
The guidance also makes clear that GPs will be able provide services under AQP where they are qualified and suggests that services currently procured through Local Enhanced Services could be provided under AQP in future.
Dr Johnny Marshall, chair of the National Association of Primary Care said the price-setting process could be a burden for CCGs in some cases but suggested GPs would choose another commissioning model if that were the case. “It depends on the size of the task. There may not be specific tariffs for some of the innovative commissioning they want to do. In that case commissioners may want to use AQP specifically for developing innovative ways of working across providers.”
Dr Michael Dixon, chair of the NHS Alliance agreed the process could be a complicated one but said it could lead to interesting comparisons between clinical commissioning groups. “If CCGs are setting different prices for the same thing in different places there will be questions asked. I suspect in practice, CCGs will probably nick each others´ tariffs in cases like this.
Dr Dixon said the question remained of whether AQP would prove a helpful tool for CCGs or an encumberance. Referring to the DH´s instruction to commissioners to employ AQP for a range of mental and community health services by September 2012, he said: “The signs aren´t good at the moment with the requirement on CCGs to select three areas for AQP. That´s completely daft.”