Commercial health companies could take over in-house PCT services in nearly half of England's PCTs, a GP survey has found.

Of 66 PCTs that answered a Freedom of Information Act request, 39 per cent were considering putting some or all of their in-house services out to tender in the next few years. Also 18 per cent said no decision had yet been reached.

Just 42 per cent of PCTs had no plans to put services out to tender, and more than half of these made clear that the situation could change.

NHS Alliance vice chairman Dr Donal Hynes, who has researched PCT provider services, said the figures seemed at odds with current DoH thinking. There was a 'different mood' than two years ago, he said.

A DoH paper released in January said PCTs should 'foster appropriate competition' to improve services previously provided in-house.

However, among the PCTs that responded to GP, some said no services would be put out to tender over the next few years, while others said only a handful would. But some suggested there would be a more radical shift.

Birmingham East and North PCT said that when current block contracts expire, 'the commissioners will go through the appropriate process to find the best provider in the marketplace who can meet the service specification'. Both its provider and commissioning arms 'will be contestable', it said.

Telford and Wrekin PCT, meanwhile, said services would be tendered 'if they fail to deliver what the PCT commissioner requires'.

Dr Hynes said tendering could help create new services, or put pressure on poorly performing providers. But he warned: 'Tendering is not conducive to rapid change. You want to have a very good reason to go out to tender. It smacks of not managing integration as well as you might.'

James Fothergill, CBI director of public services, was concerned that most PCTs still had no plans to put services out to tender. 'They need to be delivered by the best providers, not simply re-badged,' he said.

He added that tendering was 'the best way to challenge existing poor services, give patients meaningful choice and tackle health inequalities'.

jonn.elledge@haymarket.com

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