Published: 16/09/2004, Volume II4, No. 5923 Page 3 4

Primary care trusts will be compelled to offer patients the option of treatment by independent providers.

Restricted Department of Health guidance seen by HSJ says 'every PCT should have at least one independent sector provider on its menu of four or five choices for planned hospital care for five of the ten most common procedures'.

DoH head of capacity, plurality and choice Bob Ricketts told HSJ that PCTs would be expected to offer the choice of an independent sector provider as well as other NHS providers by December 2005 - when patients requiring planned hospital care will be able to book appointments from a choice of four or five hospitals at the point of referral.

'Last year we signalled that we would expect to see a range of providers on the choice menu, ' Mr Ricketts said. 'The independent treatment centre programme along with the Gsup programme [in which independent providers Capio and Nuffield will provide an extra 25,000 orthopaedic operations from this year] mean that by December 2005 it should be feasible for PCTs to provide this choice.'

He added that the DoH wanted PCTs to 'gear themselves up' for offering a range of choices to 'ensure that most patients have as wide a choice as possible'.

However, he said that PCTs would be able to decide which five of the 10 most common procedures they would commission from the independent sector.

The procedures are based on the 2003-04 healthcare resource groups and include cataracts, arthroscopies and varicose vein operations.

'We will leave it down to PCTs to decide which procedures they offer to patients [from the independent sector]; it would be wrong to be prescriptive.'

However, NHS Alliance chair Dr Michael Dixon said he did not see the need to involve the private sector if local NHS providers were providing good-quality services.

'If the government intends to make this absolutely dogmatic it will infringe on PCT sovereignty as a local commissioner.

'If the local population feel happy with the local NHS I am not sure what is to be gained by bringing in private providers, ' he said.

Dr Dixon warned that too much choice may in future lead to a limitation of options as organisations would be forced to close because of lack of popularity.

Hillingdon PCT chief executive Graeme Betts said the compulsory inclusion of the independent sector had the potential to 'undermine providers in the NHS who are doing really well'.

'This could be counter-productive to the relationships we are trying to build up with NHS organisations, in some areas this [choice] would be a complete waste of space, ' he added.

The DoH delivery framework sent to all chief executives last month also emphasises that under payment by results, PCTs should 'seek to support their popular providers'.

It states that 'this should allow patients to choose the most popular hospital while restraining any increase in waiting times that would otherwise be associated with increased referrals...This is likely to result in a balancing factor with less popular service providers' by using money originally planned to fund less popular acute trusts.

PCT chief executives are also required to submit a 'state of readiness' document to their strategic health authorities by the end of October that should detail the range of choice they expect to offer by December 2005 and highlight any gaps in capacity.

SHAs are currently drawing up capacity plans that will highlight which services the independent sector could be called on to provide across local health economies.

Once the DoH has decided how much extra capacity is needed it will then invite companies to tender for various diagnostic and elective work.