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Feature Primary care

Opening up the primary medical care market

BMJ 2009; 338 doi: (Published 31 March 2009) Cite this as: BMJ 2009;338:b1127
  1. Jo Ellins, research fellow,
  2. Chris Ham, professor of health policy and management ,
  3. Helen Parker, co-director
  1. 1Health Services Management Centre, Birmingham, B15 2RT
  1. Correspondence to: J Ellins J.L.Ellins{at}

    By the end of March every primary care trust in England should have commissioned a new health centre. Jo Ellins, Chris Ham, and Helen Parker examine the effect of this attempt to open up the market

    Government reforms to the National Health Service in England have sought to increase the choices available to patients and to stimulate competition between healthcare providers. The emerging market in primary medical care has been underpinned by the introduction of the alternative provider medical services (APMS) contract, which allows primary care trusts (PCTs) to contract services from organisations that are outside the NHS, including commercial companies and voluntary sector providers. The contract also enables PCTs to specify what they require of primary medical care providers, rather than being constrained by the terms of the general medical services contract negotiated by the government and the British Medical Association.

    PCTs were initially slow to promote choice and competition in primary medical care, and this led the government to launch the Equitable Access to Primary Medical Care programme in December 2007. Under the programme, every PCT in England is required to tender for a new general practitioner-led health centre offering bookable and walk-in services to registered and unregistered patients. The first centre opened in Bradford last November. The programme is also funding 113 general practices in the 50 most underdoctored areas.

    Supporters of the government’s reforms have argued that these “create a framework to challenge GP service delivery and encourage innovation in order to meet people’s changing healthcare needs.”1 Opponents have expressed concerns about the dangers of “the aggressive commercial takeover of general practice and other NHS clinical services.”2 Questions have also been raised about whether every PCT needs a new GP-led health centre.3 So who is right? We interviewed strategic health authorities, PCTs, and …

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