11 August 2008

New APMS "Super-Surgeries" For Coventry

Scrutiny Board 4 of Coventry City Council has decided to support the idea of APMS contracts for three new GP surgeries in Coventry.

Scrunity Board 4 is reponsible for looking at policy surrounding community services, health, culture, leisure, libraries, and neighbourhoods/community safety. You can see more information on its membership and upcoming meetings here.

Under APMS (Alternative Providers of Medical Services) contracts, potential bidders - private companies, the voluntary sector or GPs - will be invited to run each surgery on a three-year contract.

The Coventry Telegraph reports:

The Local Medical Committee (LMC), which represents city GPs, is vehemently opposed to the "commercial-isation of general practice". It was represented at the meeting by secretary Dr Jamie Macpherson who warned that the cash came with "strings attached", in the form of multinational companies looking to make a profit. Socialist Cllr Rob Windsor raised concerns about some of the multi-nationals who could be potential bidders for the new Coventry surgeries. He said: "Inviting them in would be like inviting dingos to run a sheep farm. Let's have a proper look at these companies or we could see them denying healthcare to certain people."
You can take a look at the report from the committee here (6th August 2008).

A number of interesting things upon close reading of the report:

1) The Scrutiny Board decided that:

"to suggest that general practice in its current form is somehow fundamentally different to general practice provided by a consortium of GPs, or even a private healthcare company, is generally not credible."

For the committee, for-profit healthcare is the same as GPs in their current form. Hands-up, who agrees with that? For-profit healthcare means that more profitable procedures/patients will get priority, rather than what local health necessarily needs.

2) The chair, Joe Clifford (Lab - Holbrooks) is the only member to attend all the meetings/visits/briefings listed at the end. The deputy chair, Altaf Adalat (Con - Foleshill), didn't attend any of them.

3) The committee disagreed (page 10 of the report) with both the Local Medical Committee, as well as local pharmacists (The Local Pharmaceutical Committee).

12. The LMC identified what it saw as the following general flaws:

- The APMS contract creates a business-based, profit-driven approach to health care, at the expense of the existing GPs’ service-based, patient-centred approach – Dr Wells, Vice-Chair of the LMC suggested that the new contracts might be "the end of general practice as I know it".
- Short term contracts interrupt continuity of care and the GP’s role as a patient advocate
- The procurement process creates barriers to entry for GPs, notably the significant cost of preparing a credible bid
- GPs are not, in isolation, an effective response to health inequalities
- The risk that new entrants will either destabilise existing general practice provision, or fail and leave the market, thereby wasting tax payers’ money, with the additional risk that damage to health care provision in the locality will already have been done
- There are fears for the terms and conditions of salaried GPs, and questions about the quality of the practitioners
- Private contractors will offer diagnostic services and undermine their provision at
University Hospital Walsgrave

13. The LMC’s overall view is that the existing GP contracts, the General Medical Services (GMS) contract, and Personal Medical Services (PMS) contracts are the appropriate means by which new services should be introduced.

14. The Local Pharmaceutical Committee (LPC), which represents the city’s pharmacists, came to a similar view. The LPC saw considerable risk and potential destabilisation of the provision of community pharmacy, if there was turbulence in general practice. The pharmacists feared the new practices would include so-called "100 hour" pharmacies which are exempt from the control of entry regulations. The LPC feared that these new co-located pharmacies could put existing pharmacies out of business, and reduce the provision of "High Street" community pharmacy.


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