The core contract for GP personal medical services pilots is to be torn up and GPs given the freedom to organise services as they see fit to meet local needs, without having targets imposed on them, it emerged last week.
The decision to scrap the current prescriptive core contract and replace it with a framework agreement, trailed by health minister John Hutton at last week's National Association of Primary Care conference, represents a major shift away from central specifications for service provision.
The hands-off approach to the PMS pilots emerged as latest figures showed that nearly one in five GPs are now on PMS contracts.
Around 4,100 GPs joined the third wave of pilots, bringing the total to over 5,500 - 18 per cent of all GPs.
Under present arrangements, PMS pilots are given a sum of money from the local NHS to provide services, based on local health needs.
The pilot itself decides how to spend the money on staff and service delivery.
Mr Hutton told the conference that PMS was 'here to stay' and that the core contract, which had been criticised for being too bureaucratic, would be altered.
He said: 'We are introducing a revised PMS agreement.
'The agreement has been redrawn within a clear local accountability framework.'
Mr Hutton also said the Department of Health was talking to the British Medical Association about how to make PMS more rewarding.
NAPC chair Dr Peter Smith welcomed the minister's remarks and said there was a 'certain level of synchronicity' between what the minister had said and the views of the NAPC.
He said: 'It [the core contract] is unusually restrictive and unnecessarily bureaucratic.
'I hope it [the new agreement] will restore the flexibility of the first PMS contract.'
HSJ understands that the framework agreement will only contain the broad outline of services to be provided - and specific targets, including NHS plan commitments such as the 48-hour access target - will only be mentioned in an annex.
The commitment to be able to see a GP within 48 hours will not be for a named doctor, but for any GP.
HSJ also understands that the formula for resource allocation for pilots is to be changed from next year so money is allocated according to how many GPs an area should have, rather than how many it actually has. This will benefit areas where GP recruitment is a problem, such as deprived inner cities.
It is also expected that PMS pilots will in future be able to develop franchises to manage services elsewhere.
As part of this increasing managerial responsibility, it is understood there will be increased remuneration for staff such as practice managers.
The PMS framework agreement will be in addition to whatever comes out of the current GP contract negotiations.
Although these are working towards a new GP contract comprising a national agreement with local flexibility, it now seems unlikely there could be a single contract that would embrace both PMS and the general medical services contract under which most GPs are employed.