It seems that large parts of practice funding look set to be opened up to competition under new guidance published this month that says only enhanced services of 'limited value' or where GPs are the 'only capable providers' should be commissioned directly from practices. Local enhanced services (LESs) currently held by PCTs are to be devolved to CCGs which will chose how to commission those services. The concern raised by GPC is that CCGs are worried that CCGs will be under pressure to put LESs out to tender through Any Qualified Provider (AQP) approach following a change in the way the DH describes LESs. In some areas LESs are no longer being referred to as 'local' services.
The official guidance from the NHS Commissioning Board (NHSCB) on avoiding conflicts of interest in the NHS from 2013 urges CCGs to use AQP or full tendering for LESs as it adds 'greater transparency and help reduce the scope for conflicts'.
The guidance also provides that GPs on CCG boards will not be allowed to vote on commissioning LESs if they are potentially commissioning from their own practices.
All services currently commissioned as LESs ( with the exception of public health services) will form part of CCGs baseline allocations from April 2013 so that they can determine how best to use these resources. Such services will be commissioned using the NHS standard contract rather than the GP contract (as current services are) and CCGs will need to demonstrate that those services 'go beyond the scope of the GP contract and fully meet the requirements of new procurement rules?.
Subject to proposed DH regulations on procurement and choice CCGs must decide ' where it is appropriate to commission community-based services through competitive tender or an AQP approach and where through single tender'. However the guidance does say that there may be circumstances where CCGs may be able to avoid opening up services to the open market where GPs are 'the only capable providers or where the service is of minimal value'. In these cases CCGs are advised to discuss the process with their local branch of the NHSCB if they are in doubt.
GPs on CCG boards will not be permitted to commission LESs from their own practices and will instead have to either refer the decision to the governing body and exclude all GPs from voting or co-opt individuals from the Health and Wellbeing Board on to the CCG board to make the decisions.
Needless to say many GPs fear that this policy will lead to fractured care for patients and make some practices unviable.