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How do nurse practitioners lack expertise?

The latest NHS changes will force PCTs to contract services to hospitals and private firms, warn experts ­ by Ian Cameron

Government plans to bar PCTs from providing services will speed up private sector involvement in the NHS and could shift more power to hospitals, GPs and academics are warning.

Under the latest round of NHS changes revealed last month, ministers told PCTs they could provide services only where there was no alternative.

The decision means PCTs will have to put services such as out-of-hours care, health visiting, community hospitals, mental health and PCTMS practices out to tender.

Although GPs can bid to take over the services, acute trusts and private firms are most likely to do so.

Dr Mike Dixon, NHS Alliance chair and a GP in Cullompton, Devon, said the move posed a 'gigantic risk'

to GPs' influence within the NHS

If foundation or acute trusts moved into primary care, that could perpetuate the historic dominance of secondary care over the NHS, he said. More private sector involvement risked fragmenting care.

'This goes beyond filling in the potholes,' he said.

'If we don't start bidding others will and there are big dangers of others doing it. GPs' entrepreneurial will is there in pockets but as a general sweep it is not. We are in a position of great instability.'

Professor Allyson Pollock, chair of health policy at University College London, said allowing community services to be taken on by acute trusts or private firms would reduce GPs' role.

'The Government has no intention of allowing GPs to have power,' she said.

Those entrepreneurial GPs who took on services were Government 'pawns' used to distract from the fragmenting effects of having more private providers in the NHS, Professor Pollock added.

RCGP chair Dr Mayur Lakhani admitted he was concerned about waning GP influence. 'This is the next battleground,' he said.

'If practice-based commissioning is operating correctly I think GPs are in a strong position but they can't take anything for granted.

'I would dislike acute sector involvement in primary care and am concerned about fragmentation through more independent sector provision.'

Dr Hamish Meldrum, GPC chair, criticised the Government's 'dictatorial' decision to remove PCTs' provider status.

He said ministers had assured him they did not want 'vertical integration' with hospitals taking on primary care services.

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