NHS in Scotland relies heavily on private sector for delivery of care – Alison Payne in the Herald


There has been a great deal of debate in the referendum campaign about whether or not independence could protect the NHS in Scotland from the private sector, but it has ignored the fact that the majority of people’s first and, perhaps only, contact with the NHS in Scotland is through a private sector contractor – their GP.


Although GP practices can be run directly by the NHS boards in Scotland, the vast majority are private sector businesses operating under either locally or nationally negotiated contracts.    According to ISD Scotland’s list of GP practices as at 1 April 2014, only 4 per cent, or 42 out of 994 GP practices were classed as a “2C practice” – a practice which is run by an NHS board.  The other 96 per cent were private sector contractors.


Almost all funding for these GP practices is practice-based. Expenses such as rent, wages and utility bills are taken out of this funding pot and the amount remaining, after the cost of providing clinical services has been taken out, makes up the pay available to the GP partners. Of course, not all GPs are GP partners; some will be employed by a practice, where their employer is the private sector business, not the NHS; only the GPs employed by the four per cent of practices run by NHS boards are NHS employees.


Reform Scotland has no problem with private sector contractors, in this case GP Partners, being given public money to deliver public services, and, if structured properly, a diverse range of providers can help raise standards across the board.  However, that doesn’t mean there isn’t room for improvement, and we will be publishing a report this week looking at this issue.   For example, according to a Freedom of Information response we received from the Scottish Government, there are currently no obligations placed on GP practices to publish or provide their health board with a copy of their accounts.


I am not in any way accusing GP partners of misusing public money.  However, there should be transparency and accountability when it comes to the use of taxpayers’ money.  Therefore, Reform Scotland believes that any organisation that receives taxpayers’ money should have to publish annual accounts which are available to the public.


There are restrictions on who can be a GP partner. The Tobacco & Primary Medical Services (Scotland) Act 2009 requires all contracting partners to regularly perform or engage in the day-to-day provision of primary medical services.  As a result, commercial companies are prevented from entering into a contract with a health board.  However, just because there are restrictions on who can be a partner in a GP practice, does not make that practice less private, it is still a private sector business, contracting with the state to deliver a public service.   When the legislation was debated in committee, Labour MSP Rhoda Grant commented:


I do not see why one private is good and the other private is bad. I do not understand why one private contractor’s motivation is different from another’s. If you are talking about a commitment to the NHS, surely you should be using the bill to ensure that all GPs are directly employed by the NHS rather than by private contractors.”


Reform Scotland believes reform is needed of the health service in Scotland, regardless of the result of the referendum.  However, before debating where our health service should go next, we need to be aware of where it currently is and it currently relies heavily on the private sector for the delivery of care.  By arguing that independence will protect the NHS in Scotland from the private sector I am unclear whether the Yes campaign is arguing that GP practices should be nationalised and brought into the NHS in Scotland, something that could be done regardless of the outcome of the referendum.