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At the heart of general practice since 1960

APMS providers undermine GPs

No level playing field for GPs to compete against firms

Ever since the Government opened up the prospect of competition in primary care, it has repeatedly assured GPs they will operate on a level playing field against potential new providers. The Department of Health reiterated this point last week, on the eve of its Community Services White Paper, which opens the way for a massive expansion in competition for GP services.

A spokesman said potential providers should 'come from both the NHS and the non-NHS sectors' and that PCTs should encourage both. But what has become clear from the handful of competitive tenders conducted for Alternative Provider Medical Services (APMS) contracts so far, is that this is not true.

Far from playing on a level surface, GPs are being made to battle uphill and into the wind.

GPs who have been involved in bidding to run an APMS practice say the complex process of tendering is skewed in favour of larger private companies.

And what's more, the companies agree. Those involved with the firms wanting a piece of the primary care market say individual practices, or even consortia of GPs, have little or no chance of competing.

Dr Rory McCrea, a GP in Essex, set up his company, Chilvers-McCrea, to take on practices that were struggling to recruit GPs and cope with demand.

The company has since merged with another firm to become Mercury Health. Dr McRae says he realised that in order to compete, his original company had to be bigger. He says: 'I've given up thinking about a level field. I think the field is not altogether that level.

'The bidding process is quite sizeable and if I was a practitioner on my own, or even with others, I would find it difficult. There is a lot of work to do ­ finance, premises, HR and IT.'

Another member of one of the leading firms states: 'This is very onerous and shortlisted bids are from bigger companies, larger commercial players.'

Certainly those GPs who have joined the fray have been disillusioned by the difficulties involved. Dr John Dixon's practice in Accrington is covered by Hyndburn and Ribble PCT ­ one of the Government's six areas to pilot APMS. He formed a link with a local GP co-op to put in a bid to run a new walk-in centre in the region.

But Dr Dixon says it was 'impossible' for his practice to compete with larger companies.

'There was such a lot to provide, so many reports and accounts, it just appeared it was set up so a bid could only come from a plc.'

Dr Chaand Nagpaul, GPC member and a GP in Harrow, Middlesex, says GPs are feeling 'undermined' by the sense that APMS contracts are attracting funding well above what would have gone to a similar NHS service. He says: 'There is clearly a political drive for the private sector to become involved.'

UnitedHealth Europe is one of the larger companies wanting a slice of the pie.

It has already taken over two practices in Derby and, as its chief executive, Dr Richard Smith revealed to Pulse last week, it has its sights set on 'keeping the NHS alive'.

GPs in Derby have raised questions as to tendering in their area believing the process may have been biased against GP bidders. UnitedHealth has a pre-existing relationship with Trent strategic health authority (SHA) and Derbyshire LMC has contacted the SHA to check the tender process was fair.

Dr Smith insists it won the contract on an 'absolutely level' playing field as there were 48 initial expressions of interest, 18 tenders and a shortlist of six. But he cites, and tacitly agrees with, what he says are comments from other interested companies, that to 'move beyond the best general practice you need resources'.

Simon Chipperfield, vice-president of medical services at Atos Origin, which recently won a contract to provide a walk-in centre in Manchester's Piccadilly station and is in the market for APMS deals, appears to agree.

He says GP practices are more suited to smaller APMS contracts. Setting up new services, such as walk-in centres or a new practice, would be 'too challenging'.

'I don't think it's hard for a practice to bid to support a neighbouring practice for the support of diabetes,' he says. 'But if a PCT wanted a new walk-in centre and a new practice, the scale of the opportunity would be too challenging [for GPs] and more relevant to a larger organisation.'

The next year will see the number of APMS tenders increase rapidly and will be the true test of the Government's promise of a level playing field on which all can compete.

But under the present conditions, the chances of GPs pulling off a giant-killing look slim.

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