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At the heart of general practice since 1960

How to play the private sector game: advice from the experts

GPs James Kingsland, Rory McCrea, Nigel Watson and Elizabeth Barrett give advice on how to play the private sector game.

GPs James Kingsland, Rory McCrea, Nigel Watson and Elizabeth Barrett give advice on how to play the private sector game.



GPs need to sharpen up their act and involve patients in their care if they are to fend off competition from the private sector. That's the view of Dr James Kingsland.

Like it or not, general practice is a business. Quality of service is linked to organisation. Mistakes rarely result from poor clinical competence, but organisational chaos.

If general practice is to be fit for purpose in the 21st century, organisational development must be understood. Efficient practices need not fear competition and can minimise the private sector threat.

While today's practices are no longer monopoly providers, they do have years of experience and a history of implementing change. They have a significant start on new entrants to the market, not least because their customers expect services to be delivered by existing structures.

Embracing change

The principles of organisational development are not complex. GPs should consider the following:

• embracing fair employment practice, with incentives and opportunities for staff to develop

• managing estates efficiently, controlling overheads and expenses, and making full use of space whenever premises are open

• providing a responsive, accessible service based on local need and personalised care, understanding demand and how to shape it

• generating new income streams through efficient management of private income.

Practices should provide primary care teams with a mix of skills that deliver extended care for their community and work across organisational boundaries.

Patient representatives should be given a strong voice in practices, particularly when developing services. If services are of a high standard, patients will not need to move practice or choose an alternative provider.

Where general practice is not capable of the organisation outlined above, it should consider delivering clinical expertise in a different organisational vehicle.

Most practices are currently fit for purpose, but should seek to constantly evolve so they remain core to delivery of primary care.

Dr Kingsland is chair of the National Association of Primary Care and a GP in Wallasey, Merseyside

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If you can't beat the private sector, join it. Dr Rory McCrea, chair of ChilversMcCrea Healthcare, talks GPs through how to set up their own business.

Never before has there been such opportunity for developing business ideas.

The key to success is planning. Ask yourself what you are going to do, who wants it and will they pay for it? If they have paid for it once, will they continue to do so?

Share your plans with someone experienced in business, but ask them to sign a non-disclosure agreement. Most solicitors will be able to supply one.

Think about your customers – PCOs, usually, but also patients – and your competitors. Consider economic trends, seasonal fluctuations, legislation and Government initiatives.

And think about your marketing, including key features that will differentiate your service.

Think about specific opportunities. For instance, PBC might be an ideal chance to develop out-of-hospital care.

To bring your endeavour to life, you need research, development and delivery. Plan who will manage the venture, their skills and weaknesses.

Plan also for disruptions such as GP illness or problems getting theatre space.

Ownership is an important issue. You could be a company limited by shares, or by guarantee, a limited liability partnership or a social enterprise. A lot will depend on whether you want to develop value and sell your enterprise on, or reinvest profits.

Have a financial plan. Good accountancy and legal advice is costly, but should be part of your set-up investment. Getting funding without too much risk is important too.

A big issue is whether the legal vehicle you set up qualifies for the NHS pension scheme. Once again, advice – in this case from the NHS Pensions Agency – must be sought.

Dr McCrea is chair and joint founder of ChilversMcCrea Healthcare, the largest alternative provider of NHS primary care services in the UK

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APMS tenders throw GPs into a world of political intrigue in which keeping NHS managers happy is at least as important as medical skills. Dr Nigel Watson gives his thoughts on how to cope.

To compete with private providers, GPs must understand their business environment and how to get the most from it.

Profitable practices are usually ones that get on well with their PCT. So develop relationships with its management staff, avoid conflict and hostility at all costs and try to understand the PCT's priorities and how they fit with your practice's.

PCT priorities

The current priorities for most PCTs are extended opening, PBC, the 18-week referral-to-treatment target and moving work from hospitals to the community.

None of these can be achieved without significant clinical engagement. If you work constructively with a PCT on its agenda, it is likely to view any APMS bid you make sympathetically.

So far, GPs seem to have done quite well in APMS bids when they have formed their own companies but much less well when bidding by themselves.

But most tenders have been for small practices, where profit margins are not great. The private sector is far more interested in the new, large-scale practices and polyclinics.

Private sector bidders are often part of large organisations and are professionals – producing glossy brochures, slick presentations and promises that are unlikely to be fulfilled. How can a small organisation compete?

It is essential that GPs talk to the PCT and understand what is being asked for. Any proposals GPs make must be realistic.

Spotlight your unique selling point. Prove your bid is good value. Ensure everyone is aware of the high quality nature of your bid and never undersell yourself – because others will oversell themselves. If you do not have the expertise to carry a bid off, buy it in. Or bid jointly with a partner.

GPs want a level playing field on APMS, but do not get downhearted. The private sector does not believe there is a level playing field either. It thinks GPs have an unfair advantage.

Dr Watson is chair of the GPC commissioning and service development subcommittee

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Dr Elizabeth Barrett believes GPs must mobilise to fight the encroachment of the private sector, which she sees as a threat to the success of traditional general practice.

It is essential that GPs fight the private sector. The success of general practice is its ability to provide a long-term relationship between patient and GP.

Without it, health care becomes more expensive. Allowing global private companies to act as employing agencies is naive and reckless. GPs may not be able to play with the private sector and then have their ball back later.

In 2006, I led a campaign against my PCT's decision to award an APMS contract to UnitedHealth. Eventually the tender

was rerun. By remaining motivated and organising, GPs can make a difference.

I would advise GPs to do the following:

• Become more politically aware. If you want to be left alone to get on with your job, someone is going to take over the job of employing you to do just that.

• Be careful not to concentrate power into the hands of a few partners. This may make the profession vulnerable to takeover.

• Work with your PCT to improve patient care and address inequalities. You will find yourself influential if you identify the aims you share with the PCT.

• Develop your skills, including those in management and leadership.

• Develop strong working relationships with communities. Ultimately, they decide what happens to our surgeries.

• Stay infectiously cheerful and optimistic.

All countries struggle to run a health service within budget. The UK is not uniquely cursed. There are lots of options we could choose for running our NHS. Giving it away should never be one of them.

Dr Barrett is a GP near Chesterfield, Derbyshire, and is on Derbyshire County PCT's professional executive committee

Dr James Kingsland: "Like it or not, general practice is a business" Dr James Kingsland "The key to success is planning" Dr Rory McCrea: "The key to success is planning" "Profitable practices get on well with their PCT" Dr Nigel Watson: "Profitable practices get on well with their PCT" "GPs need to become more politically aware" Dr Elizabeth Barrett: "GPs need to become more politically aware"

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