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BMC Health Services Research

, 13:S3

First Online: 24 May 2013DOI: 10.1186-1472-6963-13-S1-S3

Cite this article as: Coleman, A., Checkland, K., McDermott, I. et al. BMC Health Serv Res 2013 13Suppl 1: S3. doi:10.1186-1472-6963-13-S1-S3


BackgroundHistorically, primary medical care in the UK has been delivered by general practitioners who are independent contractors, operating under a contract, which until 2004 was subject to little performance management. In keeping with the wider political impetus to introduce markets and competition into the NHS, reforms were introduced to allow new providers to bid for contracts to provide primary care services in England. These contracts known as ‘Alternative Provider Medical Services’, were encouraged by two centrally-driven rounds of procurement 2007-8 and 2008-9. This research investigated the commissioning and operation of such Alternative Providers of Primary Care APPCs.

MethodsTwo qualitative case studies were undertaken in purposively sampled English Primary Care Trusts PCTs and their associated APPCs over 14 months 2009-10. We observed 65 hours of meetings, conducted 23 interviews with PCT and practice staff, and gathered relevant associated documentation.

Results and conclusionsWe found that the procurement and contracting process was costly and time-consuming. Extensive local consultation was undertaken, and there was considerable opposition in some areas. Many APPCs struggled to build up their patient list sizes, whilst over-performing on walk-in contracts. Contracting for APPCs was ‘transactional’, in marked contrast to the ‘relational’ contracting usually found in the NHS, with APPCs subject to tight performance management. These complicated and costly processes contrast to those experienced by traditionally owned GP partnerships. However, managers reported that the perception of competition had led existing practices to improve their services.

The Coalition Government elected in 2010 is committed to ‘Any Qualified Provider’ of secondary care, and some commentators argue that this should also be applied to primary care. Our research suggests that, if this is to happen, a debate is needed about the operation of a market in primary care provision, including the trade-offs between transparent processes, fair procurement, performance assurance and cost.

List of abbreviations usedAPMSAlternative Provider Medical Services

APPCAlternative Providers of Primary Care

EAPMCEquitable Access to Primary Medical Care

FCPCFairness in Primary Care Procurement

GMSGeneral Medical Services

KPIKey Performance Indicator

NHSNational Health Service

NHS NSRNHS Next Stage Review

NHSCBNHS Commissioning Board

PALSPatient Liaison Service

PCTPrimary Care Trust

PMSPersonal Medical Services

QOFQuality and Outcomes Framework.

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Autor: Anna Coleman - Kath Checkland - Imelda McDermott - Stephen Harrison


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