Can general practitioners compete with big business?

Editor—It is no surprise to see NHS general practice being eroded by big business.¹ Doctors advocate for all their patients; politicians (the “owners” of the NHS) have pressures that are often at odds with those of patients and therefore their doctors.

By seeking a system that reduces doctors' responsibility for patients to an employment contract (with minimum and maximum standards set by managers), politicians can have less hassle, perhaps at the expense of reduced patient care but without the electoral risk of providing for free an increasingly expensive product to an increasing number of clients within a limited budget.

In Scotland some years ago, a group of senior prison doctors attempted to bid for the contract to provide health services to Scottish prisoners but were thwarted by a tender process that seemed biased towards a single service provider with a commercial track record. During the run up to the process, proposals to set up a clinical partnership with an academic department of general practice to provide much needed clinical research into custodial medical care failed in the face of the plans to contract out to a “single service provider” by the Scottish Prison Service. From a professional clinical perspective the episode made no sense, but it became much easier to homogenise prisoner care and to downplay prisoner specific issues (such as transmission of hepatitis C) whose solutions might have been seen as controversial.

It is common practice for public bodies to have tender processes that favour big business over small businesses. “Risk reduction” is a term used to camouflage the bias away from professionally led services to easily managed services. In government terms, risk reduction often entails transferring risk away from politically sensitive bureaucratic bodies to patients (including prisoners) whose individual catastrophes are irrelevant to those who foot the bill.