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Rules for the brave new world

It's full steam ahead for GP commissioning, but it's worth getting to know the rules on co-operation and competition, says Tom Frusher

GPs have got a lot to think about at the moment. The new white paper puts GPs at the heart of NHS decision-making with greater authority over commissioning. It promises patients more choice than ever before. It may seem that anything is now possible. We recommend GPs familiarise themselves with the rules they must operate under and consider the new regulations they are likely to face when Monitor becomes the new economic regulator.

The Co-operation and Competition Panel (CCP), now 18 months old, exists to safeguard patient choice and competition in the NHS. We advise the secretary of state and Monitor – the current independent regulator of foundation trusts – on the application, and breaches, of the Principles and Rules for Co-operation and Competition (PRCC).

We have been working with the Department of Health to ensure these include possibilities for GP commissioning consortiums and the expansion of the ‘any willing provider' model. A new version was recently published.

The PRCC is intended to apply to all commissioners and providers of NHS services – public, private and third-sector organisations – and include GP PBC consortiums and shadow GP commissioning consortiums. It comprises obligations for commissioning, prohibitions of agreements or unilateral conduct that restrict commissioner or patient choice, rules on mergers and requirements to co-operate.

The recently published Procurement Guide for Commissioners of NHS-funded Services sets out further expectations and seeks to underpin the Government's commitment that, where appropriate, patients should have a choice of any willing provider that meets NHS standards.

GPs who are considering new ways of delivering services, or looking to explore the early possibilities of GP commissioning need to understand the obligations they are under in respect of the PRCC.

Where new models of care delivery are proposed that involve GP practices, for example integrated care organisations, these may require formal review by the CCP. GPs should also consider that elements of such ventures may amount to, or evolve into, anti-competitive agreements between NHS organisations that are in breach of the PRCC. In addition, it is entirely likely that conflict of interest issues will arise if GP consortiums commission from constituent practices, and GPs purchase community and other services from themselves.

It is therefore beneficial for GPs to engage with the CCP to seek advice on potential PRCC issues. While the CCP has a formal process for merger reviews, investigations into conduct and procurement appeals, we encourage informal discussions to resolve issues early on.

The PRCC is expected to apply until 2012, when the competition regime outlined in the white paper is expected to come into force, including an expanded role for Monitor as an economic regulator for the NHS as well as new responsibilities for the Office of Fair Trading and the Competition Commission. For GPs, it makes sense to use the intervening period to develop approaches consistent with PRCC.

Tom Frusher is policy director for the Co-operation and Competition Panel