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Save the NHS & GP Practices

All new GP contracts will be thrown out to private providers under APMS, in a move described as the ‘death knell’ for traditional practice,

Alex Matthews-King discovers

House of Parliament - online

Pulse has learned the full implications of scores of practices facing closure could include a mass privatisation of GP services.

NHS England has admitted its policy is that any new contracts to replace closed practices will be APMS following a full procurement process. The GPC has described this as signalling the ‘death knell’ for traditional general practice, and is seeking urgent legal advice about the move.

Other leaders have warned it will lead to GP surgeries being replaced by ‘short-term, profit-making ventures’ but managers insist competition rules mean they have no choice but to use APMS contracts, even when reprocuring GMS or PMS contracts.

APMS contracts have a chequered history. They were introduced in 2004 to open up primary care to ‘new providers’ and were famously used to procure the Labour government’s ill-fated ‘Darzi’ centres across the country.

In October last year, Pulse revealed that NHS England’s London area team was planning to procure a ‘significant’ number of APMS contracts this year.

NHS managers now say this policy has been adopted nationally.

Under Section 75 of the Health and Social Care Act, commissioners must put services out to full procurement unless it can be proved there is only one potential provider for the service.

NHS England also says an APMS contract does not carry the ‘risks’ associated with GMS contracts.

A spokesperson told Pulse: ‘Under the GMS regulations there is scope to enter into a temporary contracts but this is at clear odds with procurement law and the 2013 regulations, so best practice would dictate that this should not be used when APMS effectively does the same job and does not come with the same risks.

‘GMS can still be entered into upon reversion from PMS and the new form of PMS contract may be entered into by way of renegotiation (that is, variation) but in respect of procurements, yes they should all be on APMS.’

Ill-advised

Pulse has previously revealed an increasing trend towards APMS contracts. In February, NHS competition watchdog Monitor launched a survey on how to attract new general practice providers to regions with poor care, despite warnings from the GPC not to put ‘competition ahead of continuity’.

GPC chair Dr Chaand Nagpaul expressed surprise at the announcement of a national policy that he says would sound ‘the death knell of the whole ethos of long-term continuity of care in the way general practice operates’.

The GPC is seeking urgent legal advice on whether NHS England is correct in asserting that APMS contracts are the only way to satisfy international procurement law.

Dr Nagpaul says: ‘It’s extremely unfortunate, and highly ill-advised, that area teams should be undermining secure, long-term sustained provision of general practice through APMS contracts. There is nothing to stop an area team choosing to use a PMS or GMS as a contract, on the grounds that it offers a local population the best mechanism for the provision of general practice services.’

Dr Tony Grewal, medical director at Londonwide LMCs, says he is concerned that such a move in the capital would replace family doctors with ‘short-term, profit-making ventures that go against the ethos of primary care’.

He says: ‘What it means is, over a reasonably short period of time, given the rate at which practices are closing at the moment, you are going to have significant proportions of general practice services in London being run by the commercials or big conglomerates.’

The move comes after a Pulse investigation found more than 100 practices were at risk of imminent closure, prompting the ‘Stop Practice Closures’ campaign, launched last month. Since then, Pulse has learned:

  • NHS England says it is ‘no longer possible to maintain’ two branches of the Kington Medical Practice – Eardisley and Pembridge – in Herefordshire because of problems recruiting GPs.
  • In Sheffield, Sothall and Beighton Medical Centre told its list of 10,000 patients it was likely that ‘very significant reductions in funding’ from a review of its PMS contract may mean the closure of one of their two surgeries.
  • Cauvery Medical Practice in Scunthorpe is set to close in October when two GP partners retire – leaving 3,700 patients without a practice.
  • NHS England is undertaking a consultation regarding six Teeside APMS practices – serving 15,000 patients – whose contracts are coming to an end.
  • Consultations conclude this month on the future of three Hartlepool APMS practices, whose contracts are also ending.
  • The College of Emergency Medicine is the latest major organisation to get behind the campaign, warning that practice closures ‘accentuate the current crisis in urgent care’

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