Any Qualified Provider

The Department of Health has committed to working alongside the NHS to support the phased roll out of extended patient choice of Any Qualified Provider (AQP).

Operational guidance to the NHS setting out plans to deliver the Government’s commitment to extending patient choice of provider has been published.

Consultation response

Operational Guidance to the NHS : Extending patient choice of provider

The roll out will start with selected community and mental health services from April 2012. These services* are:

Services for back and neck pain
Adult (18+), community service for back and neck pain – manual therapy

Adult hearing services in the community
Age-acquired 55+ and GP referral only

Continence services (adults and children)
Bladder and bowel, non-prescribable products, referral and self-referral

Direct Access Diagnostic tests
Non-obstetric ultrasound, MRI

Wheelchair services
Wheelchair services for adults and children – access, assessment, provision and on-going support

Leg ulcer and wound healing

Primary Care Psychological Therapies (adults) (‘talking therapies’)
16+ years, referrals and self-referral, including IAPT

Podiatry services
Adult and children’s core podiatry (including diabetes); specialised orthotics and footwear provision including biomechanics

* 12 October 2011: The above list was updated to add definitions of each service.

The guidance sets out key actions for implementation:

  • by 30 September 2011, all PCT clusters, supported by pathfinder clinical commissioning groups, should have engaged patients, patient representatives, Health and Wellbeing Boards, healthcare professionals and providers on local priorities for extending choice of provider.
  • by 31 October 2011, clusters and clinical commissioning groups should have used the feedback from this engagement to identify three or more community or mental health services for implementation, drawing from the national list or local priorities.
  • SHAs should be notified of cluster/commissioning group priorities for 2012/13. This information will be shared with the Department to inform the next phase of the national choice offer.

To provide support to the NHS and gain the benefits of shared learning, the Department will work with volunteer PCT Clusters to produce ‘Implementation Packs’ for the priority services. Each region is, currently, confirming volunteer AQP commissioners (PCT clusters working with emerging Clinical Commissioning Groups) to co-produce packs with the Department. The implementation packs will be available for the NHS to use from November 2011. This approach will enable to test implementation and secure the benefits of collaboration, for example, minimising the cost and bureaucracy to the system and creating effective but simple governance arrangements.

Why this is being done

In developing this guidance, DH has engaged with clinicians, providers, commissioners, patient groups and voluntary organisations on how best to extend patient choice of provider. The Department has talked to these groups about which services should be subject to patient choice, how qualification criteria for providers can help to reduce bureaucracy and assure quality, and how the procurement process for extending choice of provider should operate. The approach to implementation has been developed in response to what we have heard.

The goal is to enable patients to choose any qualified provider where this will result in better care.  Choice of provider is expected to drive up quality, empower patients and enable innovation. Importantly, extending choice of AQP provides a vehicle to improve access, address gaps and inequalities and improve quality of services where patients have identified variable quality in the past.

A phased approach is being adopted and  commissioners are being asked to engage locally to determine where choice of any qualified provider best meets the demands of patients, and is expected to deliver quality improvements. The department will work with the NHS to ensure lessons are learned from each stage of the rollout. Commissioners will continue to control both contracts and prices, and to challenge providers to deliver services of the highest quality.

>> What this means for patients
>> What this means for providers
>> Your questions answered

In NHS providers, Pathfinder Learning Network | Tagged , ,

20 Responses to Any Qualified Provider

  1. Nick Pahl says:

    We would like to ensure that British Acupuncture Council (BAcC) members are part of the any qualified provider process. We are the largest body in the UK for the regulation of traditional acupuncture. With over 3,000 members, it has a track record of delivering robust self-regulation (recognised in the Secretary of State for Health’s announcement on herbal medicine on 16 February 2011).

    We would like to be part of a national qualificiation process.The recent inclusion of acupuncture in the NICE guidelines on the treatment of lower back pain is a demonstration of how BAcC members can significantly and increasingly benefit the nation’s health in this area.

    We believe that the public should have the opportunity to choose acupuncture as part of their NHS provision, and be able to receive advice and treatment from professional acupuncturists.

    • audiologist says:

      Audiology services are used mainly by the most vulnerable members of our society – older people with complex needs. AQP gives the independent sector greater access to manipulate facts and railroad them into purchasing “better hearing aids ” rather than using NHS products. Present day Audiology departments provide high tech instruments comparable to the private sector . They also have empathy , understanding and the skills to ensure an holistic and caring service – with links to Social Services etc. It is a fallacy that the NHS has long waits and only work from hospital sites. Our department provides sessions at 9 health centres , home visits and 5 days a week access at a site convenient to the user . There is continuity of care , users know who they are dealing with, where to find them and receive high class care in a safe, friendly environment . AQP will dissipate all quality and compassion . It will be a tragedy

  2. Evie Hall says:

    How will commissioners ensure that they don’t overspend on services within ‘Any qualified provider’? If the demand for some services is greater then the available provision e.g. podiatry, then isn’t there a risk that increasing the number of providers will increase the number of people receiving treatment and therefore the overall cost.
    How can current local providers ensure that they are part of any local engagemnt that takes place?

    • Hester@DH says:

      Thank you for your questions.

      As is the case now, commissioners will need to ensure that they are financially stable and do not overspend on services. The ‘Any Qualified Provider’ process allows commissioners to set the price they pay to providers, and establish clear referral protocols and clinical treatment thresholds based on best practice. This means that a set of criteria is developed, outside of which providers will return referrals to the referring clinician. In the event that patients are treated outside of these criteria, they should not be paid.

      The intention of this policy is to increase choice and access for patients. If the demand for certain services currently outstrips the supply, this means patients are not getting treated. Extending patient choice of provider might allow more patients to get the treatment they need more easily – we think this is a good thing. It is worth bearing in mind that we are rolling out Any Qualified Provider in a phased way, starting with a limited number of community and mental health services. We hope that this measured pace will give commissioners the time they need to get it right. We are currently working with the NHS to develop ‘implementation packs’ for each of the service areas. These packs will help commissioners implement AQP successfully and in a sustainable way.

      Commissioners are currently making decisions about which service areas are priorities for implementing AQP in their area. If providers have an innovative way they think they can deliver a service, they might want to contact their local PCT to discuss this further.

      Regards
      Hester Wadge
      Policy and Briefing Manager, Any Qualified Provider, DH

  3. WorriedPatient says:

    As a patient who has been cared for in a London Audiology Dept. for approx 30 years. I am horrified that it may be closed down and I will have to be referred on to a private provider for any servicing of the aids I have! The facilities and care in a hospital based Audiology Dept. are far superior to the private providers that some of my friends have been to. This is another ruse by the government to ‘pull the wool’ over the our eyes, telling us we will have more choice, and it will be better. What we will have is is total chaos, and this is privatisation by stealth, just as happened when Maggie Thatcher was Prime Minister, and I should know as I have worked in the Health Service all my life, until I retired several years ago!

    • tosh says:

      “The facilities and care in a hospital based Audiology Dept. are far superior to the private providers that some of my friends have been to. ”

      First hand experience then ;) How can you compare, when YOU have only experienced one provider? There are some excellent private providers out there, and provision WILL BE DEPENDENT ON PROVIDING A CERTAIN STANDARD OF SERVICE…. some people are so blinkered….

      This is about choice of provider. YOU choose where to go. You get MORE choice ! why would you moan at that ??? Your audiology dept will close down? Disinformation spread by worried nhs audiology staff. If their service is so good, they have nothing to worry about. However I’m sure people will vote with their feet- is THAT what’s really troubling the NHS staff?

  4. Peter Wilson says:

    What are the workforce implications for a new provider – will they need to mobilise their own workforce or can they TUPE in from the present provider. If the present provider is not chosen as a qualified provider, do those staff TUPE over to a new player and what happens when there are a number of new players all wanting to use part of that workforce.

    • Hester@DH says:

      Thank you for your question, and apologies for the delay in responding.

      Any Qualified Provider is about encouraging an increase in choice for patients from a wider range of providers delivering services. We would not want to see current providers simply replaced by new entrants to the market, as this would not lead to an increase in choice for patients.

      If a provider is unsuccessful at maintaining its services, and the activity goes to other providers under Any Qualified Provider, protections under TUPE regulations are unlikely to apply. Whilst each possible TUPE situation has to be considered on its own merits, current legal advice suggests that there will be no “transfer of undertaking” to a new provider where referral patterns shift under Any Qualified Provider.

      Employers should always seek to redeploy staff and offer suitable alternative employment, but job security cannot be guaranteed. Employees can of course apply for a job with a different qualified provider.

      Regards
      Hester Wadge
      Policy and Briefing Manager, Any Qualified Provider, DH

  5. grandparent says:

    with children’s wheelchair services how will it e ensured that the service is local. If not how will a non driving parent get child to provider or will providers need to operate mobile service.
    Who will deal with breakages/repairs renewals to chairs?
    Who will chairs belong to? (Currently on long term loans)
    Who will have final say on amount expended on each child’s equipment at present this is over rider cheapest option to meet child’s minimum needs rather than what is best for child.
    Will there be opportunity to part fund more expensive option?

    • Hester@DH says:

      Thank you for your questions, and apologies for the delay in responding.
      If a family is offered a choice of wheelchair provider, all the options offered to them will be provider organisations that have a contract with their local health commissioner. This will probably mean that most of the options will be based locally, although providers from further afield will be allowed to apply to qualify. When the family is making their choice they can take into consideration how close the service is. If parents have difficulty getting their child to a wheelchair appointment, the provider should work with the family to make sure the appropriate travel arrangements are in place.
      When the health commissioner decides they need to commission a wheelchair service, they will write a ‘service specification’. This is the instruction to all potential providers which describes exactly what should be offered to patients. This should include details about how wheelchairs will be repaired, what kind of wheelchairs should be offered, and who owns the chairs.
      Top-up payments are not currently allowed and this will not change under Any Qualified Provider – this is about choosing who provides your treatment. However, you might be interested to hear that ‘personal health budgets’ are currently being piloted. This is a way of giving patients more choice about how their health and care needs are met. You can read more about personal health budgets on the Department of Health’s website here:

      http://www.dh.gov.uk/health/category/policy-areas/nhs/personal-budgets/

      Regards
      Hester Wadge
      Policy and Briefing Manager, Any Qualified Provider, DH

  6. Jennifer Durandt says:

    Why is this being forced on CCG’s with such a short timescale and with no leeway to either reject the idea or choose different areas that make more sense locally?

    • Rod Whiteley says:

      Short timescale? Here’s a quote from a November 2006 Department of Health policy document. At the time, Patricia Hewitt was Secretary of State for Health in the Labour Government:

      For routine elective services, the principles of free choice of provider for patients and the opportunity for any willing provider to supply services (if they are licensed to do so) should not be constrained by commissioners.

  7. Trainee says:

    I think a key point that seems to have been missed is that NHS services are not there to make a profit. Any money made in providing a service was ploughed back into the department to create better, cheaper and more efficient care for the patients. It still cost the government to give this care but, all the money made benefitted the people accessing this service.

    When the government starts paying private, profit seeking, organisations to care for patients the company will be making money, as this understandably is their aim. Now the question is where does that profit now go? Some to improve services, I am sure, but some will go to the shareholders and bosses of these companies.

    It seems to me that we will, as a country, be giving money to private companies (individuals) through the Any Qualified Provider scheme instead of improving our NHS with it.

    • Hester@DH says:

      Thank you for your question, and apologies for the delay in responding.

      The aim of the policy is to increase choice for patients by increasing the number of providers available: NHS, voluntary and independent sector. All providers will be paid the same price to deliver the same service for that health commissioner. What matters is the quality of care provided, not who owns the organisation providing it.

      Furthermore, they will all sign an NHS Standard Contract, which means they will all be delivering NHS care. Because patients will tend to choose better providers that offer a more personalised service, this will allow the better providers to grow. Poorer quality providers that are not offering the best service to patients will be encouraged to improve the quality of the services they offer. We think this will be a strong incentive for all providers to invest in their services, and should ultimately drive up the quality of NHS treatment.

      Regards
      Hester Wadge
      Policy and Briefing Manager, Any Qualified Provider, DH

  8. David Lewis Director of local charity providing affordable counselling says:

    Our charity (Compass Counselling New Forest) provides a service model that the NHS apperently wants to include in their programme to deliver Talking therapies beyond cognitive behavioural therapy.
    We are able to offer affordable therapy for up to 60 people a week as a result of a considerable amount of voluntary input and operate the highest professional standards of service delivery.
    Although it seems to be just the sort of service that the government wishes to develop it is nonetheless now seriously threatened by a lack of funding
    We do not have the administrative resources to engage in complicated contractual procedures which it seems we would need to do in order to become ‘A Qualified provider’
    Do you have any suggestions as to how this apparent conundrum can be resolved?

    • Hester@DH says:

      Thank you for your comments.

      You do not state whether your commissioner has decided to use an Any Qualified Provider model to commission primary care psychological therapy services in your area. You can check this on our interactive map here: nhs.uk/aqpmap

      If your commissioner has taken this decision, I can assure you we expect that the national qualification process for AQP will minimise bureaucracy and reduce transaction costs for both providers and commissioners. All providers of NHS services will have to sign the NHS Standard Contract, however the standards to be an Any Qualified Provider will be proportionate and appropriate to the market for a particular service. Having engaged with smaller and voluntary sector providers as part of the Future Forum and as part of the Any Qualified Provider policy development, we know that there is considerable interest amongst smaller providers in offering their services through patient choice of provider – our process is simpler for all providers and as such should be more accessible for smaller providers.

      Regards
      Hester Wadge
      Policy and Briefing Manager, Any Qualified Provider, DH

  9. Sarah Davis says:

    In response to Trainee:

    I run an Independent Integrated Therapy Team and I do take objection to your comments, that the current NHS workforce will plough the money back into their service, where as Independent organisations, will not.

    The fringe benefits which NHS workers receive – sick leave, pensions, maternity leave, garden leave and so fourth is rarely seen across many private companies. None of my staff or I gain such luxuries and we would not choose to spend public money in this way, as do our NHS workforce colleagues. Many therapists stay in their posts, for precisely these benefits, not because their job offers them job satisfaction, greater development of clinical skills, successful clinical gains for their clients.

    Most therapists work in an overstretched capacity, using consultative rather than direct ‘evidence based’ approaches and in isolation of a multi disciplinary team.

    Neither do I know of many NHS departments delivering community therapy services who are running in profit to allow any funds to be re-invested into the service. In fact CPD activity is almost non existence, due to lack of funds to invest in therapists and hence the therapy options available to their clients remain limited.

    The services being delivered are therefore not demonstrating best practice. The local community in many areas face long waits, inconsistency in therapists meaning clients re-tell their story and get back in the ‘queue’ over and over again, lack of choice in therapy approaches and unsatisfactory outcomes which leads into increased difficulties as children become adults.

    Re offender rates can be linked to adults who have not received the correct therapy and access to therapy which they needed as children. This further affects the public purse.

    I have great respect for my NHS colleagues and where ever possible our team works with our counterparts to ensure they can play a part in the successful outcomes we promote for our joined up clients. However without services such as ours and other independent therapy providers, there would be few clients in local communities able to recognise what ‘therapy’ is in it’s truest sense, let alone progress as a result of access to high quality therapy.

    Please remember this is not a game between public and private sector, this is about meeting clients needs!

    Sarah Davis
    Integrated Treatment Services

  10. Tim Clifford says:

    I have never before heard sick leave and maternity leave described as “fringe benefits” that are “rarely seen across many private companies”. You must have a very happy team if your employees live in fear of falling ill or getting pregnant.

  11. Dolly says:

    Having spent the best part of the last 10 days working on the AQP application, I must say I cannot understand how the specifications are allowing us to provide a lesser service at a higher tariff than is already in place in our area. It is evident that the majority of developments, innovations and improvements that we have implemented over the past 5+ years, will be available to all our service users EXCEPT those entering through AQP referral (Direct access adult (55 years plus) non-complex hearing aid provision). Why were the commissioners not tasked to look at the quality of their local service and accept bids from other providers who could meet the same standard of care, rather than stripping away added value servcies to provide a “level playing field” for Private companies to compete on. I am fully in favour of competition and patient choice (we are, after all, all potential health service users), but cannot see how reducing a service specification to the lowest denominator will drive up quality.

  12. Dolly says:

    Having spent the best part of the last 10 days working on the AQP application, I must say I cannot understand how the specifications are allowing us to provide a lesser service at a higher tariff than is already in place in our area. It is evident that the majority of developments, innovations and improvements that we have implemented over the past 5+ years, will be available to all our service users EXCEPT those entering through AQP referral (Direct access adult (55 years plus) non-complex hearing aid provision). Why were the commissioners not tasked to look at the quality of their local service and accept bids from other providers who could meet the same standard of care, rather than stripping away added value servcies to provide a “level playing field” for Private companies to compete on. I am fully in favour of competition and patient choice (we are, after all, all potential health service users), but cannot see how reducing a service specification to the lowest denominator will drive up quality.