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Are GPs serious players in the APMS scramble?

An explosion in tenders under Darzi plans presents GPs with moral dilemma as they battle against private firms

By Gareth Iacobucci

An explosion in tenders under Darzi plans presents GPs with moral dilemma as they battle against private firms

When David took on the mighty Goliath, it is possible that more than a few of his colleagues were suspicious of his motives for doing so.

So it is with APMS tenders, which pitch GPs as underdogs against the money and organisation of private firms.

Not everyone is convinced that GPs should be taking any part in the scramble for the contracts – particularly those for polyclinics and the brand new Darzi practices. But like it not, the tendering process is set to have a huge impact on general practice across England.

GPs bidding to run the 250 plus contracts available – for GP-led health centres in every PCT, at least 100 new practices and a scattering of separate contracts - are finding themselves plunged into a dog eat dog world.

A few weeks ago health secretary Alan Johnson claimed he had ‘no doubt' the majority of contracts under the Government's plans for new surgeries in under-doctored areas would go to existing GP practices. Either he knows something we don't, or he is ignoring the evidence from the bidding process so far.

GPs on the ground are finding it tough. Practices report being bamboozled by red tape, outgunned financially by private bidders and forced into new consortiums.

A senior Government source goes further, describing many of GPs' efforts to take on their rivals in the tender process as amateurish. ‘GPs have got to be serious. Bids can't be amateur. Some GPs haven't been professional, and still expect to get a contract.'

Undercut by 25%

Pulse revealed earlier this year that GPs had lost out to private companies in APMS bids so far after being under-cut by as much as 25% on cost. GPs accounted for 51% of bids for APMS tenders, but were awarded a contract or preferred bidder status in fewer than one in 10 cases.

But the scale of the tender process has now gone through the roof, with PCTs coordinating battles between GPs and a host of commercial providers, from private giants such as UnitedHealth and Serco, to much smaller firms.

In Surrey and Sussex, of 23 providers expressing an interest, only seven were local GPs. Elsewhere, Liverpool PCT says it has received six expressions of interest from GPs and nine from private companies.

And its easy to see why GPs could be put off. The average tender document for the first serious round of bidding for a practice in an under-doctored area is likely to run up a staggering 36,000 words.

That means time. Lots of it. And money.

Dr Peter Parry Okeden, a GP in Bedford whose practice was on the initial shortlist for a polyclinic but failed to make the final cut, says the tender process has cost his practice a small fortune.

‘We haven't added up all the costs of the bid, but it will have run into thousands,' he admits.

‘A GP practice can't afford to keep doing that very many times. Companies who have done lots of them will find it easier the second, third and fourth time.'

This caution is echoed in new guidance from the GPC, which warns GPs to fully understand the costs and implications before entering the dragon's den.

GPC deputy chair Dr Richard Vautrey insists the guidance is not designed to put GPs off, but to sound ‘a realistic warning'.

‘They need to price bids very carefully. Otherwise, it could become a drain on their existing practices and resources, which could have a negative impact on the quality of service that they can provide to their existing patients.'

Yet many GPs are taking on the challenge. In the East Midlands alone, more than 200 expressions of interest have been received for all schemes, including ‘a large number of GP expressions of interest at both the expression of interest stage and bidder events'.

In Bedfordshire, where the polyclinic tendering process is one of the most advanced, local practices made up 50% of the initial shortlist of eight and hopes are high that a GP-led bid will prevail.

But Dr Vautrey says there also a ‘big concern' that GPs will end up increasingly forced to undercut each other.

‘That leaves local practices, if successful, having to provide a service that maybe isn't cost effective, or potentially they can't deliver the level of quality that they would like.'

Serious players?

Private companies may be far better equipped to shoulder such costs, many openly saying GPs cannot afford to be serious players in the tender process.

But while it is true that GP bids may not be as slickly presented as those of their corporate competitors, Bob Senior, vice-chair of the Association of Independent Specialist Medical Accountants (AISMA), and partner at Southampton accountants Tenon, says this does not mean they are intrinsically worse.

‘GPs do feel aggrieved, because their tenders are definitely bespoke to that situation, and while they might not be as glossy, it's not a Blue Peter ‘here's one I made earlier' approach, which can happen with some of the corporates.

‘GPs that have been involved don't think there's a level playing field, and feel they're being unfairly compared.'

Some GPs do not make it past the mountain of red tape.

‘I actually registered an expression of interest in the first instance, and then it gets so complicated, I've given up,' says Dr Ravi Mene, a GP in Manchester and secretary of Manchester LMC, who contemplated bidding for a GP-led health centre.

Dr Mene says other GPs in his locality were told the funding for the centres would only be provided for the first two years, and ‘after that, you're on your own'.

‘That means, for an ordinary general practice, after two years, they will be at the mercy of the market. Though we would prefer a local practice to provide this service, I don't know how many practices are keen to jump into the fire.'

Dr Eric Rose, a GP in Milton Keynes, says his practice initially felt compelled to bid for the GP-led health centre because it was being opened ‘on their doorstep', but decided against because of the demanding specification.

‘There is no way that we can bid for something that is going to be open for 12 hours or more 7 days a week. We decided the size of the operation is just totally anathema to what we've been trying to do.'

How to make the perfect bid

- Make sure you have sufficient support. If you do not have the expertise buy it in, or consider bidding jointly. Involve accountants early in the process

- Make your local knowledge a selling point. Private companies may hAPMS tendering tips Debate

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