Practices face closure as APMS contracts deemed 'less value for money'

APMS deals offer less value for money than other contract types, an NHS England area team seeking to consolidate a group of local practices has admitted, despite the national organisation insisting the controversial arrangement is used for all new GP contracts.

New GP contracts must be APMS, NHS England has said (Photo: Jason Heath Lancy)
New GP contracts must be APMS, NHS England has said (Photo: Jason Heath Lancy)

NHS England's Durham, Darlington and Tees area team, which is seeking to close one APMS practice and merge two others, said this contract type was often not as good value for money as GMS or PMS deals on a 'like-for-like' basis.

This is despite NHS England confirming that any re-procurement of practices that terminate their contracts would have to be arranged under APMS to avoid discriminating against commercial providers.

GPC said APMS did not benefit patients or the public purse.

GPs have previously raised fears that the current threat of practice closures could be used to encourage commercial providers to take over services.

'Cost-cutting project'

NHS England officials in Hartlepool published proposals to merge two existing APMS practices under a new contract and to close a third as part of what local politicians called a ‘cost-cutting project’. 

The area team is consulting until 29 September on proposals to merge services provided by Fens Medical Practice and IntraHealth Wynyard Rd Primary Care Centre under a new contract, and to decommission Intrahealth’s Hartfields Medical Practice, based at a retirement village. 

The APMS contracts have all been extended beyond their initial standard five-year terms, originally commissioned by the local PCT, while commissioners consult on the future of the services.

In its consultation document, the area teams said many APMS practices’ list sizes across the country were ‘significantly lower than the original plans’.

‘In a lot of cases, the current APMS practice numbers are significantly lower than the original plans. Local APMS contract costs are often more expensive than PMS and GMS contracts. Although APMS contracts often offer elements of service that are additional to PMS and GMS contracts in some cases, on a like-for-like basis APMS contracts still represent less value for money than the other contract types,’ it said.

Practices 'performing well'

The document revealed that the three practices had significantly lower list growth than expected. Fens practice should have reached 4,800 patients by March 2013, but still has just 2,773. Wynyard practice was expected to reach 5,100 patients, but has just 1,964 on its list. Hartfields should have 6,000, but has only 2,172.

Commissioners admitted, however, the practices under threat are performing well, with two achieving above-average QOF scores, all three scoring well in patient surveys, and two performing at a ‘consistently good’ level on all key performance indicators.

Local councillors Paul Beck and Jean Robinson, who represent a ward served by Hartfields practice, said the proposed loss of services was ‘unacceptable’ and ‘another cost-cutting project’.

Dr David Anderson, organisational medical director at IntraHealth, said a meeting of patients at Hartfields last week unanimously backed retaining the practice.

He said: ‘IntraHealth were asked about value for money; we stated at the meeting that we would anticipate that any new service would have its price set to local benchmarks as directed by NHS England, therefore service design would be set around list size and NHS financial envelope. We confirmed at the meeting that IntraHealth would tender for this service.’

Cleveland LMC said it is consulting members on the proposals. 

APMS mandate 'avoids breaching competition rules'

Meanwhile, NHS England confirmed that all new procurements of GP services must result in an APMS contract in order not to discriminate against certain private commercial providers in breach of competition regulations.

There had been no new policy decision requiring APMS contracts, an NHS England spokesman said, as the relevant regulations had applied to the body since it was formed. 

While new GMS contracts may still be entered into by reversion from a PMS contract, the spokesman said, a re-procurement following a terminated contract should result in an APMS contract.

Despite the conclusions by its Durham, Darlington and Tees area team, the spokesman said NHS England nationally had not commented on the value for money of APMS. 'Value for money depends on what the contract is being used for', he said. 

In its Call to Action on General Practice: Phase One report in March, NHS England said it would use procurement processes to bring in new providers when practices close, and develop longer-term APMS contracts to encourage new providers.

GPC deputy chairman Dr Richard Vautrey said many areas of the country had learnt through experience that ‘APMS contracts do not offer long-term benefits for patients or the public purse’.

He said: ‘Patients want GPs and practices to commit for the long-term, for them to have a GP they know and trust who will support them and their families for years to come. APMS contracts don't offer this and NHS England is letting patients down if it continues to promote this to the exclusion of GMS or PMS.’

Fens Medical Practice did not respond to a request for comment.

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