David ‘Ozymandias’ Cameron’s five NHS pledges – worthy of only the briefest flash in the news-pan yesterday – are already showing all the substance of five brown ballerinas. Even as he made his speech, the smart finger was on the money. PCTs have been running rings round the fixed national tariff for months, allowing private providers to compete on price.
The Bureau of Investigative Journalism has spotted a loophole, a loophole, we might add, that is as wide, open and inviting as a barn door, that allows – forgive the jargon – community services provided under the any willing provider procurement process to escape the national tariff. Since this is the kind of terminology that gives the rest of us a migraine, we may translate this to mean stuff done outside hospital, excluding normal general practice, that is not subject to fixed prices.
If we grab an orthopod, and stick him in a van with some kit, and have him offer drive-by carpel tunnel surgery, that fits the bill. So to does the gynaecologist doing his colposcopies in a Nissen hut, and the gastroenterologist shoving his camera where the sun don’t shine in a bike shed. Because these procedures are being done outside hospital, they all fit the bill, very nicely indeed, thank you very much, because community services are not covered by the mandatory national tariff – and that means commissioners can – and do – invite providers to compete on price.
Nonesense, I hear you say? Didn’t the Tories say no competition on price? Not a bit of it. Dr No had a quick poke around the snazzily named Supply2Health website, and it seems they are all at it. Here is the ad for orthopaedic services:
“NHS Leicestershire County and Rutland and NHS Leicester City is looking to procure services from up to 4 providers or consortia of providers to provide the following healthcare services – Community Minor Hand Surgery…The total indicative contract value is cumulative…Bidders will be required to submit a unit cost for each of the procedures detailed in the specification. The maximum cost that the PCT will pay for each patient pathway is £570.”
And the one for the ladies: “North Somerset PCT: Community based Gynaecology service, for conditions suitable for diagnosis and treatment within a community setting…to provide assessment, diagnosis and treatment of defined gynaecology conditions…in the community setting, which equals or exceeds in quality that provided in secondary care at less cost.
And the sigmoidoscopy service: “NHS Western Cheshire is currently conducting a scoping exercise to determine the potential for a community Endoscopy service through the Any Willing Provider Process (AWP)…to scope non urgent patients for Upper and Lower GI conditions i.e. Gastroscopy and Flexible Sigmoidoscopy…To provide this service at an affordable, reduced Tariff. This non-tariff local price is anticipated to be between 50% and 75% of current NHS non mandatory PbR Tariff.” One hopes they know where to stick their scoping exercise.
And – just in case the chaps are feeling left out: “South Staffordshire PCT is seeking Expressions of interest (EOI) for the delivery of a high quality community based vasectomy service…The service will be delivered under an AWP (Any Willing provider) model…The maximum price for which the PCT will commission the service is £220 per completed pathway…”
Although the menfolk of South Staffordshire may envy those of Sheffield, who it seems may be offered an altogether better class of vasectomy based on a higher price point: “NHS Sheffield is seeking Expressions of Interest from suitably qualified and experienced providers to deliver a high quality and safe one or two stage, no-scalpel technique vasectomy…in a community setting…This is an Any Willing PCT Accredited Provider (AWPP) procurement…The maximum price the PCT will commission the service for is £290 per treatment.” Why the home of British cutting steel should elect to offer non-scalpel vasectomies at a higher price is – it seems to Dr No – quite beyond commercial logic.
Note in each ad the inclusion of the crucial words ‘community’ and ‘service’; and how in each case the wording in italics subtly – or not so subtly – invites providers to compete on price.
Expect a large NHS branded articulated community lorry to turn up in a car-park near you any time soon…