White Paper could ‘force all GPs onto short-term APMS-style contracts’

By Gareth Iacobucci

Exclusive: The Government's pledge to develop a single funding model for general practice could open the door for the use of short-term APMS-style contracts, that GPs would have to re-tender for every five years, the NHS Alliance has warned.

The plans, outlined in the NHS White Paper last week, signalled the Government's wish to abolish the current two-tier system of GP funding, in a move that will spell the end of the GMS/PMS divide.

The funding implications for practices are currently shrouded in ambiguity, with the National Association of Primary Care last week urging the Government not to abandon the flexibility of PMS when negotiating a new single contract.

But the NHS Alliance has warned that the elephant in the room could be the introduction of shorter-term APMS-style contracts, that would allow greater flexibility over the cost and service being provided, and force GPs to re-tender for the contracts every few years.

The White Paper pledged to ‘seek over time to establish a single contractual and funding model to promote quality improvement, deliver fairness for all practices, support free patient choice, and remove unnecessary barriers to new provision.'

Dr David Jenner, NHS Alliance contract lead, and a GP in Cullompton, Devon, said: ‘It says it will remove unnecessary barriers to new entrants. What I think from the wording is that it will probably encompass APMS as well.

‘The really big question is, does this mean they are considering time-limited contracts with five-year compulsory re-tendering? I think there is definitely a move amongst some people to get five-yearly contracts.'

Dr Jenner said he would not object to contracts being retendered for practices that are ‘consistently bad' at delivering quality, but said he was concerned about that any move in this direction would damage continuity of care being provided in good practices.

He said: ‘General practice is about lifelong family care and long-term relationships. If a contract is performing well on quality, my own line is that it should be automatically extended without having to go through a re-tendering process.'

‘Short-team five-yearly things tend to mean the cheapest bidder wins, but as we know with out-of-hours, cheapest isn't always the best.'

Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, said the detail in the White Paper was not sufficient to understand the Government's wishes with regards to a new contract, but vowed that the GPC would strongly resist any possible overtures towards short-term deals.

‘In our negotiations, we will be firm that the strength of long-term care, and continuity of care that underpins the GMS, and the PMS contract for that matter, should not be eroded,' he said.

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