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February 2020

GP contract changes anger general practice nurses

The BMA’s GP committee has approved changes to the GP contract negotiated with NHS England including pared back plans for Primary Care Networks and increased flexibility over the additional roles reimbursement scheme.

The changes are due to be discussed at a special conference of Local Medical Committees next month, but LMCs will not be able to ‘overturn’ the negotiated contract – only express their dissatisfaction.

However, the updated GP contract – which includes a 4% increase in the global sum paid to practices, golden handshakes to attract GPs into partnership, and additional funding for PCNs to take on additional clinical roles – has angered some general practice nurses.

They say that the contract fails to acknowledge the critical role that GPNs play in delivering services, including:

  • Immunisations and vaccinations that are to become a core service with new incentive schemes to boost uptake from April 2020, and
  • Changes to the Quality and Outcomes Framework – asthma, COPDand heart failure domains have been overhauled, with 97 points recycled into 11 ‘more clinically appropriate’ indicators.

Changes to the directed enhanced service (DES) specifications for PCNs will allow the employment of health and wellbeing coaches, occupational therapists, dietitians and podiatrists, and community paramedics. The contract specifies that the additional roles should not be used to divert funding into new posts with no increase in capacity. The inclusion of Advanced Nurse Practitioners in the scheme is to be ‘explored… bearing in mind supply constraints and the critical need for “additionality” beyond the significant numbers who are already working in primary care.’

The contract also sets out enhanced maternity and paternity leave for GPs – but not their staff.

Writing on the RCN GPN Forum Facebook page, one nurse commented ‘Nurses are such a vital part of general practice but never recognised,’ while another criticised the RCN: ‘30 years nursing, 26 a PN. Never any support from the RCN or any tangible planning, representation or input for PNs. I would like to see [them], just for once, [do] something concrete and useful.’

RCN Practice Nurses’ Association chair Marie Therese Massey said: ‘The RCN has listened to your anger over the new GP contract and I can assure you we are not complacent and will work at the highest level to support you.’ Ms Massey added that the current RCN response to the Contract – below – was ‘not the last word’.

‘General practice nursing is a fundamental part of the primary care team and are leading the development of better integrated care in the community. The RCN wants to see that the opportunities are developed in the GP new contract to offer nurses leading roles in the future management of Primary Care services as equal partners with GPs both in their individual Practices and within Primary Care Networks.

‘However, we are disappointed that the new contract does not acknowledge the crucial role of nurses in general practice in the successful delivery of the proposed changes particularly around the provision of vaccinations and immunisations and LTC management. The Contract needs to provide greater improvements to the pay and conditions of general practice nurses, who are not covered by Agenda for Change. We need to see greater equivalence in general practice between the pay, terms and conditions of nurses and that of allied health professionals and their NHS colleagues, or the current recruitment and retention problems facing practice nursing will deepen. We have listened to member concerns and are looking at how to address them at the earliest opportunity.’