NHS England and Monitor are facing calls to exempt ‘vanguard’ areas from requirements to tender services, amid fears that procurement processes could undermine efforts to establish integrated primary, community and acute care models.
The calls from providers in the vanguard relate specifically to community services, many of which are on contracts due to expire at the end of 2015-16.
The central agencies are being called on to give a clear indication that clinical commissioning groups will be safe from legal challenge if they prioritise redesigning services with existing providers, rather than going to market to establish new contracts for community services.
CCGs are thought to be particularly vulnerable to legal challenge under procurement rules over community services, as these contracts are one of the most contestable parts of the NHS, with a mature market of alternative providers already operating.
Guidance from Monitor earlier this year advised against simply “rolling over” existing contracts indefinitely, as this was not in keeping with competition regulations, and said that CCGs would have to demonstrate they had considered other options and that decisions were in patients’ best interests.
Robert Flack, chief executive of community service social enterprise Locala, part of the vanguard project in Calderdale, said: “There needs to be guidance from NHS England on this. We need NHS England to give [cover] to health economies to enable partnership working to develop [in order to meet] the aims of a multispecialty community provider.”
Mr Flack said his organisation would not be able to focus fully on developing new care models if it simultaneously had to respond to a tender to retain its existing business.
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One senior commissioner in a vanguard site told HSJ they were concerned that Monitor would tell them they were acting anti-competitively if they decided to begin providing an acute outpatient service via primary care without tendering.
South Warwickshire Foundation Trust chief executive Glen Burley, whose trust is likely to lead a bid to set up a primary and acute care system as a “fast follower” to the vanguard, also appealed for stability in the community services sector.
He said: “This is a rapidly changing environment providing great opportunities to achieve truly integrated care. Traditional transaction based contracts will not achieve best value and the specifications drawn up now will not stand the test of time.
“We need to put long term partnerships in place which share risk and encourage radical system redesign. It would seem sensible to step back from traditional procurement processes to let these models develop.”
Tracy Taylor, chief executive of Birmingham Community Healthcare Trust, which is part of Vitality Partnership’s vanguard project, said: “Commissioners have to consider carefully the benefits of tendering, and if they choose to put community services out to tender without any justifiable rationale, they are in danger of cutting completely across the opportunities the vanguard sites will develop.”
NHS England and Monitor should tell commissioners that “if providers are delivering in line with commissioning intentions and are actively changing their models of care to improve outcomes then a collaborative rather than competitive approach is far better”, she said.
NHS England’s planning guidance in December told CCGs to consider how community services could be integrated with primary and acute care in line with the NHS Five Year Forward View’s vision.
However, NHS England has ruled out a moratorium on community service tendering in vanguard areas. A spokesman told HSJ: “The NHS needs to continue developing and delivering services for patients, so a moratorium on commissioning would not be helpful. Commissioners need to identify the right solution for their local area. What works will depend on what they are trying to do, and the new models of care programme will be there to assist vanguard areas as they work through how to secure the best outcome for their patients.”
A Monitor spokeswoman said: “The procurement regulations and other relevant legislation remain in force until such time as Parliament decides otherwise.
“Of course, we will not stand in the way of innovation and will work closely with the vanguard areas.”
She urged anyone with questions to contact Monitor “as early as possible”, “so that we can help them understand the regulations and avoid potential problems.”