Outgoing PCT managers are using 'emotional blackmail' to win contracts, private providers have told Management in Practice.
Independent firms claim clinical commissioning groups (CCGs), due to take hold of NHS budgets in April 2013, are being pressured into buying support offered by outgoing reconfigured PCTs in a bid to save jobs.
Dr Mike Warburton, a Director at consulting firm Capita, told Management in Practice the chaotic transition period has contributed to the company's decision to partner with existing NHS commissioning support service organisations, rather than compete to win contracts.
"A number of CCGs are being pushed to use PCT clusters for commissioning support when they really don't want to," he said. "To go into competition with PCT clusters now would seem fruitless."
Commissioning support will aid and advise clinicians in spending £60bn of NHS money.
A commissioning expert at a national law firm, who wished to remain anonymous, said a number of NHS managers are using 'scaremongering' tactics to pressure GP-led commissioning groups into using NHS support services.
The government's proposed Health and Social Care Bill pledges to give CCGs the freedom to choose who provides their commissioning support, but the lawyer claims this is merely "an illusion".
"An NHS manager recently told me they have to do everything within their power to convince GPs to buy the support services the PCT cluster is offering," he said.
"GPs are basically being told that if they don't choose the local NHS offering, all the remaining managers will be made redundant.
"This level of emotional blackmail keeps the goodwill of GPs while at the same time not truly disclosing how much of the system is being designed without GP input and consultation."
The government has estimated around 21,000 NHS managers will lose their jobs under its reforms, costing up to £1bn in redundancy payouts.
GPs leading emerging CCGs confirmed they are being denied the freedom to choose support providers.
Wakefield CCG Chair Dr Phillip Ernshaw said he feels under "intense pressure" to continue with the status quo and purchase support services from existing PCT clusters.
"We do not want PCT clusters to provide all of our commissioning support but it is difficult to retain control when it is presented as the only option," he said.
"The freedom we have been promised by the government is extremely limited. The service level agreements, or quasi contracts, we have to sign with PCT staff force us to use nascent NHS-led commissioning support organisations for a minimum of four years.
"Come 2016, it may just be too difficult to look to the private sector for support services."
Dr Amit Bhargarva, Crawley CCG Chair, agreed with Dr Ernshaw, and said the government is being "disingenuous" when offering choice to GPs.
The Department of Health's National Clinical Commissioning Lead Dr James Kingsland has criticised NHS managers using 'bullying' tactics and said they are "letting patients down by deliberating misinforming GPs".
"It is not acceptable for outgoing managers to try to tug on the heartstrings of GPs in a bid to keep their jobs. Redundancies are a part of life," he said. "What part of the word abolished do they not understand?"
However, David Stout, Deputy Chief Executive of the NHS Confederation, said PCT managers are merely pointing out the centrally allocated CCG running costs of £25 per head limit the level of support they can afford.
"This is a case of CCG leaders shooting the messenger and placing PCT managers, who are already unsure of their future, under undue pressure," he said.
NHS bosses meeting last week (2 February) raised concerns about the issue.
The NHS Commissioning Board's Finance Director, Paul Taylor, calculated the health service could face further unbudgeted managerial redundancy costs of up to £500m should CCGs opt to look to towards the private sector for commissioning support.
The Department of Health insisted CCGs do have a choice.
"We have always been clear that CCGs will be free to use their admin budgets to seek support from whoever they wish, as long as the supplier is cost effective," said a spokesman in a statement to MiP.
"Having the freedom to choose commissioning support allows CCGs to be more innovative and provide greater value for money for the NHS."
Do you feel as though you have increased choice under the reforms? Your comments (terms and conditions apply):
"I do indeed. It will be a shame if left wing trade union activities of some GPs and strong but sometimes irrational ideologies of some health service managers cause the reforms to fail. The Health Secretary should get more charismatic in the way he is presenting this reform. I believe the problem is with his message delivery strategy" – Tina Chigbo, East London