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NHS 'has less competition than under Blair'

NHS 'has less competition than under Blair'

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There is less competition in the NHS now than under the Blair government as a result of financially cautious commissioners, the chair of the proposed 'health sector regulator' Monitor has told GP Business.

In an exclusive interview, Dr David Bennett – formerly a senior policy adviser to Tony Blair – said financial pressure on the NHS has led commissioners to "stick with" service providers they know, as he urged GPs to "cast their nets wide" to providers in future.

"Frankly I think there's a degree to which commissioners are under increasing financial pressure and there's a tendency to revert to what you're familiar with," Dr Bennett told GPB.

"So if you're used to negotiating with and commissioning from a local provider, the simplest thing to do may be just to stick with that."

Dr Bennett added: "I think the intention of the bill is to get us back to where the Blair government was. Their intention was to continue to provide opportunities for providers."

He added that this included a range of providers, not just the private but also the voluntary sector or foundation trusts, which Monitor continues to regulate.

If the Health Bill is passed, Monitor will have a new role as the financial regulator of all healthcare providers in England.

Dr Bennett stressed the vital role of commissioners in the reformed NHS, and said they had a key role in deciding which areas of care would be open to any qualified provider (AQP).

When asked whether AQPs would be able to enter the market without a commissioning 'trigger' – as some GPs have suggested – Dr Bennett was adamant that commissioners would be "very much in the driving seat".

"Providers need to be in some way accredited by the commissioners," he said. "Now I don't know whether the [NHS] Commissioning Board has worked out how it's going to do this, whether it does it centrally, or it does it at different levels, but [providers] will need to have some sort of contractual relationship with the commissioners.

"True today and true in the future, the critical thing is what commissioners do," he added. "It's commissioners that should be casting the net wide when they are looking to see who's the best provider to meet the needs of their patients."

The interview with GPB followed a new report by think tank The King's Fund that claimed Monitor may "fail to fulfill" its new responsibilities set out in the Health Bill unless the government provides greater clarity about its role.

But Dr Bennett told GPB: "Where we've got to, I don't see areas where there's a lack of clarity that it would be helpful to significantly resolve."

However, he added: "We have a lot of things we now have to take into account as we come to take our various duties – that's a long list now and I certainly wouldn't want it to get any longer because it is going to be quite a challenge to balance all these different aspects that we have to take into account."

Anna Dixon, Director of Policy at The King's Fund and the lead author of the report, said: "Monitor has been set a formidable task with little precedent and supporting analysis, so the risks of failure are considerable.

"Unless economic regulation is designed and executed well, it may end up imposing more costs than the benefits it delivers."

Dr Bennett said Monitor's sector regulator role means it will need to expand to almost four times its current size to meet the requirements – but he insisted this would be still be a relatively small organisation.

"We're only 110 people at the moment," he said. "Our estimate is that we may need 300 or so people in that role, maybe a few more, we're still working it out. It's a fairly significant increase in total size but we're still going to be tiny. In the grand scheme of the NHS a few hundred is a very small number."

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