Privatising primary care.

The judicial review of the decision to award general practice services in Derby to an American corporation UnitedHealth Europe (UHE) goes to the heart of the corporate takeover of the NHS. Lawyers representing the Secretary of State told the judge that the contract to UHE was no different from replacing a retiring GP, a decision made hundreds of times a year. 1 But this careful choreography has failed to dispel growing anxieties about the aggressive commercial takeover of general practice and other NHS clinical services. There has been little discussion about the risks and costs of opening general practice to the market. When challenged, government replies that general practice has always been run as a business because GPs are independent contractors to the NHS. But there are crucial differences in the policy with serious implications for staff and patients. First, the 60-year–old arrangements where GPs contract directly with the Secretary of State to provide care has been dissolved. In its place are four new contracting options, each of which is between the government or local health commissioners and healthcare companies. GPs themselves will be under contract to companies or trusts, not the state. The alternative provider medical services (APMS) contract, the fourth route that marks off this reform from earlier revisions, allows commercial companies to hold the provider contract. 2 Second, each of the four new contracting routes and associated payment systems combine to end the open-ended commitment to provide care. Instead, primary care services are being broken up into saleable commodities under a process known in the world of privatisation as 'unbundling'. Unbundling limits the general medical service (GMS) contract to a core service that can be topped up with locally negotiated additional elements provided by large corporations. These new entry points and market opportunities for commercial providers are already being exploited for out-of-hours services and immunisation. In addition, under the privately financed investment programme known as LIFT (Local Improvement Finance Trust), primary care trusts (PCTs) can invite corporations to provide both primary care and clinical care currently provided in hospitals. For example, in Barking and Dagenham, Care UK, a company that doubled its profits last year running care homes and private hospitals, has an APMS contract linked to a LIFT scheme to provide new facilities for elective surgery which will be transferred from local NHS hospitals. Ministers want to shift at least 10% of the hospital budget to …