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GP commissioners consider diverting funding to APMS contracts under ‘frightening’ proposals



Exclusive A CCG is considering using directed enhanced service funding for a new model of primary care that would see practices switching to APMS contracts in proposals described as ‘frightening in the extreme’ by local leaders.

In its plans to co-commission primary care, NHS Basildon and Brentwood CCG wants to pilot a ‘Prime Provider’ model of primary care by 2015/16, which would involve practices working as part of an umbrella organisation involving mental health, acute care and social care professionals.  

The CCG would fund this through combining budgets currently used for DESs, CCG funding and money from the local authority in a bid to try to improve care for people with long-term conditions or frail older people.

The CCG says the contracts would be ‘entirely voluntary’, and would be commissioned under an ‘outcomes-based’ APMS contract. It also told Pulse that any plans would be subject to ‘prior approval’ from member practices.

But local leaders have warned that GPs may come under pressure to buy into the scheme and the CCG could tender for private organisations if they do not do so.

This comes after Pulse reported last week that NHS West Hampshire CCG has already proposed to take control of all QOF and directed enhanced service funding as part of their plans for co-commissioning primary care following a call for submissions from NHS England.

But under the NHS Basildon and Brentwood CCG proposals, the CCG has set out a vision of changing the model of primary care.

Papers seen by Pulse say ‘the new model would combine ‘elements of core and enhanced primary medical services for a defined population, under the umbrella of a single prime provider organisation, commissioned under an APMS contract.’

They say: ‘There is the potential for the CCG to explore the development of new contractual arrangements involving the local GP practices, on a voluntary basis.’

‘Both the development of a federated approach to collaboration between groups of practices, and the focus upon developing “named accountable professional teams” (ie designated professionals with expert knowledge of community health – physical and mental – and social care provision working in close collaboration with a “named GP” to constitute a practice-level multidisciplinary team) provide a basis for exploring the potential for developing a new service delivery model, combining elements of core and enhanced primary medical services with the delivery of community health and social care services for a defined population, under the umbrella of a single “Prime Provider” organisation, commissioned under the APMS contract.’

The CCG also says it wants to ‘exert greater influence’ over monitoring and performance management of GP practices.

Dr Brian Balmer, chair of Essex LMC, warned that the CCG could look to a private provider if GPs do reject the plans.

He said: ‘These plans are frightening and extreme. The CCG wants to take more control of what GPs do. It’s like being in a yacht club that tells you where to go and what colour to paint your boat. If everybody says no then the CCG will just go ahead and do it with a private health care provider. They say that they want to pilot a short term two-year contract, and this will lead to a salaried service.’

He also believes that the CCG plans will cause rifts between GPs in the region. ‘I know some GPs who want to take over other GPs’ contracts and bully other GPs,’ he added.

GPC chair Dr Chaand Nagpaul said that the GPC was not supportive of plans for CCGs to co-commission primary care.

He said: ‘It is vital that CCGs make sure their members are fully supportive of these radical co-commissioning plans before they submit them, otherwise the GPs will be disenfranchised.  There is a deadline of June 20 for submitting these plans and CCGs are supposed to be consulting members on any plans like these, as part of NHS England guidelines.’

Dr Nagpaul said there were ‘irreconcilable differences’ and a conflict of interest when CCGs try to commission GP contracts.

A statement from NHS Basildon and Brentwood CCG said: ‘At a meeting of our Clinical Executive Group held yesterday (12th June), it was decided that the CCG would express an interest in exploring further the opportunities that co-commissioning might offer, but any subsequent proposal from the CCG specifying the areas of co-commissioning we would be interested in, would be subject to prior approval by and engagement with our member GP practices.’

‘The CCG will be setting up a group with clinical representatives from its four locality areas to explore in greater detail, whether entering into a co-commissioning arrangement would be beneficial to us in achieving our strategic objective of supporting excellent primary care.’