AQP In West London
The following example uses two NHS Trusts rather than Foundation Trusts, but as the last section showed, the same issue occurs with Foundation Trusts.
An example of the issues presented by AQP can be seen in West London. Two NHS trusts neighbour each other, Ealing Hospital NHS Trust and West Middlesex University Hospital NHS Trust, as shown in Figure 5. Both trusts are registered as AQP providers of Adult Hearing Services.
The Supply2Health  website lists the currently awarded AQP tenders. This site shows that the AQP providers registered for Ealing are: Ealing Hospital, West Middlesex University Hospital and the private provider, InHealth Ltd. Thus, Ealing Hospital potentially could lose patients and income to the neighbouring trust and to a private provider. Consequently the trust has registered as an AQP provider to provide Adult Hearing Services in Hammersmith & Fulham CCG, West London CCG (Kensington & Chelsea), Central London CCG (Westminster) and Hounslow CCG. This is shown in Figure 6.
West Middlesex University Hospital provides services in Hounslow and Richmond-upon-Thames, Figure 5. The Supply2Health website shows that there are four AQP providers for Adult Hearing Services for Hounslow: West Middlesex University Hospital, Ealing Hospital, and two private providers, InHealth Ltd and Scrivens Ltd. The three other providers in Hounslow have the potential to take patients and income from West Middlesex Hospital. Consequently the trust has registered to be an AQP provider in Hammersmith & Fulham CCG, West London CCG, Central London CCG and Ealing CCG. This is shown in Figure 7.
West Middlesex University Hospital is an AQP provider in Ealing CCG and Ealing Hospital is an AQP provider in Hounslow CCG. Both trusts are AQP providers in Hammersmith & Fulham CCG, West London CCG and Central London CCG.
Thus Ealing Hospital is competing for patients in Houslow, for patients who would have gone to West Middlesex Hospital; West Middlesex is competing for patients in Ealing, for patients who would have gone to Ealing Hospital. In both areas there are private AQP providers (InHealth and Scrivens) and inevitably the “host” trust will lose patients to these. So to make up for patients lost to them, both NHS trusts are providing Adult Hearing Services out of area in Hammersmith and Fulham, West London, and Central London. Rationally, Ealing Hospital should provide the services for Ealing and West Middlesex Hospital should provide the services for Hounslow, but AQP has forced these two trusts to compete in their own catchment areas and further afield.