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APMS contracts explained

Justin Cumberlege explains what alternative provider medical services contracts are and how they have opened up primary care to the private sector

APMS providers may employ GPs to perform services
APMS providers may employ GPs to perform services

Private sector
GMS and PMS contracts are for GP practices or other healthcare professionals while an APMS contract can be awarded to anyone, including private sector organisations. This enables an organisation to manage the provision of the service, while employing the medical staff required to perform the service.

Many saw the introduction of APMS as the moment when primary care was opened up to the private sector. However, APMS contracts can be awarded to charities, social enterprises, GP practices, or companies formed by healthcare professionals, such as GP federations.

Primary care
Although the private sector has had other opportunities, APMS contracts have paved the way for providers that are not GPs or part of the NHS to provide primary care treatment to NHS patients, and for that treatment to be paid for by the NHS.

The impact of this is increasing: the number of services which are being commissioned at a primary care level are increasing, and the private health care sector has been given opportunities to expand, by for example, providing out-of-hours, diabetes and COPD services. 

This has allowed commercial companies to ‘learn the NHS ropes’ and then to innovate in order to find cost savings, although not always successfully.

Contract terms
The terms of APMS contracts are based on the Alternative Provider Medical Services Directions which are legally binding.

New directions, or amendments to the directions are issued almost every year. The current directions came into force in April 2010, and were amended in April 2012.

The mandatory terms in an APMS contract are based on the PMS contract with further elements added in.  In addition, many PCTs when commissioning services under an APMS contract add their own terms, which generally make the contracts very onerous.

Length of contract
As long as the mandatory terms are complied with, how services are provided is up for negotiation. But one big difference is that APMS contracts are generally for fixed terms of three years with an option to renew for another two years.  Sometimes a fixed term of five years is awarded.  So every three to five years you will have to bid to continue to provide the service.

Vacant practices
Why is APMS important for GPs? Enhanced and additional services are normally part of the GMS contract but there is no reason why they cannot be contracted separately by the PCT under APMS contracts.

Furthermore when there is a vacant practice, the registered patient list is often put out to tender and increasingly we can expect that to be under an APMS contract rather than GMS or PMS. If a brand new practice is to be set up, this too may be put to tender as an APMS contract.

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