BMA annual meeting: Doctors vote for an end to competitive tendering

BMJ 2014; 348 doi: (Published 24 June 2014) Cite this as: BMJ 2014;348:g4230
  1. Gareth Iacobucci
  1. 1The BMJ

Doctors have overwhelmingly called on the UK government to repeal legislation that requires many clinical services in England to be tendered on the open market.

Delegates at the BMA’s Annual Representative Meeting in Harrogate carried a motion that said they were “dismayed that private providers have won so many tenders for clinical services” in the NHS in England since the Health and Social Care Act came into force. The motion called for the repeal of competitive tendering legislation, in favour of a “patient focused healthcare system based on collaboration, cooperation, transparency, and accountability.”

The act introduced new rules expanding the role of competition in the NHS in England. Under the rules, clinical commissioning groups must be able to justify any decision not to tender a clinical service to multiple providers. The new legislation has led to widespread fears of legal challenges among commissioners and has brought a surge in the number of services being offered on the open market.1

The motion was proposed by Margaret Beedie—a member of the BMA’s Cambridge, Huntingdon, and Ely division—who said that the legislation had created a system where the principles of cooperation and collaboration had been marginalised. “We have got to stand up for the NHS,” she said.

And in a separate vote, doctors carried a motion instructing the BMA to “publicly and privately lobby for the requirement for competitive tendering to be withdrawn from regulations applying to the NHS.”

The votes came after the chairman of the BMA had earlier called on the UK government to abandon the “bizarre market culture” that it had created in the NHS.2 In his keynote speech to representatives, Mark Porter urged the government to rethink the new rules and expressed sympathy with commissioners who were being forced to work within them.

He cited one example where a clinical commissioning group had apparently written to 500 providers to seek advice as part of a review of NHS services in their area. “Let’s imagine the bureaucracy that this could generate,” he said. “How can we ever achieve whole and seamless care when so many services have to be touted to private bidders?”

He added, “How will these services work together for the good of patients when they are constantly eyeing up each other’s business? The government will no doubt say that commissioning decisions are made locally. Monitor [the health regulator] has told us that not all services need to be put out to tender. But, whatever the reassurances, a bizarre market culture has been created.

“I sympathise with commissioning managers. There are decent, intelligent people trying to manage the NHS, people who really want to achieve all those things they said in the review. They want to promote integration and make care better.

“But these same people are being driven to distraction by the madness of the market. They can’t do both. And a government that thinks they can just doesn’t get it.”

Porter added, “Do we really want an NHS that is so obsessed with private companies tendering for work? Or do we want a National Health Service that is passionate about tend to the weak? It doesn’t have time to be both.”

In a later vote, representatives overwhelmingly passed a motion demanding that the NHS be exempt from the Transatlantic Trade and Investment Partnership, on the grounds that its inclusion would “tip the balance of power further towards private corporations and away from the public sector.”

Kambiz Boomla, a member of the BMA’s Tower Hamlets division, proposed the motion, saying that a failure to secure an exemption would “lock the NHS into a competitive market.” He warned, “Any future government would be unable to reverse this policy.”


Cite this as: BMJ 2014;348:g4230


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