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Independents' Day

Revealed: NHS England stops issuing lifelong GP contracts

Exclusive The stability of general practice is being gradually undermined as not a single new GMS contract has been issued in five years, Pulse can reveal.

Data supplied via a Freedom of Information Act request show that almost exclusively new GP practices have been offered time-limited APMS contracts - a total of 242 between 2013 and 2017, while just one PMS contract was issued.

GP leaders said the data indicated a corrosion of continuity of care, with patients being denied the 'lifelong' doctor-patient relationships that were previously common.

APMS contracts are always issued for a limited-time period, typically around five years, after which they are subject to review. By contrast, GMS and PMS contracts are issued in perpertuity, with PMS contractors retaining a right to convert to GMS at any time.

The data show all new contracts issued since 2013 - apart from one - were APMS, with the other a single PMS contract issued by NHS England's South West regional team in 2015/16. No new GMS contracts were issued during the four-year period.

Between NHS England's inception in 2013 and last year, 210 APMS contract were procured by its regional teams. A further 32 are being procured during 2017/18, according to FOI responses.

It comes as in 2014, GP leaders took legal advice to challenge a reading by NHS managers that all new GP practices must be thrown open to competition due to the Health and Social Care Act reforms.

Since then, NHS England's advice has been that it is up to regional teams to decide which model is best on a case-by-case basis.

But, commenting on Pulse's investigation, the BMA's GP Committee said regional managers were too fearful of legal challenge to issue new lifelong contracts to GPs.

Chair Dr Richard Vautrey said: 'In areas where the population is growing and new practices are needed, patients deserve a long-term GP rather than somebody who is here one month or gone the next.

‘We do need NHS England to look at this again. When pushed they admit that the GMS contract can be offered but the reality is that local bodies default to the APMS route because of their fear of protracted legal action from those who say issuing a GMS contract is anti-competitive.’

An NHS England spokesperson told Pulse: ‘APMS contracts offer a great degree of flexibility but it is not NHS England policy that all new contracts must use this model. Commissioners are free to choose the contract type which is most suited for the service being procured.’

The issue was brought to the fore again in April when ministers revealed that 50 APMS contracts had been awarded in London since 2013, with no GMS or PMS contracts awarded.

This was followed by a warning from the GPC to practices to avoid handing back their contracts to NHS England as this would lead to them being reprocured under APMS, and potentially privatisation.

New GP contracts issues in England between 2013-2017

South West 10 0 1
Cumbria and North East 19 0 0
Cheshire and Merseyside * 19 0 0
Lancashire and South Cumbria* CCG 2 0 0
Greater Manchester 15 0 0
North Yorkshire 9 0 0
South Yorkshire and Bassetlaw 12 0 0
West Yorkshire 5 0 0
Wessex* 6 0 0
South East* 5 0 0
South Central 11 0 0
Shropshire and Staffordshire 2 0 0
Derbyshire and Nottinghamshire 8 0 0
Central Midlands 19 0 0
Hertfordshire and South Midlands 13 0 0
Northampton 0 0 0
Lincolnshire 6 0 0
West Midlands* 12 0 0
East 19 0 0
London 50 0 0
Total 242 0 1

Source: Pulse FOI request to all NHS England regional teams. Figures include 17 contracts due to be issued this year.

Exclude new contracts issued during a reversion from PMS to GMS, mergers, caretaker APMS contracts when a practice hands back its contract, and APMS contracts renewed with the same provider.

May exclude some contracts issued where CCGs have taken on full delegated commissioning responsibilities for general practice (in areas marked with an asterisk).

Readers' comments (9)

  • Loyalty and commitment needs to be
    bi-directional for General Practice to work.....

    Many GPs will ask themselves:

    "If NHS England could not care less about me or my practice then why should I care less about them"

    We seem to have entered a Nihilistic phase and things can only spiral downhill.

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  • There are many GPs who will prefer to die to save NHS in its current free for all state.

    It's high time we look after ourselves first.

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  • The good old clapped out GMS contract. Poor thing - like a smelly worn out much loved pet labrador. You know its times up as but you can't quite bring yourself to take it to the vets for the last time.

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  • it will turn out to be very expensive move. gms gps do every thing in one fixed amount in global sum. they are without doubt grossly underpaid as compared the work they do. there would very few APMS taker as profits would be very low or they will not find work force.
    glad I am out of all these.

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  • Vinci Ho

    Evil of HSC bill

    'Useless laws weaken the necessary laws.'
    Book XXIX, Chapter 16.

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  • All according to the plan - old Contracts wear out with GPs giving up while lucrative APMS Contract prop up cronies and keep the system afloat till more than half the GMS is gone. Then go in for privatization in the agony phase and nobody will be there to protest. Its called yankeeing the NHS and finally Cameron and Hunt will be CEOs of a global corporation. I've always had the feeling - this overhaul will leave more people dead than any other disaster. People are already suffering.
    Yesterday I sent a patient to the rejuvenated Medway Hospital with a letter and agreement from the Registrar for admission to AMU. Patient was literally dumped in A&E and after 6 hours the Hospital paid a taxi to send him home as there is no one to see you. The ambulance was sent by the Hospital this morning to pick him up and collect him again from home. Just 75 plus with a diagnosis of TENS.
    Where's the CQC that has declared this institution is out of the red?
    NHSE doesn't care, they are now trying to squeeze out GPs from their existing GMS Contract by reducing their weighted lists each year resulting in some Practices being pain for only 45 percent of the increased list sizes.
    Great feeling that we are part of the twentieth century world class NHS which was proudly displayed in the London Olympics.

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  • Just Your Average Joe

    Since the Privatisation started with the GMS contract, I pointed out APMS contracts were going to stifle GP practices being set up by younger GPs - as it is near impossible to compete with the tender requirements to have companies with sound financial track records as part of the bidding process, but was told don't worry the Private companies are a drop in the ocean of GP practices.

    It is a drop of poison that is spreading like the dark algae on Greenland's surface that will drown out continuity of care as companies suck out profit from practices at the expense of staff and any continuity.

    Make a return of the basic practice allowance - encourage GPs to join as partners and commit to practices and populations where there is need for recruitment.

    APMS practices do not bring any new GPs to the party, they simple poach locums and short term staff, with greater skill mix a euphemism for can't find any GPs stupid enough to join so here's a different health professional who costs us less, and allows more profit to see the patient instead, regardless if they have the skills or ability to deal with the complexity of the problems faced.

    It is not too late to turn this plague of privatisation around, otherwise the practices being replaced will continue to be given to APMS companies who often care little for patients or staff and simply follow the profits, and dump the contracts and patients/staff at the first sniff of losses.

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  • Council of Despair

    technically - is this not the end of general practice as we know it?

    the expectation of being a GP is at some point one could go into a partnership with a life-long contract. This was the reason given as to why we had to put up with a one sided contract as we had job security. With this 'sacred' principle being broken (under the GPC's watch) why should we give any loyalty?

    if the GPC has any credibility left they should now be seeking our interests as the NHS has abandoned us.

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  • Devil's advocate many GPS of this years RCGP production line will work 8 sessions for 35 years. Have you asked any. My recent experience is "none".
    Unless it is fantastically appealing ( which it d*mn well ain't) then it doesn't really matter how the contract is designed, as they will just come and go within their partnerships on an individual level. It is not the contract type, more about the daily grind factor. Don't waste time on the wrong detail when it comes to recruitment and retention!

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