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After the contract comes the commissioning

Marilyn Eveleigh
Consultant Editor

Nurses working in general practice have survived a year of review, refocusing and ­reorganisation to implement the GMS contract. There is nothing fundamentally new within the contract, but the organisation of data, services and systems has been challenging to a considerable number of practices. Baseline data is fundamental to planning effective healthcare. Being proactive is harder work than being reactive.  
Working differently has required imagination and cooperation in the team. Nurses and doctors have had to take on new approaches to patient consultations to boost the opportunity for collecting baseline and screening data from their patients - and to support this with professional advice. New workloads have emerged from the simple annual blood ­pressure recording.
And it is good news! Early indicators predict practices have achieved an average of around 950 points. The Department of Health initially estimated practices would average 777 points - a difference of £10m.
The GMS contract is a practice, not a GP, contract. Have practices felt they are more of a team having worked together to reach targets this first year? Who were the drivers getting the contract implemented? Many practice nurses report that they have been fully involved in deciding targets and plans to achieve points. However, considerable numbers report they have not been involved at all - a disappointment and missed opportunity. Many community nurses have felt the pressure to support practices where patients are in the district nursing caseload - without understanding the bigger picture.
Every practice has had a first-year-contract monitoring visit by PCT teams. At that visit, questions were asked about progress towards aspiration points and organisation of the practice. Experience has now shown that practice nurses would have been valuable to have at those monitoring visits. Nurses have established systems and standards of care, and practice visits would have benefited from that professional knowledge. Seize the opportunity and volunteer to be at the monitoring visit and questioning next year. If you are still not convinced of the responsibilities practice nursing should lead on, request a "GMS contract: a checklist for practice and community nursing" from the Editor (email to support your growing role.
And just when you thought you could relax, hot on the heels of the GMS contract comes practice-based commissioning. This is the opportunity for practices to make decisions in commissioning services for their patients and determining how they will be provided. This will influence how GPs refer patients and will lead to the shift of services, and funds, from secondary to primary care. Such options include elective operations, outpatients, community nursing, diagnostics and mental health. Community and practice nurses must contribute their unique perspective and experience to this reconfiguring of services. It allows the creation of packages of appropriate care for patients, most often with community-based services.
Don't wait to be invited to give a perspective - offer it proactively! PCTs will be developing this form of commissioning within the year, and where savings are made they can be used within surgery services.
All nurses need to ensure that they influence health services effectively. Don't be marginalised on the GMS contract you are actively delivering - and now watch out for commissioning directly for your patients.