When PMS was first introduced, hopes were high for it to deliver tailor-made services for local populations. It was a contract that recognised the health needs of people in, say, Surbiton were very different to those in Bradford. At that time, there were new waves of immigrants and refugees fleeing war torn homelands and this highlighted the need for a much more flexible mechanism for the delivery of appropriate care. The health needs of these populations, as they settled in various parts of the country, were very specific and challenging and not being met in any way by the parameters of the traditional item-of-service GP contract.
It was also hoped PMS, as a local contract, would reduce the power and stranglehold of the General Practice Committee (GPC )of the British Medical Association (BMA) in its national negotiations with the government on the GP contract.
Indeed, in its early days, first wave PMS practices, often casualties of first wave GP fundholding, delivered high quality, dedicated services to meet the very specific needs of local practice populations. It was here that we first glimpsed sight of 21st century primary health care. Innovation was allowed to flourish and the best clinicians were enabled to deliver the highest quality, world-class, primary care.
As ever, with innovation, comes imitation. PMS was often poor in vision, scope and quality; an expensive option, too, for what later waves of PMS practices delivered, in health improvements, compared with their GMS peers. Contracts were poorly implemented and poorly performance managed. And, it was these factors that gave PMS a bad name and are responsible for the siege under which it now finds itself.
The Health and Social Care Act majors heavily on localism, local health and social care economies and recognises their importance in the ‘modernisation' agenda. CCGs are charged with population health management and meeting the array of needs of local populations around the country. These objectives can only be met through local flexible contracts. A national, standard contract can no longer deliver world class primary care. It is too blunt an instrument and its days are numbered.
Whatever transpires in national negotiations for the future of a contract or contracts for general practice, NAPC will be lobbying ministers hard and will be vocal in its demands for local flexibility for primary care. We need this to retain this for our populations' well- being and we need it to retain this country's pre-eminent reputation in primary care around the world.
Maggie Marum is independent consultant at the NAPC
