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Letters to the Editor
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Primary care contracts
Break the doctors’ monopoly
From Mr Y. K. Tang, MRPharmS
I am amazed that the chairman of the British Medical Association’s
GPs Committee is advising his members to ignore primary care trust requests
for information on practice opening hours and appointments (HSJ,
14 February 2008).
GPs must be one of most blessed groups of private contractors on earth. Imagine
a car manufacturer having almost the entire UK car industry to itself; able
to dictate the price it is paid for products and the opening hours of its showrooms,
while blocking and sabotaging attempts by other manufacturers to enter the
market; receiving “incentives” to provide a high-quality and efficient
service, which it already has the exclusive right to provide; being given taxpayers’ money
to install a new computer system that is essential to provide its next-generation
products — all these while lecturing others that its main concern is
its customers, while it threatens to boycott attempts to “privatise” the
industry.
It is time GPs admitted that general medical practice needs serious “restructuring”.
Two models come to mind: UK community pharmacy and Australian general practice.
Both involve local commissioning by centrally appointed agencies and are excellent
examples of public-private partnerships.
Patient choice precipitates cost-efficiency and cost-effectiveness. Competition
is a powerful motivator, as customers vote with their feet. Having to register
with a practice is a major obstacle to health reform, as is the reluctance
to allow non-GPs to contract for general medical services.
The argument that GP-patient registration is one of the bedrocks of the UK
primary care system is flawed. Patients in Australia are not required to register
with a GP or practice. They carry a Medical Benefits Scheme (MBS) card and
can use it to see any GP. UK patients are not required to register with a community
pharmacy. Yet, most develop a long-term provider-patient relationship with
their pharmacists.
The UK general practice system no longer works. It is time people and politicians
admitted that GP practices are run as businesses and the most powerful stakeholders
are neither patients nor taxpayers.
Multiplicity of service provision means nothing if patients are not allowed
to exercise choice. A private enterprise that takes corporate social responsibility
seriously can provide as good a service as a GP practice. But would any politician
have the courage to take on the most powerful trade union in the NHS to introduce
reforms that are long overdue? And, would the public have the insight to support
those who do have that courage?
Jonathan Tang
Westcliff-on-Sea, Essex
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The
Pharmaceutical Journal