What will the next 12 months bring for general practice? There are a series of themes that are likely to loom large for GPs in 2014 – increasing regulatory scrutiny, pressure to cut unplanned admissions, and a further squeeze on practice funding. But perhaps of greatest significance, 2014 looks set to be the year that GPs are thrust into the NHS market.
As we reveal in our investigation, after a year’s grace CCGs and local authorities have decided to put enhanced services worth millions of pounds out to tender from April, opening up as much as 15% of some practices’ income to private-sector competition.
Six months later the Government will abolish practice boundaries, dramatically increasing the potential for patients to exercise ‘choice’. And then there is Monitor’s ongoing investigation into primary care, as it strives to ensure a ‘fair playing field’ for all potential providers.
Many GPs harbour deep misgivings about whether competition can deliver both an improvement in quality and the required efficiency savings. The point about a market that offers genuine choice is that it implies spare capacity in the system – and spare capacity is in somewhat short supply at the moment.
Competition for competition’s sake will penalise GPs and result in reams of unnecessary, inefficient bureaucracy. LMC leaders talk of ‘300-page’ tender documents, while some CCG leaders believe the cost of the bidding process itself could outstrip any potential benefits. Commissioners must do better than simply throwing paperwork at would-be bidders and awarding the contract to whoever is best equipped – and resourced – to fight their way through the red tape.
Another worry is the potential for fragmentation of services, when all the talk is of the need for greater integration. And then there’s the question of transparency. There can be no justification for leaving taxpayers in the dark about how their money is spent, yet all-too often an expansion of the NHS market brings down the shutters of ‘commercial confidentiality’.
And yet, in the face of the well-rehearsed objections, ministers appear determined. Like it or not, competition is about to become a reality.
Our interview with Virgin Care’s Dr Neil Goulbourne, though, perhaps offers some hope from an unexpected quarter.
Virgin Care’s under-the-radar expansion into general practice represents a significant incursion by the private sector, and GPs will of course fear that the company may compete for enhanced services or exploit the end of practice boundaries to recruit a new breed of commuter patient.
But it is striking, too, just how much of what Virgin Care does, which a few years ago might have seemed alien and threatening, is now accepted as the norm. Most GPs do some form of extended hours, many are now grappling with online access, and some are exploring new ways of sharing administrative functions, albeit via federations. Most would balk at an all-salaried model or working for a private company of course – but general practice is changing fast.
GPs are right to be anxious about competition, and understandably apprehensive both of the hassle-factor and the significant financial implications. But they may be better prepared to play the NHS market than they realise.