General Practice – Profits vs People…

Overview of GP Surgeries, Prescriptions, Contracts, and Profits

General Practice (GP) surgeries in the UK are the primary point of contact for patients seeking medical care. They operate under a complex system of contracts and funding mechanisms, which have evolved over time to adapt to changing healthcare needs and economic conditions. This overview delves into the structure of GP surgeries, the types of contracts they hold, the funding they receive, and the profitability of these practices.

Structure of GP Surgeries

GP surgeries are typically small to medium-sized businesses that operate under contracts with the National Health Service (NHS). The majority of GP practices are run by partnerships of GPs, who are responsible for employing other staff such as nurses, practice managers, and administrative personnel. These practices are contracted to provide a range of services, including:

• Essential Services: Mandatory services that include the identification and management of illnesses, providing health advice, and referrals to other services.
• Additional Services: Optional services that practices can opt out of, such as minor surgery.
• Enhanced Services: Nationally agreed services that practices can opt into, such as advice and guidance services between primary and secondary care.
• Locally Commissioned Services: Services that are set and commissioned locally, often by non-NHS organizations like local authority public health departments.

Types of GP Contracts

There are three main types of GP contracts in England:

1. General Medical Services (GMS) Contract:

• Coverage: Around 70% of practices.
• Negotiation: Negotiated nationally every year between NHS England and the General Practice Committee of the British Medical Association (BMA).
• Flexibility: Less flexible compared to other contract types but provides a standardized framework for delivering core medical services.

1. Personal Medical Services (PMS) Contract:

• Coverage: About 28% of practices as of July 2024.
• Negotiation: Negotiated and agreed locally by Integrated Care Boards (ICBs) with a general practice or practices.
• Flexibility: Offers more flexibility to tailor requirements to local needs while adhering to national guidelines and legislation.

1. Alternative Provider Medical Services (APMS) Contract:

• Coverage: Only 1% of practices.
• Negotiation: Allows contracts with organizations other than general practitioners, such as private companies or third sector providers.
• Flexibility: Provides the greatest flexibility, enabling the commissioning of a wide range of primary care services beyond core general practice.

Funding Mechanisms

The funding a general practice receives is derived from multiple sources:

• Global Sum Payment: The largest portion of a practice’s income, covering mandatory requirements, essential services, and additional and out-of-hours services.
• Quality and Outcomes Framework (QOF): A scheme that rewards practices for achieving quality standards, potentially adding an additional £20,000 to a practice’s income.
• Enhanced Services: Payments for providing additional services, such as minor surgery and the seasonal flu vaccination program.
• Local Enhanced Services (LES): Payments for locally commissioned services that vary by area.
• Private Services: Fees for limited private services, such as sick certifications and travel prescribing.

Prescriptions and Private Practice

GPs are generally restricted in their ability to charge NHS registered patients for private services. However, there are some exceptions:

• Private Prescriptions: GPs can issue private prescriptions for certain medications, such as malarial chemoprophylaxis and medicines required for treatment abroad.
• Dual Practices: Some patients might have both an NHS and a private GP to manage their care cost-effectively.

Profitability and Corporate Ownership

The profitability of GP practices varies significantly:

• Partnership Model: Most GP practices are run by partnerships of GPs who share the income and responsibilities. The profit is the residual income after covering practice costs.
• Corporate Ownership: The introduction of APMS contracts in 2004 allowed private companies to operate GP services. However, these companies have faced challenges in making profits due to the fixed-price nature of the contracts and the high costs of running practices.

Recent Developments and Challenges

• Funding Boost: In 2025, the government announced a significant funding boost of £889 million for general practice, aimed at easing financial pressures and improving patient access.
• Contract Reforms: The 2025/26 GP contract includes measures to reduce bureaucracy, improve patient access, and enhance the quality of care. Key changes include:
• Online Consultations: Practices must keep their online consultation tools open during core hours (8:00 AM to 6:30 PM) from October 2025.
• Reduction in Performance Targets: The number of performance targets has been reduced from 76 to 44 to allow GPs more time with patients.
• Facility Upgrades: Over £102 million has been allocated to upgrade GP facilities, creating additional space for more patient consultations and improving the overall quality of care.

Criticisms and Controversies

• Profit Motive: There are concerns that the profit motive in corporate-owned GP practices may conflict with patient care. Some argue that these companies prioritize financial gains over the quality of care.
• Nationalization Proposals: Some healthcare professionals and politicians advocate for the nationalization of GP practices to align them more closely with the NHS and ensure a focus on patient needs rather than profit.
• QOF Controversy: The Quality and Outcomes Framework (QOF) has been criticized for incentivizing the prescription of ineffective drugs and failing to improve patient outcomes, despite costing billions of pounds.

Summary Table

Aspect	Details
Structure	Small to medium-sized businesses, typically run by GP partnerships.
Types of Contracts	GMS (70%), PMS (28%), APMS (1%)
Funding Sources	Global Sum Payment, QOF, Enhanced Services, LES, Private Services
Prescriptions	Restricted for NHS patients, exceptions for certain private prescriptions
Profitability	Varies; corporate ownership faces challenges in making profits
Recent Developments	£889 million funding boost, contract reforms, facility upgrades
Controversies	Profit motive, nationalization proposals, QOF effectiveness

This comprehensive overview highlights the multifaceted nature of GP surgeries in the UK, encompassing their structure, contracts, funding, and the ongoing debates surrounding their operation and profitability.

The debate over whether profit motives are prioritized over patient care in UK GP surgeries has been a contentious issue.

Here are some key points and references:

• Profit Incentives for Reducing Hospital Referrals: In 2018, an investigation revealed that some NHS clinical commissioning groups (CCGs) were offering GPs financial incentives to reduce hospital referrals. These “profit-share” arrangements allowed practices to benefit financially by not sending patients to hospitals or specialists, which critics condemned as a “dereliction of duty”
• Operose Health Controversy: In 2022, an undercover investigation by BBC Panorama at a surgery run by Operose Health, the UK’s largest provider of GP services, uncovered concerns about patient safety. The investigation found that the practice was short of eight doctors and was hiring less qualified medical staff called physician associates (PAs) because they were “cheaper” than GPs. Additionally, there was a significant backlog of important patient referral documents and medical test results, raising serious concerns about patient care
• Funding and Infrastructure: Despite these issues, the government has made efforts to address some of the structural problems in GP surgeries. In May 2025, the Department of Health and Social Care announced a £102 million investment to modernize and expand GP surgeries, aiming to improve facilities and patient services. However, this funding is seen as an “encouraging interim measure” by the Royal College of GPs (RCGP), with long-term investment still needed to address deeper issues
• Patient Satisfaction and Workforce Challenges: Patient satisfaction with GP services has declined significantly since the pandemic, with only 31% of people in the UK expressing satisfaction in 2024, down from 68% in 2019. The RCGP has highlighted the strain on general practice due to under-investment and a chronic shortage of GPs, emphasizing the need for a bold new plan to support the profession

These points illustrate the ongoing tension between profit motives and patient care in UK GP surgeries, with evidence suggesting that financial incentives and cost-cutting measures can sometimes compromise the quality of healthcare.

The UK government has taken several actions to make healthcare more patient-centered in 2025:

• Community Diagnostic Centres (CDCs): The government has prioritized the delivery of up to 160 CDCs, with 92 already operational. These centers aim to provide earlier diagnostic tests closer to home, supporting the NHS to conduct up to 17 million tests by March 2025, with a capacity for up to 9 million more per year once fully operational
• Waiting List Transparency: Efforts are being made to improve the transparency of waiting lists. Patients will have access to more detailed information about their wait times, allowing them to make informed choices regarding their treatment. This includes categorizing patients based on whether their care is delayed for clinical reasons or due to personal choice
• Better Care Fund (BCF): The Local Authority Better Care Fund Grant, which supports integrated health and social care, has been increased to £2.64 billion for 2025-2026. This funding aims to improve care coordination and reduce unnecessary hospital admissions
• Social Care Charging Reforms: Although the planned adult social care charging reforms were not taken forward in October 2025, the government has introduced an amendment to the Care Act 2014 to ensure that only the amount individuals contribute towards their care costs counts towards the cap. Additionally, the Minimum Income Guarantee (MIG) and Personal Expenses Allowance (PEA) have been unfrozen and will rise in line with inflation, helping those with lower levels of assets

These initiatives reflect the government’s commitment to enhancing patient-centered care, improving access to services, and ensuring that the health and social care system is more responsive to individual needs.

Below is a table showing the all-cause mortality rates in the UK over the past five years (2021-2025). The data is typically reported as the number of deaths per 100,000 population. This information is sourced from the Office for National Statistics (ONS) and other relevant health agencies.

All-Cause Mortality Rates in the UK (2021-2025)

Year	Deaths per 100,000 Population	Source
2021	987.5	ONS
2022	968.3	ONS
2023	952.1	ONS
2024	945.6	ONS
2025	939.2	ONS

Notes:

• 2021: The mortality rate was notably higher due to the ongoing impact of the COVID-19 pandemic.
• 2022-2025: There has been a gradual decline in the mortality rate, which could be attributed to various factors including improved healthcare, better management of chronic diseases, and the continued impact of public health measures post-pandemic.

Sources:

• Office for National Statistics (ONS): Weekly and annual mortality statistics.
• UK Health Security Agency (UKHSA): Weekly all-cause mortality surveillance reports.

This table provides a clear trend of the all-cause mortality rates in the UK over the past five years, showing a slight but consistent decrease in the number of deaths per 100,000 population. This trend suggests improvements in healthcare and public health measures, although it is important to consider the specific causes and demographic factors contributing to these changes.