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Monitor investigates alleged breaches of 2012 procurement regulations

Over the course of 2013, Monitor launched a number of investigations. These were as a result of the introduction of the new National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013, which came into force on 1 April 2013.


On 5 June, Monitor launched its first investigation under the new procurement regulations, into the commissioning of radiosurgery services in Sheffield.

The investigation followed a complaint by Thornbury Radiosurgery Centre about the conduct and procurement practices of the North of England Specialised Commissioning Group (NESCG) and its successor, NHS England (NHSE). The complaint was that the NESCG had breached some of the provisions of the principles and rules for cooperation and competition prior to 1 April 2013, and NHSE had been in breach of the new procurement regulations as of April.

The case was formally closed on 26 February 2014, following NHS England entering into a contract with Thornbury. Because the case was closed before the investigation was concluded, Monitor did not publish a findings report, but instead issued broader guidance for commissioners. This guidance advised that commissioners should treat all providers equally. Differential treatment or preference for particular providers had to be objectively justified.

The guidance further encouraged commissioners to use evidence in making commissioning decisions, act transparently and publish details of all contracts awarded.

Greater Manchester and Cheshire

On 8 August 2013, Monitor launched an investigation into the commissioning of specialist cancer surgery services in Greater Manchester and Cheshire by NHSE, following a complaint by the University Hospital of South Manchester NHS Foundation Trust and Stockport NHS Foundation Trust.

Based on concerns that the process had restricted the choice of providers, Monitor launched an investigation. The case was closed when NHS England confirmed that the original commissioning process had been discontinued and that a process was being developed that would be fully compliant with the new procurement regulations.


On 10 October 2013, Monitor announced it was to investigate the commissioning of elective services in Blackpool and the surrounding area by NHS Blackpool CCG and NHS Fylde and Wyre CCG in October 2012. This followed a complaint by Spire Healthcare Limited that the two clinical commissioning groups (CCGs) were in breach of their regulatory obligations.

The complaint alleged that the CCGs sought to direct patients requiring elective care away from Spire Fylde Coast Hospital and towards Blackpool Victoria Hospital. This was strongly refuted by Blackpool CCG, who suggested that Spire had lost referrals in neurology due to the development of a faster, cheaper headache care pathway and, in orthopaedics, due to additional training for GPs to give joint injections and make referrals to physiotherapy without hospital appointments.

On 25 September 2014, Monitor published the final report on its investigation and concluded that the evidence did not support Spire Healthcare's complaint. However, it did find that the commissioners had not ensured GPs offered sufficient choice to patients, meaning that the CCGs had not complied with their legal obligations. In addition, Monitor found that the CCGs had not sufficiently publicised and promoted patient choice, but they had been compliant in offering a choice of suitable alternative provider for patients waiting more than 18 weeks to commence treatment.


Case closure decision on the commissioning of radiosurgery services.
Monitor; 2014.

Commissioning of radiosurgery services; guidance following case closure.
Monitor; 2014.

Case closure decision on Greater Manchester and Cheshire cancer surgery services.
Monitor; 2014.

Case: Investigation into the commissioning of elective services in Blackpool, Fylde and Wyre.
gov.uk; 2013.

Toynbee P.
Competition is killing the NHS, for no good reason but ideology.
The Guardian; 2013.

Investigation into the commissioning of elective services in Blackpool and Fylde and Wyre; Final report.
Monitor; 2014.