Letters, calls and emails: Private GP model would hit the usual obstacles

Dear Editor

The depth of Dr Neil Bentley's misunderstanding of NHS GPs' independent contractor status took my breath away (GP, 28 September).

The vast majority of GPs are not 'private sector' contractors, which would imply they set their own fees and charges, and so on, but are 'independent contractors', bound by national and local contracts which are in no way comparable to the way a private-sector firm would operate. If he can find 1 per cent of GP practices that are limited companies, I will eat my hat.

His limited understanding of how the NHS operates is further revealed by his indignation that 'GPs ... decide who patients get to see, when and where'. That is our role as gatekeepers of the NHS. Patients need to see a GP before they can be referred to specialist care within the NHS (and, indeed, consultants working in the private sector also insist on GP referral before they will see a patient).

This is to prevent the kind of free-for-all that reigns in the US, where patients refer themselves, which is all well and good if the taxpayer is not footing the bill.

The whole idea of the GP gatekeeper system is to ensure that patients are seen appropriately, thereby not wasting resources on unnecessary investigations and appointments and treating them in the most appropriate setting.

As for us deciding 'who, when and where', has he not heard of Choose and Book? We go out of our way to ensure patients have a say in their management both within the primary care setting and in hospitals.

If he thinks that new primary care providers will not have to bow to the same pressures and funding arrangements as current GPs, he is in for a surprise. Unless they are exempted from these, I don't think his vision of profits for his members will be realised.

Dr Amanda Lindsay, Leeds.

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