Primary care contracting
From April 2013, NHS England will be responsible for the commissioning of primary care. NHS England Local Area Teams (LATs) will administer contracts and payments at a local level, including management of the performers list.
Following the passage of the Health and Social Care Act it is a contractual requirement for a practice to be a member of a CCG. This requirement does not entail any other extra-contractual obligations.
CCGs will not hold practices’ contracts, have any contractual sanctions to or be able to oblige practices to perform out-with their contract. In all situations, the practice contract takes precedence over the CCG constitution.
NHS England will delegate responsibility for performance management of individuals and practices to NHS England LATs. CCGs will have no role in performance management of member practices. LMCs should be building relationships with the LATs to ensure that they are appropriately involved in the performance management of individuals and practices in their area.
NHS England and LATs will have reduced staff numbers compared to Primary Care Trusts (PCTs). The development of close relationships will be important in ensuring that those responsible for commissioning of primary care and contract management have good insight into the local primary care environment.
Functions currently carried out by PCTs
The LATs will also discharge functions currently carried out by PCTs such as payment of maternity, locum and translation services, the provision of occupational health services, disposal of clinical waste and premises reimbursement. The LATs will not arrange provision of locums and temporary staff for practices as PCTs currently do in some areas.
GP IT strategy and budgets will be managed by NHS England, who will commission national services such as N3. NHS England will delegate the provision of primary care IT infrastructure and support services to CCGs, to ensure a coherent local approach to IT.
From Autumn 2012, NHS England will be working with PCT Clusters to develop standard operating procedures to be adopted by LATs from April 2013. These will include a standard approach to performance management, payment policy and procurement processes.
NHS England will commission enhanced services currently commissioned as Directed Enhanced Services (DESs). NHS England will delegate to CCGs authority to commission services currently commissioned as Local Enhanced Services (LES), as part of their statutory responsibility for improving the quality of primary care.
These services will no longer be called ‘Local Enhanced Services’ and will be commissioned using the NHS Standard Contract. The Standard Contract is used by NHS commissioners to commission NHS funded acute, ambulance, community and mental health and learning disability services from all types of providers and reflects the requirements of the NHS Operating Framework.
The procurement processes will remain the same as currently applicable for LESs. LMCs should ensure that they are involved in the decisions about the commissioning of such services as they currently are with PCTs.
LMCs should encourage CCGs to commission local services as an efficient lever to drive up quality and achieve QIPP objectives.
As PCTs are currently required to, CCGs will need to provide justification for the tendering process they choose to use; whether competitive procurement, Any Qualified Provider (AQP) or a single tender process. Although competition law applies, as currently, this will only be relevant where contracts are worth over £100,000.
Local authorities will have new public health responsibilities and will be able to commission services currently commissioned as public health related LESs, for example smoking cessation, substance abuse and sexual health services.
LMCs will need to ensure that they have close links to local authority commissioners in order to feed into the commissioning of these services.
The GPC is seeking clarification about the arrangements for NHS superannuation for services commissioned by local authorities.
Conflict of interest
CCGs will be managing large amounts of public resource. It is vital that patients have confidence in the integrity of the decisions taken by clinicians in order to protect the clinician-patient relationship and maintain public confidence in the commissioning system.
Clearly, clinician-led commissioning will require robust mechanisms to manage perceived or actual conflicts of interest. Such mechanisms could include the establishment of a CCG scrutiny committee to oversee CCG decision-making, seeking advice from the Health and Wellbeing Board as an independent party or seeking advice from the LAT.
LMCs should ensure that the CCG constitution contains information about how conflicts will be managed, in particular, where the CCG is commissioning services from member practices.
Any Qualified Provider
Any Qualified Provider (AQP) aims to extend patient choice by allowing patients referred for particular services to choose from a list of qualified providers who meet NHS service quality requirements, prices and normal contractual obligations. In April 2012 eight services areas were identified by the Department of Health for the phased implementation of AQP.
Commissioners, currently PCT clusters, are required to identify a minimum of three of these services to provide via AQP. A further list of services for implementation in 2013 and 2014 will be published by the Department of Health.
All providers in an area will be paid a fixed price for an AQP service – either the national tariff or the price set by local commissioners. Commissioners will need to identify the price that should be paid for a specific AQP service in their area.
Once a commissioner has decided on services to be procured through AQP, the service specification will be advertised on the NHS Supply2Health website.
Providers will have to qualify and register to provide services via an assurance process that will test their fitness to offer NHS-funded services. LMCs should familiarise themselves with this process in order to be able to support GP practices wishing to bid for AQP services.