Editorial - There's nothing new about private practice

The fanfares that greeted the first private contract for a surgery to end local GP shortages under the DoH's White Paper plans were a blizzard of sound and fury intended to obscure the realities of primary care provision.

The 'groundbreaking deal' was the first step in the prime minister's plan to challenge the 'GP monopoly'. The £5 million, five-year deal would revolutionise access by offering a walk-in centre alongside a GP surgery as well as local care for asthma and diabetes. There would also be early-morning and late-evening opening.

The idea that this is the first time the DoH has brokered a deal with a private body to provide primary care services is ridiculous for a start. What do they think the GMS contract does?

And where do they think diabetes and asthma care is performed at the moment? Perhaps someone in the DoH should take another look at the quality framework.

As for the access issues, if PCTs were to inquire, they might well find that there are many practices, given the right premises, that would jump at the chance of running a local walk-in centre in exchange for a few hundred thousand pounds a year over and above the £500,000-odd that would be the global sum income for an average practice of this size.

Walk-in centres, Saturday surgeries and 'breakfast' and evening opening are, to a great extent, a matter of staffing and in this the Care UK surgery will be no different from any other GP practice.

In recruiting its three GPs and seven nurse practitioners, it will need to find those willing to work the promised hours. The GPs will also have to be prepared to take on a patient list of 7,000, some 25 per cent larger than average for a salary likely to be more than 25 per cent less than a partner's income.

Increased use of nurse practitioners and salaried GPs are already inevitable consequences of the new GMS contract and most practices are keen to bid for additional services or find funding for access initiatives. To suggest that a private company doing this is revolutionary is either ill-informed or disingenuous spin - take your pick. Care UK even has to take part in the quality framework, making its operations even more like the thousands of other private contractors running practices round the country.

But there is one major difference between the Care UK contract and GMS. Where newly established GMS practices are left relying on the global sum, Care UK is in effect being given a basic practice allowance. In its first year it expects to have only 1,000 patients and one GP. But it has a deal setting out its income over five years.

There is the revolution: the DoH offering a realistic deal to establish a new practice.

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