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Work patterns in UK general practice: turning the clock back?

The 1966 contract for UK GPs can be judged to have brought about a remarkable renaissance in primary care. For those unfamiliar with the history, it is worth recalling what it was like before then. Most practices were single-handed, and there was no incentive to invest in staff or premises. GPs were memorably faced with the choice of maximising their income by looking after large lists of patients, or having smaller lists, employing staff, and investing in their premises and surviving on lower incomes. Significantly, the 1966 contract marked the end of the ‘assistant with a view’. These were doctors unable to get a practice of their own, and employed by existing doctors ‘with a view’ to taking over the practice in due course. Such doctors ended up trapped, waiting for a partnership that came late or not at all, and working for another doctor at a lower rate of pay. The 1966 contract introduced a fee structure with a number of different elements, specifically rewarding doctors working in partnerships, providing generous arrangements for investing in premises, and reimbursement for employing staff.

Over time, much of this complex structure has been eroded, first with the 1990 contract, followed by personal medical services (PMS) contracts. The 2004 changes found in the new general medical services (GMS) …