Clarifications to the Section 75 Regulations that caused uproar among health professionals have been released by the government.
The Department of Health (DH) maintains that the previous wording of the regulation on competition was not meant to take power away from clinicians.
However, the changes are meant to provide clarity so that “there can be no doubt about how they apply”.
‘Step in the right direction’
The British Medical Association (BMA) and the Royal College of General Practitioners (RCGP) do not believe the update goes far enough.
BMA Council chair Dr Mark Porter said although he is pleased that the government has listened, he is “concerned” about the direction the NHS is travelling in.
He said: “It is vital that competition is not allowed to undermine integration, innovation, or clinical autonomy.
“There still needs to be a full parliamentary debate, to provide absolute clarity that CCGs will have the freedom to decide how best to secure high quality services for local populations.”
RCGP chair Dr Clare Gerada said: “"This is a step in the right direction but the revised regulations do not go far enough in ensuring that commissioners are genuinely free to decide whether or not to expose services to competition.
“It should be up to commissioners to do what they feel is best for their patients, using their professional and clinical judgment. Despite the revisions, they will still be required to show that there is only one capable provider in order to avoid having to put a service out to tender."
Dr Gerada noted that there is a “big difference” between the previous guidelines and the Section 75 regulations, which will have statutory force.
The DH said the position is the “same as now” – commissioners are able to offer contracts to a single provider where only that provider is able to provide the service.
Come April 1, commissioners will be free to commission an integrated service where it is in the interest of patients, as competition “should not trump integration”.
Hospital regulator Monitor has no power to force competitive tendering, so that decisions about how and when to introduce competition to improve services are solely up to doctors and nurses in clinical commissioning groups, a DH spokesman said.
Health Minister, Lord Earl Howe said concerns about the regulations were taken “very seriously” by the government.
He said: “It has never been and is absolutely not the Government's intention to make all NHS services subject to competitive tendering or to force competition for services. That would compromise the power and freedom we are giving to local doctors and nurses.
“I believe we now have a set of regulations which puts this beyond doubt.” Dr Peter Carter from the Royal College of Nursing (RCN) agreed.
He said: “We are pleased to see that the Government has listened to, and acted on, the widespread concerns over these regulations.”
Dr Carter believes that guidance must be issued by Monitor and the NHS Commissioning Board “as quickly as possible” to ensure that competition is used to “further enhance integrated and quality care, not undermine it”.