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PCTs urged to promote more switching of GP by patients

By Steve Nowottny

The NHS been advised by management consultants to ramp up competition between GPs by providing each patient with a choice of up to five local practices.

A briefing document by Ernst and Young, circulated to PCTs by Government policy body NHS Primary Care Contracting, concludes a high level of patient ‘churn' is essential to ensuring healthy competition.

One PCT chief executive argued that patients should be able to switch GP as frequently as their gas or broadband supplier.

The new advisory document comes a month after a series of SHA assessments of PCT commissioning skills found even those that had embraced APMS had failed to sufficiently open up the primary care market.

The Ernst and Young briefing, sent to all PCTs, argues ‘competitive tension' is key to ensuring quality, and sets out a series of ‘market management levers' trusts can use to encourage greater rivalry among providers in both primary and secondary care.

Patient switching, defined as ‘the ‘churn' in a market', is identified as a key indicator of competition, with switching of up to 60% in some markets described as ‘optimal'.

‘Switching provides the stimulus for providers to improve or maintain quality of service,' the guidance states.

PCTs should encourage competition even in areas where providers already offer high standards, it adds, with optimum switching occurring where there was a choice of between three and five local options: ‘Patients' rights to choose their provider may mean that intervention is needed in uncompetitive markets even if quality is high.'

Dr Sarah Crowther, chief executive of Harrow PCT, told policy makers at a Westminster Health Forum event: ‘The level of switching we see between practices is still very limited.

‘Our population changes its gas supplier or its broadband supplier more readily than its local GP. That has to be something we as a PCT try to promote.'

But Dr Fergus McCloghry, chair of Harrow LMC, reacted angrily to the comments, which he said would further reduce patients' continuity of care.

‘It's another attempt at undermining what's good about general practice,' he said.

‘There is no doubt if a patient's unhappy they should change, but not it's just a question of changing doctors for the sake of changing.

‘What you get from one doctor is not going to going to cost more or less than what you get from another doctor because you're not paying.'

Opening hours Ernst and Young guide for PCTs: Understanding healthcare markets

- PCTs need to define healthcare markets and consider the current state of competition – including market segmentation, geography and competition type


- Trusts should assess market dynamism – specifically looking at the number of providers offering choice, market concentration, proportion of patients switching and rivalry between providers


– PCTs should draw up market priorities and then deploy a range of market management levers, including publishing greater comparative information between providers, altering key performance indicators and where necessary decommissioning existing providers

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