GPs face APMS fight for practices

PCTs are favouring private providers and APMS bids in the race to run the 250 new practices for England, says Tom Ireland.

The future of GMS and PMS contracts could be limited as the DoH's appetite for alternative providers medical services (APMS) contracts grows.

The DoH has confirmed that all of the 250 new practices proposed in Lord Darzi's interim report are 'likely' to be run with APMS contracts.

There is also concern about premises funding for non-APMS practices.

It seems natural that the private sector's attention will switch to primary care after the government said last month that it has halved the number of contracts available for independent sector treatment centres (ISTCs) and diagnostic services.

Advantages in expansion
Health minister Ben Bradshaw said there would be 'enormous opportunities' in the expansion of primary care facilities.

'That's where people should be turning their attention - and they are.

'There is a lot of (private sector) interest in health centres and polyclinics,' he told the Financial Times.

It all points to a proliferation of APMS contracts to the detriment of GMS and PMS.

GPC negotiator Dr Chaand Nagpaul said that GMS and PMS providers were being treated unfairly.

'There are parallels between ISTCs and this fixation on bringing APMS providers into centres in primary care,' he said.

'In a similar fashion, hospitals were willing to provide extra services just as PMS and GMS practices are. Both end up being kept out of the loop and money goes into private services.'

GPC negotiator Dr Peter Holden announced last month that, in England, PCTs had been instructed to accept only APMS bids when procuring GP services, explaining why GMS and PMS practices were being rejected at the first stage.

'This is evidence of actual prejudice, where the policy is already APMS only. It's hardly open-minded,' he commented.

Dr Peter Graves, chief executive of Bedfordshire and Hertfordshire LMC, confirmed the GPC's concerns that the procurement programme is geared towards attracting limited companies rather than small practices. In this area three 'high quality' practices were rejected after handing in their pre-qualification questionnaires (PQQs) using PMS or GMS.

'We should now be asking questions at a national level whether this is a level playing field or if it is actually a national instruction,' Dr Graves said.

'There are questions in the PQQ that are difficult to answer for small practices.'

Last month the NHS Alliance called for greater managerial support for practices to enable them to compete with larger private companies.

A DoH spokesman said: 'No final decisions have yet been made about the precise procurement process, but it is likely that PCTs will use APMS contracts.

'This would ensure that the fullest possible range of potential providers, including existing GP practices, are able to put forward innovative proposals.'

Entrepreneurial streak
Dr Adrian Jacobs, an NHS Employers' GMS negotiator, told the NHS Alliance conference in Manchester last month that to secure business, GPs would need to develop an entrepreneurial streak to compete with large companies.

'The desire for primary care contracts to become contestable will increase,' he said.

'Entrepreneurial GPs are snapping up failing practices. Companies like Boots and Tesco are waiting in the wings.

'Successful practices will require local deals beyond GMS, with consumer focus, developing self-care. To be financially successful, you will need to take greater risks,' he added.

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