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Alternative Provider Medical Services (APMS) guidance

  • Last modified date:
    8 February 2007
APMS offers substantial opportunities for the restructuring of services to offer greater patient choice, improved access and greater responsiveness to the specific needs of the community. It will provide a valuable tool to address need in areas of historic under-provision, enable re-provision of services where practices opt out, and improve access in areas with problems with GP recruitment and retention.

PCTs can enter APMS contracts with any individual or organisation that meets the provider conditions set out in Directions. This includes the independent sector, voluntary sector, not-for-profit organisations, NHS Trusts, other PCTs, Foundation Trusts, or even GMS and PMS practices. If PCTs contract with GMS / PMS practices via APMS, the practice would hold a separate APMS contract alongside their GMS / PMS contract.

The PCT will want to ensure that it has transparent, non-discriminatory procedures in place for selecting a contractor, in order to encourage competition.

Contracting for APMS

In setting APMS contracts, PCTs will need to ensure that the contracts reflect the directions. There is, however, substantial freedom for PCTs to develop APMS contracts to best meet local need; the focus is on innovation whilst ensuring core NHS values are full protected and secured. When setting APMS contracts, PCTs should consider the following :

  • Service specifications
    These could include links to the Quality and Outcomes Framework standards.
  • Price of contract
    This is to be negotiated locally between PCT and provider; there are no statutory entitlements.
  • List arrangements
    The PCT must establish and maintain a registered list of patients to be held on behalf of the contractor, and have systems in place for registration and removal of patients from the list, in the case of essential services.
  • Performance monitoring and reporting arrangements
    When stipulating quality standards it is up to the PCT to negotiate a method for monitoring adherence to these standards.
  • Termination and sanctions in respect of contracts
    APMS contracts must stipulate the circumstances in which sanctions, up to and including termination of the contract, may be imposed, and the procedure by which they may be terminated.
  • Subcontracting arrangements
    The PCT has discretion to negotiate arrangements under which subcontracting will be allowed, if at all, with the contractor. Directions stipulate certain circumstances in which subcontracting will not be allowed.
  • Complaints procedure
    The PCT has discretion to negotiate a complaints procedure with the contractor, until regulations are made (by the summer) to establish a common complaints procedure which will cover all primary care contracting routes.
  • Dispute resolution procedure for organisations without NHS body status
    The PCT has freedom to negotiate an appropriate dispute resolution process to be stipulated in the contract. It is recommended that the PCT considers including non-binding independent arbitration or adjudication procedures.
  • Provision of information
    The PCT will want to inform, and keep informed, the APMS contractor of where its patients can receive any complementary services commissioned by the PCT which the APMS contractor does not provide.

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