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Merging GP practices fear being ‘forced’ to give up lifetime GMS contracts

Exclusive A group of GP practices fear they will be forced to give up their GMS contracts for time-limited APMS contracts due to rigid procurement rules.

The 23 practices based in Norwich currently co-own a provider arm, which runs an APMS-contracted GP practice and a walk-in centre.

But the practices now want to take the next step, by merging into ‘four or six’ super practices. However, they told Pulse they are currently unable to do so without giving up their ‘lifetime’ GMS contracts.

As it stands, NHS England guidance says APMS contracts cannot be merged into GMS contracts, because they have been issued on a time-limited basis only.

But Norwich Practices Ltd business manager Steve Bloomfield said the GPs are not willing to give up their GMS contracts ‘for something that you’ve got to tender for every three years’.

He said the practices want to merge for reasons including pooling admin work and GP workforce resources.

He said: ‘There are obvious advantages and a huge amount of enthusiasm for super practices and we can see the advantages for this in Norwich.’

But he added that the fact that Norwich Practices Ltd holds an APMS contract has been ‘an immense barrier’ to being able to merge with the GP practices ‘able to retain their GMS contract’.

He said: ‘Just the way the rules are written has meant that we have been unable to do this.’

Acting BMA GP Committee chair Dr Richard Vautrey warned that practices were right to be ‘wary about giving up their GMC contract and moving to an APMS one which would leave them very vulnerable for the future’.

He added: ‘Practices can work in close collaboration with one another without merging and there may be better ways for this situation to be resolved than risking their future contractual status.

Dr Robert Morley, BGPC contracts and regulations lead, also suggested there was ‘absolutely no reason why GPs should give up GMS contracts to work at scale’.

He said super practices can ‘run as a single business whilst keeping the APMS and GMS contracts separate’.

It comes as Suffolk Primary Care, a super practice formed in April, has previously told of its plans to write to the Government to urge for an update to GMS contractual rules.

It was unable to bring in a 12th practice in its 11-way merger because a GMS contract cannot be held by groups of individuals as well as a company at the same time.

Is the GMS contract slowly being phased out?

Pulse revealed in 2014 that APMS contracts were now preferred by NHS England, as this was its interpretation of the Health and Social Care Act 2012.

And GP leaders recently warned GP partners on the brink of handing back their contracts to exhaust all other options first as it would likely lead to the practice being re-procured under APMS - leaving the contracts open to privatisation and erosion of the partnership model.

Although NHS England has said it is up to regional teams to decide what type of contract to procure, it has admitted APMS allows ‘a great deal of flexiblity’.

And, in London, only APMS contracts have been handed out since the Act came into force in April 2013.

Readers' comments (9)

  • APMS has been supported despite the marked increase in cost and decline in outcomes associated with APMS practices.

    An example of ideology being supported at whatever cost.

    A perversity the GPC should be targeting

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  • Vinci Ho

    I think the Trilemma theory of globalisation applies to this as well:
    Integration (or alliance) , sovereignty and democracy. You can only have two out of three but not all three.
    NHSE will not openly say it but always has an agenda to kill off GMS

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  • You can't have a cake and eat it:) Why does one get the feeling that they want to merge their GMS with APMS arm to be paid at the APMS level but would like to retain a permanent GMS Contract. If not for enhanced income charm why rock the boat? Need more clarity as Norwich limited has probably got their priorities mixed up.

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  • Although NHS England has said it is up to regional teams to decide what type of contract to procure, it has admitted APMS allows ‘a great deal of flexiblity’.
    It allows NHSE a great deal of flexibility to get you by the balls and squeeze them when they want to.

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  • switch the APMS practice to GMS - simples! then the merger can happen.
    no way should the rules for GMS change whatsoever. the GMS contract protects GP's delivering services to communities.
    the last thing that we need is more private companies coming in to primary care.
    - anonymous salaried!

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  • anonymous salaried @10:52

    It is not "simples". APMS cannot be changed to GMS under current rules. In fact, no new GMS contracts are being handed out because they are not time-limited.

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  • There is nothing to stop the patients of the aPMS pratce registering with one of their local GMS practices. When the liust size has shrunk enough the pracyice will nolonger be viable. Terminate the aP

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  • Really can't be bothered with the self inflicted problems of these mergers.

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  • DoH right hand and left hand don't know what each other are doing. We want shared care but you can't share the Patient record. We want 8-8, 7/7 working but the patient must see the same GP. We want more GPs but we are going to change tax, pension, regulation and complaint/ litigation so as to penalise you (and reward early retirement). We want light touch regulation but we are going to choice the most complex solution where there's a choice (cant be too careful). We want fast, cheap and good; though we know you can only have 2 of the 3. No more top down revolutionary change..... oops, we did it again didn't we!

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