Anyone who’d made the mistake of thinking that we were now approaching some sort of clarity about the likely impact of the much Health and Social Care Bill would do well to discard that idea and settle back in the state of bemused confusion that’s been the default position for much of the last year. The latest twist is the realisation that the Any Qualified Provider (AQP)contracting system – which would see patients given the chance to choose services from a range of providers – may turn out to be less of a policy that will be implemented nationally and more of an option that new Clinical Commissioning Groups (CCG) may or may not choose to utilise. And even if CCGs do choose to implement AQP, that could ultimately mean a number of very different things.
Health Investor reports that: “Commissioners will not have to use Any Qualified Provider if they feel it is inappropriate, according to a senior Department of Health (DH) official. Bob Ricketts, director of provider policy at the DH, said that ‘a genuine spectrum’ of contracting systems would operate in the reformed NHS, with clinical commissioning groups, not Monitor, deciding what is the most appropriate for each service or location.”
For those readers who’ve been baffled by the debates so far, this paper from the NHS Confederation provides a (relatively) accessible guide to the possible workings of the AQP model. The first version of the model – competition in the market – involves patients being given a choice of providers that (a) have a national licence and accreditation to provide the service and (b) have agreed to provide the service at a price determined by the local CCG.
The second version of the model – known as ‘competition for the market’ – basically seems to involve CCGs running a procurement process at the end of which a provider will have a contract to deliver the services. It’s not immediately clear how patient choice will operate under this model.
A third version ‘the combined model’ is an as yet under-defined mixture of the two approaches which, broadly speaking, seems to involve a large provider tending for a contract to deliver a set outcomes but with patients receiving a wider choice of services from sub-contractors than they would under model two.
Basically, what happens in any given local area will depend largely on what new CCGs – in concert with new Health and Wellbeing boards – decide to do and how they decide to do it. Amongst the phenomenal range of questions this raises, a few with most relevance to social enterprises are:
To what extent will a diverse range of providers (including social enteprises) be willing and able to offer services under the ‘competition in the market’ model which, in theory, offers the widest possible choice to patients?
To what extent will CCGs consider wider social when awarded block contracts under model two (and will the Social Value Bill apply here)?
Based on the Health Investor report, will most CCGs even feel the need to look beyond the NHS at all when commissioning services?
How (if at all) does the regulatory model under-pinning AQP allow for the possibility that patients might want CCGs to provide funding for non-medical interventions that improve their quality of life and reduce dependency on medical treatment?