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A faulty production line

Dr Chaand Nagpaul: 'This will destroy the fabric and ethos of general practice'

NHS England is wrong to stop commissioning of GMS and PMS practices on competition grounds, says GPC chair Dr Chaand Nagpaul

The quintessential strength and unparalleled international success of UK general practice is that it offers personalised long-term continuity of care to local communities. This depends upon the security of a local GP surgery with doctors and staff that patients know, have trust and faith in, and which will serve them and their families for decades.

The BMA is therefore totally opposed to NHS England (London) Area Team’s blanket policy to only offer new GP contracts on a short term basis via APMS. This will destroy the fabric and ethos of general practice, and throw open the door to private providers running general practice on a commercial basis by remote control, and with the prospect of change and instability every few years.

NHS England (London) justifies this by stating that competition law compels them to use APMS to ensure that all contracts are open to private providers. This is frankly not the BMA’s legal understanding: there is nothing that forces area teams to solely use APMS, at the exclusion of GMS or PMS. NHS procurement regulations, as well as guidance from Monitor, clearly allows flexibility on whether to choose open competition, taking into consideration ‘securing the needs of patients’, as well as ‘value for money’.

It is unarguable that patients’ best interests are served by secure, long-term dependable local GP services.

This is precisely what patients themselves want, and who I believe would be appalled to learn of a policy to replace their local GP surgery with a five-year service run by another organisation.

Neither does APMS tick the value for money box. We need look no further than the past few years, when many costly APMS contracts, paid much more per head than GMS or PMS practices, have been decommissioned due to not being cost-effective, or not having delivered on their contract, as well as those that have created instability due to the provider leaving at the end of their tenure. 

You would have thought that stretched area teams would have greater priorities than incurring the added cost and bureaucracy of repeated tendering, creating local contracts every few years, and then managing them. This will certainly put off doctors wishing the security of providing a long-term commitment to patients and thus add to the recruitment crisis in general practice.

At the heart of this problem is competition law that applies in England, originally introduced by the previous Labour administration, and cemented in the Health and Social Care Act.

This is why the BMA has called for a repeal of the Act; to put an end to the pernicious effect of enforced competition both on this issue, as well on the wider NHS.

We will be writing formally to NHS England (London) to withdraw this blanket policy that undermines patient care, and which we believe does not accord with current procurement regulations.

I emphatically believe that ‘securing the needs of patients’ and ‘value for money’ as criteria provide a compelling and legitimate case for procuring GP services via long-term GMS contracts.

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Readers' comments (8)

  • Good luck with this, this does need to be pushed aggressively.

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  • NHS is one area where the 'Competition Law' card has been ruthlessly exploited to force privatisation.
    This government has to remember that there are public domains where you cannot allow private investments to undermine existing systems. The same would be applicable to other areas too- Would you next want to have Private Courts to make the Justice system cheaper and more efficient? No, you wouldn't unless you are hell bent on ending up in an anarchy.
    NHSE bossess should not overzealously misinterpret the law and look for loopholes to privatise as much of the NHS as they can. We, on the other hand, should support any move to get a clear exclusion from the so-called European competition law as far as NHS is concerned because it is the British national interest that is in jeopardy here!
    So go Dr Nagpaul, we are with you but please think of more radical solutions as soft talk and actions have not got us anywhere.

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  • Dr Nagpaul - " and throw open the door to private providers running general practice on a commercial basis by remote control"

    When oh when will you realise that is what the Govt intends, that is its goal. Why do you think you can argue your case with the govt by telling them that what they are doing is wrong because it will achieve their aim? You confirm to them that what they are doing is right because you are telling them that their goal will be achieved. Why do you think that line of argument will make them change their mind?

    I'm sure you are decent honest chap Chand, but you and your nicey nicey chums on the GPC just are not the right people to fight against modern government and the DoH.

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  • We are stuck, we do need to push for a campaign against NHS privatisation to peak around election time

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  • Energetically engage patients in this campaign, Chand.
    NONE of us ( esp us oldies) want to exchange our valued personalised GP services for a commercial alternative, focussed not on continuity of best care and management for the individual patient, but on maximising profit for some distant medical business

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  • unfortunately patient engagement will only lead to the sort of fudge the government allowed with MPIG in london.

    A headline,,but the details shows no real change.

    Until several practices collapse and GP's wake up and start going to work in areas which are sustainable we will end up with the worst of all worlds.

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  • Took Early Retirement

    Or take early retirement

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  • One way to make local people's voices heard against privatisation is to encourage them to sign letters to Monitor. We now have 1000s of letters signed in Lewisham and have challenged Monitor. The letter can be seen on the Save Lewisham Hospital website The letter can be used by campaigners and by practices and CCGs to show that their local populations do not see outsourcing and competition as in their best interests. This is evidence for Monitor that avoiding tendering is the right thing to do.

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