Feature Primary care

Private practice

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.a330 (Published 19 June 2008) Cite this as: BMJ 2008;336:1406
  1. Andrew Cole, freelance journalist
  1. 1London
  1. a.cole71{at}ntlworld.com

    Contracts to allow general practices to be run by private companies were supposed to be a last resort, but is this really the case? Andrew Cole reports

    APMS (Alternative Provider of Medical Services) was once just another of the myriad health service acronyms that English general practitioners (GPs) were expected to master. But in recent months the APMS procurement process has become all too familiar and has led to fears it could threaten the foundations of general practice.

    It’s a surprising turnaround. When APMS was launched it was billed as an unexceptional, indeed laudable, attempt to bring new blood into areas where practices had failed or had severe doctor shortages. In those situations contracts would be put out to tender and would be open to all comers—the private or voluntary sector or existing NHS practices.

    Initially that’s how it worked. But recently the number of APMS schemes has risen sharply while the criteria for choosing this tendering method seem to have widened. The trend gained momentum with the government’s edict late last year that 100 new general practices and 150 polyclinics be procured through APMS.

    A survey by the general practitioners’ magazine Pulse in January showed a third of trusts were now tendering for APMS contracts compared with just 10% six months earlier. And when it comes to the procurement process itself, the private sector seems to be winning hands down. Another survey by the same magazine suggests that although around half of shortlisted bids come from NHS practices, only one in 10 is successful, with 91% going to private companies. Private companies are also consistently undercutting practices on price, often by as much as 25%.

    St Paul’s Way

    One recent example of this phenomenon is St Paul’s Way Medical Centre in the heart of Tower Hamlets, which was put out to APMS …

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