Contract Issues

The GMS Contract, last negotiated in 2004 on a national basis, contains a number of components. The basic element is the core funding based on each practice’s list size, suitable weighted for age and deprivation to reflect the different health needs and resource requirements of different groups.

It is divided into two main parts regarding the services provided by GMS practices:

  • ‘Essential Services’ – which must be provided by all practices.
  • ‘Additional Services’ – for which practices do have the option to opt out of providing these services with a commensurate drop in their income. These services include, for example, contraception, childhood vaccinations and child health surveillance, cervical screening and a number of other services.
  • Quality & Outcomes Framework – in theory voluntary but involving significant extra payments for offering arrange of structured surveillance, monitoring and treatment of chronic health conditions.
  • Enhanced Services – a range of services outside core requirements, often for services previously provided in a hospital setting.

Certain areas of the GMS contract and the funding of the contract are re-negotiated annually.

The PMS contract is more complex as it varies from area to area depending on the specific health needs that the PMS contract sought to address. In recent years there have been moves to equalise funding (both GMS and PMS) and we support these moves. Our view is that contracts should be fair and equitable. Where a practice is commissioned, and agrees, to undertake work that is over and above core work then they should be remunerated accordingly.

We are happy to provide support to practices in this interim period. We are also happy to support levy paying practices that hold APMS (Alternative Primary Medical Services) contracts.


NHS England’s’ relationship with GP practices is a contractual one whereby it monitors those services that GPs are contractually obliged to carry out if they hold a GMS, PMS or APMS contract.

GPs deliver health care to patients via three different types of contracts:

General Medical Services (GMS) contracts

GMS contracts deliver core medical services and are agreed nationally. The funding for these types of contract is calculated based on the practice’s registered list size with a fixed, nationally agreed, price per patient, and the actual amount paid is calculated practice by practice.

Personal Medical Services (PMS) contracts

PMS contracts provide similar core medical services to GMS contracts and can also include extra health services that are considered to be ‘over and above’ the usual core services (for example, special clinics for homeless people in areas of high need, etc). PMS contracts make it possible to address specific local health needs. The funding for PMS contracts is worked out locally.

Alternative Medical Services (APMS) contracts

APMS contracts are contracts which can cover the provision of general medical services, as well as other locally developed services for a specific patient group.