GP services could be compromised by new provisions enabling commercial companies to provide primary care through locally negotiated contracts, researchers warn.
A study, led by the Centre for International Public Health Policy at the University of Edinburgh, cautions that, as a result of changes to how contracts are drawn up, GPs are no longer bound to provide patients with integrated and comprehensive services.
The research, carried out in collaboration with the University of Glasgow and published in the British Medical Journal, focuses on changes made in 2003 to general medical services contracts, which open up GP provision to private companies across the UK.
It states that GPs have a reduced control over the range of services provided, with contractors - including the commercial sector - now responsible for providing services "appropriate to meet the reasonable needs of ... patients".
Professor Allyson Pollock, of the Centre for International Public Health Policy at the University of Edinburgh, said: "The threat, which comes from allowing GP services to be opened up to private companies, has been played down by governments in England, Scotland and Wales. Government argues that GP practices have always been small businesses. However, this argument overlooks the loss of strong public and professional controls and the commercialisation that has been introduced under the latest reforms.
"Under the new contracts the commercial sector has an enormous amount of flexibility to reduce and change the level of service provision. The concern is that when the commercial sector is providing services, profits and the needs of shareholders come before those of the patients. Research in the US shows that the commercialisation of health care is accompanied by loss of professional autonomy and reductions in standards and quality of care and access."
The researchers warn that nationally agreed frameworks for pay and conditions also may not be adhered to because commercial primary care providers have the freedom to manage financial risk by restructuring staff costs and thereby reduce levels and quality of provision.
In the UK, there are more than 30 commercial corporations now delivering GP services through commercial contracts.
Professor Pollock said: "The commercialisation of GP services will further erode fairness in the system. All of these changes amount to a loss of public accountability and government control and that is very worrying for the public and for patients. The legislation which introduced the new GP contract should be reviewed as a matter of urgency, especially in Scotland and Wales where health is devolved and where governments are choosing to eschew markets in health care."