Recently tendering for Darzi-style health centres has been in the news, but few GPs will be aware of a new process in England for obtaining NHS contracts called any willing provider (AWP) where formal tendering is not required. I do not think that AWP contracts are realistic for individual practices, but they do suit GP consortia.
Dr Tim Kimber
At present details about AWP are thin on the ground. The main source of information is the PCT Procurement Guide for Health Services, published by the DoH in May this year. This states that AWP: '... describes a system of rules whereby, for a prescribed range of services, any provider that meets criteria for entering a market, can compete within that market, without constraint.'
AWP is not about being the successful bidder to provide services exclusively for a defined local population (such as the patient list of a vacant practice). With an AWP contract you would be one of a number of local providers that patients can choose from for a service - dermatology, for example.
AWP is to do with the DoH's free choice initiative under which patients will be offered a choice of service provider.
It applies to routine elective services although as choice is rolled out, PCTs can create local AWP policies in other areas such as long-term conditions.
Under this model, there are no guarantees of volume or payment in any contract given. How much you are paid will depend on how many patients choose to use the service rather than go elsewhere. The AWP contract is merely permission for you to supply a service.
AWP is now the preferred method of NHS services procurement. The DoH's Principles and rules for Cooperation and Competition (PRCC) requires commissioning and procurement to be transparent and non-discriminatory, and for providers best placed to deliver the needs of patients and populations to be used. And under EU law, competition is the mechanism for ensuring equality of treatment, transparency and non-discrimination.
When deciding to competitively tender, PCTs must consider the contract's estimated value, the level of market interest, capability, potential for innovation, government policy on protected services, and circumstances under which competition is not appropriate.
Essentially, formal tendering will normally only be required where the result is to create an unavoidable service monopoly (for example, taking over a vacant practice). Otherwise AWP should be used.
PCTs are now required to have an AWP accreditation process. However an internet search has shown me that a few have one and an awful lot still do not. The reason for the delay may well be the lack of clear DoH guidance on how to run an accreditation process. Nevertheless, it appears that accreditation should take place in two stages.
First is a generic stage whereby the potential provider has to show that it meets the core quality markers for the service laid down in the 2004 DoH document Standards for better health. This is concerned mainly with corporate and clinical governance: essentially, checking that the provider is a robust organisation with adequate financial and administrative backing, and that the service will be delivered safely.
All PCTs have been developing a tendering process for GP-led health centres, and part of this process has been to produce a Pre-Qualification Questionnaire (PQQ) for bidders. This PQQ is exactly what is required for the generic part of AWP accreditation. So PCTs should be aware that they have more or less done the work.
The second part of accreditation is service specific, and is to ensure that the provider will deliver the service in line with agreed local pathways.
The AWP model is risky for individual practices to take on but should suit GP consortia well, and it will enable them to get on with setting up the 'out of hospital services' promised in the DoH's 2006 White Paper Our Health, Our Care, Our Say.
There is clearly a degree of risk with an AWP contract, since there is no guarantee of any work. But GPs are well placed to set up clinical services responsive to patient needs, and under free choice, patients should be able to choose services that suit them best.
If PCTs genuinely want to realise health minister Lord Darzi's vision for future healthcare, they should accelerate the AWP accreditation process, so that those of us who have the will to do this work can get on with it.
- Dr Kimber is a GP in Littlehampton and deputy chairman of West Sussex LMC
- You can find all of the articles from our Bidding for NHS Contracts series at www.healthcarerepublic/bidding
Awarding AWP contracts
- Signal their intentions clearly and advertise the process.
- Carry out the same financial and quality assurance checks on all potential providers.
- Objectively set and evaluate terms and conditions in proportion to the size, complexity and risk of the service.
- Not favour existing providers or a particular type of provider.
- Negotiate local quality and risk arrangements fairly.
- Use the most relevant NHS contract or include standard provisions.
- Ensure conflicts of interest are managed appropriately.
- Get approval from their SHA of locally generated AWP policies.
Source: PCT Procurement Guide for Health Services, DoH, May 2008.