Personal medical services in London: new solutions for an old problem?

Abstract

A number of inquiries over the last 20 years have found London's primary care to be deficient when compared with the rest of the country, notwithstanding several development programmes aimed at addressing this inequity. Personal medical services (PMS) pilots were introduced in 1998 to replace the national contract for general practitioners and were intended to offer planners and providers of primary care with more flexibility in meeting local health needs. PMS pilots have proved particularly popular in London. This paper describes the results of a review of 13 first-wave PMS pilots in London. The pilots have resulted in new and flexible primary care organizations, more resources for the primary care workforce and greater access to services for deprived or underserved populations. However, little evidence was found to suggest that PMS pilots impacted greatly on service quality. Personal medical services pilots involve the development of local contracts, although contract management processes remain underdeveloped. Nevertheless, personal medical services pilots may prove successful in addressing some of the relative deficiencies in London's primary care and offer a powerful new tool to the commissioners of primary care to meet the diverse needs of Londoners.