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Who contracts for primary care?

R Lewis1, S Gillam, T Gosden

  • 1The King's Fund, London.

Journal of Public Health Medicine
|July 27, 2001
PubMed
Summary
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The 1997 NHS (Primary Care) Act allows local primary care contracts, departing from national negotiations. Early Personal Medical Services (PMS) pilot contracts show innovation but limited focus on cost savings or clinical guidelines.

Area of Science:

  • Health Policy
  • Primary Care Management
  • Healthcare Contracts

Background:

  • The 1997 NHS (Primary Care) Act introduced significant changes to primary care.
  • The establishment of Primary Care Groups overshadowed the implications of local contracting.
  • General practice historically operated under a national system of negotiation.

Purpose of the Study:

  • To analyze a sample of Personal Medical Services (PMS) pilot contracts.
  • To understand the early implications of allowing local primary care contracts.
  • To assess the focus on cost savings, efficiency, and clinical guidelines in pilot contracts.

Main Methods:

  • Content analysis of Personal Medical Services (PMS) pilot contracts.
  • Examination of contract details from the first year of the pilot program.

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Main Results:

  • Limited attention was given to cost savings and efficiency in the first year of PMS pilots.
  • Few pilot contracts actively promoted the use of clinical guidelines.
  • Innovations introduced include salaried general practitioners, nurse-led services, and NHS trust-managed care.

Conclusions:

  • Local contracting under the 1997 NHS (Primary Care) Act presents challenges in specifying locally sensitive services.
  • The national Statement of Fees and Allowances ('Red Book') may persist.
  • PMS pilot contracts offer valuable learning experiences for general practitioners and health authorities preparing for Primary Care Trusts.