'Any qualified provider' in the NHS

Psychological therapies in primary care are among the list of services to be opened up by the NHS in England to 'Any Qualified Provider' (AQP), including charities and other organisations, from April 2012, the Department of Health (DoH) has announced.

The development is intended to increase patient choice and drive up standards through competition. Alternative providers must meet minimum standards to offer NHS services and will compete on quality of care, not price, the DoH says, as they will be paid a fixed tariff. NHS psychological services are already being offered successfully by alternative providers in some parts of the country, according to the DoH - for example, Oxfordshire Mind (affiliated with the nationwide Mind charity) provides a county-wide IAPT (Improving Access to Psychological Therapies) service called 'Talking Space'. In Hull and East Yorkshire, a local Mind service and Relate offer employment advice as part of the local IAPT pathway.

The AQP development is a political hot potato, and commentators like Baroness Shirley Williams have raised their concerns in the media about an expanded role for the private sector in the NHS. In September, Dr Hamish Meldrum, Chair of the BMA, wrote a letter to all MPs about the wider Health and Social Care Bill going through Parliament, in which he said there 'is an inappropriate and misguided reliance on "market forces" to shape services'. The AQP policy in particular, he said, 'has the potential to destabilise local health economies if not carefully managed'.

Chair of the Society's Division of Clinical Psychology and Deputy Chair of the Professional Practice Board, Professor Peter Kinderman (University of Liverpool), recently told The Psychologist, the Society's monthly magazine, that he finds it worrying that psychological therapies are in the front line of AQP, especially when many psychologists continue to have anxieties about the consequences of NICE guidelines, the IAPT programme and overlapping competencies with other professional groups.

'But, as this rolls forward,' he said 'we will have to manage the process ... we should work closely with both central government and local commissioners ... I don't think we're opposed to change - most psychologists have been calling for radical change for many years - but we do need to ensure that the "any qualified providers" are genuinely and properly "qualified". That - as we've seen from IAPT - needs careful and authoritative oversight. In these tight financial circumstances, and with a government explicit about competition and efficiency, it's all to easy to see quality lapse. We mustn't permit that to happen.

The Department of Health website has a list of frequently asked questions about Any Qualified Provider.