Exclusive: APMS contract reviews threaten future of 25 London practices

The future of 25 London GP practices could be at risk as NHS officials look to cut costs through a wave of APMS contract reviews.

GP practice: London APMS services under threat (Photo: Robert Johns)
GP practice: London APMS services under threat (Photo: Robert Johns)

One practice providing 8am to 8pm and weekend appointments could be forced to close after NHS England announced a massive 43% funding cut.

GPs at Barkantine APMS practice, the largest in the east London borough of Tower Hamlets, believe it will be ‘unviable’ under proposals to reduce its operating hours and slash funding.

LMC leaders in the borough where the East London Save Our Surgeries campaign forced concessions over MPIG cuts, believe two local APMS services could face cuts of around £30 per patient. Around 25 APMS practices could be affected across London.

Contract break clause

Lead GP at the Barkantine practice Dr Stuart Bingham said NHS England officials were attempting to use a break clause in the practice’s 10-year APMS contract to impose drastic changes.Dr Stuart Bingham

The rewritten contract would apply the Carr-Hill formula, which NHS England has accepted is not sufficiently sensitive to some deprivation factors, to the practice’s funding - effectively slashing its weighted list size from 18,900 around 15,800.

Combined with a proposed per-patient funding cut, the practice’s income would drop by around 43%. Dr Bingham described proposals to cut the practice’s opening hours as ‘bizarre’.

‘Prime minister David Cameron said a few weeks ago all GPs will be open seven days a week, 8am to 8pm, which we have been for the past five years,’ he said. ‘They are now telling us they want us to reduce to 8am to 6.30pm Monday to Friday and 9am to 1pm Saturday.’

Practice would not be viable

‘We are negotiating with NHS England, but on the facts of the offer, we would not be viable. We have had a meeting with NHS England London and they assure us they don't want us to close. But at the moment we find it hard to see how, with both a reduction in the list size and the reduction in the pounds per patient, it would be viable.’

Dr Bingham said the practice’s funding was agreed by the former PCT as reasonable for the high quality services it provides. ‘We think general practice should be funded up to this level, not down to the lowest common denominator.’

Vice chairwoman of Tower Hamlets LMC and GPC member Dr Jackie Applebee said the proposals were an ‘attack on APMS practices’ which would have knock-on effects for all local practices. ‘It threatens general practice even more than it's already threatened,’ she said.

Dr Applebee said the Save Our Surgeries campaign launched in response to the threat to local practices from MPIG cuts would stand by APMS practices under threat.

Race to the bottom

‘It's not about whether they are being overpaid,’ she said. ‘They invested the money in brilliant services for patients and fantastic premises and they all take very little money for themselves. Are we in a race to the bottom or do we want excellent services for patients?’

A spokeswoman for NHS England London said: ‘There is a national directive to separate the 8am-8pm walk-in service from the service for registered patients at GP-led health centres, which remain the responsibility of NHS England - including the Barkantine practice in Tower Hamlets.

‘Discussions with the Barkantine practice have recently commenced to progress these changes. As NHS England is still in the early stages of negotiations with the Barkantine practice, we cannot comment on any potential reduction in opening hours.

‘The GP registered patient surgery contract will specify the minimum opening hours, and there is the option  for the practice to determine whether to extend those beyond those stipulated to meet the needs of their patients.

‘We are working in collaboration with the CCG to operate extended opening hours for all patients across a number of practices on a federated model to provide an equitable solution to all. It is not viable for every practice to offer its registered patients extended opening hours.

‘NHS England cannot comment on the viability of the practice following the changes.’

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