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General medical services
General medical services (GMS) is the range of healthcare that is provided by general practitioners (GPs or family doctors) as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are expected to do and provides funding for this work through arrangements known as the General Medical Services Contract. Today, the GMS contract is a UK-wide arrangement with minor differences negotiated by each of the four UK health departments. In 2013 60% of practices had a GMS contract as their principal contract. The contract has sub-sections and not all are compulsory. The other forms of contract are the Personal Medical Services or Alternative Provider Medical Services contracts. They are designed to encourage practices to offer services over and above the standard contract. Alternative Provider Medical Services contracts, unlike the other contracts, can be awarded to anyone, not just GPs, don't specify standard essential services, and are time limited. A new contract is issued each year.
Normal working hours of 8 am to 6.30 pm Monday to Friday are specified in the contract.
National contracting of general medical (general practitioner) services can be traced to the National Insurance Act 1911 which introduced a pool (similar to today's "global sum") to pay GPs on a capitation system building on the traditions of the friendly society.
The scheme was administered by local insurance committees covering counties and conurbations which held a panel of doctors prepared to work under the scheme. The panel doctors were subject to "terms of service" which were later lifted directly into the NHS GP contract. Lloyd George's "nationalisation of club medicine and local insurance in 1912 was the progenitor of the NHS in 1948". Lloyd George, when proposing to increase from 6 to 9 shillings per head the proposed annual payment to panel GPs insisted: "If the remuneration is increased, the service must be improved. Up to the present the doctor has not been adequately paid, and therefore we have had no right or title to expect him to give full service. In a vast number of cases he has given his services for nothing or for payment which was utterly inadequate. There is no man here who does not know doctors who have been attending poor people without any fee or reward at all".
In 1924 agreement was reached between the British Medical Association and the Ministry of Health that capitation fees would comprise 50% of a GPs income but only occupy 2/7 of his time, the remaining income being generated privately.
The meaning of independent contractor in respect of GPs has not always been very clear, but was generally tied to their rejection of salaried status. It has been argued that their behaviour has rarely been that of self-employed entrepreneurs, but rather that of salaried professionals who emphasise and defend the importance of their autonomy.
GPs' contract arrangements were originally made with local executive councils, and then their successors family practitioner committees, family health service authorities and primary care trusts. In England the contract is now between the GP practice and NHS England. In Scotland GP practices are contracted by the health boards. It was agreed in August 2014 that GPs in Scotland would have a separate contract with negotiations taking place which would come into force from 2017/18. It is proposed that they should give up employing practice staff and move 'as far towards salaried model as possible without losing independent status'.
The Beveridge Report of 1942 gave the impetus for White Paper under the Conservative Health Minister Henry Willink that supported the idea of salaried GP services in health centres. The 1946 National Insurance Act under Labour Health Minister Aneurin Bevan, which laid the foundation for the NHS, reduced the clinical role of GPs in hospitals and their involvement in public health issues. The capitation fees was based on the number of patients the GP had on his list. Proposals to make GPs salaried professionals were rejected by the profession in 1948. In 1951 the capitation started to be based on the number of doctors, rather than patients.
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General medical services
General medical services (GMS) is the range of healthcare that is provided by general practitioners (GPs or family doctors) as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are expected to do and provides funding for this work through arrangements known as the General Medical Services Contract. Today, the GMS contract is a UK-wide arrangement with minor differences negotiated by each of the four UK health departments. In 2013 60% of practices had a GMS contract as their principal contract. The contract has sub-sections and not all are compulsory. The other forms of contract are the Personal Medical Services or Alternative Provider Medical Services contracts. They are designed to encourage practices to offer services over and above the standard contract. Alternative Provider Medical Services contracts, unlike the other contracts, can be awarded to anyone, not just GPs, don't specify standard essential services, and are time limited. A new contract is issued each year.
Normal working hours of 8 am to 6.30 pm Monday to Friday are specified in the contract.
National contracting of general medical (general practitioner) services can be traced to the National Insurance Act 1911 which introduced a pool (similar to today's "global sum") to pay GPs on a capitation system building on the traditions of the friendly society.
The scheme was administered by local insurance committees covering counties and conurbations which held a panel of doctors prepared to work under the scheme. The panel doctors were subject to "terms of service" which were later lifted directly into the NHS GP contract. Lloyd George's "nationalisation of club medicine and local insurance in 1912 was the progenitor of the NHS in 1948". Lloyd George, when proposing to increase from 6 to 9 shillings per head the proposed annual payment to panel GPs insisted: "If the remuneration is increased, the service must be improved. Up to the present the doctor has not been adequately paid, and therefore we have had no right or title to expect him to give full service. In a vast number of cases he has given his services for nothing or for payment which was utterly inadequate. There is no man here who does not know doctors who have been attending poor people without any fee or reward at all".
In 1924 agreement was reached between the British Medical Association and the Ministry of Health that capitation fees would comprise 50% of a GPs income but only occupy 2/7 of his time, the remaining income being generated privately.
The meaning of independent contractor in respect of GPs has not always been very clear, but was generally tied to their rejection of salaried status. It has been argued that their behaviour has rarely been that of self-employed entrepreneurs, but rather that of salaried professionals who emphasise and defend the importance of their autonomy.
GPs' contract arrangements were originally made with local executive councils, and then their successors family practitioner committees, family health service authorities and primary care trusts. In England the contract is now between the GP practice and NHS England. In Scotland GP practices are contracted by the health boards. It was agreed in August 2014 that GPs in Scotland would have a separate contract with negotiations taking place which would come into force from 2017/18. It is proposed that they should give up employing practice staff and move 'as far towards salaried model as possible without losing independent status'.
The Beveridge Report of 1942 gave the impetus for White Paper under the Conservative Health Minister Henry Willink that supported the idea of salaried GP services in health centres. The 1946 National Insurance Act under Labour Health Minister Aneurin Bevan, which laid the foundation for the NHS, reduced the clinical role of GPs in hospitals and their involvement in public health issues. The capitation fees was based on the number of patients the GP had on his list. Proposals to make GPs salaried professionals were rejected by the profession in 1948. In 1951 the capitation started to be based on the number of doctors, rather than patients.