GMS contract changes 2003/04

Pen and form

The General Medical Services (GMS) contract 2003 ‘Investing in General Practice’, known as 'the blue book', was agreed in 2003 and implemented in 2004. It followed negotiations between the General Practitioners Committee (GPC) and representatives from the NHS, negotiating for the NHS Confederation on behalf of the Departments of Health in England and Northern Ireland and the devolved administrations in Wales and Scotland. 

The three year contract signalled a significant change with the introduction of a practice based, rather than practitioner based contract, and an unprecedented scale of investment in general medical services to reward quality of care.

The old contract paid General Practitioners (GPs) on the basis of fees and allowances. In contrast, the new contract allocated resources to GPs through three main funding streams: the global sum; the Quality and Outcomes Framework (QOF); and enhanced services payments. Separate funding streams were available for  practices to modernise their premises and improve their IT infrastructure.

The new contract was effective from 1 April 2004 and was implemented throughout the UK with specific responsibilities as follows:

  • Primary care organisations (PCOs) were accountable for implementation in their localities.
  • Strategic health authorities (SHAs), or their equivalents, were responsible for performance managing PCOs.
  • The Primary Care Contracting Team in England supported Primary Care Trusts (PCTs) and SHAs in implementing the contract.
  • The Health Departments performance manage SHAs (or their equivalents) and ministers were accountable to Parliament for overall implementation and the use of public money.

2003/04 contract documents

The main documents supporting the 2003/04 contract are below. Some of these documents have now been superseded by the 2006/07 agreement and guidance:

Supplementary 2003/04 contract documents

The supplementary documents supporting the 2003/04 contract are below. Some of these documents have been superseded by the 2006/07 agreement and guidance:

Salaried contracts
Directed Enhanced services
National enhanced services 

These enhanced service specifications outline the more specialised services which Primary Care Organisations could commission:

 Other supplementary documents

  • Innovative Out of Hours schemes - identified by NHS Confederation members and considered during the new GMS contract negotiations
  • Seniority payments- details of the new seniority scheme
  • Payment mapping - mapping of old payments to new contract income streams
  • Funding streams - new GMS contract funding streams in the four countries
  • Quality and outcomes framework - invitation to express interest in forming an expert panel
  • Quality and outcomes framework - updated guidance and explanatory note - this has been updated with agreement of all health departments and the GPC to include minor
    amendments and clarifications and to amend the Read codes. The revised guidance replaces the original version published in Investing in General Practice - Supporting
    documentation (the blue book).  For information on the revised changes please visit the DH website.

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