Commentary - Who contracts for primary care?

The implications of the 1997 NHS (Primary Care) Act have been largely overl ooked in the rush to establish Primary Care Groups. Allowing health authori ties to develop local contracts for primary care has far-reaching implicati ons and is an important departure from the national system of negotiation t hat has characterized general practice to date. This paper describes a cont ent analysis of a sample of Personal Medical Services (PMS) pilot contracts . In the first year little attention has been given to achieving cost savin gs or greater efficiency and few contracts promote clinical guidelines. The difficulties of specifying services sensitive to local health needs are hi ghlighted and the national Statement of Fees and Allowances (the 'Red Book' ) may not be swiftly supplanted. However, the pilots have introduced innova tions such as salaried general practitioners, nurse-led services and NHS tr ust-managed care. The development of local contracts provides a valuable le arning experience for general practitioners and health authorities in advan ce of the establishment of Primary Care Trusts.