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Journal of Public Health Medicine 21:367-371 (1999)
© 1999 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom

Commentary. Who contracts for primary care?


R Lewis0,z
S Gillam0
T Gosden1
R Sheaff1

0 The King's Fund, 11-13 Cavendish Square, London W1M 0AN, UK
1 The National Primary Care Research and Development Centre, University of Manchester, 5th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, UK
z Corresponding author

The implications of the 1997 (Primary Care) Act have been largely overlooked in the rush to establish Primary Care Groups. Allowing health authorities to develop local contracts for primary care has far-reaching implications and is an important departure from the national system of negotiation that has characterized general practice to date. This paper describes a content analysis of a sample of Personal Medical Services (PMS) pilot contracts. In the first year little attention has been given to achieving cost savings or greater efficiency and few contracts promote clinical guidelines. The difficulties of specifying services sensitive to local health needs are highlighted and the national Statement of Fees and Allowances (the 'Red Book') may not be swiftly supplanted. However, The pilots have introduced innovations such as salaried general practitioners, nurse-led services and NHS trust-managed care. The development of local contracts provides a valuable learning experience for general practitioners and health authorities in advance of the establishment of Primary Care Trusts.

Keywords: PMS pilots, primary care, contracts


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