Talk of a “corporate takeover” of family doctor surgeries by the private sector is so far unfounded, a leading health services researcher said on Wednesday.
Purely private sector operators are running just 10 of England’s 8,000 GP practices, despite the government’s desire to open up general practice to more competition, Chris Ham, professor of health services management at Birmingham university, said.
While existing family doctors are “mobilising to compete” for more than 250 new health centres that are out to tender, a small but growing number are doing so by forming consortia, or GP-led companies, that bring in private sector expertise to support their bids.
More than 550 providers have so far been shortlisted for just over 120 of the schemes, according to Department of Health figures. Purely private sector bids account for about 40 per cent of those. But another 13 per cent involve GPs in consortia with private providers – an arrangement that blurs the once clear distinction between traditional family doctors and the newer private sector entrants.
The high level of private sector interest has encouraged the health department. But bidders were complaining that some primary care trusts were trying to load too much risk on to the providers, Professor Ham said. As a result “some of the corporates are having second thoughts about pursuing these contracts”.
Some PCTs, he said, were being relatively generous in offering minimum income guarantees for health centres that were planned to be open 8am to 8pm seven days a week, taking walk-in patients as well as building a more traditional GP list.
Others, however, were saying that payments in the later years of the contracts should depend increasingly heavily on how many patients the centres attract. As a result, some of the bidders were saying, “we won’t continue in this game, because we are being asked to take too much risk”, Professor Ham said.
Dr Phillip Earnshaw, chief executive of One Medicare, a 50/50 consortia of GPs and a private sector investor, which runs six practices in Yorkshire and Derby, said that amid the credit crunch, bank lending for new projects remained difficult, and the contracts being offered by some primary care trusts “are a very risky business”.
Professor Ham said the new centres ran two opposite risks. First, that some might offer bidders good income guarantees but turn out to be under-used, and therefore poor value for money. And next, some GPs might take on risks that would lead to the projects failing.
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