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Is choice crusade really what patients want?

If the Government continues to pursue competition in primary care, it will have to be prepared to explain the consequences to patients of letting the market hold sway.

If the Government continues to pursue competition in primary care, it will have to be prepared to explain the consequences to patients of letting the market hold sway.


Professor Allyson Pollock, in her book NHS plc, makes a number of key criticisms of the internal market within the health service. She claims introducing tendering processes will be hugely expensive.

She wonders whether private providers will be as committed to high-quality care as NHS staff. And she questions the rationale for choice and competition within the health service – pointing out that true choice can only occur if there is an excess of capacity.

A group of Norfolk GPs this week showed they understood the implications of that argument. Their co-operative is to run a GP-led health centre almost entirely as a walk-in service, to avoid it competing with, and destabilising, existing practices. It is an attractively collegiate approach and will probably provide local patients with exactly what they want – good quality care from a GP they know, supplemented by ease of access if they need it. Unfortunately, this approach is anathema to the Department of Health.

If there were hopes the DH might be easing off the gas in its drive to promote competition, that optimism was shattered this week. A new Government document sets out in brutal detail how PCTs will be expected to use a raft of new contractual measures to set practices against one another. GPs will be assessed on QOF scores, extended hours offered and patient surveys.

Performance will be rated on ‘balanced scorecards', and pay docked if GPs don't come up to scratch. Patients will be able to move practice at will in an effort to encourage a fluid transition between providers. And trusts will be urged to tender for a new wave of APMS services.

Hazardous policy

Pulse revealed in November that a new crusade on choice and competition was on its way, after PCTs admitted to performing abjectly against Government targets to ramp up the intensity of competition in general practice.

But even the DH admits the policy is not without its hazards. Its new document warns PCTs there is a danger new services could replicate those that already exist, ‘causing confusion for patients and exposing the PCT to paying twice'.

There are other dangers too in replicating the corporate marketplace. Capitalism requires not only that success is rewarded but also that failure is harshly punished, as recent economic events have made plain. If the Government insists on treading this path, it must willing to watch practices go to the wall – and see patients left without a local GP.

Ministers will also need to be prepared to explain how such an outcome is consistent with their mantra of patient choice.

editorial

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