New wave of APMS tenders announced

Posted on January 22, 2010. Filed under: News stories | Tags: , |

Pulse | By Yvette Martyn | NHS South West Essex | 22 January 2010

A PCT has announced plans to farm out 10 GP practices under a new wave of APMS tenders, in a move raising questions over the Government’s new-found commitment to ensure the NHS is the ‘preferred provider’.

NHS South West Essex will tender the contracts for the practices, which it currently runs, over the next 18 months as part of the process of splitting commissioning and providing roles.

Private companies and social enterprises will be allowed to bid for the contracts, even though health secretary Andy Burnham recently said alternative providers should only be sought to run services as a last resort.

In a sign of the confusion within Government policy, the PCT said the tenders were going ahead to satisfy a parallel drive to ensure PCTs only managed practices directly for short periods or in emergencies.

The first phase of tenders will see three practices transferring management with contracts to be awarded in Autumn 2010 and the remaining seven tenders to follow.

The trust insisted the move would not affect the services available or put the jobs of staff at risk. It said patients would be involved in the process and invited to give feedback on the plans, with a representative having input in the selection process.

Marc Davis, director of primary care for NHS South West Essex, says: ‘There are no plans to close or move any of the 10 GP surgeries, or reduce the range of NHS services available. The practices will still be NHS services, but like most other practices they’ll be managed by an independent contractor appointed by us.’

Dr Brian Balmer, chief executive of Essex LMCs, said: ‘The PCT has encouraged the GPs to bid for them and we are hopeful current employees will have a fair chance of getting a contract. We have organised training for GPs and practice managers in tendering and winning tenders.’

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Lansley accepts cash donation from wife of Care UK chief

Posted on January 15, 2010. Filed under: GP-led health centres, News stories | Tags: , , |

Pulse | By Gareth Iacobucci | 15 January 2010

Shadow health secretary Andrew Lansley has accepted a large cash donation from the wife of the head of one of the biggest private firms to provide services for the NHS, it has emerged.

The wife of John Nash, chairman of Care UK, whose portfolio includes numerous APMS practices and GP-led health centres across the country, gave £21,000 to Mr Lansley’s personal office in November.

The revelation comes just days after Pulse revealed that the Tories have opened talks with a series of private firms, after their manifesto pledged to increase the role of the independent sector in the NHS.

The party told Pulse talks were ongoing with ‘a wide range’ of providers as part of a drive to create a more competitive NHS marketplace, with sources close to Westminster disclosing that Care UK were among the firms talking to the Tories.

A spokesman for the Conservative party said: ‘We have been completely transparent about this donation. It has been properly registered with the parliamentary register as well as with the Electoral Commission and is therefore fully within the rules.

‘John Nash and his wife have a wide range of interests, of which Care UK is just one. This donation to support Mr Lansley’s office was made through Conservative Campaign Headquarters. Mr Lansley did not solicit this donation. Donations from private individuals in no way influence policy making decisions.’

Liberal Democrat Shadow Health Secretary, Norman Lamb said the donation exposed the Tories’ conflict of interest on the NHS.

He said: ‘This is a staggering conflict of interest which completely undermines the Tories claim that the NHS would be safe in their hands. Many people will question Andrew Lansley’s judgement and the impact that these donations have on Conservative health policy.

‘With Labour in the pockets of the unions and the Tories taking money from private health firms, only the Liberal Democrats can be trusted to run our NHS.’

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In-store APMS practice markets itself with Boots products

Posted on January 11, 2010. Filed under: GP-led health centres, News stories | Tags: , |

Pulse | By Gareth Iacobucci | 11 January 2010

Exclusive: High street pharmacy giant Boots is giving away goody bags of cosmetics that include invitations to register at an APMS practice co-located within one of its stores, it has emerged.

Students in Bristol were given goody bags containing Boots products and a flyer advertising services available at the practice run by out-of-hours co-operative Brisdoc, which Boots has hosted in one of its city-centre stores since last July.

But local GPs are unhappy at the move, claiming it is inappropriate for a pharmacy to promote one particular GP practice and warning that Boots was leaving itself open to accusations of indirect inducement – which may break NHS promotion rules – by including the leaflet in a gift package.

The row is the latest in a string of controversies over the way GP services are marketed. Last June, Pulse revealed that a GP-led health centre in Plymouth had taken out eight-second ads in a local multiplex cinema, while NHS Norfolk chose to promote its GP-led health centre on the side of city buses.

Dr Simon Bradley, chair of Avon LMC, said it was ‘entirely reasonable’ for practices to market themselves, but said it was wrong for pharmacies to recommend patients to particular practices.

He said: ‘It’s entirely reasonable for practices to [advertise their services], but that’s very separate from a particular pharmacy or any other commercial body associating themselves with one particular practice and promoting it. Practices can’t promote individual pharmacies. It was naïve of them,’ he said.

He added: ‘If we lose practice boundaries, it will become increasingly important that we tell patients about the services available, to be able to compete.

‘But the key is to do it in a professional way and don’t offer inducements for patients to register. [Boots] lay themselves open to that accusation. I don’t consider it to be best practice.’

Bristol PCT said the practice, which was procured under the nationwide Equitable Access scheme, registered 1,000 patients in its first three months of opening.

A Boots spokesperson confirmed staff from the practice gave out goody bags with Boots products but added: ‘This in no way constitutes an inducement to join the practice.’

Advertising APMS

– Pulse revealed last June that a GP-led health centre in Plymouth had taken out eight-second ads in a local multiplex cinema

– NHS Norfolk promoted its GP-led health centre on city buses

– The GP-led health centre in Sheffield has marketed its services by leafleting the public within a shopping centre, targeting student communities, and telemarketing and leafleting within Sheffield businesses

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Competition panel rules in GPs’ favour in branch surgery battle

Posted on December 18, 2009. Filed under: News stories, Providers, Uncategorized | Tags: , |

Pulse | By Gareth Iacobucci | NHS Kingston | 18 December 2009

The Co-operation and Competition Panel (CCP) has ruled in favour of a local GP practice after concluding that a PCT’s decision to prevent them from expanding their practice nearby was ‘inconsistent’ with competition rules.

The panel ruled that NHS Kingston’s decision to deny Churchill Medical Centre the chance to open a new branch surgery was at odds with the Principles and Rules for Co-operation and Competition, and urged the DH and NHS London to ensure that the PCT allowed the practice to proceed with its plans.

Pulse first reported the conflict last year, after the PCT blocked the practice’s plans to open a new branch surgery on the grounds that it might have threatened the viability of a new APMS service, run by private provider AT Medical.

The review – which followed a complaint by the practice that the decision was anti-competitive and restrictive to patient choice – said it had taken into account the best interests of local patients, as well as value for money for taxpayers.

The panel concluded that the decision to deny the opening of a branch surgery would have prevented around 1,500 patients from accessing their first choice for more convenient GP services, and may have undermined improvements in service quality for local patients more generally.

Dr Charles Alessi, a GP at the Churchill Medical Centre, who had previously described the PCTs position as ‘untenable’, said he was pleased with the outcome of the case.

He said: ‘I’m very pleased we can put this behind us and concentrate of healthcare. We’re happy we had a fair hearing, I hope the PCT will allow us to proceed.’

CCP Director, Andrew Taylor said: ‘We carefully considered NHS Kingston’s concerns that allowing the new branch practice to open may negatively impact on the viability of a nearby practice and impose additional financial costs on NHS Kingston.’

‘However, the panel’s view is that any potential adverse effects arising from the opening of the new branch surgery are likely to be small or immaterial. Any such effects would not be sufficient to outweigh the potential benefits to local patients and taxpayers of improved access, choice and quality derived from the introduction of the new branch surgery.’

Mr Taylor added: ‘Our recommendation takes into account a number of factors specific to this case, in particular Churchill Medical Centre’s willingness to develop the new branch surgery at its own cost and having not sought reimbursement for this initial outlay, ongoing rent or other costs normally requested by GP practices from a Primary Care Trust.’

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New GP Practices for Rotherham Primary Care Trust

Posted on December 18, 2009. Filed under: GP-led health centres, Reports/papers | Tags: |

Rotherham PCT | A public consultation May to July 2008 | accessed 18 December 2009 [pdf]

Rotherham Primary Care Trust (PCT) is committed toimproving people’s health. One way in which we cando this is by making it easier for people to see theirGP. We want to set up a new GP practice and a newGP-led health centre in Rotherham. They need to belocated in the areas of Rotherham that will bringmost benefits to local populations.

Our plans link in with those of Health Minister, LordDarzi, who is currently running a national reviewcalled ‘Our NHS, Our Future’. Last year he gave acommitment to establish 150 GP-led health centresand 100 new GP practices across the country in areasof greatest need. Rotherham will benefit from newinvestment to support these developments.We have carefully considered where the new Practiceand Health Centre should be, taking into accountthe health needs of particular areas, the location andnumber of current GPs, population trends and wherenew housing is being developed.

New GP Practice

We are proposing to set up a GP Practice in the North of Rotherham in the Wath/Hoober Wards. At this stage we have only identified the area rather than the precise location. The new GP Practice is likely to have four doctors working together to serve at least 6,000 patients. They must offer new services and extended opening hours so people can visit the Practice at different times that go beyond the normal working day.

New GP-led Health Centre

We are planning to provide a new GP Practice in the new Health Centre which will open in Rotherham town centre in November 2008. This facility will allow the maximum integration of a GP Practice with a Walk in Centre and other diagnostic services (including x-ray and ultrasound) that are available on site. They will offer longer opening hours and services to registered and non-registered patients in an innovative way.

How are we going to do it?

We are going to advertise for anyone interested in establishing a new GP Practice or the GP-led Health Centre and we will be looking to award contracts by the end of December 2008. We will be looking for these new GP practices to be run under a contract known as Alternative Provider of Medical Services (APMS). This means that services could be run by local GP practices, NHS organisations or other commercial providers of such services. Regardless of who runs them, the NHS services will remain free at the point of delivery.

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Proposal for a new GP-led health centre in Leeds

Posted on December 14, 2009. Filed under: GP-led health centres, Press/News Releases | Tags: |

If you are reading this document then we believe you are interested in what happens to your local health services and would like to get involved. We welcome this and are pleased to hear your thoughts.
1 What this document is about

1.1 This document has been produced by Leeds Primary Care Trust (PCT), the local NHS organisation responsible for planning and paying for GP services. We want to let you know about our plans to open a new GP-led health centre in Leeds and are seeking the views and comments of patients who use health services, the public and stakeholders.
1.2 We will run a formal 12 week consultation from 19th May 2008 to 11th August 2008. This is an excellent opportunity for you to tell us what you want from your GP services so that we can develop a service that meets your needs.
Please use the comments form provided with this document to give us your views or ring the Patient Advice and Liaison Service (PALS) on freephone 0800 0525 270 who will listen to your views and feed them into the consultation process.

2 Background

2.1 In October 2007, Health Minister Professor Lord Darzi published his interim report into a review of the NHS, Our NHS, Our Future. Following this, the Government announced its intention to see 150 new GP-led health centres established across England, one in every PCT area.

2.2 The health centre can be established in an existing health building or a new building, and must offer new services and longer opening hours so that people can visit outside of normal working hours.

2.3 It must be located in an area which would benefit from additional primary care services.

2.4 In addition to this it must also be located in an area that is easily accessible for all Leeds patients.

2.5 The proposed new health centre in Leeds will make sure more patients will have access and choice of treatment from health care professionals. It is an additional service in Leeds. Please be assured that no GP practices will be closing.

2.6 This consultation process is about the services the Leeds GP-led health centre could provide.

3 What is a GP-led health centre?

A GP-led health centre is one where a GP is in attendance at all times. Nurses and other health professionals will also see patients.

4 Who will be able to use it?

Anyone who lives within the area covered by the health centre boundary will be able to register with the practice in the usual way. Patients who are not registered will also be able to access services, such as people who work in Leeds but don’t live here.

5 Where will it be?

5.1 The Burmantofts area of Leeds has been identified as a priority area that would benefit from increased primary medical care services. The GP-led health centre will initially be provided from the already established Burmantofts Health Centre which is currently owned by Leeds PCT.

5.2 There will be some improvements made to the building to make sure that it meets the requirements of a GP-led health centre. In the longer term the PCT will work with relevant stakeholders, for example local organisations, doctors and the local community, on future plans for Burmantofts. This may include further building work or looking for a brand new building.

6 Why will it be here?

6.1 We have looked at information about people’s health in Leeds and the existing services already available. This includes other centres in Leeds which are open across a range of hours where people can currently access health care. (Please see section 6.5). We have taken these into consideration and thought about how a new service can complement those services that are already in operation. Using all this information our proposal for the location of the new GP-led health centre is Burmantofts.

6.2 Information about the health needs of the local population supports this decision. For example, this area currently has higher than the city’s average rate of teenage pregnancies, low birth weights, deaths from cancer, coronary heart disease and circulatory diseases.

6.3 Burmantofts is to the east of the city, close to St. James’s Hospital, and has good public transport services from Leeds city centre.

6.4 We believe that by opening the new GP-led health centre at Burmantofts we have focused on one of the areas where the need is greatest. Burmantofts Health Centre is also easily accessible to all patients from the city centre.

6.5 Other centres where patients can obtain health services from include:

St. George’s Minor Injury Unit, Middleton, Leeds

Open 8am – 9pm Monday to Friday (times may vary over holidays)

Wharfedale Minor Injury Unit, Wharfedale Hospital, Otley

Open 8am – 11pm every day (times may vary over holidays)

Commuter Walk-in Centre, The Light, Leeds for minor illness and injury

Open 7am – 7pm Monday to Friday including bank holidays (except Christmas Day, Boxing Day and New Year’s Day)

Current opening times of these centres are being evaluated as part of a review of urgent care. This is based on what the people of Leeds told us last year during a similar engagement process.

7 What services will it provide?

Registered Patients

7.1 The health centre will register local patients in the same way as a normal GP practice would, but anyone else should also be able to get an appointment or access the walk-in service even if they are not registered at the practice.

7.2 It will be open from 8am until 8pm, seven days a week.

7.3 As well as the services that you would usually receive at a GP practice, we would also like to offer more services. At the back of this document are a few questions that will help us decide what additional services you would like us to put in the health centre.

7.4 The health centre will provide core services that must be provided by any GP practice for its registered patients. It will also provide a range of additional services that will be required to meet the needs of its local population, such as: outpatient clinics, minor surgery, alcohol services and sexual health services .

7.5 Non registered patients

The health centre will provide a range of services to non registered patients that have either requested an appointment, or wish to be seen on a drop-in basis. This could be because they can’t get to their own GP and are at work or it is outside of their own GP opening hours.

7.6 Walk-in services

People not registered with the GP-led health centre will be able to obtain fast access to health advice and treatment for a range of conditions such as: – sprains, coughs, colds, headaches, bites, burns, and rashes.

8 Who will run the health centre?

8.1 We are advertising for anyone interested in providing new GP services and we will be looking to award the contracts by the end of 2008. The new centre should then be up and running by early 2009.

8.2 The contract we award is known as an Alternative Provider of Medical Services (APMS) contract. This means that the NHS services could be provided by local GP practices, NHS organisations, social enterprises or commercial providers of such services. This will still be an NHS service which is free at the point of delivery to all patients and be expected to meet and exceed all the minimum standards around quality of care, safety and governance.

9 How are patient and public views being listened to?

9.1 We are keen to hear your views on how this service could best be developed to suit the needs of patients. Here in Leeds we are planning a number of drop-in events and these will take place over the next three months until 11th August. We will also be gathering comments and feedback from written questionnaires. Please see the enclosed feedback form and how to give us your thoughts and ideas.

10 How to give your views

We hope that you will take the time to let us know your views and anything else you think we should consider when developing the new GP-led health centre, including what services you think should be made available there.

11 How we will use the information

11.1 The outcome of the consultation will be used to influence the final specification of the new health centre and what we ask the company or organisation which wins the contract to provide.

11.2 A report of the analysed responses will be widely published and shared at a public Board meeting, the date of which has yet to be agreed. This report will be written once the consultation period has ended in August.

11.3 This report will be published on Leeds PCT’s website at http://www.leedspct.nhs.uk

Terms used in this document

GP-led health centre

A health centre that provides a range of services, including GP services and community nursing where the care is managed by GPs. In addition to GPs, nurses and other healthcare professionals will also see patients.

Primary care

When people develop a health problem, usually their first point of contact is their doctor, dentist, pharmacist or optometrist. These health professionals work as part of the NHS front line team which is referred to as primary care. They work alongside practice nurses, district nurses, health visitors, speech and language therapists and other healthcare specialists to provide a wide range of non hospital-based health care services to the local population.

Stakeholders

Organisations and individuals with an interest in the activities of the NHS. Stakeholders are involved in partnership working and are used for consultation purposes.

Walk-in centre

Centre led by nurses providing treatment for minor illnesses and injuries, for example, sprains, coughs, colds, headaches and flu-like symptoms. This service can be used by anyone on a walk in/drop in basis. No appointment is necessary.

Non registered

Patients that are not registered with any GP or patients living in or outside of Leeds that are registered with a GP Practice, but not registered with the GP-led Health Centre.

Health centre boundary

Designated area around the health centre. People who live in this area will be able to register as a patient at the health centre. The boundary has yet to be agreed.

Further reading

Our NHS, Our Future: NHS next stage review – interim report

Department of Health October 2007

Website: http://www.ournhs.nhs.uk

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GPs win first victory in competition case against PCT

Posted on November 26, 2009. Filed under: News stories | Tags: |

Pulse | By Nigel Praities | 26 November 2009

Entrepreneurial GPs have been granted a full inquiry after NHS managers blocked their plans to open a new surgery because it would be in competition with a nearby private provider.

The NHS competition watchdog said it will proceed with its inquiry after it found ‘potential concerns’ about the way NHS Kingston acted towards a practice in their area.

GPs at the Churchill Medical Centre in Kingston-Upon-Thames were prevented from opening a self-funded branch surgery on the basis of ‘preventing competition’ with a local APMS practice.

The GPs had already received a green light on leasing new premises before they were told their plans were being shelved by the PCT.

After hearing evidence from both parties, the Co-operation and Competition Panel said further investigation was warranted and it will now proceed with ‘stage two’ of its probe.

The panel monitors the implementation of DH rules on competition in the NHS and can force PCTs to commission alternative services or withdraw money from them

‘The conduct may reduce choice and competition in the relevant local area, which in turn could lead to lower levels of service, quality, efficiency and innovation.’

‘The conduct raises potential concerns under the Principles and Rules. Since the panel considers that further investigation is warranted we will proceed to a Phase Two investigation,’ the judgement reads.

The Co-operation and Competition Panel has published its judgement in full on its website.

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LMCs draw up federation blueprint to protect against ‘APMS-hungry PCTs’

Posted on November 26, 2009. Filed under: Federations, News stories | Tags: |

Pulse | By Lilian Anekwe | 26 November 2009

Londonwide LMCs are working on new plans to help practices group together into federations to avoid small practices being ‘picked off’ by their PCTs.

Small practices in London are increasingly being forced either to close or to aggregate into groups of practices, according to Londonwide LMCs chief executive Dr Michelle Drage, and need to explore GP federations or risk being targeted for closure by trusts.

‘We are trying to advise practices that want to federate and offer a package of advice on how to do that, and promoting the fact that these can be done.

‘What practices don’t have at the moment is a description of what federations should look like, in legal and financial terms.’

‘We’re trying to offer practices a range of options that will help them move out of the target zone of being a small practice in the spotlight of the PCT for inappropriate reasons and toward something more appropriate.’

Dr Drage said Londonwide LMCs were also exploring ways of offering salaried and sessional GPs more career opportunities, and cited the Hurley Clinic – whose partners include RCGP vice chair Dr Clare Gerada – as an example of a practice offering an ‘intermediate partnership’ that allows GPs to take a step up the career ladder.

GPs at the Hurley Clinic, in Kennington, south east London, can join the group as a stakeholder – helping to run the practice and keeping a share of the profits – while aspiring to become a full partner within the group itself.

‘The current model of partnership is not providing them with the autonomy that they seek and one of the things we are supportive of is providing career progression for salaried and sessional GPs who are looking for them,’ said Dr Drage.

‘We are looking at how we can create career development opportunities without the millstone round doctors’ necks of having to have equity and so on.’

‘It’s overt, how practices are still being picked off because it does not fit the model. It will be important for small practices that when they come up for retirement they invest in the future rather than allowing themselves to be picked off by APMS-hungry PCTs.’

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Safety in numbers: the rise of the GP federation

Posted on November 17, 2009. Filed under: Arm's length providers, Federations, News stories, Providers, Social enterprise | Tags: , |

Pulse | By Nigel Praities | 17 November 2009

It’s two years since the RCGP proposed its ‘roadmap’ for general practice, which envisaged practices working together as federations, pooling skills and resources to broaden the range of services on offer in primary care.

Many at the time thought it would go the same way as the Middle East roadmap for peace. Yet increasing evidence is emerging that GPs are experiencing a major shift in the way they work, some more voluntarily than others.

Nigel Praities investigates the growing move towards new models of working and asks if federations are now the only way forward.

Where does the idea of primary care federations come from?

The RCGP’s ‘roadmap’ was largely designed to steal a march on the market-based approach being spearheaded by Lord Darzi and his NHS Review.

The concept was one of primary care federations giving patients better access to services with change being championed locally by GPs, rather than through ‘one-size fits all’ plans from central Government.

Initially federations were seen as nothing more than glorified practice-based commissioning hubs, but a 2008 paper from the RCGP was crucial in putting more flesh on the bones of the federation concept.

Federations, the paper said, could give practices ‘economies of scale’ they could not achieve otherwise, by sharing back-office functions and directly employing managers and nurses to provide new services.

It gave a list of characteristics a federation should have, including a formal legal structure, an executive management team and a written public constitution.

What evidence is there that federations are beginning to evolve?

There are no official numbers on primary care federations in the UK but, anecdotally at least, it seems more practices than ever are working collaboratively.

Pulse has uncovered evidence of practices linking up in all areas of the country – from the centre of post-industrial Sheffield to the rural heart of Worcestershire.

Trailblazing schemes in Croydon and South London have been followed by other partnerships, with some practices forming limited companies or provider arms.

The schemes involve nearly 300 practices in a wide range of different models, from collaborations with private companies to organic growth from successful PBC hubs.

In Sheffield is a group of 90 GPs working in an area with high deprivation and social need that is heading towards a federated model.

It directly employs specialist nurses to run diabetes and ENT clinics in the community and is working on several schemes to bring other services closer to home, such as midwives to provide obstetrics clinics in GP surgeries.

All the 28 practices in the consortium sign an agreement and work with centrally employed practice managers. They have also formed a provider company this year, Central Care Sheffield Ltd, to take on their projects and save administrative costs.

Paul Wike, Primary Care Lead Manager at the consortium, says: ‘It is safety in numbers, they have another 26 practices standing should-to-shoulder.’

What different models have emerged?

As in Sheffield, many of the practice groupings have grown organically out of PBC clusters or consortiums.

GPs in Brent have recently set up a federation council that contains representatives from the five PBC local clusters. It sits on an executive council with the PCT and looks at how services can be commissioned all over Brent

Dr Ethie Kong, a GP in Brent and member of the federation council, says it gives GPs a powerful voice in how primary care services are commissioned for areas such as improving health inequalities and care for long-term conditions.

‘Some of the needs are common and some specific to the locality. We work within our clusters, and across clusters, and Brent-wide we liaise with the PCT.

‘This means we have local autonomy as well as borough-wide co-operation,’ she explains.

Services are currently provided by the PBC clusters themselves under a not-for-profit social enterprise model, but this may change in the future.

Other areas are working closely with private companies to form provider companies. A network of 22 practices in Worcestershire have formed a ‘GPCo’ through a 50:50 partnership with the company Assura.

Assura provides money to set up the company and shares the profits with the GPs. A statement from Assura says it enables GPs to ‘exploit the economies of scale that a national organisation brings’ by reducing the costs of service design, bid management and service implementation.

‘Due to the fact Assura operates nationally, all of its members are able to benefit from its bulk purchasing power of equipment and utilities, as well as understanding how other localities provide services more efficiently,’ the company says.

PCTs are also seeing the benefit of making practices work together. NHS Tower Hamlets has recently dangled a massive £12million carrot in front of their practices to fund the development of new care pathways and ‘networks’ of GP practices.

As Pulse revealed last week, the PCT – in one of the poorest parts of the country – brought in the external consultants McKinsey to assess their primary care services.

They recommended a 40% increase in funding for primary care and that this should be used to develop networks – with hubs for each care package – and would eventually include specialists, local voluntary organisations and the borough.

Are there any dangers for GPs?

One risk is that the schemes will cause GPs to surrender the protection of their nationally negotiated contracts.

In Tower Hamlets, the additional investment in primary care is dependent on all practices switching to APMS. That could be a bad decision in the long-term, as their contracts could be rewritten at the whim of the PCT or handed to private providers.

The involvement of private companies could also open up GPs to criticism they are profiteering rather than seeking to improve the care of patients.

Dr Michael Dixon, chair of the NHS Alliance, says the way GPs develop their federations will be crucial to whether they survive or not.

‘There are some really big questions here that general practice has to ask itself – are we in it to make a short-term profit or for the long term to make services more responsive to local patients?

‘I think a social enterprise is the best model, because it is really important the extension of services is seen as something done for local people, rather than tabloid headlines saying we are “fleecing” local people again.’

There is also a danger federations will bite off more than they can chew. They are able to take on more risk than an individual practice, as it can be spread more thinly, but this could backfire.

A PBC federation of 32 practices in Bexley made £4m worth of savings after being given real budgets for prescribing last year, but they also took on responsibility for 54% of any overspend, which could have cost them tens or hundreds of thousands.

What does the future hold?

If Tory plans are anything to go by, GPs could see themselves with much greater responsibility for commissioning and real budgets written into their contracts from next year.

This could push those not currently in a federation into thinking about how they can work closer together and become more business-like in the way they organise commissioning.

The NHS Alliance is due to launch a paper this month on developing ‘local care organisations’, extending the federation model to secondary care and other partners.

This model – similar to the networks planned by Tower Hamlets – could see the traditional barriers between different aspects of healthcare being blurred, ideally with GPs driving the changes.

This is the best case scenario, but whatever happens GPs working on their own is likely to be a thing of the past. The formation of federations may be the only way to ensure GP practices remain the basic unit of care for patients, albeit with risks.

As Dr Dixon warns: ‘Whichever party is in power next year, there will be a much bigger drive to emancipate these organisations. Whatever happens there will be change, and GPs should be developing these systems in readiness.’

RCGP chair Professor Steve Field is in no doubt federations are the future.

‘This is the way forward,’ he says. ‘The most important thing is strong GP leadership and that patients are at the centre of it.’

Increasing numbers of practices appear to be heeding that call.

How GP Federations are progressing across the country

1. Bexley: PBC federation of 32 practices that was responsible for making a £1.4 million saving in prescribing cost last year and is now looking at working with consultants to develop new pathways of care

2. Brent: Initially a PBC cluster of 67 practices, it has now progressed to have a GP Federation Council and is involved in all mainstream commissioning and planning

3. Worcestershire: 22 practices working in a ‘limited liability partnership’ with the private company Assura to develop PBC opportunities

4. Lincolnshire: Cluster of 14 practices that is registered as a ‘limited provider company’ and has worked to ensure their local hospital survives by having primary care-led acute medical beds, a GP-led A&E department and holding additional diagnostics in the community

5. Croydon: Led by RCGP fellow Dr Agnelo Fernandes, it is made up of 16 local practices covering 140,000 patients. Recently it won an award for its diagnostics-in-the-community project, providing ultrasound, echocardiography and direct-access MRI

6. Surrey: Epsom Downs Integrated Care Services is a collaborative venture involving a federation of 20 practices in Surrey. It has established nearly 30 new community clinics, enabling over half of out-patient consultations to take place closer to home

7. Sheffield – Consortium of 28 practices that has been working on schemes to improve prescribing and community services for chronic pain and COPD. Has just set up their own provider company – Central Care Sheffield Ltd

8. South London – RCGP vice-chair Dr Clare Gerada’s group of five GP practices across Southwark and Lambeth has set up new musculoskeletal clinic and gynaecological services and was mentioned as a good practice example in the Darzi review

9. Tower Hamlets – Revolutionary plans for primary care ‘networks’ with a hub for each long-term condition, with GPs working with specialists and community/social care services and local voluntary groups

10. Kingston – The Kingston Co-operative Initiative is a not-for-profit limited company overseeing PBC on behalf of 27 practices. Runs an education and support service and a GP-led referral management scheme. Also developing a service provider arm.

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McKinsey identifies need for 40% increase in GP funding

Posted on November 11, 2009. Filed under: News stories | Tags: , |

Pulse | By Gareth Iacobucci | 11 November 2009

Exclusive: GPs in one of the poorest parts of the country are so underfunded through the global sum they need a 40% increase in their annual payments, a report by NHS external consultants has concluded.

Trailblazing PCT NHS Tower Hamlets has agreed a £12m-a-year increase in primary care spending after the report by McKinsey found its GPs were receiving only a fraction of the funding they needed to do their jobs effectively.

But the PCT, which has led the way in using external consultants to guide commissioning, has attached strings to the new money, with practices expected to work together as federations to manage patients with chronic illness.

Eventually GPs will become part of much bigger integrated care organisations, including secondary care, community care and social care providers, according to a PCT document, released to Pulse under the Freedom of Information Act.

NHS Tower Hamlets, which is seen as one of the leading trusts in the country and came second in World-Class Commissioning rankings, has modelled its plans partly on the Kaiser Permanente model in the US.

It will increase LES funding sixfold to nearly 40 participating practices to plug the identified gap, but though initially they will stay on GMS contracts, negotiations have begun to persuade them to switch to APMS.

Jane Milligan, director of primary care at the trust, said: ‘The clinical engagement of GPs has been critical to this work. It would be a shame if contracts ended up tying us up in knots.’

For participating practices, any LES payments related to long-term conditions will be shifted to the new formula from next April.

The report suggests a 70% increase in staff will be required to deliver packages of care for illnesses such as diabetes, hypertension, COPD and asthma, with more than 100 extra nurses potentially to be recruited.

Dr Kambiz Boomla, a GP in Tower Hamlets and chair of City and East London LMC, said the programme could easily be translated to other areas with high prevalence of long-term conditions.

‘It is an investment programme designed to take us above the level elsewhere. Our PCT actually had money to spend. The argument is, you get more health gain by spending it in primary care,’ he said.

But he warned: ‘They have produced a very tight, performance-managed set of targets.’

HOW THE EXTRA MONEY WILL BE SPENT

• Care packages to be launched for diabetes, immunisations, hypertension, coronary heart disease, COPD, asthma, depression and CKD 
• PCT to launch network of providers, starting with GP practices, which will eventually become fully integrated with secondary care, community care and social care providers 
• Up to £12m increase in LES payments with aim to switch to APMS contracts
• Practices to get performance bonuses based on outcomes, patient experience, access and process performance

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Lord Darzi’s white elephant legacy

Posted on November 4, 2009. Filed under: GP-led health centres, News stories | Tags: |

Pulse | Editorial Comment | 4 November 2009

With GP-led health centres failing to hit their patient sign-up targets, is Lord Darzi’s dream of easy-access healthcare hubs turning into a highly expensive nightmare?

Dr Kailash Chand, GPC member and now a PCT chair, put it neatly. He said of Lord Darzi’s national network of GP-led health centres earlier this year: ‘They will poach patients from neighbouring practices or else they’ll become white elephants. Either way the taxpayer will be short-changed.’

Well, as it turns out, Darzi centres look destined to become more elephant than poacher. Pulse’s investigation this week reveals two-thirds of centres are on course to miss their PCT targets for numbers of registered patients. In some cases, they are registering patients at only a third of the rate they need. One has only 100 registered patients after six months of operation.

There is early evidence, too, that the chances of a GP-led health centre being a success are particularly poor in areas that already had an ample supply of doctors. Two of the four centres in underdoctored areas that provided figures were on course to meet registration targets, but just three of 11 in areas that were not underdoctored.

It may be a tentative trend, but it’s exactly what you would expect – the result of a simple mismatch between demand and supply. It’s that mismatch that goes to the core of the polyclinic controversy. Nobody – not Pulse, not the BMA – objected to introducing Darzi centres where there was local appetite for them. It was their blanket imposition, even in the face of active opposition from local GPs and patients, that was so destructive. It is partly vindicating, partly dispiriting, to have the futility of that policy so starkly exposed.

So the blanket rollout of Darzi centres was a mistake. But don’t just take that from Pulse – take it from the Department of Health.

It admitted at a recent NHS ‘lessons learned’ event that undertaking a mammoth 264 APMS procurements all at once had run the risk of ‘saturating the market’. And the DH conceded, in a rare mea culpa it had presumably hoped to keep private, that forcing through plans for Darzi centres without proper consultation had also been an error. ‘We should have built in more time at the first and final stages of procurements, particularly for engagement with the public,’ a presentation made at the meeting said.

It will be fascinating to see how those observations will feed into the Government’s promised review of the cost-effectiveness of Darzi centres, if that ever sees the light of day. A previous Pulse investigation found some centres were due to cost as much as £560 per registered patient, even by the projected figures for enrolment. If actual enrolment is only at a fraction of what had been expected, the cost per patient will be even higher – in the short term at least.

In the longer term, though, those running Darzi centres know a lack of patients is a threat to their existence. They are now urging PCTs to renegotiate contracts to focus more heavily on walk-in consultations – an area where demand has been much healthier.

The Government has spent two years and £250m rolling out its network of Darzi centres and practices. It will be hard to see that money as well spent if the Government ends up with a network of walk-in centres – exactly what it had when it started.

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Alliance calls for NHS providers to get priority

Posted on October 26, 2009. Filed under: News stories, Press/News Releases | Tags: , , |

Pulse | By Gareth Iacobucci | 26 October 2009

The NHS Alliance is urging the Government to slam the brakes on privatisation of NHS services by adopting new rules on APMS tendering.

Under its proposals PCTs would be barred from approaching independent providers unless they could satisfy detailed criteria that existing NHS services were not meeting quality standards.

In Scotland legislation has already been brought in to bar private companies from taking over the running of NHS services.

It also backs the Department of Health’s advice to NHS trusts to give current providers ‘at least two chances’ to improve where they are found to be under-performing, and for alternative providers to only be considered as a last resort.

In a paper entitled Rebalancing the Market, launched at last week’ NHS Alliance Conference in Manchester, the organisation backs the Government’s shift in emphasis, and recommends a revamp to the way services are tendered for.

For years PCTs have been encouraged to court private providers to bid for APMS contracts but the Alliance advises that in the future, PCTs should only invite private bidders in to bid to run services where there are no current providers of sufficient quality willing to tender.

It also calls on SHAs and PCTs to offer ‘formal support’ to NHS bidders during the tendering process, and recommends bidders be assessed on their ability to provide continuity of care and engage with local patient groups.

Dr Brian Fisher MBE, public and patient involvement lead, at the NHS Alliance, who presented the paper, said: ‘This will respect the importance of continuity in integration of local services and organisations that have historically provided a good local service.

‘It will encourage competition where services are of insufficient standard or too expensive, without destabilising primary care provision when it is already good.’

Market forces need to be put in service of patients

NHS Alliance | 21 October 2009

NHS organisations should be the first choice for commissioners as preferred providers, says the NHS Alliance. 

In a paper entitled Rebalancing the Market, which will be launched at the NHS Alliance 12th Annual Conference in Manchester, the organisation suggests two new approaches to tendering and commissioning that would improve cooperation and increase efficiencies. 

The paper states that tendering for services to include private bidders should be encouraged only when there are no current providers of sufficient quality prepared to offer extended services or conventional GP services at the right price. 

Dr Brian Fisher, National Public and Patient Involvement Lead, NHS Alliance, and the paper’s author, said: “Too often, the result of a business model is an NHS organisation that looks for increased income, which can come at the expense of patient care. The Alliance would like to see market forces better directed to improve the service to patients.” 

Although working with the independent sector has its advantages, it also poses many challenges, not least to the patient who, instead of being at the centre of healthcare planning, becomes part of a tug of war between primary and secondary care. 

Independent sector organisations may be more expensive and exit the market when the going gets tough. They may also decide to cut costs using short-term and/or inexperienced clinicians.

The paper also highlights that collaborative commissioning, programme budgeting and horizontal/vertical integration could be the answer to creating an environment where all partners have a common interest in improving care pathways and producing efficiencies. It says: “It may be that a cooperative approach works in some situations and not in others – there may well be a mixed set of approaches both within and between PCTs.”

For a copy of Rebalancing the Market or to arrange an interview with Dr Brian Fisher please contact the NHS Alliance press office on 07951204999/pressoffice@nhsalliance.org 

Ends.

Notes to Editors
1. For more information, please contact the NHS Alliance press office on 07951204999/pressoffice@nhsalliance.org 

2. The NHS Alliance is the only independent body that brings together primary care trusts’ chief executives and other senior managers, doctors and practice managers, nurses, pharmacists and allied health professionals, along with board chairs and members. We are a value-driven organisation, with no political affiliation, which works in partnership with various bodies associated with the NHS to create a progressive health service that is free from the traditional tribalism of single interest groups.

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PCT offers practices £220k to create partnerships

Posted on October 22, 2009. Filed under: News stories | Tags: |

Healthcare Republic | Jonn Elledge | Essex PCT | 22 October 2009

A PCT in Essex has offered practices £220,000 to create partnerships if they abandon GMS status.

GMS practices in south west Essex will be offered £220,000 over four years to pay for an additional partner. 

In exchange, the practices have to switch to PMS or APMS status.

NHS South West Essex said the move was intended to attract more GPs to the area, and to smooth succession at a number of single-handed practices where partners are up for retirement.

‘The aim of this scheme is to recruit young, innovative GPs into the areas of most need and to enable these GPs to establish their careers,’ said a spokesman. ‘It will enable smaller practices to develop into larger surgeries offering more GPs, providing additional capacity able to respond to the growing population in these areas.’

Dr Brian Balmer, chief executive of Essex LMC, welcomed it as a ‘genuine attempt to attract new GPs into an area which badly needs partners’. 

The PCT had wanted all practices in the scheme to move onto APMS contracts, he said. But he persuaded the PCT that GPs would not be prepared to relocate to take up a contract that could be cancelled after three years.

‘What practices gain outweighs the extra PCT control’ involved in moving to PMS status, he added.

The scheme offers practices £80,000 in year one, £80,000 in year two, and £60,000 split over the following two years. So far five practices are thought to be involved.

The move was announced in the Essex LMC newsletter.

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APMS firm got 10% pay boost

Posted on October 20, 2009. Filed under: News stories, Providers | Tags: , |

Pulse | By Steve Nowottny | 20 October 2009

Exclusive: A private company received 10% extra over the value of its core APMS contract through a single local enhanced service-style payment in the first year of running a GP practice, Pulse can reveal.

Creswell Primary Care Centre in Derbyshire, which was taken over by the company ChilversMcCrea Healthcare in 2007, received a payment of £63,906 for ‘Note Summarisation’ in 2007/8, details released under the Freedom of Information Act reveal.

ChilversMcCrea said the funding was prompted by the ‘exceptional amount of work’ required to summarise notes after taking over the village practice.

But local GPs have raised concerns that the payment, which was not offered to any neighbouring practices, was far above the going rate and indicative of preferential treatment for the private sector.

The payment for note summarisation represents 10% of the total value of Chilvers McCrea’s contract, which a separate FOI response has disclosed was £631,833 in 2007/8. The payment equates to roughly £10 per patient.

However, in the following year, 2008/9, the practice scored poorly on four QOF indicators relating to notes summarisation, being awarded 0% for an indicator on whether it had up-to-date clinical summaries in at least 60% of patient records.

Dr Trefor Roscoe, a GP in Sheffield who worked as a registrar in the Derbyshire practice 20 years ago, said: ‘We pay our summarisers about £6 an hour, and they do four or five sets of notes an hour. That’s the going rate. I suspect ChilversMcCrea has said, “there’s no way we can take this practice on – the notes are a mess and we need some money to sort it out”. The trust has added 10%, but this is money the public purse should not have had to spend.’

A PCT spokesperson said the payment was ‘not a formal LES’ but had been listed as such in its FOI response ‘to be fully transparent’. ‘As it wasn’t a formal LES, it wasn’t offered to other practices,’ the spokesperson said.

The trust declined to comment on whether the funding was over the odds, but said it ‘was to reflect the need to improve the notes [Chilvers McCrea] inherited’.

Asked about its subsequent QOF score, the spokesperson said: ‘This process has only just been completed and payments to the practice reflect this.’

Dr Sarah Chilvers, managing director of ChilversMcCrea, said: ‘When we took over the practice, an exceptional amount of work was required to bring the notes up to standard. This work has helped us to significantly improve access to healthcare for patients.’

Dr John Grenville, secretary of Derbyshire LMC, said: ‘On the face of it, it looks very discriminatory. But although they’ve listed it as a LES, it’s an APMS contract so LESs don’t really count. Because the definitions are so different, it’s impossible to tell if the playing field is level.’

ChilversMcCrea, which manages over 30 practices across the UK, has endured a difficult few months. Earlier this month NHS North East Essex threatened to remove its APMS contract for a local practice after accusing the firm of ‘underestimating’ the challenge of running GP services.

In April, the company was forced to terminate its contract for a practice in south-east Essex, blaming the economic climate.

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Walk-in doctors’ surgery launched in Nuneaton

Posted on October 20, 2009. Filed under: GP-led health centres, Integrated care, Journals, Press/News Releases, Providers | Tags: , |

Coventry Telegraph | 20 October 2009

AN INNOVATIVE walk-in doctor’s surgery has been launched at a health centre in Nuneaton.

It will allow patients to have an appointment even if they are registered with another surgery and is part of a government programme to increase access to family GP services.

George Eliot Hospital has become the first Acute NHS Trust in the country to run a GP-led facility, which is based at Camp Hill Health Centre, and is supported by NHS Warwickshire.

Health Minister and North Warwickshire MP Mike O’Brien, who performed the opening, said: “This will make a huge difference in improving access to health care for local people.

“Centres like this one are opening up and down the country, complementing services provided by existing practices.

“The centres are proving popular with patients who have told us that they want to be able to see a GP at times convenient to them.

“This centre will offer patients the greater choice and flexibility they want, being able to see a doctor or nurse between 8am and 8pm seven days a week, while still remaining registered with their family GP if they so wish.”

As well as increasing access to GP services, the Ramsden Avenue centre will also have a strong focus on promoting better health and ensuring everyone has access to the services and care they need, particularly for hard-to-reach groups.

Some of the health checks and treatments on offer will include physiotherapy, minor surgery and family planning.

Paul Jennings, chief executive of NHS Warwickshire, said: “We know that those living in the north of the county are statistically more likely to suffer ill-health and we are focused on tackling these health inequalities.

“Camp Hill Health Centre is the result of effective partnership working between NHS Warwickshire, the local community and George Eliot Hospital. Its opening is sure to have a positive effect on health services in the area.”

Sharon Beamish, chief executive of George Eliot Hospital, said: “As a well known local NHS health care provider we are delighted to have been given the opportunity to provide primary care to the community.

“We are looking forward to working with local people to develop services that they want and need in the area and we are fully committed to providing the best care possible to all who choose to use the services in Camp Hill.”

Opening of new GP-led health centre with Warwick Medical School

Warwick Medical School | News Release | accessed 1 October 2009

A new GP-led health centre in Warwickshire developed in conjunction with Warwick Medical School has officially opened its doors for the first time. 

The Camp Hill Centre, based in Nuneaton, has been opened by the Minister of State for Health Services Mike O’Brien MP.  

The Camp Hill area was chosen to benefit from a new health centre as part of the Department of Health’s alternative providers medical services (APMS) contracts. These contracts enable PCTs to deliver health services tailored to local needs. 

Warwick Medical School has contributed towards the development of the health centre and created a learning environment for both its undergraduate and postgraduate students. The health centre will become a teaching hub, providing local leadership to teaching practices.    

Hospital trust opens GP centre

Health Services Journal | 20 April, 2009 | Updated: 23 April, 2009 0:00 am | By Sally Gainsbury

A hospital trust in Warwickshire has become the first to take over the running of a GP-led health centre.

George Eliot Hospital trust plans to open the new 8am to 8pm health centre this October.

The development will be watched carefully as there have been concerns that hospitals should not be allowed to “vertically integrate” with GP services lest they be tempted to use them to create additional demand for acute care.

DH approval

The Department of Health’s guidance on the issue states that any such proposals must be agreed with the department.

But George Eliot trust chief executive Sharon Beamish said the trust “fully supports the drive to provide care closer to home”.

She added: “As an organisation that provides local hospital services we are well placed to extend these services within the community to offer a complete range of healthcare and have a more direct impact on improving the health and wellbeing of [the area].”

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Malling Health centres

Posted on October 16, 2009. Filed under: Press/News Releases, Providers | Tags: , |

Malling Health | News Release | accessed 16 October 2009

  1. NHS Westminster award flagship centre to Malling Health
  2. NHS Kingston appoint Malling Health as preferred provider for their ‘Chessington World of Primary Care’
  3. NHS Cambridgeshire have chosen Malling Health for their GP led Health Centre in St Neots
  4. Double win for Malling Health in Telford
  5. NHS shropshire awards Malling Health with Shrewsbury GP led Health Centre contract
  6. Malling Health scoop all four APMS contracts in Sandwell including one GP led Health Centre
  7. NHS Coventry awards Malling Health with 2 new surgery contracts: Malling Health will set up 2 new surgeries in Coventry, one in Foleshill and the other in Stoke Aldermoor. Both services are expected to commence in April 2009.
  8. Malling Health wins bid to run new surgery in Worle, Weston-super-Mare. This exciting service will be set up on a new site and we expect it to open in early summer 2009. 

It is our aim to work with commissioners as well as patients to find solutions that best fit the needs of the local population, always aiming to involve all other agencies.

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DH throws new lifeline to ‘low-scoring’ GP practices

Posted on October 6, 2009. Filed under: News stories | Tags: |

Pulse | By By Gareth Iacobucci | 6 October 2009

The Department of Health is to hand a lifeline to practices that score badly in balanced scorecards as part of a huge policy shift in the way GP services are commissioned.

New guidance to NHS trusts will advise them to give current providers ‘at least two chances’ to improve where they are found to be under-performing, and that alternative providers should only be considered as a last resort.

The move will be seen as a welcome boost to GPs under scrutiny on issues such as performance and value for money, who will now be given more time to get things right.

It represents a significant change in stance from the DH, which had been actively encouraging PCTs to stimulate the market by putting more GP services out to tender under APMS.

The move has already been attacked by former health secretary and architect of the 2000 NHS Plan, Alan Milburn MP, who told delegates at the Labour Party conference that the NHS needed more not less competition to remain financially sustainable.

But PCT bosses said the move was a necessity in the current climate. Dr David Paynton, commissioning director at NHS Southampton City and a GP in the city, said choice was not compatible with financial deficit.

Speaking at the Primary Care Live conference in London, Dr Paynton said: ‘We are going to have to look at how we are going to manage choice.

‘If we’re going to cope with the economic situation then we can’t afford to commission for overcapacity. If you commission extra capacity to increase competition, that will increase demand and we can’t afford it.’

Angela Gibson, DH lead on World Class Commissioning assurance framework and director of commissioning at Sutton and Merton PCT, also speaking at the event, said: ‘You should try to drive up quality of care in existing providers before going out to the market.’

BMA chair Dr Hamish Meldrum welcomed the move: ‘We see this as a very positive sign that the Health Secretary is listening to the concerns of the BMA and others about the increasing commercial involvement in the NHS. We look forward to his words being translated into real change on the ground.’

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Private provider faces PCT sanctions

Posted on October 6, 2009. Filed under: News stories, Providers | Tags: , |

Pulse | By By Gareth Iacobucci | NHS North East Essex | 6 October 2009

NHS managers are threatening to remove a private company’s APMS contract after accusing the firm of ‘under-estimating’ the challenge of running GP services and not providing continuity of care.

NHS North East Essex is threatening to take ‘draconian measures’ against Chilvers McCrea Healthcare, after patients at the Green Elms surgery in Jaywick complained about the lack of full-time GPs.

Speaking at a public meeting, Penny Lansdown, head of primary care commissioning at NHS North East Essex, said the trust was planning the strongest possible sanctions.

‘Frankly, it has not delivered,’ she said. ‘I think it under-estimated the challenge here.’

‘We are taking quite draconian measures. I am going to go into the surgery every week. If we do not get what we want, and soon, we will take the steps necessary.’

‘What we would like to do is work with the company to see if it can get it right. If it does not perform, we will use the leverage in the contract to remove it if necessary.’

Dr Rory McCrea, chair of Chilvers McCrea Healthcare, said the company was investing ‘considerable time and resources’ in the practice.

‘Our number one priority is patient care. That’s why we have spent considerable time and resources recruiting permanent GPs to the Green Elms Medical Centre.

‘By the start of November there will be four full-time GPs with a further permanent GP to be recruited next month.’

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Private firms are ‘more likely to win’ APMS bids

Posted on October 1, 2009. Filed under: News stories | Tags: , |

Healthcare Republic | GP newspaper | By Tom Ireland | 1 October 2009

APMS contracts Research shows GP bidders for contracts rarely emerge on top if private firms compete.

Richard Vautrey

Richard Vautrey

GPs are only likely to win APMS contracts when large private firms are not bidding, according to research.

A review of APMS contracts in the British Journal of General Practice found just two cases where an independent GP beat commercial companies to secure an APMS contract.

‘GPs or social enterprises are more likely to win a contract in the absence of any competition or when they are competing with each other,’ it found.

‘This raises serious concerns about the existence of a “level playing field”,’ write its authors, from the University of Edinburgh’s Centre for International Public Health Policy.

The researchers asked all PCTs in England for details of any APMS contracts that had been awarded or were out to tender. A total of 49 PCTs had awarded one or more of the contracts and 30 also gave details of unsuccessful bidders.

Half of all APMS contract tenders were awarded to large commercial companies (36 out of 71) compared with 28 awarded to GPs. At least 14 commercial providers hold APMS contracts in England, and at least eight other firms have bid unsuccessfully.

The researchers said the lack of data the DoH has on APMS deals makes comparing cost, value and services difficult.

GPC deputy chairman Dr Richard Vautrey said the research showed private companies were ‘cherry picking’ financially attractive deals. 

He also said the difficulty obtaining information about APMS contracts from PCTs was ‘a real concern’. ‘There isn’t the openness and support we see with standard contracts. That’s worrying when the government is pronouncing value for money.’

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NHS Kirklees FOI Requests

Posted on July 30, 2009. Filed under: GP-led health centres | Tags: |

NHS Kirklees | FOI Requests | accessed 30 July 2009

#30 Request received 12 May 2009

Please could you answer the following query under Freedom of Information. 
 
Q: Please provide details of the cost-per-patient for the GP-led health centre/s in your PCT* 
 
*Please note: Provided that the tendering process for each contract has been completed, we do not believe this information can be withheld on the grounds of commercial confidentiality, as contracts are NHS funded with public money. This should therefore permit the information to be released into the public domain.  

Best Regards,
(name supplied)

Response sent 1 June 2009

Thank you for your request for information under the Freedom of Information Act.

Please find detailed below the information that the PCT holds in response to your question.

Q: Please provide details of the cost-per-patient for the GP-led health centre/s in your PCT.
 
The requested information cannot be released. This is on the basis of commercial interests and that its disclosure would, or would be likely to, prejudice the commercial interests of the NHS (Para 43(2)). Release of this information is not deemed to be in the public interest because it may prejudice the NHS’s ability to secure value for money in similar procurements and hence impact on the effective use of public funds. This is because the procurement process for aGP-led health centre is still underway in other PCT(s) within Yorkshire and The Humber; once all such closely-related procurements are completed (currently expected Autumn 2009, but subject to change) there is not expected to be any objection to releasing the information.”

If you have any further questions, please do not hesitate to contact us.

Kind Regards
NHS Kirklees

#32 Request received 19 May 2009

To whom it may concern,
 
Please can you give me details of all the APMS contracts you have with providers covering medical or nursing services; Including the name of the provider, details of the service(s) the contract covers and its location or area.
 
With thanks
(name supplied)

Response sent 26 May 2009

Thank you for your request for information under the Freedom of Information Act.

Please find detailed below the information that the PCT holds in response to your questions.

There is one APMS contract.  This is Local Care Direct who provide a GP service (GP Led Health Centre) 
The location of this is:-

School House Practice 
Dewsbury Health Centre
Wellington Rd
Dewsbury
WF13 1HN

If you have any further questions, please do not hesitate to contact us.

Kind Regards
NHS Kirklees

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