The Department of Health has recently circulated a letter about its proposals for the future of GP practices and health centres set up under the Equitable Access to Primary Medical Care programme. This responds to confusion as to where responsibility for these contracts will sit under the proposed NHS reforms.

Equitable access services were commissioned by PCTs under Alternative Provider of Medical Services (APMS) contracts. The confusion about future responsibility for these APMS contracts arose from the fact that many of the equitable access health centres provide both GP practice services to registered patients and “open access” care to patients not registered with that practice. Under the proposed reforms, the NHS Commissioning Board will be responsible for contracting for GP practice services, while GP commissioning consortia will contract for open access services (including things like urgent care and out of hours care).

So who will be responsible for commissioning the services of equitable access health centres, following PCT abolition? The letter proposes that the NHS Commissioning Board will take over responsibility for the majority of equitable access APMS contracts from April 2013, even though many cover both registered patient services and open access services. The only exception will be contracts for health centres with little or no registered patient activity. In those cases, GP commissioning consortia will be responsible for the contracts.

It is also proposed that the NHS Commissioning Board will be able to delegate to GP consortia some aspects of responsibility for managing these contracts, in line with the wider proposal for this to be possible in relation to other primary care contracts.

The proposals suggest that in the longer term, following expiry of the existing contracts, responsibility for commissioning the registered patient services and for commissioning open access services will split between the NHS Commissioning Board and GP commissioning consortia. This raises the question of whether equitable access centres will continue in their current form, or whether the two commissioning organisations may each decide to take forward the commissioning of registered and unregistered patient services in different ways.

Note that the proposals are subject to the Health and Social Care Bill being passed. However, at this stage PCTs are to plan on the above basis.