Editorial: APMS should not replace existing doctors

How quickly the goal posts shift on primary care's much-vaunted level playing field. It was only a few months ago that, in the wake of the White Paper, we were being told that private providers and APMS contracts would be used to increase access to GP services, especially in under-doctored areas.

To most of us that meant such contracts would bring additional providers into communities or be used to take over practices that could not attract GPs. But now PCTs are putting practices out to tender, even when there are GPs ready to take them over, in the name of 'premium quality and value for money'.

A case in point is Dr Simon Collins, a salaried GP in the employ of Swale PCT in Kent. Over the past four years, Dr Collins has tripled the practice list and won awards for the quality of service he provides. He was keen to take over the practice as a principal. Instead the PCT is putting the practice up for APMS tender.

Swale PCT is one of the most under-doctored areas in England. But its approach to APMS may lose it a clearly popular GP who could be faced with leaving the practice or working for a private provider which will benefit from his hard work. Swale may be short of doctors but there is little to gain from devaluing the work of one it does have.

PCTs in this position need to look carefully at how they use their resources.

These are surely better spent recruiting providers to expand services and develop new practices rather than alienating those doctors already in the area. There is little to gain for patients who, as the White Paper confirms, value continuity of care.

If patient choice is the guiding principle of the latest round of health reforms, this approach to APMS and the private sector is at odds with it. Patients are apparently already using this practice in droves. If the PCT wants real competition it should invite tenders for an additional local practice.

GP shortages are likely to increase before they improve and PCTs need to make an effort to attract GPs, not drive away those already providing care.

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