CCG leaders have been blocked from securing permanent arrangements for NHS 111, after NHS England halted any re-procurements of the service until April 2015.
NHS England said that no other 111 contracts should be re-procured to start before April 2015 in order to ‘maintain stability across the system’ and to give the body time to ‘agree the optimum service specification’ for the urgent care line.
New statistics from NHS England show that 93% of the English population has access to NHS 111. But 11 regions – including the North West and the West Midlands – only have interim contractural arrangements in place following the withdrawal of NHS Direct from all its contracts.
It comes as commissioners in the West Midlands announced that West Midlands Ambulance Service would be providing the NHS 111 service in Birmingham, Solihull, the Black Country, Shropshire, Herefordshire, Coventry and Warwickshire until April 2015.
But this looks to be one of the last to be procured in this way, after Dame Barbara Hakin, the deputy chief executive of NHS England, told CCGs to refrain from undertaking any procurement processes until the new specification was developed.
GPC and commissioning leaders have welcomed the move, stating that they believe ‘lessons have been learnt’ by NHS England around 111.
The NHS England letter, dated 20 September, said: ‘In order to maintain stability across the system and to give time to agree the optimum service specification for 111 in the future, NHS England has decided that no other 111 contracts should be re-procured to start before April 2015.
‘As you are aware, we are currently reviewing the National NHS 111 specification. This together with the need to learn the lessons from the initial procurement of NHS 111, the need to reflect the outcomes of the Urgent & Emergency review, and our desire to take on board the concerns we have heard from many CCG commissioners, has meant that we have concluded that we need more time to be sure that the next round of procurements fully deliver all we need to give patients the best service.’
Because of this, it added, ‘we have therefore agreed that no NHS 111 contract re-procurements should commence until after April 2014’.
Dame Barbara added that the majority of contracts finish on or after April 2015, but NHS England will ‘support commissioners in ensuring there are appropriate contract extension arrangements in place’ for contracts that finish before then.
The letter finished: ‘I am aware a small number of you were keen to move ahead with re-procurement plans sooner. However, I am confident that the additional time we take to review and consider our options will lead to the development of a strengthened service, which is more responsive to the needs of patients and the NHS as a whole.’
GPC negotiator Dr Peter Holden welcomed Dame Barbara’s letter. He said there was ‘an argument that says that CCGs should not be dictated to’. However, he added: ‘The reality is that a 111 service is most likely to cover more than one CCG so there is a need for uniformity. When it comes to urgent and emergency care, the only way you can get uniformity of service is by having some uniformity of contracting. I’d go further and say this should not even be a competitive tender.
‘This is far too important to the survival for the whole chain of care right from general practice to being admitted to hospital via A&E. That system will not be achieved by having lots of different providers each with their own take on things.’
Dr Holden said he met NHS England officials last week. He added: ‘I think lessons have been learnt about 111 procurement.’
Dr Amanda Doyle, chief clinical officer at NHS Blackpool CCG and co-chair of NHS Clinical Commissioners said: ‘CCGs will generally welcome the opportunity to spend a bit longer evaluating the lessons from the first year or so of the NHS 111 service and to include the outcomes of the urgent and emergency care review in an integrated model of urgent care, rather than rushing straight into re procuring 111 services.’
Dr Andrew Mimnagh, the urgent care lead at Sefton CCG, said: ‘The Dame Barbara Hakin letter is welcome as it sets clinical safety first.
‘It does however raise some interesting questions regarding the potential future exposure of CCGs to commercial challenge, and a potential lack of clarity as to whether “accountable for” and “in control of” are correctly aligned in the current NHS structures with regard to the future of NHS 111.’