Monitor this week published a suite of recommendations aimed at encouraging commissioners to allow providers to compete more to supply NHS care. The healthcare sector regulator concluded opportunities to compete were being “unduly limited” by existing commissioning practices.
Around half of the 30 recommendations in the eagerly awaited review of barriers to a “fair playing field” for providers of NHS services from the state, private and charitable sectors were focused on changing commissioner behaviour.
The review found commissioners “often fail to give due consideration to all available options” when planning the provision of local services”. Non-incumbent” providers “may be disadvantaged” by poor procurement practices and a lack of information for patients on the range of available providers.
It concluded that opportunities to compete were being “unduly limited” because of constant changes to the NHS commissioning system and short-term budget settlements encouraged a “short-term outlook” for commissioners. It complained a lack of high-quality information with which to compare providers or models of care left commissioners “uncertain about the effects of changing current patterns of provision”. It also said commissioners believed they were most likely to be challenged when trying to effect change, making “the status quo the easier option, even when an incumbent is underperforming”.
Most of the review’s recommendations for tackling these perceived barriers were addressed to Monitor itself, or to the NHS Commissioning Board.
It advised that the two organisations should measure and publish information on how often patients were offered a choice of provider by April 2014, in line with NHS constitution rights. They should also issue guidance setting “clear expectations” for how commissioners should procure services, emphasising the “importance of considering all available options for improving patient services”; and should gather evidence on the “risks, costs and benefits” of using competition. The first tranche of evidence will be published on a new website in October.
It said Monitor should “clarify” how it would use its powers of intervention over commissioners, and begin work next April to develop evidence on the risks, costs and benefits of extending local patient choice.
It also called on the board to begin, from April 2016, to fix commissioner allocations over periods longer than a year, and to encourage clinical commissioning groups to offer contracts longer than a year where appropriate.
Other key recommendations of the Fair Playing Field review:
- All providers of NHS services – public or private – should be subject to the same transparency requirements, including the requirement to answer Freedom of Information Act requests.
- The government should review whether certain public sector providers remain eligible for VAT refunds, and should consider extending VAT refunds on contracted out services to charitable providers of NHS care.
- Monitor should issue a call for evidence by June 2013 on whether the commissioning and provision of general practice is working in the best interests of patients.
- The government should not alter the current corporate tax arrangements for public, private or charitable providers of NHS services.
