GPs are counting the cost of snubbing socially deprived areas
By Norma Beavers
The shortage of doctors in deprived areas is opening primary care to the private sector and paving the way to a very different health service, says Dr David Colin-Thome, National Clinical Director for Primary Care. Many GPs are still not prepared to work in deprived areas but will readily complain that the private sector is taking over their livelihood, Dr Colin-Thome told health managers at Primary Care 2007.
“There is the perennial problem of the number of GPs in socially deprived areas. Although we have more GPs than ever before in general practice the number working in deprived areas is staying the same. We need to encourage more GPs, more practices and other primary care to work in socially deprived areas and we are doing this through Alternative Provider Medical Services,” he said.
The controversial APMS policy is not just letting the private sector in but others as well, although there are limitations he said. For example, “we are not saying Acute Trusts can run a list based general practice because there would be a conflict of interest,” he explained. “But it could be private sector, it could be other practitioners as long as they can demonstrate proper management talent and can deliver a quality service.”
Dr Peter Smith, President, The National Association of Primary Care, agreed the problem has become worse in areas of deprivation. Dr Hamish Meldrum, Chairman, General Practitioners’ Committee of the British Medical Association, said GPs have only themselves to blame if general practice becomes overrun by the private and other third sector parties. Already United Health is attempting to take over two practices in Derbyshire and more recently Care UK has been contracted to run primary care services in Barking and Havering. Dr Meldrum added “and there are other examples of what might be viewed as the onward march of the private sector.” While this is “worrying” he said it is not “Disastrous, or the end of general practice as we know it but the answer lies in our own hands.”
Dr Meldrum said: “One of the main things you asked us to do when we embarked on the negotiations for the new contract was to control the ever-increasing workload and give GPs the power to say “no”. We can argue – and we will – just how successful we’ve been, particularly when we look at the shambles in some parts of the country over enhanced services. But, despite that, the new contract has given us the power to say “no”. However, if we can say “no”, then we can’t stop others saying “yes”, and the more we say “no”, the more politicians and managers will turn to others who will say “yes”.
“So we, as GPs, need to be the ones who continue to develop, to grow and to innovate, as we’ve always done. More than that, we need to enthuse and encourage the younger generation of GPs, so that they don’t just want to do the vitally important job of seeing patients but, in addition, seek to take on the roles and responsibilities that have given British general practice so much of its added value,” he stressed.
While APMS is one solution to the shortage of GPs in deprived areas, Dr Meldrum explained that there are risks attached “if it becomes too widespread.” These risks include bureaucracy of the market; vertical integration; privatisation of commissioning; a threat to traditional general practice and fragmentation of the service leading to a loss of “NHS ethos.”
It is too early to predict what is going to happen to general practice in the future, but Dr Meldrum told that while GPs shun certain areas there is the fear that APMS will attract “those that put the interests of their shareholders first.” The end result may be an environment featuring more salaried GPs and downward pressure on GP salaries.