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Primary medical services in England

Primary medical services in England are mostly delivered by self-employed contractors to the NHS.  These contractors provide services under three different types of contracts: the General Medical Services Contract (GMS), the Personal Medical Services Contract (PMS), or the Alternative Provider of Medical Services (APMS) Contract.  GMS and PMS contracts are granted in perpetuity to contractors who must be General Practitioners or in the case of the latter, employees within the NHS.  APMS contracts are time limited and can be granted to anyone with the means of fulfilling the requirements of the contract.  Each of these contracts are for primary medical services to be delivered to registered patients of the provider.  The contracts are issued by NHS England on behalf of the Secretary of State for Health and Social Care, with the day to day management of the contracts devolved to local Clinical Commissioning Groups (CCGs).  By acting with delegated authority, CCGs are accountable to NHS England.

The terms of the GMS contract are defined nationally by NHS England following annual negotiation with the General Practitioners Committee of the British Medical Association (BMA GPC).  The agenda for contractual negotiations is set by the Department of Health and Social Care (DoHSC) and the BMA GPC after consultation with relevant stakeholders.  PMS contracts are varied annually, mirroring the terms of GMS contract as a minimum, although additional features can be locally agreed.  APMS contracts are agreed nationally, regionally or locally depending upon the scale of the service.  APMS contracts are usually varied 5 yearly.

Quality of care provided by contractors to the NHS is closely monitored.  Individual clinicians working within the NHS must undergo annual appraisal and Doctors must undertake revalidation every 5 years.  Clinicians must be registered with their appropriate Professional Regulatory Body and contractors must register their services with the Care Quality Commission (CQC), who undertake regular assessments of those services.

The use of medicines and medical devices in the NHS is governed by the Medicines Healthcare Products Regulation Agency (MHRA), which is a UK Government agency.  Guidance of the use of medicines and technology in the NHS is created by the National Institute for Health and Care Excellence (NICE).  NICE is sponsored by the UK DoHSC.

Primary medical services can also be delivered by private providers, but this is rarely seen except in affluent communities.


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