BMA calls on government to abandon price based competition in NHS

BMJ 2011; 342 doi: (Published 21 February 2011) Cite this as: BMJ 2011;342:d1142
  1. Tomasz Pierscionek
  1. 1BMJ

The BMA’s General Practitioners Committee yesterday called on the government to abandon its proposed move to competition on the basis of price in the NHS in England, saying that it would affect the quality of care.

The government introduced the concept of price competition in the NHS in its NHS Operating Framework for 2011-12, published in December (BMJ 2010;341:c7366, 21 Dec, doi:10.1136/bmj.c7366). One clause of the framework said, “One new flexibility being introduced in 2011-12 is the opportunity for providers to offer services to commissioners at less than the published mandatory tariff price, where both commissioner and provider agree.”

The idea also appears in the Health and Social Care Bill, which is currently being scrutinised by a House of Commons committee (BMJ 2011;342:d996, 11 Feb, doi:10.1136/bmj.d996).

The General Practitioners Committee said that evidence showed clearly that competitive pricing adversely affected the quality of care. It voted to endorse any amendment to the Health and Social Care Bill that would “preclude price competition within the National Health Service.”

In a press briefing after the meeting committee members said that the clause might lead to a private provider taking “work away from an [NHS] hospital trust on the knife edge of survival,” so leading to its closure.

A second motion called for the new GP commissioning consortiums to have powers to decide which healthcare providers would be able to offer services to patients. It also called for GPs to “have access to a national list of licensed providers” to which they could refer patients seeking treatment outside their community.

The committee’s vote came in the same week that David Nicholson, the NHS’s chief executive, wrote to the heads of all NHS trusts denying that there would be any change to the present arrangements. His letter said: “Services subject to tariff will continue to compete on quality: there is no question of introducing price competition.”

The letter seems to be at odds with the previous messages from the Department of Health. When asked by the BMJ whether this meant that the government was rowing back on its plans to introduce price competition, a department spokesman said, “There is no U turn, because we never intended to introduce price competition. There has been incorrect reporting around this, and Sir David’s letter simply sets that straight.

“There is no change to the policy set out in the 2011-12 Operating Framework and first set out under the previous government in December 2009. Given the potential risk to NHS business planning of the incorrect speculation that this policy amounts to price competition, Sir David’s letter serves to reaffirm this policy—that we want to see competition on quality, not price. Anyone can see that it is difficult for the government to U turn on a policy which it inherited from the previous administration and which it has not amended since coming into office.

“The NHS Operating Framework published last December remains unamended.”


Cite this as: BMJ 2011;342:d1142


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