The Department of Health command paper on choice, competition and a failure regime for trusts sets out some specifics but leaves many questions unanswered.
“A piece of work with the royal colleges” will be undertaken to identify the services most “at risk of cherry picking”, it said.
It said work on ensuring “fair prices” for these procedures would be “prioritised” to enable them to start in 2013-14.
There were also specific measures outlined to “require providers to accept patients referred to them unless there are genuine and overriding clinical concerns”.
The duties of Monitor remain largely as they were set out in the 10-page response document last week: a duty to “protect and promote patients’ interests” using the same powers as the Office of Fair Trading and the principles of co-operation and competition already in use by the Co-operation and Competition Panel.
The 60-page document said an example would see the regulator “take action against a provider seeking to frustrate patient choice, or colluding with another provider not to offer patients home-based treatments.
“Monitor will retain its proposed new functions on price-setting and supporting the continuity of vital services in the event of failure, and its function of licensing providers.”
The document referred to “setting limits on Monitor’s powers to take action against commissioners”. It says: “We will narrow Monitor’s powers over anti-competitive purchasing behaviour by the NHS Commissioning Board or clinical commissioning groups, so that these are more proportionate and focus on preventing abuses rather than promoting competition as though it were an end in itself”.
The fate of the PCT estate is still unknown but the report said Monitor would no longer be allowed to force providers to allow competitors to use its facilities.
It said this was “potentially too disruptive”.
The document also removed the April 2014 deadline for trusts to become foundation trusts but said any not authorised by then would “work towards foundation trust under new management arrangements” – but did not clarify what these would be.
On the choice agenda the command paper said the mandate to the board “will make it a priority to extend personal health budgets, including integrated personal budgets across health and social care” but subject to evidence from the current pilots.