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Jane Lewis
Wellcome Unit for the History of Medicine and Fellow of All Souls College, Oxford
For most GPs their individually held contracts have symbolized their fiercely defended status as independent contractors. However, the meaning of this status and the precise nature of the contract have not necessarily been clear. The nature of the services that GPs had to provide under the terms of the 1966 contract were extremely vague: 'A doctor is required to render to his patients all necessary personal medical services of the type usually provided by general practitioners'.1 Indeed, as Rudolf Klein has commented, until 1990 the contract was essentially a 'gentleman's agreement'.2 This changed dramatically in 1990, when the terms and conditions of the contract became much more closely specified at a time when market principles built around the purchaser/provider split were being introduced into the NHS as a whole and into other forms of service provision, such as housing, education and community care.
To government, the closer specification of the 1990 contract did nothing to jeopardise the GP's status as an independent contractor; on the contrary, it took the idea of a contract with a group of self-employed contractors rather more seriously. However, the 1990 changes marked a radical departure on two counts. First, historically GPs had interpreted their contract rather differently. They looked to it as a bulwark against interference and as a means of protecting their right to control what they did and how they did it. In other words, it had in their eyes rather more to do with their defence of their professional status than with their position as providers in the medical marketplace. Second, the new contract was introduced in 1990 in tandem with the wider move to contract within the NHS which fundamentally changed the meaning of contract, and which continues to pose major challenges to the way in which general practice is organized.
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| Book Title: Making Sense of The Red Book | ||