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Dr Chaand Nagpaul: ‘This will destroy the fabric and ethos of general practice’



The quintessential strength and unparalleled international success of UK general practice is that it offers personalised long-term continuity of care to local communities. This depends upon the security of a local GP surgery with doctors and staff that patients know, have trust and faith in, and which will serve them and their families for decades.

The BMA is therefore totally opposed to NHS England (London) Area Team’s blanket policy to only offer new GP contracts on a short term basis via APMS. This will destroy the fabric and ethos of general practice, and throw open the door to private providers running general practice on a commercial basis by remote control, and with the prospect of change and instability every few years.

NHS England (London) justifies this by stating that competition law compels them to use APMS to ensure that all contracts are open to private providers. This is frankly not the BMA’s legal understanding: there is nothing that forces area teams to solely use APMS, at the exclusion of GMS or PMS. NHS procurement regulations, as well as guidance from Monitor, clearly allows flexibility on whether to choose open competition, taking into consideration ‘securing the needs of patients’, as well as ‘value for money’.

It is unarguable that patients’ best interests are served by secure, long-term dependable local GP services.

This is precisely what patients themselves want, and who I believe would be appalled to learn of a policy to replace their local GP surgery with a five-year service run by another organisation.

Neither does APMS tick the value for money box. We need look no further than the past few years, when many costly APMS contracts, paid much more per head than GMS or PMS practices, have been decommissioned due to not being cost-effective, or not having delivered on their contract, as well as those that have created instability due to the provider leaving at the end of their tenure. 

You would have thought that stretched area teams would have greater priorities than incurring the added cost and bureaucracy of repeated tendering, creating local contracts every few years, and then managing them. This will certainly put off doctors wishing the security of providing a long-term commitment to patients and thus add to the recruitment crisis in general practice.

At the heart of this problem is competition law that applies in England, originally introduced by the previous Labour administration, and cemented in the Health and Social Care Act.

This is why the BMA has called for a repeal of the Act; to put an end to the pernicious effect of enforced competition both on this issue, as well on the wider NHS.

We will be writing formally to NHS England (London) to withdraw this blanket policy that undermines patient care, and which we believe does not accord with current procurement regulations.

I emphatically believe that ‘securing the needs of patients’ and ‘value for money’ as criteria provide a compelling and legitimate case for procuring GP services via long-term GMS contracts.