Alternative Providers of Medical Services (APMS)

Posted on July 15, 2009. Filed under: Uncategorized | Tags: , |

Department of Health – last accessed on 15 July 2009

Alternative Provider Medical Services (APMS) is a contractual route through which PCTs can contract with a wide range of providers to deliver services tailored to local needs.

It offers substantial opportunities for the restructuring of services to offer greater patient choice, improved access and greater responsiveness to the specific needs of the community. It will provide a valuable tool to address need in areas of historic under-provision, enable re-provision of services where practices opt out, and improve access in areas with problems with GP recruitment and retention.

What is APMS and why was it introduced?

Why was APMS introduced?

Alternative Provider Medical Services (APMS) is a contractual route through which PCTs can contract with a wide range of providers to deliver services tailored to local needs. It was introduced to allow PCTs to make arrangements outside of the established contracting routes with additional providers.

What services can be provided under APMS?

APMS can be used to provide essential services, additional services where GMS/PMS practices opt out, enhanced services, out-of-hours services or any one element or combination of these services.

How does APMS differ from the other routes?

Under APMS, PCTs are able to contract for primary medical services with commercial providers, voluntary sector providers, mutual sector providers, social enterprises, public service bodies, GMS and PMS practices (through a separate APMS contract) and NHS Trusts and NHS Foundation Trusts.

Does APMS mean privatisation of the NHS?

No. APMS is just a contractual route to deliver NHS services. Regardless of the type of provider, the NHS remains free at the point of delivery.

Can APMS be used for children’s services/drug or alcohol services/mental health services/sexual health services/complementary health services?

It is for PCTs to determine the health needs of their populations and to commission or provide services. Services such as those described can be provided using any of the contracting routes, including APMS, as long as the services are primary medical services.

How is an APMS contract regulated?

The APMS Directions 2006 set out mandatory requirements, but also allow extensive flexibility. APMS gives PCTs considerable discretion to shape locally appropriate services responsive to the needs of the community. A ‘model’ APMS contract is available through the link to EAPMC below and can be used as a guide for local APMS contracts.

Equitable Access to Primary Medical Care (EAPMC)

 

Standards, regulations and pensions

What factors apply to APMS contracts?

  •  The APMS Directions place a duty on the PCT to set out various clauses in each APMS contract.  These apply to:
  1. basic requirements: who can be patients, the services to be provided, circumstances in which the contract can be terminated or sanctioned;
  2. common standards with PMS: provisions equivalent to the PMS regulations, including premises, GP appraisal and assessment, clinical governance, confidentiality, inspection by the Healthcare Commission;
  3. extra requirements: covering dispute resolution, additional restraints on prescribing, qualification of staff;
  4. requirements applicable to essential services (where these are provided under the APMS contract)
  • Why is APMS regulated at all?

The APMS Directions have been designed to ensure quality standards across all contracting routes, and so that minimum statutory requirements apply across the board.

What standards do APMS providers have to meet and how are these enforced?

PCT service specifications should include requirements across all dimensions of performance, and state what performance standards will be applied, including NHS and local performance management standards. These should be incorporated into the contract between the PCT and provider.

What is the difference between APMS and a Service Level Agreement (SLA)?

An SLA is not an enforceable contract. Under an SLA, where the two bodies involved in the agreement are health service bodies, the contract will be an NHS contract which is not enforceable at law, and where disputes will be dealt with via the NHS Dispute Resolution Procedure. APMS contracts with private and voluntary organisations which are not health service bodies set out legally enforceable provisions, including safeguards for patients, and, since the contract is not an NHS contract, appropriate mechanisms for resolving disputes and breaches of contracts.

How are APMS contracts paid for?

This is for PCTs to determine, using the PCT’s unified budget.

How much will APMS contracts cost?

This is for agreement between the PCT and provider. As with all contracts, APMS contracts should seek to balance outputs against value for money.

Can GMS and PMS practices provide APMS services?

Yes. PCTs can contract with GMS and PMS practices through the APMS route. The practice would hold a separate APMS contract alongside their existing GMS/PMS contract.

Are APMS arrangements pensionable under the NHS Pension Scheme?

The NHS Pensions Regulations enable APMS contactors and their staff to be eligible to remain in, or join, the main NHS Pension Scheme providing the APMS contractor also meets the eligibility criteria for the provision of GMS or PMS. For pension purposes, staff will be treated as practice staff. As members of the main NHS Pension Scheme, practice staff are entitled to retirement benefits. However, they are not entitled to the separate but related benefits in respect of injury, early payment or extra service on the redundancy or Voluntary Early Retirement with the employer’s consent (where the employer agrees to meet the cost so the pension is not reduced).

If the APMS Provider is a NHS Trust or a Foundation Trust then the staff will have the same pension rights as other NHS Trust or Foundation Trust employees.

The eligibility criteria for providing GMS are section 28S of the NHS Act 1977. The eligibility criteria for PMS are in section 28D of the Act – set out in the Annex to this note.

APMS contractors who do not meet the eligibility criteria for the provision of GMS or PMS will not be eligible to remain in, or join, the NHS Pension Scheme.

How many PCTs are currently using APMS?

The Department does not collect or hold this information. We do know that many PCTs in England are contracting for out-of-hours services under the APMS route and there is much interest in the wider opportunities presented by APMS.

The Department has been supporting six PCTs with the procurement of alternative providers.

Do PCTs need to tender for APMS contract?

Any decision to place a tender for primary medical services provision is a matter for the commissioning PCT. In reaching a decision the PCT will need to meet DH procurement guidelines and would also be expected to seek its own legal advice.

While PCTs will be aware that health services are not covered in full by the EC Directive on the procurement of services they may, as good practice to ensure delivery of high clinical standards and good value for money services, seek to test the market via the procurement process.

Can pharmacy, dental or optometry services be provided under an APMS contract?

No. APMS is for the provision of primary medical services.

What is the difference between APMS and SPMS?

Specialist PMS (SPMS) is a PMS model of delivery that does not require the provider to have a registered list of patients, the involvement of a GP or the provision of essential primary care services. What makes SPMS different is that it can only be provided by those who would otherwise qualify to hold a PMS agreement, as in Section 28D of the 1977 Act and Part 2 of the PMS Regulations.

How do PCTs procure services using APMS?

NHS PASA have produced an APMS Procurement Toolkit  to support PCTs in the procurement process, available on NHS PASA’s website. The toolkit gives advice on developing service specifications, advertising, tendering, evaluating applications, project managing contracts, and monitoring outputs.

NHS Purchasing and Supply Agency (opens new window)

 

What other help is available to support APMS development?

The Department of Health has issued Directions and guidance. For general guidance on contracting and commissioning, see links below.

The National Primary Care Collaborative (NPCC) supports PCTs in 28 pilot sites to develop an integrated approach to primary care commissioning, using all contracting routes. Further details are on the Improvement Foundation website

Commissioning Friend (opens new window)

 

Primary care contracting (opens new window)

 

Improvement Foundation: Practice-based commissioning development programme (opens new window)

 

Eligibility of contractors

This is an extract from the Health and Social Care (Community and Health Standards Act) 2003. Anyone entering into a contract for the provision of primary medical services is advised to take legal advice.

‘(1) A Primary Care Trust or Local Health Board may, subject to such conditions as may be prescribed, enter into a general medical services contract with:

(a) a medical practitioner;

(b) two or more individuals practising in partnership where the conditions in subsection (2) are satisfied; or

(c) a company limited by shares where the conditions in subsection (3) are satisfied

(2) The conditions referred to in subsection (1)(b) in relation to a partnership are that-

(a) at least one partner is a medical practitioner; and

(b) any partner who is not a medical practitioner is either-

    (i) an  NHS employee;

    (ii) a section 28C employee, section 17C employee or Article 15B employee;

    (iii) a health care professional who is engaged in the  provision of services under this Act; or

    (iv) an individual falling within section 28D(1)(bc) above.

(3) The conditions referred to in subsection (1) (c) in relation to a company are that-

    (a) at least one share in the company is legally and beneficially owned by a medical practitioner; and

    (b) any share which is not so owned is legally and beneficially owned by a person referred to in subsection (2) (b) (i) to (iv).

(4) Regulations may make provision as to the effect, in  relation to ageneral medical services contract entered into by individuals practising in partnership, of a change in the membership of the partnership.

(5) In this section:

       ‘health care professional’ has the same meaning as in section 28M above; ‘NHS employee’, section 28C employee’, ‘section 17C employee’ have the same meaning as in section 28D above.

 

Section 28D of the 1977 Act  (Persons with whom PMS agreements may be made)

This is an extract from the Health and Social Care (Community and Health Standards Act) 2003 and is provided for information. Anyone entering into a contract for the provision of primary medical services is advised to take legal advice.

‘(1)   A Strategic Health Authority or a Health Authority may make an agreement under section 28C (personal medical or dental services) only with one or more of the following:

    (a)    an NHS trust or NHS foundation trust;

    (b)   a medical practitioner who meets the prescribed conditions;

    (ba)    a dental practitioner who meets the prescribed conditions;

    (bb)    a health care professional who meets the prescribed conditions;

    (bc)    an individual who is providing services:

        (i)   under a general medical services contract  
        (ii)   in accordance with section 28C arrangements, section 17C arrangements or Article 15B arrangements; or 
        (iii) under section 35 of this Act, section 17J or 25 of the 1978 Act or Article 56 or 61 of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No 1256 (NI 14)); or has so                provided them within such period as may be  prescribed;

(d)  an NHS employee, a section 28C employee, a section 17C employee or an Article 15B employee;

(e)  a qualifying body;

(f)   a Primary Care Trust or Local Health Board.

(1A)   The power under subsection (1) to make an agreement with a person falling within paragraph (bc) or (d) of that subsection is subject to such conditions as may be prescribed.

(2)   In this section –

‘the 1978 Act’ means the National Health Service (Scotland) Act 1978;

‘Article 15B arrangements’ means arrangements for the provision of services made under Article 15B of the Health and Personal Social Services (Northern Ireland) Order 1972 (1972 No 1256 (NI 14));

“Article 15B employee’ means an individual who, in connection with the provision of services in accordance with Article 15B arrangements, is employed by a person providing or performing those services;

‘health care professional’ means a person who is a member of a profession regulated by a body mentioned (at the time the agreement in question is made) in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002;

‘NHS employee’ means an individual who, in connection with the provision of services in the health service in England and Wales, Scotland or Northern Ireland, is employed by

(a)   an NHS trust, an NHS foundation trust or (in Northern Ireland) a Health and Social Services Trust;

(b)   a Primary Care Trust or Local Health Board;

(c)   a person who is providing services under a general medical services contract;

(cc)   a dental practitioner whose name is included in a list prepared in accordance with regulations made under section 36(1)(a);

(d) an individual who is providing services as specified in subsection (1)(bc)(iii) above;

‘qualifying body’ means:

(a)   a company which is limited by shares all of which are legally and beneficially owned by persons falling within paragraph (a), (b), (ba), (bb), (bc), (d) or (f) of subsection (1); and also

(b)   in the case of an agreement under which primary dental services are provided, a body corporate which, in accordance with the provisions of Part IV of the Dentists Act 1984, is entitled to carry on the business of dentistry;

‘section 17C arrangements’ means arrangements for the provision of services made under section 17C of the 1978 Act;

‘section 17C employee’ means an individual who, in connection with the provision of services in accordance with section 17C arrangements, is employed by a person providing or performing those services;

‘section 28C arrangements’ means arrangements for the provision of services made under section 28C; and

‘section 28C employee’ means an individual who, in connection with the provision of services in accordance with section 28C arrangements, is employed by a person providing or performing those services.

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