REVEALED: ALL NEW GP CONTRACTS WILL BE THROWN OPEN TO PRIVATE PROVIDERS
From the FMS Global News Desk of Jeanne Hambleton PULSE 18 August 2014 | By Alex Matthews-King
All new GP contracts will be opened up to bids from the private sector by NHS England in a move that GP leaders have warned marks the ‘death-knell’ of traditional life-long general practice.
As a tide of practices face closure, managers have told Pulse that because of competition law they will not be replaced with GMS or PMS contracts, but with time-limited APMS contracts instead.
The move has taken GP leaders by surprise, with the GPC seeking urgent legal advice about the move. Some have warned it will lead to the privatisation of the NHS with surgeries replaced with ‘short-term, profit making ventures’.
APMS contracts were introduced in 2004 to open up primary care to ‘new providers’ and were famously used to procure the Labour government’s ill-fated ‘Darzi’ centres across the country.
In October last year, Pulse revealed that NHS England’s London area team was planning to procure a ‘significant’ number of APMS contracts this year.
And managers say this policy has been adopted nationally, to ensure that NHS England complies with competition regulations.
An NHS England spokesperson said: ‘Under the GMS regulations there is scope to enter into a temporary contract but this is at clear odds with procurement law and the 2013 regulations so best practice would dictate that this should not be used when APMS effectively does the same job and does not come with the same risks attached.
‘GMS can still be entered into upon reversion from PMS and the new form of PMS contract may be entered into by way of renegotiation (ie variation) but in respect of procurements, yes they should all be on APMS.’
Pulse has previously revealed an increasing trend towards APMS contracts. In February, NHS competion watchdog Monitor launched a probe on how to attract new general practice providers to regions with poor care, despite warnings from the GPC not to put ‘competition ahead of continuity’.
GP leaders are warning that, with practices under increasing workload and financial pressure, strict tender requirements could exclude smaller practices from primary care and drive the invasion of private providers.
And they are advising practices to seek alternatives to contract termination, for example by merging, when partners reach retirement in order to avoid losing ‘invaluable’ GPC contracts.
GPC chair Dr Chaand Nagpaul said he was surprised to hear about the national policy that would ‘spell the death knell of the whole ethos of long-term, continuity of care in the way general practice operates’.
He said the GPC was seeking urgent legal advice on whether NHS England was correct in asserting that APMS contracts were the only way to satisfy international procurement law.
He added: ‘It’s extremely unfortunate, and highly ill-advised that area teams should be undermining secure, long-term sustained provision of general practice through APMS contracts. There is nothing to stop an area team choosing to use a PMS or GMS as a contract, on the grounds that it offers a local population the best mechanism for the provision of general practice services.’
Dr Tony Grewal, medical director at Londonwide LMCs said they were worried about the moves in the capital that would replace family doctors with ‘short-term, profit making ventures that went against the ethos of primary care’.
He added: ‘APMS is only for five years, potentially renewable, which means that you cannot invest time, you cannot invest in the long term. It is designed for people to go in, to make a profit, and to go out again. Which is not, in my opinion, what general practice is about.’
‘What it means is, over a reasonably short period of time, given the rate at which practices are closing at the moment, you are going to have significant proportions of general practice services in London, being run by the commercials or big conglomerates.’
And Dr David Jenner, GP contract lead at the NHS Alliance and a GP in Cullompton, Devon, warned that the move would mean that independent GPs would struggle to compete with larger healthcare corporations.
He said: ‘Often minimum requirements of IT, quality, financial backing, in practice can make it difficult for small providers to effectively compete.
‘It can be a very inefficient way of procuring a service of limited value. There is also the danger of providers bidding low to win the contract and then being unable to meet the terms of it.’
BMA Council member and Lewisham GP Dr Louise Irvine told Pulse: ‘I am worried about that becoming the new model of care, we have already seen new models of private companies bidding for these APMS contracts, some of them have been successful and it is hard for ordinary practices to bid against them.’
She added: ‘It is very much part of a trend, it is part of this big push to privatise, to commercialise and bring in private, for profit companies to run more and more, not just primary care, but community and secondary hospital care.’
MONITOR LAUNCHES PROBE INTO ATTRACTING NEW PROVIDERS TO RUN GP PRACTICES
From the FMS Global News Desk of Jeanne Hambleton PULSE 6 February 2014 | By Sofia Lind
The NHS competition watchdog is to investigate how to make it easier for alternative ‘high quality’ providers to set up GP practices in areas of low quality care, reveals a report today.
The report from the competition and integration regulator Monitor says that it requires a ‘better understanding’ of what barriers there are currently that prevent practices from expanding and new providers entering the market.
The conclusions come despite the BMA’s submission to the review warning against putting competition ahead of continuity, while RCGP warned against any move to extend the use of ‘loss-leading’ APMS contracts.
The wide-ranging report identifies several priority areas for more research, after its ‘call for evidence’ on how it should act as a regulator of general practice.
Monitor will also map out supply and demand for GP services and embark on a mission to ensure that CCGs understand competition regulations and do not allow them to hinder local integration plans.
The regulator said it received 140 responses to the call for evidence, many of which came from patients, and has concluded its work should focus on efforts to reduce health inequalities, support self-care, move care out of acute settings, and provide coordinated care for older patients and those with long-term conditions.
As part of this drive, it said it wants to help existing high quality practices to expand, especially in areas with ‘currently low levels of access and/or quality’.
The document says: ‘What we have heard suggests that, as sector regulator, there is scope for Monitor to support these efforts in three principal ways.
‘First, by undertaking further research to gain a better understanding of variations in access to and quality of GP services and the factors which limit patients’ ability to make choices about their care.
‘Second, by doing further research to gain a better understanding of the factors that limit commissioners’ ability to enable high quality providers of GP services to invest in expanding their services, or for high quality potential providers to begin offering GP services, especially in areas with currently low levels of access and/or quality.’
Monitor’s senior policy adviser Paul Dinkin, who led the review, said that they would be looking at how to ensure that new providers were attracted to areas that were under-doctored.
He said: ‘One of the concerns that some commissioners have is if you did allow that to happen in a non-targeted way you… could end up with a situation where you have got GPs being attracted away from areas that are already under-doctored, or have fewer doctors per patient, into more attractive areas.’
But GPC deputy chair Dr Richard Vautrey warned: ‘There is no problem with expanding services if you have an expanding resource to be able to do that, but if you do that by taking away resource from other providers then you destabilise them and you end up with a worse situation that we have at the moment.’
He added: ‘[Expansion of existing GP practices] comes down to resources and a sense of stability that has been absent for the last 10 years. Practices will only make long-term investments if they are confident their investments are secure.’
PMS PRACTICES FACE £260M LOSSES AS NHS ENGLAND ANNOUNCES TWO-YEAR REVIEW OF ALL CONTRACTS
From FMS Global News Desk of Jeanne Hambleton PULSE 3 February 2014 By Sofia Lind
Exclusive PMS practices face £260m of their funding being ‘redeployed’ over the next two years, after a major review of contracts by NHS England found the money was not linked with providing any additional services to patients above GMS.
Pulse has learnt that NHS England has written to all area teams to ask them to review all PMS contracts locally from April and aim to ‘secure best value’ from PMS funding that is not tied to defined additional services or performance indicators.
NHS England’s review found that overall, PMS practices are paid a ‘premium’ above equivalent GMS practices of £325m for England as a whole, equating to £13.52 above spending per patients registered with GMS practices.
Out of this, it could link £67m to defined enhanced services or key performance indicators (KPIs) but the remaining £258m had no formal link. It also found no link with the additional funding and the level of deprivation.
NHS England said that the £258m would be reduced to £235m over the next seven years with the redistribution of MPIG, but urged area team managers to review all PMS contracts over the next two years to ensure they were value for money.
The reviews will be conducted according to a number of criteria, including that it should reflect strategic plans set out by the area team or the CCG, help reduce health inequalities or support fairer funding distribution locally.
Writing in the letter, NHS England’s director of commissioning policy and primary care Ben Dyson and the director of commissioning (corporate) Ann Sutton said: ‘Area teams should begin a programme from April 2014 to review all local PMS contracts… and complete this review process by March 2016 at the latest.
‘[They should] seek to secure best value from future investment of the “premium” element of PMS funding by ensuring available resources for investment are deployed in line with the criteria set out in the annex to this letter.’
NHS England ruled out moving the funding released from PMS contract reviews into core general practice funding, as suggested by the GPC, as it would leave area teams with a lack of funds to address local ‘transformation of primary care’.
The letter added: ‘This would significantly reduce the ability of area teams to support the transformation of primary care locally, in line with the original objectives of PMS contracts.’
‘It is essential, however, that we apply the principles of equitable funding by moving towards a position where we can demonstrate that all practices (whether GMS, PMS or APMS) receive the same core funding for providing the core services expected of all GP practices.’
Deputy GPC chair Dr Richard Vautrey said: ‘NHS England had a golden opportunity with this review to invest in core general practice in order that practices could plan for the future with confidence and invest in GPs and other staff to meet the core needs of their patients, not least in offering enough appointments.
‘Instead, they are taking a massive amount of funding away that will cause huge concern to PMS practices, with the expectation that they can only earn some of it back if they do even more work. At a time when practices are being crushed by massive workload, and GP recruitment and retention is reaching a crisis point, this is the last thing they wanted to hear.’
NAPC chair Dr Charles Alessi said he was ‘very disappointed’ by the approach NHS England was taking.
He said: ‘It is really disruptive. We would be the first to say that it is inappropriate that one practice gets more for providing the same service as another practice, but this process is too indiscriminate.’
Commenting on the news, Mr Dyson added: ‘NHS England is committed to supporting innovation and quality improvement in primary care and reducing health inequalities. We want to continue to use PMS arrangements to achieve these objectives. At the same time, we need to ensure that there is an equitable approach to funding.’
‘Where GP practices are receiving extra funding per patient, this has to be fairly and transparently linked to the quality of care they provide for patients or the particular needs of the local population that they serve.’
‘The purpose of this review has been to put in place a much clearer framework that will enable our area teams to ensure that extra investment in PMS meets these criteria. In reviewing local arrangements, our area teams will work closely with local communities to ensure that these resources are used to help provide more joined-up services for patients.’
NHS ENGLAND LOOKS AT EXPANDING CARE.DATA EXTRACTIONS TO INCLUDE ‘SENSITIVE’ PATIENT INFORMATION
From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY 19 August 2014 | By Alex Matthews-King
Exclusive NHS England wants to expand its care.data extraction scheme to also include ‘sensitive’ patient information, despite initially saying these conditions would be excluded.
Currently, diagnoses such as HIV or AIDS, sexually transmitted infections and medical history mentioning abortions, IVF treatment, convictions or abuse have been classed as ‘sensitive’ and are set to be excluded when the Government’s flagship record-sharing scheme goes live. However Pulse can reveal that NHS England is preparing to consult on expanding the scheme to include some or all of this information in the extract, as well as who has access to the database.
The proposals were revealed in minutes from the latest meeting of NHS England’s care.data advisory group, where care.data programme director Eve Roodhouse presented a paper suggesting the extended scope. The minutes read: ‘Eve presented… a paper which sets out proposals for expanding the scope (e.g. by expanding the data collected from GP practices) and utility (e.g. who has access to the linked data). The details of the consultation process to support this future roadmap is currently being worked out.’
They added: ‘It was proposed that this be supported by a consultation process to ensure that scope change submissions are appropriate.’
However GPC said care.data was ‘controverisal enough’ without any expansion of the dataset.
GPC deputy chair Dr Richard Vautrey said: ‘The original plans for care.data were controversial enough and the anxiety they caused led to the current delay. This suggested mission creep will only add to the concerns held by many patients and clinicians about this project and make them even less likely to support it’s wider roll-out.’
A privacy protection group represented on the care.data advisory group expressed concern that patients may come to withhold information from their own GP if they are concerned about confidentiality.
medConfidential coordinator Phil Booth said: ‘The two conditions that crop up in discussion – mental health and HIV/AIDS – are stigmatised conditions. It is really complex because if you look at the top level and all the good that can be done then it is a good thing. However on an individual level, some patients are actually still needing to be convinced to confirm their HIV status to their GP.’
But Dr Neil Bhatia, a GP in Yateley, Hampshire who launched the care-data.info site to inform the public about the scheme, said specifically excluded certain conditions while branding them as ‘sensitive’ could further add to existing stigma.
He said: ‘Some with those diagnoses, such as for example HIV, say that specifically excluding such diagnoses as “sensitive” further stigmatises those with the disease, and so such read codes should be uploaded. They absolutely should be telling people that the datasets will be expanded to include these items, but then they barely told people about care.data in the first place.’
An NHS England spokesperson said: ‘The care.data advisory group has agreed that it will look at methods for future scoping around inclusion of sensitive data, highlighted in the notes from the meeting in June. In the meantime there will not be any change to the original plans for the data extract.’
- data was delayed in February to build public understanding and will now be preceded by a pilot in 100-500 practices.
Information extracted to care.data can only be used for the ‘benefit of health and care’ after new legislation was enacted in the wake of revelations that records had been sold to insurance organisations.
Is this an intrusion into our privacy ? Or is it a good idea if it means better treatment? But will it? I am certainly not sure about who should have access to my health information as I did opt out when were asked sometime ago.With all these “private providers” making money out of the NHS, we could be snowed under with health offers. Will we given the option as patients to choose?
They said, “will now be preceded by a pilot in 100-500 practices”
So maybe we will not have a choice. What happened to civil liberties
They said “care.data can only be used for the ‘benefit of health and care’ after new legislation was enacted”
This means we must write to our MPs. Parliament has the corridor of power. If anyone can protect our rights, our own MPs should. To find out who your MP is and his email or contact details try http://www.theyworkforyou.com or http://www.parliament.uk. You will need your post code or your constituency or the name of your MP. Your post code will solve the problem.
What happened to our civil liberties and human rights?Wikipedia says: Civil liberties are personal guarantees and freedoms that the government cannot abridge, either by law or by judicial interpretation? (But we will have to make a lot of noise with lots of folk writing to their MPs).
Author: Louise Smith, barrister – Updated: 16 August 2014, wrote: |
Civil liberties are the rights and freedoms that protect an individual from the state and which are underpinned by a country’s legal system. Civil liberties are the basic freedoms granted to a country’s citizens – they are often defined by law (including, but not limited to, human rights law) and evidenced in government documentation. People need not earn civil rights – citizenship automatically confers them in most cases. Civil liberties prevent governments from abusing their powers and restrict the level of interference in peoples’ lives.
Sorry to get excited but I feel strongly about any invasion of privacy.
I do not know about you but I am tired of reading NHS abbreviations and not knowing what they mean. It is true my information is being drawn from medical news service PULSE where the news is written for GPs. So presumably they will know what all these abbreviations mean. But at last I have found the answer to all abbreviations the NHS uses and it amounts to a booklet.
Just look at this to get our answers http://www.aimtc.nhs.uk/pdf/NHS%20Abbreviations%202012.pdf
I have discovered NHSE is NHS England and I know NHS is National Health Service. I even know GP is General Practitioner.
If I have time before tomorrow I will look up what I think are practices. APMS, GMS, PMS? What is CCGs, GPC, MPIG, NAPC, RCGP ?
To be honest I did not know where to look and it became a round-to-it job. But still got to do tonight’s jeannehambleton77,wordpress.com
So it will have to wait for tomorrow. In fact I think it is almost tomorrow by my UK time clock. See you Wednesday but later in the day. Jeanne