Last week, the government announced plans to let supermarkets and retail pharmacies provide GP services, particularly in underdoctored areas. Boots the Chemist welcomed this as "good news" but doctors raised concerns that this may be "a back door way of privatising the NHS."
A report in this week's British Medical Journal (Open all hours BMJ Volume 334 pp 668-9) asks: is "24/7 healthcare" really likely, and how real is the threat of backdoor privatisation?
It's understandable that GPs might fear this new face of primary care as a threat to their business, writes author and freelance journalist, Lynn Eaton. But so far no company has voiced any intention of being direct providers of primary care. If anything, they want to steer clear of it, insisting they are merely renting out empty space to others.
However, GPs cannot afford to be complacent, warns Michael Dixon, chair of the NHS Alliance. "It's a wake-up call for the profession," he says. "If supermarkets are going to open surgeries with longer hours, it's going to put pressure on GPs to open longer too."
The national clinical director for primary care, David Colin-Thome, believes that shifting GP surgeries into supermarkets is, potentially, a good idea, but stresses the need to keep the principles of good general practice.
The threat of backdoor privatisation of primary care is real enough, if you look at what has happened in social care in the last decade, writes Eaton. Voluntary sector organisations now sit alongside multinationals, while care homes are run by anyone from big companies, like BUPA, through to local entrepreneurs. What's to say primary care won't go the same way?
One flaw in the "backdoor privatisation" argument is that GP practices are already independent businesses, so maybe the real question is not whether primary care services will be privatised, but whether we might now see the corporate heavyweights – the chains and multinationals that grace our shopping centres – muscling in on the primary care act.
The supermarket model is a step too far for most doctors, but Michael Dixon does see change ahead, as primary care trusts try to provide patients with the longer opening hours and Saturday morning surgeries.
Mr Dixon warns: "There is pressure on GP practices to shape up. The government has tried the command and control method, but they can't do that because GPs are independent practitioners. The next thing was to bribe us – which was the new GP contract. The last thing is to create the big bad wolf of open competition, which is what we are beginning to see now."
To view the full paper, go to: http://press.psprings.co.uk/bmj/march/obs668.pdf