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Medical profession demands clarity over extent of competition

Urgent and absolute clarity is needed on how competition will be managed in the NHS ahead of major changes to the health service next week.

The BMA and RCN (Royal College of Nursing) have called on the government to amend regulations on competition to give the necessary assurance over the freedom of commissioners to make decisions on tendering healthcare services.

Regulations were laid before Parliament in February on how competition and patient choice would work under the Health and Social Care Act.

The government had amended the Section 75 regulations in light of concerns from the BMA and others over a requirement that most services should go out to competitive tendering.

However, there continues to be considerable confusion and concern over when commissioners will have to tender all service, in the absence of the expected guidance from Monitor and further government assurances.

Confusion remains

BMA council chair Mark Porter said: ‘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.’

The government has stated in Parliament that commissioners would have the freedom to decide when to tender services but this is not clear in the existing legislation and key guidance on the issue has not yet been published. This has heightened doctors’ and nurses’ concerns.

Guidance from the regulator Monitor on procurement and competition was expected to provide the clarity on what will be expected of commissioners and how Monitor will discharge its functions from when the reforms come into effect on April 1. 

Dr Porter 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.’

Joint demands

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.

RCN chief executive and general secretary Peter Carter said: ‘Even with the recent revisions to the regulations there is still a worrying lack of clarity over how much freedom commissioners will have to provide the best possible care for patients. There is a very urgent need for Monitor and [the NHS Commissioning Board] to publish the promised guidance for commissioners.

‘We remain concerned that despite government assurances commissioners may not be able to put the quality of patient care and integration above the need to provide competition without facing potentially costly challenges … 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.'