The market in primary care
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39303.425359.AD (Published 06 September 2007) Cite this as: BMJ 2007;335:475
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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/PublicationsPoli...
(3)Department of Health. Long Term Conditions – Local Evidence and
Guidance. September 2007.
http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Long...
Competing interests:
None declared
Competing interests: No competing interests
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
Competing interests: No competing interests
More questions than answers.
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/a...
(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
Competing interests: No competing interests