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Independents' Day

Fifth of GPs intend to work with other practices to win enhanced services contracts

Exclusive More than one in five GPs are planning to form alliances with other practices when enhanced service contracts are put out to competition, amid warnings that single practice bids are being overlooked when services are put out to tender.

A Pulse survey of 400 GPs reveals that only 8% of practices in areas that may put enhanced services out to competition intend to bid for those services alone.

Some 22% of them said they planned to bid in conjunction with other practices, and 24% said that they would not bid at all.

The survey reveals that practices are heeding warnings that they need to work together in alliances, former provider companies or more formal federations to preserve their practice funding.

A Pulse investigation last month revealed that commissioners are removing millions of pounds worth of enhanced services from practices and putting them out to tender, while one CCG – Newham, in east London – has told practices they must federate if they wish to continue providing the services.

The survey comes as procurement experts and prominent GPs warned that single practices were likely to lose out when enhanced services are put out to competition.

There has been a big push for practices to collaborate, with GP leaders, CCGs and think-tanks all calling on practices to merge, federate or form ‘super practices’. Former chair of the RCGP, Professor Clare Gerada, recently claimed that smaller and single-handed practices would be unable to survive for much longer unless they worked together.

Dr Phil Yates, a GP and chair of the GPCare provider organisation - a federation of 100 practices in Bristol - said the ‘unremitting workload’ faced by individual practices means they needed to work together.

He said: ‘I don’t think it will be possible for individual practices to bid for and win CCG-wide contracts. There’s a danger we will lose out to pharmaceutical companies and even supermarkets.’

Tendering consultant Janet Roberts, director of Tendering for Care, said GPs were already missing out. She cited a recent council tender for an alcohol misuse service LES, for which two practices bid. ‘Neither was successful. There were over 80 bids, two from international companies, three from national companies and one from a charity.

‘[The practices] did not know what is required to tender. Local authorities won’t take the risk with GP practices unless they can prove they can do the job.’

Dr Nigel Watson, chair of the GPC commissioning subcommittee and Wessex LMC, said that his practice in Hampshire had already federated with two others.

He said: ‘This enables us to have a single practice manager between the three and to some extent share premises and back-office functions. We’ve also formed a provider company across the whole of the New Forest with 17 practices. This is because CCGs want bids to cover whole localities.’

About the survey: Pulse launched this survey of readers on 21 January 2013, collating responses using the SurveyMonkey tool. The 28 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey.

As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. This question was answered by 369 GPs.

Readers' comments (4)

  • Vinci Ho

    (1) thanks to section 75!
    (2) there will be an enhanced service called 7 days opening with a ceiling of funding(of course!)
    (3)the number of GPs available to deliver these services is not going to increase proportionally ( but you can put a gun on the head of all these guys coming out from medical school and force them to do general practice, ha ha ha)

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  • This is like April fool stuff. On the one hand, we are running out of GPs and on the other, we are having to federate to survive as all manner of things are put out to tender.
    Either we are a NHS or we are private. If we have to start competing against other bidders and they take millions out of General Practice, it is time to think of leaving the NHS completely.
    GPC, you cannot have the flesh of General Practice and the fish of tendering and competing - we GPs simply do not have time in our day left over from looking after a list size that was probably OK for the Babbage at Bletchley, but impossible in this era.
    Seriously, we GPs must consider if with the introduction of competition in Practice whether we can continue to work in the NHS. I, for one, do not have the energy nor patience nor time to start competing after seeing 45 patients a day. I am leaving as soon as I can.

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  • Vinci Ho

    (1) Life goes in full circle. What it used to be GP Co-operative is just coming back. The difference is you have all these enhanced services floating around for you to catch plus the '7 days open' issue.
    (2) There is a difference between every GP practice open 7 days(obviously what politicians wish) and only one or two sites in the 'GP federation ' being open in out of hours. That is not something the public has understood.
    (3) Then it is the bidding process for enhanced services: to ensure that you , an AQP, will be selected in the final interview, you have to be big , really big in size with guaranteed financial stability . Thanks to section 75, CCGs are obliged to let everybody come in to bid . And you know the score , of course.
    (4) The irony is when you are big and have got 60+ local practices in the federation , many of you will have members sitting in CCG . There comes the conflict of interest . You know then those private companies will come after you! Isn't life interesting ?
    (5) Partnership of 4-5 is already difficult to ensure everyone gels together , a super-partnership is a high mountain to climb unless certain independence is still preserved.
    (6) Yes, you can have a federation controlled by a few partners(big brothers and sisters ) and otherwise all salaried doctors (many many of them) but are they really happy with the way they have been treated by bosses?
    (7) The government ultimately does not care and just want to squeeze every single drop of juice out of general practice . No New Money--as the report from Institute of Fiscal Study (IFS) states:
    After adjusting for the fact that the NHS will be looking after an increasing number of older patients in the years ahead, the IFS has predicted that spending per person will fall by 9% between 2010-11 and 2018-19.(BBC news)
    (7) Sadly , our obsession to ' get it right' is well used by the government as a bait to fulfil their political agenda. We will not know when to stop and say 'enough is enough'..............well , in fact , some are more than happy to do 'everything' to please the politicians........

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  • Vinci Ho

    Read what Lord Robert Francis QC said today in BBC news about financial pressure hampering care to improve
    He criticised what he saw as the "oppressive reactions" of the system to hospitals that ran into trouble with budgets and hitting targets.
    He said hospital leaders (hence all bureaucrats, my opinion)needed to be "frank" about whether they could provide high-quality care with current levels of funding.

    Most importantly ,
    "It is unacceptable to pretend that all can be provided to an acceptable standard when that is not true," he added. Ladies and gentleman , we are talking about honesty here!

    How is the government and hence NHSE going to respond to this?

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