Commissioners frequently ask us if the rules around competition and choice prevent them from encouraging GPs to work together and with hospitals, and from awarding contracts to GP federations.
As part of our research into improving GP services, we found that GP practices are increasingly working together to be able to provide services to people when they need them, including working in federations. We heard that this approach allows GPs to disseminate best practice, share back-office functions and extend their opening hours to evenings and weekends.
Agreements between GPs can improve services for patients. A GP federation providing dermatology services from local GP practices, for example, may be easier for patients to attend than a hospital-based service.
We also hear that GPs are increasingly working with other providers, including hospitals, through models such as primary and acute care systems (PACS) set out in the Five Year Forward View, to break down the distinction between primary and secondary care.
But can commissioners confidently award contracts to these GP federations?
The short answer is ‘yes’ - as long as they take appropriate steps to manage three key risks.
Manage conflicts of interest carefully
We recently blogged about how conflicts can arise from having GPs involved in both commissioning and delivering local services. In a GP federation, this potential conflict is also present as commissioners are often members of the GP federations that are bidding for work.
If the GP federation comprises a large number of the GPs in the local area many, even all, of the members of the governing body of a clinical commissioning group (CCG) might have a potential conflict. In that case, the CCG will need to manage the conflicts but also ensure it has the necessary clinical input in making decisions about the procurement.
Read our recent post to see how one CCG managed potentially conflicted clinical members and sourced alternative clinical expertise.
Be careful not to specify services in a way that only works for federations
Even if conflicts of interest are managed appropriately, there is still a risk that CCGs may intentionally or unintentionally favour GP arrangements over other providers when designing procurements and awarding contracts.
A procurement might specify that a particular service needs to be provided from GP practices in the local area for example. This specification is likely to make it difficult for a provider other than a GP federation to win the bid even if they are better able to meet the needs of patients in other ways.
This risks the CCG not getting the provider most capable of meeting the needs of patients or providing the best value for money.
Preserve patients’ right to choice
If properly designed and implemented, arrangements between GPs and hospitals could help to ensure that transition between primary and secondary care is as seamless as possible for patients.
However, in thinking about these kinds of arrangements commissioners and providers should remember that any arrangement must ensure that patients’ right to choose their provider of elective services is preserved, and maintain providers’ incentives to improve services to attract patients.
This means a GP cannot require their patients to attend a particular hospital for elective care regardless of any arrangement between the GP and the hospital. Even where a hospital is providing primary care services itself it must offer a choice of provider to patients requiring a first outpatient appointment with a consultant or member of a consultant’s team.
More information
For more guidance on how the rules around choice and competition apply to the ways in which GPs can work together, please see our choice and competition toolkit: scenarios for GPs working together.
How are you engaging with the GP federations in your area? And CCGs with fully delegated co-commissioning responsibilities – how are you approaching the new challenge of commissioning primary care?
We’re always more than happy to answer your questions, so leave us a comment or get in touch (our email address and phone number are to the top right of the screen) if you want to discuss how the regulations apply to your particular situation.
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