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Regulator rejects private hospital's complaint against CCGs

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Monitor has finally concluded its first and only investigation into claims of anticompetitive behaviour by a clinical commissioning group, finding no evidence to support the allegation.

A statement issued by the regulator last week said it had not upheld a complaint by private provider Spire Healthcare that commissioners in Lancashire “were directing patients away from its Spire Fylde Coast hospital towards a nearby foundation trust”.

Spire had alleged that a block contract agreed between Blackpool Teaching Hospitals and two CCGs – Blackpool, and Fylde & Wyre – offered a “clear incentive” for GPs to refer patients to the foundation trust.

Amanda Doyle

Amanda Doyle said the investigation highlighted discrepancies between Monitor and NHS England’s processes

But Monitor’s report – issued nearly a year after it began investigating the complaint – found that “the data did not support the view that referral behaviour had changed” in the period leading up to or after the contract was signed.

However, the healthcare competition regulator did conclude that Blackpool CCG’s plans did not “go far enough” to ensure patients would be offered choice, or that the right to choice would be “publicised and promoted”.

Monitor is now consulting on what steps Blackpool should take to remedy this, with suggestions floated by the regulator including leaflets to promote choice in GPs’ surgeries, and the provision of information about choice on the CCG’s website.

Monitor executive director of cooperation and competition Catherine Davies said: “Commissioners in other parts of the country will no doubt want to see what lessons they can learn from this case about how to make sure patients are offered a choice and how to promote and publicise those choices.”

Blackpool CCG chief clinical officer Amanda Doyle said the group recognised that Monitor “did not find enough evidence that we promoted choice in GP surgeries or on the home page of our website” and it would be “looking to implement their recommendations”.

But she continued: “It is somewhat concerning, however, that in their search for evidence to demonstrate whether choice was promoted and offered in GP surgeries, not a single GP, practice manager or patient was spoken to by the investigating team, nor was a single practice visited.

“Placing the burden of proof on CCGs in this way causes unacceptable pressures in terms of both cost and administrative capacity.”

She said that the process also raised questions about “the discrepancy between Monitor’s finding that the CCG did not promote choice and the outcome of NHS England’s authorisation process, which, less than a year before the start of this investigation, found that the CCG was fully compliant with its duties around promoting choice”.

Dr Doyle said the CCG was pleased that “following an extremely thorough, year-long investigation, Monitor has found that there was no substance at all to Spire’s complaint”.

She added: “We will now make every attempt to help repair the relationship between this provider and the local GPs, whom they wrongly accused of acting against the best interests of patients in Blackpool.”

A statement issued by Spire said it was pleased that “Monitor has agreed that the CCGs were not providing sufficient objective information to support patients and their GPs in choosing a hospital for routine elective care”.

It continued: “Spire is disappointed that Monitor did not reach a conclusion on whether the block contract between the CCGs and Blackpool Teaching Hospitals Foundation Trust, which provided the trust with a guaranteed income regardless of the number of patients that chose to use its services, was against patients’ interests.

“However, Spire notes that this agreement between the clinical commissioning groups and Blackpool Teaching Hospitals Foundation Trust has now ended.”

Liz Cousins, hospital director at Spire Fylde Coast Hospital, said: “We were extremely reluctant to raise this complaint with the regulator one year ago but we felt strongly that the rights of patients to choose to be treated at their preferred hospital, which [are] guaranteed by the NHS constitution, should be defended.”

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