Should GPs fear rise of private firms?

When UnitedHealth backed out of the primary care market in the UK this year, there was speculation that private companies had had their day as providers of general practice.

Dr Mark Hunt: 'The independent sector is not everyone’s choice. But there are some advantages' (Photograph: M Alsford)
Dr Mark Hunt: 'The independent sector is not everyone’s choice. But there are some advantages' (Photograph: M Alsford)

But other companies running NHS primary care services have no intention of following its lead. Care UK and Assura Medical both say they will continue to seek practices to run and have not ruled out bidding for the stream of PCT-run practices due to be tendered in the coming months.

The Practice plc, which operates about 60 primary care sites, continues to advertise for 'career-minded GPs' to support its 'rapid growth'.

GP leaders say it is likely that the number of privately run practices will grow, with NHS Alliance GMS/PMS lead Dr David Jenner estimating that one in 10 practices will be run by a private company by 2014.

But if there is a substantial increase in these practices, what does this mean for GPs?

Keep the focus on community
RCGP chairwoman Dr Clare Gerada says that she is worried about moving parts of the NHS, including GP services, into the corporate market.

Dr Gerada is a partner of the Hurley Group, an NHS organisation that bids to run GP practices. But she points out the group is not a corporate body, nor does it have shareholders or earn 'vast profits'.

'We don't go for the low-hanging fruit,' she says. 'We go into the hardest areas of London and focus on transformational change. We focus on dealing with patients nobody wants. We are part of the community.'

GPC deputy chairman Dr Richard Vautrey echoes this focus on community. 'GPs are usually local people who are accountable to communities. You face your patients in local supermarkets as well as in your surgery. With larger organisations, management is more remote. You begin to lose that local connection that drives up quality.'

He also says the rise of privately run practices could affect partnership opportunities, because most are primarily staffed by salaried GPs. Similarly, privately run practices do not offer the same opportunities for GP trainees, he adds.

But Dr Jenner says that newly qualified GPs coming into general practice are not always seeking partnership options.

He says many GPs are 'nervous of the uncertainty' around the NHS reforms, with many unwilling to make long-term commitments or capital investments in general practice.

'Younger GPs are often attracted by the salaried option, which gives a better deal on benefits and removes the bureaucracy of running a practice,' he says.

Patterns of practice
Dr Mark Hunt, a GP and managing director of Care UK, agrees there is now a change in the pattern of general practice, with GPs not wanting to 'settle in a partnership for 30 years'.

He says GPs working for privately run practices have flexibilities to experience a number of environments, whether working as a GPSI in a one-stop outpatient service or gaining emergency care experience in urgent care centres.

He says: 'Working for the independent sector is not everyone's choice. But there are some considerable advantages for people at different stages of their careers.'

King's Fund senior fellow Nick Goodwin, author of its inquiry into general practice, says there are opportunities for joint working between traditional GPs and companies.

'The exciting element is where private companies increase the capability of general practice to deliver services in new ways and to people who need care but are not necessarily getting it,' he says. Mr Goodwin points out that clinical commissioning will mean GPs can often control decisions about whether to involve the private sector.

GP commissioners will not control GP contracts, but GP leaders have said federation and succession planning offer GPs alternatives to seeing their practice run by a company once they retire.

GPs may have more tools than they think to protect traditional general practice. But a key factor could be convincing the next generation that it's worth it.

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