In addition to a long standing PMS contract the Ridge Medical Practice in Bradford holds two APMS contracts with our local PCT, both for relatively small practices of around 2,500 patients each. One of these is now in its fifth year with us and the other we have just passed our first anniversary.
We tendered for these as part of our growth strategy believing that the best way of securing our future and being able to remain viable whatever changes happen in the coming years is to be larger and to offer a wide range of services.
You may feel, and patients may also feel, that it is shame the small single-handed GP is becoming rarer. But, whatever our emotional attachment, the stark reality is that such practices will become increasingly unsustainable in a tight financial environment; where increased levels of clinical governance need to be demonstrated along with coping with a greater demand for a more comprehensive level of care.
Tendering for APMS contracts
The tender process for APMS contracts is cumbersome and extremely time consuming, but it is possible for a practice to be successful. Often the local knowledge and clear track record of delivering a high standard of care in the local area, coupled with a deep understanding of the needs and issues of the local population will make you competitive.
The process of tendering goes through a number of formal stages:
- Expression of interest - this gives you all the information to decide if you wish to progress.
- Pre Qualification Questionnaire (PQQ), which is an assessment of your organisation to see if you meet the minimum criteria to be able to run the contract.
- Invitation to Tender (ITT). If successful at PQQ you will be invited to tender which is where you have the opportunity to present how you would run the practice – and what you will charge. Or, if the costs are fixed, what resource you can provide for the specified money.
- Bidder Interviews. Bids are assessed against a scoring matrix which is variously weighted between different parts of your tender, short listed and some will be called in for bidder presentations and interviews.
- Contract Award. A preferred supplier will be chosen and then final negotiations on the detail of the contract will be undertaken prior to signing and then transition to transfer.
The key facets of a high quality tender bid include:
- A track record in delivering the highest levels of clinical quality and governance
- Ideas for innovation based on an understanding of the local population
- A proposal that is responsive to the detailed needs of the community with a focus on health education and improvement
- An understanding of the local community and how they current engage with health services
Integrating the new practices
Despite the fact that these are time limited contracts we have moved to fully integrate all of our practices. Where the patient first chooses to register determines under which contract we are reimbursed for their care, but once registered all patients are exactly the same – with all of them being able to access any clinician and any service at any of our sites.
We have merged the patient records into a single database. We have also merged all the staff teams and, while staff work regular shifts at regular surgeries so that patients can get continuity, all staff move around all our sites. This is important for us to operate a consistent level of care and for good clinical governance. It also ensures that we work as a single practice team – something that is a challenge with over 130 employees.
We have been successful in merging and running these practices as they have both been local to us and we are working with a single PCT. Had we been operating in a wider geographical area I don’t think we would have gained the same economies of scale and the logistics would have been far more complex.
Don't underestimate the challenge
Don’t underestimate the scale of the challenge in taking on a new practice and the time and resource needed to effectively integrate them into your practice. Many practices will be tendered under APMS contracts because of a history of problems and may need a lot of work in terms of introducing new policies and procedures and bringing QOF, the quality of prescribing and care up to your normal standards.
The practice may well be understaffed and you are likely to inherit staff under TUPE and such a change is always unsettling for employees and they may take time to adapt and many will move on.
We recognise there is a risk that we work hard for five years and then lose the contract when it is re-tendered. One of our contracts has a rolling one-year extension, but the other is obliged to be re-tendered after a maximum of seven years.
It would be challenging to unravel either one from the wider practice if required, but we felt that it was not fair to the patient to limit the care we offered them in case we lost the contract. Our view is that if we work hard and offer a great level of care we will remain in the best position to be successful again at tender if or when the situation arises.
- Nick Nurden is business manager at The Ridge Medical Practice, Bradford