GPs can shape services by bidding for provider contracts

GPs need to get to grips with the ins and outs of alternative provider medical services (APMS)—a new type of contract for providing primary care services—if they are to compete with private enterprise and shape the future of community health services, says the BMA.

The new contractual arrangement was first outlined in the NHS Improvement Plan in June 2004. It allows primary care trusts to commission medical services from the independent sector, voluntary sector, not for profit organisations, NHS trusts, other primary care trusts, and foundation trusts. They can also commission services from doctors who are on the more traditional contracts for general medical services or personal medical services.

The new alternative provider contract aims to encourage GPs to cover areas in which it has proved difficult to recruit doctors or in which new forms of provision may be needed, such as surgeries offered in the late evening to meet the needs of commuters. Another objective is to improve standards and efficiency in primary care by increasing competition.

But the scheme has already encountered difficulties. United Health Europe, a subsidiary of the US based United Health Group, recently won a bid to run a general practice in Derbyshire. But the award is currently being investigated after a resident challenged its legality (BMJ 2006;332: 68416565102).

In guidance on the new system, which aims to ensure that GPs and commercial businesses have an equal chance when bidding for the new contracts, the BMA says, “While there are many legitimate concerns about APMS, this method of contracting, if fairly implemented, does offer GPs the potential to further shape primary healthcare provision.”

The BMA's guidance provides factual background on the alternative provider contract and suggests ways in which GPs can tender for such contracts and work collaboratively to make a bid to take over other practices.

Hamish Meldrum, the chairman of the BMA's General Practitioners Committee, said, “Along with traditional GP providers of general practice, APMS contracts are open to bids by commercial profit making companies.

“Our view is that there must always be a level playing field in the bidding process. We don't know the extent to which APMS will change primary care, but family doctors need to know all about it both in terms of bidding for these contracts and from the point of view of future working for APMS bodies.”

The alternative provider contract is part of a package of reforms introduced by the government to diversify healthcare providers in the NHS and increase competition and patient choice.

The guidance highlights concerns that the new contract will increase the fragmentation of general practice and threaten continuity of care. It also worries that operating under the “commercial takeover” model may give large independent companies an inbuilt advantage or that they may be given one by commissioning primary care trusts.