William Laing from health consultancy company Laing & Buisson suggested CCGs' and NHS England's commissioning should be merged to attract commercial investment and expand general practice.
He said: ‘I think it’s quite extraordinary to have, on the one hand, CCGs funding and commissioning… services, but [to have] the primary care economy through NHS England.’
However, Mr Laing admitted that the removal of this division in commissioning was unlikely to happen.
Speaking at a conference on GP premises organised by Aitchison Raffety, Mr Laing said general practice had the lowest level of ‘corporatisation’ across the healthcare sector. The revenue of the five largest commercial providers accounts for just 1% of the market.
General practice effectively remains part of the public sector, despite its independent contractor status, because of the government ban on the sale of goodwill in medical practices.
The ban, in place since the founding of the NHS, would have to be removed to attract commercial investment, he said.
Mr Laing said this was often talked about but would depend on the BMA’s position.
However, the union has a conflicted interest, he said. On the one hand, it represents GPs who could benefit from the sale of goodwill, and on the other it must recognise that this would create an entry point for corporate investors to commercialise the NHS.
But, he said, new sources of capital in general practice would lead to the commercial reconfiguration of services, resulting in cost reductions. This would also prompt the creation of a salaried service, while the introduction of protocols such as better telephone triage could reduce demand and pressure on practices.
Mr Laing predicted ‘big general practice’ was the future. The current service does not have the scale to deal with future demands of integration, the shift of care out of hospitals and the increase in long-term conditions, he said.