The new general practice contract and reform of primary care in the United kingdom.

In April 2004, the United Kingdom introduced a new General Medical Services (GMS) contract that provided new governance and incentive arrangements for general practice. In particular, the new Quality and Outcomes Framework is a points-based system that sets targets for clinical, organizational and practice-related standards with financial payments for achieving set levels of performance. This paper describes the new contract arrangements and their impact on general practice - focusing on the experience in England, where wider policy changes are also having an important impact on practices - and drawing out potential lessons that will be of interest to Canadian practitioners and policy makers.