Intended for healthcare professionals


A fresh new contract for general practitioners

BMJ 2002; 324 doi: (Published 04 May 2002) Cite this as: BMJ 2002;324:1048

Complex, with risks attached, but addresses many of the profession's concerns

  1. Richard Lewis (, visiting fellow,
  2. Stephen Gillam, director
  1. Primary Care Programme, King's Fund, London W1G 0AN

    The imposition of the 1990 contract by Kenneth Clarke was a blow from which professional morale among general practitioners has never really recovered. For many general practitioners it marked the end of a golden age. The “Red Book” has long been criticised as bureaucratic and inflexible, and the launch of personal medical services pilots in 1998 was an acknowledgment of the need for change. Currently, allocation of resources only poorly reflects patients' needs; the contract is highly focused on the individual practitioner and fails to recognise adequately the role of the practice team; quality measures are sparse and crudely applied; and perverse incentives often serve to reward poor quality services. A recent BMA survey exposed high levels of stress, poor morale, and planned early retirement or exit from the profession.1 The proposals for a new national contract, announced on 19 April jointly by the NHS confederation and the British Medical Association, mark an important departure. 2 3 A new weighted capitation formula will replace the work of …

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