Letters Open all hours primary care

Feathering the cuckoo’s nest

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1876 (Published 01 April 2010) Cite this as: BMJ 2010;340:c1876
  1. Hendrik J Beerstecher, GP principal1
  1. 1Sittingbourne, Kent ME10 4JA
  1. hendrick.beerstecher{at}nhs.net

    Hawkes’s assault on traditional primary care contractors was presumably to provoke a response from the champions of the public service NHS.1 I am not one, although I hold a general medical services (GMS) contract. However, inequities are increasing in the system, as exemplified in Barking and Dagenham.

    In 2006 we were provided with payment details of all GMS and PMS (personal medical services) contractors in the primary care trust, except the new APMS (alternative provider medical services) provider. This became the subject of a three and a half year legal wrangle with the Department of Health through the Information Commissioner.

    The figures reveal that the APMS contractor received reimbursement for rent, rates, and facility management costs, and £92 712 a year for “fixed costs.” Additionally the contractor received £235 per list patient a year and £33 for each walk in patient episode in the first year.

    The average GMS and PMS contractor respectively receives £62.67 and £97.96 per list patient. Various payments for premises apply, usually equivalent to rent and rates.

    The generosity towards APMS is doubtless a bitter pill for all the GMS contractors who built up their list through years of hardship and investment, often in the most deprived areas.

    But the most puzzling question remains: why are only certain contractors allowed to see the patients of other practices? Surely, if the real intention was to open competition, all contractors should be paid the same and be given the same opportunity to offer their spare capacity in an open market?

    For the sake of the public purse we should obtain the services from the most cost effective source. But to determine this, and let the markets play it out, we should offer the same payments and demand the same quality of all providers, not feathering the nest of the chosen few with public monies.


    Cite this as: BMJ 2010;340:c1876


    • Competing interests: HJB is a GMS contractor.


    View Abstract

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
    Sign up for a free trial