Law change 'to harm GP services'

GP patient relationship is valued

Doctors have warned that a law change could damage patient services and undermine the new GP contract.

The British Medical Association (BMA) said young doctors would be prevented from getting a foothold in general practice.

The law change will lift the ban on selling goodwill - the value above the staff and premises, based on reputation - for some GP services.

The Department of Health dismissed the BMA's claims.

The core services of GPs, treating patients who are ill or believe themselves to be ill, will not be affected.

The law change will only apply to additional and enhanced services under the new GP contract, which comes into effect on 1 April. These include cervical screening, immunisations, minor surgery and clinics for dealing with violent patients.

This will encourage a fragmentation of primary care services and will mean young doctors may not be able to afford to take up partnerships in GP practices Dr John Chisholm

But the BMA's fear is that by removing the ban on the sale of goodwill, these services will become more attractive to private firms and less accessible to GPs because of the cost involved.

Young doctors starting out in medicine would face paying large sums of money to get into a practice which had a range of extra services on offer. Prices can already range from £100,000 upwards.

Dr John Chisholm, chairman of the BMA's GPs committee, said: "There has been a ban on the sale of goodwill in general practice since the NHS began in 1948. Family doctors don't want to trade in goodwill.

"This will encourage a fragmentation of primary care services and will mean young doctors may not be able to afford to take up partnerships in GP practices."

Resources

The new GP contract is supposed to bring more resources into general practice, help control workload and encourage more young doctors to become GPs.

Under the contract, individual doctors will be able to opt out of some services, such as evening and weekend cover, which will instead be provided by private firms.

Dr Chisholm added: "We recognise that if practices cannot provide a service then the NHS must make sure it is available locally so that patients are not disadvantaged.

"That is what we negotiated in the new contract. Introducing the sale of goodwill at this stage will, I believe, threaten the holistic nature of general practice."

However, the Department of Health said the law change would not alter the current situation and patient services would not be harmed.

A spokesman said: "All practices that provide services to a list of registered patients will continue to be banned from selling goodwill. We have always done this to control the cost of entry to general practice and this will not change."

Private firms

He said the change would affect private firms who run additional services. They are currently sub-contractors to GP surgeries, but under the new general practice arrangments will become contractors to primary care trusts.

The spokesman said: "From 1 April many healthcare providers who have traditionally been sub-contractors and able to sell goodwill will become contractors.

"As contractors traditionally cannot sell goodwill we need to change the current arrangements so that we don't unfairly deprive these providers of the goodwill that they have accrued."

The providers would not be able to sell goodwill when providing services to a list of registered patients, the spokesman said.

Dr Ron Singer, president of the Medical Practitioners Union, said he was writing to Health Secretary John Reid to warn him about the knock-on effects of fragmenting primary care and young doctors being "frozen out" of practice.

"This is a complex but important issue that the Government is now laying before Parliament before any public announcement or debate can take place.

"It signals the end of the part of the NHS that the public respects the most - its relationship with GPs and the integrated, holistic care that the public wants and the Government has pretended it supports."