In response to Liberating the NHS: greater choice and control, the DH has issued operational guidance to commissioners and providers on the implementation of the Government’s commitment to extend patient choice of provider.

Choice for patients can manifest itself in the way care is provided or in the ability to control budgets and self-manage conditions. The NHS Future Forum supported the concept of patient choice of any qualified provider (AQP). In its response to the listening exercise, the Government has stated that it would maintain its commitment to extending a patient’s choice of AQP, with phased implementation over the next few years, and focusing on the services where patients say they want more choice.

AQP means that when patients are referred for a particular service, they are able to choose from a list of qualified providers who meet NHS service quality requirements, prices and normal contractual obligations. The Government proposes to extend AQP beyond the existing routine elective procedure.

The guidance sets out how patient choice of AQP will be extended between the present time and April 2013.

The key principles of the AQP approach are:  

  • providers qualify and register to provide services via an assurance process that tests providers’ fitness to offer NHS-funded services;
  • commissioners set local pathways and referral protocols which providers must accept;
  • referring clinicians offer patients a choice of qualified providers; and
  • competition is based on quality, not price; providers are paid a fixed price determined by a national or local tariff.

There will be a phased implementation of patient choice of AQP beginning with a limited set of community and mental health services. The DH has identified a list of potential services for priority implementation which includes musculo-skeletal services for back and neck pain, adult hearing services in the community, continence services, diagnostic tests closer to home, wheelchair services for children; podiatry services, venous leg ulcer and wound healing; and adult primary care psychological therapies.

PCT clusters, supported by pathfinder clinical commissioning groups, should select three or more services for implementation in 2012/13 from this list. (They may choose other services which are higher local priorities if there is a clear case to do so. Shadow health and wellbeing boards will be a key forum for discussing such priorities).

The timetable for commissioners is as follows:  

  • by 30 September 2011, all PCT clusters must have engaged their local communities on local priorities for extending choice of provider;
  • by 31 October 2011, feedback from this engagement should have been used to identify three or more community or mental health services for implementation;
  • by November 2011, PCT clusters will have developed an implementation pack for each service on the national list; and
  • by September 2012 clusters should have implemented patient choice of AQP for those services.  

Strategic health authorities will oversee the development of patient choice of AQP.  

The qualification process will ensure that all providers offer safe, good quality care. A provider should be qualified if they:  

  • are registered with CQC and licensed by Monitor (from 2013, where required) or meet equivalent assurance requirements;
  • will meet the terms and conditions of the NHS Standard Contract;
  • accept NHS prices;
  • can provide assurances that they are capable of delivering the agreed service requirements and comply with referral protocols; and
  • reach agreement with local commissioners on supporting schedules to the standard contract including any local referral thresholds or patient protocols.  

Providers will be listed on a directory for patients and general practitioners. PCT clusters must register qualified providers for payment purposes and will hold providers to account for monitoring quality via the NHS Standard Contract.

The DH is developing a further list of services to consider for patient choice of AQP implementation in 2013/4. The list may include, maternity (antenatal education and breastfeeding support), speech and language therapy, long term conditions self management support, community chemotherapy (including home chemotherapy), primary care psychological therapies (CAHMS), and adult wheelchair services.

The next steps are that the DH will begin working with selected PCT clusters to develop implementation packs and PCT clusters must begin local engagement as set out above.