History of The Contract
National contracting of General Medical (General Practitioner) Services can be traced to the 1911 National Insurance Act which introduced a pool (similar to today's "global sum") to pay GPs on a capitation system. The Beveridge Report of 1942 gave the impetus for White Paper under the Conservative Health Minister Henry Willink that supported the idea of salaried GP services in health centres. The 1946 National Insurance Act under Labour Health Minister Aneurin Bevan, which laid the foundation for the NHS, reduced the clinical role of GPs in hospitals and their involvement in public health issues. The capitation fees was based on the number of patients the GP had on his list. Proposals to make GPs salaried professionals were rejected by the profession in 1948. In 1951 the capitation started to be based on the number of doctors, rather than patients.
A milestone in defining the role of General Medical Services is the 1966 contract. The contract addressed major grievances of GPs and provided for better equipped and better staffed premises (subsidised by the state), greater practitioner autonomy, a minimum income guarantee, and pension provisions. Despite some changes, the capitation principle and the pool survived.
The Conservative government under Margaret Thatcher from 1979 onwards looked for ways of changing the NHS, with a greater role of the private sector, and for limiting health spending and it was not afraid to take on the doctor's trade union, the British Medical Association (BMA). The 1990 contract linked GP pay more strongly to performance. The terms and conditions of primary medical service delivery were closely specified. The 'Red Book' (Statement of Fees and Allowances) detailed the payment tariffs for each individual treatment.
Today, the UK General Medical Services (GMS) contract covers the pay arrangement between the Primary Care Trust (PCT) or the Health Board(in Scotland) and a General Practitioner (GP) practice.
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