Procurement, providers and patient preference

In July the Cooperation and Competition Panel (CCP), the body responsible for ensuring the Principles and Rules of Cooperation and Competition (Principles) are followed by NHS commissioners, issued recommendations regarding a complaint about a procurement run by NHS North Yorkshire and York PCT (PCT). The procurement was for an orthopaedics and musculoskeletal (MSK) clinical assessment, triage and treatment service. In March, the CCP published its advice in relation to the complaint and this can be found on the CCP website ( The CCP's advice found that the PCT's award of a contract to York Hospitals (Hospitals) put the Hospitals in the dual position of both referring patients for routine elective care and of competing for referrals of such patients.

The PCT's action was found to be a breach of Principle 5: "Commissioners and providers should promote patient choice including - where appropriate - choice of Any Willing Provider and ensure that patients have accurate reliable and accessible information to exercise more choice and control over their healthcare." In looking into how this breach might be remedied the PCT invited comments from interested parties and suggested to such parties potential remedies including:

  • the introduction of an independent healthcare adviser to advise patients;
  • provision of objective information regarding patient choice to patients;
  • performance monitoring; and
  • patient advice provided by relevant third sector entities.

Oxfordshire PCT also suggested an alternative approach which it considered could "be effective at ensuring that patients are offered objective choice in similar circumstances". This suggestion involved GPs noting a patient's preferred provider of elective care before being referred into the community MSK service. Such choice would be notified to the PCT who would monitor any changes in the patient's choice of provider as they progressed along the care pathway to ensure there was no undue influence.

After consideration of input from the interested parties and its own review the CCP concluded that there were two proportionate and equally effective remedies - both of which could "address the adverse impacts on patients and taxpayers identified [in the CCP's March advice]".

The first of these was the introduction of an independent healthcare adviser to provide a choice advice service to patients. Such advisor would be employed by the PCT. This preservation of patient choice would result in competition between service providers ensuring benefits to patients and taxpayers. The patient choice service provided currently by the Hospitals would be removed and replaced by the independent healthcare advisor to ensure that there was no unnecessary duplication to the patient pathway.

The second suitable remedy was that put forward by Oxfordshire PCT as set out above together with the additional view that the PCT should also ensure that leaflets providing details of providers (including average waiting times infection rates and patient survey scores) were available to patients. However information being available on its own did not constitute a suitable remedy. Performance monitoring could only be an 'after event' remedy rather than preventative and using third sector entities to provide advice depended on finding suitable willing third sector providers.

The Secretary of State is currently deciding whether or not to accept these recommendations.

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