Most GPs think of themselves as being part of the NHS, but officially they are classed as independent contractors. It is a status that dates back to the beginning of the NHS, and at the time suited both policy makers – who wanted to keep costs down, and GPs – who were and remain keen to maintain their independence from NHS management. Why does it matter?
Some commentators now use the status of the 36,000 GPs in the NHS to suggest that it nullifies concerns about creeping private sector involvement because general practitioners are effectively private contractors and have always been part of the makeup of the NHS, but missing from this analysis is an appreciation of motivation. Most GPs treat only NHS patients, work to NHS guidelines and uphold the principles of the NHS. They are not seeking a business advantage or profiteering.
Commercialisation has however crept in through policy changes to the GP contract and controversy has followed through a stream of instances where outsourcing to GP firms has affected standards, fairness and the reliability of services. The catalyst came in 2004 when a new form of GP contract allowed companies to bid for and run NHS GP services. The new APMS (alternative Medical Provider services) arrangement resulted in a number of companies buying up chains of GP practices, but as yet none has become dominant, or expanded significantly and several firms have since left the market including the largest player Virgin – who bought out Assura in 2012, and at that point 358 surgeries were listed as being part of these provider companies.
These commercially orientated APMS contracts currently only account for 3% of the overall number, although as the Lowdown revealed in February 2021 the sale of AT Medics that ran 37 GP practices across London to Operose, a subsidiary of the US health giant Centene, has introduced a huge new corporate player into the market and the suggested possibility of expansion and merger with other services.
Campaigners have reacted to the threat by organising a legal challenge in the High Court. Anjna Khurana an NHS patient and Islington councillor has agued through her legal representatives that there should be a Judicial Review of the sale as she was one of 375,000 patients across London who were not consulted about the takeover.
Key facts
27% of GPs are salaried employees of their practice
There are 36,000 full-time equivalent GPs (including trainees and locums)
The average number of patients per practice rose from 7,100 to 8,900 between 2014/15 and 2020/21 – the number of practices fell from 8,000 to 6,800.
3% of contracts are APMS (typically used to contract with companies)
A GP working in a practice serving the most deprived patients in 2019 was, on average, responsible for almost 10% more patients than a GP in the most affluent areas
General practice in England is under major strain. GP consultation numbers are now higher than before the pandemic but the number of permanent, fully qualified GPs has fallen since 2015. Current policies on general practice risk widening existing inequities
source: Health Foundation
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