Have made steady, if unspectacular, progress

Pilot schemes for personal medical services are now in their fourth year. Rapid growth in their numbers means that 22% of England's general practitioners now choose to work in more than 1700 pilot schemes.1 A national evaluation has recently reported on the progress of the first wave of pilots.2 What evidence is there to justify health minister John Hutton's endorsement of personal medical services as “a proven success?”3

Pilots of personal medical services were brought into life by the NHS (Primary Care) Act 1997 and promptly endorsed by the incoming Blair administration. They are an antidote to the “one size fits all approach” of the national contract for general practice and a response to doctors' dissatisfaction with their traditional employment options.4

Yet the pilots amount to more than an alternative contractual framework—they have fundamentally changed the relation between government and general practice. Personal medical services entail local service contracts, negotiated between the provider and primary care trusts. They are subject to local targets, budgets, and monitoring. This leaves little room for national collective bargaining, and the General Practitioner Committee of the BMA has been disempowered as a result. Personal medical services break the monopoly of the independently …