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Adapt or die: White Paper's warning to GPs

GPs challenged to compete with private companies to provide more and better services

GPs will have to open longer, take on more patients and offer more services in order to survive under Government plans to shake up primary care.

The 'Our Health, Our Care, Our Say' White Paper unveiled this week proposes a massive increase in competition for GP services, with PCTs given Department of Health backing to bring private firms into under-doctored areas.

New providers and existing GP practices will be incentivised to serve a wider area and take on work from hospitals.

Patients will be given greater rights to choose which practice to join, supported by a raft of information from PCTs on list status, access, patient survey results and GPs' performance.

One former Government adviser said the proposals sent an 'adapt or die' message to GPs because of the extra power given to patients.

The White Paper unilaterally rewrites GPs' contracts by axing 'open but full' lists, forcing practices to either be open or closed.

It also gives patients the option of registering with a practice near their work rather than their home and the right to an NHS 'life check' at five points during their lifetime.

Dr Hamish Meldrum, GPC chair, urged practices to buy into the reforms to ensure they won a share of the spoils.

He said: 'Whether you are a small or big practice the White Paper tells you to innovate and adapt. You might not get so much of any goodies coming along if you don't do that.'

Professor Chris Ham, former director of the Department of Health strategy unit and professor of health policy and management at the University of Birmingham, warned practices would find it 'difficult to survive' unless they changed.

He said: 'If patients are attracted by a wider range of services at other surgeries it will be a case of adapt or die.'

Health Secretary Patricia Hewitt denied the plans spelt the end for smaller practices. But she said they would not be able to remain in isolation.

She said: 'Where you have small practices who don't have the space or choice to run a full range of services they will be encouraged to work in partnership with other practices and their PCT.'

Ms Hewitt said 5 per cent of funding would switch from secondary to primary care over the next decade to support the shift in work.

Dr Mayur Lakhani, RCGP chair, said he was reassured that GP registration had been preserved but concerned about fragmentation of care, workload and funding.

The White Paper also ordered NHS Employers to negotiate an end to the Minimum Practice Income Guarantee, claiming it hinders patient choice.

Key points

  • Rewards for expanding practices
  • Private providers to increase capacity
  • End to 'open but full' lists
  • Pledge to ditch the MPIG
  • Self-assessment 'life checks' for all patients
  • Fundamental review of PMS contracts

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