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Shifting GP contract to private provider 'increased costs by 64%'

The procurement of an APMS contract to a private provider - after the closure of a GMS practice - meant costs to the NHS increased by 64%, shows figures obtained by LMC leaders.

Partners at the St Lawrence Medical Practice in Braintree, Essex, were forced to hand their GMS contract back after they were unable to recruit more partners, and NHS England replaced it with an APMS contract run by Virgin Care.

An FOI to NHS England, revealed by Dr Katie Bramall-Stainer from Hertfordshire LMC at the LMCs Conference in Edinburgh, showed that the first year of the Virgin Care practice contract cost 64% more than the final 12 months of St Lawrence’s GMS contract.

The FOI, seen by Pulse, also revealed that the Sutherland Lodge practice in Essex was replaced by a Virgin Care APMS practice that increased costs by 16%. Sutherland Lodge had earlier been awarded an ‘outstanding’ rating by the CQC but was forced to close due to the PMS reviews.

The figures were announced as part of a debate on NHS England’s decision to put all new GP practices contracts out to tender under APMS – first revealed by Pulse.

Local leaders voted in favour of the motion, which called on the GPC to take legal advice to ‘challenge the notion that only APMS contracts may be awarded when procuring general medical services’.

Dr Bramall-Stainer told delegates: ‘There was the case of the “Outstanding” Essex practice that was forced into handing back their contract last year due to the enforced PMS contract review.

‘This undermines the whole ethos of long-time continuity of care.’

The FOI response from NHS England said: ‘The budget for the current APMS contract (which commenced on 1 June 2016) will exceed the actual expenditure within the last twelve months of the former GMS partnership (1 June 2014 to 31 May 2015).

‘Following the procurements of the current APMS contracts for the St Lawrence and Sutherland Lodge practices we can confirm that the procurements resulted in the following approximate percentage increases in contract value rates compared to the GMS and PMS arrangements previously in place; St Lawrence: 64%; Sutherland Lodge: 16%.’

Pulse revealed earlier this year that more practices closed in 2016 than ever before.

Virgin Care was approached for comment, but did not respond in time for publication.




Readers' comments (15)

  • AlanAlmond

    This kind of bull shit is just what's required 'for the 21st century'. A fully salaried service run by the private sector's really 'now' and obviously where we should be headed.

    Seriously this IS the future ..fekin lunacy.

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  • Funny how several FOI requests were denied due to "commercial sensitivity" on this exact question but now that time has moved on they are being allowed.

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  • That's normal isn't it. In the Southeast, we have been informed by hospital consultants that the local OOH provider is asking £45 per spirometry. The funny bit is that this service has never been discussed with local GPs and the deal would be made and agreed quietly. Of course, most would know the region in Southeast prone to shady deals. GPs are expected to do these things for free 'for the good of mankind' while OOH Providers who are basically people evolved from the PCT structures are given ludicrous payments for the same. Could wager, the OOH will be given at least £30 for every spiro while blithering naïve idiots that GPs are considered to be, they will continue to see patients with unlimited care for just 85 pounds a year minus the LMC and 'Voluntary' levy and deductions for not working 24 hours a day. The Voluntary levy bit on your Exeter statements is the intriguing one as we don't even know what it is so how could we have volunteered to pay?

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  • I would be shocked if the private provider was 'only getting' 64% more.

    My suspicion is that there would alternative off book sources of funds provided as sweeteners.

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  • Yes these guys get start up costs ,refit costs, cqc upgrade costs and the wonderful CCGs who are our highly paid GP colleagues bowing to secondary care and letting little filter to local services ,other than associated colleagues must be checked by our well paid LMC members.
    I may be wrong but we can't see the transparency.
    We are going back to gps treated like offal containers of little use and we need to have some support or no one will be a GP.

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  • I hope the additional 'resilience' funding translates in longer holidays, and being paid, like my accountant, per minute.
    Maybe Julian Assange can help with the so needed information we do not seem to be allowed to see...

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  • Vinci Ho

    Always about uneven distribution of resources:
    'Unwilling to give away money for a good purpose but
    more than willing to let go for injustice'
    The contradiction of the government is going down the route of capitalism/marketing on APMS on one hand and collectivism with austerity on the rest of general practice on the other.
    Of course , the ultimate agenda is to pull out from funding and investing in NHS as much as possible. Sooner or later, I think even private providers will leave as things dry out further .The overall austerity of NHS is to carry on so as to be , as I said in the past, part of the STP(sustainability and transformation plan) of Brexit .

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  • Vinci Ho

    The certainties and unpredictabilities of an extraordinary general election

    ''The people of England regards itself as free; but it is grossly mistaken; it is free only during the election of members of parliament. As soon as they are elected, slavery overtakes it, and it is nothing.''
    Jean-Jacques Rousseau, The Social Contract

    Some really long thoughts before I could write this comment. The time is about right as all parties had made pledges through their manifestos. Some critics would say these pledges are promises never to be delivered. As Rousseau alluded , an election was merely a game of politics to grant people power to dominate others . He , hence,advocated direct democracy rather than representative parliamentary politics . While I cannot totally agree but this is still a very good substance for academic debates.
    But we have extraordinary circumstances right here , right now . The EU referendum last year , by definition, was an exercise of direct democracy(though only on a single issue)which did not come often as far as political culture in the country is concerned (Scottish independence referendum was arguably only voted by people living in Scotland).
    Rather than providing solutions, this exercise of direct democracy generated more questions for us to think about our future and coming generations. A revolutionary idea always comes with prices: resignation of a fully confident prime minister , severing a long term relationship with our neighbours(people called it a divorce but that logically ,should require agreements to go separate ways from both sides!), economic uncertainties with a depreciated English pound(with pros and cons) and an early call of a general election while many people are probably exhausted mentally.
    Ironically , we need to revert back to indirect democracy and let our politicians to 'mop up' the mess made by this result of this EU referendum.
    So it goes back to the old , boring question, ' which party am I going believe?'
    If you are die hard fan, you perhaps have an easy answer(or not ??). Or if you are convinced by the media polls , the winner is too obvious even though there has been some catching up by Labour in recent days.The odds offered by the bookies are like : 6 to 1 for Corbyn to be PM , 10 to 1 for no majority win , 20 to 1 for Labour majority win and they are not interested in bets for May to be PM. Given the results of the recent local election , there should be no second guess technically and Tories should be preparing themselves for the exuberance and even
    debauchery of a landslide victory.
    So is that it?

    ''This is the best reason to learn history: not in order to predict the future, but to free yourself of the past and imagine alternative destinies. Of course this is not total freedom – we cannot avoid being shaped by the past. But some freedom is better than none.''
    Yuval Noah Harari, Homo Deus: A Brief History of Tomorrow

    From Home Secretary to Prime Minister , May remains in the comfort zone of a technocrat , strong and stable easily . She is long way from being charismatic and visionary (at least superficially) . Denying the existence of 'Mayism' somehow shot herself in the foot when one started to compare with long serving PMs like Thatcher and Blair. In a way , one has to respect her 'honesty' because quite frankly, the Tory 'manifesto to win big majority' was stitched up by her aides. The changes in social care funding could potentially become their ' Achilles' calcaneum 'shot by Paris in the Trojan War.
    My mate Simon said ,'she does not have any children and is not qualified to be a PM!'. My take is while it is unfair to dig into personal matters , it is important to understand how our elderlies see their own as well as their children's future. There is a Chinese saying,'when there is a new policy from the top , there will be strategy to counteract from down below.' The threshold of £100,000 after which you have to pay for your social care without a ceiling (the total cost was capped at £75,000 currently, a policy from Cameron in 2013) will simply enforce old people to rethink and sell their properties to cash out and give away anything in excess of £100,000 to their children and relatives. This , of course, can generate uncertainties or even rivalries amongst family members . As GPs long enough in this business, how often did we come across similar stories when our elderly patients die? Ultimately, people would not let the State retrieve this money after death .
    One would wonder why this policy even needed to appear on the manifesto. The answer perhaps goes back to the single objective of winning a majority of seats in House of Commons so as to produce a strong and stable leadership and accordingly, would deliver a 'good' deal on Brexit negotiations. A landslide fallacy can be negated by a landslide victory. So technically, for May , she needs to win back votes from UKIP(relatively easy now) and confiscate those from Labour supporters (and the undecided). Somebody called her the 'Red Tory' and indeed ,her views on the Just About Managing (JAMs) might sound like justice. The truth is she had to succumb to her true colour with no freedom. On Brexit , she had to surrender to the far right brexiters in the government. On domestic issues , she ended up with a row with her Chancellor(rumours suggested he swore down the phone),as there was no alternative to raising tax or national insurance to solve a genuine problem of social care funding. Thanks to Cameron again with his 2015 manifesto.
    On NHS , she dared not use a different health secretary , burying the head in the sand for all the crises on going in the health service . Repeating all the rhetorics used by Cameron is the best she can do. On education , she loves the old Tory ideology of grammar school and clearly drew blood with the ex-education secretary (well entertained by the cat-fight stories about how much their pants and handbags cost!).
    May be , just may be , as Enoch Powell once said ,
    'For all prime ministers , their human flaws are inevitably amplified by the stresses in office , eventually end up as failures.'
    At least,I now do believe Auntie May is not Auntie Thatcher 2.0 , just as Uncle Trump is never Uncle Reagan 2.0.
    Trying to move on with lives after the local election , Labour simply produced a manifesto to 'please' . It is always easier for the oppositions if the ruling government is dogged by all sorts of contradictions. Clearly , the distraction of Brexit is perhaps so far reaching that May and her cabinet are putting more doubts in people's mind.
    But once again , history sticks(especially if people involved in the stories are still alive). Corbyn and McDonnell are both haunted by their old selves . The former cannot shake away from his affiliation with anti-nuclear campaigns and still stuttered on the question whether he would 'press the button ' in life and death crisis . The latter's faith on Marxism(he wanted to call himself socialist now) is questionable. And both were named in a The Telegraph's report(19.5.2017)about M15 opened a file on their links to IRA.
    While the prime minister and her party are willing to continue austerity on public sectors with low taxation , Labour is to open the cheque book with at least higher corporation tax . Typically, the latter wants to swing the pendulum all the way to the left with policies like nationalising the mail , rail and energy firms. Even my mother-in-law would say the answer to these is simply raising the tax. Question is how desperately have these domestic issues deteriorated over the last few years? And , yes, Brexit is once again blocking in the way as far as solutions are concerned.
    Ultimately, it is about the lives of common people. This general election cannot be just about Brexit. In fact , recent surveys suggested the 'fever' amongst voters is dying down .
    Interestingly , even The Economist published a critique on McDonnell's attachment on Marxism(13/5/2017):
    'Labour is right—Karl Marx has a lot to teach today’s politicians' While the author clearly supported a landslide victory of the conservatives,absolute capitalism will harm people and the economy. Quoted from the article:
    ''the number of listed companies has declined at a time when profits are close to their highest levels ever. Concentration is particularly pronounced in the most advanced sectors of the economy ''
    '' Average wages are still below their level before the financial crisis in 2008 and are not expected to exceed it for several years. The rise of the Uber economy threatens to turn millions of people into casual workers who eat only what they can kill.''
    The pay gap between company CEOs and ordinary workers is widening and middle class is on its way to extinction.
    Bottom line is 'do you believe a strong and stable government only for the sake of Brexit will be up for these more essential deep-seated domestic issues?' I don't have the answer.
    Confucius said ' one cannot stand if people do not trust' ,Analects. For modern politics, it is perhaps more about who and what you trust the least .

    PS : one has to excuse my relative lack of attention on Lib Dems and UKIP. The former is struggling with their mission of redemption and atonement as far as the young voters are concerned. The latter , mmmm, internal fightings with actual physical brawl ,only ex-MP went through mutiny twice and a short lady leadership of only 18 days ,tell you all about the virtues.

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  • Just Your Average Joe

    How do Virgin get extra money not available to the previous GPs running the service that was failing?

    Surely this is discrimination and evidence of unfair practices within the NHS - how are NHS England giving away taxpayers money to private organisations, which will swallow it as profit and give it to shareholders to run the same required service, on an uneven playing field for normal hard working struggling practices.

    If that money is given to Virgin - it should be equally be available for all practices in the same area.

    If this is justified by them offering services above and beyond the GMS/PMS contracts then it should be offered as a LES to all practices.

    STOP sweetening the deal for private companies coming in to cherry pick NHS services, who run and dump failing practices when they start to take a loss - without any regard for patient safety or duty of care.

    If any normal GP tried to do this they would be referred to responsible officers and the GMC, but Private companies wriggle out under commercial sensitivities and duty to shareholders.

    Take the loss, run with the same budgets as normal GP practices, stop the blatant favouritism to APMS contacts, as there are no more GMS/PMS contracts being awarded in London and the South East as far as I am aware.

    Essentially there will be a gradual privatisation of GP services practice by practice as contracts come up - to the point where the flood will not be stoppable.

    We as a profession have a duty to stop this - where are the RCGP and BMA when they need to be stopping this. Worryingly cosy with JH and the DOH.

    Make things come to a head - force the government to fund Primary care properly - it would only take a small percentage of the money ear marked for White Elephants like HS2 and Trident. Shave a couple of billion in efficiency from those and fund Primary care well - and let us get on with our day jobs, rather than try and carry the balancing the entire NHS budget on our shoulders.

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