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Background Alternative provider of medical services (APMS) legislation enables private commercial firms to provide NHS primary care. There is no central monitoring of APMS adoption by primary care trusts (PCTs), the new providers, or market competition. Aim The aims were to: examine APMS contract data on bidders and providers, patient numbers, contract value, duration, and services; present a typology of primary care providers; establish the extent of competition; and identify which commercial providers have entered the English primary care market. Design of study Cross-sectional study. Setting All PCTs in England. Method A survey was carried out in March 2008 gathering information on the number of APMS contracts, their value and duration, patient numbers, the successful tender, and other bidders. Results A total of 141 out of 152 PCTs provided information on 71 APMS contracts that had been awarded and 66 contracts that were out to tender. Of those contracts awarded, 36 went to 14 different commercial companies, 28 to independent GP contractors, seven to social enterprises, and two to a PCT-managed service; one contract is shared by three different provider types. In more than half of the responses information on competition was not disclosed. In a fifth of those contracts awarded to the commercial sector, for which there is information on other bidders, there was no competition. Contracts varied widely, covering from one to several hundred thousand patients, with a value of £6000-12 million, and lasting from 1 year to being open-ended. Most contracts offered standard, essential, additional, and enhanced services; only a few were for specialist services. Conclusion The lack of data on cost, patient services, and staff makes it impossible to evaluate value for money or quality, and the absence of competition is a further concern. There needs to be a proper evaluation of the APMS policy from the perspective of value for money and quality of care, as well as patient access and coverage. [ABSTRACT FROM AUTHOR]

The authors describe the complexity of the financing arrangements of primary care premises. They explain how the early vision of integrating health and social services within local health centres failed to be realized, with GP-owned practice premises remaining as the dominant model. There was a switch to private finance when the government loan body (General Practice Finance Corporation) was privatized in 1989. Although capital can now be freely raised by the private sector for investment in the National Health Service (NHS), these debts have to be repaid through NHS funds or user charges. The complexity, combined with demographic factors, makes it likely that as GPs opt for the Personal Medical Services (PMS) scheme and a salaried service, the trend towards for-profit corporations owning and buying out GP premises will accelerate. [ABSTRACT FROM AUTHOR]

Discusses the reasons why private finance is moving primary care into corporate ownership. Reasons for the establishment of the National Health Service (NHS) of Great Britain, to integrate primary care and health and social services in health centers; How the aim was compromised by the absence of public capital and the reluctance of the Treasury to buy out practice premises owned by general practitioners; Question about the extent to which planning, population needs and accountability are incorporated into the procurement process.

Addresses concerns in the United Kingdom of whether primary care trusts leads to United States-style health care. Ability of a National Health Service (NHS) body to charge for personal care and hotel costs; How government guidance on intermediate care restricts entitlement to NHS care to six weeks except in exceptional circumstances; Details of the incentive structure of the new system, which will force care trusts to find ways of constraining expenditure through rationing, user charges, and commercial activities.

The article looks at the extent of the changes to community pharmacy in Great Britain under the revision of the National Health Service (NHS) community pharmacy contract. Reforms were implemented by the British government in 2005 aimed at increasing access and patient choice, reduce general practitioner workload and lower costs to the NHS. An overview of the community pharmacy market is presented, as well as changes to control of entry regulation and an analysis of its implications for primary care.

Discusses the advantages and disadvantages of community oriented primary care as a method of teaching and applying public health skills in Great Britain. Description of King's Fund pilot project; Factors for needs assessment; Support for health authorities.