The Co-operation and Competition Panel (CCP) has recently published a report on the Any willing provider policy in routine elective care in which it criticises PCT commissioners for various tactics used to manage demand including restricting patient choice, activity caps and minimum waiting times.

It makes the following nine recommendations:  

  • Commissioners review their existing practices in relation to restrictions on patient choice and competition, and take steps to bring themselves into compliance with the principles and rules.
  • Commissioners be required to approve any such restrictions at board level and annually publish (eg, as part of their annual report or statement of commissioning intentions) details of any restrictions on patient choice they have adopted, the underlying rationale for the restriction, an analysis of its impact and terms of the restriction, including the period for which it will operate.
  • Commissioners also be required to:
    • publish the approach they have adopted to activity planning with providers in their locality; and
    • when imposing waiting time requirements on providers, publish on the home page of their website clear information about the minimum waiting time imposed by the PCT on each provider.
  • Strategic health authorities (SHAs) and in future the NHS Commissioning Board (NCB) implement oversight arrangements to ensure that commissioners are not restricting patient choice and competition in routine elective care against patients’ and taxpayers’ interests.
  • The DH:
    • requires commissioners to ensure that referral management centres (RMC) implement the choose and book system effectively and share with all local providers the scripts and any other communications used by RMC staff when referring patients to a provider for routine elective care; and
    • requires commissioners to copy to all local providers any information they supply to GPs concerning providers.
  • DH takes action to ensure that SHAs and commissioners are implementing payment by results in accordance with the code of conduct for payment by results and national guidance, including ensuring that commissioners publish the details of any locally adopted variations to the national tariff.
  • The DH, in developing accreditation arrangements for future commissioners, requires that commissioners demonstrate to the NCB an understanding of the policies and rules concerning patient choice and competition, and a commitment to complying with their obligations under these policies and rules. Compliance with the policies and rules concerning patient choice and competition should also be made a condition of continued accreditation.
  • DH reviews the rationale for the activity planning provisions in the standard acute contract, and if these provisions remain necessary, assess whether amendments could be made to make these provisions less susceptible to being used to restrict patient choice and competition.
  • DH reviews the way in which the market forces factor is incorporated into the tariff for routine elective care, and assesses whether the incentives that the current arrangements create for PCTs to restrict patient choice are outweighed by other considerations.