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How 'any qualified provider' will affect practices

What is AQP, how will it work and how will it impact on GP practices and the services they provide? Marina Soteriou reports

Dr Mike Dixon: 'AQP is turning out the way clinical commissioners want'
Dr Mike Dixon: 'AQP is turning out the way clinical commissioners want'

What is any qualified provider?

Any qualified provider (AQP) is the government’s policy to extend patient choice. When a service is opened up to a choice of AQP it means that patients can choose where to have their treatment from a range of providers who meet NHS standards and price and are Choose and Book compliant. Providers can be from the NHS, the private or voluntary sectors.

The government hopes that patient choice will drive up quality if patients are able to choose their provider based on outcomes or waiting times. The DH has said services put out to AQP will remain free for patients to use and that access will be based on clinical need, in line with the NHS Constitution.

From next April, England’s 212 clinical commissioning groups (CCGs) will be responsible for commissioning and will have to open up some services to AQP. The services that are tendered under AQP will vary from area to area.

In theory AQP could benefit practices because they could bid to provide some of the services put out to tender. However, the GPC fears that CCGs will feel pressured to use AQP when buying local enhanced services (LESs) in the future. This could mean that some LESs might be taken away from GPs and ‘flogged off’ to the private sector, according to the GPC.

What is happening now?

The roll out of AQP started in April 2012 with a selection of community and mental health services. It will extend further this year – this month the DH said it was on track to put a further 39 services to AQP through PCTs in the autumn (see box below for the full list).

The contract details for AQP are still being finalised by the DH and are due to be announced in the autumn.

The DH has said that there is nothing to stop CCGs from commissioning certain services from GP practices, but that there needs to be a separation between the commissioner and the provider function of the practice.

How will AQP work in practice?

Providers of services under AQP will need to be registered with the Care Quality Commission (CQC) if they are carrying out a service that is already regulated. Some providers will have to hold a licence from Monitor, but details of this will not be finalised until a consultation on Monitor’s functions closes at the end of October.

The DH has already said that, under AQP, providers do not necessarily need to be regulated by the CQC or licensed by Monitor, unless this requirement already exists for that service.

Providers will also need to agree to provide the service under the tariff set by the commissioners, which is likely to be the national tariff.

Commissioners will only be able to refuse to accept providers if they reject the price offered, refuse to agree to local standards or to comply with pathways and referral thresholds, or if they fail quality standards.

The Monitor consultation says that ‘interested parties’ will have the power to appeal to Monitor if they believe that commissioners have failed to act transparently or that private interests have affected their decisions.

Monitor expects to be ready to issue licences to NHS foundation trusts in April 2013, and other providers needing a licence from April 2014, ‘subject to the results of this consultation’.

Is this marketisation of the NHS?

The NHS Confederation says that, as a model, AQP is not new and has been in place for elective care since April 2008, managed by a national level contract for each provider on the Extended Choice Network.

But the BMA fears that AQP will lead to increased marketisation of the NHS. It says private providers will be able to cherry pick the services which will return the largest profit for their shareholders. The government insists that extending competition and choice in the NHS will improve quality and innovation.

GPC negotiator Dr Chaand Nagpaul says AQP should not be the default position of the NHS. ‘AQP shouldn’t be enforced on commissioners and CCGs,’ he says. ‘There should be integration and direct dialogue between primary and secondary care and AQP will threaten this. It is another bureaucratic process and increases the marketisation of the NHS.’

However, NHS Alliance chairman Dr Michael Dixon says critics of AQP will be appeased when the final guidance is published, because it will be up to CCGs who they approach to ask them to submit a tender.

‘Critics thought of AQP as a way of providing preferential treatment to private provider over NHS providers, but the way it is turning out is the way clinical commissioners want,’ Dr Dixon says.

‘Traditional tendering is terribly burdensome. For a PCT to draw up a tender takes six months and costs at least £100,000. We need things to move forward and provide the means for CCGs to be leaner, faster organisations. The fear that it would be imposed on CCGs will dissipate when the final model comes out.’

Will LESs be affected by AQP?

In July the NHS Commissioning Board (NHSCB), which will hold GP contracts from next April, published guidance called Code of Conduct: managing conflicts of interest where GP practices are potential providers of CCG commissioned services.

It says that there could be instances where a CCG could commission services from a practice on a ‘single tender basis’.

‘CCGs will need to decide, subject to the proposed DH regulations on procurement and choice, and subject to current procurement rules set out in the Public Contracts Regulations 2006, where it is appropriate to commission community-based services through competitive tender or an AQP approach and where through single tender, ' the document says.

'In general, commissioning through competitive tender or AQP will introduce greater transparency and help reduce the scope for conflicts. There may, however, be circumstances where CCGs could reasonably commission services from GP practices on a single tender basis, i.e. where they are the only capable providers or where the service is of minimal value.’

CCGs could decide that this guidance applies to some LESs, which may mean that they will not be put out to open tender. However, it remains to be seen how this will actually work in practice.

List of services due to be put out to AQP this autumn
  • ADHD and autism
  • Adult hearing
  • Anti coagulation
  • Child and adolescent mental health services (CAMHS) tier 2
  • Community cardiac diagnosis
  • Community fracture clinic
  • Continence
  • Continuing care
  • Continuing care (children)
  • Continuing care adults
  • Continuing care other
  • Core nail surgery
  • CT
  • Dermatology
  • Diabetes education and self management for ongoing and newly diagnosed (DESMOND)
  • Dual-energy X-ray absorptiometry (DXA, previously DEXA)  
  • Diabetes education
  • Diagnostics
  • ECG
  • Endoscopy
  • Glaucoma
  • Lymphoedema
  • Mental health spot placements
  • Minor oral surgery
  • MRI
  • Musculoskeletal (MSK)
  • MSK carpal tunnel management
  • Non-obstetric ultrasound
  • Ophthalmology
  • Pain services
  • Podiatry
  • Psychological therapies
  • Smoking cessation
  • Supported accommodation
  • Termination of pregnancy
  • Vasectomy
  • Venous leg ulcers
  • Weight management
  • Wheelchairs

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