Commissioners have voiced concern that their efforts to integrate services will be hampered by ‘enforced competition’ after Monitor released a report warning them against simply rolling over existing community services contracts.

The regulator’s report urged clinical commissioning groups to use the end of current contracts – anticipated for many services in 2015-16 – as an opportunity to introduce new care models recommended in the NHS Five Year Forward View.

In a statement released yesterday alongside the report, Monitor said half the CCGs it spoke to with community services deals ending in 2015 planned to extend at least one of their contracts with the current provider.

It warned that CCGs should not automatically roll over existing contracts.

Steve Kell

Monitor’s report highlights a ‘significant gap between their rhetoric and reality’, Steve Kell said

CCGs reacted with anger, saying freedom to integrate care should not be blocked by “unnecessary enforced competition”.

Catherine Davies, Monitor’s executive director of cooperation and competition, said: “We do not think that commissioners should automatically roll over community services contracts. As the [current contracting] arrangements run out they should take the opportunity to explore ways of improving the community care available to their patients.

“Looking to improve services for patients does not mean necessarily putting contracts out to full competitive tender, but it may be the best option in some cases.”

Steve Kell, co-chair of NHS Clinical Commissioners, responded: “We know from our members that CCGs are not automatically rolling over community services contracts, but are actively improving local services by finding and developing local solutions.

“The last thing we need if we are to deliver the better care fund is competition where it is not in the best interest of patients.

“This report from Monitor highlights the significant gap between their rhetoric and reality, and it is essential that CCGs are allowed the freedom to deliver integrated care and that this is not prevented by unnecessary enforced competition.”

Most areas’ community services contracts were established at the beginning of 2011-12 under the Transforming Community Services programme, with many on three year deals with the option to extend to April 2016. The total sector is worth £9.7bn annually.

The regulator’s report links the renewal of programme contracts to the forward view vision of new care models “that break down the traditional divides between primary care, community services and hospitals”. It says commissioners “now have an important opportunity to commission community services in a way that will support this shift to more coordinated care for patients closer to home”.

It adds that competition is one of several options available to CCGs when existing contracts expire, but where it is not used, CCGs will have to demonstrate they have considered other options and their decision is in patients’ best interests. Rolling over the existing contracts indefinitely without doing this is not in keeping with competition regulations.

NHS England’s planning guidance in December told CCGs they should take actions in 2015-16 that would enable them to quickly adopt new models of care. “For example, rather than proceed with a standalone re-procurement of community services, one option CCGs may want to consider is how best to integrate these within a new [multispecialty community provider] model,” the guidance said.

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