Confidence in the government’s drive to open up the primary care arena to the private sector is running low, at least according to the results of a recent survey of practice managers in the UK.

Private sector involvement in healthcare services is a key aspect of the government’s healthcare reform, but the majority (68%) of 609 practice managers responding to the survey, conducted by Management in Practice, think the initiative poses “a serious threat to the quality of general practice and to patient care”.

Many voiced concerns that the initiative could leave the National Health Service with having to provide the more costly and unprofitable services while the private sector snaps up the most lucrative ones, and there were also worries that profits could be placed before patients in the new primary care environment.

There has certainly been a great deal of opposition to opening the door to private companies wishing to bid for the provision of healthcare services. Laurence Buckman, chairman of the British Medical Association’s GPs Committee, for one, has in the past slammed the government for “wasting time and energy on stimulating markets within the NHS and developing new practices rather than supporting existing ones”, and insists the focus should be on investing in improving existing services as opposed to establishing new ones.

But the government remains steadfast in its belief that introducing a more competitive element to primary care will help to boost the quality of the service. And to help allay fears over the effective commissioning of services, it was recently announced that the NHS will establish a new system that will give healthcare providers unprecedented power by allowing them to appeal against local decisions if they believe they have been treated unfairly.

The move is designed to ensure more rigorous evidence is used for commissioning decisions made by primary care trusts, and will enable small social enterprises, groups of GPs, as well as private firms to challenge such decisions if they feel it necessary.

PBC and QOF also under fire
Private sector involvement in the provision of healthcare was, however, not the only government initiative aimed at improving service delivery that was considered by practice managers in a rather unfavourable light. Nearly 65% of survey respondents said they felt practice-based commissioning - under which PCTs are given their own budgets to make local decisions on what to commission - had not yet had any effect on bettering patient care, while 93% said the Quality and Outcomes Framework - an annual incentive and reward scheme for GPs - had increased workloads, with nearly half believing it to have dampened morale.

But, somewhat surprisingly, despite these issues, 81% of practice managers said their current morale ranged from moderate to high, which is in stark contrast to the findings of a survey of over 11,000 GPs by the BMA last autumn, which found that one in six doctors is considering throwing the towel as morale in the sector continues to decline.