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Monitor launches probe into attracting new providers to run GP practices

The NHS competition watchdog is to investigate how to make it easier for alternative ‘high quality’ providers to set up GP practices in areas of low quality care, reveals a report today.

The report from the competition and integration regulator Monitor says that it requires a ‘better understanding’ of what barriers there are currently that prevent practices from expanding and new providers entering the market.

The conclusions come despite the BMA’s submission to the review warning against putting competition ahead of continuity, while RCGP warned against any move to extend the use of ‘loss-leading’ APMS contracts.

The wide-ranging report identifies several priority areas for more research, after its ‘call for evidence’ on how it should act as a regulator of general practice.

Monitor will also map out supply and demand for GP services and embark on a mission to ensure that CCGs understand competition regulations and do not allow them to hinder local integration plans.

The regulator said it received 140 responses to the call for evidence, many of which came from patients, and has concluded its work should focus on efforts to reduce health inequalities, support self-care, move care out of acute settings, and provide coordinated care for older patients and those with long-term conditions.

As part of this drive, it said it wants to help existing high quality practices to expand, especially in areas with ‘currently low levels of access and/or quality’.

The document says: ‘What we have heard suggests that, as sector regulator, there is scope for Monitor to support these efforts in three principal ways.

‘First, by undertaking further research to gain a better understanding of variations in access to and quality of GP services and the factors which limit patients’ ability to make choices about their care.

‘Second, by doing further research to gain a better understanding of the factors that limit commissioners’ ability to enable high quality providers of GP services to invest in expanding their services, or for high quality potential providers to begin offering GP services, especially in areas with currently low levels of access and/or quality.’

Monitor’s senior policy adviser Paul Dinkin, who led the review, said that they would be looking at how to ensure that new providers were attracted to areas that were under-doctored.

He said: ‘One of the concerns that some commissioners have is if you did allow that to happen in a non-targeted way you… could end up with a situation where you have got GPs being attracted away from areas that are already under-doctored, or have fewer doctors per patient, into more attractive areas.’

But GPC deputy chair Dr Richard Vautrey warned: ‘There is no problem with expanding services if you have an expanding resource to be able to do that, but if you do that by taking away resource from other providers then you destabilise them and you end up with a worse situation that we have at the moment.’

He added: ‘[Expansion of existing GP practices] comes down to resources and a sense of stability that has been absent for the last 10 years. Practices will only make long-term investments if they are confident their investments are secure.’

Readers' comments (6)

  • Alternative Providers I assume means APMS contracts which only last for 5 years. Who is going to be prepared to make long term payback investments on short term contracts. APMS in Camden with United Health Europe and then The Practice.was disappointing to say the least.

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  • About time too. Hope they look at a procurement process that in reality excludes young enthusiastic GPs from bidding. They also need to look at ATOS' abject failure after 3 years of running a practice and the circumstances of their exit. The procurement needs to be on quality not price.

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  • Excludes young enthusiastic GPs?????

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  • APMS is and alternative contract NOT and alternative provider. An alternative provider will presumably be given a GMS contract the same as any other practice otherwise it would be deemed unfair and the purpose of Monitor is to make sure that everything is fair!

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  • At present if a practice fails, GPs are individually responsible for costs of closure including redundancies.
    It seems that private contractors may have been able to hand back contracts without incurring these costs.
    Would one idea be to level the anti-competetive advantages of private providers by allowing GP practices to acquire limited liability status?

    btw - is Monitor correct in saying that it is the sector regulator?
    ( ‘What we have heard suggests that, as sector regulator, there is scope for Monitor to support these efforts in three principal ways.)

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  • The key barrier - you don't pay enough. Done. Sort it.

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