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Agenda for Change and the GP contract: the latest

Lynn Young
Primary Healthcare Adviser for the RCN

The ballot is over and the result well and truly known. And what a result considering the vitriolic blasting, potential votes of no confidence, and threats of mass GP walk out from the NHS? Seventy per cent of GPs chose to vote and an overwhelming 79% put their precious cross in the yes box. So now it is full speed ahead towards grand implementation and what we hope will be a wholescale rebirth and freshly energised world of general practice.

Primary care organisations (PCOs) have the great joy and supreme challenge of ensuring that local people have access to the full range of primary healthcare services, even where general practices have chosen to opt out of providing certain services. In the longer term it is farewell to traditional general practice - with all its flaws and strengths. The mission for the new world is to embrace the historical wonders of general practice, which are those of continuity of care, personal knowledge of individuals and families, and long-term relationships. At the same time we must seek to ensure that there is more equity in the system and that the best of care is allowed to flourish everywhere and not simply in discrete patches.

And on the subject of equity it is time to start talking about the working life of those nurses employed by our friends and colleagues, the GPs. There is much confusion out there regarding GP-employed nurses and their access to Agenda for Change, so here is a golden opportunity to, once more, put the record straight.

The fact is that both Agenda for Change and Improving Working Lives (government policy for human resources) are referred to in the new GP contract (GPC). General practices will receive external funding in order to pay for GP-employed staff to have Agenda for Change. The plain and simple truth is that in the future GPs will not be able to make the excuse that "the practice cannot afford it, if we give you a pay rise patient services will have to go". General practices must declare their intention to award their staff Agenda for Change and the money should then flow into the practice to pay for it.

But we know only too well that all good things take huge effort to achieve. The RCN is already putting pressure on the two PCT Early Implementer sites (Hereford and Central Cheshire PCTs) to include GP-employed nurses in their activities. We will be meeting with the GPC negotiators after the summer break to explore joint RCN/GPC action; Beverly Malone, General Secretary of the RCN will also bring the matter to the attention of the relevant ministers; and letters will go to all PCOs reminding them that practice nurses and nurse practitioners mean serious business!

The current situation is one of great hope, but not one of guarantee. Somehow we need to dispel the myth that GP-employed nurses are out of the tent in terms of Agenda for Change. The truth is that while they are not entitled to it via their contract of employment (in the same way that nurses employed by the independent and higher education sectors are not), the funding is there for GP-employed nurses to have the benefits of Agenda for Change. Common sense, wisdom, equity and justice are key players in this critical issue and the good news is that the new GPC gives us a system that makes success likely. Given the complexity and chaos of primary healthcare we cannot afford to be complacent or make assumptions that people see the good sense of Agenda for Change. Constant reminders will need to be made by nurses to GPs that implementing Agenda for Change will bring benefits to the practice, not simply the nurses in question. The quality and human resource frameworks will bring in added cash, thus making a modern pay system affordable. In the meantime look at your job descriptions and ensure that they truly reflect your skills, competence and responsibilities.

Nursing in Practice will keep you informed of progress and the lessons being learnt from the two PCT Early Implementer sites.