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



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.