Loophole in APMS contracts threatens primary care stability, enquiry warns

A serious loophole in APMS contracts allows GP practices to become a 'commodity traded in the private market', an enquiry into the closure of a London practice run by a private company has found.

Camden Council called for greater transparency on deals with private firms involved in running NHS services (Photograph: Alamy)
Camden Council called for greater transparency on deals with private firms involved in running NHS services (Photograph: Alamy)

Camden Council’s Health Scrutiny Panel of Enquiry report into the closure of the Camden Road Surgery in north London, due to be discussed at a council meeting tonight, is urging the NHS Commissioning Board (NCB) to take ‘prompt action’ to prevent a repeat of the incident.

The panel hit out at private companies involved in running the surgery for failing to provide evidence to the enquiry, and called for greater transparency on deals with private firms involved in running NHS services.

Private healthcare firm United Health won a five-year contract to run the Camden Road Surgery in 2008, but then transferred the contract to another provider, The Practice plc, in April 2011.

A year later, in April 2012, the surgery was shut down when its premises lease ran out, forcing its 4,700 patients to register elsewhere.

The report reads: ‘There appears to be a serious loophole in the national contract for alternative providers, which allowed United Health to transfer the contract.

‘The panel were of the view that this was a serious loophole. In our view, primary care by GPs should not be a commodity traded in the private market and prompt action should be taken by the NHS Commissioning Board, which will be responsible for commissioning primary care, to remedy this.’

Minimise use of locums
The panel said it would welcome further discussions with NHS North Central London and with the NCB on how contract specifications can best ensure continuity of care and to minimise the use of locums.

Its report reads: ‘Contracts should promote the long-term commitment to continuity of GP care, to counter the concerns expressed in evidence that large private providers have less commitment to a local population.’

The enquiry said it welcomed the prospect that from next April councils’ health and scrutiny committees will have enhanced power to require private health providers and GP practices to go before them.

It said: ‘A regrettable aspect of this enquiry was the failure of United Health or The Practice to provide any evidence whatsoever.

‘We welcome the decision of the Information Commissioner’s Office to order Camden PCT to disclose details of the contract with United Health, including the pricing, and believe further consideration needs to be given by the NHS Commissioning Board to the transparency of contractual arrangements as the market for alternative providers increases.

‘The Panel were concerned that there does not appear to be an open and transparent protocol for monitoring performance in primary care, which is understood by the public and public agencies.'

The report added: 'In the absence of any evidence to the contrary we have no reason not to believe that the reason for United Health UK’s decision [to transfer the Camden Road contract to The Practice plc] was their desire to concentrate on providing services to the GP commissioner consortia being set up under the National Health and Social Care Act 2012.’

A spokeswoman from United Health UK said:  'In our time working with the Camden practices, we made substantive improvements across all three of the surgeries we ran. Quality improved at each practice, including the Camden Road Surgery, year on year.  During our tenure the practices extended their opening hours and new services including chronic disease clinics and childhood immunisation programmes were introduced.

'Wherever we had a full QOF review - the independent measure of quality - the scores increased; and when patient satisfaction surveys were completed, results were impressive.

'All our dealings with Camden NHS were completely transparent and met all our contract requirements. Camden Council’s report in large part investigated events which occurred after our work in the area so we did not feel it was appropriate to comment.'

Spokespeople for the Practice plc were unavailable to comment.

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