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APMS deals giving firms no incentive to take long-term view

The Practice may have an oddly generic name, but it’s one that has been grabbing the headlines over the last couple of weeks. First the UK’s largest private provider of GP services announced it was closing its APMS practice in Camden – which when it was owned by UnitedHealth was the focal point for many of the arguments over privatisation of general practice. Then, as Pulse reports this week, the Practice decided to de-register 166 elderly patients who were signed up as part of an NHS Buckinghamshire pilot to look after people in care homes.

In each case, there were extenuating circumstances. In Camden, there were problems extending the surgery lease. And in Buckinghamshire, the PCT offered far less money for care home services than The Practice felt was needed, leaving the company with restricted funding to look after patients beyond its normal practice boundaries.

In neither case is there any suggestion The Practice has broken any primary care regulations, or done anything wrong by normal corporate ethical standards. But that, of course, is not the key question. The real question many GPs are asking is, would a GMS or PMS practice, working under a standard NHS contract without a five-year time limit, have behaved under similar circumstances in the same way?

When the last government introduced APMS contracts in 2006, they were limited to five years to keep the provider on its toes. It could never relax into complacency, as ministers were suggesting GPs sometimes had, because there was no guarantee the five-year deal would be renewed. But it is not only the companies that cannot relax – it is also their patients. The Camden practice had provided 90-odd years of unbroken service to its patients, but it took only four years under an APMS deal to bring that to an end.

Short-term deals prevent providers making the long-term investments a good practice requires, and discourage them from tackling the kind of long-standing problems – such as premises leases – that crop up at all practices from time to time.

In Buckinghamshire, too, the action taken by The Practice feels out of kilter with the traditions of general practice. The company can justifiably argue it was left in an impossible position, expected to care for vulnerable patients at a distance from its premises without the funding to cover its costs. But there must be suspicions that the decision to chase registration of the patients in the first place, and then to de-register some of them when funding proved inadequate, was made with greater recourse to spreadsheets and budget reports, and less discussion over long-term responsibilities to patients, than might have occurred at a GMS or PMS practice. That was certainly the view of the LMC, which claimed elderly patients had been ‘messed around’.

Of course, Government ministers have repeatedly argued that all GP practices are private providers; and that their degree of financial motivation is exactly the same, whether GMS, PMS or APMS. But to many GPs, the traditional world of general practice differs more markedly from private providers such as The Practice than the names might suggest.