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General practice and the impact of the new GMS

Lynn Young
Primary Healthcare Adviser

As always, when huge national change is implemented, progress is patchy, but nurses working in general practice seem to be gathering strength and authority in their endeavours to deliver the demands of the quality framework.
A number of enquiries have come to the RCN from nurses who are interested in becoming partners within their general practice - certainly more than I anticipated at this stage. The more nurse partners the merrier, as long as they understand the risks as well as the benefits and have the confidence and trust in their potential partners to negotiate a reasonable and intelligent deal - for themselves, colleagues and patients.
There are several points to remember when embarking on the partnership model. The RCN indemnity insurance scheme does not provide cover for the role of employer (a nuisance, I know, but this issue is currently being explored with the RCN insurance brokers and hopefully we will quickly crack this matter). The Medical Defence Union provides "employer" cover at a fairly reasonable cost, so is worth contacting, but in most well-developed practice this cost, and indeed RCN membership fees, is funded by the practice, not individuals.
The RCN has published a document offering advice for budding nurse entrepreneurs. There is also a briefing paper on the new GMS contract on the RCN website. However, these cover only the principles of partnership, not the financial detail, which would be impossible to do well at national level. The RCN is not able to enter into individual partnership business agreements or contracts, in the same way we do not give detailed business advice to nurses buying nursing homes or nursing agencies. The best partnerships are based on trust and respect, so nurses will need to feel confidence in their fellow partners regarding the business side of the practice. A number of GP partners have experienced partnership breakdown, and nurses will not be immune to similar events.
The traditional model of general practice is shifting from one of self-employed medical partnerships to a variety of models, including salaried GPs and multidisciplinary partnerships providing a variety of services.
England will be introducing the "Alternative Personal Medical Services" (APMS) model and practice lead commissioning in April 2005. Once again, these offer nurses and others the opportunity to develop necessary services that are currently not being provided in their area. The difference with APMS is that no doctor is required within the team. Possible examples of APMS being discussed are the provision of expert nursing home care and of services for the homeless and people suffering from substance abuse. Some of you, having witnessed deficits in local provision, will be in a strong position to think up other examples. The government is clearly intent on seeking a gradual breakup of the monolithic traditional general practice model and is being pretty smart about it! Rather than going on a full-frontal confrontation with GPs, it is simply developing health policy that enables different opportunities for other disciplines to set up primary healthcare services without the input of medicine.
There is no doubt that a variety of different models will gradually emerge and will be warmly welcomed by communities as long as public interest is well served.
A final note on the implementation of Agenda for Change (AfC) in general practice. Nurses employed by GPs need to know that the world of general practice is slowly becoming interested and attempting to get to grips with AfC principles. Practice nurses must play their part and look at the RCN website for up-to-date information, so they can approach their GPs with information, knowledge and logic. The RCN achieved much on this tricky issue at national level during 2004. 2005 will be the year of local agitation, action and persuasion carried out by the practice nurses themselves, while at the same time the RCN promises to continue lobbying at national level.

For more information on RCN Direct Nurse Entrepreneur and Agenda for Change documents, call 0845 772 6100.