Editorial: Trust vertical integration threatens GPs

'Vertical integration' is a buzz phrase GPs could be forgiven for being unfamiliar with. It refers to moves by foundation hospital trusts (FTs) into primary care and general practice.

In January, GP reported a legal row over a tender process for out-of-hours contracts in the north-east of England. Among bidders understood to have won contracts from a GP-led organisation were FTs, including a hospital and an ambulance trust.

Our analysis on pages 29 and 30 shows opinion on the merits of such moves varies as competition is increasingly introduced to the NHS.

Newcastle and North Tyneside LMC chief executive and GPC member Dr George Rae fears 'empire building' by FTs could mean primary care services being taken out of the control of GPs, while Nuffield Trust senior fellow and south London GP Dr Rebecca Rosen warns that entrepreneurialism and innovation in general practice could be lost if practices are simply taken over by FTs.

Elsewhere, NHS Alliance chairman Dr Michael Dixon is less worried. He believes the motives of FTs need to be watched, but all integration is good.

Dr Jane Lothian is Northumbria Healthcare FT GP clinical director, as well as the LMC chairwoman. She is employed to make sure the trust's activities are GP-friendly and linked to what is happening in primary care.

GPs' fears are legitimate, she says, where trusts will not listen to primary care, but where there is co-operation, GPs should not be afraid to explore the possibilities.

Nigel Edwards, King's Fund senior fellow and KPMG director of global healthcare, points to the value of co-operation rather than competition.

It is left to Dr Dixon to warn: 'If general practice doesn't step up, then others will,' and 'that will be the death knell for general practice'.

GPs would do well to heed his advice to start grouping with neighbouring practices, developing a vision for the future, getting the management they need to implement that vision, and building relationships with CCGs. The survival of your practice could hinge upon it.

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