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Digital GP providers to bid for 20-year APMS contracts in ‘under-doctored’ areas

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Exclusive NHS England has set in motion a programme that would award digital-first providers APMS contracts lasting 20 years in under-doctored areas, Pulse has learned.

The contracts could be set up in 27 CCGs across the country, an NHS England briefing note has said.

GP leaders have warned the move could ‘destabilise’ practices, leading to closures.

Last year, NHS England announced plans to make it easier for digital-first providers to set up practices in under-doctored areas via APMS contracts from April 2020.

The plans, which formed part of a consultation on out-of-area patient registration, said potential providers would have to demonstrate a ‘credible plan’ for bringing new GPs to the area and offer face-to-face appointments in underserved areas.

An NHS England document has now revealed it has started engagement with under-doctored CCGs, with procurement for the programme via a ‘dynamic purchasing system’ proposed to follow.

The NHS England ‘preliminary engagement’ document, dated July 2020 and published by Hounslow CCG, said it expects to set up digital-first APMS practices via the programme in 27 CCGs.

It said: ‘We will work to create new opportunities for providers to set up new services in areas of greatest need, for example, under-doctored areas or areas with poorest access and long waits for a GP practice appointment. 

‘Our current expectation is that these opportunities will be available in the 20% of CCGs with the highest need. There are 135 CCGs (since April 2020). Given this, we would expect providers to be able to establish themselves in 27 CCGs.’

The document added that the ‘aim’ is to implement ‘longer-term’ standard APMS contracts of up to 20 years ‘to enable providers to deliver sustainable positive outcomes for populations’.

This could involve long-term contracts of 15-20 years with break clauses, such as every three to five years, when ‘contract requirements are reviewed’, it said.

The document said it is ‘for engagement’ and that ‘proposals are subject to change’.

However, if the plans go ahead, each CCG ‘identified as having a need will need to mobilise a contract with any qualified provider that expresses a desire to provide in their area’, it added.

Meanwhile, CCGs will need to ‘work through PCN membership’ with any new digital-first providers, it said. 

NHS England reiterated that providers will be expected to provide both digital-first and ‘full face-to-face services’ and will have to demonstrate that their list reflects the local population’s demographics.

It said: ‘We expect providers to be innovative and inclusive in improving access for the whole population, including support and alternatives for those at risk of being ‘digitally excluded.’

In a document responding to the plans, Hounslow CCG’s primary care committee confirmed it is one of the areas identified as eligible for the programme.

The document, dated September 2020, said NHS England has now launched its programme to procure a new digital-first provider out of a list of those who meet certain national standards – which are ‘to be determined’.

NHS Hounslow CCG warned that the move could lead to ‘practice closures’ if new providers do not bring extra capacity to the area.

It said: ‘There is no detail on what would happen to the provider if they do not bring new GPs into the area – it is unlikely that any action would be easily enforceable under an APMS contract.

‘Practices in deprived areas are smaller, currently experiencing income decline. This puts additional pressure on resilience. The loss of workforce or practice list would lead to an increase in practice closures.’

It added that the requirement to maintain a ‘balanced’ list is ‘not clearly defined’ and could be unenforceable contractually.

An anonymous source told Pulse that the programme is set to be live by 1 April 2021.

The Milton Keynes, Tower Hamlets, Lincolnshire and Central London CCGs are also said to have been approached by NHS England in conjunction with the plans.

Lincolnshire LMC medical secretary Dr Kieran Sharrock told Pulse the news is ‘very worrying’ because it could ‘further destabilise’ practices in under-doctored areas.

He said: ‘I have fears that it might destabilise the locum market because if these new providers start up and doctors who are working as locums may quite rightly go and start providing distance consultations for them – then the practices that need locums won’t be able to get them. 

‘It actually further destabilises those practices in under-doctored areas.’

He added: ‘We have under-doctored areas where it is difficult for us to provide services to our patients, so what we would really want is to have support from our CCGs for those practices to recruit substantive people – not find an online digital-first provider who would potentially destabilise the practice because of the shortage of locums or other clinicians.’

Meanwhile, digital-first providers are not able to offer patients continuity of care, while ‘cherry-picking’ the least complex patients, Dr Sharrock said.

He told Pulse: ‘The more difficult patients who have more complex conditions are less likely to approach a digital-first provider. 

‘So you’re defunding a practice by taking away the patients who make it easier for that practice to actually work and leaving only the more difficult patients.’

Londonwide LMCs chief executive Dr Michelle Drage and deputy Dr Lisa Harrod-Rothwell urged NHS England to invest in digital infrastructure for all GP practices, warning that ‘technology is an enabler, not a panacea’.

They said: ‘As the representative body for NHS general practice in the capital, it is disappointing that we are yet to be consulted or advised of planned changes to NHS England’s seemingly well-advanced changes to general practice contracting. 

‘We have seen GPs make dramatic leaps in the use of digital consulting since the start of, and over, the pandemic. For the further potential of digital health to be realised, all GP practices need the infrastructure to provide it, the knowledge to use it effectively, and the patient clinical demand to justify the investment of time and money in new systems and ways of working.’

NHS England declined to comment on the plans.

In July, health secretary Matt Hancock said all GP consultations should be carried out remotely going forward, unless there is a ‘compelling clinical reason’ to see a patient face to face.

But a Pulse analysis earlier this month showed that GPs aren’t confident it can continue as the health secretary would like, citing concerns about patient harm and medical negligence claims.

It comes as NHS England’s primary care medical director was forced to apologise after GPs were this week ‘insulted’ after NHS England issued a ‘reminder’ that they should offer face-to-face consultations.

The NHS long-term plan committed that every patient in England will have access to a digital-first primary care offer by 2023/24.


Anonymous 18 September, 2020 12:03 pm

In old days it was called open are where any gp can start practice but no financial help and designated Area when you would get financial help.local gps do get angry because the loose patients if they did not keep patient happy,

Anonymous 18 September, 2020 12:07 pm

I’m quite impressed with the Hounslow paper.

It’s well thought through and cogent – especially when compared to the pie in the sky mess that is the NHSE presentation.

Anonymous 18 September, 2020 12:47 pm

just so they know there is no profit to be made in general practice – you have to add a minimum of 25% costs to every bid to pay for the extra overtime that is currently unpaid to staff to make the system work, plus pay rises for all of the staff which includes the GPs who currently don’t get them as partners, plus pay for all the training time, which is unpaid for all GP partners, plus locum costs for holidays and sick leave etc which GP partners and salaried staff currently cover unpaid but would then need to be paid for by the apms. So what ever you bid for you will need in reality, an extra 50% to break even at least and at least an extra 75% on the contract to make any profit. Just so you know how sh##e the current GP contract is, how much of a bargain we provide and how out of touch our paymasters are to reality of running primary care services, of which a large proportion is run on unpaid overtime. every time you lose a FT GP partner you actually lose a 1.5 WTE one. if you do not understand this you will fail, like all the other companies who have tried and failed.

Wendy Domleo 18 September, 2020 7:01 pm

Agree with 12.47.
The NHS primary care runs on the charity of the staff and partners. If we “worked to rule” the whole thing would collapse overnight.

David Mummery 18 September, 2020 8:22 pm

The whole Digital thing has the feel of a bubble that might well burst

Finola ONeill 22 September, 2020 11:50 am

the digital GP schemes siphon off the young and/or fit patients that require minimal inout for easier profit and leaving the complex work to us. Govt needs to change the way primary care is funded, based on patient complexity; age, comorbidites, social deprivation and not on qof. Then no quick buck for these digital companies. Job done. Oh and fund us properly. Job done