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GPs up against private firms in NHS sell-off of entire care pathways

By Ian Quinn

Exclusive: GPs are to be pitched into competition with private firms for the right to provide entire NHS care pathways, under Government-backed plans to put huge tranches of the health service out to tender, Pulse can reveal.

A pilot set to launch across the east of England has already involved talks with a series of private companies about a dramatic expansion in their NHS role, and is seen by the Department of Health as a model for the whole country. It follows Prime Minister David Cameron’s pledge last month to end the state’s monopoly in provision of public services.

The plans will hand private firms, GPs, or combinations of the two provider contracts for a fixed amount of money, creating an ‘incentive’ to increase profit margins by delivering cheaper care out of hospital.

But the proposals come as anger mounts over the potential for the NHS reforms to privatise and fragment the health service, and are also likely to generate fierce controversy over perceived conflicts of interest between GPs’ commissioner and provider roles.

NHS East of England will meet this week to discuss launching pilots of ‘integrated pathway hubs’ in up to six PCTs, with musculoskeletal, respiratory, and frail and elderly care the first three pathways lined up to go out to tender.

Dr Steven Laitner, a GP in St Albans and associate medical director at the SHA, said the plans could deliver ‘transformational change’ to the NHS.

Dr Laitner is shared decision making lead at QIPP Right Care, a Government-backed unit set up to spearhead the NHS’s £20bn savings drive. He told Pulse: ‘We’ve got support from the DH and are looking to test this model across the country.’

He said he envisaged contracts for clinical pathways being taken by multi-disciplinary teams involving GPs, specialists, third-sector organisations and private firms, adding that contracts would ‘align clinical and financial incentives’. Contracts would be more lucrative for GPs and private firms if they cut referrals, he added.

Dr Laitner downplayed fears of privatisation: ‘I’m very comfortable that we test the market. This is about providing an integrated service and if the private sector can do a better job that’s fine. But I’m not sure any private provider has all the disciplines that will be involved in running these pathways.’

Ms Parbinder Kaur, project lead for the hubs, said: ‘The push has come from GPs. They are open to the market coming in with new ideas.’

She said a string of meetings with GPs and private providers had shown both had ‘appetite’ for the idea, with the next stage a bidding process for contracts, which are due to go live in April 2012 to fit with the Government’s ambitious transition timetable: ‘It will involve a competitive tender. We expect this to involve a combination of third-sector, independent-sector and NHS providers.’

Ms Kaur said contracts would set clinical targets: ‘Quality targets are the priority, but if providers are given the entire budget they’ll have to manage that and if they over-refer they’ll bear the brunt financially.’

There have also been discussions about tackling the huge potential for conflict of interest. ‘There are going to be GPs commissioning and providing. We have to make sure we’re transparent,’ Ms Kaur added.

NHS Oldham is also looking to split care pathways among competing providers, starting in May. The PCT is to launch tenders for ophthalmology, sexual health and diabetes services in the next three months, and has awarded a contract to take on the entire budget for elective orthopaedic and rheumatology services to a private firm, Pennine Musculoskeletal Partnership. Dr Laitner said a national rollout would create ‘a distinct alternative to hospital specialist care’.

But Pulse has learned the GPC and RCGP are drawing up guidelines on conflict of interest, after leaders warned incentives could damage GPs’ reputations. Dr Nigel Watson, chair of the GPC’s commissioning and service development sub-committee, said: ‘You have to draw a line in the sand at any suggestion GPs could be rewarded at practice level for reducing referrals. It’s absolutely unethical.’

The DH said it would be interested to learn from the pilot, but claimed there were no plans to roll it out nationally.

Dr Steven Laitner