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GPs in Avon air their concerns over the 'cold steel of competition'

Fears over market for GP services

By Helen Crump

A market for primary care services will force surgeries to change drastically – and not necessarily for the better, GPs and practice managers warned at a meeting in Bristol last week.

Delegates at a practice-based commissioning conference held by Avon LMC were confident that they provided a high quality service.

But they were worried PCTs would award future contracts to provide services simply to the cheapest bidder.

Dr Tom Frewin, a GP in Clifton, Bristol, said both providers and commissioners should be made legally, financially and personally accountable for their decisions to guarantee high quality services.

He said: 'Private providers come and go. There's got to be a very heavy financial penalty if they can't do it.

'If [PCTs] commission a service that goes wrong, those commissioners should be legally liable. It's about quality and efficiency.'

But Dr Frewin was not confident about GPs' prospects of competing.

'We don't stand a chance the way things are going because it's not a level playing field,'

he said.

Steve Mercer, chief executive of Avon LMC, said private sector providers had the ability to run a service as a loss leader whereas GPs did not.

Mr Mercer also suggested the traditional model of general practice could change 'quite radically' with more of a skills mix and GPs at the head of

multidisciplinary teams.

He said: 'We're not in the business of paying Mercedes costs when you could do just the same in comfort in a Renault Mégane.'

A number of GPs said their practices were unused to overt competition and would find it hard to change the way they worked.

One GP told the meeting that practices operated on a fixed cost basis that was 'far too high'.

'We have very little scope in the way we're currently organised to reduce our cost per consultation,' he said.

'I think that renders us very, very vulnerable to the cold steel of competition.'

Josie Tarnowski, a practice manager in North Somerset and an ex-PCT director of primary care, said longer opening hours was an inevitable consequence of the pressure being exerted on practices.

'A lot of health policy is aimed at the floating voter and those patients want us to be open until 10 at night and all weekend,' she said.

'How will we meet those expectations? If we don't, a proportion of our patients will just walk to other providers who will say "We can set up in a shopping mall".'

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