Review

Avoiding the issues

PRIMARY HEALTH CARE AND THE PRIVATE SECTOR
Maureen Devlin
Radcliffe Medical Press, 1998, £15.00

In recent years it has become fashionable to talk in terms of ‘partnerships’ between the public and private sector, and this is certainly true of the health service. The current enthusiasm for renting new NHS hospitals from private sector landlords under the Private Finance Initiative is frequently presented in these terms. But the obvious fact that the desire to make a profit inevitably motivates private sector involvement in such partnerships is rarely discussed. It is particularly interesting, then, to come across a book which examines the ‘benefits and consequences’ of such involvement in primary care.

Unfortunately, this slim (68 pages of text) volume does little more than scratch the surface in a way which is so bland as to make one wonder if some issues are being deliberately avoided. There is the uncomfortable feel of corporate PR about it.

For example, the seven page chapter on the current structure and activity of the NHS is curiously titled ‘the UK health care market’. The ‘private sector’ is said to include the voluntary and informal sectors, but soon becomes the ‘independent sector’, and no attempt is made to distinguish for-profit and not-for-profit involvement in primary care, though the implications for primary care may be quite different.

Similarly, in a chapter of case studies of private sector involvement, it is claimed that these represent examples of ‘services that either could not be sourced by the NHS, or which can be provided more cost-effectively by the private company’. Yet no evidence is provided for this highly debatable assertion. Ironically, the first example is Healthcall, the medical deputising service which is currently facing strong competition from the NHS in the shape of GP co-ops and NHS Direct.

And the author? It turns out that she has been seconded from the pharmaceutical company GlaxoWellcome UK.