Extending the patient choice of provider

Update December 2011

Recent engagement with stakeholders, patients, staff and clinicians and the consideration of financial, contractual and market issues, as well as the ability to meet timescales for implementation, have led the PCT cluster to determine that the following services will, during 2012/13, have an extension of the choice of provider available through the ‘any qualified provider’ process:

• Dermatology;
• Psychological therapies (IAPT);
• Primary care diagnostics, specifically endoscopy.

A report on how the cluster came to this decision can be found on the right hand side.

Background

The Department of Health (DoH) has already engaged with clinicians, providers, commissioners, patient groups and voluntary organisations on how best to extend patient choice of provider. They have considered which services should be subject to choice, what qualification criteria for providers should be employed, and how the mechanism for patient choice of AQP should operate.

The NHS Future Forum as part of the response to the listening exercise for the Health and Social Care Bill supported the concept of extending patient choice. In its response to their recommendations, the Government stated that it would maintain its commitment to extending patients’ choice with phased implementation from April 2012, and focusing on the services where patients say they want more choice.

The DoH has issued guidance for NHS commissioners and current and prospective providers of NHS-funded services in England which sets out how patient choice of AQP will be implemented until April 2013. Specifically it stated

• By October 2011, PCT clusters will have identified three or more community or mental health services in which to implement patient choice AQP in 2012/13, based on the priorities of pathfinder clinical commissioning groups, and the views of local stakeholders. The selection of these services should be based on local priorities for improving quality of, and access to, NHS services
• Between April and September 2012, PCT clusters should implement patient choice AQP in those services agreed locally

Key principles of any qualified provider approach

The following principles govern the AQP approach to contracting for services

• 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 for the service being referred to
• competition is based on quality, not price. Providers are paid a fixed price determined by a national or local tariff

Qualification process

The qualification process is intended to ensure that all providers offer safe, good quality care, taking account of the relevant professional standards in clinical services areas. The governing principle of qualification is that a provider should be qualified if they

• are registered with Care Quality Commission (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 which includes a requirement to have regard to the NHS Constitution, relevant guidance and law
• accept NHS prices
• can provide assurances that they are capable of delivering the agreed service requirements and comply with referral protocols reach agreement with local commissioners on supporting schedules to the standard contract including any local referral thresholds or patient protocols

Details of how potential providers will be qualified will be published in the autumn.
Providers will be listed on a directory so that patients and GPs know who is providing what services where. Details of this will also be published in the autumn.
PCT clusters must register qualified providers for payment purposes and will hold providers to account for monitoring quality via the NHS Standard Contract. They would have the option to make reasonable amendments to service specifications and additional contractual requirements on service quality and/or local referral protocols.

Implementation of patient choice of any qualified provider to April 2013

There is a phased implementation of patient choice AQP, treating 2012/13 as a transitional year, starting with a limited set of community and mental health services. Based on discussions with national patient groups and an assessment of deliverability, the DoH has identified a list of potential services for priority implementation as follows

• musculo-skeletal services for back and neck pain
• adult hearing services in the community
• continence services (adults and children)
• diagnostic tests closer to home such as some types of imaging, cardiac and respiratory investigations to support primary assessment of presenting symptoms
• wheelchair services (children)
• podiatry services
• venous leg ulcer and wound healing
• adult primary care psychological therapies

PCT clusters are required to select three or more services for implementation in 2012/13 from the list set out above. Alternatively, they may choose other services that are considered to be higher local priorities, if there is a clear case to do so based on the views of service users and potential gains in quality and access.
The NHS Bournemouth and Poole and NHS Dorset cluster are also considering the following service in addition to those identified above

• community based dermatology services

The Department of Health is developing a further list of services to consider for patient choice of AQP implementation in 2013/14. This will be subject to further engagement with patients, professionals and providers but 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)
• wheelchair services (adults)

Subject to the outcome of further national and local engagement, the Department of Health plan to announce these services in the autumn of 2011, to maximise the time for commissioners and providers to prepare.

Actions required in 2011/12

By 31 July 2011, Strategic Health Authorities will identify lead PCT clusters to develop implementation packs – consisting of service specifications, contract currencies (including safeguards against cherry picking), information models and tariffs - for each service on the national list. These will be complete from November 2011.

By 30 September 2011, all PCT clusters must have engaged patients, patient representatives, healthcare professionals and providers on local priorities for extending choice of provider.

By 31 October 2011, feedback from this engagement should have been used by clusters and clinical commissioning groups to identify three or more community or mental health services for implementation, drawing from the national list or local priorities. Strategic Health Authorities should have been notified of cluster/commissioning group priorities for 2012/13.

By September 2012, PCT clusters should have implemented patient choice of AQP for identified and agreed services, taking account of the NHS Operating Framework and standard contract. The DoH expect some services to be available before this date.