A disagreement between NHS England and Monitor appears to be delaying the release of resources to help commissioners navigate choice and competition issues in the NHS, recent board papers reveal.

In 2012 the two bodies agreed to develop a “choice and competition framework” to help commissioners decide how and when to use these policy levers to improve patient outcomes.

However, NHS England’s February board papers state there is a risk “partnership with Monitor” could prevent it from “providing the system with the clear, robust and consistent policy framework, evidence and advice it needs” on choice and competition issues.

The language used by NHS England to describe the difficulties it has experienced trying to produce the framework is strikingly strong.

The papers claims Monitor “unpicked the agreed content…of the choice and competition framework” and “pulled back from [the framework’s] agreed philosophy”.

HSJ understands the disagreement between the organisations relates to the scope and format of the proposed framework.

The framework was originally due to be published by July 2013, but the papers suggest the future of the project may now be uncertain.

The papers state: “Agreement to publish the framework is not guaranteed as new policy owners in Monitor view their guidance as the key resource for commissioners to understand choice and competition in the NHS”.

In December last year Monitor published guidance on the procurement regulations which implement section 75 of the Health and Social Care Act 2012.

At the start of this year the regulator also set out how it would deal with trusts considering mergers and other service reconfigurations.  

When asked about the comments in the NHS England paper, a Monitor spokesman said: “We are currently running ten workshops with commissioners around the country, hosted jointly with NHS England, to improve understanding of choice and competition within the NHS.

“We are also committed to working with NHS England on developing a website that will bring together in one place all the materials that commissioners and providers need in order to understand how best to use competition to achieve improved outcomes for patients.”

In a statement NHS England said they would “continue working with Monitor… with a view to publishing the framework shortly”.

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