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York FT must change gatekeeping role, says competition panel

The competition regulator has ruled against a deal between a primary care trust and a hospital which saw the latter refer some patients who it went on to treat itself.

Assura East Riding complained to the Co-operation and Competition Panel about the arrangement between York Hospitals Foundation Trust and North Yorkshire and York PCT.

The CCP today ruled there was “a material adverse impact on patients and taxpayers” from the deal which saw the foundation trust awarded the contract for the assessment, triage and treatment of musculo-skeletal patients in an open tender run by the PCT.

In its report the advisory body to the Department of Health said: “An employee of York Hospitals is not able to provide independent advice to patients when choosing the location of their routine elective care (as York Hospitals is the employer of the adviser).”

It is now consulting on a range of possible remedies including “provision of independent information regarding patient choice to patients”, “an independent choice adviser” or letting charities advice patients before their admission.

The CCP’s report said the existing safeguards, under which the PCT audits York’s referrals if more than 40 per cent of them are found to be going to the trust, were insufficient.

It suggested continual “proactive” monitoring instead.

Assura East Riding made two complaints to the CCP in September.

The other complaint was that York Hospitals had “predatory priced” the service. Assura said it “believed it was not possible for York Hospitals to meet the service specification of the bid at the price it tendered”.

The CCP dismissed this complaint.

It found there had been a mistake which saw York’s costs over the life of the contract calculated for 34 months and the other bidders’ over 36 - but said this would not have changed the outcome of the tender exercise.

Assura East Riding is a joint venture between Virgin Care and some GP practices in the East Riding. Assura also provides a community MSK service in the area.

The CCP will make a recommendation on a remedy to the gatekeeping issue to the health secretary in April.

Readers' comments (6)

  • Jonathon  Tomlinson

    Does this mean that if an orthopedic surgeon sees a patient in their outpatients that would benefit from physiotherapy, they cannot recommend the physiotherapists in their own hospital? Furthermore is tax-payers money, part of the NHS budget, being spent paying the CCP to deal with complaints from private providers? Is this part of the QIPP? or perhaps hidden in the risk-register?

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  • Richard Russell

    I have not seen the detail report but the articles reads that the issue is about who is making the initial referral. So an orthopaedic surgeon who then arranges for physio isn't covered by this as probably there will be the pathway where the referral covers all care required within that referral so includes physio.

    An alternative example which I think supports your point is where a GP refers a patient to their own service rather than to a community or hospital alternative as they are making the primary referral.

    Given that the primary care service is typically cheaper than the hospital alternative and GPs will be responsible for the finances how will we know if patients are being given information about the full range of options available to them.

    Hopefully not an issue...

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  • Jonathon  Tomlinson

    It would be good if Ben could illustrate this article with some examples about how this ruling will effect hospitals, patients and referring doctors. What is the 'material adverse impact on patients'?' This sounds like a serious danger to their health, but Isn't it ideological fear-mongering nonsense?

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  • Surely it cannot be just to prevent an employee of an organisation recommending a patient to attend their own organisation!? That would be a gross infringement of liberty and not necessarily in the patient's best interest; however this is what the ruling seems to suggest.
    It is in everyone's interests, and certainly the patient's interests to be recommended to the best place, irrespective of who the adviser's employer happens to be, but the ruling seems to rule this out.

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  • Jonathon  Tomlinson

    It would be good if Ben could illustrate this article with some examples about how this ruling will effect hospitals, patients and referring doctors. What is the 'material adverse impact on patients'?' This sounds like a serious danger to their health, but Isn't it ideological fear-mongering nonsense?

    Unsuitable or offensive?

  • Jonathon  Tomlinson

    It would be good if Ben could illustrate this article with some examples about how this ruling will effect hospitals, patients and referring doctors. What is the 'material adverse impact on patients'?' This sounds like a serious danger to their health, but Isn't it ideological fear-mongering nonsense?

    Unsuitable or offensive?

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