A GP investigation uncovered more than 120 APMS contracts under review or consultation by NHS England area teams in August and September.
Some could face closure, while others are expected to be reprocured on reduced per-patient funding as area teams capitalise on time-limited APMS contracts coming up for review to force down costs.
In London, GP understands 25 GP-led health centres could have break clauses in their contracts invoked by NHS England to push through funding cuts. One practice said its funding could be cut by 43%, leaving it unviable (see case study, below).
Shadow health secretary Andy Burnham told GP he feared NHS England had forgotten lessons from the past that led the previous government to put more money into under-doctored areas through APMS contracts.
The revelations will compound fears over the threats to GP services from MPIG withdrawal, PMS
reviews and other funding and workforce pressures.
In consultations, NHS England area teams have said APMS contracts are often more expensive than other contract types and some had failed to attract enough patients.
Last week Cumbria, Northumberland, Tyne and Wear area team announced the closure of Wearside Medical Practice, one of four APMS services in Sunderland, citing value for money and a low patient list.
In August, GP revealed that Durham, Darlington and Tees area team cited value for money in consultation over several APMS practices. Eleven of the area’s 14 APMS practices are currently under review, seven of which could be closed.
Many of the services under review were opened under the last government’s drives to encourage new services in under-doctored and deprived areas, when hundreds of new APMS contracts were awarded.
Providers of some of the services under review told GP they had been given little information about the
options area teams are considering.
One practice manager in the north-west of England said she believed there would be closures in her area.
Many contracts are up for review now because they were commissioned at about the same time. However, others are understood to have been given initial extensions, but then called in for review.
Speaking exclusively to GP at Labour’s annual conference in Manchester, Mr Burnham said he was ‘worried’ by the reviews.
NHS England, he said, was ‘almost forgetting the lessons of the past, which were that general practice wasn’t getting to some parts of the country’.
‘It is saying, why does this one cost more than that one,’ he said. ‘But actually there were good reasons.’
Mr Burnham said no practices should be closed because of funding changes. The whole of GP funding should be reviewed, he added.
Managing director at provider IntraHealth, Greg Moorhouse, said most of its 13 contracts are under review or have recently been reviewed. Most were awarded for five years in the mid-to-late 2000s in areas of high health inequality with historic underprovision.
He said these conditions had not gone away, so he was optimistic most contracts would be reprocured.
The current NHS vision for providing at greater scale was partly behind the concerns over APMS list sizes, said Mr Moorhouse. Area teams were also looking to introduce consistent per-patient prices, as with GMS and PMS contracts, he said.
Area teams with high numbers of reviews include Greater Manchester, with about a third of its 37 APMS contracts under review, South Yorkshire and Bassetlaw, with nine out of 12, Kent and Medway, with nine out of 15, and Wessex with seven out of nine under review or consultation.
A spokesman for NHS England said: ‘NHS England inherited a number of APMS contracts, including those established under the DH 2007 Equitable Access Programme.
‘NHS England will review such arrangements on a case by case basis and depending on local circumstances and recognising it has a responsibility to secure high quality general practice for all patients.’
Case study: London practices under threat
A practice providing 8am-8pm and weekend appointments could be forced to close if a massive 43% funding cut goes ahead.
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 about £30 per patient. Some 25 APMS practices could be affected across London.
Lead GP Dr Stuart Bingham said NHS England officials were attempting to use a break clause in the practice’s 10-year APMS contract to impose changes that would cut its weighted list size from 18,900 to about 15,800.
An NHS England (London) spokeswoman 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.’