13 April 2007
The Department of Health's latest scheme to invite private companies to take control of GP services has been condemned as potentially destabilising and unnecessary.
Calls for expressions of interest to run GP services in four locations were published on Easter Sunday with further contract details due on April 13. The four procurements are being managed by the DoH as part of the first wave of its 'Fairness in Primary Care' programme, which aims to increase the number of GPs in 'under-doctored' areas.
But Dr Hamish Meldrum, chair of the BMA's GP committee, told Public Finance: 'There are difficulties in defining 'under-doctored' areas. We do have concerns about the method that is being used, and that the government's objective is more about getting private provision of NHS care than simply trying to look at the number of doctors in a particular area.'
The move came as Health Secretary Patricia Hewitt announced that from July orthopaedic patients would be able to choose from any NHS or private provider, as long as they met NHS standards and costs.
At a launch in London on April 10 she named ten pilot sites in which local libraries would guide patients through the choice options available to them as an alternative to GP consultations.
Last year's white paper listed the 30 most under-doctored areas in England. These included County Durham, Great Yarmouth & Waveney, Hartlepool and Nottinghamshire County primary care trusts, which will be the subject of the first wave of procurement, expected to be worth £30m over five years.
In Durham and Great Yarmouth bidders will be invited to take over primary care services currently run by the PCT. In Nottinghamshire and Hartlepool bidders will be asked to establish new practices, also independent of the PCT.
This follows uproar in 2005 when the DoH's Commissioning a patient-led NHS memo implied that PCTs should divest themselves of their provider functions. Hewitt later said that PCTs could continue to provide their own primary care services 'unless and until they decide otherwise'.
But senior sources have told PF that PCTs were offered little choice over their involvement in the current procurement. A Durham County PCT board document from the end of March also explains that although local efforts to increase GP numbers had brought the PCT just 1.25 whole-time equivalent GPs below their target, the trust was still 'being steered by the DoH for inclusion in tranche one of the national procurement on a “no option” basis'.
Pat Keane, director of business development at Durham PCT, told PF there was no coercion but admitted that 'the support offered by the DoH in terms of business case development and procurement costs' made it a 'no-brainer from our perspective'.
Dr John Canning, secretary to the Cleveland Local Medical Committee, covering Hartlepool, told PF: 'The whole thing is being driven by the centre. I don't think the PCT had any choice. They don't want to be involved but can't get out of it. This is the national tail wagging the local dog.'
He said he had 'serious doubts' about the figures used to prove Hartlepool was 'under-doctored' as it was likely that they were out of date. The DoH is tendering for a new provider to set up an extended primary care practice from scratch and that risked destabilising existing practices, which could lose patients and therefore funding, further decreasing GP numbers.
'This seems to be part of an agenda of bringing in non-proven providers and I'm very concerned about the effect that will have on patients,' he said.
Dr Chris Locke, chief executive of Nottinghamshire Local Medical Committee, told PF he had similar concerns. Last year, two existing GP practices had agreed to merge in order to provide more extensive services. But the PCT claimed a contract deadline had been missed in those negotiations and so was now forging ahead with the procurement plans.
'There is significant pressure from the DoH, and [the PCT] was named and shamed in the white paper. Other hands have been involved from the centre who are not receptive to local voices. It's a bit of a mess,' he said.
He said that as the new provider would have to start a new practice from scratch, only an outfit with significant financial backing would be able to take on such a risk as a 'loss leader' and local people had not been consulted on whether they were happy with the prospect of a multinational company running their GP services.
PFapr2007
