The model of GPs running practices providing continuous care with a financial stake as a partner under a GMS or PMS contract has served the NHS very well. The model has many merits and it would be a great loss if this model ceased to exist.
However, partnerships are clearly less attractive than they once were. When single handed GPs retire many NHS England area teams are struggling to find a replacement.
APMS contracts have been increasingly used by primary care commissioners to allow providers to run GP practices partially as a response to the recruitment problems they are faced with. There has been considerable criticism of this model - some of the comments are accurate while others are not.
Cost is one such criticism but this is due to detail of an individual contract rather than APMS as a model. I see APMS as a modern solution to a problem rather than demise of the independent contractor status which reflects a changed world.
I have been involved in working with APMS providers of GP services and there are benefits. Firstly APMS contracts can be used to contract a number of practices in an area or even further afield. The advantage of this is that it can bring groups of practices together under one provider.
The financial benefit can be that the provider can use economies of scale for back-office services. For instance, is it necessary for five single-handed practices each to have a practice manager, secretaries and staff booking appointments? Equipment and more specialist services and facilities can also be shared or several small local practices could be brought under one roof with a variety of advantages.
From a clinical care perspective, most APMS contracts have key performance indicators that can be used by commissioners to encourage a more effective approach to public health issues such as smoking and obesity. There can also be peer-to-peer support both on a day-to-day basis and with joint educational sessions over a provider group.
With clinical staffing an issue, a provider organisation can employ people to work in more than one place, so help to smooth short- to medium-term staffing issues. This can be further enhanced by making use of different working models using a wider variety of staff.
APMS is no universal solution
For GPs, working hours and other contractual issues are better circumscribed with support and all the benefits that being an employee provides. The salary may be less than the headline rates for partners but if one works out the whole package and the hourly rate then it may be more comparable than it first appears.
APMS does not provide a universal solution, but it is an option and one that CCGs are likely to increasingly explore when they begin taking responsibility for primary care budgets. APMS contracts are time-limited and the contracts need to be of longer duration with less risk of a provider being 'turfed out' even if they are performing well, and I see that this is currently an issue.
I also would like to see an option for GMS/PMS contracts to be transferred to APMS more easily if a suitable GP could not be found or where a partnership wish to become part of a provider group.
Dr Charlson was writing in his role as a Hull GP and One Medical Group director. His comments do not reflect the views of any political party.