The GP community was always divided about Andrew Lansley’s legislation. It’s flattering to be trusted with a £65bn commissioning budget and to be wooed by Cabinet ministers, yet many doctors smelled a rat.
Those who opposed the Health Act did so for various reasons, ranging from principled concern for NHS values to scepticism about the role of “commissioning support”. Many GPs simply prefer practising medicine to dabbling in management. Most at least acknowledge the harm that being at the sharp end of rationing might do to doctor-patient trust, and ultimately to the profession.
But GP practices weren’t themselves meant to be victims. Promises were given about the any qualified provider competition regime not stretching into primary care. Practice boundaries would be preserved. General practice had the British Medical Association to protect it. Besides, since 1948 GPs have become adept at straddling the boundary between the private and public sectors: independent contractors when necessary, bedrock of the NHS when it suits.
So this month’s report by Catalyst corporate finance, which suggests the private sector could deliver up to 20 per cent (that’s around £2bn) of England’s community health needs by 2020, has caused a stir. For Catalyst’s analysts also highlight the opportunity offered by an £8.3bn GP market, in which private providers - they mean multi-practice groups like The Practice and Virgin Care - only currently cover 2.2 per cent.
At its core the act was never about commissioning, but two strategic pan-government objectives: reducing government’s role in provision, and sharply reducing government’s role as an employer. The big outsourcing companies are happy to oblige. Virgin Care grabbed the £500m NHS Surrey contract in March - with, as we now know, the assistance of a local MP, one Jeremy Hunt - taking 2,500 NHS staff with them. Serco, meanwhile, took the £140m NHS Suffolk community health contract.
In the acute sector, Circle already has Hinchingbrooke, and that ambition to make foundation trusts the world’s largest social enterprise sector still stands. So why would primary care expect immunity? An £8.3bn income stream, coupled with hard-to-measure outputs, makes it a juicy enough prize.
Noel Plumridge is an independent consultant and former NHS finance director, firstname.lastname@example.org