A study, published by the Journal of the Royal Society of Medicine in 2015 found that 347 of the 8,300 general practices in England were run by under ‘alternative provider medical service’ contracts. The study found the introduction of the alternative contract had not led to improvements in quality and may have resulted in worse care. The results showed that APMS providers performed significantly worse across 13 out of the 17 indicators (p=<0.01 in each) in each year from 2008/09 and 2012/13, and were significantly worse than traditional general practice in three out of the five years for a further two indicators.