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At the heart of general practice since 1960

A&E doctors flock to general practice for a better deal

Ian Cameron examines the threat to GPs' central role in primary care from the 'forgotten' contract

GPs have had to get to grips with another array of acronyms since the new contract was introduced. But one that has received scant attention so far is set to have a huge impact on the future of general practice.

APMS ­ Alternative Primary Medical Services ­ is the contract PCTs can use to bring in the private and not-for-profit sector to compete against GPs to provide services.

It was introduced alongside the new GMS and PMS contracts supposedly to give trusts a way to fill gaps in services by contracting with providers other than GPs ­ such as charities, intermediate care and private firms.

Initially, it was thought the contracts would be only for additional or enhanced services and leave GPs' hegemony over essential care intact.

But the Department of Health, as part of its crusade to increase 'plurality of provision', has given PCTs the green light to oust any practices they believe are 'underperforming' and replace them with private firms.

Department officials have even said a practice's poor score on the quality and outcomes framework could be cause for PCTs to start an investigation into its performance.

NHS Alliance GMS contract lead Dr David Jenner, a GP in Cullompton, Devon, said any interest by PCTs in using APMS for essential services would suggest they no longer considered GPs as preferred providers. This meant dire consequences for practices if they were not up to standard. He says: 'If they are opening up a free market with no right for GPs they could lose contracts and go out of business.'

At least 15 trusts have already signalled their interest in using APMS by joining an NHS Confederation forum, where they meet and discuss plans with potential providers.

At this stage, most seem to be restricting their interest to additional and enhanced services. But they are careful to keep their options open.

Martin Phillips, head of primary care at Middlesbrough PCT, which already has an APMS contract with deputising service Primecare for out-of-hours care, says APMS should not be used for 'back-door privatisation'.

Peter Whiteman, deputy chief executive of Huntingdonshire PCT, adds it would only cancel contracts with existing practices as a last option if support from the trust had failed. 'We would be talking about severe poor performance across a range of things,' he says.

The GPC has signalled GPs would not lay down without a fight if they were challenged.

GPC deputy chair Dr Laurence Buckman warns any trust that tried to oust a GP for poor performance would find itself mired in legal wranglings. 'PCTs would have to prove it before a Family Health Service Appeals Authority hearing,' he says.

The companies looking to provide services, however, are chomping at the bit to pick up contracts from PCTs and are not restricting their sights to enhanced services.

ChilversMcCrea Healthcare already runs a handful of practices through traditional GMS and PMS contracts, such as in Brighton where the trust was unable to replace a retiring singlehanded GP.

Chairman Dr Rory McCrea, a GP in Waltham Abbey, Essex, describes APMS as 'his game plan' for the future.

'The route to essential services is now through PMS, GMS and APMS,' he says. 'If you are going to bring a substantial amount of money into some areas APMS would be worthwhile.'

With such eagerness among potential providers, and with PCTs being encouraged by the Department to 'consider all the options' when contracting, it is clearly a matter of when, not if, practices will start facing a challenge to their core business.

Who is interested

in using APMS?

PCTs in the NHS Confederation's APMS Core Group forum

·Birkenhead & Wallasey

·Brighton & Hove City

·City & Hackney

·Darlington

·Hyndburn & Ribble Valley

·Kensington & Chelsea

·Lewisham

·Luton Teaching

·Maidstone Weald

·Middlesbrough

·Nottingham City

·South Birmingham

·Vale of Aylesbury

·West Hull

·West Lincolnshire

Private companies

and other providers

in the forum

·Birkdale Clinic

·Chilvers McCrea

·Clinovia

·Healthcare at Home

·Mayflower Hospitals

·Mercury Health

·Pfizer

·Rethink

·Stroke Association

·Terrence Higgins Trust

·Tunstall Group

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