In the UK, Large Corporations Awarded Contracts to Run GPs Surgeries

The British Medical Journal’s News section reported UnitedHealth Group’s latest foray into the British market [Arie S. Can GPs compete with big business? Brit Med J 2006; 332:1172-1173 ] (I write this in the hope that I am not misunderstanding any important aspect of the context in the UK.)

Apparently, in the UK, primary care trusts (PCTs) may contract with a variety of parties to provide primary care services in particular areas. Increasingly, these contracts are being awarded to for-profit corporations, some based outside the UK. For example, the article recounts the search for a new primary care provider for Langwith village in Derbyshire. A local general practitioner (GP), Dr Elizabeth Barrett, "proposed setting up a small team to run the Langwith surgery," Instead, the contract was awarded to United Health Europe (UHE), a "fledgling subsidiary" of UnitedHealth Group.

There are a number of reasons that "private healthcare companies are in the process of snapping up several other small surgeries around the country." One is that "PCTs are under huge pressure to find the cheapest solutions." Furthermore, some may see "large companies as providing stability, reducing risks and costs, and offering longer opening hours and more efficient and specialised services." Furthermore, the PCTs often set up complex bidding processes. So, "although GPs may have an inherent advantage over private firms because of their experience in primary care, the way the bidding process has changed, if you don’t have a masters degree in business administration you’ll struggle to cope with the paperwork." For example, "just to express interest, a bidder has to present its ‘vision’; submit a 16 page prequalification questionnaire; and provide a three year projection of cash flow, income, and expenditure." "Many NHS professionals do not know how to put together proposals that can compete with a large corporation."

It saddens me that the UK seems to be heading towards duplicating some of the mistakes made here in the US. The process used to select primary care providers seems to embody the notion that managers know more than doctors about health care promulgated by the early advocates of managed care in the US (see related post here). Why else would anyone think that skill at filling out complex bureaucratic applications is the most important attribute of a primary care provider?

Furthermore, some in the UK seem to think that the major characteristics of large, for-profit health care organizations, such as UnitedHealth Group, are stability, reduced costs, and more efficiency. Maybe they should be reading Health Care Renewal to find out some other things about such organizations. For example, we have recently posted about the lavish compensation afforded the CEO of UnitedHealth Group, in contrast with its stated mission to provide affordable and accessible care (see recent post here, with links to previous posts). UnitedHealth is currently under investigation by the US Securities and Exchange Commission (SEC) and a US federal grand jury because of questions about the timing of stock options given to the CEO. And UnitedHealth has been subject of a number of news reports showing how it has aroused the ire of physicians and patients alike (for example, see most recent posts here and here).

On the other hand, some in the UK are resisting repeating mistakes made in the USA. In its reporting about Langwith village, the BMJ noted "several local people in this traditionally staunchly Labour voting area are up in arms that the PCT wants to put their surgery into the hands of what this small, isolated, and deprived community sees as a foreign company. They say they will boycott the new practice if UHE is allowed to take over." A former miner said, "they think we’re daft. They always thought miners had no brains. What miners have is courage." Maybe they have both courage and brains.