The report by Norman Traub about the granting of a contract to a commercial organisation to provide a GP service in Southend was very reminiscent of a similar situation which arose in Scotland in late 2006.

Following the dissolution of a partnership in a GP practice in the village of Harthill, North Lanarkshire, to the north east of Glasgow, the relevant Health Board advertised the vacancy without excluding tenders from commercial parties.The legislation then, as now, provided for this, though in practice had seldom, if ever, been effected.This took place in an environment where health related issues were still sensitive following a vigorous and well-publicised campaign to retain Accident and Emergency services at Monklands Hospital. This had been faced with closure under the former coalition of Labour and Lib Dem in the previous administration. That decision was reversed when the SNP led government took over the reins.

(Ref.1).  An application was submitted by Serco in November 2006. It was noted that two former members of NHS Lanarkshire Health Board worked for that organisation at that time.A public meeting was held in January 2007 at which concern was expressed by local residents about the implications of introducing commercial interests to the provision of medical care in a GP setting.  Within days of the meeting a motion was lodged in the Scottish parliament calling for a review of the interpretation of the law relating to the tendering process.The same MSP subsequently asked if NHS Lanarkshire was entitled to exclude GP companies limited by shares, from the tendering process for providing GP services in Harthill.  After the tendering process had been completed, NHS Lanarkshire carried out a public vote which involved representatives from the protest group. The outcome was that the contract was awarded to two GPs, a conclusion which appears to have been welcomed by the local community.However the need to amend the legislation under The Primary Medical Services Act 2004 remains and this was raised with the Cabinet Secretary of Health and Wellbeing, Nicola Sturgeon, when delegates of the Scottish Health Campaigns Network met with her in 2008.A consultation document, Eligibility Criteria for Providers of Primary Medical Services was produced by the Scottish government and responses were invited by 17 December 2008.

( Ref.2)  The responses were published in March 2009

(Ref 3)The Scottish Health Campaigns Network was one of the organisations which, in principle, supported the recommendations contained within it.  Pollock et al, in their response noted that the proposals to control entry run contrary to competition law frameworks in the UK and EU and they were of the opinion that the proposed changes were unlikely to succeed.The same responders also noted that the commercial sector already operates in such spheres as long term care, pharmacy and dentistry, and questioned whether, in a commercial environment, companies involving GPs would adopt policies different from companies not involving practising GPs.The Cabinet Secretary for Health in the minority led Scottish government has clearly stated that her intention is not to extend the private sector within the NHS north of the border.We shall have to wait until parliament resumes before learning if the change to exclude the commercial sector from providing primary medical care within the NHS will pass into legislation.

Ref 1—Scotland’s National Health Service, A Review. NHSCA Newsletter Sept 2006, Dr Robert Cumming, Chair Scottish Health Campaigns Network.

Ref 2 -  Scottish Government Consultation on Changes to Eligibility for Providers of Primary Medical Services.

Ref 3 - Consultation Responses.

Malcolm Allan

Scottish Health Campaigns Network

16 August 2009