Trust being in short supply lately, GPs greeted last week’s apparent relaxation of the any qualified provider regime with scepticism.
Royal College of GPs chair Clare Gerada is unconvinced by the move. She argues that unless the Department of Health’s retreat on the policy finds its way into the Health Bill, it will soon be unpicked in the courts.
For there’s big money in any qualified provider, which requires commissioners to open specified, non-acute services to competition. It has powerful supporters.
Rather than combing the bill for privatisation plots, or viewing Circle’s acquisition of Hinchingbrooke Health Care Trust as the thin end of some wedge, NHS prophets of doom would do well to focus on non-acute services being opened to competition last autumn. In a tearing hurry, regardless of local circumstances or existing agreements. Why the urgency?
Viewed from a strictly commercial perspective, taking over NHS hospitals in the current trading environment appears deeply risky. The tariff is being squeezed. Growth prospects are laughable. Only problem hospitals are coming up for sale. And then there’s the kind of reputational damage that firms such as Tesco and Burger King are increasingly anxious to avoid after their encounters with unpopular government work experience schemes.
Non-acute care, by comparison, offers rich pickings. Relatively undeveloped ways of measuring performance. Billions up for grabs. Few serious competitors. Much lower levels of public recognition. And, following the fragmentation of last year’s transforming community services initiative, significant numbers of employees are no longer even part of the NHS.
In the absence of tariffs, primary care trusts have been scurrying to create suitable currencies. A nice irony, this. Back in 2004, payment by results was justified as the essential building block for competition. Now competition becomes the essential building block for extending the tariff.
“Competition,” says the DH, “should always be in the interests of patients, not an end in itself.” Maybe not, but it’s policy. And across the EU cutting public sector employment certainly appears an end in itself. Clinical commissioning groups may have their hands tied.
And GPs perhaps have another reason to be cautious. What exactly is the logic of exempting GP practices from competition?