General medical services

General Medical Services (GMS) is the term used to describe the range of healthcare that is provided by General Practitioners (GPs or family doctors) as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are expected to do and provides funding for this work through arrangements known as the General Medical Services Contract. Today, the GMS contract is a UK-wide arrangement with minor differences negotiated by each of the four UK health departments.

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 building on the traditions of the Friendly society.

The scheme was administered by Local Insurance Committees covering counties and conurbations which held a panel of doctors prepared to work under the scheme. The panel doctors were subject to “Terms of Service” which were later lifted directly into the NHS GP contract.Lloyd George's "nationalisation of club medicine and local insurance in 1912 was the progenitor of the NHS in 1948". Lloyd George, when proposing to increase the from 6 to 9 shillings per head the proposed annual payment to panel GPs insisted: "If the remuneration is increased, the service must be improved. Up to the present the doctor has not been adequately paid, and therefore we have had no right or title to expect him to give full service. In a vast number of cases he has given his services for nothing or for payment which was utterly inadequate. There is no man here who does not know doctors who have been attending poor people without any fee or reward at all".

General practitioner

In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.

A general practitioner manages types of illness that present in an undifferentiated way at an early stage of development, which may require urgent intervention. The holistic approach of general practice aims to take into consideration the biological, psychological and social factors relevant to the care of each patient's illness. Their duties are not confined to specific organs of the body, and they have particular skills in treating people with multiple health issues. They are trained to treat patients of any age and sex to levels of complexity that vary between countries.

The role of a GP can vary greatly between (or even within) countries. In urban areas of developed countries their roles tend to be narrower and focused on the care of chronic health problems; the treatment of acute non-life-threatening diseases; the early detection and referral to specialized care of patients with serious diseases; and preventative care including health education and immunization. Meanwhile, in rural areas of developed countries or in developing countries a GP may be routinely involved in pre-hospital emergency care, the delivery of babies, community hospital care and performing low-complexity surgical procedures. In some healthcare systems GPs work in primary care centers where they play a central role in the healthcare team, while in other models of care GPs can work as single-handed practitioners.