Unintended effects of limiting out of area placements?

NHS mental health trusts could, according to a report in HSJ, face regulatory action for not reducing the time patients spend in units a long way from home (known as ‘out of area placements’). There is little to argue about with a policy that is aimed at ending by 2020/21 what are known in NHS-speak…

Competition from app-based GP services poses challenge for CMA

NHS England has announced the piloting of an app that allows patients to access a GP through their smartphone. GP services offered through the app will compete with existing bricks and mortar services, and represents a massive injection of competition into primary care services. Patient migration to the app-based service will leave existing GP practices…

Making more NHS mergers more successful

NHS merger activity has increased markedly in the past 12 months. The Competition & Markets Authority (CMA) has just cleared major transactions in Manchester and Birmingham, and further NHS mergers are planned in Essex, Gloucestershire, Dorset, and elsewhere. Everyone in the NHS knows that while mergers can provide opportunities for significant service improvements, they also…

Joint bidding as a competition issue

Late last month the Competition & Markets Authority (CMA) published an open letter to public sector procurement officials with advice on how to spot bid rigging. Bid rigging is rightfully regarded as a very serious offence. When bidders collude to share contracts and/or make purchasers pay more, their behaviour is little more than theft. The CMA’s advice…

Brexit and NHS competition and procurement rules

Brexit’s impact on the regulation of NHS procurement and competition, as foreshadowed in HSJ last Friday, is likely to be limited. At the risk of unnecessarily adding to the volume of Brexit-related discussions, this blog post looks in further detail at the likely impact on procurement, merger control, state aid and prohibitions on anticompetitive behaviour in…

How much does competition influence Acute Trust behaviour?

Merger analysis is about assessing how much competition will be lost if two organisations merge, and deciding whether this matters. My last blog talked about how GP referral analysis could be used to answer this question for NHS hospital mergers. Analysing NHS hospital mergers, however, is different to most non-NHS mergers because deciding whether a…

Using patient referrals to analyse hospital competition

This week the Health Foundation hosted a panel discussion which looked back on the Competition & Markets Authority (CMA) review of the planned merger between Ashford & St Peter’s Hospitals NHS Foundation Trust (ASP) and Royal Surrey County Hospital NHS Foundation Trust (RSC). The CMA, Monitor and the two Trusts reflected on the case and…

Agency price caps: one year on

Almost a year has passed since the Government’s plans for agency price caps were first reported. At the time, I asked whether staffing agencies were really ripping off the NHS, and whether capping agency rates was likely to save the NHS money. Christopher Cook, from BBC Newsnight, asked similar questions as did others. NHS Improvement, however, has now said that…

When is competitive tendering good for services?

HSJ has reported that an increase in competitive tendering of NHS contracts may be a result of the new Public Contracts regulations that come into force in April. There is an interesting contrast between a requirement for more competitive tendering, and the poor outcome experienced with the recent tender for older people’s services in Cambridgeshire. That said,…

Competition risks for GP federations and super practices

The trend towards delivering GP services at increased scale seems to have gathered pace over the past few months. In January, HSJ tracked how GP federations and other large scale GP practices have been forming across England. It identified 268 ‘at scale’ GP organisations operating across 171 CCGs, with a further 20 in the process of…