Primary care may need more radical reform, says The King's Fund report

Changes to family doctor services and health care commissioning have so far failed to generate sufficient improvements and more radical solutions should at least be considered, says a new report by The King's Fund, published today.

The report, The Future of Primary Care: Meeting the challenges of the new NHS market, considers the challenges and possible options for change in three main areas: increasing the quality of primary care; developing commissioning; and ensuring that primary and specialist care services work well together.

The King's Fund Chief Executive Niall Dickson said:

'We are seeing the rapid introduction of market incentives into the NHS as an attempt to improve hospital services but, until recently, primary care has not been given a similar focus. There has been a quiet revolution in contractual arrangements, opening up who is allowed to do what and introducing some targeted financial incentives, but this does not appear to have brought about significant change. Overall satisfaction with GPs remains very high but hospital referral rates and practice quality is variable, especially in some inner cities.

'Commissioning has also consistently been shown to be in need of strengthening, not least because the NHS is under considerable financial pressure and because we need a counterbalance to the pull from hospitals who have been given incentives that could encourage unnecessary admissions and treatments.

'This should not mean a cut throat market but it could mean encouraging new players to come in and provide services in the community, and primary care trusts could be encouraged to support and work in closer partnership with those who provide services, to monitor quality and efficiency and to hold them to account for the care and treatment they offer.'

The report considers a whole range of options for further reform in primary care and commissioning, looking at potential risks as well as benefits, including:

Increasing the quality of primary care

  • Trying to increase responsiveness by opening up the primary care 'market' to any appropriately qualified professionals (or organisation employing qualified professionals) who meet performance management and quality assurance standards
  • Greater powers for primary care trusts to remove the contracts of GP practices who are not delivering a good enough quality of care.

Strengthening commissioning

  • Introducing competition: between commissioning organisations for NHS-let contracts; between commissioning management organisations for contracts let by groups of GPs; between commissioners for patients.

Ensuring primary and specialist care services work well together

  • Developing a new type of group or network – akin to some of the US managed care organisations - made up of GPs and specialist doctors, sharing the same clinical priorities and financial incentives.

Speaking at a King's Fund breakfast debate on the future of primary care, report co-author and Senior Fellow in Primary Care Richard Lewis, said:

'Primary care has much to be proud of and is one of the most popular parts of the NHS but there is a need for reform if it is to keep up with patients' demands.

'With hospitals facing stronger incentives to take on more work, primary care has a vital role to play in managing demand for care in the emerging NHS market. However, there is a need to balance the notion of added competition between care providers, with the need for different professionals and organisations to collaborate with each other in order to provide patients with high quality care. Careful regulation will also be required if service quality, patient safety and equity are all to be maintained.'

Read the report: The Future of Primary Care: Meeting the challenges of the new NHS market

Notes to editors: 

  1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The Future of Primary Care: Meeting the challenges of the new NHS market by Dr Richard Lewis and Dr Jennifer Dixon is launched at a King's Fund breakfast debate on the future of primary care on Wednesday 16 November 2005. For embargoed copies of the report please contact the King's Fund press office.
  3. The report is part of the King's Fund work on NHS market futures. For more details on this work, including other papers and breakfast debates, please see the NHS market futures page on the King's Fund website.
  4. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.