Update on Monitor's first investigation under the NHS Procurement Regulations

Monitor has recently published a statement of issues in its investigation into the commissioning of Gamma Knife radiosurgery services, its first investigation under the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 (Regulations). The statement of issues is available here.

Monitor has stated that it will be focusing on whether NHS England has complied with the Regulations rather than looking at the actions of the North of England Specialised Commissioning Group (the SCG) under the previous Principles and Rules for Co-operation and Competition. NHS England took over responsibility for commissioning these services from 1 April 2013.

The statement of issues explains the exact nature of the complaint raised by Thornbury Radiosurgery Centre (Thornbury). Thornbury has been a designated treatment centre since 2011 but NHS England has declined to enter into an NHS Standard contract with Thornbury for Gamma Knife radiosurgery services. It has also asked Thornbury to stop accepting direct referrals on the basis that Thornbury does not comply with its requirements relating to multi-disciplinary teams (in service specifications which have not yet been formally adopted).

Monitor considers that the evidence it has seen so far suggests the case 'raises a number of potential issues around the compliance by NHS England' with the Regulations. However it stresses that no conclusions have been reached on any of the issues it has identified.

NHS England's response:
NHS England has issued a response to the statement of issues which Monitor has also published together with its statement. Together with putting its version of the circumstances surrounding the complaint and explaining its actions NHS England raises some interesting points concerning the application of the Regulations to commissioning specialised services.

It notes that these specialised services are by their nature different from routine non-specialised services procured from general acute providers. However the Regulations make no such distinction. NHS England suggests that particular considerations need to be factored in when commissioning specialised services. In particular it notes the importance of preventing the proliferation of service providers where this may result in insufficient volumes to ensure high quality cost effective service provision.

Next steps:
Other interested parties have also responded and Monitor is (according to its timetable) currently gathering further information/analysing the evidence submitted so far. It expects to make a provisional decision in November 2013.

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