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Hold the schadenfreude – the first Darzi centre closure could be bad news for ordinary GPs

If the first closure of a Darzi centre goes ahead, many GPs will celebrate, writes PulseToday editor Steve Nowottny. But there may be a catch…

When Pulse first reported earlier this month that NHS Peterborough was to become the first PCT in the country to close its Darzi centre, there was general approval from readers.

‘Everybody had to have a GP-led health centre a couple of years ago – but obviously we don't need ours,' a disarmingly honest PCT spokesperson said, and many GPs – who for the most part widely opposed the imposition of GP-led health centres a couple of years ago – couldn't have agreed more.

But, as our follow-up story yesterday revealed, it's never quite as simple as that.

For one thing, NHS Peterborough's decision to close the centre seems more a cost-cutting exercise than anything else – the PCT is £12.8m in debt, and believes closing the centre will save £800,000. For another, the Alma Road Primary Care Centre actually provides cheaper care per registered patient than many of its neighbouring practices.

And the GP-led health centre in this case is very much led by GPs, rather than a profit-motivated private company. As the medical director Dr Rupert Bankart put it when I spoke to him on Friday:

‘We're a bunch of seasoned GPs who saw Tesco and Sainsbury's on the horizon and said come on, let's not just complain about this, let's do something to ensure the NHS remains run by the NHS.'

That said, the closure of Darzi centres is still just a matter for Darzi centres, right? The local GPs who formed groups to bid for GP-led health centres – including, of course, BMA chair Dr Hamish Meldrumm - were unlucky, but they should have known the risks they were taking in bidding for such a politically-charged contract.

Well… maybe. But speaking to Dr Bankart last week, he offered one very good reason why GPs might want to go easy on the schadenfreude.

The mechanism likely to be used by NHS Peterborough to close the Alma Road centre is clause 55.1, a ‘no cause' clause which allows trusts to terminate the contract even if they have no particular reason for doing so. It's a pretty standard clause in APMS contracts (you can see a version in the model template for an APMS contract posted on Londonwide LMCs' website), and it makes APMS practices particularly vulnerable at a time of across-the-board cost-cutting.

But it may not just be APMS practices for much longer. Part of the Government's White Paper plan is to end the two-tier system of GMS/PMS funding, and move GPs onto a single contract. And as the NHS Alliance warned last month, this could be a short-term APMS-style contract.

Could it also include a clause 55.1, making every practice in the country vulnerable to ‘no cause' closure? Well, it's something the GPC would be bound to resist furiously, but it's not impossible.

Or as Dr Bankart puts it: ‘If we were to be closed – and we're hoping we won't be – there is a precedent for future APMS contractors throughout the country, which may be every practice.'

‘We're in the firing line now, but it's a warning sign to everyone else.'

Steve Nowottny is the editor of PulseToday

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