PRIMARY CARE ACT
PERSONAL MEDICAL SERVICES (PMS) PILOTS

The Personal Medical Services (PMS) contract introduces new flexibility to primary care, in order to encourage creative approaches to service delivery and to promote local solutions to often intractable problems. It allows individual practices, groups of practices including primary care trusts (PCTs), and/or community trusts to negotiate unique arrangements for service provision, including salaried general practitioners, extended roles for nurses, and reconfiguration of practice/community boundaries for organising care. The experiment is now entering its fourth wave, with more than 1300 pilots operating and 19% of English patients already registered with PMS doctors.

The National Evaluation of the first wave PMS pilots aimed to assess the impact of the new arrangements developed by the pilot sites for the provision of primary care. The key objectives by which the provision of healthcare within the pilots was evaluated are: fairness, efficiency, effectiveness, flexibility, accountability, integration and responsiveness.

In June 1998, four separate research teams were commissioned by the Department of Health to conduct the National Evaluation of the first wave PMS pilot sites. Each team focused on one or more of the seven themes identified above and developed evaluation and data collection methods to address their specific issues.

The four studies and their themes are:-

1. Organisational Change: accountability, integration and responsiveness.
   Health Services Management Centre, University of Birmingham.
   Lead researcher: Nicola Walsh
   Health Services Management Centre
   University of Birmingham
   Email:N.C.Walsh@bham.ac.uk
   Tel: 0121 414 3178
   
    
2. Evaluating Quality of Care.
   University of Southampton and the National Primary Care Research and Development Centre, University of Manchester.
   Lead researcher: Dr. Andrea Steiner
   Department of Social Work Studies
   University of Southampton
   Email: steiner@cats.ucsc.edu
   Tel: 02380 593898
   
    
3. Salaried GP schemes: impact on GP recruitment, retention, workload, quality of care and costs.
   National Primary Care Research and Development Centre, University of Manchester and the University of Nottingham.
   Lead researcher: Professor Bonnie Sibbald
   National Primary Care Research & Development Centre
   University of Manchester
   Email: Bonnie.Sibbald@man.ac.uk
   Tel: 0161 275-7604
   
    
4. Addressing Inequalities.
   Queen Mary, University of London.
   Lead researcher: Professor Yvonne Carter OBE
   Department of General Practice and Primary Care
   Queen Mary, University of London
   Email: y.h.carter@qmul.ac.uk
   Tel: 020 7882 7904

   Co-ordination
   National Primary Care Research & Development Centre
   University of Manchester
   Co-ordinator: Dr Brenda Leese
   Email: b.leese@leeds.ac.uk
   Tel: 0113 233 1914

This document is a summary of the four final reports submitted by the study teams to the Department of Health in December 2001. Each report identifies key findings related to each study. Set out below is a list of key messages relating to the general findings from the National Evaluation.

Key Findings

• PMS provides a framework within which new approaches to primary care provision can be delivered
• PMS cannot provide the answer to every problem in primary care but, in the right circumstances, it can encourage innovation and act as a catalyst for change
• PMS can generate substantial service changes and benefits to patients as a result of increased flexibility
• PMS can provide improved services for disadvantaged groups of patients
• There is no single model of PMS, making defining success problematic
• PMS proved modestly successful in improving GP recruitment and retention by introducing flexible, salaried contracts in areas where GMS posts were previously hard to fill
• Salaried contracts were associated with increased GP job satisfaction, reduced job stress and enhanced work productivity
• In the right circumstances, PMS can improve quality of care, but so can GMS
• Health authority support for PMS pilots has been variable but can be crucial
• In order to achieve their goals, pilots require strong leadership and the ability to change professional relationships.

Earlier reports published by the PMS National Evaluation Team are as follows:-

Leese B, Gosden T, Riley A, Allen L, Campbell S (on behalf of the PMS National Evaluation Team). Setting Out. Piloting innovations in primary care. NPCRDC, University of Manchester, July 1999.

The PMS National Evaluation Team. National Evaluation of First Wave NHS Personal Medical Services Pilots. Integrated interim report from four research projects. NPCRDC, University of Manchester, December 2000