Scenario 1: We need to put it out to tender

What’s happening

PCTs have been quick to put anything and everything out to tender because of fears of breaking competition rules and having too many players on the field. But misunderstanding around tendering has caused conflict of interest to raise its head more frequently than is necessary.

If PCTs used the any willing provider model (AWP), many perceived problems around conflict of interest would disappear.

Expert opinion Dr Stewart Findlay, practice-based commissioning chair at Durham Dales cluster, says there has been reluctance by PCTs to use the AWP model because they are worried about relinquishing control.

‘The guidance is that unless you are going for a single provider you should use AWP. For example, if you’re going to have a dermatology service, you should allow, at any time of the year, any willing provider to come along and say “we can provide the service or a bit of the service, here are our quality standards, here’s what we’re going to do and here’s the targets we’re going to achieve for you”.

‘In our PCT they have said, “We need to go out to tender because a lot of people are interested.” But it is not the job of the PCT to restrict the number of providers and it would be impossible for them to do so.’

The AWP model also gets around EU rules on thresholds at which services must be put out to tender. If, as a PCT, a single provider for a costly service such as forensic psychiatry is needed, it must go to tender. But for most specialities, such as dermatology, urology, gynaecology, cardiology, and so on, there is a tariff so the AWP model is appropriate, even if the service costs £500,000. ‘Perceived conflict of interest has caused problems. But actually for the little providers – the GPs – if you use the AWP model it doesn’t really matter,’ says Dr Findlay.

‘There’s no reason why GPs can’t just come up with a provider plan – if they have a good idea, let’s help them get on with it.

‘It gives PCTs more control because they can spend their time performance managing, which should be their main role.’

The guidance to quote

Clinical commissioning: our vision for practice-based commissioning, 2009

‘What is clear is that robust governance has too often been mistaken to mean drawn-out approval processes or open tendering for all new services, sometimes linked to simplistic views about commissioning and provision.

‘There will be occasions where a single service provider is needed and where it is right to test the market through competitive tender.

‘World-class commissioners will, however, increasingly use any willing provider arrangements to stimulate a range of providers for more specialist services and extend patient choice into community settings.’