General medical services (GMS) contract
Around 55% of GP practices in the UK operate under GMS contracts. Funding uplifts and changes to the deal are negotiated nationally on an annual basis between the BMA’s GP committee (GPC) and NHS Employers, which acts on behalf of the government.
Practices receive core funding based primarily on the age and sex of their registered patient population – a ‘global sum’ payment for each practice is calculated via a formula that takes these factors into account.
This funding system took effect from 2004, when the current GMS contract was implemented. Because more than 90% of practices earned more core pay under the old GMS contract, a ‘minimum practice income guarantee’ (MPIG) was devised to top up practice income to ensure that global sum formula ‘losers’ did not lose out financially. Around 65% of GMS practices still receive MPIG funding top-ups.
Core pay covers essential services, which all practices must offer, and additional services, which most practices offer but can choose to opt out of. These can include maternity services and vaccinations.
Part of the reason why practices earned less core pay under the new deal was that a significant proportion of the total funding available for general practice was diverted to fund a performance related pay mechanism – the Quality and Outcomes Framework (QOF).
Practices now earn around a third of their income from the QOF. A total of 1,000 QOF points are can be earned by practices by hitting targets. Each point is worth a basic £133.76, with additional weighting according to disease prevalence and practice list size.
All practices in Wales and Northern Ireland operate under GMS contracts and the vast majority of practices in Scotland are GMS.
Primary medical services (PMS) contract
Around 40% of practices in England operate under PMS contracts, which are negotiated locally. Annual funding uplifts to PMS contracts are at the discretion of local primary care organisations, but generally mirror uplifts given to GMS practices.
Growth funding given to PMS practices when they first moved to the local deals, which aimed to encourage them to take on extra staff to deliver extra services, is being whittled away by reviews aimed at cutting costs to GMS levels.
Alternative provider medical services (APMS) contract
This is a form of GP contract more akin to a normal commercial contract. It is time limited, and can be held by any private company, whereas GMS and PMS deals can only be held by GPs, nurses or other health professionals.
Like PMS contracts, APMS contracts are only available in England.
Further funding comes from enhanced services. Directed enhanced services are agreed nationally and all practices have a right to offer these services at a fixed price. National enhanced services are priced and agreed nationally but primary care organisations are not obliged to commission them. Local enhanced services are extra services that organisations can set up, agree funding for and roll out locally.