The introduction of APMS contracts in 2004 has not led to improvements in quality and could actually have worsened care, researchers from Imperial College London said in the Journal of the Royal Society of Medicine.
The researchers looked at practices under GMS, PMS and APMS contracts from 2008-13, taking data from the Health and Social Care Information Centre and the national GP Patient Survey.
They assessed all practices in England on 17 key indicators including clinical measures, patient ratings and efficiency.
Quality vs diversity
‘Traditional’ GP practices with GMS and PMS contracts come out on top when judged on 15 out of 17 indicators, such as the number of patients whose BP and diabetes is kept under control, hospital admission rates for chronic conditions, cervical screening rates, and overall patient satisfaction.
APMS practices scored better when the study authors looked at patient satisfaction with opening hours and the percentage of statin prescriptions that are low-cost.
The study results show that diversity of care providers does not necessarily lead to better quality for patients, and in some cases the opposite is true, the researchers say.
Dr Christopher Millett, lead author of the study, from the School of Public Health at Imperial, said: ‘The lesson is that increasing diversity does not necessarily lead to better quality.
‘Regulators should ensure that new providers of NHS services are performing to adequate standards and at least as well as traditional providers.’
APMS practices, which account for 4.1% of practices in England, were found to be smaller and served more diverse and more deprived populations than other providers.
Even after adjusting for these variables, the researchers said the ‘patterns of poor performance are concerning and merit further examination’.
APMS providers ‘may be acting to maximise profit from pay-for-performance systems and shifting costs from primary care to secondary care’, the study authors wrote.
‘As general practice in England gradually evolves from a ‘cottage industry’ into something that may look more corporate, it is important that the impact of these changes on quality, expenditure and utilisation is carefully evaluated.’