Private firms eye changing NHS

With GP consortia due to run an £80 billion annual commissioning budget by 2013, the private sector is widely expected to cash in on their lack of management expertise.

But what are the opportunities for private firms and how bold are their ambitions? Will they offer back-office support to consortia, or aim to take over commissioning altogether?

Firms such as UnitedHealth UK, Tribal and Humana already provide support services to PCTs across England. They collect data, analyse health systems and manage contracts.

Assura Medical has developed around 30 partnerships with groups of practices, helping them redesign local services - a model which now looks highly relevant.

But unions and campaign groups say the White Paper Liberating the NHS represents a massive step towards private-sector-led commissioning.

Health secretary Andrew Lansley has yet to fully explain who will step in where local GPs fail. The BMA fears the private sector will be invited to take over if consortia slip up.

Dianne Conduit, director of commissioning support at Humana, says the firm would consider taking over commissioning in areas where GPs fail.

'We can provide elements of the service or look at providing the whole package,' she says.

Others are more cautious. Kingsley Manning, director of Tribal, questioned whether Mr Lansley's reforms will go that far. 'It could happen down the road I suppose, but it's difficult to see how legislation could ever devolve responsibility for NHS services fully to a private company,' he says.

Assura Medical 'hasn't considered it at all', says its chief executive, Bart Johnson. He says the firm is 'committed to working in partnership' with local GPs, who 'know best what needs fixing in their area'.

Similarly, UnitedHealth UK seems determined to support, not compete with GPs at this stage. A spokesman said: 'Ultimately it'll be for consortia to decide which levels and types of support they need.'

GPs are not hugely confident about commissioning, suggesting they may want to buy in help. A recent GP survey found that more than 70 per cent think they will lack the skills and resources to commission well.

But Dr Darin Seiger, chairman of Nene Commissioning, says consortia can work effectively with a small team of in-house managers. 'You could keep out the private sector if you wanted to,' he says.

Predictably, firms say they have developed tools that will be invaluable to GPs hoping to improve services for patients.

'If consortia are going to fly, they have to use the best available technology,' says Mr Manning. 'We provide services GPs will struggle to replicate.'

Ms Conduit says GP consortia will lack the resources and infrastructure to collect the data they need. 'As there will be more consortia than PCTs, the resources to do that work will be very stretched. We can collect data GPs can use to make informed decisions.'

Cost-cutting may limit how much support GPs can afford to buy. The NHS is aiming to halve management costs in the drive to make £20 billion in efficiency savings by 2014.

'There is a vital discussion over how much (GP consortia's) management allowance will be,' says Mr Manning. 'If the management fee is too small it may not be financially viable for companies to provide support.'

Ms Conduit says Humana must wait to see 'what's left' of PCTs before they can understand the size of the market.

She adds: 'I think GPs will be more savvy (than PCTs) about when they need to use the private sector.'

Providing services may also be easier for private firms under the White Paper plans. Mr Manning says plans to allow any willing provider (AWP) to run NHS services may be more significant for companies than GP commissioning.

The DoH is 'opening up community services especially to outside providers to a new degree', he says. The NHS Alliance also warns that changes to the GP contract and an AWP policy will make it easier for private firms to take over primary care services.

But GPC deputy chairman Dr Richard Vautrey says GP commissioners have 'no real enthusiasm' for the private sector. 'We would hope GPs will realise that the resources are available locally and it may be more cost-effective,' he says.

Whatever GPs decide, the swarm of private firms looking for a piece of the action will make sure they won't be short of offers of help.

White Paper: private sector opportunities
  • Providing commissioning support to GP consortia.
  • Providing support to the NHS Commissioning Board.
  • Potentially taking over failing GP consortia.
  • Provision of all services opened up to 'any willing provider' - GP services, community services, mental health, acute care.
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