The GP contract

The GP contract

Community pharmacy teams need to work closely with colleagues in general practices in order to provide the best possible care for patients. Effective collaborative working is helped by GP and pharmacy teams understanding how their colleagues work on a day to day basis.

This section of the website contains a brief description of the GP contract and related resources for community pharmacists and their teams in order to support understanding of the way GP practices operate and thus joint working at a local level.

Since April 2004, three contracting routes have been available to enable commissioning of primary medical services (‘GP services’). The routes are:

      1. General Medical Services (GMS);
      2. Personal Medical Services (PMS) which includes Specialist PMS (SPMS); and
      3. Alternative Provider Medical Services (APMS).

General Medical Services (GMS)

This contracting route is provided for by the NHS Act 2006 and the NHS (General Medical Services Contracts) Regulations, and it is underpinned by a nationally agreed GMS contract. About 53% of primary medical services are provided under GMS contracts. 

Personal Medical Services (PMS)

This contracting route is provided for by the NHS Act 2006 and the NHS (Personal Medical Services Agreements) Regulations. PMS contracts are negotiated locally but are underpinned by national regulations. Around 44% of primary medical services are currently provided through PMS contracts. Specialist PMS is an additional, local flexibility to help to address unmet needs amongst client groups that traditionally have experienced primary medical services as being more difficult to access, for example, homeless people, prisoners, drug users. 

Alternative Provider Medical Services (APMS)

APMS contracts are provided under Directions of the Secretary of State for Health. APMS contracts can be used to commission primary medical services from traditional GP practices as well as others such as:

      • Commercial providers;
      • Not-for-profit organisations;
      • Voluntary and community sector organisations;
      • NHS Trusts; and
      • NHS Foundation Trusts.

Primary medical services

Primary medical services comprise:

Essential services – every GMS practice is required to provide Essential services (or, in PMS, their equivalent) to their registered patients and temporary residents. Essential services cover the:

      • Management of patients who are ill or believe themselves to be ill, with conditions from which recovery is generally to be expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable;
      • General management of patients who are terminally ill; and
      • Management of chronic disease in the manner determined by the practice, in discussion with the patient.

Additional services – all GMS and PMS practices have a preferential right to provide additional services. Practices can, however, temporarily or permanently, opt out of providing additional services in accordance with fixed rules. Where opt-outs occur, NHS England is required to commission the services from a different provider.

Out of hours services – since April 2004 all GMS and PMS practices have had the opportunity to opt out of their responsibilities for securing out-of-hours services for their registered patients. Where that responsibility remains retained by GMS and PMS practices NHS England will be the commissioner as the duty to secure out-of-hours is an integral part of the GMS and PMS contract.

NHS England will be responsible for ensuring that all opted out GP out-of-hours services are commissioned as part of Clinical Commissioning Groups responsibilities for developing 24/7 urgent care services. Clinical commissioning groups will be responsible for monitoring all NHS commissioned GP-out-of-hours services and assuring the quality of these to consistent standards.

Enhanced services – Enhanced services are generally understood and defined as (a) Medical services other than Essential services, Additional service or out of hours services; or (b) Essential services, Additional services or out of hours services or an element of such a service that a contractor agrees under the contract to provide in accordance with specifications set out in a plan, which requires of the contractor an enhanced level of service provision compared to that which it needs generally to provide in relation to that service or element of service.

NHS England will commission some Enhanced services nationally using single specifications. These nationally commissioned Enhanced services replace the previous arrangements that placed Primary Care Trusts under a duty through legal directions to commission prescribed enhanced services to meet the needs of the population (services currently known and commissioned as ‘Directed Enhanced Services’).

NHS England also has the flexibility Primary Care Trusts enjoyed to commission Enhanced services locally to meet the differing primary care needs of local populations. Local commissioning will reflect the fact that clinical commissioning groups are largely responsible for the resources attached to previous Local Enhanced Service schemes commissioned by PCTs (excluding those supporting defined public health services where responsibility passes to local authorities). Provision could include clinical commissioning groups commissioning local services from existing GPs or other primary care contractors. 

Related resources

PSNC has worked with NHS Employers and the GP committee of the British Medical Association to develop guides to general practice and community pharmacy for pharmacy and GP teams respectively.

NHS England webpage on the GP contract

PSNC Briefing 027/16: General Practice Forward View (May 2016)
The GPFV document contains specific practical and funded steps on investment, workforce, workload, infrastructure and care redesign. This PSNC Briefing summarises the elements of the plan which are of most relevance to community pharmacy.

PSNC Briefing 020/16: Changes to the GMS contract in 2016/17 (March 2016)
This briefing sets out a summary of the key changes to the General Medical Services contract in England for 2016/17, which may be of relevance to community pharmacy teams. These changes have been agreed between NHS Employers, on behalf of NHS England and the British Medical Association’s General Practitioners Committee.

PSNC Briefing 012/16: Update on Patient Facing Services (PFS) (February 2016)
This PSNC Briefing describes patient facing services (PFS) being provided via NHS and GP IT systems. Such services increasingly allow patients to use the internet to view their electronic medical record, order repeat prescriptions, communicate with their GP practice and book GP appointments. Community pharmacy teams may want to ensure they understand how these services are being used in their area in order to allow them to provide appropriate advice to patients.

PSNC Briefing 027/14: The Proactive Care Programme (November 2014)
Following on from PSNC Briefing 026/14: Transforming Primary Care: Safe, proactive, personalised care for those who need it most, this briefing provides more detail on the Proactive Care Programme, which was one of the main proposals in the Transforming Primary Care document.

PSNC Briefing 010/14: Changes to the GMS contract in 2014/15 (update) (April 2014) 
This briefing updates PSNC Briefing 107/13 which summarised the changes being introduced to the GMS contract in April 2014. This briefing incorporates extra information on the changes, following the publication of briefings on the changes to the contract by NHS Employers. It highlights those aspects of the changes that may have an impact on community pharmacies.

PSNC Briefing 009/14: NHS England’s emerging findings from the general practice Call to Action (April 2014)
In March 2014 NHS England published a summary of the responses to the general practice CTA and its emerging findings. The report focuses on the central role NHS England wants general practice to play in wider systems of primary care, and it describes their ambition for greater collaboration with clinical commissioning groups (CCGs) in the commissioning of general practice services. This PSNC Briefing provides a summary of the key elements of the document.

PSNC Briefing 107/13: Changes to the GMS contract in 2014/15 (December 2013)
This briefing summarises changes being introduced to the GMS contract (the GP contract) in 2014/15 and highlights those aspects of the changes that may have an impact on community pharmacies

PSNC Briefing 089/13: Changes to the GMS contract in 2013/14 and development of a strategic framework(September 2013)
This briefing is an update to a briefing issued earlier in 2013 (PSNC Briefing 047/13) which summarises the changes to the GMS contract in 2013/14 and highlights those aspects of the changes that may have an impact on community pharmacies. The briefing also highlights the NHS England call to action for general practice which was published in mid-August 2013 as part of the wider development of a primary care strategic framework. 

 PSNC Briefing 047/13: Changes to the GMS contract in 2013/14 (May 2013)
This PSNC Briefing provides a brief summary of the changes to the GMS contract which the Department of Health has decided to impose on general practices, following negotiations between NHS Employers and the GP Committee of the BMA and a subsequent consultation process.



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