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The contract has arrived: are you ready?

Lynn Young
Primary Healthcare Adviser for the RCN

The most radical overhaul of general practice since 1947 is currently taking place, and is causing confusion but also exciting new opportunities for energetic and talented nurses. Obviously, the nurses who are most affected by the new contract are those directly employed by GPs, but the demands of the additional and enhanced aspects of the contract should also affect those community nurses employed by the primary care organisations and even nurses based in the hospital.

The provision of out-of-hours services will prove to be a tough nut to crack. But we need to remember that, despite the threat of a large number of GPs choosing to opt out of providing traditional out-of-hours services, many will opt in to being part of the new services. In the future, it could prove to be the case that similar numbers of GPs will participate in providing the medical component of out-of-hours care, but in different ways from the past.

PCTs have the awesome responsibility of ensuring that their people have access to high-quality out-of-hours services should they need them. The GP co-ops will be involved in developing new services, but other disciplines will also be playing their part in the world of the new GMS.

Nurses are already being considered as essential to new out-of-hours services, as well as better trained and equipped paramedics. In the longer term, the out-of-hours issue will prove to be a key player in the drive to develop a modern, more multidisciplinary, team-based workforce.

And other initiatives are already poised to make a contribution to helping the ideals and rhetoric shift quickly into positive action.

The world of primary healthcare (PHC) needs all the first-contact care nurses, nurse practitioners, NHS Direct nurses, nurses with special interests and every other type of nurses it can get its demanding hands on.

Where are we going to find these essential nurses? The newly recruited international nurses, however capable, cannot safely function immediately in the community. As we know, the community nursing workforce is mature. Maybe we are not thinking creatively enough how we can prepare acute-based nurses quickly for the community.

Maybe the days of nurses needing to take one academic year to become a health visitor or district nurse are numbered? Distance learning, part-time learning with high-quality supervision and mentorship are all being considered. But tradition is always difficult to blast, and discarding it does not always bring improvement. Reform in itself never guarantees a better way of doing things.

Nurses who play such a vital role in the community health scene must be part of discussions on these issues. Nurses must not have change dictated to them by others who truly - and often with the best of intent - do not understand the demands and needs of people requiring care in their homes and other community-based facilities.

Chronic disease management, out-of-hours services, access to services, effective patient and public involvement, and the development of services closer to people's homes are the stuff of 21st century healthcare. General practice is central to this agenda but cannot deliver unless an army of GPs, nurses, therapists, paramedics, managers and social care personnel is keen to be part of it.

High-class student clinical placements are critical. Impressionable students (regardless of discipline) must have access to general practice and the wider community and enjoy their placement. Let students be inspired by how PHC delivers such excellence and value to its local people. We will be in a very weak position if we do not attract a fair proportion of the newly qualified into PHC.

Surely it is possible for the most talented, skilled and energetic of managers and clinicians to choose the community as the place where they wish to work?