All new GP, Alternative Providers of Medical Services (APMS) contracts To be offered exclusively to Private Healthcare providers
NHS Contract Terminology
1. Personal Medical Services contracts (PMS)
Contracts are agreed between NHS England and GP practices, together with funding arrangements. In England, approximately 40 per cent of GP practices are on PMS contracts.
2. General Medical Services (GMS)
practice-based contract rewards practices for essential services, as well as additional services that practices can choose to offer.
3. Alternative Providers of Medical Services (APMS)
Under APMS, PCTs are able to contract for primary medical services with commercial providers, voluntary sector providers, mutual sector providers, social enterprises, public service bodies, GMS and PMS practices (through a separate APMS contract) and NHS Trusts and NHS Foundation Trusts.
Exclusive All new GP contracts will be opened up to bids from the private sector by NHS England in a move that GP leaders have warn marks the ‘death-knell’ of traditional life-long general practice. As a tide of practices face closure, because of competition law they will replaced with time-limited, (usually 5 year) APMS contracts instead. The move has taken GP leaders by surprise, with the GPC seeking urgent legal advice about the move. Some have warned it will lead to the privatisation of the NHS with surgeries replaced with ‘short-term, profit making ventures’.
The foregoing changes are now well under way in England. High street pharmacies will be increasingly offering a range of services previously the remit of GP’s. Computerised private patient records will be made available to contractors. GP service provision will be dismantled over a period of 5-10 years in favour of large Private Healthcare providers. The Scottish government recently restated that healthcare provision in Scotland will not be subject to such abuse, which favours profiteering by large private healthcare contractors. But in the event of a, “No” vote the English NHS model in all respects will be imposed, (by stealth) on Scotland. Scot’s who wish to retain the existing Scottish NHS should vote, “Yes” in the referendum.
A few views from senior NHS medical staff
An NHS England spokesperson said: ‘Under the GMS regulations there is scope to enter into a temporary contract but this is AT CLEAR ODDS WITH PROCUREMENT LAW and the 2013 regulations so best practice would dictate that this should not be used when APMS effectively does the same job and does not come with the same risks attached. “GMS can still be entered into upon reversion from PMS and the new form of PMS contract may be entered into by way of renegotiation (ie variation) but in respect of procurements, yes they should all be on APMS.”
GP leaders are warning that, with practices under increasing workload and financial pressure, strict tender requirements could exclude smaller practices from primary care and drive the invasion of private providers and they are advising practices to seek alternatives to contract termination, for example by merging, when partners reach retirement in order to avoid losing, “invaluable” GMS and PMS contracts.
GPC chair Dr Chaand Nagpaul said he was surprised to hear about the national policy that would, “spell the death knell of the whole ethos of long-term, continuity of care in the way general practice operates”. He said the GPC was seeking urgent legal advice on whether NHS England was correct in asserting that APMS contracts were the only way to satisfy international procurement law. He added: “It’s extremely unfortunate, and highly ill-advised that area teams should be undermining secure, long-term sustained provision of general practice through APMS contracts. There is nothing to stop an area team choosing to use a PMS or GMS as a contract, on the grounds that it offers a local population the best mechanism for the provision of general practice services.”
Dr Tony Grewal, Medical Director at Londonwide LMCs said they were worried about the moves in the capital that would replace family doctors with, “short-term, profit making ventures that went against the ethos of primary care”. He added: “APMS is only for five years, potentially renewable, which means that you cannot invest time, you can’t invest in the long term. It’s designed for people to go in, to make a profit, and to go out again. Which is not, in my opinion, what general practice is about.” “What it means is, over a reasonably short period of time, given the rate at which practices are closing at the moment, you are going to have significant proportions of general practice services in London, being run by the commercials or big conglomerates.”
Dr David Jenner, GP contract lead at the NHS Alliance and a GP in Cullompton, Devon, warned that the move would mean that independent GPs would struggle to compete with larger healthcare corporations. He said, “Often minimum requirements of IT, quality, financial backing, in practice can make it difficult for small providers to effectively compete”. “It can be a very inefficient way of procuring a service of limited value. There is also the danger of providers bidding low to win the contract and then being unable to meet the terms of it.”
BMA Council member and Lewisham GP Dr Louise Irvine said, “I’m worried about that becoming the new model of care, we’ve already seen new models of private companies bidding for these APMS contracts, some of them have been successful and it’s hard for ordinary practices to bid against them.” She added, “It’s very much part of a trend, it’s part of this big push to privatise, to commercialise and bring in private, for profit companies to run more and more, not just primary care, but community and secondary hospital care.”