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Your Practice 2010 - Time to size up the primary care market

GPs need to act if they are to slow the tide of private providers in primary care, writes Fiona Barr.

Last month the BMA's Annual Representatives Meeting called for private sector provision of NHS services to stop. But GPs' opposition is unlikely to deter private companies from bidding for primary care contracts.

Former GPC negotiator Dr Simon Fradd, who (with ex-GPC chairman Dr John Chisholm) set up the company Con- cordia Heath to offer general practice services, believes GPs should be under no illusions.

'This is not going to be confined to the under-doctored areas,' he says, predicting that alternative-provider medical services (APMS) contractors will also target the leafy shires.

Private sector push

There is no shortage of interest in NHS general practice. Firms like Sainsbury's and US-owned UnitedHealthcare are setting out their stalls in the marketplace alongside smaller firms with equally big plans.

ChilversMcCrea, set up by an NHS GP and a former nurse, has been quick off the mark.

It manages 18 general practices, some via the APMS mechanism. Concordia Health has similar aims, although Dr Fradd questions whether his company should be described as a private sector provider: 'We happen to have set ourselves up as a limited company, but we are providing NHS services and the patient doesn't pay.'

The key question is whether these services pose a threat to the NHS practitioners' livelihoods or to the NHS itself.

Tamara Powderley, a former PCT director, believes GPs are in a strong position. Her organisation TP Medical advises eight GP groups formed for practice-based commissioning (PBC) and to fight off the entrance of private sector players.

'GPs are positioned well to become active players in the market, ' she says, arguing that unless the government fully removes the ban on sale of goodwill, the market will not open up. GPs will remain the natural providers of primary care.

Drug companies are barred from providing GP services under Association of British Pharmaceutical Industry rules, but several are interested in entering the market by running long-term condition schemes.

Even if GPs are the 'natural providers', a worry remains: will private sector companies gain a foothold by offering contract bids that substantially undercut traditional GP partnerships? Will they then use commissioning budgets to boost profits?

GPs like Dr Prasad Rao in Stoke-on-Trent have been quick to counterattack by forming GP-led companies to win NHS contracts and sell their services.

Dr Rao has convinced 38 local practices to contribute an initial £5,000 share each, and the company is currently handling six 'firm enquiries' from practices where new teams of doctors will be needed as partners retire.

'We are not going to bid against local GPs if a practice wants to take on a neighbouring partnership. We are here to support,' he says. 'We have to grab this opportunity or see encroachment from private companies.'

Like Dr Rao, Manchester LMC secretary Dr Peter Fink practises in an area with large numbers of single-handed and two-partner practices of GPs nearing retirement. Localities like these are attractive to the private sector, and Dr Fink fears GPs cannot compete with commercial firms' experience in bidding for contracts and preparing business plans.

He points out that in one Manchester PCT, every vacancy is going out to tender.

APMS contracts

Long-standing GPC member, Newcastle GP Dr George Rae believes the BMA needs the stop the drift towards widespread use of APMS contracts outside under-doctored areas.

'In the north east of England, in general practice and secondary care there is delivery of excellent NHS care.' he says. 'It's imperative that we end unfair criticism of the NHS, and that we stem the tide now.'



Who they are:
High-street health and beauty retailer.
NHS contracts: None so far but in talks with Poole PCT to rent floorspace for consulting rooms for a range of NHS services.
What they say: A spokesman told The Guardian that the company was in talks with a range of PCTs about setting up diagnostic clinics, weekend emergency GP services and full GP services in its stores.


Who they are: Own 21 private hospitals and eight NHS treatment centres.
NHS contracts: None so far to run GP practices.
What they say: 'We are keen to find opportunities for using our expertise within the primary care arena, whether through formal tender processes, joint ventures or more informal local working arrangements, and we are exploring possible opportunities.'


Who they are: Owners of independent hospitals and 90 care homes; company also supplies out-of-hours services, works in prison health and runs independent-sector treatment centres (ISTCs).
NHS contracts: As well as the ISTCs, a five-year contract to provide a GP practice and walk-in centre in Greater London.
What they say: Group marketing director Geoff Benn: 'Our focus is on patient-centric care and we also offer a slightly different approach to administration and first-line diagnostic facilities, longer opening hours and a good understanding of the available technology.'

ChilversMcCrea Healthcare

Who they are: Run by GP Dr Rory McCrea and former nurse Sarah Chilvers, the company proposed corporate general practice to the DoH in 2002. It has also has formed a strategic alliance with Mercury Health Primary Care Ltd - part of the Tribal Group - 'a leading UK provider of consulting and professional support services'.
NHS contracts: 18 GP practices plus a walk-in centre.
What they say: 'We are dedicated to providing primary care management services that are uniquely relevant to client and user needs. Every part of our work is led by practising clinicians who understand exactly what help is needed.'

Concordia Health

Who they are: Company set up by former GPC negotiators Dr John Chisholm and Dr Simon Fradd.
NHS contracts: Primary care services at two London practices.
What they say: Dr Fradd: 'What we are offering is not fundamentally different, but we want to take advantage of everything on offer in terms of enhanced services, PBC, improved access and so on.'


Who they are: Set up by a pharmacist, the company has historically offered a range of services to practices including medicines management and long-term conditions management.
NHS contracts: Four practices in County Durham and Bedfordshire.
What they say: Website: 'IntraHealth Ltd is a well-established innovative company working exclusively in the NHS primary care environment. We contract with a range of NHS bodies including PMS and GMS GP practices.
'Through these contracts we have gained unique and extensive experience of delivering high-quality services.'


Who they are: UK supermarket giant interested in offering GP services in their stores.
NHS contracts: None.
What they say: 'We have responded positively to the government's interest in GP surgeries and we are also committed to working with them on delivering at least one GP surgery in store. We are currently looking for potential sites.'

UnitedHealth Europe
www.uhc.com  (US website)

Who they are: European subsidiary of US health giant UnitedHealthcare, aims to work exclusively with the NHS in the UK. Former BMJ editor Dr Richard Smith is its chief executive.
NHS contracts: Two practices in Derbyshire. The PCT's decision to award the contract to UnitedHealthcare was subject to a judicial review, and the judge ruled that the tendering process had been unfair.
What they say: 'United is interested in providing primary care services and is particularly focused on reducing health inequalities by improving primary care in deprived communities.'

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