Any Qualified Provider

The Operating Framework for 2012/13 [1] says that from April 2012 commissioners must identify at least three services that will be commissioned through Any Qualified Provider. This policy means that commissioners can use any provider as long as the service is commissioned for at most the national tariff for the service (if the tariff exists) and the provider meets the quality specifications provided by the commissioner.

A summary of the main services [2] that PCTs have declared will be commissioned through AQP is given in Table 6. (Omitted from this table are the 18 other services commissioned by 63 PCTs through AQP, which are listed in the Appendix. [3]) Out of 25 services, seven are identified most frequently as an AQP service.

Table 6 AQP services declared by PCTs

Service Number of PCTs Commissioning Through AQP
Adult hearing 90
Continence 33
Diagnostics 73
Musculoskeletal 38
Podiatry 59
Psychological therapies 28
Wheelchairs 52

Many trusts mentioned the affect of AQP on their services in their Forward Plans. Almost a third (43) of trusts said that they were concerned that they would lose services through AQP, but a similar number (40) said that they saw AQP as an opportunity.

For example, Derby Hospitals say in their Forward Plan [4] that it sees AQP as an opportunity:

However, in areas such as audiology which is out for tender in Derbyshire we view this as an opportunity to develop the service. In surrounding counties muscular skeletal neck and back pathways and diagnostics may also represent an opportunity for business growth in 2012/13.

However, Northern Lincolnshire and Goole Hospitals say in their Forward Plan [5] that if they do not get the tender for one of the services being offered under AQP (unplanned care services) it will have a “significant detrimental impact”:

Commissioning discussions held have indicated that the following services are likely to be tendered during 2012/13:

– Unplanned care services across NHS North Lincolnshire encompassing A&E and MAU services currently delivered at Scunthorpe General hospital;

Other foundation trusts are relatively neutral about AQP, for example, Salisbury NHS Foundation Trust says in its Forward Plan [6]:

The Any Qualified Provider (AQP) initiative is being progressed in Hampshire and Dorset – it is not yet clear whether this will have a material impact on the Trust’s workload.

Several trusts said that they were expecting to lose services through AQP but were planning to register as an AQP provider with the intention to deliver the service outside their area. For example, its Forward Plan Berkshire Healthcare [7] says:

NHS Berkshire is extending patient choice during 2012 by offering some audiology services and podiatry services through the Any Qualified Provider initiative. Audiology services will be offered from September 2012, and podiatry services in the autumn 2012. BHFT is mitigating the potential loss of business by focussing on enhancing service quality, and patient outcomes and satisfaction levels. The Trust will also apply for AQP status to offer services in new geographical areas where the Trust can offer high quality accessible services with minimal risk.

In its Forward Plan Royal Berkshire [8] says:

In addition the introduction of Any Qualified Provider (AQP) is going to have a marked impact on us. In Berkshire direct access hearing aid services and direct access non-obstetric ultrasound are moving to an AQP delivery model as of September 2012. We currently have a 95% share of the audiology market and are the only provider of direct access non-obstetric ultrasound for GPs in Berkshire West. Following the introduction of AQP we will almost certainly see a reduction in market share and income.

However, the trust says that they will mitigate any loss by attempting to offer the same service elsewhere:

Increased competition also brings opportunities which we will harness. AQP gives us the opportunity to expand our services into other geographical areas. We will be actively marketing our direct access hearing aid services outside of our traditional catchment area with the aim of increasing our market share in these areas. The new activity we hope to generate will help compensate for the loss of share that is probable in Berkshire West.

The QEH Kings Lynn is very aggressive, they say in their Forward Plan [9] that:

in 2012/13 we continue our two broad strategic aims of maintenance of market share, through the development of existing services, and a growth in market share, for services which are currently provided by others.

And

The QEH has undertaken a review of its competitors and this review will inform the refreshed Trust strategy planned for later in 2012/13. This will allow for sub strategies to mitigate or take advantage of AQP, acute and community trust potential changes and the evolving private sector market.

Of the ten FTs with private patient income over £10m nine omit to mention the effect of AQP on their services, and the other trust, Chelsea and Westminster, has a comment favourable to AQP saying it will register as an AQP provider locally and with other commissioners [10]. The five FTs with Financial Risk Ratings of 5 (the lowest risk) all omit to mention the effect of AQP on their finances. It is reasonable to conclude that these trusts do not think that AQP is a threat to their income.

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[1] www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131360
[2] www.supply2health.nhs.uk/AQPResourceCentre/AQPMap/AQPMap.aspx
[3] nhsprivate.wordpress.com/executive-summary/appendix-1/any-qualified-provider-services/
[4] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=10681
[5] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=10601
[6] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=11031
[7] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=11461
[8] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=10641
[9] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=10651
[10] www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?id=10901