Competition in the NHS will retain a key role in delivering high quality and “efficient” care in the new landscape carved out by the NHS Five Year Forward View, a senior official from Monitor has indicated.

In an exclusive interview with HSJ, the regulator’s director of cooperation and competition also questioned whether the preferred provider policy, which is advocated by Labour, would result in the “best outcome for patients”.

Catherine Davies

Catherine Davies said there was a difference between ‘the political debate’ and what NHS staff ‘actually say on the ground’

Under the opposition party’s preferred provider policy, the NHS would always get the first chance to run services before there are put out to competition.

Catherine Davies’ comments make clear that competition is still seen by Monitor as an integral part of NHS policy, despite its lack of mention in the forward view, which was published last month.

Ms Davies said that policies favouring one type of provider looked “through the wrong end of the telescope”.

“I don’t really see how a policy that discriminates in favour of a particular type of provider is the right way to get the best outcome for patients,” she added.

“What’s most important is that you have someone who can provide the services that meet the needs of patients in a particular area.”

Ms Davies added that competition could be used “effectively to create a system that’s responsive and to incentivise high quality and efficient care”.

She said Monitor could also envisage competition opening up between “integrated care” providers,  which offered services across sectors, such as primary, community and social care.

“You might have some GPs who were integrated with a community services provider competing with other GPs who were integrated with a different community services provider,” Ms Davies said.

Monitor was also confident that conflicts of interests that could be at play in the new models of care proposed by the forward view could be navigated.

Ms Davies pointed to the example of “multispecialty community providers”, which the forward view suggests could bring GP practices together to deliver community, social care and even acute services.

While recognising that GPs in these MCPs might benefit from referring patients to their own elective services, Monitor considered potential conflicts of interest could be avoided.

The model could be structured to ensure “the person actually making the decision about where someone is referred to isn’t someone who then stands to benefit financially”, Ms Davies suggested.

She added that clinical commissioning groups had already established a track record of commissioning services provided by GPs.

This indicated “people are managing to mitigate those conflicts of interest”, she said.

NHS managers were also less anxious than a year ago about the rules around competition regulations, Ms Davies added.

This pointed to what she saw as a “difference” between “the political debate” and “what people actually say on the ground”.

“When we go and speak to CCGs, they seem fairly relaxed with what they’ve been asked to do and they’re just getting on with doing it as best they can really,” she said.

This story was updated on 28/11/14 14:51 to clarify that Ms Davies had questioned the “preferred provider” policy rather than Labour Party policy