GP anger over 'destructive' APMS policy from NHS England

GP leaders have warned that an NHS England policy which opens up practice contracts to competition with commercial providers could irrevocably damage continuity of care and see 'swathes' of general practice handed to private companies.

The GPC accused NHS England of failing to follow government regulations, after the body vowed to use only controversial, short-term APMS deals for all new practice procurements.

This contract type allows non-NHS and private providers to bid to run practices. NHS England said APMS deals must be used in all new procurements to avoid discriminating against certain types of provider and breaching competition regulations.

Senior GPC figures said the policy represented poor value for money and warned it could ‘destroy the entire ethos of long-term holistic care that general practice is based on’.

GPC chairman Dr Chaand Nagpaul has pledged to write to NHS England to contest the policy, following advice from BMA lawyers.

NHS England said that while the law does not require a full procurement process to be operated in all circumstances, where it is undertaken, APMS deals must be used.

Threat to practices

GPs have warned that the threat of practice closures could be used to encourage commercial providers to take over services, which would be procured under fixed-term APMS contracts, typically for five years.

GP reported in May that commercial providers were seeking to take over practices forced to close by funding pressures and looking at longer-term APMS contracts to assist them.

NHS England has previously vowed to use procurement processes to bring in new providers when practices close, and develop longer-term APMS contracts to encourage new providers. Its APMS procurement policy has not changed since April 2013, when the organisation was formed. But GP leaders said this was the first time the policy had been made explicit.

While new GMS contracts may still be entered into by reversion from a PMS contract, an NHS England spokesman said, reprocurement following a terminated contract should result in an APMS contract.

Dr Nagpaul told GP that commissioners must consider the best service for patients, the best use of resources and the most appropriate provider. ‘Our legal advice is that to make that decision, to replace or procure a GP contract to APMS without considering and then justifying that decision for open competition, is not in keeping with the regulations and Monitor’s guidance.’

Commissioning a GMS contract with no open procurement would be the most appropriate option in some cases, he said. ‘There is provision within the regulations not to use competition,’ he added.

‘I believe this is misguided and it will result in unnecessary, additional expense and poor value for money, and it will not provide the continuity of care patients need. It will incur greater administrative and bureaucratic cost for area teams, as well as greater costs of the contract itself.’

Dr Robert Morley, chairman of the GPC contracts subcommittee, said NHS England was ‘using competition regulation as an excuse to stop awarding GMS contracts and open general practice to short-term commercial contracts against the interests of patients’.

He asked: ‘Why not say, tenders are invited and the type of contract will be determined depending on who is the successful bidder?

‘If we are not going to get any more long-term contracts awarded for general practice, it is going to destroy the ethos of long-term holistic care that general practice is based on.’

He added that, with the threat of practice closures, ‘we run a risk that huge swathes of general practice are going to be handed over to the private sector with short-term contracts’.

Procurement law

An NHS England spokesman said: ‘Procurement law requires NHS England to award contracts in a manner that is non-discriminatory between providers on the basis of ownership.

‘Whilst the law does not require a full procurement process to be operated in all circumstances, where a process is operated, it should clearly not discriminate against any particular provider or class of providers – this is an explicit requirement of the regulations, as well as being consistent with the generally applicable overarching EU principle of non-discrimination.’

APMS contracts ‘less value for money’

Commissioners in the north-east of England have admitted APMS contracts are often ‘less value for money’ than GMS or PMS, during a consultation on the future of nine local practices

Amid the unfolding row over the use of APMS contracts in new procurements, the comments were made during an NHS England consultation on the future of nine practices across Durham, Darlington and Teesside, some of which could be closed.

Councillors in Hartlepool, where an APMS practice on the site of a retirement village faces closure, called the plan an ‘unacceptable, cost-cutting project’.

A spokeswoman for NHS England’s Durham, Darlington and Tees area team said the APMS contracts under review were ‘high value’, providing similar services to GMS/PMS. She said: ‘It’s not the APMS contract form that dictates what value for money is achieved; it’s how the contract form is used.’ Any reprocured services, she added, would be contracted under APMS and would aim to ensure value for money.

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