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A regulator still looking for a job

You could be forgiven for a slight feeling of déjà vu when reading the report published today by ‘sector regulator’ Monitor into GP services.

Although it does a thorough job of covering most of the pressing issues in general practice – from the pressures of patient demand outstripping GP supply to the problems of crumbling practice premises – most of this has already been said before.

It has the feeling of a university dissertation. Covering most of the major issues and consulting lots of people on their views, but providing precious little insight into how they can be addressed.

It concludes that quality and access are lacking in some areas, but gives no insight into how those pressing problems can be fixed.

It says that the barriers preventing GPs to expand and new providers from establishing themselves should be researched, but it shies away from endorsing outright any plan to promote wider competition in the sector.

In fact, the 30-plus-page report almost completely avoids any concrete recommendations altogether, preferring rather to recommend that it carries out more research or supports others (most often NHS England) in their work. So what is the point in this document?

According to Monitor, the aim of this ‘call for evidence’ was to explore what role it may take as a sector regulator for general practice, a sector with which it has had limited contact to date.

But Monitor’s role is complex. While the CQC has a clear role setting essential standards for providers, and the GMC in ensuring doctors do their job, Monitor has the rather contradictory role of protecting both integration and competition.

And therein lies the problem. With its integration hat on, it refers to the risk of service fragmentation because CCGs have an overblown fear of getting caught up in a lawsuit for failing to address conflicts of interest. But rather than recommending any concrete changes to competition regulation, Monitor concludes it should rather ‘promote’ existing guidance.

Asked whether they thought they had unveiled anything new in their report, leading policy adviser Paul Dinkin seemed to admit that Monitor itself is quite confused by its dual role.

He told Pulse: ‘This was very much a scoping exercise for us to understand exactly what we could be doing and so I think that is exactly what it is. It is a question of saying “look, we have got some very wide-ranging duties relating to competition, related to integrated care, and our overall duty to promote the best interest of patients. Where does that leave us in relation to this part of the sector?”’

When it comes to general practice, it appears Monitor is still a regulator looking for a job to do.

 Sofia Lind is a senior reporter at Pulse