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All change for primary care: watch this space!

Marilyn Eveleigh
Consultant Editor

Two issues that will have a profound impact on primary care nursing are causing a frenzy of interest at the moment - I say frenzy in that there is a lot of talk and supposition but nothing concrete at present.
One of these is the financial details of the new GP Contract, which was announced with much excitement by the Department of Health in February. GPs are considering whether to accept the Contract as we go to press. Should they vote "yes" it could affect the role and potential of practice nurses dramatically as the practice decides what level of patient service they wish to provide - basic, additional care programmes and possibly an enhanced level, which will attract the patients and funds away from the local acute hospital and thereby reduce waiting lists.
While we wait for its practical interpretation, it is a good time to consider the level the practice might take on and how the service will be provided. Practice nurses need to be involved in this debate from the outset - its success depends on their clinical, visionary and organisational skills. Note that funding is paid upfront to provide a service, so planning will have to consider staffing levels and skills with appropriate remuneration, equipment and facilities. Over the next year NiP will be bringing you articles on innovations and outcomes spawned by the new Contract - let us know what you are doing! Turn to Lynn Young's article for her sharp perspective.
The other "hot potato" that is being debated is the modernisation of the pay structure for NHS staff, excluding doctors, dentists and senior managers. This was first considered in the government paper Agenda for Change and is now being tested in 12 trusts in England, including two Primary Care Trusts. Early announcements hint at higher salaries for nurses - newly qualified nurses will have a 6% increase starting at £17,000 - and the world looks rosy for healthcare assistants.
In summary, the Whitley system of terms and conditions of service is to be replaced - well, it was developed in the 1920s. So, out goes clinical grading, and in comes job evaluation and clinical competencies. Out goes different working weeks depending on your profession, and in comes standardisation at 37.5 hours per week. Overtime rates will also be standardised at time- and-a-half, and double-time on bank holidays. Annual leave entitlement will depend on years of service. There will be additional pay for high-cost areas and where there is a shortage of particular staff. We will see career progression matched to service need and an individual's personal development plan.
There is now a lot of negotiating to do with the unions, employers and DoH. Everyone will need to be satisfied that changes will not disadvantage staff and that the transition, alongside newly developing patient services, will be smooth. There is some concern that the voluntary services of union representatives at local level will not be able to handle the volume of work this change will trigger. Again, NiP will keep you posted, but do access the website for the latest details ( There is just one problem at the moment … the modernisation of pay is aimed at NHS-employed staff. Practice nurses who are independently employed by GPs are to have separate details announced, and I await these with great anticipation.
Remember to book your place at the NiP 2003 conferences and exhibitions - in September in London or October in Birmingham. These promise to be great events for primary care nurses - with lively professional and political debates, comments by national opinion leaders and a feast of exhibitors for your interest and entertainment, all for free. See this edition for further details.
Hope you are enjoying NiP - write and tell us what you think and what you want!