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Moving AQP into the next era

The concept of Any Qualified Provider has been around for some time initially in the guise of Any Willing Provider (AWP). It has been treated with caution by PCTs and latterly fledgling CCGs because it is complex and there is fear that it will allow some fairly aggressive providers into a market place where they are not wanted.

The basic principles of AQP can be found on the Pulse learning site and in Department Guidance.
Essentially a commissioner decides which services they might like to provide through a joint strategic needs assessment process. This sounds complex but it does not have to be and it is up to commissioners to decide how they go about this. There is already a nationally provided list of potential services but commissioners are free to choose how many and what they do. This Government plans not to be prescriptive about the finer details and commissioners have a freer rein than some might realise.
 Once the needs are decided the commissioner offers a particular service under AQP and provides a service specification. This is currently advertised on Supply2Health. Providers submit their applications which are qualified by the Qualification Centre of Excellence. If providers pass the qualification process they are offered a contract and a start date.

The first AQP offer for adult hearing was posted on Supply2health on February 8th and a further 23 PCT offers for a range of services are now available. The Department of Health (DoH) has issued implementation packs to help both commissioners and providers develop services.

The DoH is keen to see how things develop in the coming months and review progress. Later in the year there are college visits planned to services provided under AQP to assess their impact and clinical quality. The plan is to focus on clinical outcomes but it is likely to be well into next year before realistic outcomes can be obtained.

Patient groups are broadly supportive of AQP choice as a means of addressing poor quality provision and limited access among a range of community and mental health services From a patient point of view the system is simple. They simply choose the service that suits them best. In time outcomes will be published allowing better informed choice.

From a commissioner point of view AQP is not as simple. Ensuring services are used appropriately and costs are controlled is essential. If a national pricing structure does not exist for a particular service a detailed consideration of the 'currency' and the price of these contracts is needed.  One can see the benefit of a single provider commissioned contract which can be easily managed as opposed to a plethora of AQP providers which might use up more of the limited resources managing them.

However the advantages of AQP are :
1.      A relatively quick time from advertisement to start of service.
2.       Competition between providers encouraging better patient access which might prevent other 'downstream' costs such as hospital admission.
3.      The opportunity to create innovation and better more cost effective services.

Providers will see AQP as a way of entering the market place in areas where they were previously excluded. However with no guaranteed volume of activity there is a risk. The effect of this will make it more difficult for small providers to enter due to set up  and fixed running costs. However compared with single provider tendering at least they can enter. Single provider competitive tendering virtually excludes small providers as they have no previous track record. Other issues are that the contracts may be only marginally profitable and dependent on cost control and attracting enough activity. Both these mitigate against paying clinicians enough to attract them to give up more certain income streams elsewhere. Again larger organisations are more able to cover initial loses in order to gain a foot hold in a market place which will become more profitable as activity increases  due to other providers failing.
The Department of Health has taken expert advice on AQP and has concluded that it provides a useful method of providing service improvement and innovation. It is be no means the finished article and it does require a significant shift in culture from both commissioners and providers.

Dr Paul Charlson is a GP and RCGP clinical commissioning champion