The AQP Merry-Go-Round
In their annual plans, 43 Foundation Trusts say that AQP is a threat and 40 say that it is an opportunity. However, there is some overlap, and some twelve trusts say that AQP is both a threat and an opportunity, this is illustrated in Figure 4.
For example, Berkshire Healthcare says in its Forward Plan  that there is a potential that it will lose business, but it wants to be an AQP provider in “new geographical areas”:
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.
Whereas nearby Royal Berkshire also says in its Forward Plan  that AQP is a real threat to the trust:
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. Where market shares are not retained services will be redesigned to mitigate any losses with transitional support where necessary and where affordable to NHS Berkshire West.
The trust says that “we will almost certainly see a reduction in market share and income”, but like Berkshire Healthcare, Royal Berkshire also sees AQP as an opportunity. The trust even says that it is hoped that its out of area AQP activity could help compensate for the loss of income due to AQP in its catchment area:
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.
In Derbyshire, the Chesterfield Royal Hospital says in its Forward Plan  that it may benefit from AQP:
Potential to exploit a range of markets outside the normal catchment areas, principally on the borders
However, the trust also outlines the threat of the new competitive environment:
The threat of losing services through new contracts, tender processes and new providers in the market – all seeking to offer best value and high quality – sets the trust a number of challenges.
It is interesting to note that Audiology is a mandatory service for Chesterfield Royal Hospital FT . The Schedule 2 statement for the trust says that in 2012/13 the trust must deliver 4,585 spells of Audiology. Foundation Trusts have to provide these services and if they fail to deliver the levels of activity specified it will affect their governance rating . Audiology is an AQP service of the main commissioners of Chesterfield Royal Hospital, so if the trust loses patients to AQP providers it could mean that it will not be able to provide the mandatory service to the required level.
A neighbouring trust, Rotherham, also sees AQP as a threat, saying  that there is a potential “loss of services”:
The key threat and opportunity anticipated is that presented by the fast emerging development of Any Qualified Provider with work now beginning in earnest to take forward this agenda. There are threats in terms of potential loss of services currently provided and henceforth subsequent loss of associated income.
However, this trust also sees AQP as an opportunity:
Whilst there are significant threats, there may also be potential opportunities for income generation should we decide it appropriate to pursue any rewarding opportunities. We will strategically assess the opportunity as well as the risk of AQP in order to balance any losses by extending activities where economically viable to do so, as set out in the 11/13 Marketing Strategy.
Introduction of Any Qualified Provider is running at pace and we perceive this a both a threat and a potential opportunity but until specific details are made available it is difficult to assess the impact – it is our knowledge of the potential threat/opportunity that is most important factor, meaning we will be keen to keep abreast of AQP activity across the region.
These trusts’ statements about AQP threats and opportunities are typical for Foundation Trusts. As these examples have shown, there are often neighbouring trusts that see AQP as an opportunity, which can only mean they hope to treat patients in their neighbour’s catchment area, potentially, in each other’s area.