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From corner shop to Tesco metro?

Chris Ham
University of Birmingham

You can read Chris Ham's speech in several formats:

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Primary care is one of the strengths of the NHS and helps to explain the ability of the UK to offer universal and comprehensive services at a reasonable cost. Survey evidence shows that primary care is highly rated by the public and attracts less critical comment than other areas of the NHS. Why then is a debate developing about the future of primary care and the role that new providers might play?

There are two main reasons. First, public attitudes are changing with people expecting to exercise choice in most areas of their lives. In the case of the NHS, the government has responded by increasing the choices patients can exercise in secondary care. This includes the procurement of additional capacity from the independent sector. Similar developments are under consideration in primary care, building on the establishment of NHS Direct and walk in centres.

Second, the pattern of need in the population is changing, with chronic diseases being one of the most significant challenges now and in the future. Effective care for people with chronic diseases depends on high quality primary care, and this is available in many parts of the NHS. It also depends on practices having rapid access to diagnostic services and specialist support, something that is often lacking in the fragmented nature of medical practice and NHS organisation.

How then might primary care develop in the future? The outcome will be clearer when the government publishes the white paper it has promised on health care outside hospitals. It seems certain that NHS Direct and walk in centres will have a continuing role, and that practices as we know them will still be major providers of services. More speculatively, encouragement may be given to so-called ‘super surgeries’ that house a number of practices, perhaps co-located with outpatient and diagnostic services.

How might super surgeries develop? One route would be through existing practices extending their role by taking over neighbouring practices and forming local chains of primary care providers. A second route would be through NHS Foundation Trusts reaching out into primary care with a view to becoming vertically integrated providers. A third possibility would be for new market entrants to play a bigger part in primary care, analogous to the role of independent sector treatment centres in elective surgery.

The prospect this holds out is of primary care in some areas developing beyond the corner shop to become ‘Tesco metro’, offering a wider range of products to a more consistent standard. If this prospect becomes reality, the challenge will be to ensure that patients’ access to care is not compromised, and that the personal touch between patients and family doctors is not undermined.