By Nick Triggle
Health reporter, BBC News
The GP market in England could become monopolised by private firms, doctors and campaigners fear.
Doctors fear the GP market may become monopolised by private firms
The first in an expected new wave of deals allowing firms to run GP services was signed in east London last week.
More contracts are also up for grabs, but doctors' leaders believe, if the process remains unchecked, a few firms could end up dominating GP care.
Opponents claim this will harm care but the government said private firms were filling gaps in under-doctored areas.
Barking and Dagenham PCT signed a £5m deal with Care UK, a private firm which runs hospitals and care homes, last week to provide GP services for more than 7,000 patients.
The deal was brokered by the Department of Health, which sees private firms as the answer to plugging gaps in areas which have traditionally struggled to recruit doctors.
Ministers are also encouraging other NHS staff and voluntary sector organisations to bid for contracts.
But Richard Vautrey, of the British Medical Association's GPs committee, said it was not a "level playing field" as the huge resources of big health firms gave them an advantage in the bidding process.
"My fear is that we are going to see the GP market go like the pharmacy industry has.
"Years ago, there were independent pharmacists on every high street.
"Now you are hard pushed to find ones other than Boots and Lloyds in some areas."
And he added that, unless local health bosses gave GPs help and training to bid for contracts, a similar change could be seen in the family doctor market.
Paul Evans, of the campaign group Keep Our NHS Public, agreed the traditional GP model was under threat.
"The danger is that once these firms are in place they will destabilise the local GP network.
"They may well compete for patients and discriminate against ones with the most complex needs."
Private involvement in primary care is not new, but to date it has been largely limited to organisations such as Chilvers McCrea, which was set up four years ago by an NHS nurse and doctor.
It now runs over 20 practices in a variety of places across the country.
But critics claim organisations such as these differ because they are run by former NHS staff and specialise in the primary care market.
A Department of Health spokesman said there was no limit for the number of practices being run by private firms, but a recent white paper had made clear that the idea was to focus on the minority of areas which were classed as under-doctored.