The changing NHS
- 26 September 2012
- From the section Health
The coalition government's health service reforms have provoked huge controversy, particularly over the role of private companies.
The changes mean there are many new opportunities for businesses to bid for NHS work.
Ministers maintain this will mean better care and value for money.
But critics worry that private firms will put profits before the interests of patients.
Much of this debate has centred on the role of private hospitals treating NHS patients. But as the NHS in England opens up for business, there are new opportunities in primary care and community based services.
Virgin Care already has a strong presence in this field. The company has 25 GP partnerships across England, covering nearly three million patients.
The practice at Summerfield Health Centre in Birmingham has no obvious sign that it is part of Virgin Care. The branding is very much "NHS". It has managed to register 4,000 patients in a little over two years - well ahead of the company's initial projections.
Dr Neil Goulbourne, a GP and spokesman for Virgin Care, says patients are signing up because they like what is on offer.
"Because we're a national company we have the opportunity here to draw on the experience of a wide network of clinicians and managers so we learn lessons from around the country. I think by deploying that in this service - and it's the same throughout the country - we manage to provide something that is just so much better than what people are used to."
The company says its "secret weapon" is its token box system which allows patients to score the service at the practice, providing valuable feedback. Dr Goulbourne says the results compare very well with the NHS.
Patients we spoke to were complimentary, although one said she had been frustrated by a "mix up" over her prescriptions.
Critics say GPs working for private firms such as this one face unacceptable commercial pressures. Dr John Lister, from the campaign group Health Emergency, says it is bad for patients.
"There's bound to be divided loyalty there. There'll be the NHS logo outside, but there'll be the employer which is a private company. And the private company is not there for the good of our health. It's there in order to ensure that they make money at the end of the day. And the GP will be torn."
Dr Goulbourne says there is nothing new in GPs working for profits.
"Ordinary GP practices - the kind that many people have been registered with for many years, are profit-making businesses, so the income of the partners is the profit of the company. So I think within the NHS people are very used to the idea of individual providers making profit but nevertheless providing a very safe and high quality service."
Under the government's changes GP and community services are opening up for business as never before, with new opportunities to provide services, such as scans, physiotherapy, foot care, wheelchairs, and much else besides.
Healthcare analysts Laing and Buisson say the market for community services is worth £10bn, and that this could grow as more care is taken out of hospitals to be provided in community settings. They envisage 20% of this business going to private companies at a "conservative estimate".
Virgin Care says it is "really excited" about the opportunities to provide more care in more areas.
'Conflict of interests'
But John Lister is worried about a conflict of interests, as GPs take over responsibility for managing a large share of NHS budgets. He is worried that some will be able to buy in services from their own company, with an eye for profits, rather than patients' needs. He suspects private companies will use their GP partnerships as a "foot in the door" to the lucrative community services market.
"These big companies are also providing a range of other services across the NHS. And there will inevitably be pressure on GPs employed by these companies to refer to those services rather than necessarily taking a broader view of what other services might be available."
Dr Goulbourne insists that Virgin Care has taken steps to ensure this will not happen.
No-one knows how well private companies will fare in winning more health service work. Despite tight finances in the NHS, the commercial opportunities are potentially enormous. But opponents - who see this as a plan for privatisation - will fight the process every step of the way.