DoH denies GPs extra help for APMS

As the debate on private providers continues, Nick Bostock spoke to Lord Warner.

Much of the debate about alternative provider medical services (APMS) contracts in England has focused on the need for a level playing field.

Many GPs, along with the GPC, believe large corporations bidding for contracts have a huge advantage over GP practices.

Such firms have staff dedicated to putting together winning bids for work, experience of commercial tendering processes and plenty of financial backing.

But despite pledging his commitment to a level playing field at last month's LMCs conference, health minister Lord Warner revealed this week in an interview with GP that his view of what this meant was very different to the GPC's.

Lord Warner told GP he was 'chary' of any extra support for GPs. He argued that GPs had an advantage over other bidders for contracts in their area: 'The people who know their particular area, know what their community's needs are, start with an advantage over an outsider.'

He was disparaging about GPs' motives for complaining about the bidding process.

'Sometimes, why you are having the competition is because people are dissatisfied with the existing providers,' he said. 'You are going to have a bit of noise in the system, I suspect, if you open up areas of service to new providers when people have been quite comfortable with the present set of arrangements.'

The GPC wants funded locum cover to allow GPs to take time out of their everyday practice responsibilities and switch their attentions to bidding for contracts. It also wants a guarantee about transparency, and support from PCTs to help practices draft bids for contracts.

GPC deputy chairman Dr Laurence Buckman said: 'We need someone to work with all bidders, GPs or otherwise, to help them design and put forward proposals in a manner that trusts will favour.

'This is for the benefit of the NHS - if the taxpayer is going to have the best possible bidding process and the best possible deal, everyone needs support.'

But Lord Warner said much of the debate over private involvement in the NHS was artificial.

'GPs are small businessmen and have been operating profit and loss accounts since the beginning of the NHS, that is the reality,' he said. 'The idea that they are not capable of organising their affairs in a competent manner is slightly insulting.'

A level playing field, he said, could be achieved by ensuring PCTs allowed all bidders enough time to draw up proposals, and clarity over the rules of bidding and the service to be provided.

Although this view clashes with GPC thinking, other GPs have no problem with it. National Association of Primary Care chairman Dr James Kingsland said: 'If practices want to compete, why should they get pump-priming?'

He said APMS contracts were there to allow PCTs to 'plug the gaps' in primary care, and that they would be used to bring in providers to areas where 'the current NHS family was not delivering', and where GPs had shown no previous interest in working.

He added that the contracts were not financial free-for-alls. 'These are the most difficult jobs in primary care - practices should be focusing on delivering practice-based commissioning, not competing for APMS contracts,' Dr Kingsland said.

The disagreement between the DoH and the GPC on the need for help for GPs to compete against private providers can only add to the disquiet some GPs feel over the increasing role of the private sector in primary care.

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