Does too much private competition damage primary care? The answer, according to Dutch GPs, is an unequivocal “ja!”
Some 90% of the country’s 7500 GPs went on a three day strike in May. Doctors are so incensed at Government plans to allow insurance companies to compete for patients that they tied their hands together in a huge line in protest.
The single basic health insurance package is due to be introduced in January 2006. It will mean that Dutch GPs will get a cut in the income they receive per patient, as well as losing 6% of their budget to the insurance companies. These private companies will then be free to set up their own minor surgery, on-call and chronic disease clinics, thereby depriving GPs of even more business.
The competition will drive prices down but the cheaper services will be largely nurse-led and doctors worry that standards will suffer.
Sound familiar? In the UK, 10% of the PCT budget will be set aside for “innovative private solutions” to the patchy provision of primary care.The money will be doled out under LIFT (local improvement finance trust) and ring-fenced – bad news for GPs in the many PCTs heavily in debt.
So will NHS GPs take mass industrial action against this privatisation of primary care? I suspect not. British doctors encompass such a broad spectrum of political opinion that 90% of us will never agree on a single cause and then be brave enough to strike.
I once dreamt that all the doctors in the NHS were picketing the Department of Health: “What do we want?”“We’re not sure!”“When do we want it?”“Whenever you tell us!”
Some of the more entrepreneurial GPs I’ve spoken to even relish the opportunities that private investment in the NHS can bring. They’re busy forming their own companies, buying up cottage hospitals and providing everything from routine surgery, outpatient clinics and full diagnostic facilities – all in direct competition with the DGH.
The theory is that in future, you’ll only go into hospital to have major surgery – everything else will be done in primary care.
Pragmatists and opportunists stand to make a killing from all the extra money in the NHS. As one GP told me: “I can’t understand why my colleagues say no to everything. In every other service industry, you make a living by saying yes.”He’s busy attracting private investment to build a load of super-surgeries at a much lower price that the average LIFT contract.
And as nurse-led out-of-hours goes pear shaped, the Times Online reports that 25 NHS GPs in Canterbury have formed ChaucerDoc, a private out-of-hours service which will charge patients £55 to see a doctor.
Medical manager of the new service Dr Peter Biggs put it: “We believe there is a demand for an out-of-hours, face-to-face GP consultation. In the future, to be guaranteed to be seen by a GP in this area out of hours, patients will need to pay.”1
So what are you going to do when primary care falls to pieces? Go on strike, retire or go private? It’s not a coincidence that practice led commissioning is PLC.