By Steve Nowottny
Exclusive: PCTs across England have begun unpicking dozens of APMS contracts awarded under the previous government’s controversial Darzi-centre initiative, a Pulse investigation has found.
Information on 196 GP-led health centre and APMS practice contracts, obtained under the Freedom of Information Act, shows that almost half have been renegotiated since they were signed. In dozens of cases terms have been adjusted since the new health centres opened – often to reflect excess demand for walk-in consultation and too few registrations.
Some 84 contracts are under review, in some cases as part of routine contract monitoring, but in others specifically to find out if they offer value for money.
Many of the 96 contract renegotiations known to have taken place so far appear to have focused on ‘over-contract’ walk-in activity, with many trusts seeking to cap spiralling costs.
NHS North Lincolnshire has begun renegotiating the terms of its GP-led health centre contract ‘due to predicted significant costs over budget linked to activity’, while
NHS Lewisham said discussions had centred around walk-in activity.
NHS Westminster said it had already begun to renegotiate the terms of its GP-led health centre’s contract before the Halfpenny Steps Practice actually opened its doors on 20 October. The contract for the first Darzi centre, opened in Bradford, is currently being renegotiated.
Some PCTs appear to have amended contracts in favour of the provider, with NHS Trafford agreeing to a one-year extension to the ‘honeymoon period’ for all key performance indicators.
The Laurels Neighbourhood Practice in Haringey, north London, became the second GP-led health centre contract to be terminated on 31 October, following NHS Stockport’s decision to decommission its 8am-8pm centre last month.
A spokesperson for NHS Haringey said: ‘On 1 November, a local practice will be taking over the contract for nine months while the PCT undertakes a full procurement process for a permanent provider.’
Dr Nigel Watson, chair of the GPC’s commissioning and development sub-committee, said: ‘It’s highly likely that PCTs and the new consortia will wish to renegotiate or even terminate some of the Darzi contracts, because they weren’t wanted, they weren’t needed and they don’t provide value for money.’
Dr Peter Holden, GPC negotiator and and a GP in Matlock, Derbyshire, said: ‘The last Government couldn’t see further than the end of the underground map. So now some of us are working in areas with these things in a corner somewhere, soaking up resources like there’s no tomorrow. Now consortia are going to have to pick up the poisoned chalice.’
NHS Bradford and Airedale said it is currently renegotiating changes to the contract at the Hillside Bridge Health Care Centre NHS Bradford and Airedale said it is currently renegotiating changes to the contract at the Hillside Bridge Health Care Centre How Darzi contracts are being renegotiated
Amended its contract with the Open Access GP surgery ‘to reflect the increased activity over the predicated activity’
NHS Bournemouth and Poole
Currently considering further contract negotiations with the Boscombe and Springbourne Health Centre ‘in light of performance in year one’
NHS Derby City
KPIs for the contract with the Derby Open Access Centre adjusted, and new terms negotiated as ‘the walk-in element of the contract is above target’
Planning meeting with the Angel Medical Practice ‘to review whether the service is meeting local need and any unintended consequences of the contract; this may include the financial terms and KPIs’
Has made a number of changes to its contract with the Crown Health Centre in Haverhill – among them including a maximum waiting time for walk-in patients and ‘wording around reducing emergency admissions and A&E attendances’
Source: FOI responses from PCTsDarzi contracts across the country
Use our interactive map to see how PCTs across the country are reviewing contracts for Darzi centres.
To view the map with the full results from our investigation, please click here.