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Continuity fears as only temporary GP contracts awarded since NHS Act

Only temporary contracts have been awarded in new GP practice procurements in London since the new Health and Social Care Act was introduced in 2013, the Government has revealed.

But GP leaders said the decision to only award APMS contracts, and not a single GMS or PMS contract, risked causing ‘disruption’ to local GP services.

Since 2013, NHS England’s London regional team has procured – or are in the process of procuring – 50 new GP contracts, all of which are in the form of APMS.

Unlike GMS and PMS contracts, which are awarded in perpetuity, APMS contracts are always awarded for a time-limited period, after which they have to be reprocured.

But Londonwide LMCs said the move, which is nationally encouraged by NHS England, creates insecurity for staff and patients and favours large private providers over small GP groups.

They also pointed to instances of APMS contractors already opting not to re-tender for their contract at the end of terms upon finding they are not able to turn a profit – leading to higher costs for commissioners.

Responding to a question from the MP for Hampstead and Kilburn,Tulip Siddiq, health minister David Mowat said there are currently 15 APMS contract in procurement across London, plus an additional 35 APMS contracts having been awarded since 2013.

This includes new contracts, or reprocurements where an existing APMS contract has ended, but does not include care-taker arrangements where providers have pulled out and a local provider has stepped in.

Mr Mowat added: ‘NHS England has also confirmed that there have been no GMS or PMS contracts procured across the 32 London CCG areas for core general practitioner services since 2013.’

But Londonwide LMCs medical director Dr Elliott Singer told Pulse that NHS England’s short-term thinking over contracting left local communities to endure disruption.

He said: ‘In our work supporting hard-pressed GPs in the capital, we typically find that larger private companies are more successful in bidding for the APMS contracts commissioned to replace GMS practices than those offering traditional general medical services.

‘Anecdotally, providers struggle to maintain even a reduced service under an APMS contract and nationally a number of providers have handed back their contracts at the point of expiry if not before.’

‘This means that local communities often face closures or the disruption of recommissioning within three-to-five years if a service is deemed to be insufficiently profitable.’

Dr Singer highlighted a recent case where a PMS practice stepped in as caretaker for another practice with an intention to tender for the contract when it was handed back by the APMS provider.

But because ‘they could not get the complex tendering paperwork in on time’, the practice was not awarded the contract and ‘now, a new provider is being sought for a five-year contract meaning this massive uncertainty has impacted on staff morale and NHS England has had to pay for two tendering processes’.

The news comes as Pulse revealed in 2014 that NHS England were advising regional teams to throw open all new GP contract to competition, as this was its interpretation of the the Health and Social Care Act 2012 that came into force in April 2013.

But, following challenge from the GPC, NHS England made reassurances that GMS and PMS contract could still be procured.

Asked about NHS England’s current position, a 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.’

London new GP contract awards

Year/Contract type APMS GMS PMS
2013 10 0 0
2014 9 0 0
2015 6 0 0
2016 10 0 0
2017 15* 0 0
Total 50    
*under procurement    

Source: NHS England