PCTs should not put every service out to competitive tender, the NHS chief executive has said.
Speaking at the NHS Alliance conference in Bournemouth last week, David Nicholson said that contestability 'is not an end in itself, it is a tool for driving up standards'.
'That is a big change from where people thought we were,' he added.
Mr Nicholson said that recent guidance to PCTs made clear that they had the flexibility to decide whether to tender for services. But if they decide not to they might be asked to account for the decision.
Early figures suggest that GPs are holding their own in the battle for contracts, despite concerns that the tender process would favour private providers.
But some delegates at the conference said that the complexity of the process had put them off developing new community services.
Stockport GP Dr David Bostock said that his practice had pitched for a PCT contract to develop its unscheduled care services. But the PCT had insisted on putting the scheme out to tender, because it feared legal action from unsuccessful bidders.
'We watched them wallowing around, trying to invent specifications for services they didn't really understand,' he said. 'And the only organisation they wouldn't talk to was the only one that really understood it - us.'
Mr Nicholson also defended the decision to force PCTs to introduce 250 new practices, as the best way to tackle health inequalities.
Previous DoH attempts to improve primary care services had been blocked by a 'cosy conspiracy' between GPs and PCTs, he said.
But NHS Alliance chairman Dr Michael Dixon rejected the suggestion that competition was the only way to improve performance.
'If PCTs and practices are asked to do something that will make a difference, they will do it,' he said. 'So it's a bit unfair to say PCTs and practices are colluding,' he added. 'I think the main problem is that they're not colluding enough.'
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