Commissioners will need to be robust about which services they put out to tender, the NHS Confederation has warned.

In a report on the future of community services, the confederation says that if done well, tendering could improve the service quality, but if it is done badly patients could lose out.

David Stout, the confederation’s Primary Care Trust Network director, said: “If you fragment the care pathway into a million different providers, do you ultimately damage patient experience because of the increasing number of handovers? Every component might appear good value and cost-effective but when you put the lot together, does it add up to something that’s not very effective at all?”

Department of Health policy is that PCTs should draw up detailed plans for their provider arms by October. These could involve putting all or part of the services out to tender. That presents a challenge for commissioners, who scored worst on stimulating the market in world class commissioning assessments (news, page 4, 5 March).

Mr Stout said: “It’s in the interest of commissioners to make this as easy as possible [for potential providers] without bending so far backwards that you distort priorities.”

He said big private companies providing more “generic” services might find it hard to respond to more specific tenders “but the market is what the market is and if they want to get into it, they need to adapt their business models”.

Recent tenders advertised include a £2m wheelchair service and a £250,000 end of life respite care scheme.

There is also ambiguity over whether merging provider arms would fall foul of the co-operation and competition panel.

Mr Stout said community services offered less choice than acute services so merger would be unlikely to mean a net reduction in choice for patients.

HSJ is holding Excellence in NHS Procurement on 23 September, visit