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Conflict between integration and competition likely to create ‘difficulties’, admits head of Monitor

The conflicting aims of the health bill to simultaneously integrate services and open them up to competition is likely to ‘create difficulties' for commissioners, the head of Monitor has said.

Monitor is the body set to be responsible for ensuring that private sector providers are not prevented from accessing NHS contracts, whilst also ensuring care is integrated, but the head of the organisation said the NHS Commissioning Board will have to resolve the contradictions between these aims.

Speaking at a public meeting today, interim chief executive of Monitor David Bennett said there was an issue with promoting integration and extending the use of Any Qualified Provider at the same time.

In response to a question from Pulse, he said: ‘This is fundamentally an issue for the NHS Commissioning Board but I think there is an issue here.'

‘What you essentially do with AQP is take elements of an individual care pathway and create choice around those elements whereas what you also want to do is provide an integrated pathway. You do have to work out how that is going to work together.'

‘For example, someone  providing a service within a care pathway sees an opportunity for an element of it to be provided by someone else under AQP, well, can they choose to simply move that element out of the integrated pathway and go elsewhere? That would create difficulties I would have thought and that is one for the commissioning board to work out.'

The issue of promoting integration in the NHS has been a touchstone issue for GP leaders.

GPC deputy chair Dr Richard Vautrey said the comments from Mr Bennett showed that the Government's ‘ideological' plans don't join up with the financial reality.

‘AQP is clearly more about ideology than improving patient services. At a time when PCTs have had to cut back on commissioned psychological services in order to cut costs, it is hard to understand how a PCT cluster is now expected to find the money to commission more services again and at the same time control demand.'

‘The same situation applies to musculoskeletal services. Lots of patients who currently see physios or chiropractors privately will simply ask to see them on the NHS instead, making it harder for commissioners to control demand and costs will rise as a result.