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Primary medical care

NHS Primary Medical Services are provided by around 36,000 GPs in England working in around 8,200 GP practices, and who directly employ around 22,000 practice nurses and around 5,000 care assistants – who between them carry out over 300 million patient consultations a year.

Since April 2004, four contracting routes been available to enable primary care trusts (PCTs) to commission or provide primary medical services for their populations. The routes are:

- General Medical Services (GMS)
- Personal Medical Services (PMS) – which includes Specialist PMS (SPMS)
- Primary Care Trust-Led Medical Services (PCTMS)
- Alternative Provider Medical Services (APMS)

Primary medical services contractors are required to provide patients with essential services, can opt out of providing additional services, and in addition may provide enhanced services which have additionally been commissioned from practices by the PCT.

The primary medical care contracting arrangements enable the NHS to provide a wider range of GP services closer to where patients live and improve the quality of care provided.  

GP contracts are funded from PCTs’ allocations – eg from a PCT’s overall primary care budget or from the unified budget, depending on the service to be provided.

GP practices act as both the gateway to and coordinator of patient access throughout their care journey (pathway).  They are usually the first point of contact for a patient seeking treatment or advice about their health.  Around 90% of people's contact with the NHS is with these services.

GP practices have a close relationship with wider community services – social care and health services.  Core community services such as community nurses and health visitors, are often co-located within defined localities based around primary care providers such as GP practices.  More specialist community services, such as podiatry, speech and language therapy, school nursing and health promotion, are similarly based around defined local communities and have a close interface with primary care providers.

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