GP care facing 'franchise threat'

By Adam Brimelow
Health correspondent, BBC News

Dr VJ Abrol is among those opposed to the plans

Health bosses have provoked uproar among family doctors over plans to franchise out services along the lines of fast food outlets or estate agents.

The Heart of Birmingham Teaching Primary Care Trust is building 24 new surgeries to house over 70 GPs.

They have told the existing doctors unless they move into the buildings they will bring in the private sector.

Bosses said they could learn from the likes of supermarkets Tesco and Asda on improving customer service.

But doctors have accused them of arrogance and taking patients for fools.

I don't think my patients would feel these new premises to be as welcoming as my premises are Dr VJ Abrol

Most of the doctors are currently practising on their own and believe the current arrangements are more suitable.

Dr VJ Abrol, whose surgery is just round the corner from one of the new health centres due to open in February, said: "I don't think my patients would feel these new premises to be as welcoming as my premises are.

"This will be a crowded place. There'll be six, seven, eight doctors, and it'll be like a supermarket, whereas my place at the moment is like a corner shop, where the atmosphere is more personal."

Dr Abrol agrees that having a big new building to bring more providers under one roof may work well if you're selling groceries or T-shirts, but he says it is not right for providing medical care.

And he has received support from his own patients.

'Important lessons'

Louis McCollin, 55, a former firefighter, has been seeing doctor Abrol for the last 20 years.

"You go into a closed room, and you speak to your doctor, and you have a chat and you tell him what's wrong and he prescribes the treatment, and it's that personal touch that we need, and not going away from it."

Chris Williams, 58, a retired solicitor, agrees: "I think it's important to have a personal rapport with your doctor.

"He should be your friend, your confidant. And I think in a large environment it doesn't always follow that will be the norm."

However, the PCT thinks there are important lessons to learn from retailers like Tesco and Asda about raising standards for consumers, including a clean, smart front of house.

The trust believes the NHS could learn from the private sector

It wants to set up a business franchise on a similar model to fast food restaurants or convenience stores that would require doctors to provide agreed standards of service and access within big reliable organisations.

But the British Medical Association says the trust seems to have forgotten what general practice is all about.

Dr Laurence Buckman, chairman of the British Medical Association's GPs committee, said there were very good reasons why this has not been tried out before.

"Over the 600 years that there have been GPs no one has come up with this model, and people feel uncomfortable with it because they don't think it will work. And nobody has asked us whether we're prepared to work that way."

He said the BMA was also worried about private firms coming in to run the franchises, and putting shareholder before patients.

But this is much more than a local rumpus. It goes to the heart of efforts to get a lot of GPs to raise their game - a key priority for the government as it tries to develop more care out of hospitals, in community settings.

Specialist services

Trust chief executive Dr Sandy Bradbrook said this plan will allow GPs to do more for their patients.

"When people walk into the new centre they get all the right level of service and greetings. "They can see their own doctor because they're registered with that doctor.

"But they have access in those facilities, and their doctor has access to a wider range of services which might include mental health, other specialist services, diagnostic services, which is taking bloods, maybe taking x-rays, or ultrasound."

And he also insisted that he wants to see the surgeries up and running with local GPs in charge.

He said the trust had consulted local doctors and that some backed the idea, while others were undecided.

But if they don't go along with it, then outsiders will be brought in, and the success of the scheme ultimately will depend on where patients choose to visit their GP.