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A faulty production line

GP leaders hit back over claims patients need better choice of GP practice

Exclusive GP leaders have hit back over a move to gather evidence on whether competition among practices is operating in the ‘best interests of patients’, claiming instead that more investment is needed to ensure patients have greater choice of services.

Pulse has learnt that both the BMA and the RCGP have submitted statements to Monitor emphasising that patients are generally satisified with their GP, and warning against any move to extend the use of ‘loss-leading’ APMS contracts.

They also both said that any extension of the pilots that abolished practice boundaries in some cities would destabilise practices and warned that the bureaucracy of Any Qualified Provider was reducing - rather than extending - choice.

The response was to a ‘exploratory exercise’ by the NHS competition and integration watchdog gathering evidence on whether patients are able to switch practices easily, whether they are open at convenient times and the rules for setting up/expanding a general practice.

The call for evidence cames after Monitor’s ‘Fair Playing Field’ review was unable to examine issues pertaining to general practice in detail.

The BMA said that although patient choice was important, patients valued continuity from GPs. It said: ‘Large numbers of existing providers in general practice would very much like to provide more extended services for their patients and take over some of the work provided in secondary care.

‘However, they are often unable to do this due to a lack of funding both for provision of care and investment in premises.’

It also argued that the bureaucracy and the uncertain income from providing services under AQP was also another factor reducing the choice of services that GPs could provide.

It said: ‘These contracts offer no guaranteed income, but pay providers retrospectively for services delivered. This clearly disadvantages smaller practices who may be less willing to risk investment of time and resources in qualifying as an AQP provider.’

The RCGP in its response said that increasing choice in general practice was a ‘meaningless’ exercise whilst there are still too few GPs.

The RCGP response said: ‘The primary challenge faced by general practice is workforce capacity. The Centre for Workforce Intelligence has concluded that “the existing GP workforce has insufficient capacity to meet current and expected patient needs”.  

‘In order for choice and competition to be meaningful it is necessary to have excess supply in the market; this is clearly not the case for many areas of general practice.’

It went on to warn against ‘loss-leading’ by allowing companies to set up short term APMS-contracted practices in which there may not be sustained investment for the long term.

Its submission, signed by honorary secretary Dr Amanda Howe, said: ‘We would strongly caution against the assumption that the challenges faced by general practice are caused by a lack of competition, or that the best lever to reduce perceived variability in access and/or quality would be an increase in competition.’

The RCGP further warned that GP practices would be destabilised by a removal of practice boundaries because it would be more difficult to plan to meet demand, which could especially be to the detriment of the most vulnerable patients.

Dr Howe said: ‘It is likely that a number of rural practices would become unsustainable, as they would face losing significant numbers of their patients - typically younger, healthier commuters - and would be left caring for a greater proportion of patients lacking mobility and/or with complex, long-term conditions.

‘This imbalance would rarely be viable in the long term and would thus ultimately reduce choice in rural communities, to the detriment of the most ill and vulnerable.’

It comes as Londonwide LMCs urged Monitor to consider a shift of resources and incentives away from hospitals towards better primary care.

In a statement, the LMC said: ‘The solution to much of the challenge to the NHS in supporting general practice in London clearly lies in redirecting investment both towards practices’ workforce, infrastructure and technology needs.’

It added: ‘CCGs need to work out what LESs are needed to support non-emergency issues including decent community, social and mental health services with a shift of resources and incentives away from hospitals towards better primary care.’

Readers' comments (8)

  • I totally disagree that "competition among practices" can ever be in the best interests of patients as I believe that one of the many strengths of primary care is the way practices work together to serve the community. Introduction of competition between them will destroy that relationship.

    However I do believe that general practice should be investing in itself to provide services as would any business. The formula for risk and reward exists in any industry and the less you have to lose the less effort you will put in.

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  • Competition was never in the interests of the patients but a falsity propagated to justify the Health act. The purpose of the Act was to add the NHS to 'UK Plc' and move large chunks of it into the hands of private sector orgs many of which employ MPs and Lords. AQP producing less choice is a scandal that needs to be really promoted. The supposed justifications for the legislation crumble each and every day.

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  • Peter Swinyard

    There is sadly an influential group of people inside No 10 who believe that "Choice" is the solution to all evils. It just ain't that simple. Choice might be valid if there were an excess of GPs competing for work.
    I have not noticed an excess of GPs available. Anywhere.

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  • I can see how the process would be difficult to manage and tend towards monopoly eventually. Already we are seeing that individual practices are struggling. Patients will want what they have always wanted: the support of the their GP's. They want empathy, compassion, and competence. Given what has been said elsewhere on this site about the potentially challenging relationships some GP's are having with supporting their patients with the DWP's processes I feel sure that some patients will welcome this move.
    GP's perceived attitude to their patients counts for a great deal. Give patients a choice and they will move away from practices which don't meet their needs, for whatever reason.

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  • >Given what has been said elsewhere on this site about the potentially challenging relationships some GP's are having with supporting their patients

    Unfortunately this doesn't work.

    These patients will gravitate to GP Practices that are willing to take on this non-contractual, unfunded work. The practices will sink - either financially or when the partners can't cope and burn out, meaning that the practice close and patients are left looking for other practices again.

    This is not the solution to the DWP problem, and as anyone who knows anything about GP this is a non-starter since for choice, you need extra capacity.

    There is none.

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  • Given that we are continuosly reminded on this site how cost effective and efficient primary care is then I cant see how any other provider is going to be able to compete with the current practices.

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  • Lack of capacity is certainly a huge problem in some parts of the country.
    The government has decided a lot more needs to be dealt with in and by Primary Care yet much of the money needed to support these aspirations is tied up in secondary care.
    Patients and local communities expect it to be that way. It will take a lot of persuasion for them to think that hospital closures are a good idea so GP's can have more money for example.
    I agree that patients moving around is not the solution to the 'DWP problem' but it is what patients will do, in the short term at least.
    The 'DWP problem' needs to be dealt with by the profession as whole, it needs to engage the government and patient/'claimant' groups and charities to find a way forward.
    This needs to happen soon before relationships break down through use of litigation.
    The actions of certain LMC's have political consequences that have the potential to be hugely damaging to the profession as a whole and that should be of concern to everyone. 'Perception is reality' and people act accordingly. It would be a shame if, through a lack of leadership, this issue damaged credibility and public support.

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  • The real problem is that there are too many fingers in the pie.

    GP's should be left to care for their patients as they think fit, without all the meddling from government.

    It is not that GP's don't care about the patients, in fact the very opposite is true, but the time they should be offering patients is taken up filling in bits of paper fro the government.
    Go into any hospital ward and ask a nurse why she isn't doing XYZ foe the patient, the reason will be paperwork.
    this government must get through quite few forests each week with the amount of rubbish they expect folk to write down, and probably never gets read!

    Why don't we allow GPs to do their job, which is caring for the sick?

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