Exclusive All new GP contracts will be opened up to bids from the private sector by NHS England in a move that GP leaders have warned marks the ‘death-knell’ of traditional life-long general practice.
As a tide of practices face closure, managers have told Pulse that because of competition law they will not be replaced with GMS or PMS contracts, but with time-limited APMS contracts instead.
The move has taken GP leaders by surprise, with the GPC seeking urgent legal advice about the move. Some have warned it will lead to the privatisation of the NHS with surgeries replaced with ‘short-term, profit making ventures’.
APMS contracts were introduced in 2004 to open up primary care to ‘new providers’ and were famously used to procure the Labour government’s ill-fated ‘Darzi’ centres across the country.
In October last year, Pulse revealed that NHS England’s London area team was planning to procure a ‘significant’ number of APMS contracts this year.
And managers say this policy has been adopted nationally, to ensure that NHS England complies with competition regulations.
An NHS England spokesperson said: ‘Under the GMS regulations there is scope to enter into a temporary contract but this is at clear odds with procurement law and the 2013 regulations so best practice would dictate that this should not be used when APMS effectively does the same job and does not come with the same risks attached.
‘GMS can still be entered into upon reversion from PMS and the new form of PMS contract may be entered into by way of renegotiation (ie variation) but in respect of procurements, yes they should all be on APMS.’
Pulse has previously revealed an increasing trend towards APMS contracts. In February, NHS competion watchdog Monitor launched a probe on how to attract new general practice providers to regions with poor care, despite warnings from the GPC not to put ‘competition ahead of continuity’.
GP leaders are warning that, with practices under increasing workload and financial pressure, strict tender requirements could exclude smaller practices from primary care and drive the invasion of private providers.
And they are advising practices to seek alternatives to contract termination, for example by merging, when partners reach retirement in order to avoid losing ‘invaluable’ GMS and PMS contracts.
GPC chair Dr Chaand Nagpaul said he was surprised to hear about the national policy that would ‘spell the death knell of the whole ethos of long-term, continuity of care in the way general practice operates’.
He said the GPC was seeking urgent legal advice on whether NHS England was correct in asserting that APMS contracts were the only way to satisfy international procurement law.
He added: ‘It’s extremely unfortunate, and highly ill-advised that area teams should be undermining secure, long-term sustained provision of general practice through APMS contracts. There is nothing to stop an area team choosing to use a PMS or GMS as a contract, on the grounds that it offers a local population the best mechanism for the provision of general practice services.’
Dr Tony Grewal, medical director at Londonwide LMCs said they were worried about the moves in the capital that would replace family doctors with ‘short-term, profit making ventures that went against the ethos of primary care’.
He added: ‘APMS is only for five years, potentially renewable, which means that you cannot invest time, you can’t invest in the long term. 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.’
‘What it means is, over a reasonably short period of time, given the rate at which practices are closing at the moment, you are going to have significant proportions of general practice services in London, being run by the commercials or big conglomerates.’
And Dr David Jenner, GP contract lead at the NHS Alliance and a GP in Cullompton, Devon, warned that the move would mean that independent GPs would struggle to compete with larger healthcare corporations.
He said: ‘Often minimum requirements of IT, quality, financial backing, in practice can make it difficult for small providers to effectively compete.
‘It can be a very inefficient way of procuring a service of limited value. There is also the danger of providers bidding low to win the contract and then being unable to meet the terms of it.’
BMA Council member and Lewisham GP Dr Louise Irvine told Pulse: ‘I’m worried about that becoming the new model of care, we’ve already seen new models of private companies bidding for these APMS contracts, some of them have been successful and it’s hard for ordinary practices to bid against them.’
She added: ‘It’s very much part of a trend, it’s part of this big push to privatise, to commercialise and bring in private, for profit companies to run more and more, not just primary care, but community and secondary hospital care.’