New government proposals to drive primary care services even closer into the community could see business giants such as Virgin, Boots and Tesco opening up GP surgeries on the high street.
Health minister Sir Ara Darzi, who has been tasked with carrying out an “unprecedented” review of the National Health Service, is putting forward plans to ministers for a radical overhaul of the traditional GP system, allowing patients access to more flexible primary care services.
A spokesperson for the Department of Health told PharmaTimes UK News that potential private healthcare providers have been invited to attend a Primary Care Summit next month to discuss ways of improving access to GP services by placing surgeries closer to the workplace, gyms or shopping centres. It could mean that private providers just provide space, or that primary care trusts would commission new services through the Alternative Provider Medical Services contracting route.
APMS gives PCTs considerable discretion to develop different ways of improving primary care capacity and shaping service delivery, the spokesperson explained. It allows PCTs to contract with commercial, voluntary and mutual providers, and with current practices, to deliver high quality, value for money, patient centred primary care services.
"As the Secretary of State said in his speech to the New Policy Network last week, improvements to primary care is at the forefront of our quest to improve the health of the whole country,” the spokesman told PharmaTimes UK News. "On that basis, the Secretary of State has asked Lord Darzi to include in his interim report in October some concrete proposals on how we can make primary care services more accessible to people in their daily lives.
Radical expansion of services
Last month, the DH ordered health authorities to radically expand patients’ access to GP services – using private care if necessary. A letter by Mark Britnell, the Director of Commissioning for the Department of Health in England, told NHS organisations to make GP surgeries more consumer-oriented and to expand GP opening hours.
One of the key concerns with the current system is that GPs can opt out of out-of-hours care, making it more difficult for patients to make appointments on the weekends or after work. It is hoped that, by involving private companies which are not bound by the GP contract, more patients will be able to visit the doctor closer to where they work and at a time suitable to them, in line with the government’s mantra of improving patient choice. Furthermore, the move should help relieve some of the strain on GP services, many of which are already stretched to their limits.
Sir Ara stressed that many hospital A&E departments are bombarded with patients requiring services normally provided by the family doctor, and he warned: "The system will not be sustainable in the next decade if we don't have alternative models of out-of-hours," according to media reports.
Furthermore, the proposals could help tackle some of the health inequalities across the nation by making primary care services more accessible. “Northumberland and Wandsworth have more than twice as many doctors per head as Barking and Dagenham, or Oldham. Oxfordshire and the New Forest perform almost twice as well on the Quality Outcomes Framework as Bradford and Bromwich,” said Health Secretary Alan Johnson in a speech last week, highlighting the geographical differences in service provision. “The local GP practice is the principle gateway to the NHS: so, if the quantity, quality and accessibility of GP services are uneven, it is no wonder that health inequalities are prevalent.”
'Rigid and outdated' services
News of the government’s ideas came as the Confederation of British Industry – the UK’s leading employer’s organisation - slammed “rigid and outdated GP services” that are placing an “unnecessary burden on employees and businesses”. Independent research by Boots, it said, show that some 3.5 million working days are lost each year because of time spent at the doctor’s, which is more than four times as much as was lost last year to industrial action and cost the economy around £1 billion.
“Official figures show 10 million adults in England alone cannot book an appointment with a GP more than 48 hours in advance. It's time there was real and fundamental reform with the needs of the patient coming first,” said John Cridland, CBI’s deputy director-general.
And Alex Gourlay, managing director of Boots, said: "There is a real opportunity to offer wider access and greater choice in primary care to help people lead healthier lives and make better use of public finances.”
"Our experience in Poole, where there is a satellite surgery in the Boots pharmacy, is that patients have welcomed more convenient access to their GP. Only by working together as businesses, employers and health service professionals can we deliver a first-class health service for patients."
But the British Medical Association has opposed the changes. In an emailed statement, the group said: “The increasing amount of private sector involvement in the NHS will lead to fragmented care for patients and will adversely affect the well-liked and valued continuity of care that is so much an integral part of UK general practice.”