Reforms in the NHS
The different reforms has taken place in National Health Services (NHS) and lead to different organizational changes. These changes related to the working and liberalizing the NHS clinical services have started since 1948. A reform of ‘internal market’ had taken place in 1990s to introduce the term of competition. Whereas, the New Labour made a declaration of ‘ill-conceived’ internal market in the year of 1997 that made the reform ineffective (Dragoonis, 2009). The major reform that ruled the healthcare services had taken place after the enactment of Health and Social Care Act, 2012.
The Health and Social Care Act, 2012 had included the provisions and requirements a commissioner to regulate the collaborations and competition to the procurement regulations. In this paper, the procurement regulations that monitor the CCG’s work shall discuss with the guidelines provided in HSCA with implementations of The National Health Service (Procurement, Patient’s Choice, and Competition) (No.2) Regulations 2013. The paper shall also discuss the patient’s choice to evaluate the relation of NHS and private healthcare sector.
The Healthcare and Service Care Act, 2012 regulates the related guidelines for the monitor to regulate the health care services and to follow guidelines regarding procurement, patiet’s choice and competition (monitor.gov.uk, 2013). The patient’s choice has to be in priority while procuring services from private healthcare sector. The guidelines to monitor the procurement regulations were adopted by the HSCA and the National Health Services (Procurement, Patient Choice, and Competition) (No.2) Regulations, 2013 gave further clarity on this (Hudson, 2013). The Clinical Commissioning Group (CCG) procure the private healthcare services from General Practitioners (GPs) to provide effective services to the patients. The principles regulating this procurement ensures to benefit of the patients through patient’s choice in the treatment process that shall reflect the CCG-private healthcare sectors (Guy, 2019).
Regulation 2 of the National Health Services (Procurement, Patient Choice, and Competition) (No.2) Regulations, 2013 mentioned the rules where the CCG while procuring GPs for private practice has to maintain the following principles:
- to secure the needs of the patients that used the clinical services,
- to improve the service quality for the patients, and
- to improve the efficiency while providing the services(legislation.gov.uk, 2013).
The patient’ satisfaction level from this liberalized form of clinical services by procuring GPs practices were reflected in the statistical data of the increased number of patients i.e. 46642 patients registered for GP practices from February 2022 to March 2022. This shows that CCGs could increase this data if it regularly gives the patient satisfaction as per the regulations (digital.nhs.uk, 2022).
Regulation 3 of NHS (Procurement, Patient Choice, and Competition) (No.2) Regulations, 2013 mentioned the following general requirements followed by the relevant body (CCG) procuring healthcare services:
Regulation 3 (2): Actions need to take by the relevant body to work in ethical manner in this clause:
- the relevant body has to act in proportionate and transparent way while procuring the services,
- has to treat the service provider in unbiased manner without any discrimination(legislation.gov.uk, 2013).
Regulation 3 (4): This clause highlights the actions need to take by the relevant body to improve the quality of the procured clinical services:
- to provide the services in more consolidated way through including other healthcare and social services,
- enable the service providers to give efficient services,
- prioritize the patient’s choice of provider of the services(legislation.gov.uk, 2013).
The CCG has to apply all the regulations to improve the quality of the clinical services to accomplish the patient’s needs through prioritize the patient choice. CCG has to act unbiased towards the GPs practice and include more practitioners to provide best services to the patient. Since 2015, CCG approached the GPs to provide clinical services and make a step forward to improvise the quality of clinical services. The quality improvement had reflected in a survey of patient’s feedback conducted in the year 2017. The percentage of patient’s satisfaction has increased by 6% from 2009 to 2017 for clinical services. Whereas, there are still some fields that need an improvement like discharge and information services (NHS, 2018).
Procurement Regulations and Guidelines
The most important concern of CCG must be patient’s choice for the service provider. The Health and Social Care Act 2012 provides that monitor has to put the patient’s choice at priority and abide the commissioners to take effective steps for that. This indicates the relationship between the CCG and the private clinical service sector. To take a survey about following the regulation to improve the quality of the services, the HCSC Act, 2012 introduced the NHS Five Year Forward View in Oct. 2014 (Guy, 2019).
The privatization process taken place to liberalize the clinical services put the NHS and private clinical services together and increase the quality of the services. It is the choice of the patient to choose either the NHS services or being private patients. Going towards the privatisation is the result of patient’s satisfaction from the private service providers and the need to procure the GPs practice in NHS is an initiative taken by the CCGs. The influence made by the private service providers shows that these sectors are enumerating better quality of care in clinical healthcare services. It could be said by these observations of going private that collaboration between the NHS and private healthcare sector shall provide better services to the patients.
The NHS privatisation now provided a chance to private service providers to compete with the public healthcare services while providing NHS clinical services through NHS collaboration.
The commissioners or buyer of the healthcare services that serves to the public sector has to follow the public procurement policies regulated by the Crown Commercial Services (CCS). CCS provided the legal framework required to be followed by the commissioners of the service providers. These regulatory policies are based upon the UN treaty and includes the following principles:
- principle of non-discrimination
- principle of free movement of goods
- freedom to provide services
- freedom of establishment.
The above principles are the fundamental principles that has to be followed by the commissioner i.e. CCG. Whereas, in the context of procurement, following are the generalised principles that the CCG has to apply while procuring the clinical healthcare services:
- treatment equality,
- transparency,
- mutual recognition by the commissioner, and
- proportionality(CCS, 2015).
To ensure the competition in the open market, EU has established different directives to rule the contract related aspects between the commissioners and the service providers. The recent directives are as follows:
Public Sector: Directive 2014/24/EU: Public Procurement and Repealing Directives
Concessions: Directive 2014/23/EU: Award of Concession Contracts
Utilities: Directive 2014/25/EU: Directives related to procurement by the utility services like water, postal services, transport, and energy.
The public procurement and repealing directives provides the guidelines related the prohibition of anti-competitive acts in the contracts between the commissioners and the private service providers (Mossialos, et al., 2010).
The contract mentioned in above directives referred the contractual relationship of the Clinical Commissioning Group and the private clinical healthcare sector that shall determine the aspects to procure the services. This contract must be collaborative in nature and must not include anti-competitive acts. While protecting the competition in healthcare sector, the patient’s choice should not be elapsed by the public-private collaboration. The patient’s welfare should be always be in priority by these sectors (gov.uk/monitor, 2014).
Patient’s Choice in Procuring Clinical Services
The Healthcare and Social Care Act 2012 provide the powers to the Monitor and Competition and Market Authority (CMA) to regulate the terms related to healthcare services of the Competition Act 1998 (CA98), and provisions of EU’s Treaty.
The Monitor shall also scrutinize that whether CCGs and GPs are serving for the welfare of the patient and give the effective and improved quality of the services to the patients. No contract for the healthcare services shall include any ‘undertaking’ as mentioned by Competition Act 1998. Both CA98 and Treaty on the Functioning of the European Union restricts the undertakings to enter into anti-competitive agreements and abuse of dominant position (gov.uk/monitor, 2014). The provisions related to the dominant position has been mentioned in Chap 1 and Chap 2 of the CA98 and Article 101 and 102 of the Treaty on the Functioning of the European Union. These provisions states that a person who is in the dominant position, if, exploits the customer or suppliers shall be liable for abuse of the dominant position (ucl.ac.uk, 2020). In this case, CCG has this position and needs to provide the clinical services to patients at reasonable prize. CCG is also having dominant position on GPs practices and need to treat them in non-discriminatory way.
The CCG or any other commissioner of NHS has to enter into a contract for the collaboration of the public-private healthcare services. The CCG has to provide the healthcare services to the patients by improving the services by going beyond the way. This could be possible through applying integrated ways using different professionals to provide the required services to the patients. The GPs practice mostly take the other GPs together like nurses and other managers to serve their services and provide customer satisfaction. To serve individually or in partnership with other GPs, the CCG and GPs has to enter into a contract that shall rule the general principles to work.
- General Medical Services (GMS): 70% of GP practices operated in this contract in 2018/19. Most of the CCGs or NHS England contracts have opted for this mode of contract to operate general practices (local) for an area(Beech & Baird , 2020).
- Personal Medical Services (PMS): This contract offers to act in flexible manner while acting according to the national guidelines and legal framework. According to the survey 26% of the GP practices opted for this contract(Beech & Baird , 2020).
- Alternative Provider Medical Services (APMS): In this type of contract, other practitioners like private companies or third party provider of healthcare have involved. This provide more flexibility and area of work. 2% of GPs practices opted for this contract(Beech & Baird , 2020).
The collaboration of CCGs has the responsibility to act in an integrated way to provide efficient services to the patients with an aim to provide ‘value for money’ for the patients. The local healthcare services given by the commissioner (CCG) has to be in good quality and provide highest patient’s satisfaction. The social care provided by the collaboration of NHS and the private healthcare services must be integrated and benefit the patient at most (Guy, 2019).
The collaborative requirements needs to set in accordance to provide efficient work practices in healthcare sector. The joint strategic needs assessment (JSNA), the joint health and wellbeing strategy, and the joint health and wellbeing board (JHWB) are some requirements need to follow by the NHS to accomplish the collaboration aims. These requirements raise the obligation for the CCG to act in integrated way to make the services a value for money for the patients (Hudson, 2013).
As stated above, every CCG and private healthcare sector need a contract that bind them to work to obtain the patient’s needs. These collaborations and contracts The Department of Health consultation in 2012 asserts the ways for good procurement practice. The principle laid by the department of health states that the commissioners has to use the GPs and other private healthcare providers to be best in their services. The principle to opt for the best provider shall obtain the aim of patient’s satisfaction and give priority to the patient’s choice (gov.uk/monitor, 2014).
Competition and Collaboration with Private Healthcare Sector
Between these contractual relationships between NHS and the private healthcare providers, the interest of the patient has to be protected. No contractual liability shall affect the patient’s interest. To give the best quality to the patients the NHS has to act for the benefits of the providers also. The CCG has to act in non-discriminatory way through keeping transparency between the CCGs and GPs. This shall motivate the provider to give their full efforts to get the patient’s needs and satisfaction.
The aspects related to the unbiased treatment to the service providers, provide best quality in service and applying patient’s interest shall also cover the ethical perspective in an organisation. As the public and private healthcare providers are involved in this case, the acts has to be according to the ethical rules and principles.
The Mental Capacity Act 2005, states that every adult has a right to take the decisions of his/her life. This provision authorized the patient to make his choice to take either NHS service or private service. With legal regulations, the CCG also has an ethical obligation to put the patient’s choice at its priority.
The Healthcare and Social Care Act 2012 also specify some ethical principles to be followed by the CCGs for the procurement of the clinical services by GPs. These principles have broadly regulated by the NHS Commissioning Board (NHS CB). The NHS CB described the following core ethical principles that CCGs shall follow while procuring the clinical healthcare services:
- The principles mentioned the investment principles that allow the funding on the high-priority clinical matters like high priority services and needs.
- The treatment provided to an individual patient by the CCG shall not differentiate for the patients consuming same nature of treatment. This principle establish the rule to treat the people in unbiased way. The value for money is the primary scope to prioritize the funding on healthcare services(england.nhs.uk, 2013).
The NHS (Procurement, Patient’s Choice, and Competition) specifically described the ethical framework in which the CCG has to treat the service providers with transparency and proportionality.
Conclusion
The above paper reflected the working regulations of the CCGs while procuring the GPs for local clinical healthcare services. The CCGs and GPs maintained the public-private relationship to provide best clinical healthcare services. The CCG has to take the following steps for the procurement of the healthcare services as per the guidelines of NHS:
- The CCGs has to act in non-discriminatory way for the patients as well as the service providers.
- The contract of collaboration of the CCGs and GPs, the priority should be the patient’s needs and patient’s choice. The choice of patient results competition and put the CCG in dominant position but CCGs has to act fairly and shall not include any anti-competitive actions while procuring the healthcare services.
- The CCG has to provide the services at reasonable prices.
- To prioritize the funds CCGs has to provide the equal fund investment on the patient’s needs and services that are taking similar nature of treatment.
- The CCGs has to take the initiatives to provide the integrated services and procure the GPs of different professions for the patient’s satisfaction.
- The CCGs and GPs are dealing with the local general practices that concluded that they signed the GMC between them.
Beech , J. & Baird , B., 2020. GP funding and contracts explained. [Online]
Available at: https://www.kingsfund.org.uk/publications/gp-funding-and-contracts-explained
[Accessed April 2022].
CCS, 2015. Guidance on Public Procurement Policy. [Online]
Available at: https://www.gov.uk/guidance/public-sector-procurement-policy#introduction
[Accessed April 2022].
digital.nhs.uk, 2022. Patients Registered at a GP Practice, March 2022. [Online]
Available at: https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice/march-2022
[Accessed 04 April 2022].
Dragoonis, P., 2009. Have new NHS market reforms learned from failings of old?. London Journal of Primary Care, 2(2), pp. 153-157.
england.nhs.uk, 2013. Commissioning Policy – Ethical Framework for priority setting and resource allocation. [Online]
Available at: https://www.england.nhs.uk/wp-content/uploads/2013/04/cp-01.pdf
[Accessed April 2022].
gov.uk/monitor, 2014. Application of the Competition Act 1998 in the healthcare sector: guidance for providers. [Online]
Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/354078/cc_Guidance_on_application_of_CA98.pdf
[Accessed April 2022].
Guy, M., 2019. Between ‘going private’ and ‘NHS privatisation’: patient choice, competition reforms and the relationship between the NHS and private healthcare in England. Legal Studies; Cardiff, 39(3), pp. 479-498.
Hudson, B., 2013. Competition and Collaboration in the ‘New NHS’, s.l.: Centre for Health and the Public Interest.
legislation.gov.uk, 2013. The National Health Services (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. [Online]
Available at: https://www.legislation.gov.uk/uksi/2013/500/part/2/made
[Accessed April 2022].
monitor.gov.uk, 2013. Enforcement Guidace on the Procurement, Patient Choice and Competition Regulations. [Online]
Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/283508/EnforcementGuidanceDec13.pdf
[Accessed April 2012].
Mossialos, E., Permanand, G., Baeten, R. & Hervey, T., 2010. Health Systems Governance In Europe: The Role of European Union Law and Policy. Health, Economics, Policy and Management, pp. 337-378.
NHS, 2018. 2017 Adult Inpatient Survey, England: NHS Patient Survey Programme.
ucl.ac.uk, 2020. Competition Law (EU and UK) (LAWS0049). [Online]
Available at: https://www.ucl.ac.uk/laws/study/llm-master-laws/modules-2019-20/competition-law-eu-and-uk-laws0049
[Accessed April 2022].
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
