A corporate model is not the way forward

Just as the profession sits down to digest the implications of the RCGP's road map document on the future of general practice, another august body has decided to offer its perspective on the issue.

'Just what the patient ordered' is the CBI's prescription for the profession and takes the view that if only general practice was run as a market and took lessons from large corporations, everything would be fine and dandy.

The authors appear to know a lot more about business than they do about general practice. Among their recommendations we find that patients should be allowed to change practices if they wish and there should be a set of standards against which to measure the quality of general practice. They also call for more information on GP services to be made available to patients - something that was clearly required by the authors.

Ill-informed comment and support for extended opening, polyclinics and practice-based commissioning aside, the report does raise some interesting questions about attitudes to primary care and who is best placed to run it.

The CBI calls for patients to be 'in the driving seat' but by patients it seems to mean big business. Recent surveys suggest patients are happy with access as it is and survey data reveals that smaller practices are scoring best with patients. Battles over APMS contracts also reveal that patients trust GPs over large private providers. But the CBI report bemoans the fact that contracts have mainly gone to 'local entrepreneurial GPs'.

Yes, efficient use of the NHS budget is essential. Yes, primary care services must be of the highest quality possible. Yes, there are many changes needed in how healthcare is delivered.

But this does not mean that the corporate model is necessarily the way forward. Moving, as the CBI suggests, to a purely market-based model would mean the end of the MPIG and potentially the end of some practices, and no business would open longer for no increase in their income. The NHS can learn from business, but that doesn't mean it can be run like an airline or a supermarket.

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