Types of GP contract
‘Every individual or partnership of GPs must hold an NHS GP contract to run an NHS commissioned general practice. These set out mandatory requirements and services for all general practices, as well as making provisions for several types of other services that practices may also provide, if they choose’. (GP funding and contracts explained, The Kings Fund).
There are 3 types of contract arrangement in England:
- General medical services (GMS) | the national standard GP contract to deliver ‘core’ medical services, negotiated nationally every year between NHS England and the British Medical Association’s (BMA) England General Practitioners Committee (GPC England). The GMS contract is then used by the commissioner to contract general practice services in a geographical area.
- Personal medical services (PMS) | another form of core contract but negotiated and agreed locally by the commissioner with a practice or practices. These contracts are subject to local variations.
- Alternative provider medical services (APMS) | a more flexible framework allowing contracts with organisations, such as private and third sector providers, other than general practice to provide primary care services beyond that of ‘core’ general practice. For example, a social enterprise could be contracted to provide primary health care to asylum seekers or the homeless.
All types of contract are managed by the NHS commissioner. Where contracts are locally negotiated, local medical committees (LMCs) representing GPs may advise or participate in discussions alongside regional BMA representatives. You can find guidance on undertaking the requirements of the contract in the Primary medical care policy and guidance manual (PGM).
Most contracts in England are GMS contracts. Figures for October 2022 show 70% of practices held GMS contracts, 29% held PMS contracts and 1% held APMS contracts.
Note | For the latest information about the requirements within the GMS contract in general, and the digital elements of this, please check the NHS England website.
Nature of general practice
GP practices are independent businesses that are contracted to provide services for the NHS. Staff working in general practice are usually employed directly by the GP practice and not by the NHS.
A small number (figures from The Health Foundation in 2020 suggested 1 in 10) of general practices are operated by a single GP. The majority are run by a partnership, comprising at least 2 GPs, and can include other clinical and non-clinical partners such as nurses and practice managers. They can also be run by a company, subject to certain conditions. The individual GP, partnership or company holds the contract with NHS England.
GP practices are expected to offer digital first primary care, to address the challenges facing general practice, whilst delivering the expansion and improvements to services and outcomes set out in the NHS Long Term Plan.
The Five-year framework for GP contract reform is intended to stabilise general practice and allow it to be a key vehicle for delivering many of the commitments in the Long Term Plan. The framework will see investment of up to £3.4 billion by 2023/24, of which £2.4 billion is to be invested directly into primary care networks (PCNs).
The implementation of PCNs saw groups of GP practices joining together to deliver elements of the GP contact as a group rather than as individual practices.
PCNs also recruit additional staff, such as clinical pharmacists and social prescribing link workers, as a network, through the Additional Roles Reimbursement Scheme (ARRS). The aim of the scheme is to support the recruitment of 26,000 additional staff into general practice by 2023/24.
The core general practice contract
The core parts of a general practice contract set out:
- the geographical or population area the practice will cover
- the requirement to maintain a list of patients for the area, who this list covers and under what circumstances a patient might be removed from it
- the essential medical services a general practice must provide to its patients
- standards for premises and workforce, and requirements for inspection and oversight
- expectations for public and patient involvement
- key roles and responsibilities including complaints, liability, insurance, clinical governance and termination of the contract
In addition to these core arrangements, a general practice contract also contains a number of optional agreements for services that practices may enter into either on their own or with their PCN colleagues, in return for additional payments. These include the nationally negotiated directed enhanced services (DES). The DES must be offered to all GP practices in England by the commissioner and practices can decide whether or not they want to sign up to and provide these services.
Locally commissioned services can be developed by commissioners and practices choose whether or not to opt-in. These services are not agreed nationally and can vary in scope and funding across England. The BMA provides examples of locally commissioned services on their website.
Digital requirements of the GP contract
The digital requirements of the GP contract originated in the NHS Long Term Plan and the Five-year framework for GP contract reform and have built up over time. The GPIT Operating Model provides a comprehensive framework of requirements, standards and specifications for digital technology services.
The contract aims to embed changes to the use of technology in general practice, including IT infrastructure reform. It provides that commissioners will supply the digital infrastructure and services required by the practice to deliver patient services.
Going forward, the GP contract specifies that all practices must provide the following patient-facing digital requirements, which form part of the core digital offer, including:
- cloud-based telephony
- the offer and use of video consultation, including the ability to hold a video consultation between patients, carers and clinicians
- the ability for patients to request and manage prescriptions online
- online appointment booking – the 2022/23 contract stipulates that all appointments that do not require triage should be available to book online as well as in person or by telephone, including online and video consultations (practices have been enabled with the tools and functionality for this as part of the commissioners’ infrastructure responsibilities)
- online consultations that can be used by patients, carers, and practice staff on a patient’s behalf, to gather structured, information and to support triage, enabling the practice to allocate patients to the right service for their needs
- two-way secure written communication between patients, carers and practices, such as a secure text messaging service, and an online consultation tool
- an up-to-date accessible online presence, such as a website, that, amongst other key information, features prominent links to an online consultation system and other online services – including signposting to a validated symptom checker and self-care health information (e.g. UK) – and an NHS.UK practice information page
- shared record access, including patients being able to add to their online record and full prospective record access
- the functionality for patients to use an online method to inform their practice of a change of address, contact details or of their demographic information, including ethnicity
- offering and promoting electronic ordering and management of repeat prescriptions and using electronic repeat dispensing for all appropriate patients
(All of the above functions are available to patients through the NHS App.)
- a contractual requirement for a timely transfer of patient records when patients move between practices
- a plan to support the modernisation of GP registration, with the ability for patients to register digitally without the need for a ‘wet’ signature
- that digital services can be delivered by contractors through locations other than practice premises
- removal of the requirement for GP practices to print and send copies of deceased patients’ records to Primary Care Support England (PCSE) but then to respond to Access to Health Records Act (AHRA) requests for deceased patients’ records (it is expected that the savings from not having to print and send the electronic record will far outweigh the additional burden of managing a small number of AHRA requests)
In addition there are non-contractual digital services that GPs may decide to adapt and use, e.g. population risk assessment tools, demand management etc..
The COVID-19 pandemic saw the introduction of digital enablers much faster than originally planned. Practices rapidly accepted new technology and moved to new ways of working in order to manage patient care during this challenging time. A high proportion of patients embraced the technology introduced and will continue to access digital healthcare services in the future.
Practices must, however, remain vigilant to the risks of exclusion and inequality for patients who cannot, or will not through choice, access GP services digitally.
Medical services within the core contract
The GMS contract sets out a range of medical services that are required to attract funding. You can read about these in the NHS England document Standard General Medical Services Contract 2023/24, and NHS Digital’s GP Contract Services – England, 2022-23.
- essential services, provided during core hours, to registered patients and temporary residents who are, or believe themselves to be:
- ill with conditions from which recovery is generally expected
- terminally ill
- suffering from chronic disease
They must provide appropriate ongoing treatment and care including:
- advice in connection with the patient’s health and relevant health promotion advice
- onward referral
- immediately necessary treatment
- contraceptive services
- postnatal mother and baby checks
- cervical screening
- maternity medical services
- vaccinations and immunisations
- childhood vaccinations and immunisations
- child health surveillance (under 5s)
- out of hours services, for which the majority of practices choose to transfer responsibility to NHS England
- enhanced access, primarily offered through a PCN arrangement
- minor surgery, which practices can opt out of
The funding of general practice is complex, and money comes in from different streams, often through differently named schemes, via the GP contract. You can read more about funding in the Kings Fund article GP funding and contracts explained, and in the BMA overview of enhanced services GP practices can seek funding for.
Updates to the contract
The GP contact is updated at the very least on an annual basis, but changes can be implemented at any time throughout the year to ensure it is responsive to national concerns. During the COVID-19 pandemic, for example, practices were asked to reprioritise work to support the COVID vaccination programme, with pay-for-performance targets suspended.
The GP contract has a current focus on the management of long-term conditions, chronic disease control and ensuring timely access for patients with urgent care needs. The contract also reflects the wider Long Term Plan prevention agenda.
Note | For the latest information about the GMS contract in general and the digital elements of this, please check the NHS England website.
Related GPG content
- Primary Care Networks (PCNs)
- Online consultation tools
- Online appointment booking
- Electronic repeat dispensing (eRD)
- NHS.UK online resource for patients
- Practice websites
- Calculating Quality Reporting Service (CQRS) and Quality Outcomes Framework (QOF)
- Patients updating personal details online
- GP2GP – transferred in records – processing
- Health equalities and inclusion
- NHS App
Other helpful resources
- British Medical Association (BMA), GP contract changes England 2022/23
- NHS England, Network Contract Directed Enhanced Service Frequently Asked Questions 2020/21
- Kings Fund,2020/21 update to GP contract explained
- NHS England and BMA, 2019, Investment and Evolution – The five year framework for GP contract reform to implement The NHS Long Term Plan
- BMA, Comparison table between GMS and PMS contract
- NHS England, Primary care networks
- NHS England, What is integrated care?
- NHS England, Digital first primary care
- Email address for contract/policy queries – email@example.com