Lothian LMC / is it my job? / what is GMS

Reference

What is GMS?

What the Scottish GP contract actually requires, what sits outside it, and why the line between the two is argued about so often.

GMS is the national contract between a Health Board and a practice for the provision of primary medical services, made under section 17J of the NHS (Scotland) Act 1978. Its terms are set by the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018, as amended, with payment governed by the Statement of Financial Entitlements.

Everything a practice is obliged to do flows from one short definition:

Services required for the management of its registered patients and temporary residents who are, or believe themselves to be — ill, with conditions from which recovery is generally expected; terminally ill; or suffering from chronic disease — delivered in the manner determined by the practice in discussion with the patient.

Regulation 18(3), SSI 2018/66. “Disease” means an ICD-10 three-character category. “Management” is defined at 18(4) as offering consultation and, where appropriate, examination to identify any need for treatment or further investigation, and making available such treatment or investigation as is necessary and appropriate, including referral and liaison with other professionals.

Note what this is not. It is not a list of tasks, procedures or conditions. The contract defines a population and a duty of management, and leaves the content of that management to clinical judgement. Nowhere in the regulations is there a schedule of what a GP must or must not do. That absence is the source of nearly every scope dispute.

The layers

What GMS does not cover

• Out of hours. Removed from the regulations in 2018. It is the Board’s responsibility.
• Work for a third party’s purposes. Examination and reports for employers, schools, insurers, courts, the police and compensation claims sit outside primary medical services and are chargeable under Schedule 5.
• Certificates beyond the prescribed list. Only the ten certificates in Schedule 4 must be issued without charge — fit notes, still-birth, jury service, absent voter, prescription charge exemption, council tax SMI, cause of death and a few others.
• Travel health. Travel immunisations for which no Board fee is payable, travel kits and malaria chemoprophylaxis are all chargeable.
• Specialist care. Investigation, monitoring and prescribing that belong to the clinician who holds clinical responsibility. Referral and liaison are core; taking over the specialist’s work is not.
• Being the provider of last resort. The Board is ultimately responsible for primary medical services. Where another service cannot see a patient, that gap does not transfer to the practice.
• Anything transferred without agreement. Work moved from secondary care or from a Board service does not become contractual by being sent.

Why the line is contested

Because it was never drawn. Regulation 18 sets a duty of management, not a task list, so almost any clinical activity for a registered patient can be argued into it, and almost any can be argued out. The BMA’s own guidance concedes that it is not always clear which services fall within core GMS, and that practices in different areas interpret it differently.

Three further pressures make it worse. Board-delivered services under Schedules 2B and 2C are patchy in practice, so work falls back on practices by default rather than by agreement. Secondary care transfers work with no contractual mechanism to accept or refuse it. And the 2018 contract’s expert medical generalist model describes a direction of travel rather than a boundary, so both sides can cite it.

Questions worth asking before accepting work

1. Is this the management of illness, terminal illness or chronic disease in one of our registered patients or temporary residents? If not, regulation 18 does not reach it.
2. Is it named anywhere as an additional, vaccination, enhanced or Board-delivered service? If it is specified and funded elsewhere, it is not core by definition.
3. Who generated the work, and for whose benefit? Work transferred for another provider’s convenience creates no obligation on the practice.
4. Is there an immediacy duty — accident or emergency under 18(6), or a patient who will come to harm today without a CTAC or pharmacotherapy intervention the Board has not delivered? Those are the narrow points where the practice must act regardless.
5. If it is core, does the manner of delivery remain ours? Regulation 18(3) leaves that to the practice in discussion with the patient, and Schedule 6 paragraph 4 leaves home visiting to the practice’s reasonable opinion.