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Dr Charles Alessi: 'It is good that GPs have a choice of contracts'

PMS and APMS contracts allow commissioners to be more sensitive to their local population’s health needs, says National Association of Primary Care chair Dr Charles Alessi

APMS and PMS contracts are in essence a good thing, because they can more closely satisfy the needs of local populations better than national contracts, but of course it depends on how they are configured.

There have been criticisms that they do not provide value for money. But there are three reasons and explanations for this. First, in the past, PMS and APMS contracts have been copies of GMS contracts – they don’t need to be.

Second, the argument that they pay more is still not totally clear. There are still inconsistencies in the baselines, so we might be comparing apples with pears.

And finally, the contract itself depends on the commissioners being skilled enough to commission smartly and deliver added value above GMS. If they don’t, it is the commissioner who it is at fault. PMS and APMS are generic forms of contract – if they are misused and deliver GMS processes for more resource, the fault lies with the commissioner (the PCT in the past).

There are numerous examples of PMS and APMS contracts delivering value. There are lots of contracts based around disadvantaged populations, especially in urban areas. They have a specific aim of attracting that cohort and managing them in a way that is far more sensitive to their needs.

Another example is in areas with a significant number of older patients, like Brighton or Eastbourne, where it is much more sensible to have primary care contracts that are more focused to the needs of older people.

The difference between national and local contracting processes exists because we are not in a completely homogenous society. One part of England is different to another, so it is difficult to have a national contract that is sensitive to the needs of everybody equally.

It is good that GPs have a choice of contracts. There is an argument that it is important to have a national basis for contracting and another where it is important to have locally sensitive contracting. Both arguments are equally tenable.

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Readers' comments (3)

  • Another helping of platitudes from one of the individuals who were presumably bending Lansley’s ear when he was in opposition, and who went on to support, most vehemently, the proposals incorporated in the disastrous NHS Bill: not withstanding the opposition of, amongst others, virtually the entire medical profession, the Royal Colleges, the BMA, the RCN, the professions allied to medicine etc etc. Dr Alessi and his band of entrepreneurial acolytes knew better and the impression created in much of the the media was that they represented mainline medical opinion, a misconception which, so far as I could tell, they did nothing to disabuse. These so called reforms were introduced with their support, resulting in the unmitigated disaster that now confronts what is now left of the NHS. I have just watched an interview with Dr Alessi on Sky TV, which I found most disturbing because of his unfortunate presentational manner and the fact that he seems to be living in a world of his own. Where are all the facilities, nurses, GPs etc who are going to provide much of the care which, according to Dr Alessi, will no longer need to be provided by hospitals? The majority of GPs who continue to see and manage patients are under immense pressure. Does he not know about the shortages of hospital beds for acute and elective admissions and the lengthening waiting lists for surgery? No amount of tinkering with attendances at A & E is going to resolve that problem. Does he not understand the risks involved in the early discharge of patients into the community following major surgery, especially on a Friday? I, for one, think that common sense should prevail, and a period of silence from the likes of Dr Alessi would be most helpful.

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  • Only one word is appropriate now ...profits. Of course commercial confidentiality will ensure privacy of the arrangements that Dr Alessi has fought so hard for and clearly supports whatever the long term consequences. Must be nice being on first name terms with those responsible for the destruction of the NHS.

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  • I know. Time for a break. Alessi coffee anyone? Medicine won't be the same out of this pot.

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