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Agenda:

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.

However, the debate has ignored the fact that the majority of people's first and, perhaps only, contact with the health service 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 Information Services Division (ISD) Scotland's list of GP practices (as at April 1 this year), only four per cent, or 42 out of 994 GP practices, are run by an NHS board. The remaining 96 per cent are private-sector contractors.

Surgeries receive practice-based funding, out of which comes rent, wages, utility bills and the cost of providing clinical services.

The surplus is distributed to the GP partners, as owners of the business.

Non-partner GPs are employed by the business, not by the NHS.

Reform Scotland has no problem with private-sector contractors.

Private-sector GP partnerships are being given public money to deliver public services.

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 have published 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 no obligations placed on GP practices to publish or provide their health board with a copy of their accounts, despite them being in receipt of public money.

We are not in any way accusing GP partners of misusing public money. There is no evidence to suggest this is the case.

However, there should be transparency and accountability when it comes to the use of taxpayers' money.

We believe that any organisation in receipt of taxpayers' money should have to publish annual accounts that 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, Rhoda Grant, Labour MSP for the Highlands and Islands, 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 forthcoming referendum on independence.

However, before debating where our health service should go next, we need to be aware of where it is at present. It relies heavily on the private sector for the delivery of care.

It is unclear in the present debate whether the Scottish Government is arguing that existing GP practices should be nationalised and brought into the NHS in Scotland in order to remove them from the private sector.

This could certainly be done regardless of the outcome of the referendum.

Contextual targeting label: 
Health

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