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In September 2012, Mr Peter Wightman, Interim Director of Primary Care for NHS Cambridgeshire and NHS Peterborough, wrote to the registered patients of maple surgery, advising them of the ongoing process of selecting a new provider of medical services in Bar Hill and announcing a public meeting to be held in Bar Hill on 23 October 2012. Over 100 people turned up for the meeting where more details on the tendering process were explained, followed by a lengthy question and answer period. Answering questions were Dr Richard Spires, Mr Peter Wightman and Ms Susan Last.
NHS Cambridgeshire contracted the Acorn Surgery Partnership to provide primary healthcare services in Bar Hill following the retirement of the previous holders in early 2010. After a successful 18-month probationary period, the contract was extended for another 18 months. This contract will end on 5 April 2013 so NHS Cambridgeshire has begun a tendering process to select a healthcare provider to take over the provision of medical services in Bar Hill from that date.
This new contract will not be permanent but for a fixed term of five years with the possibility of extending it another two years. There are broadly two types of contracts between NHS Commissioners and GP practices:
Due to changes in legislation, Primary Care Trusts (and their successors, the National Commissioning Boards) are no longer able to offer this second type of contract. The current government wants more competition in the health care market; thus, the contract for the provision of healthcare services in Bar Hill will be subject to competitive tendering at regular intervals.
The call for bids has closed and four providers have made formal bids to take over primary healthcare in Bar Hill. The identities of the four bidders cannot be made public at this time; however, if the incumbent is among the four, it does not have an automatic advantage. For the practice size (about 3500 patients), four bidders is considered a good number. NHS Cambridgeshire is aware of the dangers of having large out-of-town companies coming in and swallowing up small surgeries. No one wants the Bar Hill surgery to become a very small and insignificant part of a much larger and distant organisation. However, very small practices pose their own problems. It has been shown that GPs stay professionally up-to-date better in larger practices, through regular interaction with their colleagues. In smaller practices, GPs can become isolated and out of touch with new developments.
The committee tasked with choosing the new provider will consist of a range of people, including healthcare professionals and patients. Two or three patients who are registered at the surgery will be chosen to represent patient interests. A total of seven or eight people in total will serve on the committee, with outside specialists (in areas such as IT) advising as necessary.
It is expected that the committee will meeting three or four times later this year or early in the new year. These meetings will last all day and NHS Cambridgeshire hopes to find a suitable venue in Bar Hill. However, if this is not possible, then patient representatives will have their travel expenses met.
The proceedings will be behind closed doors, with a decision hopefully by February. All representatives will have an equal voice; the process is more like a jury and rarely if ever comes down to voting. Previous cases have always thrown up a clear and unanimous winner.
Patient representatives will be trained and supported in their duties.
NHS Cambridgeshire has described in detail the services it expects the new provider to deliver. All surgeries are expected to see patients but other services, such as drawing blood for tests, performing cervical smear tests, etc., are extra. Bidders will be required to offer such extra services and not just the bare minimum. The next provider will be expected to deliver the same or higher level of service currently on offer at the maple surgery.
NHS Cambridgeshire has not put the specification of services in the public domain but that may yet happen. However, some basic questions each bidder has had to answer include
The spending per head is about as expected for the surgery. The main challenge is the relatively small size of the patient list.
There is no probationary period for the new provider. A GP will conduct a performance review every three months to make sure the provider is delivering a good service. The review contains approximately 20 measures of performance, including clinical performance. This is in contrast to the more traditional lifetime practices which do not undergo regular outside reviews. Thus, there is a much tighter audit of the surgeries operating under fixed-term contracts.
The minimum term is five years, with the opportunity to extend it another two years. However, if a breach of contract occurs, there is a staged process to address the problem, including withdrawal of the contract in the most severe instances.
Continuity of care is perhaps the most important issue for patients. Many people prefer to see 'their' doctor every time, particularly if they have long-term or complicated health issues which require repeat visits. Data on a computer monitor is no substitute for personal knowledge.
Short-term contracts make it difficult to attract and retain staff, and NHS Cambridgeshire recognises the problems the surgery is having in trying to recruit staff for such contracts. Partners are particularly difficult to attract. However, as most GPs are salaried and not partners, they can be retained at the surgery even if the management changes every five to seven years. Salaried GPs lead to stability whereas non-salaried locum doctors lead to instability. Even if the Acorn Partnership is not chosen to continue providing services in Bar Hill, it is entirely possible that some staff members will be staying on in their current roles.
The provider will be part of the clinical commissioning group that decides how money will be allocated locally to their various healthcare providers so Bar Hill should get its fair share. 'Expensive' patients (those with long-term, chronic or serious illnesses who make a lot of use of the healthcare system) cannot be taken off patient lists simply because they are ill. It is very difficult for a patient to be removed from a particular surgery's list.
All current services and clinics currently operating at the maple surgery will continue to be available as usual. Patients will be informed when a final decision on the new service provider is made.
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Last updated on 1 February 2013 by the Webmaster