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Loss-leader ploy as private firms eye GP practices

By Helen Crump

Private providers may bid to run GP services as 'loss leaders' in order to gain a foothold in primary care, the GPC fears.

It said the advent of a primary care market meant large companies may choose to subsidise the takeover of practices through other areas of their business.

The warning came as the GPC released new guidance for GPs on how they can make best use of alternative provider medical services (APMS) contracts.

APMS is the contractual option favoured by the Government and PCTs for setting up new primary care services.

The GPC said APMS had the potential to revolutionise primary care, but there had to be a level playng field to allow GPs to compete.

Dr Richard Vautrey, GPC negotiator, said PCTs might get a short-term financial gain from loss-leading bids, but these could lead to pain for local health economies:

He said: 'You may find an

organisation comes in and

offers what appears to be an attractive initial package but it becomes more expensive over time.

'Private providers may also try to make significant savings by offering poorer terms and conditions to salaried GPs and other staff.'

Staff working for non-NHS providers cannot be included in the NHS pension scheme.

Dr Vautrey urged GPs to compete by offering a quality service, but admitted there was a fear that PCTs were being expected to bring in private pro-viders, whatever the situation.

He said: 'The only way PCTs can avoid that accusation is by being open and honest and ensuring there is a genuine level playing field.'

Dr Rory McCrea, GP and chair of ChilversMcCrea Healthcare, which has taken over the management of more than a dozen practices, said PCTs would spot companies that were loss-leading. He said: 'Our experience is that PCTs are very discerning and understand they need a service in a certain area for many years.' He added that GPs should 'take heart and take up the battle'.

Dr Hamish Meldrum, GPC chair, said it was not fair to say practices would only be taken over by private providers and each case should be looked at on its merits.

Part of the BMA's remit was to support GPs working for APMS providers and ensure they had fair conditions, he added

GPC guidance on APMS

· PCOs can enter into contracts with any individual or organisation meeting provider conditions

· GMS and PMS providers can hold APMS contracts

· When tendering, cost all components of any service

· BMA salaried contract's minimum terms and conditions do not apply under APMS and PMS

· APMS services replacing existing services may be affected by TUPE

· Requirement for providers with APMS-only contracts to provide similar pension arrangements 'probably not enforceable'

· No formal appeal procedure for failed bids ­ GPs should consult their LMC

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