General practices which fail to improve services for their local populations will be subject to competition from other primary care providers, the NHS czar for primary care has warned.

Remarks from Dr David Colin-Thome, a part-time GP and frontline moderniser for the Department of Health, signalled that accelerated change in primary care will be one of the top priorities for Labour in its third term in office.

Until now the government has only promoted competition between the NHS and the private sector in secondary care, but Dr Colin-Thome told an industry audience at a recent EyeforPharma conference that competition in primary care could soon become a reality.

Striking a no-nonsense tone, he warned that practices in areas of social deprivation that fail to live up to expectations, or those with closed patient lists would find their monopolies challenged, either by existing primary care practitioners or new providers.

"If they are that stressed perhaps they need a bit of help with some competition," he said.

The approach has emerged partly because of the failure of PCTs to bring about faster and more radical reform of services. He remarked on the tendency of some to become bogged down in paperwork, and become the new 'centrists' unable to bring about radical change and devolve power to the frontline.

The creation of 'super surgeries' which pool large numbers of GPs, nurses and primary care clinicians into purpose-built practices with diagnostic facilities are central to this vision, and the government is set to incentivise primary care staff to sign up to such schemes.

The first super surgeries have already arrived, and a new venture involving staff from 16 practices in Surrey is the latest to be launched.

Epsom Downs Integrated Services (EDIS) has just been awarded the contract by East Elmbridge and Mid-Surrey PCT to provide a range of health services, including many that were previously only available in hospitals.

Staff from the group have put £70,000 of their own funding into the project -  just the kind of 'entrepreneurial' spirit former Health Secretary John Reid had called for in order to energise staff and produce patient-centred services more rapidly.

But many in the health service are alarmed by the increasing use of the private sector in the NHS, and the speed with which the changes are being introduced.

The recent Queen's speech included a number of new NHS reforms, including a white paper on primary care, which may include measures to open general practice to the same level of competition hospitals are now facing, but is certain to focus on extended patient choice.

Commenting on the proposed legislation Dr Paul Miller, chairman of the BMA Consultants Committee, said: "Shorter waiting times for patients must be applauded, but the government's determination to push forward with plans for a market-driven NHS and further investment in the private sector is threatening to derail our health service."

He said the increasing reliance on the private sector would force NHS units to close because of unfair competition, claiming an orthopaedics unit in Southampton has become one of the first casualties.

"I would urge the Government to engage with doctors and the BMA as soon as possible so that we may work together to ensure the new market economy does not destabilise the NHS and risk its future existence," he concluded.

While the one-stop shop approach of super surgeries, which will encompass better chronic disease management is welcomed by many, others say the changes could spell the end of the traditional family doctor.

Speaking also as a practising GP, Dr Colin-Thome acknowledged concerns expressed by many of his colleagues about the shift towards much larger surgeries.

"My fear is that as we do more and more in primary care we could create impersonal primary care factories. We don want to throw away the baby with the bathwater of traditional general practice," he concluded.

Reforming the care pathways is one of the key tasks in practice-based commissioning, a process which the czar said the pharmaceutical industry could assist in.

Asked for more specific ways in which the industry should approach the NHS, he told Pharmafocus: "We don want to spoon-feed the industry, and tell them that this is what you must do. I simply want to tell them this is the primary care approach see what you can do within that framework."

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Tuesday , April 26, 2005

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