The days of a single national contract for all GPs 'must now be considered to be in doubt', according to a King's Fund study.

A study looking at nine personal medical service pilots says they represent 'a significant challenge to the traditional model of primary care' and may come to be seen as a 'turning point' in medical policy.

The pilots allow for a salaried service, which has attracted some GPs, particularly women. It also allows for nurse-led services, described in Transforming Primary Care as 'a major move forward for the nursing profession', despite identifying difficulties, including lack of acceptance by GPs.

Personal medical service pilots were introduced by the 1997 NHS (Primary Care) Act. The first wave in April 1998 covered about 800,000 people. The second wave, which begins this month, will cover about 2.5 million people.

Analysis shows that 22 of the 30 most deprived health authority areas in the country have pilots, and the study concludes: 'PMS pilots are located in more deprived areas, and this is particularly true for nurse-led and trust-based pilots.'

Co-author Richard Lewis said: 'The single national contract has sometimes prevented the NHS from locating primary care services where they are most needed. PMS pilots herald a new way of providing primary care to overcome the blockage.'