General practice

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. A new contract is issued each year.

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 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".

In 1924 agreement was reached between the British Medical Association and the Ministry of Health that capitation fees would comprise 50% of a GPs income but only occupy 2/7 of his time, the remaining income being generated privately.

The meaning of independent contractor in respect of GPs has not always been very clear, but was generally tied to their rejection of salaried status. However their behaviour has rarely been that of self-employed entrepreneurs. They have more often behaved as salaried professionals who defend their right to control what they do and how they do it.

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