Every GP practice in England operates under one of three NHS contract types: General Medical Services (GMS), Personal Medical Services (PMS) or Alternative Provider Medical Services (APMS). Which one your practice holds determines who negotiates your terms, how your funding is calculated, and what grounds NHS England or your integrated care board (ICB) has to terminate your contract.
These are not interchangeable labels. Each contract type sits under different regulations, is negotiated by a different body, and carries different risks and flexibilities. For a GP partnership, understanding which contract you hold, and what that means in practice, is as fundamental as understanding your partnership agreement itself. This is the first thing we check when a practice comes to us with a contractual query, and it shapes the advice that follows.
This post sets out the legal position on each contract type, how they compare, how funding works under each, and where the main legal risks sit. It is the reference point for the other posts in our NHS contracts series, which we link to throughout.
The Three NHS GP Contract Types
There are three distinct contractual routes into providing NHS primary medical services in England, each governed by its own legal framework.
General Medical Services (GMS)
The GMS contract is the national default. It is governed by the National Health Service (General Medical Services Contracts) Regulations 2015 (SI 2015/1862), made under Part 4 of the National Health Service Act 2006, and is negotiated annually (or, occasionally, on a multi-year basis) between NHS England and the General Practitioners Committee of the British Medical Association. Around 70% of practices in England hold a GMS contract. Once negotiated nationally, the terms are used by ICBs to contract with individual practices in their area, so a GMS practice cannot negotiate away from the national terms in the way a PMS practice can.
Personal Medical Services (PMS)
The PMS contract is governed by the National Health Service (Personal Medical Services Agreements) Regulations 2015 (SI 2015/1879). Unlike GMS, PMS agreements are negotiated and agreed locally between an ICB and an individual practice or group of practices. This gives PMS practices scope to agree local variations, for example additional services tailored to a particular population, in exchange for different funding arrangements, while still operating within the same national legislative framework and the same core legal protections. Roughly a quarter of practices hold PMS contracts.
Alternative Provider Medical Services (APMS)
APMS is the most flexible of the three. It is not delivered through the same regulations as GMS or PMS but through arrangements made under section 83(2) of the National Health Service Act 2006, set out in Directions issued by the Secretary of State from time to time (the current framework is the Alternative Provider Medical Services Directions 2019, as amended). APMS allows ICBs to contract with organisations other than GP partnerships, including private companies and third sector or social enterprise providers, and can be used to commission services beyond core general practice, for example services targeted at homeless populations or asylum seekers. Around 4% of practices operate under APMS.
GMS vs PMS vs APMS: A Direct Comparison
| Feature | GMS | PMS | APMS |
|---|---|---|---|
| Governing regulations | NHS (General Medical Services Contracts) Regulations 2015 (SI 2015/1862) | NHS (Personal Medical Services Agreements) Regulations 2015 (SI 2015/1879) | Directions under s.83(2) NHS Act 2006 (APMS Directions 2019, as amended) |
| Who negotiates terms | Negotiated nationally between NHS England and the BMA’s GPC England | Negotiated locally between the ICB and the practice | Negotiated locally, typically via competitive tender |
| Who can hold the contract | GPs and GP partnerships (and some companies limited by shares) | GPs and GP partnerships, NHS trusts, and other approved persons | Any organisation approved by the ICB, including private and third sector providers |
| Approximate share of practices | Around 70% | Around 25% | Around 4% |
| Term | Generally open-ended (in perpetuity, subject to termination grounds) | Can be open-ended or fixed-term | Usually fixed-term, often 3 to 5 years, subject to re-tender |
| Scope for local variation | Limited; terms follow the national contract | Greater flexibility to agree locally tailored services and funding | Most flexible; scope and services set by the commissioning ICB |
None of these labels is inherently better than the others. A GMS practice benefits from the stability and predictability of a nationally negotiated, open-ended contract. A PMS practice trades some of that certainty for local flexibility. An APMS contract offers commissioners the most room to shape services around local need, but for the provider it usually means a fixed term and the prospect of re-tendering, which brings a different set of commercial risks that a GMS or PMS practice does not face.
How Funding Differs Across Contract Types
Regardless of contract type, most core funding flows through the global sum, calculated on a per-weighted-patient basis using the Carr-Hill formula, which adjusts for factors such as patient age, sex, and additional needs. For 2026/27, the global sum payment per weighted patient rose from £123.34 to £130.07, a net uplift across GMS, PMS and APMS contracts of £6.73 per weighted patient, equating to a 5.5% GMS contract uplift. NHS England confirmed that commissioners would apply this same uplift to PMS and APMS contracts with effect from 1 April 2026, so that the three contract types move broadly in step even though PMS and APMS terms are locally agreed.
On top of the global sum, practices can receive income from:
- The Quality and Outcomes Framework (QOF), a voluntary scheme rewarding performance against clinical and organisational indicators, which typically accounts for around 10% of practice income. For 2026/27, QOF was amended to reward uptake of the MMRV (measles, mumps, rubella and varicella) vaccine and to add new indicators on cardiovascular disease, diabetes and obesity.
- Enhanced services, both the nationally set Directed Enhanced Services that commissioners must offer, and Local Enhanced Services agreed with the ICB.
- Premises payments, generally reimbursing rent in full where a practice leases its premises, or mortgage interest where it owns them.
- Network Contract DES funding through the practice’s primary care network, which for 2026/27 totals up to £2.606 billion nationally, including core PCN funding of £3.059 per patient per year and reimbursement for additional roles staff.
Where PMS and APMS contracts differ from GMS in practice is not usually in the headline uplift, which NHS England has confirmed will track GMS, but in the detail of local variations agreed years earlier, some of which include locally negotiated premium payments (sometimes referred to as PMS “growth money”) that are not automatically replicated in GMS terms. Any practice considering a move between contract types should have those local terms reviewed before assuming the figures are directly comparable.
Core Requirements Under All Three Contract Types
Whichever contract a practice holds, it sits on a common structure of obligations. Every GP contract:
- defines the geographical or population area the practice covers and the patient list it must maintain;
- sets out the essential medical services the practice must provide to registered patients and temporary residents, during core hours of 8.00am to 6.30pm Monday to Friday, excluding bank holidays;
- sets standards for premises, workforce, and requirements for inspection and oversight, including registration with the Care Quality Commission;
- establishes expectations for patient and public involvement; and
- sets out the contractual framework for indemnity, complaints, liability, insurance, clinical governance and termination.
For 2026/27, the core contract was tightened further: practices must now treat clinically urgent requests as requiring same-day action, cannot ask patients to call back on another day, and cannot cap the volume of online consultations accepted, building on the requirement (in force since October 2025) to keep online consultation tools open throughout core hours. The advice and guidance service, previously funded separately as an enhanced service, has also been folded into the core contract for 2026/27. These changes apply across GMS, PMS and APMS contracts, since they sit within the essential services requirements common to all three.
Termination and Breach: Where the Legal Risk Sits
A GMS contract can only be terminated in the circumstances set out in Part 8 of Schedule 3 to the GMS Contracts Regulations 2015, specifically paragraphs 65 to 71. These include termination where a partner ceases to meet the conditions to hold the contract, where untrue or inaccurate information was provided, where a breach puts patient safety at serious risk or exposes the commissioner to material financial loss, and, more routinely, through the remedial and breach notice process at paragraph 70. Under paragraph 70, most ordinary breaches must first be the subject of a remedial notice giving the practice at least 28 days to put things right (or a shorter period where patient safety or financial loss requires it), before termination can follow. Where the contract is terminated, paragraph 74 generally requires at least 28 days’ notice, and invoking the NHS dispute resolution procedure within that window can suspend the termination date until the dispute is resolved.
Because a GMS contract otherwise runs indefinitely, and because a partnership holds the contract collectively (so a change of partner does not, by itself, end it, provided proper notice is given), the termination provisions are the practical mechanism by which the relationship can end outside of a negotiated exit. PMS and APMS agreements contain broadly equivalent provisions under their own regulations and directions, though APMS contracts, being typically fixed-term, also come to a natural end on expiry or non-renewal rather than relying solely on breach.
We cover the practical side of this in detail in our companion posts on breach of GMS and PMS contracts and on automatic contract termination, both of which set out what triggers these provisions and how practices can respond.
What This Means If You Are Reviewing, Varying, or Taking On a Contract
A few practical points come up repeatedly when we advise practices on GP contracts:
- New partners joining a GMS or PMS practice need to be notified to the commissioner promptly, since a failure to do so correctly can itself create a compliance issue quite separate from anything the new partner has done.
- Local variations agreed years ago under a PMS contract are easy to lose track of. We regularly find practices operating on terms that nobody currently in the partnership has actually read.
- APMS providers approaching the end of a fixed term should start planning for re-tender well in advance, since losing an APMS contract on expiry is a commercial event, not a breach, and needs to be planned for as such.
- Any correspondence from an ICB referencing a “remedial notice” or “breach notice” should be treated as time-critical. The 28-day clock set out in the regulations starts running from the date of the notice, not from when the practice gets round to reading it properly.
If you are setting up a new practice, taking on a partnership share, or reviewing the terms you already hold, our related posts on the GP partnership agreement and on recent changes to the GP contract cover the areas that most often interact with the underlying NHS contract itself.
What This Means for Your Practice
Whether you hold a GMS, PMS or APMS contract shapes almost every other legal question your practice will face, from how new partners are admitted to what happens if a dispute with your ICB escalates. We act for GP partnerships and other primary care providers across London and the South East, advising on contract reviews, variations, disputes and terminations under all three contract types, including the wider NHS regulatory compliance obligations that sit alongside them. If this affects your practice and you would like to talk it through, get in touch with our healthcare team or call us on +44 207 566 1188. You can also reach us by email at info@gurvelegal.com.
