General Medical Services (GMS) is the foundational contractual framework for the majority of General Practitioners (GPs) operating within the National Health Service (NHS) across the UK. This nationally negotiated agreement defines the specific medical services practices must deliver to their registered patients. By establishing a uniform standard for access and quality, the GMS contract ensures a consistent baseline of community-based healthcare provision. For the average person, GMS dictates the fundamental relationship they have with their local doctor’s office and the scope of care they are entitled to receive.
The Role of GMS in Primary Healthcare
The GMS contract functions as the core legal and financial instrument through which the NHS commissions medical services from independent general practices. It defines the relationship between health authorities and the GP practice, setting the terms for service delivery and reimbursement. The contract is negotiated annually at a national level between NHS England and the General Practitioners Committee of the British Medical Association (BMA), establishing standardized requirements for most practices.
Integrated Care Boards (ICBs) or their equivalents then use this nationally agreed framework to contract with local general practices. This centralized negotiation ensures equity and consistency in the services offered to patients, regardless of where they live. The GMS contract mandates that practices provide services appropriate to meet the needs of their registered patients throughout the core working hours, typically 8:00 a.m. to 6:30 p.m., Monday to Friday. This provides a stable commissioning environment for the health service and the independent GP contractors.
Mandatory Services Covered by GMS
Practices operating under a GMS contract must provide a defined set of “essential services” to all registered or temporary patients. These services focus on managing illness and maintaining general health. Mandatory provision includes the initial assessment, diagnosis, treatment, and referral for patients presenting with conditions from which recovery is expected. It also covers the management of terminally ill patients, ensuring they receive appropriate supportive and palliative care within the community setting.
A primary component of essential services is the ongoing management of chronic diseases, such as asthma, diabetes, and hypertension, involving regular review and monitoring. The GMS contract also includes “additional services” that practices are expected to provide, though they can opt-out under specific circumstances. These commonly include:
- Cervical screening
- Contraceptive services
- Childhood vaccinations and immunisations
- Child health surveillance
- Maternity medical services and minor surgery procedures
The Structure of a GMS Practice
A GMS practice functions as an independent business, usually structured as a partnership of GPs or occasionally as a single-handed GP. These practices hold the GMS contract with the local commissioning body. GP partners are responsible for business management, including hiring staff, maintaining premises, and covering overhead costs, while conforming to the standards set by the NHS contract.
The primary funding mechanism is capitation, paid through the “Global Sum.” This system provides the practice with a fixed amount of money per registered patient per year, regardless of how often the patient uses the service. The capitation payment is adjusted using a formula that accounts for factors influencing workload, such as the age and gender profile of the patient population, local deprivation levels, and the cost of staff in that area. This funding model incentivizes practices to focus on preventative care and efficiency.
GMS Compared to Other Healthcare Contracts
While GMS is the national standard for the majority of GP practices, the NHS also uses two other main contractual arrangements for primary care: Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS). GMS is distinguished by its national uniformity, with terms negotiated centrally and applied consistently across the country. This provides a stable, long-term contract for GP partners, ensuring predictability in service requirements and funding.
The PMS contract is negotiated locally between the commissioner and the practice, allowing flexibility to tailor services to specific local needs. Practices under PMS may receive different funding or be required to deliver locally determined services that exceed GMS core requirements. APMS contracts offer the greatest flexibility, allowing non-traditional providers, such as private companies or third-sector organizations, to deliver primary care services. APMS contracts are often time-limited and used to commission specialized services, such as health services for the homeless or specific out-of-hours care.