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Independents' Day

Will all new GP contracts be thrown open to private companies?

Read our Q&A on NHS England’s policy on procuring APMS contracts

What are the three main contract types?

The General Medical Services (GMS) contract is the most common type of GP contract. Each year it is negotiated nationally by the GPC and Department of Health, it can only be held by NHS GPs and there is no time limit on the contract.

Personal Medical Service (PMS) contracts are locally agreed alternatives to GMS, often providing region specific additional services for an additional funding premium. They are negotiated between the practice and local area team, and any PMS practice can transition back onto GMS at any time.

Alternative Provider Medical Services (APMS) contracts are the only GP contracts that can be negotiated with NHS and non-NHS bodies, such as the private or voluntary sector. Contracts are typically awarded for a five-year period, but may be extended.

Which contract type will NHS England award?

In August, NHS England claimed that all new contracts would be APMS.

It argued that APMS procurement allows non-NHS bodies to tender for practice contracts alongside GPs. NHS England states that for new GP contracts that procuring NHS-GP only GMS contracts is ‘at clear odds with international procurement law and the 2013 regulations [The Health and Social Care Act]’. APMS contracts are also time limited which NHS London said ‘allow greater flexibility of provider’.

However, it has seemed to backtrack on this position, and says it will advise local area teams to look at this on a ‘case-by-case’ basis.

Why has it changed policy?

NHS England claimed that it hadn’t changed policy, but GP leaders said this new position was ‘better’.

The new position followed a letter from GPC, which took advice on the legality of awarding only APMS contracts.

Although NHS England says it will be looked at on a case-by-case basis, the GPC says that we will have to see how this is implemented in practice.

What is the problem for GPs if they are put out to APMS?

APMS competitive tenders would enable private GP providers and the voluntary sector to compete alongside GPs, but putting in a tender can cost tens of thousands of pounds and many small or single-handed GP practice might not have the backing to compete.

Dr David Jenner, GP contract lead at the NHS Alliance told Pulse: ‘Often minimum requirements of IT, quality, financial backing, in practice can make it difficult for small providers to effectively compete.

He added: ‘The other risks of tenders is that there is significant cost and opportunity cost [time] in procurements, especially for small scale ones. It can be a very inefficient way of procuring a service of limited value.’

What indications are there that contracts will still be put out to APMS?

Londonwide LMCs’ medical secretary Dr Tony Grewal told Pulse they had been aware of NHS England (London) area team’s preference for commissioning via APMS contracts since the health and social care act came into force.

And Dr Jenner told Pulse procuring practices on APMS contracts had been customary for years.

Why are GMS contracts ‘invaluable’?

Dr Jenner told Pulse GMS contracts were invaluable, because unlike PMS they are not time-limited.

Dr Jenner said: ‘My opinion is that, with general practice, which is about life-time care to people and local communities, actually a permanent contract makes really good sense for patients.’

While Dr Tony Grewal described APMS as ‘a short-term process, and it’s designed for people to go in, to make a profit, and to go out again. Which is not, in my opinion, what general practice is about.’

Both are advising that practices, wherever possible seek to retain their GMS status if a partner is retiring, for example by merging with another practice. Londonwide LMCs are trying develop support mechanisms to prevent practice closures and the loss of GMs or PMS contracts, Pulse is also campaigning for emergency funding for struggling practices.

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Readers' comments (9)

  • In many cases People do not necessarily know who 'their GP' is any longer ...if the public are going to support their practice they will trade off being told that the alternative will provide a better service against this

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  • Prvivatisation of NHS is already a reality. The problem is that procurement is too costly and cumbersome for individual GPs or even smaller partnerships. They are no match for the big Providers.
    NHS England would have exorbitant costs to bear if it allowed patient care to be transferred APMS as some of the APMS Providers are paid up to 250 pounds per patient.

    The solution would be to have a fixed price as in the AQP system and anybody willing to offer services at that price should be allowed to do so without having to go through unecessary, time consuming and unaffordable tenders.

    But, if you can come to that agreement, then we might as well increase the funding per patient in the global sum and leave the job to be done under existing GMS Contracts offering the APMS Providers to join in at this rate which definitely will be lesser than if contracting took place 'for APMS' Providers.
    Today, as a GMS Provider, one cannot be alloed to open a walk in centre. The APMS Providers who are doing so are being paid as mentioned above - up to 250 pounds per patient. If GMS Practices are allowed to open such centres under GMS - you might well get a service considerably cheaper at around 150-175/patient or even less.

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  • Is there any evidence that the UK system of family physicians (GPs) providing lifelong care is cost-effective? Yes. In "Redefining Healthcare", a detailed study across USA, US states that had a healthcare model involving lifelong care by GPs delivered better population health, higher quality healthcare, and (massively) lower costs than US states that had a healthcare system based primarily on hospital consultants without GPs.
    I know that many GPs don't know all their patients personally - they check their clinical notes as soon as the patient walks through the door. But patients develop a relationship of trust with their GP - whether it's the GP they know by sight, or a GP who has an established track record in the practice, that they trust. Patients need to be listened to, and they aren't going to unload to a complete stranger with no reason to trust them. And if they don't unload their worries and problems, they will get very sick and cost a fortune.
    In other words, APMS is a very short-sighted view. Yes it gives NHS England some situational power. But it provides rubbish service for patients, and could end up costing 3* as much in NHS costs alone in increased use of unscheduled and emergency care, quite apart from all of the social problems that develop.
    I'm afraid the research has already been done, and its conclusions are pretty obvious. NHS England can try to plead special circumstances, but that won't hold water. GMS works (it's what made NHS great). PMS is very good for local flexibility (it's what keeps NHS the greatest in the world). APMS is a power play which will cost the nation far more, for lower quality healthcare, and its introduction is probably predicated on the fact that well people don't spend on healthcare - with all of these US healthcare providers wanting to charge for services now lobbying MPs (did i read that 15% of all lobbying funds are now from private healthcare providers?) they want people to spend more.
    So Obamacare stopped the rip-off in USA, as USA tries to get more like NHS because it pays off for the nation. Why are we regressing?

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  • completely agree nhs manager last post.
    why?because the current government and nhs england quango and private health care company nexus are pushing there own catastrophic privatisation agenda purely because of self interested bigotry.they are by far the worst leaders the nhs has ever had.
    they profoundly sicken me.
    they have less than zero mandate for this.
    i hope the electorate will severely punish them and they will become accountable for tbeir frankly evil disastrously wasteful policies.
    i loathe them with a will.
    i can only hope we are not following in thefootsteps of the former democracy now become a corrupt corporate state called the usa.
    electorate..wake up!

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  • This comment has been moderated.

  • APMS - Allows Private (companies) (to) Make Sh@t (loads of cash).

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  • Every APMS contract is sucking money out of the NHS to step closer to Privatisation of the NHS.

    All politicians with any link to lobbyists should declare their conflict of interest and withdraw themselves from any decision making processes/votes.

    They should be prevented from getting any financial inducements from lobbyists - as they are meant to represent their voters not be bought for their lobby.

    Our esteemed 'Leader - past and present should all be thrown out if they are in Cahoots with the privatisation/destruction of the NHS - they are like Judas accepting their 30 pieces of silver.

    APMS cannot be allowed to pay larger than GMS value for any contract, with hidden payments for 'Extra non existent services' or 'Services not availalble for same funding to the rest of the GMS/PMS practices', to top up funding to make it profitable for them.

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  • Its been obvious to many that the Health and social care act was a sneeky backdoor for privitisation for Cameron and his chums, most of them with ties to private health care providers.

    What is not so obvious is where the heck are our leaders? Why is there such muted concern about this issue?

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  • GP practices are just another business and it has been the philosophy of politics to continue the re privatisation of the NHS. If GPs were NHS employees they might have more sympathy from other NHS staff and their patients. Rarely see same person twice, 2-3 week waits for appointment and impersonal letters. Sorry but it has largely been the greed of QOF to pay for adequate care, rather than fine or shut failing GPs

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  • Argil

    It was May 2011 when I wrote "the NHS is being dismantled". Well, most of my expectations have been met. And we cannot blame it all on the Government. Some GPs have enjoyed "expansion of their business". Bidding for different practices, when they could not physically work in all of them, and most of the time reducing their clinical working hours instead, I am not so sure cannot be called privatization. Unfortunately, it may all come back hunting us. However, perhaps, it was unavoidable and it was right who just endorsed the change.

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