Tendering out general practice is bad for doctors—and patients
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2461 (Published 18 April 2012) Cite this as: BMJ 2012;344:e2461All rapid responses
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According to a senior partner at the Caversham Group Practice in NW5, they have the capacity there to 'absorb' all 4,500 people from the closed surgery (Camden New Journal, 22 March 2012). According to the NW Central NHS, there are nineteen suitable practices within one mile of the Camden Road Practice (GP Commissioning Guide 27th March). This seems to give some prospect of choice between the mega big Caversham Group Practice which some people are not comfortable with and the few smaller practices which have not yet been hoovered up by these types of health centres. Whatever it seems there should be some kind of official process in place to help and advise people if they are obliged to move from a closing practice.
Competing interests: No competing interests
Dear Editor,
Particularly in view of Katy Gardner's article this week (page 31) I hope you will be covering the three days of public enquiry here in Camden into the mismanagement and final closure of the GP surgery at 142 Camden Road, Camden, by both the PCT (NCL), United Health and 'The Practice plc'.
There is much to come out of this enquiry not least the policy of the PCT to tender out NHS services to private companies apparently excluding strong bids by NHS GPs and organisations. This was the case with three GP surgeries 4 years ago leading to the eventual closure of this surgery.
Further, for instance, it is now openly known that only private companies have been short listed for the OOHrs contract for this area of London despite an appropriately strong bid by Haverstaock Health, a consortium of all Camden GPs.
This has all been happening long before the Lansley Bill/Act comes into effect.
Hence there are number of motions going to the ARM this summer to make it BMA policy to support CCGs in their attempts to keep health services in the NHS
when they take over commissioning next year.
Competing interests: No competing interests
I have also, with my colleagues in service numbering over 100, experienced the stress, uncertainty and demoralisation of being out to tender. Although, like your experience, the threat went away after a prolonged period of time of almost 2 years, with no explanation, the threat continues to lurk just over the horizon, like a forest fire burning, lighting up the sky. Is it a new dawn or an all consuming deadly conflagration? I, like you, cannot see how this process, repeated time and time again is good for patients. The administration costs alone must outweigh any perceived savings and efficiency dies on the altar of cost saving.
Competing interests: No competing interests
Re: Tendering out general practice is bad for doctors—and patients
Our medium sized practice in Tyneside is also facing the prospect of engaging in a competitive tendering process but our journey is somewhat different to this Liverpool practice. In 2006 the local PCT announced that it would be letting go of the management of its GP practices including the one I had joined 2 years previously. This practice had been causing huge concerns due to the PCTs inability to recruit any GPs despite advertising for over 2 years. I had chosen to take on the challenge and with the support of a GP colleague we transformed it from a struggling practice to a high performing GP training practice. The decision was made to put the practice up for a full competitive tendering process.
Our registered patients expressed concerns about the process fearing they might lose their regular GPs. Questions were raised about the legality, integrity and necessity of the process which resulted in a pause in the tendering process. After a period of review the tendering process was recommenced. My colleague and I engaged a professional manager to support us but we still had to dedicate a huge amount of time and effort into the process in order to formulate a credible bid. It was an enormous distraction from our work as GPs and considerable source of anxiety for the whole team as well as our patients. In 2007 we were informed that we had been successful in winning a 5 year aPMS contract to provide GP services to the patients registered with our practice.
Since this time the Health and Social Care bill has worked its way through parliament. This was accompanied by unprecedented national protest which also resulted in a pause in the process. This only briefly delayed what most people realised was the inevitable implementation of a bill that would significantly ramp up the marketisation of the NHS. The marketplace is seen as a means of driving up quality and ensuring there is a fair process where qualified providers are able to prove their worth in open competition with rivals.
The contract has now reached the the end of it's term and the decision has been made to put our highly successful and innovative practice out to tender again. The process we are facing is familiar but this time feels very different. In 2007 the PCT rightly pointed out that although the patients were concerned they might lose their GPs, the practice did not belong to the GPs who were in fact employees of the PCT and that they would retain employment rights if they were unsuccessful in winning the contract. Having won the contract my colleague and I formed ourselves into a traditional GP partnership which now employs salaried GPs as well as the normal compliment of practice staff. If we are unsuccessful in winning the contract this time all our employed staff will have some job security whilst my GP partner colleague and I would find ourselves out of work.
The prospect of being out of work is a bit of concern although the GP marketplace currently seems in favour of job applicants. Few doctors seem to be seeking a career as a GP and huge numbers are taking retirement much earlier than they had planned. The loss of regular GPs and break in continuity of care will certainly be an issue for the patients. The practice will lose leadership and vision, albeit that it might be replaced by a different vision belonging to a large corporate healthcare provider. The local primary care community will lose a GP trainer, a GP tutor and an enthusiastic member of our local CCG group.
This GP practice is not just another contract for a private healthcare provider. It is my livelihood but far more importantly to me it is my vocation. Issues such as relationship based medicine, continuity of care, community focus, functioning small teams and integrated primary care teams are at the heart of what I do. It is what I specialise in and the idea that my role and team I lead should live under constant threat of demise is not only demotivating but undermines the best features of general practice.
The outcry that went out locally and nationally in 2006 has been replaced by a widespread resignation that this competitive process is here to stay. The RCGP is encouraging GPs to band together in federations to help them survive with little sign that practices are following their lead. The LMCs which could be active in supporting GPs in the skills of bid writing are ominously quiet. The BMAs recent attempt to propose a case for GPs to be given preferential treatment if they voluntarily offer to take on out of hours care has been deemed anti-competitive by NHS England.
It seems all we can do is to roll up our sleeves and get ready to prove our worth yet again. The David and Goliath victory we achieved in 2006 might be repeated again but then again, it might not.
Competing interests: No competing interests