John Hutton – 2004 Speech on Alternative Provider Medical Services


Below is the text of the speech made by John Hutton, the then Minister of State for Health, on 23 November 2004.

Can I first of all thank the NHS Confederation for asking me to say a few words this morning at this very timely event. It’s important we have the opportunity to talk about the future of primary care, to shape and mould it. It’s been the cornerstone of the NHS for fifty years. And will continue to remain so for the next fifty years. The boundaries between primary and secondary care going to shift. We are going to see new and different services being provided in primary care settings and this is all to the good.

Primary care must never be seen simply as a set of organisational structures. Like the NHS itself, it is instead a set of values that reflect a particular concept of care. It can be delivered by different types of providers – some in the public sector, some in the private sector. What matters is the quality of care being provided rather than who is commissioned to provide it. It is the sense of care being designed around the needs of the individual in settings that are convenient and accessible that really matters most to patients. Those characteristics should be the hallmarks of modern Primary Care services. I think it is in this sense that APMS can play an important and distinctive role in this in the future.

So we are on a journey. Services are going to change. The boundary between primary and secondary care is going to shift. And not before time.

If we are going to take advantage of these opportunities there needs to be further significant investment and change in primary care. Not change for changes sake because we don’t want to do that. But reform with a very clear purpose. To strengthen primary care and to improve the service it provides helping, in the process, the NHS to become the service we all want it to be.

Advances in technology and in our understanding of illness and disease together with an expanded workforce and greater resources will allow us to provide more services to a higher quality. So in the future more surgery, testing and diagnostics will be performed in primary care settings. GPs will have more direct access to diagnostics. Health professionals like physiotherapists will be taking more direct referrals from GPs and more self referrals from patients. We should be looking to use LIFT schemes to help build up a new infrastructure in primary care capable of accommodating this shift from hospital to community based models. Bringing our services closer to where people live and work.

GPs with a special interest will take on new roles that have, until now, always been the exclusive preserve of hospital consultants – particularly in the area of chronic long term illness. Nurses and other health care professionals working in primary care will similarly see their responsibilities expand as they enter into new partnerships with GPs to deliver GMS and PMS.

If this process of change is going to be managed properly we need to get the basics right.

Firstly, we need to get additional resources into primary care and they need to get to the right part of the system. It is for these reasons that investment in primary care is set to rise by a third over the next two years with more to come in future years. It is for PCTs to use these resources effectively. The best way to do this is to fully involve primary care professionals in the decision making process.

Secondly, we will need a range of flexible contracting mechanisms so that we can tailor local services to meet the needs of local people. The new primary care contracts – GMS and PMS – will help us to focus on quality and convenience. But I do think it is absolutely right that PCTs should have other routes available to them in order to ensure that local needs are being properly met. That is why APMS is so important.

APMS allows PCTs to contract with commercial, voluntary and mutual providers, with GMS and PMS practices, and with NHS Trusts, including Foundation Trusts for primary medical services. APMS can be used for essential, additional, enhanced and Out of Hours services. Overall, because APMS embodies minimal – although important – statutory requirements, it gives PCTs considerable discretion to develop different ways of improving primary care capacity and shaping service delivery. Possible examples include:

– Improving access in areas with GP recruitment and retention difficulties

– Providing services where GMS and PMS practices opt-out

– Commissioning services for particular populations

– Developing greenfield or brownfield sites

– Provision of out-of-hours services

For our part in the Department, we have deliberately kept the requirements for APMS contracts to a minimum so that it will remain a flexible instrument that can be adapted to meet local circumstances. It will stay that way. It is not to be strangled by red-tape at birth.

APMS will, I hope, be seen as a powerful tool to level change and improvements in primary care services. Our job at the centre is to support PCTs, who are working to secure these ends: helping the NHS become the service we all want it to be.