GPs have always had an ambiguous position in the NHS. On the one hand, they are self-employed entrepreneurs, employing their own staff, owning their own premises and providing services for a fee, just like a solicitor or estate agent. Indeed, many GPs have diversified into owning private clinics, nursing homes and other businesses.
On the other hand, they are seen by patients as part of the NHS. They get a final salary pension just as NHS employees do, most of the services they provide are funded directly by primary care trusts through a nationally negotiated contract which GPs do not have to compete to get or keep, and once appointed it is almost impossible for PCTs to remove them. GPs have always been pretty hard-nosed about negotiating that contract with the Department of Health, and using it to maximise their income.
Will they be equally good at profiting from the NHS reforms? They could do so in four main ways:
• They will be paid to set up and run GP commissioning consortiums – a "management allowance" of about £55,000 per GP. This money could be spent on employing other people to do the work of the consortium, or they could pay their existing staff or themselves with this money.
• They will be paid a new "quality premium" for taking on commissioning, which the government says will be based on outcomes and efficiency. No one knows how much it will be, and GPs fear it will come out of existing income and will be intended to incentivise them to refer fewer patients to hospital.
• GPs could start to provide services which their own consortium commissions from them, often instead of patients having to go to an NHS trust or another provider. This already happens in services such as minor surgery but it could dramatically expand. For example, GPs who set up and own their own diagnostics centre could send patients there for ultrasounds and X-rays, instead of sending them to the local hospital.
• GPs in a consortium could set up a private company which they own, and then get the consortium to contract out the commissioning of healthcare to that company. If that company can make savings by spending less than it gets from the consortium, the surplus could then be distributed to the shareholders – the GPs – as profit. This is where the big money is: if they can save 5%, the surplus for redistribution would be about £140,000 per GP.
The NHS reforms envisage a much bigger role for the private sector in both commissioning and providing NHS-funded healthcare. Once NHS money flows out of public bodies such as PCTs and the new GP commissioning consortiums into the private sector, it's very hard to work out how it's being used and who is profiting from it. The Freedom of Information Act does not apply to private companies, the National Audit Office has no powers to require data from them, and past experience suggests that NHS bodies will claim that the details of contracts with private companies are commercially confidential. So we may never know who makes how much money from these reforms.
UPDATE: and just to show not all GP's are greedy, here's a post from one GP:
16 March 2011 12:50PM
I am a GP.
I think this is a well argued article that explains why the profession is split in two by these reforms. One group of GPs 'the Pathfinders' are the entrepreneurs who will set up limited companies to cream money off the NHS. The others like me simply aren't interested, because we have enough work to do just seeing patients, and regard ourselves as already well paid for what we do.