Primary Medical Services - Archive Page
This page is an archive of all old material. The newest material will be posted on the primary medical home page.
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PMS
A short overview of PMS, why it was introduced and what benefits it will bring for patients, staff and the NHS as a whole.
What is PMS?
The Personal Medical Services (PMS) contract will become the permanent local alternative to the new national General Medical Services (GMS) contract.
Ever since it was introduced in pilot form in 1998, the overriding principle of PMS has been to give primary care professionals the freedom to innovate and work more closely as a team to improve services for patients. The contract gives primary care teams the scope to try out new and better ways of meeting the needs of their local patient populations and addressing inequalities in health care provision. This might mean, for example, offering different surgery opening hours or setting up new services for special groups such minority ethnic communities or the homeless.
In PMS, as with GMS, the contract is between the primary care trust and the practice – not with individual GPs as was the case under the old primary care contracting arrangements.
- PMS is different to the new GMS contract because it is a truly local arrangement. Under PMS, it will be for Primary Care Trusts to agree local contracts with PMS providers – the GP practice, a salaried GP, nurses or other primary care professionals. GMS, on the other hand, is a national contract with local flexibilites. Unless the Primary Care Trust (PCT) is the provider then it is up to the Strategic Health Authority (SHA) to agree the contract.
- PMS is different from the old GMS contract in that payment to practices, GPs and other PMS providers is more closely linked to the quality of the services they offer – not the quantity as was the case under the old national contract.
Why was PMS introduced?
PMS was introduced in pilot form in 1998 as a local alternative to the national GMS contract. The key aims of PMS when it was introduced were to provide greater freedom for GPs and other primary care staff to address the needs of patients. The pilots allowed them to do this though greater team working and using the skills of staff in different ways – for instance training more nurses to safely carry out procedures once only done by the GP.
PMS was also introduced to address recruitment and retention problems in areas where there had traditionally been doctor shortages. It gave GPs the option of being salaried so they benefited from a steadier, more assured income based on the quality of services they offered to patents.
The pilot stage of PMS ended in March 2004, with PMS becoming a permanent alternative to new GMS. More than 40% of GPs in England now work under PMS contracts.
What are the main benefits for patients and staff?
For patients: PMS means new services designed specifically round their needs, including easier and more convenient access to their GP, to highly-trained nurses and to other primary care professionals. Deprived areas in particular are benefiting from the ability of PMS to attract and keep more doctors and nurses.
For GPs and practices: Enhanced team working; more opportunities for primary care professionals to extend their roles; less central bureaucracy; improved cash flow; and less time spent chasing up claims for fees are just some of the benefits of PMS.
In addition, PMS providers will benefit from many of the same provisions offered under the new GMS contract, for instance: the ability to opt out of providing out of hours services; the same pension rights; and access to financial rewards for quality through local versions of the GMS incentives system - the Quality and Outcomes Framework.
What is specialist PMS?
Specialist PMS is a new model within PMS where the provider is not expected to deliver the totality of essential primary medical care services.
Specialist PMS providers may register patients, but they would be expected to have in place a sub contractual arrangement with another GP practice to deliver essential primary medical care services to those patients.
More detailed information about Specialist PMS is available on the Department of Health website in the PMS guidance: Sustaining Innovation Through New PMS Arrangements
A summary of the changes
- From 1 April, new contracts were introduced for local family practices, accompanied by new, extra funding for local health services.
- Over time, the new contracts should lead to the development of a wider range of high-quality NHS services closer to where patients live.
- The new contracts give doctors greater flexibility over what services they provide. This will enable some to reduce their workload - an important factor in helping the NHS recruit more doctors to work in family practice, and others to take on new services. Practices can also choose to hand over responsibility for evening, weekend and bank holiday services to their local PCT. The PCT will ensure that at least the same level of services as is currently available, continues to be provided.
- The contracts encourage practices to make more effective use of the skills of other trained health professionals- nurses, pharmacists and therapists. They will carry out some of the tasks previously done by GPs, freeing up doctors to see the patients only they can help.
- Under the contracts, practices must continue to provide essential services which means treating sick and terminally ill patients. However, they can choose to forfeit a portion of their income and opt out of providing some 'additional' services such as child immunisation, maternity and contraceptive services and cervical tests. This would usually happen only if a practice's workload grows bigger than it can cope with.
- The overwhelming majority of practices are maintaining or expanding the range of services they provide.
- The new contracts mean, for the first time, all practices are being significantly rewarded for the quality of care they give and not just the numbers of patients they treat. This will mean practices will be rewarded for ensuring patients can see a GP within two working days or another health care professional within one day. Over time, rewarding the quality of care should also lead to significant improvements in care given to those with chronic diseases as well as an expansion in the range of services provided by practices.
- Under the changes, primary care trusts enter into direct contracts with all practices in their area. In the past, they have been able to enter into direct contracts with GPs under local Personal Medical Services (PMS) arrangements. However, the majority of GPs have operated to a national contract - the General Medical Services (GMS) contract - over which PCTs have previously had no say.
- The new contracts give PCTs a better overview of what services are available in local neighbourhoods and help them strategically plan improvements to both the quality and range of local services.
More detailed information about Specialist PMS is available on the Department of Health website in the PMS guidance: Sustaining Innovation Through New PMS Arrangements
Checklists and "Friends" publications
The new GMS and PMS contracts give real scope for PCTs to commission services across a whole health system and meet patients' needs along the whole of the care pathway, including primary, secondary and social care. This creates organisational and skills challenges for PCTs. The following links bring together the growing range of practical support on offer. Click here to download the flowchart.
GMS and PMS Checklist to help PCTs ensure that they have the processes, contracts and procedures in place to support them in managing the new medical primary care contracts from April 2004.
PCC work on commissioning and contracting acute services also includes support that is relevant to primary care contracting. This includes:
The Commissioning Friend for PCTs a series of publications called Friends to help in various areas of commissioning
The Primary Care Contracting Collaborative (formerly the GMS/PMS Collaborative) is currently being set up and will help create awareness of the opportunities presented by contracting for different models of primary care provision. It will also place primary care commissioning within the wider context of commissioning for all services and will help to give an improved, shared strategic view between PCTs and practices of what primary care services need to be contracted for locally. Details will be available and posted on this site. For an overview see:
Commissioning Services under the new GMS contract
The Contractors Companion - a toolkit which aims to support PCTs in their role as commissioners and contractors of services from NHS Trusts.The Contractors Companion
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PCT and SHA primary care contracting implementation leads |
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Chief executives of SHAs and PCTs | |
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Practice managers | |
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PCT lead nurses | |
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Employers of nurses in general practice | |
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Nurses working in general practice | |
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GPs | |
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Finance directors working in primary care |