The NHS Cooperation and Competition Panel has begun a probe of the competition implications of providers operating systems to manage patient referrals.
The panel said it had received a number of requests for advice in recent months about how NHS competition rules apply to financial incentives relating to referrals. Questions have previously been raised about GPs referring patients to their own services.
It has also received queries about the rules around attempts by providers to manage referral processes “in a way that may affect patient choice or competition”, for example referral management services operated by GPs or community service providers.
Panel director Catherine Davies said: “We are increasingly being approached by commissioners and providers for informal advice on how patient choice can be protected in any treatment pathways they design. So we felt it would be a valuable exercise to publish some informal advice on this issue. We are keen to use a variety of examples, particularly ones demonstrating good practice.”
The panel aims to publish its advice in the autumn, and has issued a deadline of 18 July for submissions to the review.
Robert McGough, a partner at law firm DAC Beachcroft, said the risk in referral management systems was they could be seen as driving patients towards services in which the providers operating the systems had an interest. The risk was likely to be particularly immediate for GPs, who will take on responsibility for commissioning under the health reforms.
“We’ve spent so many years moving away from providers and commissioners being in the same body, and now we’re moving back to a point where commissioners are also providers of a large number of these services,” he said.
Under the 2012 Health Act, health secretary Andrew Lansley will issue regulations for the new commissioners, requiring them to avoid anti-competitive behaviour and promote patients’ right to choice. This will be supported by procurement guidance issued by the NHS Commissioning Board.
In a code of conduct published earlier this month, the board said commissioning through competitive tender or “any qualified provider” mechanisms would, in general, “help reduce the scope for conflicts” for GP commissioners.
However, a statement issued by the Chartered Society of Physiotherapy, issued shortly beforehand, claimed the government’s policy of opening up NHS services to competition through any qualified provider had “compromised choice by allowing GPs and private providers to refer to services they were providing”.