The general decrease in NHS funding and recent contract changes imposed by the government has meant that most GP practices in the UK are facing increasing financial challenges, resulting in a fall in income.
However there are some changes in the NHS that offer opportunities to GPs in England to improve services and provide additional income. Applying to provide any qualified provider (AQP) services is one such opportunity.
Several services are already being commissioned across England using the AQP process. Examples include community ultrasound, ‘no-scalpel’ vasectomy, endoscopy, podiatry and audiology. More services will be commissioned using the AQP in future.
Our vasectomy service
Bretton Medical Practice is a sub-urban practice in Peterborough with a list size of about 12,000 patients. We have a long history of service provision that predates even practice-based commissioning and has evolved through various processes to the current AQP process.
The practice started a small, private vasectomy service in 1983 that was limited to about 10 patients year. The service expanded significantly in 2003 after we invested in building an operating theatre and we were awarded a contract by our PCT.
The practice offered a ‘one-stop’ process and in 2004 started offering the ‘no-scalpel’ vasectomy technique. In 2005 the practice gained another contract with Peterborough PCT.
In 2008 the practice underwent an ‘any willing provider’ application, as it was then called, and was successful in renewing its contract with the Peterborough PCT. This was followed by another successful AQP process in 2012.
We now provide ‘no scalpel’ vasectomy services to three PCTs, which have now become one CCG.
The practice has also provided an AQP community endoscopy services from its theatre and is exploring other AQP opportunities.
Advice for practices wanting to bid for AQP contracts
There a number of things practices will have to consider if they want to provide a service under AQP.
As a partnership you will need to decide if offering additional services is something you want to do. You should discuss this at your away day or have it as part of you practice strategy. The practice will need to consider the pros and cons, risks and rewards of such plans.
Your decision should be based on your potential as a practice. Do you have the space? Are you prepared to invest in physical development or purchase of equipment, such as ultrasound?
Are there any GPs with a particular skill or interest you could use, or are you willing to support one of your GPs to train as a GPSI?
Remember you do not have to offer the clinical service yourself. The endoscopy service at our practice is run by a GPSI from another practice and hospital consultants working as locums.
Engage with your CCG
You will need the support of the partners and staff. It also helps to be actively engaged in your CCG. This allows you to be more aware of the various local services and any existing and potential AQP offers.
You could study local service provision and identify gaps in services that you could be potentially offer. Our local commissioners had no plans for an endoscopy service but were convinced by the potential for patient benefit when we suggested it to them. This led them to develop an AQP specification and advertised for potential providers.
Consider going into a strategic partnership or alliance with another practice or an existing provider. This could range from a full joint venture or merely a tenant-landlord relationship.
The key to success
The key to becoming a successful AQP provider is to do your research well. It is useful to speak to other practices who have undertaken the process and are providing services.
Check the supply 2 health website where all NHS AQP services are advertised. The site also contains a lot of useful background information about the process and details of existing AQP offers. You might find services being offered in other regions, which you could suggest to your CCG to commission under AQP.
Submitting your application
Once the service has been advertised, the application process on the supply2health website is cumbersome. It involves filing a lengthy application form on an unfriendly website. Ensure that you meticulously dot all the ‘i’s and cross all the ‘t’s.
Despite the challenges involved in bidding for these services, as a practice we have always found the whole exercise (from planning potential services through to the application and delivery) gives us an opportunity to review our strategy and priorities. It also enables us to reconsider our policies and outcomes and refocus our commitment to excellent patient care.
- Dr Mark Attah is the business development lead GP at Bretton Medical Practice in Peterborough