Why GPs remain the providers of choice

Does the creation of the APMS contract mean all GPs will be salaried and working for Tesco in the near future?

It would appear not if research by the King's Fund into organisations awarded the first APMS contracts is anything to go by.

Last year Chris Town, chairman of government White Paper advisory group the Working in Partnership Programme, forecast that up to 30 per cent of practices in England could be run by private firms by 2010. His theory was that the actual level would be determined by the willingness of existing practices to expand.

This week GP reports that Boots, Asda and Virgin are all targeting primary care in different ways. So far, so worrying. But now to the researchers at the King's Fund for the encouraging news. They found that of the first 34 APMS contracts to be awarded by PCTs, 24 went to entrepreneurial GPs ahead of private firms.

Not only that, but some PCTs had reversed their decision to provide alternative-provider-run primary care services, preferring to use APMS to contract with traditional GP organisations.

At a time when the DoH is seeking to cap practice income and Wessex LMC has launched a campaign highlighting the value for money offered by primary care, this show of faith from PCTs is heartening. Patients can be assured that not only does their GP only cost them 20p a day, as the Wessex LMC campaign highlights, but he or she is involved in winning three quarters of new APMS contracts in potential competition with private firms.

However, there are reasons not to celebrate just yet, including the possibility that PCTs have been slow to take up the change offered to them because they have been undergoing their own structural re-organisation. The researchers say that PCTs are being cautious about using the flexibility of the APMS contract to commission alternative types of primary care provider from the commercial sector.

They say that the values of the PCT board and senior NHS managers may be influencing decisions about the use of the independent sector. Whatever the reasons, many PCTs and their GPs have not been the closest of friends for some time now. PMS GPs in Coventry and Suffolk, facing threats of revised contracts, would certainly agree with that.

However, the fact remains that since April 2004 the APMS contract has existed as a way of employing the private sector to run GP practices.

The message that entrepreneurial GPs and traditional general practice is the option of choice for almost three quarters of PCTs must not be ignored by those at Richmond House.

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