MedEconomics: Time for GP groups to take on services

PCT mergers slowed the move of services to the community, says Dr Tim Kimber.

The past 12 months has seen a rapid growth in the number of GP practices forming joint working arrangements, such as private companies and limited liability partnerships.

All over England, practices are concerned about the perceived threat from alternative provider medical services (APMS). Forming into groups, or federations seems to be a way of offering each other some protection.

Innovations in Primary Care (IPC), of which I am a director, is now two years old. Based in Worthing, on the South Coast, IPC was one of the first GP companies in the country (GP, 25 February, 2006).

We cover a population of about 300,000. Local practices are generally stable making it more difficult for APMS providers to get a foot in the door, however we cannot afford to be complacent.

Service development

Last year, the DoH White Paper, Our health, our care, our say trumpeted the move of services into the community. However, our efforts to make this happen have been slow to bear fruit.

We started with a huge list of projects, looking at which outpatient services might transfer to a primary care setting. We talked to consultant colleagues about how to do it, and how they would be involved. Some were enthusiastic, some felt threatened. We also looked at diagnostic services.

We are running training courses for doctors in clinical areas where we hope to provide services. We have devoted many hours to a clinical assessment service to be owned by and run by local clinicians.

However, although our timing is spot-on in terms of the government's plan for rapid and radical change, implementation of our projects has dragged because of the PCT mergers that were part of this same plan.

In our area, five PCTs merged to form West Sussex PCT. For many months an almost total administrative vacuum prevailed. We also felt we were perceived as a group of GPs out to make a fast buck.

Although we want to expand, our aim is to help manage the local health economy while protecting our core business.

We have had some success. IPC has negotiated a contract to perform minor surgery previously done at the local hospital. We ran a successful training course alongside this. We are negotiating with the PCT and the local hospital to provide anticoagulation, dermatology and vasectomy services in the community.

Discussions have taken place with a local optician about community-based retinal photography and negotiations continue on the clinical assessment service, including consultant-to-consultant referrals.

IPC is also providing a private flu and hepatitis B vaccination service.

We have received numerous approaches from GPs and NHS organisations to do consultancy work.

But IPC has now reached a critical point: we need to build on our early success. If the government is genuine in its proclamations and can galvanise PCTs to act accordingly, IPC and other GP-run organisations are ready, willing and able to lead the way.

- Dr Kimber is a GP in West Sussex


- IPC is a company limited by shares. All GPs at practices in the Worthing area are shareholders.

- IPC has made a successful bid to provide minor surgery. It is currently negotiating to provide community dermatology, vasectomy, retinal photography and anticoagulation services.

- IPC is also providing a private influenza and hepatitis B vaccination service, and private minor surgery.

- The company is a vehicle to provide training to practices (administration staff and clinicians).

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