Forthcoming guidance on the “any qualified provider” policy will see competition phased in more slowly than expected and the creation of a national register of private providers authorised to bid for NHS work, HSJ can reveal.
The guidance is being drawn up amid concerns from professional bodies, unions and academics over the government’s plans to significantly open up the NHS market.
Competition is one of the areas of the Health Bill the government has pledged to look at during the “listening exercise” being carried out by ministers, which has resulted in a one month “pause” in the reforms.
The any qualified provider – formerly known as “any willing provider” – framework will see a national register of providers that meet four criteria. This will involve Monitor and Care Quality Commission registration, signing a standard NHS contract and an explicit guarantee of adherence to NHS quality standards.
Details of the fourth “qualification” are not known but existing providers have been told it will make little difference to current contracting arrangements.
The current AQP procurement framework applies only to acute elective surgery but the Department of Health intends the expanded database to be up and running next year.
HSJ understands that instead of applying AQP to “most sectors of care”, as the bill said, the system will at first be limited to effective and specific community services.
The process will be led regionally with different services trialled in different areas, and the learning then shared across the NHS.
It is thought the register will be run by the NHS Commissioning Board. Due diligence of providers supplying more straightforward services will be carried out by local commissioners, while the board will take responsibility for complex services such as cancer.
NHS East of England director of strategy Stephen Dunn told HSJ his region was considering opening up AQP to areas including chlamydia screening, musculo-skeletal services, audiology and smoking cessation.
He said: “East of England is looking at using some of the big pharmacy chains to encourage choice for patients. There is a real prospect of putting NHS services on the high street in more accessible locations.”
One region is considering putting admissions avoidance services like urgent care centres under its AQP framework.
Referring to the four criteria, NHS Partners Network director David Worskett said: “If that’s what they mean by a qualified provider it seems to be an additional level of bureaucracy implying a lack of trust of the CQC and Monitor. Why not just use those two bodies to do the job you want done?”
His comments reflect increasing anxiety in the independent sector about the impact of the government’s “natural pause”.
Jocelyn Ormond, a partner at law firm Beachcroft, said the uncertainty could harm early discussions on joint venture deals in which private providers would help foundation trusts develop private patient units.
He said that ahead of Andrew Lansley’s announcement last week, there had been concern in the independent sector “as to the short term risk of planning based on the government’s reforms”.
Those concerns will have “greatly increased” since the statement, he said. “One of the great political hot potatoes at the moment is investment from the private sector, and the government has been echoing Liberal Democrat rhetoric that the independent sector providers can’t cherrypick services. I think that will have a braking effect on some of the discussions going on at the moment.”
H5 Private Hospitals Alliance chief executive Matt James said: “There’s nothing new in the bill in relation to choice or any willing provider. So if you’re going to start to reduce what’s in the bill you can only go backwards.”
HSJ last week reported how the government’s own amendments to the bill had “softened” competition rules over and above the changes ruling out price competition. This appeared to be confirmed in a subsequent letter from Mr Lansley to the Commons health committee to “clarify” the role of competition.
He wrote that commissioners would not be required to “promote competition for competition’s sake”. Case law suggested regulations on commissioners “would be limited to requirements as to due process, managing conflicts of interest and prohibiting anti-competitive conduct that acted against patients’ interests”.
A Department of health spokeswoman said: “Patient choice and competition is one of the key areas for engagement as part of the current listening exercise, and no decisions have been taken on any potential qualification process. Our aim is to ensure that competition works in the best interests of patients. This means that providers must be safe, be effective and meet the needs of patients at the local level.”
“Where services are not under Any Qualified Provider, procurement would be a matter for local commissioners and we have no plans for a national register of private providers qualified to bid for local contracts.”