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FEATURE: Andrew Cole Private practice BMJ 2008; 336: 1406-1407 [Full text]

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Level playing fields? General practice can compete but will have to step up to the challenge.

Richard. L Puleston   (21 June 2008)

Level playing fields? General practice can compete but will have to step up to the challenge. 21 June 2008
Richard. L Puleston, Public Health Specialist Registrar Northamptonshire Teaching Primary Care Trust, NN15 6XR Send response to journal: Re: Level playing fields? General practice can compete but will have to step up to the challenge.	Andrew Cole's article illustrates the brave new world that health services have to work in. While on the face of it may seem that existing, traditional general practices haven't a chance of competing, this would be to give the wrong impression. Most would agree that achieving the best outcomes possible for our patients and the population as a whole, within the available resources is important to aspire to. Yet, on many measures, the UK still lags behind other international comparators. World Class Commissioning is the government's response to this continued gap. This requires that commissioners (Primary Care Trusts and Practice Based Commissioning Groups) ensure services are provided by the provider best able to meet the rigorous standards / specification required within an affordable financial envelope. If a private provider is able to do all this at a lower cost than traditional general practice then the commissioners would be negligent in their use of public funds to ignore this. The competitive winds blowing through the primary care sector at the moment may be uncomfortable for traditional general practices, however they can compete. General Practice has always been good at adapting to change and this situation is no exception. It will require a different response from before, but it is possible for the profession to step up to the plate. If practices want to tender for such work, then they will have to think out of the box and make the playing field more level. For example: Practices could work together acting as consortia to allow more manpower to work on the bid and economies of scale. The profession could choose to develop business support / tendering advice services at a national level to support such bids. Practices could enter into joint bids with commercial suppliers. Although many general practitioners have a keen business interest, few health professionals have formal business training. This may hamper them in developing high quality business cases. Practices would be well advised to seek advice on writing and developing robust business cases. In summary, the new situation general practice finds itself in is new, but not insurmountable. It should look on it as an opportunity to be grasped and surely must do so, otherwise perhaps the service may change in the same way as food retailing has. What is certain, is that general practice will have to move out of its comfort zone and tackle the challenge head on. Dr Richard Puleston, MBChB, DCH, MBA, MPH, MFPH Competing interests: Former GP, Warwickshire. Responsible for reviewing commissioning business cases as part of current role.