APMS and PMS contracts are in essence a good thing, because they can more closely satisfy the needs of local populations better than national contracts, but of course it depends on how they are configured.
There have been criticisms that they do not provide value for money. But there are three reasons and explanations for this. First, in the past, PMS and APMS contracts have been copies of GMS contracts – they don’t need to be.
Second, the argument that they pay more is still not totally clear. There are still inconsistencies in the baselines, so we might be comparing apples with pears.
And finally, the contract itself depends on the commissioners being skilled enough to commission smartly and deliver added value above GMS. If they don’t, it is the commissioner who it is at fault. PMS and APMS are generic forms of contract – if they are misused and deliver GMS processes for more resource, the fault lies with the commissioner (the PCT in the past).
There are numerous examples of PMS and APMS contracts delivering value. There are lots of contracts based around disadvantaged populations, especially in urban areas. They have a specific aim of attracting that cohort and managing them in a way that is far more sensitive to their needs.
Another example is in areas with a significant number of older patients, like Brighton or Eastbourne, where it is much more sensible to have primary care contracts that are more focused to the needs of older people.
The difference between national and local contracting processes exists because we are not in a completely homogenous society. One part of England is different to another, so it is difficult to have a national contract that is sensitive to the needs of everybody equally.
It is good that GPs have a choice of contracts. There is an argument that it is important to have a national basis for contracting and another where it is important to have locally sensitive contracting. Both arguments are equally tenable.