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A faulty production line

NHS England to award ten-year £100 per patient APMS contract

An NHS England area team is looking to award a ten year APMS contract, valued at £100 per weighted patient, despite local GP leaders’ concerns, Pulse has learnt.

The Kent local area team has put an invitation to tender out for the contract for the Martello Health Centre, valued at £342,691, which had a patient list of 2,699 as of July 2014, of which nearly 40% are over 60.

It is unclear what additional services the practice will have to provide, but Kent LMC has warned the local area team that such a contract could give the practice an unfair advantage over neighbouring practices in the area, and stress that other no other practice receives this level of funding.

The LMC’s October newsletter states: ‘NHS England area team have issued prospectus and an invitation to tender for a 10 year APMS contract where there is currently a single handed vacancy, valued at £100 per weighted patient.

The LMC told Pulse that the area team hadn’t yet specified exactly what services the practice would be expected to provide, and Pulse was unable to obtain further details despite numerous requests.

The service currently provides routine opening hours and is being run by locum cover and practice staff who have been retained after the original, single-handed contract holder retired.

The Memorandum of information for the contract states: ‘The aim of the service is to deliver essential, additional and enhanced services to registered patients from premises located in Dymchurch.

‘As of 1st July 2014, the registered list size was 2,699 patients, with a normalised weighting of 3,426.91 patients.

‘The positive weighting reflects the higher than national and CCG average number of patients aged 65 and over registered with the practice.’

Pulse recently revealed that NHS England had issued its area teams with directions not to procure new GMS or PMS practices and to only use APMS contracts, though it subsequently reversed this stance following GPC pressure.

Kent LMC medical secretary Dr Mike Parks told Pulse that he sympathised with the problems the area team faced in attracting providers, but added: ‘We are concerned about contracts being placed that give a competitive advantage to one practice over their neighbours.

‘And equally we think that if the area team are saying “this is what primary care is worth”, why aren’t they saying “well this is what we should be paying all of primary care”?’.

‘I understand why it’s difficult to recruit people to take on new contracts, but that’s the case everywhere. Obviously, this particular practice is in a very rural area, and is a relatively low list size. Which of course makes it even more difficult to be financially viable.’

‘But the neighbouring practices, Dymchurch on Romley Marsh, obviously face some of the same issues and problems that the Dymchurch practice does.’

Dr Parks added: ‘Additional services at the moment are not defined, they are talking about some KPIs (Key Performance Indicators) over and above what’s in the standard GMS contract. But we don’t actually know what those will be.’

Dr Robert Morley, chair of the GPC’s contracts and regulations subcommittee, said he could not comment on specifics without knowing exactly what the contract holder had to provide.

But he told Pulse: ‘I would be surprised if any contracts were incredibly overgenerous compared to GMS and PMS, but if it does seem too incredibly generous, then local practices should get their act together to try and bid for it themselves.’

‘It’s not easy, but if practices can organise themselves into larger entities then they can be in a position to bid. And that’s increasingly what practices are going to have to do because they’re in as competitive market place now.’

This is the latest example of APMS practices being paid more than the global sum, after Pulse revealed in 2008 that some APMS practices were being offered £186 per patient.

Readers' comments (17)

  • We should be challenging them in court not protest to the undersecretary`s typist!
    Obviously if NHSE feel that £56 or whater the GMS value is is not going to get any bidders! Says a lot about what we are paid now.

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  • It would be interesting to take the global sum or a PMS contract and then add in all the other enhancements, additional and enhanced service fees etc that go on top and then do a comparison. I bet most GPs would be surprised. Lets be sure we're comparing apples with apples before we dismiss APMS contracts as not cost effective.

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  • £100/pt is still not adequate for any contract. for those being paid less (once you adjust it with all the extras which are paid on top of £/pt) if its still less than £100/pt: move to a better contract!

    We have an APMS contract: paid nearly the same rate but lots of tick boxes before we get paid such amount including more appts/1000pts, achieving all KPI otherwise money gets withdrawn, in-house phlebotomy service including in it etc.
    We took over a surgery which was failing, was significantly overbudget, high referral rates, 60 appts/1000 pts/week.
    4yrs down the line: we are now in budget, slightly high in referral rates compared to baseline but nowhere near what it used to be >5yrs ago and provide >80 appts/1000pts/week.

    before any GMS/PMS partner comments on this please add all the additional income to compare like for like.

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  • Peter Swinyard

    It is pleasing that a single handed practice in a rural area is to be preserved - the continuity of care is potentially excellent news for the patients.
    It is probable that the funding is about right and may well be directly comparable to GMS depending on whether the APMS contract includes premises reimbursement or not. Either way, it shows how poor the usual GMS funding is and how unlikely it is that they can persuade someone to take on this practice under GMS.
    Let's try and level upwards, not downwards, folks.

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  • sorry: forgot to add: we are partners in APMS contract and hence have stable workforce=continuity of care.
    only downside: I dont know my future beyond 5yrs which is very frustrating and will need to go through tender process again which will cost us alot despite performing better than some of the existing neighbouring practice who have lifetime contracts.

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  • It's fairly useless to come out with the figure without understanding what they expect in return. If they expect the surgery to be run like my surgery then it is an extremely generous deal (and all local practices should be bidding).

    If they expect it to be run like my GMS practice + doing all the enhanced services but without reporting on them then it is even better.

    If they expect it to run 6am-10pm 7 days a week - see unlimited walk ins-from other surgeries and run their own short stay ward then 100 pounds a year does not seem enough.

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  • Peter Swinyard, I may be missing something but I don't think "continuity of care" equates to seeing different doctors ( with a different agenda) in the same building.

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  • £100 per patient year with consultation rates having gone up from 4 to 6 in the last 9 years. Take it if you wish. You might have to provide 10 appts in 10 years.
    I must confess that, on a personal basis, the whole GP thing is so rotten it is time to leave en masse.

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  • without the detail of what the expected service delivery makes this article a little meaningless. For all we know they could have to deliver what other practices do for additional ES to get the 100 per patients which would not be a great deal - more detail please

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  • £100 per patient,the devils in the detail,what do they expect.If its frozen for 10 years with no inflation factor there are diminishing returns for the saps that fall for this.
    Just like ourselves and what has happened sine 2004.What a mess!

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