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DH orders wide-ranging review into opening up GP services to competition



The Department of Health has ordered the NHS finance and competition regulator to launch a review into whether GPs are ‘operating in the best interest of patients’ and concerns about ‘a lack of choice’ of practices for patients.

Monitor will look at how a ‘fairer playing field’ can be achieved in general practice and why new services are not commissioned that are ‘against the wishes of existing local practices and LMCs’.

Monitor’s ‘A Fair Playing Field’ report, published yesterday, said there were ‘perceived conflicts of interest that may in future prevent clinical commissioning groups from commissioning services from new entrants’ and ‘concerns about a lack of choice of GPs for patients.’

The body will also review the rules for setting up a general practice and the different contractual terms that exist.

It said: ‘Monitor should issue a call for evidence by June 2013 to help determine the extent to which the commissioning and provision of general practice and associated services is operating in the best interests of patients.’

Today, the Department of Health, which initially commissioned Monitor’s review, confirmed that it has now asked the regulator to set up a review group in light of recommendations.

Health minister Lord Howe said: ‘We are committed to making sure that patients can access services delivered by the best possible providers. We are constantly working to improve the quality of care that patients receive and creating a fairer playing field will help to do this.’

But GPC deputy chair Dr Richard Vautrey rubbished claims as ‘complete nonsense’.

He said: ‘This is clearly being pushed by those that want to expand into general practice. But again, our experience in recent years has been that those larger corporates which have tried to do so have found that it is not as profitable as they were maybe led to believe.’

‘There is and has been opportunities for large companies to set themselves up through APMS contracts and they have not worked out in the way that they may have been envisaging, because the vast majority of patients don’t want to change GP. They are content with the service that they receive.’

He said that the GPC has repeatedly told the DH that the best way to widen patient choice is to invest general practices so they are able to hire more staff and expand services.

He added: ‘To suggest that an LMC could prevent PCTs or NHS England from establishing new practices in their area is simply nonsense. They don’t have that detail and they never had that detail.’

‘The idea that somehow these are cartels preventing things happening is complete nonsense.’

Asked whether the GPC would push to be part of the review group, Dr Vautrey said: ‘We would want to be engaged with anybody investigating general practice for whatever reason and we will be open to discussing that.’

It comes as critics including the GPC, the RCGP and the Labour Party launched an attack last month against the controversial Section 75 secondary legislation to the Health and Social Care Act, which seemed to recommend that CCGs run full competitive tenders in all procurement procedures.

What the review will look at

The extent to which the commissioning of general practice and associated services in particular is operating in the best interest of patients, including:

– The rules for setting up a general practice

– The different contractual terms under which practices operate

– The perceived reluctance of PCTs to commission new services against the wishes of existing local practices and LMCs

– Perceived conflicts of interest that may in future prevent CCGs from commissioning services from new entrants

– Concerns about a lack of choice of general practitioners for patients. 

Source: ‘A Fair Playing Field’ report, Monitor 2013

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