A number of private providers are likely to take complaints to the NHS’s new competition regulator Monitor over the next three years, the chief executive officer of Ramsay Health Care UK warned last week.

Jill Watts, whose organisation was ranked the largest private provider of NHS funded acute care in the most recent study by market analysts Laing and Buisson, said she could “almost guarantee” there would be challenges to come.

She told a Westminster Health Forum conference that the April switchover to clinical commissioning groups under the government’s health reforms had not produced uniform changes in commissioners’ attitudes to the private sector.

“In one part of the country, where we had almost adversarial relationships and they didn’t want to use us at all, they’re very keen to work with us now,” she said.

“In another part of the country, where we’ve been providing very good services − excellent feedback − for ages, we have a lead commissioner who is very interested in protecting the local trust and has blatantly said, ‘We will not work with you, we have told the GPs to direct all the work to the local trust.’”

Asked if Ramsay was likely to take a complaint to Monitor in the next three years, she said she could “almost guarantee there will be challenges that will come” from “a number of organisations”.

Noting that some providers had already taken complaints to the new competition regulator, she continued: “On behalf of ourselves we have avoided taking that as the first line, because we prefer to try to deal with things in different ways first.

“But clearly when people behave right outside what the policy direction is, sometimes that’s the only avenue.”

To date, Monitor has opened investigations into two complaints about NHS commissioning decisions since it took on its new powers in April. The first was brought by a private provider of gamma knife radiosurgery in Sheffield; the second was brought by two Greater Manchester foundation trusts, and concerned the commissioning of cancer surgery. In both cases, the responsible commissioner was NHS England.

However, Monitor’s executive director of cooperation and competition, Catherine Davies, told the conference it had also seen a “big ramp up in the number of requests for informal advice, partly because we keep telling people that we’re happy to give it”.

In one case the regulator was currently looking at, she continued, “We have someone who’s complained because they’ve lost a contract, and the winner of the contract was apparently decided on a show of hands in the room.”