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At the heart of general practice since 1960

Ground rules needed in march to APMS

When does general practice end and private enterprise begin?

When does general practice end and private enterprise begin?

Over the years, it's a question the Government has asked repeatedly, and provocatively, whenever GPs or members of the public have questioned the growing role of the private sector in the NHS.

The answer, according to ministers, is that there never has been much of a dividing line - GPs, they claim, are as private as any of the new entrants to the healthcare market.

GPs have always strongly rejected that notion - and particularly the slur that they are somehow less committed to the NHS than other healthcare workers.

A glance at what GPs actually did strongly supported their case. GPs have always been focused on the core principles of patient-centred care - the doctor-patient relationship and the GP's role as gatekeeper, guide and advocate. It's a far cry from the staples of the private sector - competition, product development, marketing and profit.

But a fascinating new report from the Health Services Management Centre in Birmingham demonstrates just how much the lines are becoming blurred.

At first reading, it appears to be straightforwardly good news for general practice, with GPs at the helm of about nine in 10 winning APMS bids.

But the true picture is far more complex - for the vast majority of those contracts have been won not by general practice in its traditional form, but by GP-led private companies. Many of these companies were counted as belonging to the private sector in a previous Pulse investigation on the subject.

As Professor Chris Ham, lead author of the report, puts it: 'The categories we've used in the past are increasingly unhelpful.'

There is much to celebrate in the sight of GPs showing the entrepreneurial nous to set up companies and take on the private sector at its own game. GPs were once famously told to adapt or die by ministers, and adapt they have.

But not all of general practice is so enamoured by the latest developments, particularly as business-minded GPs have begun to win contracts for services sometimes hundreds of miles away from their own practice.

The concern over such arrangements - that patients will end up with a changing guard of salaried doctors - is much the same as when contracts are won by the big corporate providers.

The profession needs to work out what it thinks about this increasingly corporate approach and perhaps set some guidelines on what is considered appropriate. After all, GPC chair Dr Laurence Buckman said last week that the failure to employ new partners was the greatest threat facing general practice.

Surely the increasing reliance on salaried contracts is at least partly just a marker of a much more fundamental trend.

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