Three more general practices in England to be run by private company

BMJ 2008; 336 doi: (Published 07 February 2008) Cite this as: BMJ 2008;336:295
  1. Susan Mayor
  1. 1London

    GPs in England say that they cannot compete with private companies in bidding to take over the running of general practices that come up for tender. It was announced last week that a London primary care trust had awarded to a US private healthcare company a contract to run three practices.

    The US company won the contract despite competition from a consortium of local GPs who had previously been managing one of the practices successfully.

    Camden Primary Care Trust awarded the tender to UnitedHealth Primary Care. The company will start running three general practices at King’s Cross Road Practice, Camden Road Practice, and Brunswick Medical Centre over the next few months.

    Four local GPs who bid for Brunswick Medical Centre, which they had been managing successfully for the previous six months, allege that the primary care trust had “not provided an equal playing field for all bidders.”

    Since taking over the practice the GPs had increased the practice’s opening hours from 36 to 45 hours a week and had set up weekly antenatal clinics, a diabetes clinic, and a Bengali clinic (the practice has a high proportion of Bengali speaking patients), at the same time as reducing the cost of prescribed drugs.

    Stephen Amiel, chairman of Camden and Islington local medical committee, the elected body representing GPs in the area, and a GP in Kentish Town, London, said, “There was clear evidence that the bid accepted did not score the highest on quality markers.”

    The four GPs who took part in the bidding process are concerned that the decision was based on cost rather than quality. One of the GPs, Stephen Graham, said, “I am dismayed that patients will have to endure yet another change in doctors. It appears that cost cutting has won hands down over quality of service provision.”

    Camden Primary Care Trust said that it had made the decision after reviewing bids for three practices and on the basis of a specification developed after a public consultation on primary care services in the borough. It said that the decision was based on quality of services and value for money.

    In a statement it said, “UnitedHealth already provides family doctor services elsewhere and has delivered improvements in care, extended opening hours from 8 am to 8 pm, increased opportunities for patients to have their say in the way services are shaped, and introduced a wider range of services to local people.”

    The US company took over the management of the Normanton Medical Centre in Derbyshire in 2006 (BMJ 2006;332:194 doi: 10.1136/bmj.332.7535.194-b), in one of the first contracts for primary care services between the NHS and a private provider. Since taking over, UnitedHealth has “made considerable improvements to patient care, the patient experience, and staff morale,” say minutes from a recent meeting of Derby City Primary Care Trust.

    In the London bid, Dr Amiel believed that Camden Primary Care Trust had a target price of £85 (€113; $170) a year per patient. The bid from the group of GPs was about £100 a patient to provide the care they had proposed in their bid. He thought that UnitedHealth’s bid had come in at £74 for the level of care they were offering.

    “The dice are loaded against GPs in lots of ways,” he said. “Even when they have demonstrated quality in the practice they are bidding for, with the advantage of local experience and knowledge, they are unable to compete. The financial muscle [of large companies] means that GPs start at a huge disadvantage to a large private company. These organisations have staff that put bids together all the time, while GPs have to do it in their spare time.”

    Laurence Buckman, chairman of the BMA’s General Practitioners Committee, said, “There has to be a level playing field in the bidding process for GP practices and it must be fair and totally transparent. We are very worried that primary care trusts are being put under pressure to opt for private providers.

    “Our concern is that large, corporate firms will put profits and the needs of their shareholders before patients and their quality of care. I hope the service patients get will continue at the level of care they were used to.”

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