Last week Monitor published its initial findings into a complaint by a private provider against a Primary Care Trust. Whilst PCTs have ceased to exist Monitor says that this case will serve as 'guidance for local commissioners and their approach to commissioning services'.

The report sets out Monitor's provisional findings in relation to the complaint made by St. Piran’s Healthcare Ltd about Cornwall and Isles of Scilly PCT’s commissioning of specialist inpatient mental health and learning disability services.

St Piran's complained that the PCT breached the Principles and Rules for Co-operation and Competition (PRCC) by deciding not to commission specialist inpatient mental health and learning disability services from independent sector providers in Cornwall, and specifically from St Piran's. St Piran's operated a 14 bed hospital in Cornwall, which provided services for adults with learning disabilities who required inpatient medical, psychiatric and nursing care.

Monitor’s provisional findings include that:

  • the PCT did not decide that it would not commission specialist inpatient mental health and learning disability services from independent sector providers;
  • the PCT did make statements suggesting it had closed its mind to the possibility of commissioning services from St Piran’s. The main reason for the PCT's view was its objection to the type of services provided (inpatient services), as it was the PCT's policy to avoid inpatient placements for individuals with learning disabilities, in line with national policy;
  • no adverse effect on patients was found to result from the PCT’s conduct and accordingly the PCT’s actions did not have the effect of restricting choice and competition against patients’ and taxpayers’ interests in breach of the PRCC, or unduly discriminating against St Piran’s in breach of the PRCC.

In light of these findings, Monitor recommends that CCGs:

  • keep an open mind in order to obtain high quality, value for money and clinically appropriate services for patients;
  • have a clear rationale if they decide not to commission a particular type of service from a particular provider;
  • ensure that commissioning policies do not restrict choice and competition or unduly discriminate against a provider or category of providers;
  • ensure that commissioning decisions are made in a fair and transparent manner, including by recording reasons for decisions and applying clear decision-making and governance processes.

Monitor also noted the importance of effective provider engagement, considering new entrants to the market and taking into account patients' needs in making commissioning decisions.

Monitor is seeking comments from interested parties before it completes its investigation and issues a final report. The closing date for submissions is 28 May 2013 and Monitor will publish its final report on the case on 21 June 2013.