The biggest US healthcare company is preparing to take over two GP practices in poorer areas of Derbyshire in a deal set to become a template for the government to develop its plans for more competition.
The European division of United Health, a $28bn (£16bn) corporation based in Minneapolis, has been chosen from a field of 18 bidders as the "preferred provider" in inner-city Derby and Creswell, a former mining village.
The company's vice-president and head of European operations is Simon Stevens, the former senior health policy adviser to Tony Blair. The corporate giant's interest in bidding for an apparently minor local contract was based on common knowledge in the industry that Patricia Hewitt, the health secretary, is preparing to ask companies and social entrepreneurs to provide more choice for patients in under-doctored areas.
She set out her strategy to the cabinet yesterday, for a white paper on reforming the NHS outside hospitals, due for presentation to parliament later this month. It will include a commitment to enhance medical services in poorer areas that tend to have fewer GPs per head of population.
Ms Hewitt is understood to have told cabinet colleagues that she is determined to break the so-called inverse care law, the tendency for the poorest areas with the greatest health needs to have the fewest GPs. Ms Hewitt wants to correct this anomaly by making it worthwhile for new providers to enter the market.
She prepared the ground in July by announcing pilot schemes to help primary care trusts in London, Liverpool, Lancashire, Plymouth and Yorkshire open new facilities in the most under-doctored areas - offering consultations as early as 7am and with late surgeries open until 10pm. Contracts have not yet been awarded, but the white paper is expected to extend the scheme to tackle health inequalities nationwide.
The Derbyshire contract won by United Health foreshadows this approach. It was awarded by North Eastern Derbyshire primary care trust after a national tendering process that attracted 48 expressions of interest and 18 firm bids. Neither the PCT nor the company would reveal the value of the contract.
Richard Smith, chief executive of UnitedHealth Europe, said it hoped to extend the range of services locally, without the need to go into hospital. These could include diagnostic tests at the surgery, gyms, healthy food shops, information services and "step-up beds" for frail elderly people who might need a few days of care, but not the full services of an acute hospital.
Dr Smith said: "One of the reasons I am enthusiastic about this deal is that it is the reverse of cherry-picking. These are not the easiest areas to provide services, but among the hardest. Around the country there are lots of inner-city areas where general practice is falling over. The awful reality after more than 50 years of the NHS is that it has not been able to solve the inverse care law: the best general practice is in the areas that need it least. This is now the opportunity to set that right."
Ms Hewitt explained the philosophy of the white paper in a lecture to the NHS Confederation on Tuesday. She said: "A truly patient-led NHS will mean real differences for our friends and neighbours: the expectant mother who can make choices about pain relief and where she has her baby; the busy commuter who can get his checkup at the station before catching the train home; a retired mother who chooses to have her hip operation at a hospital near where her son lives so that he can look after her while she recovers."
Hamish Meldrum, chairman of the BMA's GPs' committee said last night: "We want to see patients getting good access to primary care, particularly in under-doctored areas. Equally we would want to ensure that ... bidding processes are not set up so that only large independent providers could compete. We don't have enough information to know whether that was the case in Derbyshire."
