Published: 27/06/2002, Volume II2, No. 5811 Page 4 5

GPs could soon be referring NHS patients directly to private hospital outpatient departments in a further extension of the role of the private sector, HSJ has learned.

HSJ understands that the Department of Health will shortly put arrangements in place to allow primary care and acute trusts to contract with independent sector providers for outpatient services as well as operations.

Arrangements are expected to cover either outpatient-only services, with patients transferred back to the NHS, or both outpatient and inpatient treatment, where the patient could either be referred to the private provider by their GP or transferred from a trust outpatient waiting list.

The outpatient options are being seen in the context of 'patient choice', but officials are understood to be concerned that patients seen for an outpatient appointment in the private sector and then treated shortly afterwards are not seen to jump the waiting-list queue.

The DoH is also believed to be seeking to ensure that private providers do not recruit staff from the NHS in order to fulfil their contracts. But it is understood that measures to tackle this might be weak, with private providers prevented only from luring staff away without an NHS body's permission - which would not be 'unreasonably withheld'.

NHS Confederation policy manager Nigel Edwards said the move to buy outpatient services from the private sector was 'logical', adding that the government was 'very worried about delivering the outpatient waiting target'.

And he added: 'The point about giving patients choice could conflict with meeting [inpatient] waiting targets if the patients do not choose to move.'

But 'buying the whole pathway' would work better as patients would be more likely to move to the private sector at the beginning of their treatment. 'Once the patient is in the process and talking to a consultant about a procedure, it is much harder to shift to another provider.'

Commons health select committee chair David Hinchliffe, a longstanding critic of the use of the private sector, said he was 'not hugely enthusiastic' about the outpatient plan. 'It seems to me there is a contradiction between the message from the new consultants contract, that there would be 14 per cent more time [spent by consultants] in the NHS, and the increase in use of the private sector. It doesn't seem to square up to me.'

He added that the recent select committee report had highlighted the 'drift' of NHS staff into the private sector 'in many areas'.

NHS Alliance chair Dr Michael Dixon said commissioning outpatient services privately would add 'a slight competitive edge' and was 'not a bad thing'. But he added: 'Even more inventively, you could develop a primary care centre within the PCT to employ consultants to see the patients, or possibly employ GPs or nurses with a specialist interest, and do it in-house. Outpatients is going to become a thing of the past.'

A capacity for change

Overseas healthcare operators are to be offered initial three-year contracts to develop surgical and diagnostic units as part of the government's drive to tackle waiting times.

The plans are set out in Growing Capacity: a new role for external healthcare providers in England , a prospectus containing plans to attract capacity from abroad.

The document confirms that the government is embarked on a twin-track approach: to attract overseas clinical teams to work in existing NHS units or new-build diagnostic and treatment centres; and to encourage independent health service providers to develop similar treatment centres, again staffed with overseas clinicians, to treat NHS patients.The document says clinical teams working in NHS units would be paid on a 'price-volume basis for identified amounts of work'.

Three-year contracts are envisaged for the early projects to provide the units with a period of financial stability. It adds 'for more complex schemes, the more appropriate contract length many be substantially longer'.

www. doh. gov. uk/internationalestablishment