In an earlier post on this subject I praised the hospital staff for their care and consideration of me, and others, during a short stay. I also lamented the attitude which I experienced of some GP receptionist staff. Although the person about whom I complained was very rude and uncompromising, maybe there is a deeper concern, perhaps endemic, which could give rise to such an attitude.
Since hospital I need certain medical equipment to enable me to live a normal life. A specialist nurse advised me, and supplied an initial stock of the equipment, together with the details necessary for re-ordering. When the re-order was necessary my preferred supplier advised that the local GP reception had reduced the order by 75%, had refused to deal with them again, and made no arrangement to inform me! Once again, on enquiry I discovered that notwithstanding my changing need my GP surgery will deal with only one supplier and is dismissive of the others.
There are certain implications in all this. the most charitable is that their preference is for economic reasons. Since the surgery do not pay the supplier directly (the bills are paid by the NHS centrally) the economies, if any, have to be procedural. Dealing with only one supplier provides for less confusion among staff, fewer destinations for prescriptions etc., easier training and control and a stable system. They also may be better able to assist patients with queries about the supplier and to smooth the path to hitch-free supply.
Contrast this with an alternative scenario. How much disruption to the GP's system would the presence of a competitor supplier cause? True there would be the possibility of the wrong document being sent to the wrong supplier, but with electronic mail and the innovation of the Electronic Prescription Service (EPS) this is negated. A little more training of staff may be necessary, but only concerning document recognition. An alternative supplier may be cheaper for the NHS, surely a consideration, and if they are found unreliable in their dealing with patients or GPs they can always be replaced; is that the rub?
When I was in commerce one of my responsibilities as a manager was to deliver value for money. Our agents (other companies) were always under review, and they knew what was expected of them. If my company were not receiving the revenue expected, or the service agreed, meetings were arranged to thrash out any difficulties (on either side) and if matters continued to be less than satisfactory the agent was replaced. Why should that not happen in the NHS? I have no evidence to suggest that it doesn't other than the aggressive stance taken by the surgery and their operation of an apparent monopoly.Do they serve the best interests of the patient who ultimately pay their salary, the GP who directly employs them and has a tight budget to run, and the NHS which constantly tries to fit quarts of expenditure into pint pots of income? I'd like to think so but it should be transparent - it is MY NHS after all.
Competition is healthy for any business so long as it is fair, it forces prices down and service levels up. If a company is found wanting in any area the competition will eventually eliminate the laggard or force it to change. Monopolies on the other hand are incestuous, inflated, anti-improvement, and generally loss-making. Without profit there can be no new investment, no expansion to attract more staff, and probably no development. The company stagnates, becoming out-dated and fossilised, benefiting no-one. So the employees suffer, the patients too and the GPs and ultimately the NHS. Sound familiar? And all for the want of diversity.