Privatising general practice is a scandal
From Dr JM Orchard, Alfreton, Derbyshire
As a GP in Derbyshire operating a 'normal' practice of 9,000 patients, but who has been, in addition, managing two other local practices with 9,000 patients for the past three years, I can give some insight into the scandalous privatisation of general practice.
When the nearby local practices were failing, doctors retired or left and could not be replaced. Patients swarmed to us in droves as the only open list to meet their needs. We realised our infrastructure was inadequate to cope, but the facilities they were leaving (surgeries, nurses, staff) could, if managed properly, meet demand.
My partners and I approached the PCT and were shocked to find the scale of underfunding which had caused these practices to fail. When doctors, nurses or staff left, the funding was withdrawn from these deprived areas. As the crisis deepened, the funding reduced until neither pracice was viable.
We merged the practices, reduced overheads and worked for nothing for two years to produce a practice achieving the national average quality points score.
Were we rewarded? No. We are told we are over-funded. In spite of offering specific services to meet local needs (family planning targeted at teenagers in an area of high teenage pregnancy, state of the art diabetes care) which should attract enhanced services payments, the PCT has no money to fund these services.
We can recruit high-quality doctors but keeping them requires increased investment.
So what of privatisation? The sole reason United Healthcare Europe has been awarded the contracts in Derby and Cresswell is because it is willing to operate these practices at a loss.
Local practices have to make a profit to pay staff and pensions and improve services.
I have seen the budget for the Cresswell surgery and it is at least £50,000 less than that of any comparable practice and yet it needs to improve. How can services improve without investment?
The cycle of deprivation and the inverse care law will continue unless investment follows need. United Healthcare will not want to fail and so will have to invest its own money in these loss leaders. It cannot do this for long.
As a business the plan is to undermine local practices that are part of communities and replace them with Tesco-like health shops one size fits all except even Tesco stores vary.
Compare the metal box in Alfreton with the aesthetic premises in Chesterfield. Do you want your health care delivered in a metal box?