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.’