Abstract
Thomas Cowling’s et al. 1 excellent article showed that practice owned by corporate companies offer a worse patient experience. The reason for this cannot be private ownership itself, since general practitioner practices are also privately owned.
The worse experience is because general practitioners working in the corporate entities no longer have vested interest in the practice nor directly employ practice staff. General practitioners in these clinics are salaried. Many, if not most, general practitioners are now part-time and wish to avoid the burden of practice ownership and seek out salaried posts. Just one in ten trainees intends to work full time. The general practice accepted this trend by readily giving up key contractual obligations. It started with relinquishing the monopoly of primary care provision general practitioners had enjoyed by ceasing to be responsible for out-of-hours care. General practitioners gave up running the contracts for their computer systems. In Scotland, general practitioners may be handing over being responsible for their building contracts. The latter may result in Scottish doctors losing their self-employed status.
The challenge for the National Health Service is how it can maintain patient satisfaction while general practitioners go part-time with no other stake in their clinical practice. Perhaps general practice is past its sell-by date. General practitioners should move into hospital polyclinics and be salaried, finally completing the nationalisation of the Health Service. Patients seem to want to go to hospital anyway.