The news that healthcare services in the NHS are being increasingly being funded by commercial companies has been a cause for concern for many in the country, for at least the last 10 years.
We noticed the first signs of change when a large number of polyclinics were built to provide NHS GP community services by private companies, and leased to the primary care trusts long-term at a cost of several million pounds.
Since the late 1970s, many local OOH services have been provided by local GPs through non-profit-making GP co-operatives which were entirely owned and run by their employees. I was privileged to set up Bolton Medical Services, the very first GP co-operative in the UK, in 1977. It replaced a commercial deputising service, which employed junior hospital doctors who did not know the patients. No wonder there was a lot of dissatisfaction among the doctors and the patients.
After the launch of our co-op, thousands of other GPs all over the country went on to found more than 300 GP co-ops, serving around 30 million patients. In fact, Harmoni was set up as a GP Co-operative too. Patients were happy in the knowledge that all doctors were local GPs who knew their patients.
The introduction of new GP contract in 2004 relieved GPs of the responsibility to plans out-of-hours care and took away the incentive to organise medical care after 7pm. This prompted some co-ops to diversify in order to generate revenue in the absence of funding from the PCTs.
In Bolton we transformed our co-op into Collaborative Medical Services in 2004 – and it is still entirely owned and run by local GPs to provide care for patients in Bolton, Wigan and Salford areas. Every GP in the area of our coverage was invited to buy shares and most people became shareholders.
By contrast, HARMONI diversified into a commercial company which would bid to win any contracts that were put to tender, to provide out-of-hours services in and beyond their local boundaries. It went on to win 12 other contracts as well as the new NHS 111 phone line.
The news that the company has now been sold to Care UK for a reported figure of £48 million and at least five GPs are set to become millionaires as a result has highlighted commercial nature of this transaction. It should cause concern to us all if this sets the trend for future out-of-hours care, driven by profit motivation rather than the desire to improve the quality of care to patients. In this kind of scenario patients become merely the instruments to drive up the profits.
One of the main concerns about the current NHS reforms is that private providers are able to walk in and win the tender to take over the services. But whilst may be adept at tenderingfor contracts, it must be remembered that their commitment to the service is conditioned by their profit motivation rather than service and personal care to the patients who by and large trust their own local GPs, rather than some locums parachuted from somewhere.
The best way forward is for the CCGs to encourage local GPs to form collaborative consortia, on the basis of co-ops – businesses wholly owned and run by the local GPs. They are best placed to triage patients and provide face-to-face consultations, and naturally relieve the pressure from inappropriate visits to A&E.
Dr Krishna Korlipara was the founder of the first GP co-operative, Bolton Medical Services, and is a retired GP from Bolton.