Editorials

Personal medical services: a barometer for the NHS?

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7273.1359 (Published 02 December 2000) Cite this as: BMJ 2000;321:1359

As PMS contracts become the norm the scope for innovation declines

  1. Jonathan Shapiro (J.A.Shapiro@bham.ac.uk), senior fellow
  1. Health Services Management Centre, University of Birmingham, Birmingham B15 2RT

    The personal medical services (PMS) pilot scheme in the British NHS has been in existence for over two years and was designed to allow experimental schemes to test alternative models for delivering primary and community care.1 So far the scheme has proved popular, but three new factors make it important to review the future of the scheme and its direction: the New NHS white paper2; the very popularity of the scheme; and the impact of the “NHS plan.”3

    Because British general practitioners have traditionally been self employed, the contract under which they perform work for the NHS (the general medical services (GMS) arrangements set out in the “red book”) is elaborate and is perceived as being inflexible and bureaucratic. The personal medical services scheme allowed participants to test contractual mechanisms that would have been illegal under the normal arrangements. Although the personal medical services scheme has sometimes been called the “salaried doctors” scheme (to contrast with the normal self employment arrangements), this has not been its defining characteristic. Rather, the …

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