Choice and competition

The Health and Social Care Act 2012 requires commissioners to follow good practice when commissioning services and to promote and protect patient choice. Choice and competition are among many tools that a commissioner may decide to use to improve services for patients. The Act requires commissioners to act transparently and be able to demonstrate the rationale for their procurement decisions.

In its June 2011 report, Choice and competition – delivering real choice, the NHS Future Forum highlighted the role of competition in the NHS as a tool for commissioning clinical services where it serves the interests of citizens and choices they wish to make. The report said competition should operate within a framework that ensures integration, and safeguards choice, quality and patient safety.

Support from NHS England and Monitor

The regulatory framework is set out in the NHS Procurement, Patient Choice and Competition (No.2) Regulations 2013. These came into effect on 1 April 2013 when clinical commissioning groups and the NHS Commissioning Board (now known as NHS England) took on their full commissioning responsibilities. NHS England worked closely with Monitor and with CCGs to help Monitor develop their statutory guidance – Substantive guidance on the Procurement, Patient Choice and Competition Regulations – which Monitor published in December 2013. The guidance is designed to help commissioners understand how to apply the Regulations when procuring clinical services. Monitor also published guidance on how they enforce the Regulations and a set of hypothetical case scenarios. This suite of documents is available on Monitor’s website here.

Monitor’s statutory Guidance and the Regulations outline the choice and competition framework that commissioners should use to make decisions – including helping commissioners to decide where choice and competition may be in the best interests of patients. The framework is principle-based, and should be applied on a case-by-case basis, depending on local circumstances.

Beyond the written guidance, NHS England and Monitor have run a series of joint workshops for commissioners and continue to provide advice and support in individual cases, where appropriate. NHS England and Monitor continue to regularly review whether to issue any further written guidance or other materials, in response to commissioners’ needs.

Further advice

The Department of Health publishes the NHS Choice Framework. This sets out patients’ rights to choice in the NHS, where to find information to help them choose, and how to complain if they are not offered choice. It is available on the Department of Health’s website here.

As a patient, healthcare provider, commissioner, patient group, or representative body, you may contact Monitor for informal advice, or to make a formal complaint, about procurement, choice and competition in the NHS. Further information is available on Monitor’s website here.

Since April 2014 patients have had the legal right to choice of provider and team at first outpatient appointment for mental health services. Further information, implementation guidance and clinical scenarios are available on NHS England’s website here.