The Heart of Birmingham PCT seems to be losing the plot, as demonstrated by its Corporate Franchising Strategy for primary care which draws heavily upon Kingsley Manning & Newchurch. (Available here)
A few contentious quotes from the document:
The concept of moving from the current structure of 76 separate practices within HoB towards 24 primary care units has been approved by the PEC and trust board as part of the modernisation strategy. This paper explores the mechanism that can enable this aggregation to take place as it is believed that this will lead to firmer and more solid base from which to deliver consistent high quality primary care.
The evidence for this claim would be welcome.
As it would for this claim:
According to Kingsley Manning the make-up of the profession is changing, with new entrants, predominantly women and young business- minded individuals seeking portfolio type working arrangements, who are less willing and able to take on a single-handed model or adopt the small business mentality required to run a GP partnership.
Has anyone asked these young women / business-minded individuals? What I hear from them is the dearth of partnerships being made available.
Medical graduates are more likely to be seeking a career than thinking about taking on the challenge of running their own businesses. Over the last couple of years, the Heart of Birmingham tPCT has consistently referred to a potential scenario whereby up to 30% of inner city GPs would be likely to retire within the short to medium term.
Another unsupported claim that is not borne out even by their own experience as admitted in the next paragraph.
However, to date, this hasn’t shown any signs of happening to this extent see figure 1 below.
It is thought that there will be fewer medical graduates and professionals willing to make the financial and personal commitment to replace current GPs on a ‘like for like’ basis – this would result in the continued operation of the current system and perpetuate the inherent disadvantages.
Again, backing up statements such as these with actual evidence would help. So why this urgency to act on something that people have been crying wolf about for a number of years & where there is little or no evidence of any actual change?
There is no discernible relationship between practice quality (as measured by number of QoF points obtained) and the spend per patient.
Hang on, since when was there agreement that QOF was the definitive measure of clinical quality?
There was no statistical difference in the QoF scores of those practices who scored between 50 - 75% and those with top scores of over 75%.
Further statistical analysis fails to identify any significant association between practice size and QoF score.
There is a wide variation in the patient satisfaction ratings of individual practices but if we look at average scores single handed GPs score higher than multi partner practices (76% v 68%).
So patients prefer the care provided by single-handed GPs & yet the proposal is to force them to franchise with Asda or Tesco. But as stated above, does QOF really define quality?
There is a growing interest in primary care as a future market from a number of non-health organisations who are convinced they can be effective and efficient suppliers of these services in terms of both quality and cost. Many of these organisations have well established and trusted brand names such as Virgin, Tesco and ASDA. These organisations are confident they can replicate the best aspects of the GP partnership’s relationship with its patients, as they do this with their own customers on a daily basis.
Of course they are. But as even the experience in the US where concierge medicine is on the upswing shows, patients value their relationship with their doctor, not an anonymous provider. Hmm, not to my knowledge the supermarkets don’t have nearly the same relationship.
Currently a number of local practices experience difficulties in attracting and retaining core skilled health professionals as a direct result of the perception that stability of employment can only be offered by larger organisations.
Unsupported statement again here. I have not known too many healthcare professionals express this sentiment.
However national surveys have demonstrated that despite criticism of access and services, the public on the whole still trust the NHS brand and see it as a guarantee of quality; reliability; security and that more specifically, the GP profession still has the continuing support of its patients.
Anyone stopped to think that maybe this will not be the case in the new model if the patient cannot trust the franchisee to behave in their best interests?
Someone needs to tell this lot that one of the defining characteristics of GPs is the value they place on their own independence. Most GPs I know left acute NHS trusts just to avoid the bureaucracy & wouldn’t go back to that model if they had a choice.
I have no problem with franchising as a business model & indeed have advocated its use in my own practice. There are a number of potential models of healthcare provision & it remains to be seen as to which provide the best outcomes. However leaps of fancy, circular arguments & a lack of understanding of primary care do not make for a sustainable policy.
Tags: PCT NHS primary care GP doctors franchise privatisation
The GPC seems het up about the Fairness in Primary Care procurement, with a dossier of evidence apparently being collected.
I have heard similar grumbling from Third Sector organisations & the claims of the DoH / CD that there is no bias in the procurement process start to sound a little hollow.