We wanted to trigger a debate on resource inequality in health care, so were not expecting someone to call our financial judgement into question, and use our letter to warn against APMS contracts.
First, our defence: we made careful calculations, agreed and accepted by the appointing PCT. In addition, our bid price was above the minimum recommended by the BMA at the time. In that sense, we believe that responsibility for the financial judgement is a shared matter, and directing criticism at one party unhelpful.
APMS contract setting continues to evolve, and we understand that some contracts are now approaching a fairer reflection of what is needed to provide high quality care in the local context. If this continues, then APMS may yet become an effective vehicle for redressing the inequity of resource we observed in our original letter.
That said, Dr Zuckerman makes a valid point about caveat emptor. Our experience shows the real risks that a single practice faces when bidding for an APMS contract. By comparison, large commercial organisations can probably write off the loss of an underfunded contract for several years, so as to get their foot in the door.
This, however, creates a dilemma: for existing practices to sit on their hands while commercial organisations harvest large swathes of primary care, or to seek to preserve the qualities of continuity and professionalism that characterise general practice by exposing themselves to risk. Judging the effects on health inequalities of action versus inaction is difficult. The logical alternative — for large groups of independent practices to form partnerships to increase their clout — still seems too unappealing for most GPs to follow it through.
No one held a gun to our heads, but our sense of threat to general practice was and remains strong. We chose to act by applying for this contract. Despite the financial challenge, the practice team remains positive. The majority of our patients are being treated by experienced GP principals, not locums or salaried doctors on short-term contracts. Had we been over-inhibited by caveat emptor this situation could be very different.
- © British Journal of General Practice, 2008.
