Benefits Of Opening Up The Primary Care Market May Not Be Realised, Warn Experts, UK

Main Category: Primary Care / General Practice
Article Date: 03 Apr 2009 - 3:00 PDT

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Government reforms to increase the choices available to patients and to stimulate competition between healthcare providers may result in underused capacity in some areas and difficulties in attracting new providers into other areas, warn experts in an article published on bmj.com today.

There is also a risk that new providers may unintentionally destabilise existing practices delivering a high standard of care to patients if they are offered guaranteed funding for the provision of services, they add.

By the end of March every primary care trust (PCT) in England should have commissioned a new general practitioner-led health centre, write Jo Ellins and colleagues from the Health Services Management Centre in Birmingham.

Supporters of these reforms have argued that these "create a framework to challenge GP service delivery and encourage innovation in order to meet people's changing healthcare needs." But opponents have expressed concerns about the dangers of "the aggressive commercial takeover of general practice and other NHS clinical services." Questions have also been raised about whether every PCT needs a new GP-led health centre.

So who is right?

The authors interviewed strategic health authorities, PCTs, and provider organisations and found that, by October 2008, more than 100 practices were being run by alternative providers. Most of the contracts had been awarded to GP-led companies, with corporate providers having only 10 practices between them - hardly a commercial takeover of primary care, they say.

They found shortcomings in the quality and effectiveness of commissioning by some PCTs. Concerns were also raised about the quality of business cases being submitted by local general practices and their ability to effectively compete against well resourced corporate providers and national GP-led companies.

Finally, they found little evidence that patient choice is happening in practice. For example, PCTs raised concerns about low public awareness of the right to choose a GP and the shortage of reliable public information about the availability and quality of local services.

Unless this changes, the potential benefits of a more plural provider market may not be realised, warn the authors.

The introduction of a national procurement programme has the potential to address health inequalities by increasing the number of primary care professionals in areas of unmet need, as well as broadening the range and availability of services provided closer to home, they write. But the programme is not without risks. The extent to which equitable access can bring in new providers is also in doubt, especially in the current financial climate.

Spare capacity and instability may be necessary to create the conditions for choice and competition, but their consequences will need to be managed if the government's policies are to deliver real benefits for patients, they conclude.

"Feature: Opening up the primary medical care market."
BMJ online

Source
British Medical Journal

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