APMS merger plans could freeze out small providers, GP warns

Plans to force three APMS practices to merge across Sunderland could freeze out small GP providers and undermine patient services, according to a doctor who built up one of the practices over a decade.

GP contract: Three APMS deals could be merged

Sunderland CCG has said plans to bundle three APMS contracts into a job lot for tender will not result in any changes to services.

Commissioners took the decision to merge the practices to make the contract size and price ‘more attractive’ to bidders, ensuring sustainability of services as well as supporting NHS England’s drive for equitable funding across contracts. The plans also aim to ensure greater choice of access for patients.

But a GP at one of the practices said the plan went against the CCG’s own ethos of providing care at a locality level. ‘The worry is that large organisations which run things remotely struggle,' said Dr Ashley Liston of Encompass Health Care in Washington, Tyne and Wear. ‘They don't have the same sense of passion to care for patients, and loyalty to the team, and all these enduring features of general practice. I think that could be lost.’

GP workforce

Dr Liston, who said he built up a failing practice that had no GPs when he took it on in 2004 and has now made it a success, fears he faces a choice of either losing his job or having to take on two more practices in an area with serious workforce problems.

‘I'm just a normal GP, not a big businessman,' said Dr Liston. ‘We have a traditional partnership. In order to win the contract now, I have to work out how I can put [a bid] together, alongside an extremely busy job. [I'm] having to tender - put a bid together - to run my practice. And if I win, I have to run three practices all of a sudden, which is crazy, and if I don't win, I'm out of a job.’

He added: ‘I've no interest in running three practices, I'm interested in caring for my list of patients.’

Dr Liston questioned the rationale of forcing his practice to merge with another over six miles away, undermining the chances of his locality-based federation bidding for the contract.

GP practice mergers

The process, he said, had been ‘geared up’ to favour larger organisations, and now risked losing an experienced GP in an area with serious recruitment problems. ‘Having come and rescued the practice at the beginning, I'm now being rewarded by being tossed out to the marketplace,' he said.

A spokesperson for Sunderland CCG said: ‘We understand that this process can be unsettling, and would like to reassure patients and providers that we are committed to providing quality healthcare while fulfilling our duty to make the best possible use of NHS resources.

‘This will mean a change to the way the GP services are contracted and as a result of the tender may mean a different provider of the service, but there are no changes to the services the new provider will need to deliver.’

The CCG, which has fully delegated primary care co-commissioning powers, has carried out a patient engagement process throughout October and will write to patients again next month.

Photo: iStock

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