Contracting for quality or local fixes? Two Personal Medical Services pilots

Abstract

As an alternative to the national contract with general practitioners (GPs), Personal Medical Services (PMS) is a way of contracting with GPs for providing primary care, intended to enable individual contracts with practices which are appropriate to the specific needs of their populations. The national plan for the NHS (2000) strongly supports the extension of PMS as a means of improving the quality of primary care. This paper reports two small pilots which found PMS a useful mechanism for achieving desired changes within the practices. In one case, the GPs are now employed by the local community trust and the primary health care team has been expanded, with some clinical functions redistributed among the team. In the other, the primary health care teams of two practices have developed a tool for assessing the health and needs of older people during a home visit. Participants in both pilots expressed satisfaction with the results, although there were some dissenting voices. In both cases, the pilots were unable to demonstrate in detail any improvements in patient care or to quantify the work-load implications of the changes. Perhaps because of their ‘pilot’ status, the initiatives tended to be inward looking, and opportunities for learning across the local health economy have been missed. PMS' value as a driver for improving the quality of primary care is not demonstrated by these two examples.