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Competition for patients will be no holds barred

GPs to get incentives to expand their boundaries and open for longer

Practices will be thrust into 'no holds barred' competition with each other for patients as part of a Government drive for improved access.

The White Paper outlines proposals to stoke competition by rewarding 'responsive providers'. GPs will also get an 'expanding practice allowance' to take on more patients.

The plans also release APMS providers from the requirement for practice boundaries ­ effectively forcing neighbouring practices to abandon their own borders to compete.

GPs warned it was essential competition took place on a level playing field. They also questioned how practices could expand their boundaries when the White Paper did not appear to have changed requirements for home visits.

Under the plans, the expanding practice allowance would only be paid to practices with open lists, growing 'significantly' and offering extended hours.

Ending geographic registration will enable patients to choose a practice purely on convenience, quality and services, ministers believe.

The new focus on access will initially be aimed at under-doctored areas, with six PCTs with poor provision being aid- ed to commission additional practices as an 'urgent priority'.

Dr Mike Dixon, chair of the NHS Alliance, said the fact there was now 'no-holds barred' competition would be good for GPs, but urged a level playing field and a mixed economy of providers.

He said: 'If we replace practices with large corporations wholesale it would be an enormous admission of failure.'

Dr Rebecca Rosen, fellow in health policy at the King's Fund and a GP in south London, warned that expanding lists could fuel pressure to reduce consultation times.

She insisted GPs would need more back-up: 'It has childcare consequences. Each of us at my practice has taken on a late shift. That will be more of an issue in small practices.'

Dr Dinesh Kapoor, a GP in east London who took part in a Government pilot of 8am to 8pm opening hours, said larger 'enterprising' practices should be able to thrive and grow using longer opening hours.

But he warned: 'It's not everyone's cup of tea. There has to be balance and you should make sure it doesn't affect your domestic life.'

The White Paper also calls on PCTs to prioritise expanding practices when allocating capital funding.

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