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Unions call for NHS competition resolution

Doctors’ and nurses’ leaders are calling on the government to amend controversial regulations to make it absolutely clear how competition will be managed amidst continued confusion and anxiety about the changes.

With only days to go until new commissioning arrangements for NHS services come into force, there are increasing concerns from doctors and nurses that competition will be enforced. The BMA and RCN say clarity in the legal framework is crucial, placing beyond doubt the limits of competition.

Regulations laid before Parliament last month provided greater details about how aspects of patient choice and competition would operate under the Health and Social Care Act, which takes effect on 1 April. They were intended to ensure good procurement practice, but prompted widespread concern and uncertainty about the apparent requirement for competitive tendering for most health services.

Although the regulations have since been revised to acknowledge some of these concerns, there remains a lack of clarity around when commissioners will be required to tender all services, the BMA and RCN claim. They’re concerned that competition risks fragmentation of services, creates unnecessary transaction costs and increases scope for legal challenge, making it harder for the NHS to deliver high-quality, cost-effective and integrated care to patients.

During the passage of the Act, the government stated on a number of occasions that commissioners would have the freedom to decide which services they would tender. Monitor has the task of producing guidance for commissioners on procurement and competition which is expected to provide clarity on what will be expected of commissioners and how Monitor will discharge its functions in this area. However this guidance has still not been published, causing further uncertainty for commissioners.

The BMA and RCN are asking the government for:

– Immediate and definitive assurances on whether commissioners could legitimately seek to limit competition in all circumstances where it is in patients’ best overall interests;

– Assurances to be clearly reflected in the legal framework;

– A firm commitment that commissioners could prioritise patient services over competition and choice, thereby avoiding fragmentation.

Dr Mark Porter, chair of BMA Council, said: “Although the revised regulations improved the original wording, we stressed the need for this to be supported by clear guidance to provide the assurance and clarity that is needed to ensure that competition does not undermine integration, innovation, or clinical autonomy.

“With major NHS changes coming into force on 1 April, that guidance has still not been published. This has created great uncertainty and anxiety for clinicians and patients, and left commissioners in a potentially vulnerable state. We have not received satisfactory assurances from the Government that would alleviate the considerable fear that commissioners are facing.

“Until we see how the regulations work in practice we cannot be sure that commissioners will have the freedom to act in the best interests of patients. The stakes are too high to take such risks in what is untested territory.”

At its meeting last week the BMA’s GPs committee was of the view that the rewritten regulations did not satisfactorily assuage GPs’ concerns and there was a lack of clarity for commissioners about the circumstances in which competition does not have to be used. The committee called for the withdrawal of the regulations relating to this.

Porter added: “We urge the government to give immediate and absolute assurances about the limits of competition, changing the wording of the regulations if this is what it takes, to ensure that its prior commitments match the reality on the ground. Commissioners need to be completely clear about the rules governing commissioning and to know that they will be allowed to make the best decisions for their patients.”

Dr Peter Carter, chief executive & general secretary of the RCN, said: “The priority for the health service right now should be encouraging integration between services to cope with increasing demand and driving up the quality of patient care. Without Government assurances being reflected in the Regulations, we are concerned that clinicians will not be able to focus on these priorities and commission the services that their patients need.”

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One Response to “Unions call for NHS competition resolution”

  1. Malcolm Morrison says:

    It would appear that the modern politician is full of THEORY but unable to foresee the PRATICAILITIES of their suggestions. Furthermore, they employ draughtsmen who cannot write, in CLEAR ENGLISH, regulations that mean what they say, so that others are not left in doubt!

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