STRUCTURE: The Cooperation and Competition Panel has approved seven acute and mental health providers to take over GP practices, but says Monitor should review the arrangements in the future.

The providers are acquiring the PMS/APMS practice contracts from primary care trust providers, under the transforming community services process. They are George Eliot Hospital Trust from NHS Warwickshire; Royal Salford FT from NHS Salford; South Tees FT from NHS South Tees; Sheffield Health and Social Care Trust from NHS Sheffield; County Durham and Darlington Foundation Trust from NHS County Durham; South Tyneside NHS Foundation Trust from NHS South of Tyne; and Oxfordshire and Buckinghamshire Mental Health Foundation Trust from NHS Oxfordshire.

A Cooperation and Competition Panel review of the Warwickshire case, also applicable to the other cases, said it could go ahead, but only if the providers gave a series of assurances which were agreed by the Department of Health.

They include the provider making it clear to all patients that the GP practice is owned by the trust by displaying external and internal signs; displaying leaflets making it clear patients have the right to choose their hospital; reviewing referral patterns and providing information to the PCT regularly; and funding the PCT to appoint an independent “choice adviser”, if the PCT believes it necessary.

Without those assurances, the panel said, there is “a realistic prospect that the merger may result in a material adverse effect on patients and taxpayers”, because of the risk of the GPs preferring to refer to the hospital trust’s secondary services rather than others - therefore limiting choice and competition.

Even with the assurances, the panel’s report said: “We continue to be concerned that there is the potential for a conflict of interest to arise in these circumstances and suggest that this is a potential issue for Monitor or the NHS Commissioning Board to consider in future, once they have been established.”