Primary care trusts in the North West risk being performance managed on the number of patients who use the private sector-operated national clinical assessment services across the patch, HSJ has learned.

In a letter seen by HSJ, NHS North West chief executive Mike Farrar warns PCTs that the strategic health authority is seeking guidance as to whether PCTs will be measured on the number of patients who choose to use integrated clinical assessment and treatment services run by private companies Netcare and Partnership Health Group.

Mr Farrar says the SHA is 'expecting reassurance from the Department of Health that if PCTs achieve their access targets and if under-utilisation is caused by patients exercising choice, they will not be performance managed against this'.

However, speaking to HSJ this week, Mr Farrar could not provide this reassurance. 'To check PCTs have made a good investment and are meeting the 18-week waiting time target we obviously have to count the numbers and feed those back to the DoH,' he said.

Mr Farrar said PCTs needed to ensure there was enough choice available to patients but balance that against expected throughput. 'They need to assess what volume they need in a competitive environment,' he said.

In the government's first-wave independent sector treatment centre contracts, PCTs were forced to pay the private sector for the full size of the contract regardless of whether it was used. But the DoH will pay for any capacity not used in the second wave, which includes ICATS.

Stockport PCT chief executive Richard Popplewell said while it was fair to be performance managed the estimated numbers given when the contracts were let could now be inaccurate. 'PCTs and GPs, through practice-based commissioning, have done an awful lot recently on demand management and appropriate referrals. And they have got the numbers down. This success might cause problems with the ICATS contract.'

Mr Popplewell added that PCTs did not know what would happen if they were deemed to be performing 'unsatisfactorily' on ICATS.

The DoH would not comment on whether PCTs will be performance managed on patient use of ICATS.

In the letter Mr Farrar also said: 'The SHA will look particularly closely at PCTs where GP groups are in danger of having a conflict of interest between the practice-based commissioning and other business interests'.

Patient and public involvement forums for both Royal Liverpool and Broadgreen University Hospitals trust and Liverpool PCT last week called on the PCT to suspend the local ICATS scheme for dermatology over a potential conflict of interest.

Two companies Assura Liverpool Local Partnership and Our Care Ltd won the contract to provide local ICATS to the south central area of Liverpool PCT. But PPI forums questioned the role of one of the GPs who helped design the specification of the service for the PCT because of links with Assura. HSJ understands that Our Care Ltd also has a number of GPs from the Liverpool area on its board.

Royal Liverpool and Broadgreen University Hospitals trust chair Maggie Andrews told HSJ there had been no local consultation on the ICATS scheme.

She asked the PCT to tell Liverpool's health and social care select committee if there were irregularities in the conduct of the interview panels for ICATS bids relating to declarations of interest and if PCTs had investigated conflicts of interests.