'Running a practice may not be a huge money-spinner for commercial firms, but the rewards from a greater role in commissioning could be considerable'

The government's push to improve access to primary care is gathering pace. Discreetly, and even before this summer's arrival of the new ministerial team, the Department of Health has been working with nine primary care trusts to put GP services out to tender (see 'GP tendering could herald new era of competition for practices').

The focus is on areas with particularly weak GP provision such as Luton, East Lancashire and Hartlepool.

GPs, charities and private firms can all bid. Big commercial names are taking a look, with Care UK and Clinovia confirmed and others such as Boots and Virgin believed to be interested.

The sensitivity of the subject is plain from the response of the NHS Alliance; while the primary care-based organisation agrees a little competition for existing services would be a good thing, it fears 'white hot' competition - not a common occurrence in the health service - could be counterproductive. The tenders could be the 'tip of the iceberg' which future PCTs might abuse to 'put a bomb' under their GPs, it claimed.

While the alliance conjures up apocalyptic visions of exploding icebergs, the commercial firms are seeking to play down the size of the financial prize. Indeed, just running a practice may not be a huge money-spinner in their terms, but the rewards from a greater role in practice-based commissioning could be considerable.

Clearly there would be little to gain in using tenders to settle scores with established GPs. If there is one thing that has been subject to over-supply in the NHS in recent years it is confrontation. The idea is to end up with more and better services, not to drive existing providers out of business.

But all involved have to recognise that patients in the chosen areas - and many more besides - need more GPs and better access times. Widening access must be seen as progress, not a threat. This is not an issue between GPs and ministers, or GPs and PCTs, or GPs and the private sector; it is an issue between GPs and patients, and will not go away.