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Benefits of opening up the primary care market in doubt

Government reforms to increase the choices available to patients and to stimulate competition between healthcare providers may result in underused capacity in some areas and difficulties in attracting new providers into others, warn experts in an article published on

There is also a risk that new providers may unintentionally destabilise existing practices delivering a high standard of care to patients if they are offered guaranteed funding for the provision of services, they add.

By the end of March every primary care trust (PCT) in England should have commissioned a new general practitioner-led health centre, write Jo Ellins and colleagues from the Health Services Management Centre in Birmingham.

Supporters of these reforms have argued that these "create a framework to challenge GP service delivery and encourage innovation in order to meet people's changing healthcare needs."

But opponents have expressed concerns about the dangers of "the aggressive commercial takeover of general practice and other NHS clinical services." Questions have also been raised about whether every PCT needs a new GP-led health centre.

The introduction of a national procurement programme has the potential to address health inequalities by increasing the number of primary care professionals in areas of unmet need, as well as broadening the range and availability of services provided closer to home, they write.

However, the extent to which equitable access can bring in new providers is also in doubt, especially in the current financial climate.

Spare capacity and instability may be necessary to create the conditions for choice and competition, but their consequences will need to be managed if the government's policies are to deliver real benefits for patients, they conclude.