Published: 12/08/2004, Volume II4, No. 5918 Page 5 6

Primary care trusts are advertising for commercial firms to run core GP services under Department of Health plans to open up the primary care market.

A new alternative provider medical services (APMS) contract has been devised so that PCTs can encourage competition for primary care services.

HSJ understands that PCTs have been told by the DoH that they must consider using APMS if they expect practices to struggle to meet GP access times.

Privately run groups of GPs have already begun to run core services under existing personal medical services contracts. But until now there has been no scheme which allows major companies to provide these kinds of services.

The Department of Health and NHS Confederation have established a 'stakeholder forum' to discuss the future of APMS, which includes major private sector players such as Pfizer and Mercury Health, 15 PCTs, voluntary sector organisations and other bodies like the British Medical Association. The forum expects to produce an interim report on the future of APMS next month, but PCTs are not waiting for that to be published.

City and Hackney teaching PCT is among those that have decided to advertise all future gaps in services to the private sector under APMS, as well as to NHS providers such as existing GP practices. Its director of primary care and community services Steve Gilvin said APMS would 'add a fourth option to the way we can provide services to our patients'.

He admitted that his PCT would be unable to provide sufficient capacity without using the private sector. And he said he suspected his PCT was not alone.

Mr Gilvin said his PCT was 'yet to test the market', and he suspected that the private sector's capacity to provide these services was currently limited. But he said his PCT's professional executive committee had been consulted over its decision and reluctantly agreed that it was a necessary step:

'Many of our local GPs feel very anxious about the involvement of the private sector. It is not just competition; they genuinely worry about continuity of care.'

Nottingham City PCT is also considering using the private sector under APMS to help meet patient access guarantees, as well as replacing a slew of retiring single-handed GPs.

A spokeswoman said the PCT would need the backing of its PEC, but that it was watching developments in APMS closely.

ChilversMcCrea Healthcare was the first private firm to run GP practices under PMS contracts after it initiated talks with the DoH 18 months ago. It now runs practices in Essex, east London, and Brighton. Chair Dr Rory McCrea said he expected a 'push' from the DoH for PCTs to use APMS.

He said that this could offer his firm the chance to consider floating on the stock exchange to raise investment funds. This would only be allowed under APMS.

He said many PCTs were planning to advertise to fill gaps in GP services under APMS contracts because it would 'bring the best of corporate structure to what is effectively a cottage industry'.

He said he viewed APMS as a solution for PCTs when PMS or general medical services could not provide the answer, but he believed it would not mean the 'privatisation of general practice'.

Dr McCrea, who is also PEC chair for Epping Forest PCT, said his organisation would ensure that clinical requirements, not contractual structures, were the driving force for primary care provision.

Commons health select committee chair David Hinchliffe said he would be 'uneasy' with any increased use of the private sector to provide primary care which he said was a 'short-term fix', that should instead be solved by providing more NHS GPs.

A spokeswoman for the British Medical Association commented that she did not expect the use of APMS to 'open the floodgates' for private provision, but she said the BMA would 'keep a close eye' on the situation to ensure that any growth in the market for private provision did not 'erode the ethos of general practice today'.

APMS: the fourth way

There are now four ways that primary care trusts can provide primary care services on their patch: general medical services;

personal medical services; primary care trust medical services; and alternative provider medical services.

Guidance for PCTs when setting up APMS contracts, advises them to consider:

l service specifications, which could include links to the GMS quality and outcomes framework;

l price, which will be negotiated solely between the PCT and provider;

l that the PCT must negotiate a method for performance monitoring of contracts;

l that APMS contracts must stipulate what sanctions, including termination of the contract, may be imposed.