The evolution of GP contracting: learning from history and other countries
As work on the 2025/26 GP contract progresses, there are huge pressures facing general practice. This series of articles on contracting for general practice services describes the context in which negotiations for contract will take place, highlighting underlying challenges with creating a contract that works for all. The series summarises the history of the GP contract and its variants and provides four international examples of how contracts have been used to bring about change, before providing a set of approaches to contract setting for policy-makers to consider.
In England, the NHS General Medical Services (GMS) contract and its later variants – the Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts – set the terms on which general practices provide care to NHS patients.
But since the launch of the NHS in 1948, the general practice contract (‘GP contract’) has been seen as problematic by many of its main stakeholders: the politicians and policy-makers who shape the contribution of general practice to the NHS; the GPs who must deliver services in line with contract requirements; and patients who, as users of general practice services, are indirect stakeholders in the contract.
As work on the 2025/26 GMS contract progresses, the context is challenging. General practices, facing intense financial and workload pressure, need a contract that will enable them to sustain their businesses, manage their workload and provide safe, high-quality care. For politicians, policy-makers, patients and general practice innovators, stabilising the status quo is not enough. The contract is the potential vehicle for wider policy ambitions to: improve access through extended use of digital and other technologies and workforce redesign; embed general practice in an array of integrated services; and increase its role in prevention. The 2019–24 GP contract, with its national incentive scheme to form primary care networks (PCNs), used the contract to drive another key policy ambition: to increase the size of general practice providers.
This linked series of articles on contracting for general practice services (click hyperlinks in list below to jump straight into a specific article):
The considerations draw particularly on the international examples, which illustrate options for: contracting with different types of general practice organisation; using a mix of financial incentives; and supporting contract implementation with timely data and intensive operational and change management support. The four international examples are:
Considerations for developing future GP contracts
Negotiating a new contract or contracts for general practice will be easier if there is a fair financial settlement for primary care, allocated through a funding formula that adjusts for levels of deprivation in general practice catchment areas and addresses the current mismatch between inputs into primary care and population health needs. This would help to set a context in which contracting for general practice can both sustain existing services and support transformation for the future. In addition to this, policy-makers should consider:
Read the first article in the series
The context for developing a new GP contract
Blog postA short history of the GP contract and its evolution in England
Blog postWhat can we learn from international examples of contracting for general practice services?
Blog postDesigning a new GP contract: considerations for policy-makers and the profession
Blog postAppears in
Designing a new GP contract: considerations for policy-makers and the profession
Blog postWhat can we learn from international examples of contracting for general practice services?
Blog postA short history of the GP contract and its evolution in England
Blog postThe context for developing a new GP contract
Blog post