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Trouble in store over Boots plans

News that high-street giant Boots is planning to open up to 150 GP surgeries in its stores has left many GPs wondering what the surgery of the future may look like.

News that high-street giant Boots is planning to open up to 150 GP surgeries in its stores has left many GPs wondering what the surgery of the future may look like.

The chemist is planning to create 'destination health departments' in its stores, and even claims pharmacists could take on the vast majority of work traditionally handled by GPs.

But whereas some see the potential for a spanking new source of investment in GP premises, others are deeply worried about the threat from the private sector.

Boots's plans, on the back of what it says was a successful pilot of a GP surgery at a store in Dorset, were revealed in the same week as deadlines ran out for bidders for APMS contracts in four areas of the country – County Durham, Great Yarmouth and Waveney, Hartlepool and Nottingham – under the Government's provocatively named Fairness in Primary Care Procurement programme.

This process – and indeed the whole area of APMS – has already caused controversy with claims that big multinational private health companies will have a massive advantage over far smaller GP bidders.

But with more APMS tenders set to be rolled out this year, the prospect of high-street retailers getting involved whose financial muscle dwarfs that even of Boots is likely to tilt the balance even further.Supermarket titans Asda and Sainsbury are just two other companies pressing ahead with plans to launch GP services.

And although GPs may have been sceptical about Government claims to have brought about a £29bn facelift of the NHS estate, made in a report released last week, many are even more worried that future investment will require that surgeries end up located next to the fruit and veg aisle.

Some suspect the Government may see the likes of supermarkets as a perfect way not only of providing investment in premises but also of boosting provision of primary care out of core GP hours.Alex Gourlay, Boots's healthcare director, insists Boots sees itself merely as landlord – leasing out empty space in its stores to PCTs and GP surgeries, as it did in the Poole pilot.

'We're adding additional services on to have a full healthcare offer – the idea that people can come into Boots and whether they need to see a pharmacist or a GP they can,' he says.

Mr Gourlay, who claims that more than 66% of GPs' consultations could have been undertaken by a pharmacist, adds: 'If we work in partnership, GPs can see patients that really need to see them.'

But Dr Chaand Nagpaul, chair of the GPC's commissioning and service development subcommittee, warns Boots is just one of many private companies 'waiting in the wings' and that it is a small step for them to move from being a GP landlord to a GP employer.

Asda is planning to launch surgeries to offer GP consultations at unsociable hours, and is in talks with a number of PCTs. 'A lot of PCTs see supermarkets as being a good place to offer services as it's somewhere everyone has to go,' says a spokesperson.

Sainsbury's move
Sainsbury's is also seeking a GP partner to trial a surgery in a supermarket pilot, and Tesco has not ruled out a move.

Dr Elizabeth Barrett, a GP in Shirebrook, Derbyshire, hugely opposes such moves. 'Marketisation will lose us the NHS,' she says. 'I don't think the electorate has given its consent to this – it's being done by the back door.'

She believes 'faceless multinationals' could end up running primary care, leaving others unable to compete. 'It's stupid to think the bargaining power of huge multinationals is not greater than PCTs and that they can't run rings around them.'

But Dr Mark Nelms, a GP in the Carlisle House surgery that operates the Boots practice, says it gave room to expand, emphasising that the surgery is run as a satellite – patients need to be registered and have an appointment, so it is not a walk-in centre.

Moving 'lock, stock and barrel' into a Boots store would have been a different story, he adds. But Dr Stuart Saunders, a GP in Derbyshire who was set to move into shiny new premises as part of a Sainsbury's development two years ago – until the store pulled out at the 11th hour – warns that GPs could be 'left high and dry' in schemes with big private companies.

He believes companies will not be able to give GPs the security and reassurance they need to 'futureproof' their businesses.But GPC negotiator Dr Peter Holden believes there is nothing sinister about the likes of Boots entering the fray. 'I'm sorry but we are in a commercial world and if the only space for a surgery is on the second floor of a Boots then so be it.'

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