A scheme allowing primary care trusts greater sway over GP services could be the 'tip of the iceberg' in exposing family doctors to competition.

The Department of Health has renewed its attempt to get GPs into under-doctored areas, working with nine PCTs that are seeking bids to run their GP services.

The scheme, called Fairness in Primary Care procurement, will see care provided under an alternative provider medical services (APMS) contract, allowing PCTs to specify obligations such as longer opening hours. The bidding is open to independent and third-sector providers, as well as existing practices.

County Durham; Great Yarmouth; Hartlepool; and Nottinghamshire County PCTs are in the first tranche of the schemes. Ashton, Leigh and Wigan; Bolton; East Lancashire; Luton; and Manchester PCTs are in the second. An additional second-wave scheme is seeking bids to run a family planning and sexual health service (see list below).

Independent providers Care UK, ChilversMcCrea and Clinovia have confirmed they are making bids for at least one of the contracts.

HSJ understands there have been around 40 bids for the first-tranche contracts. The DoH expects the deals to be awarded in early 2008.

ChilversMcCrea chair Rory McCrea said APMS contracts can be tailored to the population. By including specifications such as longer opening hours, they would force other practices to compete.

He admitted GPs could see the move as a threat. 'But once they get over that they will look at what they can do to compete,' he told HSJ.

'Small practices can do it but it takes resources. Big companies have the financial and managerial support but small practices have know-how and local knowledge.'

NHS Alliance chair Dr Michael Dixon voiced concern that these contracts would be 'the tip of the iceberg'. 'We may see a creep' of APMS contracts into areas where there is not a problem with provision, he warned.

'Some competition would be good but PCTs need to be extremely subtle and sophisticated. If they try to use APMS to put a bomb under local GPs it could be counter-productive when trying to get them to sign up to practice-based commissioning.'

British Medical Association GPs committee chair Dr Laurence Buckman said: 'While we have concerns about introducing private providers into general practice we recognise there is a need where there are no practices to do the work. We would be concerned if PCTs used this to get private providers in areas where NHS services are provided.'

But NHS Confederation policy director Nigel Edwards said that while some might use APMS as a competitive lever to improve access, he did not feel it would be used where provision was not a problem.

Previous attempts by the DoH to get provision in under-doctored areas were drastically scaled back. Just two of six pilot PCTs went ahead with the plan under an earlier national procurement programme.

Barking and Dagenham PCT signed a deal with Care UK to provide a practice. Mercury Health, which has been taken over by Care UK, also provides two practices in City and Hackney PCT.

Care UK managing director Mark Hunt said the new system is better because there is a promise of a larger number of patients to sustain a practice, there is an emphasis on local knowledge and the process is more streamlined.

Great Yarmouth and Waveney PCT chief executive Michael Stonard said the trust was establishing a primary care medical service in the most deprived community.

'Improving access to primary care services is not just about geographical location, it's also about opening hours and this process enables us to address both issues.

'We know some practices are watching carefully and have said they will review their opening times if the extended hours are popular with patients.'

The contract scramble

Tranche one

  • County Durham PCT: one general practice
  • Great Yarmouth and Waveney PCT: one general practice
  • Hartlepool PCT: three general practices
  • Nottinghamshire County Teaching PCT: primary care centre, including a general practice

Tranche two

  • Ashton, Leigh and Wigan PCT: several general practices
  • Bolton PCT: one general practice
  • East Lancashire PCT: one general practice
  • Luton Teaching PCT: two general practices
  • Manchester PCT: one general practice
  • Trafford PCT: sexual health and family planning service