Viewpoint - What's wrong with competing practices?

Services won by GPs often improve, rather than adversely affect, health outcomes says Paul Corrigan.

Professor Corrigan: why is the RCGP against competition? (Photograph: JH Lancy)
Professor Corrigan: why is the RCGP against competition? (Photograph: JH Lancy)

This month the RCGP published The Government's Health Reforms: An analysis of the need for clarification and change. It criticised the government reforms because it proposed too much competition.

GPs have proved themselves good at competition. GP organisations win tenders to provide primary care services across different communities. The alternative to a tender is that the state distributes who can and cannot provide primary care as a form of largesse to one practice or another.

There are different forms of organisation for those practices that want to expand their capacity. Obviously if you bid for new work, you have to have a flexible approach to expanding your organisation. Often success expands a GP organisation by having salaried GPs. While these are employed they often work to a profit-related bonus scheme. This encourages them to help identify local priorities and maximise revenue.

The RCGP knows that some of its members' organisations of care will try to expand their business by taking over new registered lists that had previously been provided by other GPs. Some GPs are very entrepreneurial and want to expand.

For them irrespective of what the RCGP says about competition they would recognise that competition has led to growth of good care.

No effect on services
But the RCGP report claims this is not true. It says: 'Despite the increased use of market forces in the health service over the past two decades, the evidence that this policy improves outcomes is limited. A review finds there is no conclusive evidence that market competition has any effect on the quality, equity or efficiency of healthcare delivery.'

I would claim that the services that have been won by GP entrepreneurs in competitive tender often lead to genuinely improved health outcomes for their new patients. I am sure that GP organisations that are growing would agree and would be puzzled by the RCGP which claims that there is no evidence that competition leads to improvement.

But I don't understand why the RCGP is against competition if patients have better services as a result?

What I find disappointing is that it seems to want to limit the right to compete for NHS patients to the organisations within the NHS at the moment.

If a charity were to set up a primary care provider employing salaried GPs which would be incentivised to improve services through some form of profit sharing, as current GP organisations do, what could be wrong with that?

Such an organisation would then be in a position to compete with existing GP-led organisations to gain NHS patients.

Why should NHS patients be denied the right to have that as a possibility?

  • Professor Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at

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