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Revealed: NHS England stops issuing lifelong GP contracts



Exclusive The stability of general practice is being gradually undermined as not a single new GMS contract has been issued in five years, Pulse can reveal.

Data supplied via a Freedom of Information Act request show that almost exclusively new GP practices have been offered time-limited APMS contracts – a total of 242 between 2013 and 2017, while just one PMS contract was issued.

GP leaders said the data indicated a corrosion of continuity of care, with patients being denied the ‘lifelong’ doctor-patient relationships that were previously common.

APMS contracts are always issued for a limited-time period, typically around five years, after which they are subject to review. By contrast, GMS and PMS contracts are issued in perpertuity, with PMS contractors retaining a right to convert to GMS at any time.

The data show all new contracts issued since 2013 – apart from one – were APMS, with the other a single PMS contract issued by NHS England’s South West regional team in 2015/16. No new GMS contracts were issued during the four-year period.

Between NHS England’s inception in 2013 and last year, 210 APMS contract were procured by its regional teams. A further 32 are being procured during 2017/18, according to FOI responses.

It comes as in 2014, GP leaders took legal advice to challenge a reading by NHS managers that all new GP practices must be thrown open to competition due to the Health and Social Care Act reforms.

Since then, NHS England’s advice has been that it is up to regional teams to decide which model is best on a case-by-case basis.

But, commenting on Pulse’s investigation, the BMA’s GP Committee said regional managers were too fearful of legal challenge to issue new lifelong contracts to GPs.

Chair Dr Richard Vautrey said: ‘In areas where the population is growing and new practices are needed, patients deserve a long-term GP rather than somebody who is here one month or gone the next.

‘We do need NHS England to look at this again. When pushed they admit that the GMS contract can be offered but the reality is that local bodies default to the APMS route because of their fear of protracted legal action from those who say issuing a GMS contract is anti-competitive.’

An NHS England spokesperson told Pulse: ‘APMS contracts offer a great degree of flexibility but it is not NHS England policy that all new contracts must use this model. Commissioners are free to choose the contract type which is most suited for the service being procured.’

The issue was brought to the fore again in April when ministers revealed that 50 APMS contracts had been awarded in London since 2013, with no GMS or PMS contracts awarded.

This was followed by a warning from the GPC to practices to avoid handing back their contracts to NHS England as this would lead to them being reprocured under APMS, and potentially privatisation.

New GP contracts issues in England between 2013-2017

Region APMS GMS PMS
South West 10 0 1
Cumbria and North East 19 0 0
Cheshire and Merseyside * 19 0 0
Lancashire and South Cumbria* CCG 2 0 0
Greater Manchester 15 0 0
North Yorkshire 9 0 0
South Yorkshire and Bassetlaw 12 0 0
West Yorkshire 5 0 0
Wessex* 6 0 0
South East* 5 0 0
South Central 11 0 0
Shropshire and Staffordshire 2 0 0
Derbyshire and Nottinghamshire 8 0 0
Central Midlands 19 0 0
Hertfordshire and South Midlands 13 0 0
Northampton 0 0 0
Lincolnshire 6 0 0
West Midlands* 12 0 0
East 19 0 0
London 50 0 0
Total 242 0 1

Source: Pulse FOI request to all NHS England regional teams. Figures include 17 contracts due to be issued this year.

Exclude new contracts issued during a reversion from PMS to GMS, mergers, caretaker APMS contracts when a practice hands back its contract, and APMS contracts renewed with the same provider.

May exclude some contracts issued where CCGs have taken on full delegated commissioning responsibilities for general practice (in areas marked with an asterisk).