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Removing Restrictions on Numbers of General Practice Sugeries To Increase Competition

Comment 8th July 2010

At present the number of NHS general practitioners in any area is limited and controlled by the local PCT.  This regulation is liked by the PCT as it gives them more control and very popular with existing practices as it gives them a local monopoy to supply services.

This anti-competitive regulation gives existing practices an unhealthy level of protection and at best encourages complacency or at worst allows bad practice to continue unchallenged until there is need for a formal complaint.. The threat of another practice opening nearby would make practices much more responsive to patients opinions and needs.

The new regulations allowing parents the freedom to set up their own schools could be mirrored in general practice with groups of patients setting up and running practices with the services that they felt were needed in their area. Putting the patient in charge would revolutionise general practice and vastly improve levels of care. Patients are the best judge of the services they want and the doctors who treat them best.

As the new regulations for schools will awaken education, so new practices could lift general practice to much more patient centred services without extra costs.

The following are some examples of incidences where repeal of this regulation would have been much better for patients.

Suffolk.

In a small coastal town a doctor appointed an old college friend as a junior partner. This man was arrogant , had a rude off hand manner that upset patients but rarely justified a formal complaint. There was substantial unrest amongst the patients who tried to set up another doctor in an alternative sugery , but they were prevented by the PCT.

Eventually the doctor concerned refused to visit a child who later died of meningitis . He left the practice after this incident but patients remained upset as they had always realised he was uncaring and probably dangerous.

Hove

In a three doctor practice all the partners are male. Last year when the senior partner retired a large number of patients requested that a woman doctor be appointed. In spite of this a further man was appointed as the partners did not want the bother of a partner who might get pregnant. Had there been the possibility that a woman doctor or two could put up their plates in the locality and start a new practice they would have been very successful. Probably the threat alone woud have been enough to moderate the doctor centred behaviour of the two partners who appointed like for their own comfort.

Camden

A doctor in Camden reported her partners to the PCT for dishonest and dangerous practice. When the complaints went to the GMC one doctor was deemed in need of retraining and the other was suspended for more than two years. The doctor who complained was locked out of the practice by the two doctors at fault and prevented from practising. Patients were distraught at losing their much loved doctor and asked the PCT for permission to set her up in practice in the local muslim community centre. There was adequate funding and enormous patient enthusiasm for this project but the PCT refused and refuse to allow it.

Had the two faiing doctors had the threat that this doctor could open an opposing practice present then they would have modified their behaviour earlier as they were aware that they were not popular with patients.

Why does this matter?

General practice has become far less responsive to patients needs over the last decade. The target centred culture encouraged by the last government has not been good for patients.

Increasing competition would encourage doctors to do more visits, to tailor out of hours services to patient needs and to be more polite.

Patients are the best judges of their needs and their voice should be better heard.

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