During a parliamentary debate, practising GP and Labour MP for Stockton South Dr Paul Williams described how GPs in Stockton, Hartlepool and Darlington had successfully set up not-for-profit collaboratives to run extended hours services in the evenings and at weekends.
Dr Williams said the services - running for over two years in Darlington and for 18 months in Stockton and Hartlepool - were ‘a success by all measures’.
‘During the last year there have been 26,000 extra GP and nurse appointments for routine care,’ he said. Of these, 96% of GP appointments and 70% of nurse appointments have been used. He added: ‘This hasn’t just been good for patients, it’s reduced the pressure on local practices… The model has energised local GPs.’
Tendering process
However, local commissioners last month put contracts for the work out to tender - allowing private providers to bid to take over GP extended hours services. Dr Williams called the move ‘privatisation for privatisation’s sake’.
Addressing health minister Steve Brine during the debate, Dr Williams argued: ‘The service works, so why privatise it? What on earth could be gained? It’s ridiculous.’
He said that GPs working in Darlington, Hartlepool and Stockton 'are doing everything they have been asked to do by this government and the NHS’ by organising themselves into collectives.
Quoting the Conservative manifesto, which promises to ‘make non-legislative changes to remove barriers to the integration of care’, Dr Williams added: ‘This service has been put out to tender quite simply because of the law.
‘The 2012 Health and Social Care Act mandates competitive tender for certain contracts worth more than £615,000 a year and in this case I’m contending that the law isn’t working. It doesn't work for patients, it won’t work for doctors, it won’t work for NHS leaders and I suspect it’s probably not even what the minister wants.
Collaboration
‘There is a hypocrisy here - a fundamental difference between what the government is saying and what they are doing. If private companies are going to be invited to competitive tender for this, every GP has something to fear from this collaboration.’
Responding to Dr Williams, Mr Brine said: ‘As long as patients receive care that is high quality, that is timely [and] that is free at the point of use the status of the provider is of little, if any, significance. It is necessary to ensure that where a local clinically-led CCG decides that it is in the interests of patients and taxpayers to look at a range of potential providers for a service that they are able to do so.
‘Securing the best possible treatment is what we all want to achieve but we also have to use NHS resources for the good of all patients so I would say that achieving value for money is not just about making the numbers add up - it’s about how we make sure that everyone gets the quality of treatment that they deserve.’
When pushed to confirm whether or not the local CCG 'had the option under law' of not going out to procurement, Mr Brine replied: ‘Let me just repeat, they absolutely decided - the clinically-led local CCG decided - that it was in the interests of patients and taxpayers to look at a range of potential providers for the service that they wanted to do. That is the process that they are going through. Ultimately these are decisions for the local NHS they are not decisions for ministers.’
The Observer has reported that CCGs in Lincolnshire, Nottinghamshire and Hertfordshire are also planning to put extended hours contracts out to tender.
A spokesperson for NHS Hartlepool and Stockton-on-Tees CCG told GPonline: 'In order to support the achievement of improving quality of care whilst ensuring value for money for patients and taxpayers, and ensuring the CCGs acted in accordance with the law, the CCGs agreed that the services should be procured through a formal tender process.
'The CCGs are not considering privatisation of any NHS services commissioned. The CCGs, in line with government policy, are fully committed to the NHS as a public service that is free at the point of need, regardless of whether care is provided by NHS organisations, or by the private, voluntary or social enterprise sectors. The CCG expects that all commissioned providers of NHS services deliver standards of care in line with NHS terms and conditions and of the highest quality irrelevant of provider status.'
Fragmentation
GPC chair Dr Richard Vautrey told GPonline: ‘We have highlighted our concerns to NHS England about the different approaches being taken by CCGs to the delivery of extended access services.
‘These services should be connected to and directed by local practices so that the appointments they provide are an extension of the local practices and by doing so it helps to manage workload pressures. Most CCGs have done this as otherwise it runs the risk of yet more fragmentation of services and confusion for patients.’
Bids for the extended GP access services are currently being assessed with a view to the contract starting in April 2019.
An NHS England spokesperson said: ‘For the first time NHS patients across England can now get GP evening and weekend appointments, and local GP-led CCGs are responsible for arranging these extra services in their own area.'
