Primary Medical Services, the new GMS contract, and QOF

This page provides a brief summary of the wider context for the Quality & Outcomes Framework.  It is essential that the information reported on this website is interpreted carefully in the context of the contracting arrangements of individual practices.  In particular, practices with contract types 17C and 2C may only use some of the QOF indicators and thus may not appear to achieve as many points as other practices who use all of the QOF indicators. 

Primary Medical Services

With effect from 1st April 2004, The Primary Medical Services (Scotland) Act 2004  amended The National Health Service (Scotland ) Act 1978 by placing a duty on NHS Boards to provide or secure 'primary medical services' for their populations.  NHS Boards can do so by providing services directly (this is known as 'direct provision' Section 2C of the 1978 Act) or by making arrangements (by 'contract' or 'agreement') with a range of 'providers' through:

• a 'GMS' (General Medical Services - Section 17J of the 1978 Act) contract - nationally negotiated with some local flexibility for GPs to 'opt out' of certain services or 'opt in' to the provision of other services.
• a 'Section 17C' (formerly known as 'Personal Medical Services' or 'PMS') agreement - locally negotiated agreements which are more flexible in accordance with local circumstances
• a 'Health Board Primary Medical Services' contract (Section 2C of the 1978 Act) - the NHS Board can, in certain circumstances, make arrangements with, for example, a non-NHS organisation for the provision of NHS services

Within the in-hours period (i.e. the hours when practices are normally open to patients), the majority (approximately 90%) of general practices in Scotland have a new GMS contract.  The largest proportion of the remainder is made up of Section 17C Schemes, with a small number of services provided under 'direct provision'.  In the out of hours period (e.g. night-times), 'direct provision' (section 2C) is the predominant model.  

The new GMS contract

The new GMS contract, implemented throughout the United Kingdom since 1st April 2004, was the product of negotiations between the British Medical Association's (BMA's) General Practitioners Committee and the NHS confederation.  The new contract was introduced to support the ongoing development of primary care, and to give greater flexibility in how general practices deliver patient care, and are paid.  A fundamental component of the new GMS contract is a system of financial incentives for delivering clinical and organisational quality - the Quality & Outcomes Framework (QOF).  Further information on the new GMS contract is available in the  Scottish Guidance on the 2006/07 contract (includes QOF guidance still relevant in 2007/08), via the  nGMS contract   pages of the NHS Scotland Pay Modernisation website and on the Primary Care Contracting  pages of the NHS Employers website.

The Quality & Outcomes Framework for practices with new GMS contracts

The QOF, although fundamental to the new GMS contract, is nonetheless a voluntary part of it; general practices can aspire to achieve all, part, or none of the points available in QOF.  Whilst, to date, most GMS practices in Scotland have participated fully in the QOF, it is important to note that for some practices it may be impossible to achieve all the points available in the framework.  For example, some of the clinical indicators relate to very specific subgroups of patients, and if the practice does not have any patients in that particular subgroup, they cannot score any points against the relevant indicator(s).  This means that it is not necessarily possible for all practices to achieve full achievement against the QOF.

Additionally, practices with section 2C or 17C agreements may choose to participate in the QOF (see below).  For further details on the nature of the QOF, see What is the QOF?

Quality & Outcomes Framework data for practices with 17C or 2C agreements

Section 17C or 2C schemes include quality and outcomes as part of their locally negotiated agreements, and in many cases, they opt to use part or all of the new GMS QOF as a measurement tool.  However, it is possible to tailor the quality and outcomes requirements of a Section 17C or 2C agreement in accordance with local circumstances - such as the needs of a particular group of patients - and, again, subject to local agreement.  Such practices might use quality measures that, although rigorous and appropriate, are not identical to those used in the GMS QOF.  Therefore, although 17C/2C practices may record full QOF data if they wish, they may deliberately use only part of the QOF, or may not use it at all.

This means that practices with contract types 17C and 2C may sometimes not appear to achieve as many points as other practices who use all of the QOF indicators.