GPs are told to tender for their own practiceBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7559.113 (Published 13 July 2006) Cite this as: BMJ 2006;333:113
GPs are told to tender for their own practice
A well performing surgery in Tyne and Wear is being put out to tender despite being run by committed GPs and supported by patients. Zosia Kmietowicz asks why
Ashley Liston seems like a model GP. He has an altruistic streak, inspired he says by Julian Tudor Hart, the socialist doctor and passionate advocate of the NHS who worked as a GP in Wales for 30 years. Two years ago Dr Liston gave up his position as principal GP in a practice in a comfortable Newcastle neighbourhood, where he had worked for eight years, to become a salaried GP at a practice that had relied on locums for 30 months.
"I wanted to maximise the benefits of my skills without going abroad. I wanted to make a difference and to have a personal challenge—to work somewhere where I could feel fresh about work, not stale," he said.
If the feedback from his patients at the Encompass practice in Washington, Tyne and Wear, is anything to go by then Dr Liston, who works with another salaried GP, has achieved what he set out to do.
Elizabeth Lowery, a patient at the practice for 30 years and a member of the practice’s patient support forum, has seen the practice through a number of changes. The arrival of Dr Liston in 2004 "transformed the place," and it now has "very high standards" and expectations, she says.
When patients learned in May this year that Sunderland Teaching Primary Care Trust had decided to put the practice out for tender, allowing any interested parties, including private enterprises and giant healthcare corporations, to bid to run the practice, the forum collected 1200 signatories, out of a list of just under 4000 patients, in just three weeks.
"As soon as patients heard, they came down to the surgery just to sign the petition," said Ms Lowery.
The petition was delivered to the House of Commons by the local MP, Fraser Kemp, and also to the trust’s board.
George Rae, a local GP and secretary of the Newcastle and Tyneside local medical committee, said that the situation at the Encompass practice has "gone beyond the initial remit of APMS [alternative provider medical services]."
Launched in 2004, the alternative provider medical services scheme was designed to plug gaps in general practice services in areas with a history of recruitment difficulties. Guidance on the scheme issued by the Department of Health in 2004 states that the new arrangement "will provide a valuable tool to address need in areas of historic under-provision, enable re-provision of services where practices opt out, and improve access in areas with problems with GP recruitment and retention."
"The situation in Sunderland has caused a lot of discomfort and unease," said Dr Rae. "We have a doctor of excellent calibre who went to an area where general practice delivery was not what it should be. He turned the practice round and is now providing a ‘gold standard’ service with teaching status and maximum QOF [quality and outcomes framework] points. Now he is being asked to go through the procurement process to run the practice, but where is the logic in putting this practice out to competitive tender?"
The trust has said that it will go ahead with the advertisement despite the clear preference of patients and 80% of local doctors for the present GPs to remain. But it would not disclose how many groups or companies had expressed an interest in the venture or exactly when the tender would be advertised.
The trust’s main objective is to move the Encompass practice away from its control to independent status. It said, "The route of advertising is the only route ….. which would allow Dr Liston to apply. It is also the route which complies with the Standing Orders. The advice was in line with routine practice for a contract of such value, and also the route traditionally used—[that is,] to advertise practice vacancies." Not putting the practice out to "open competition" carried certain "risks," said the trust after seeking legal advice.
"The advice confirms that if the TPCT does not follow a reasonable process this could be challenged through a judicial review and the TPCT could also be subject to a claim for damages," said the trust.
However, according to Dr Rae it is "within the gift" of the trust to hand over the practice to Dr Liston without advertising it. "PCTs [primary care trusts] are being encouraged to pursue this pluralistic ideology with multiple providers, which is the way the government puts across choice—which is not to do with the needs of patients," he said.
Elizabeth Barrett, a GP in Shirebrook, Derbyshire, who recently bid to run a practice in nearby Langwith but lost out to United Health Europe, a subsidiary of the US based United Health Group, the biggest private healthcare corporation in the United States (BMJ 2006;332:1172-3, 20 May), believes something sinister is afoot.
"What has happened at the Encompass practice demonstrates that the proposal by the Department of Health—that private healthcare providers would only be invited to bid to manage primary care services which were in deprived areas and were poorly performing—is a sham," she said.
"The Department of Health was using the deprivation factor as a means of moving the private sector into the NHS. They thought that vulnerable communities would be so grateful about what they got that there would be no opposition to it. But it seems they are not interested in quality; they are interested in takeovers. That seems to be patently obvious, and it is a scandal."
The health department’s recent advertisement in the Official Journal of the European Union inviting private companies to demonstrate how they would run primary care trusts, which was later retracted amid claims of drafting errors (BMJ 2006;333:61, 8 Jul), has fuelled the notion that the government has a secret and widespread privatisation plan for the NHS, said Dr Barrett.
"The idea that this advert was wrongly drafted is absurd. It is basically saying that the NHS is moving from a provider to a commissioner role," she said.
The last two years have been something of a personal political awakening, said Dr Liston. But some things remain the same.
For Dr Liston the management of any general practice is about patients’ satisfaction. He has nothing against alternative providers stepping in where GPs are difficult to attract. But to impose change and perhaps install a perpetually changing team of GPs when a reliable partnership is already in place seems to go against the principles of good general practice.
"Personal care is at the heart of general practice, and continuity of care is one of the most important outcomes. You have got to be wary of disrupting that," he said.
- GP who worked shifts for out-of-hours service while on sick leave is struck offBMJ August 21, 2019, 366 l5232; DOI: https://doi.org/10.1136/bmj.l5232
- Helen Salisbury: Balancing patient safety and autonomyBMJ August 20, 2019, 366 l4948; DOI: https://doi.org/10.1136/bmj.l4948
- Rammya Mathew: The pursuit of being a good doctorBMJ August 20, 2019, 366 l5139; DOI: https://doi.org/10.1136/bmj.l5139
- MMR vaccine: Johnson urges new impetus to increase uptake as UK loses measles-free statusBMJ August 20, 2019, 366 l5219; DOI: https://doi.org/10.1136/bmj.l5219
- No-deal Brexit may worsen drug shortages, pharmacists warnBMJ August 20, 2019, 366 l5226; DOI: https://doi.org/10.1136/bmj.l5226