Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Sale of Goodwill
- Peter B Graves (21 September 2007)
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Market Forces Health Improvement
- Richard Alan Mendelsohn, Peter Thebridge, Andrew Donald and Sophia Christie (3 October 2007)
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More questions than answers.
- Hendrik J Beerstecher (8 October 2007)
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Peter B Graves, Chief Executive of Beds & Herts LMC Ltd Astonbury Farm SG2 7EG
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Sir, the article entitled "The Market in Primary Care", September 8th 2007, is misleading with respect to the sale of Goodwill in General Practice. It states that the ban on the sale of goodwill was "lifted" and infers that practices or individual GPs can sell goodwill relating to the entire practice profits. This is not the case. In this circumstance, the goodwill element of a practice only relates to Additional and Enhanced Service profits and any profits made from the provision of Out of Hours (provided by very few practices these days). Such profit margins after expenses for providing such services would be very small and barely worth anything in the way of "Goodwill". Further, paragraph 3 of The Primary Medical Services (Sale of Goodwill and Restrictions on Sub-contracting) Regulations 2004, states that: "The following performers or providers of primary medical services - (a) a GMS contractor (b) a PMS contractor that has a registered patient list... etc. may not sell the goodwill of their medical practices in any circumstances (and no other person may sell that goodwill in their stand)." Whilst the regulations on the sale of Goodwill may have been somewhat relaxed, they have been far from lifted, and any one thinking that GPs may earn another huge chunk of money from working in the NHS is seriously misguided. Competing interests: None declared |
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Richard Alan Mendelsohn, Acting Director of Chronic Disease Systems Birmingham East and North PCT, Waterlinks House, Aston, Birmingham B7 4AA, Peter Thebridge, Andrew Donald and Sophia Christie
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Pollock and colleagues (1) cite Pfizer Health Solutions as a company with a commercial contract to provide primary and community medical services to the NHS in England – specifically chronic disease management for Birmingham East and North Priamry Care Trust (PCT). They also suggest the provision of these services is through the ownership of health centres or general practices. This is not the case. Pfizer Health Solutions (a business division of Pfizer Ltd) works in partnership with Birmingham East and North Primary Care Trust and NHS Direct to deliver Birmingham OwnHealth®, a chronic disease management service. The service does not, and was never intended, to replace general medical services, but rather to act in tandem with them to support its members in helping patients to better self-care. In 2005, the predecessor PCTs went to the emerging Market in Primary Care under the aegis of the then Birmingham and Black Country Health Authority in order to respond to the need for accelerated Health Improvement in a deprived population relatively starved of effective chronic disease management systems. The result is Birmingham Own Health® – an evidenced based, effectively commissioned telehealth project which delivers care management for diabetes mellitus, heart failure and ischaemic heart disease (2) over the telephone to some of the PCT’s most deprived, hard to reach residents. Results from both routine service monitoring (3) and user evaluations have shown improvements in behavioural and biochemical markers in relation to diabetes and heart disease and high levels of patient satisfaction - indeed these findings form part of a complex evaluation strategy. Such a strategy ensures that the service performs above the norms expected for an NHS service. Furthermore, the Partnership is jointly accountable through its own parent Boards – and the Professional Executive Committee in the case of the PCT thus ensuring that there is local NHS scrutiny of access, costs and quality. Finally, the provision of this service through NHS Direct ensures that the Care Managers are employed in NHS posts governed by national agreements. We believe that this is an example of the Market in primary care meeting a health improvement need alongside more traditional service models to everyone’s benefit in a controlled manner. (1)Pollock AM, Price D, Viebrock E, Miller E. The Market in Primary Care. BMJ 2007;335:475-477 (2)Long Term Conditions Team, Department of Health. Self care for people with long term conditions., November 2006. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063157 (3)Department of Health. Long Term Conditions – Local Evidence and Guidance. September 2007. http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Longtermconditions/DH_4128530 Competing interests: None declared |
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Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA
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Dear editor, Pollock et al ask ‘how will NHS spending be accounted for in the new primary care market?’ We received this reply to the question in July 2006 when I asked to see the financial details of the contracts with private providers: ‘I can confirm that the Department holds details of the cost of the Walk in Centre and general medical services, however it is not currently prepared to release this information’. (1) With all the talk of competition, some questions remain. Why are PMS, APMS and private contractors not offered the same capitations as GMS contractors, determined by an allocation formula that is taking account of patient needs? (2) Why did the advisory board for APMS contracting contain several of the private companies that are now providing primary care services? (3) A final detail, the Barking and Dagenham surgery and walk-in centre (that reputedly received £5 million for a 5 year contract) is not catering for 7,000 patients yet, that is the potential amount of patients registered at the end of the 5-year period.(4) How many patients are registered for primary care services and at what cost remains known exclusively to the Department of Health for the time being. (1)Response to your Query : - Ref:DE00000117554 - Government- brokered deal - FOI request. 19-07-2006. (2) Morgan CL, Beerstecher HJ. Primary care funding, contract status, and outcomes. An observational study. British Journal of General Practice 2006; 56: 825-829 http://www.ingentaconnect.com/content/rcgp/bjgp/2006/00000056/00000532/art00004 (3) The NHS confederation. APMS Core Group Meeting 21st July 2004, London. http://www.bmj.com/cgi/content/full/335/7622/DC1 (4) Michael Day. UK government accused of privatising the NHS. BMJ 2006;333:61. http://www.bmj.com/cgi/content/full/333/7558/61 Competing interests: None declared |
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