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GPs go forth

CCGs 'are merging practices to remove APMS contracts'

Exclusive Some CCGs across the country are actively merging practices that are under the APMS contract with those that are under GMS or PMS contracts in order to remove APMS from the system, the BMA has claimed.

CCGs are doing this because AMPS contracts are too difficult to manage and ‘don’t deliver better quality of care’, according to BMA GP Committee chair Dr Richard Vautrey.

This news comes despite NHS England previously saying that all new contracts should be APMS.

APMS - Alternative Provider Medical Services - contracts were first introduced in 2004 to open up primary care to ‘new providers’ and were famously used to procure the Labour government’s ill-fated ‘Darzi’ centres across the country

Unlike GMS contracts, they are awarded with a time limit, rather than perpetuity, and they can be held by companies as well as GP partners.

In 2014, Pulse revealed that all new GP contracts would be time-limited APMS contracts instead of GMS or PMS, with NHS England saying that ‘APMS effectively does the same job and does not come with the same risks’ as GMS contracts, and so all new GP practices should 'be on APMS'.

But GPC chair Dr Richard Vautrey told Pulse that CCGs are now switching practices from AMPS to GMS, through mergers.

He said: ‘What I know they have done, is look for existing PMS/GMS practices in the area and invited them to come forward and effectively merge their contracts. So it reduces the number of practices, but it reduces it in a favourable way, but removing AMPS out of the system.’

Dr Vautrey continued: ‘There are a number of CCGs that are doing this, where they see the difficulty of contract managing an APMS contract and all that goes with that, is really not worth the hassle that they have, and they don’t deliver better quality of care, they are not delivering in the way that maybe people thought they would.

‘They are finding it much better to bring practices into a GMS or PMS arrangement, give them some certainty and make sure they are aligned with other practices in the area.’

Pulse previously revealed an increasing trend towards APMS contracts, with NHS competition watchdog Monitor investigating how to make it easier for alternative ‘high quality’ providers to set up GP practices in areas of low quality care, despite warnings from the GPC not to put ‘competition ahead of continuity’.

NHS England and NHS Clinical Commissioners both declined to comment. 

Readers' comments (11)

  • another way to reduce the number of practices as a previous 'unnamed' correspondent on here was keen to do. It seems NHS England is still keen to close down general practice and replace it with something untried and probably much less efficient.

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  • Does this just represent that the GMS/ PMS contracts are hugely under-priced. It seems impossible to tender an APMS contract for less than a GMS payment - and that tender process is probably judging the value/price of the service correctly. Often APMS is 2x a GMS contract price.

    What is needed is re-balancing so that the cost of GMS/ PMS contracts is at least close to the cost applied to APMS contracts.

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  • Depends APMS contracts are same - or will be for GMS reg services...APMS sometimes has extra bits - walk in centres or used for the extended access work - locally 3 apms contracts have just been awarded for 5 years

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  • Sounds good, although would prefer it also result in practices of reasonable size, not massive, and with increased fairer funding to ALL GMS practices, of course!

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  • It's a clever way of managing the decline of primary care. If a practice is no longer viable and has to close, then if it is small enough NHS England will disperse the list, if they think they can get away without causing a domino effect.

    The other strategy is to allow mergers by any other means. This results in GPs and CCGs doing all the heavy lifting of the mergers to create superpractices. When they are big enough, NHS England can come in and cherry pick and convert them to APMS.

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  • AlanAlmond

    Sounds like the random swirls of chaos in a bucket of water draining out a hole in the bottom. The guy filling the bucket thinks he’s in control but the water just runs where it must, as he continues to ignor the leak.

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  • Spot on Alan

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  • Latterly,APMS contracts contracts were too much hassle and not economically viable for the corporates[ most are getting out or reducing] and too much time and hassle for NHSE and the CCGs to monitor.
    Much better to get GMS /PMS/Federation GPs to pick this up if they will do it!

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  • David Banner

    Starve GMS to breaking point.
    Feed APMS until unaffordable.
    Merge to build the perfect beast.
    Evil genius.

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  • Come to Medway and get APMS Contracts today for £145 Plus per patient without any hassles - ask me who to contact in NHSE and in the CCG. Contracts given and extended to company of 'highest earning GP of 2012'. At that time they were paid 250 per patient plus massive amounts for KPIs, today they can still get them.
    Guess who was and is in the PCT/CCG and in NHSE - the same people who gave previous contracts - no procurement law applies in this company's case. Welcome to banana land.

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