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Ministers have given primary care organisations the green light to replace 'underperforming' practices with private firms, Pulse can reveal.

The Department of Health said PCOs could bring in companies on alternative pro-vider medical services (APMS) contracts if they believed a practice was 'not providing an acceptable standard of service'.

A spokesman for the department said it would be down to individual PCOs to judge a practice's performance and whether to terminate its GMS or PMS contract.

The move, the latest in the Government's drive to create a market in GP services, raised the prospect that high numbers of complaints, poor quality achievement or anomalies in referral or prescribing data could be used to oust GPs.

It emerged as members of a forum linking PCOs with private, not-for-profit and voluntary health companies said they expected soaring activity in APMS contracts, including for essential services.

It had been expected most interest from private companies would centre on additional or enhanced services.

Dr Rory McCrea, chair of ChilversMcCrea Healthcare, which runs some practices under personal medical services contracts, said the company was talking to venture capitalists about the potential for APMS.

He said: 'We are happy to do essential, additional or

enhanced services. If an area with a huge problem came up for tender APMS would be natural.'

PCTs stressed they would not want to use APMS because of performance problems, but said they were interested in using private firms to provide essential services.

GPC negotiator Dr Stewart Drage said the Government was 'upping the ante' by stressing private firms could take on essential services and it would examine pressure being put on PCOs to use APMS contracts.

But he added there 'may be opportunities for GPs as well as threats'.

Peter Whiteman, deputy chief executive of Huntingdonshire PCT, said GPs' performance would have to be 'severe....across a range of things.' He added: 'We would not want to raise the bar of performance in general practice.'

NHS Alliance GMS contract lead Dr David Jenner said there was 'no doubt' ministers wanted more competition, but GPs should keep a preferential position for essential services.

David Owens, partner at health care sector law firm Bevan Ashford, said PCOs would increasingly look to the market for services and GPs hoping to compete would have to think innovatively.

'Where GPs bid they might not want to restrict themselves to just a GP service,' he said.

By Ian Cameron

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