Tony Blair seems to have given his blessing to the expansion of companies like Boots into the healthcare market. As ideological rows about the involvement of the private sector hot up, Jennifer Trueland asks what the high street could offer the NHS.

Tony Blair seems to have given his blessing to the expansion of companies like Boots into the healthcare market. As ideological rows about the involvement of the private sector hot up, Jennifer Trueland asks what the high street could offer the NHS.

It started, so it would seem, with a briefing.

Towards the end of July, it was let slip to several newspapers that Boots was planning to put GP services - and possibly hospital consultants as well - into its stores.

Negotiations were at an advanced stage, the stories went, with a practice expected to open in Poole primary care trust before the end of the year. In the same week, prime minister Tony Blair shared a stage with Boots chief executive Richard Baker to discuss the role of the private sector in social marketing.

And the chemist is not the only giant with an interest in the healthcare market. Sainsbury's has also announced its intention to open a GP practice, although the location and timescale is not yet decided.

So does this herald a new era of accessible healthcare, available (free at the point of delivery, of course) in handy city centre locations where local people already go? Or is it the first step for GP services to be provided by companies better known for shampoo and Jamie Oliver's favourite olive oil?

Both, believes NHS Confederation deputy director of policy Jo Webber. 'I think if you look at Commissioning a Patient-led NHS and the Our Health, Our Care, Our Say white paper, it's clear that other models of provision are probably going to happen. I'm sure there are many companies looking at this. And it wouldn't be a first foray for Boots - they've already provided things like podiatry and dentistry. And I'm sure supermarkets will be looking at it as well.'

A month after the original story broke, it appears Boots does not have plans to provide GP services itself - at least for the time being - and not in Dorset.

Indeed, Poole PCT director of planning and service improvement Richard Benson sounds a little weary when asked about any proposed deal. 'We can't really say a lot about it because we are negotiating a contract and then it will have to be approved by the board. But we're not talking about anything that radical. Boots would be the landlord for some NHS facilities; we'd be renting space off them. We're not talking about Boots providing services.'

At first glance, then, it would appear that no new ground is being broken. But philosophically it is a difficult issue. On the one hand, Boots is a major commercial operator. Any expansion into GP services will therefore be greeted with suspicion by those who do not want to see further privatisation of the NHS. It has already been a tough summer for some private providers of GP services. Last month, UnitedHealth Europe's hopes of taking over a Derbyshire practice were thwarted, at least for the time being, when the Appeal Court

said the local PCT had to start the tendering process again, a move welcomed by anti-privatisation campaigners.

People power

But these same people might well approve of attempts to bring health services and messages nearer to the people they serve. Boots is backed by impressive statistics. For example, 88 per cent of women go there at least once a fortnight, the organisation dispenses 100 million NHS prescriptions annually and each year its stores are visited 1 billion times. Surely that must include some hard-to-reach groups, such as young men, whom the NHS is desperate to attract.

But Boots head of financial media Donal McCabe emphasises that the company does not intend to provide GP services itself. 'We are not looking at employing GPs - we envisage that should any surgeries be in Boots stores, they would be provided by the NHS on a landlord/tenant basis.

'We are in discussions with PCTs all the time. Some of those discussions have touched on the PCTs providing doctors' surgeries or health services from space in some of our stores. We have not gone into any detail on where these discussions have been or what detail we are talking about.'

As for what Boots itself would get out of it, he says: 'We would get greater acknowledgment of Boots as the place to go for your healthcare needs. It naturally fits with the brand.'

He also argues that, with 1,400 stores, Boots is 'accessible and convenient'.

That is an argument which works, up to a point, for North Birmingham PCT chief executive Sophia Christie. 'Most PCTs are struggling with infrastructure - there's lots more we could be doing if only we had the space,' she says. 'Also, PCTs are asking themselves: ?Where do people go??. So it makes sense to talk to people like Boots and supermarkets.'

Her PCT already has deals with two Boots stores. The first hosts a walk-in, nurse-led primary care centre, while the PCT runs a smoking cessation clinic in another.

'It's a collaboration, no money changes hands,' says Ms Christie. 'We get the space and they get the profile, I suppose. And maybe if people want to stop smoking they might get their gum or whatever from Boots. It works both ways.'

The PCT also runs a smoking cessation clinic in a local Asda store. 'It's important to be where people are,' she says. 'Someone who might not go to their health centre for help to stop smoking might just pop in when they're in doing their shopping.'

Her area has no problem attracting GPs, she says, so would be unlikely to look to any private provider of GP services. 'In any case, speaking personally, I believe the independent contractor model of general practice has worked well for the NHS and you meddle with that at your peril,' she says. 'And I suppose you'd have the British Medical Association placarding at your gate as well.'

Yes indeed. While Dr Hamish Meldrum, chair of the BMA's GPs committee, is not preparing to man the barricades over the issue, he is not entirely happy.

'I don't think there's been the rush from private providers that some people predicted. And those who have been interested, such as UnitedHealth, have had their own problems. Where we'd have concerns would be if private providers cherry-picked some bits of general practice, which could lead to services being fragmented. That would mean losing one of the most valuable things about general practice - the continuity of looking after the whole person.'

Dr Meldrum also believes it would be difficult for private providers to make much of a profit from general practice, making it less likely that they would go down that route. 'GPs run efficient businesses,' he says. 'Money-making opportunities are limited.'

He has less of a problem with Boots renting out space to GPs. Indeed, his own three-practice health centre has pretty much done the opposite, by bringing a pharmacy on site. 'It means patients have a one-stop shop - they can come to see us then take their prescriptions to the pharmacy,' he says.

The Department of Health is clearly in favour of such moves, providing that any new facilities are in addition to, not instead of, existing services. 'We need to extend access to GP services, and use of the private sector, including supermarkets and chemists, is just one of the ways that this could be done,' says a DoH spokesman.

He adds that, in line with the recent white paper, the government will be 'looking with interest' at innovative ways to improve access and responsiveness.

At the moment, it would seem that the DoH, at any rate, is talking about involving primary care providers, be they private, NHS or third sector, in using space on the sites owned by big companies such as Boots or Tesco. But, under the government's own rules, there is nothing to stop Boots, or anyone else, being able to bid for an alternative provider medical services (APMS) contract.

So if they did, would primary care trusts be receptive?

Open to suggestions

Rotherham PCT chief executive John McIvor certainly has no ideological objection. 'We've not had any discussions with Boots about providing healthcare. But as a commissioner, I would look at alternative providers, as long as they met the same standards as the NHS and came in at the right price.

'We already have a partnership with the Weldricks chain of chemists to provide podiatry, physiotherapy and substance misuse services, and it works very well.'

Rotherham, like Birmingham, is a 'well-doctored' area, he says. But if it had difficulty recruiting, he would not have a problem with looking to other providers of GP services.

For social marketing too, Rotherham PCT, like others, already used pharmacies to put across health messages. 'These can be around safer sex or our latest big campaign is encouraging people not to waste prescription medicines by getting repeat prescriptions they don't need.'

Public services union Unison is less happy. 'The main duty of private companies is making profits for their shareholders,' says a spokeswoman. 'We can't blame them for that. But we can say that they shouldn't be involved in providing health services like this. What happens to the patients if a company sets up a GP practice then decides somewhere down the line that it's not commercially viable? In any case, most people would probably find that their existing GP practice is closer than their nearest Boots.'

Boots can take some comfort from Dr Meldrum, however, who believes that as a healthcare-based company it might be a better fit for the NHS than other high street names, including supermarkets. 'We've got to think of the messages we're sending out,' he says. 'I certainly don't want to see the Meldrum practice sponsored by McDonald's.'

Back in Poole, Mr Benson seems to agree. 'The PCT is responding to government calls for services to be closer to the populations they serve and so is looking for a city centre location. Renting is going to be cheaper than building something ourselves,' he says. 'But we could be talking about renting from any organisation, not just Boots.'

Even McDonalds? 'Maybe the board would have had something to say about that,' he concedes.

Boots expands chlamydia services

Boots has announced that from October it will offer£25 chlamydia tests at more than 1,000 of its pharmacies in England and Wales.

The move follows feedback from the free chlamydia testing service at Boots stores in London, which was launched last year as a two-year pilot for the DoH.

As well as tests, many of the stores will also offer treatment.

Boots director of Healthcare Alex Gourlay said the London pilot had shown a demand for tests from people beyond the 16-24 age group covered by the free scheme. A decision regarding national rollout of free tests for the 16-24s is expected in 2008.