The new Government has issued revised versions of the Principles and Rules of Co-operation and Competition (PRCC) and Procurement Guide, amended in light of the recent White Paper and the revised Operating Framework.
A revised PRCC (published March 2010) was already due to come into force on 1 October 2010. The further revised version will come into force on the same date, although that date is still stated to be subject to consultation by Monitor on appropriate changes to the Foundation Trust Compliance Framework
. A key change is that the new principle 7, which concerns access to essential services, will not come into force on 1 October as previously planned. Instead, it will operate as guidance only for the time being.
The new principle 7 states that providers may not refuse to supply essential services or to use services supplied by others, where this restricts patient or commissioner choice against patients’ or taxpayers’ interests. This is controversial, as in practice it will involve things like providing the services of hospital consultants to new providers (this is the example given in the PRCC document). In addition, it may mean that providers have to give third parties access to their facilities and equipment (although this is under further consideration by the Department of Health, Monitor and the Co-operation and Competition Panel). Providers will be relieved by the delay in implementing this principle, as this recognises that further work is needed to ensure that it is workable before it is introduced.
The other main change is to principle 5, which relates to patient choice. This has been amended so that commissioners have to “promote” rather than “encourage” patient choice, and to reflect the increasing importance of the any willing provider model. The principle now expressly states that promoting patient choice will include, where appropriate, choice of any willing provider.
The third key change to note is that there is express reference to the PRCC applying to shadow GP commissioning consortia. This clears up any doubt as to whether GP commissioners will be caught by this area of NHS policy.
Looking forward, the revised document notes that the status of the PRCC is expected to change in light of further developments flowing from the White Paper, including the responses to the consultation documents. In the longer term, the PRCC is expected to continue to apply until the new competition regime is established in 2012. The new regime will be overseen by Monitor in its new role as Economic Regulator.
The revised Procurement Guide has been renamed from the PCT Procurement Guide to the Procurement Guide for commissioners of NHS-funded services. This is a clear change in emphasis and so it is no surprise that the guide now expressly states that it applies to shadow GP commissioning consortia.
In applying to shadow GP consortia, the Procurement Guide introduces a number of responsibilities that GP consortia may not have anticipated. For example, all commissioners are expected to state their short/medium term commissioning intentions on their website, all procurements and contract award notices must be published on NHSSupply2Health and all commissioners must use the NHS standard contracts. This gives some clarity around expected arrangements for GP commissioning at this stage. However, in relation to governance, the guide simply states that the arrangements may need to be changed to reflect changes to accountability arrangements resulting from the White Paper.
As with the PRCC, the revised Procurement Guide places more emphasis on increasing patient choice, and in particular the use of the any willing provider model to achieve this. Further guidance is to be issued on this in the context of community services.
It is also worth noting that the new guide expressly states that no advantage must be given to any market sector. This clears up any doubt left by the previous Government’s references to the “NHS as preferred provider”, which is no longer mentioned.
The revised Procurement Guide is applicable to procurement activity commencing from August 2010 and will be revised further as the White Paper reforms progress. In particular, it will be revised substantially for 2011-12 to reflect the transition to shadow GP consortia and establishment of the shadow NHS Commissioning Board.