What shape the new provider landscape is likely to take

The last Care Conversation of 2010 heard from NHS Director of Provider Policy, Bob Ricketts, on what shape the new provider landscape is likely to take.

The government’s aim was to expand and intensify patient choice, Bob Ricketts told delegates at November’s Care Conversation. Its White Paper Equity and excellence – liberating the NHS, published in the summer, had ‘profound implications for the NHS and anyone who wants to provide NHS services.’ he said.

The White Paper spelled out the ‘reforming, and in many cases, abolition’ of NHS commissioning structures, he said, ‘setting a clear direction of travel for the NHS,’ with patient choice at the centre. ‘Any patient who wants to, should be able to exercise choice and contro’,’ he told delegates. ‘These are very radical commitments’. Choice would extend not only to treatment and clinician, but to ‘any willing provider’, he stressed. ‘In future, commissioners won’t be able to say, “actually, no thank you, I’m doing quite well with my local provider”. Any provider with the necessary registration will be able to provide those services.’

The range and quality of services would also become much more transparent,with potential for the growth of intermediary organisations to help patientsmake choices. ‘It’s big reform, big agenda,’ he told the seminar. ‘‘Any willing provider’ is two years away, which means this is nothing if not radical in terms of scope and pace. We’re also going to be moving to a whole new range of commissioners.’ These were GP consortia, he said, with the new public health service also operating as a commissioner around prevention.

‘Those providers with very lean pathways, good cost control and economies of scale will do well in the new environment. Anyone who doesn’t control their costs will catch a cold.’ The provider field would be ‘much more pluralistic, with many of the barriers to entry removed’, he said, and many more people entering the market.

Although NHS funding was not being government cut, there were still ‘major efficiencies’ to be found, he stressed, with foundation trusts moving to a position where they would be economically regulated like any other provider and a ‘much more explicit failure regime’. The new regulatory regime would be provider neutral – ‘it won’t distinguish between state, voluntary or private’ – but the regulator would have stronger powers than at present. New Monitor would also have a role in promoting competition, where appropriate, and carrying out market reviews.

While ‘any willing provider’ would necessarily exclude things such as ambulance services and emergency admissions, it would apply to most services. But what could make sense in terms of complex services such as end-of-life care would be for commissioners ‘to group together and procure on a population basis, specifying outcomes, and seeking to shift risk to providers on a gain-share basis, and see who offered best value’, he said.

The Department of Health would also continue to promote social enterprises as part of the Big Society agenda.

‘We’re looking to revise and align payment systems, probably using tariff in a more aggressive way,’ he told the seminar. The government would also be freeing up foundation trusts from central control, ‘enabling them to innovate and be much less risk averse’, with all trusts eventually achieving foundation status.

‘The new landscape will be a dynamic market of autonomous providers, operating on a fair playing field,’ he told delegates. ‘We’re moving from no market to a genuine market for most services.’