Tougher APMS targets to raise bar for all GPs

High performance targets and long opening hours in an APMS contract obtained by GP are set to be rolled out nationally.

Senior NHS managers said the contracts would put pressure on other practices to work longer for no extra pay.

A contract between private firm Care UK and Barking and Dagenham PCT, obtained under the Freedom of Information Act, demands weekday practice opening hours of 8am–8pm and 10am– 2pm on Saturdays at the Broad Street practice in east London.

It will have to deliver 13 enhanced services, be in the top 10 per cent of practices in the PCT for low referrals and emergency admissions, and hit other targets such as low generic prescribing.

Around 30 APMS deals will be rolled out across England in 2007. Senior NHS managers and GPs expect the contracts largely to mirror these tough terms.

Lawyers say the deals will favour large providers, but practices keen to expand will have to accept contracts on these terms to match private competitors.

Justin Cumberlege, a primary care legal expert from Carter Lemon Camerons, said PCTs  were obliged to put all vacant practices out to tender on APMS deals under European law.

He said PCTs may offer vacancies as either GMS, APMS, PMS or PCTMS but, to secure a deal, providers would have to prove they could match the terms of the APMS deals.

The Barking and Dagenham deal allows the PCT to end the contract with six months’ notice. ‘Large firms will be better able to cope with the losses this would bring. Small providers could go bust,’ said Mr Cumberlege.

Care UK operations director Carl Hughes said the list at the Barking and Dagenham surgery had increased from no patients before it opened in July 2006 to 1,500. It aims to reach 7,200.

Dr Barbara Hakin, lead negotiator on the GMS contract for NHS Employers and NHS East Midlands SHA chief executive, said: ‘It will be interesting to see if patients choose to move to practices with longer opening hours.’

David Stout, director of the NHS Confederation’s PCT Network, said APMS deals were likely to push for ‘high standards’.

National Association of Primary Care chairman Dr James Kingsland said: ‘These are the  contracts that PCTs are trying to put in place.’

GPC chairman Dr Hamish Meldrum said that unrealistic APMS targets could cause high provider turnover, leaving patients at risk.

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