Editor Jaimie Kaffash reflects on the issue of APMS contracts replacing GMS contracts
A decade ago, we exclusively revealed that NHS England had decided to replace all GMS contracts that were handed back with APMS contracts. At the time, it made little sense. And, as the years have gone by, it makes even less sense.
In July, we reported that partners at the ‘high-performing’ East Barnwell Health Centre in Cambridge were forced to hand back their GMS contract due to ‘increasing financial difficulties’. Last week, we reported that this has been replaced by an APMS contract that is paying £40 per patient extra.
As the partners told Pulse: ‘Had timely support been offered to us when we were repeatedly raising our concerns, this outcome could have been very different.’
If a GMS practice is struggling – which was the case for East Barnwell, which is in a deprived part of the city – then it is up to commissioners to support them, in the same way they would any hospital. This has benefits for everyone: it provides continuity for patients, it retains GPs who are embedded in the local health economy, and it broadly ensures that funding is geared towards patient care.
Yet the policy to favour new, more expensive APMS contracts over additional support to GMS contracts makes no sense, and highlights the contradiction within APMS contracts.
Because the big problem with APMS for me is that it serves a dual purpose. On the one hand, it is useful when the GMS contract is not adequate for practices who deal with a very particular population, such as homelessness.
Yet that is not its only purpose. Because inherent in APMS contracts is that they are put out to procurement. And, as a result, they tend to be won by larger companies who have experience in winning tenders. Normal GP partners, like those at the East Barnwell Health Centre, won’t beat a company that already runs dozens of practices.
This is not to say all APMS contract holders are cowboys, or offer shoddy care. But I simply don’t think that these companies can offer the same benefits we see from the GP partnership model – from a practice where those who see patients day in day out are the same ones who own the business.
We saw this happen in Lancashire, where commissioners seemed desperate to award a contract to a bigger company, but patient pressure made them award it to the original partners. Sadly, this is an unusual case.
There is a deeper point here, of course. If a practice like East Barnwell is unable to operate on a GMS contract, then we need to take a look at the GMS contract.
But until that day comes, it is absolutely essential that commissioners do all they can to support effective GP partners who are struggling financially. You never know, it might even be cheaper for them – which seems to be the number one priority for commissioners and the Government.
Jaimie Kaffash is editor of Pulse. Follow him on X @jkaffash or email him at [email protected]
Jaimie is quite right : it is those big companies with experience tendering for contracts who will will over GMS GPs, because they know how to win contracts, and all the tricks involved.
Some years ago, a GP practice was providing an MI thrombolysis service at a cottage hospital more than an hour away from the DGH (and more than 4 hours away from that DGH’s tertiary referral and cath lab centre). Helth Board was paying the cost of the Streptokinase, providing free iv access and lines, and providing the hospital bed and staff for recovery afterwards. Health Board decided to put service out for tender (it was before DESes, etc).
GPs tendered on the basis we would provide the service at low cost for doctor time, and that cottage hospital facilities would continue to be used when possible, but unsuitable patients transferred to local DGH or OUR nearest tertiary centre, but included cost of reimbursement of streptokinase in their tender.
Ambulance Trust put in a lower tender for providing the service, and won, but then NONE of the patients were being thrombolysed locally, they were all being transfered to local DGH, which was then paying the cost of the drug, and recovery etc. It turned out Ambulance trust had tendered on the basis of not actually thrombolysing anyone locally, so had not included the cost of Streptokinase in bid, and that was why it was so much chealer, and, obviously, won.
That was not a win for patients or the NHS finances, in the long run, as costs were just shifted to the DGH drugs bill.