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GPs buried under trusts' workload dump

PCTs reveal plans to expand private sector provision

By Gareth Iacobucci

PCTs are set to ratchet up their efforts to draft private providers into general practice under the Government's flagship World Class Commissioning scheme.

Trusts are failing against Government targets to intensify competition in primary care and are set to bring in new providers to ramp up capacity, documents seen by Pulse reveal.

Two SHAs – NHS South West and NHS South Central - have even employed accountancy firm AT Kearney and private health company BUPA health dialogue to support their plans to increase competition.

The moves mean suggestions by GP leaders that the ‘eye of the storm' may have passed on private provision could prove wide of the mark.

Trust self-assessments carried out under orders from the Department of Health reveal a sizeable proportion of PCTs rank themselves particularly poorly in having stimulated the primary care market to date, one of the key aims of the strategy.

Reports by PCTs suggest the APMS rollout to date is just the tip of the iceberg – even though every PCT is procuring at least one GP-led health centre and many more are procuring new practices in underdoctored areas.

PCTs are required to submit self-assessments of their ability to meet the Government's list of 10 commissioning competencies for WCC, before being judged by SHAs next month in the first major test of WCC.

Of 13 PCT self-assessments seen by Pulse, four trusts rated themselves a 1 - the lowest possible ranking for the specific indicator of stimulating the market.

No trusts ranked themselves above 2, with every PCT eventually expected to reach a 4 to demonstrate they have reached World Class status.

With all PCTs facing a grilling from SHAs, trusts currently lagging behind are already putting new measures in place to stimulate more competition for GP services.

Hounslow PCT, which said ‘GP practice quality is variable' in its area, was one trust to rank itself 1 on its ability to stimulate the market, despite tendering for a GP-led health centre and having procured six AMPS contracts in 2007 alone.

Bath and North East Somerset PCT said it wanted to ‘address one of our weaker competencies by providing us with a roadmap of commissioning interventions to achieve that vision'.

Hampshire PCT, said the development of ‘markets' in its locality was ‘far from complete'.

Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, said the indicator was an inappropriate way of raising commissioning standards.

‘An indicator that by definition will result in GPs fearing about surviving is a very questionable and unhelpful one that may generate the opposite of improving services.

‘I'm not surprised PCTs have scored low. I doubt this will improve, because we know that the private sector is shying away from the primary care market. It will be very difficult for this indicator to develop in the way that the Government will intend it.'

PCTs rush to increase competition

• All PCTs in South West SHA and South Central are currently being advised by accountancy firms AT Kearney and BUPA health dialogue on stimulating the market.
• Hounslow PCT, which says that ‘GP practice quality is variable' in its area, ranked itself 1 on its ability to stimulate the market. It said it was looking to use competition ‘to stimulate improved performance'.
• Worcestershire PCT, which also rated itself 1, admitted it currently had an ‘Inability to develop skills of commissioning staff particularly relational contracting, market management and procurement.'
• Western Cheshire PCT has produced a strategy document for increasing competition. It says: ‘We need to constantly challenge current service provision to understand where it could be possible to introduce new providers and where this will be effective for our population'.

Dr Chaand Nagpaul: plans will have GPs fearful for their future Dr Chaand Nagpaul: plans will have GPs fearful for their future

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