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The GMS contract - very nursing, very skilled and very necessary

Marilyn Eveleigh
Consultant Editor

The new General Medical Services (GMS) contract is not far away. GPs and practice managers are already reviewing the services and patient coverage levels they hope to achieve and that will at least maintain the practice income. The contract is to be implemented from April 2004. From that date, patients will be registered with a general practice, not an individual GP list. The contract is a practice contract that attracts the funding for those registered - should a GP leave a practice there will be no loss of funding, but the practice will be expected to offer the same level of service. That means that nurses, specialist nurses or nurse practitioners may well be employed instead of a doctor, especially in those areas where there are chronic GP shortages. I predict that some interesting roles and relationships will develop.

This contract depends on nursing skills and organisation. To get a minimum coverage level of 25% of patients for the specified chronic diseases - coronary heart disease, stroke/transient ischaemic attack (TIA), asthma, COPD (chronic obstructive pulmonary disease), diabetes, hypertension, mental illness and epilepsy - every opportunity to record, monitor and review must be taken at a patient consultation. All nurses must be prepared to have basic skills in all areas, rather than specialise in only one. New ways of working must be considered - and the delegation of some clinical tasks, such as blood pressure measurements, electrocardiograms and checking inhaler technique, might be appropriately undertaken by healthcare assistants.

Having closely dissected the content of the contract, as a starter I would urge practices to develop safe and efficient means of:

  • Recording the smoking status of patients.
  • Offering a variety of smoking cessation strategies.
  • Monitoring blood pressure in all those over 45 years and those with relevant chronic diseases.
  • Systematically managing the cervical cytology programme.
  • Offering a holistic childhood immunisation programme.
  • Implementing infection control and equipment calibration and maintenance.

All of that is very nursing, very skilled and very necessary.
More than 50% of the payments under the contract will be for quality standards that are stipulated. Nursing underpins the good practice and organisational skills that are required.
Yet many nurses tell me they have not seen the contract! If you are one of those nurses, make it a priority to see it. Ask the practice manager or GP what they have in mind for nursing to provide, if you have not yet been included. Scrutinise the requirements and identify what nursing can do - but be prepared to alter some ways of working. Delegate stock ordering, cleaning and maintaining equipment to nonclinicians, and develop your specialist clinical skills to maximise patient coverage.

If you do not have appraisals, offer to train and appraise other practice-employed nurses, introduce professional development plans for all staff, and ensure all staff know how to implement the local child protection procedures - all of these represent good practice and are rewarded by payment points in the contract.

Stick your neck out and mould the shape of things to come - it is your practice contract, and you haven't much time left before April 2004! Go on - make it your New Year's resolution. Have a great Christmas. Be good to yourself.