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A modern GP contract for modern primary healthcare

Lynn Young
Community Health Adviser, RCN

By the time you read this, GPs in the UK will have voted on the framework for the new GP Contract. The work has only just begun, but the negotiators know the importance of having the confidence of the GPs before they work out the difficult but important details. This is a crucial initiative, and nurses, particularly practice nurses, should be ­interested and informed on its progress.
Despite a vociferous and energetic group of GPs who have strong negative views on the framework, most frontline GPs are positive and believe this is an excellent start.
General practice is a slightly eccentric and independent healthcare setting. It is also a supremely human and personal one. Many enjoy working within a small but beautiful organisation that has minimum bureaucracy - so unlike the main part of the NHS. But it is not perfect. It is difficult to control and manage independent practitioners, although Mr Blair's health reforms are gathering general practices and herding them into more corporate-like organisations (English PCTs, Welsh LHBs, Northern Ireland LHSCGs and Scottish LHCCs).
The aim is for a more modern GP Contract (a UK initiative) that fits comfortably with the primary healthcare  organisations. New relationships should lead to more effective contracting arrangements aimed at improving community health. All plans must have two aspirations - development of services that improve community health and better working conditions for staff.
The RCN believes that any new GP contract must seriously consider the health of those nurses working close to general practice. We want PNs to have excellent working conditions and opportunities to develop professionally, allowing them to take on a more ­strategic and managerial role - if they are capable and if it is what they want. The funding of the GP Contract needs to take into account PNs and other GP-employed staff.
With succession planning and workforce development in mind, general practice must also open its doors to student nurse placements, to encourage an enthusiastic next generation of talented PNs.
The next stage of negotiations should look at the lessons learnt from the Personal Medical Services (PMS) pilots. Ideally a new and more flexible Contract will diminish the need for PMS pilots, and enable nurse/doctor partnerships and the development of nontraditional general practice services. There need to be incentives and rewards for those practices that try to improve public health, reduce health inequalities and care for people who are impoverished and socially excluded. Research carried out on the PMS pilots has shown that, by being more flexible in their approach to service delivery, a number of sites were able successfully to meet the needs of patients with special needs, such as asylum seekers and refugees.(1) Nursing roles have expanded and enhanced within a number of pilots, and it is important for the new Contract to ensure that these opportunities increase.
The framework also calls for practice-based patient registration rather than maintaining the historical GP list. The RCN welcomes this as an ideal way of improving access.
The best of traditional general practice flourishes on providing high-quality continuity of care to its patients. It is crucial that this dimension is not challenged. Patients, particularly those suffering from chronic conditions, benefit from receiving continuity of care. General practice must ensure that this is actively encouraged and sustained.
Modern general practice requires modern IT systems, and the introduction of electronic patient records is urgently needed. Once we, as members of the public, are in possession of our own electronic records, true ­continuity of care could become a reality.

Reference

  1. Roe B, Walsh N, Huntingdon J. Breaking the mould: nurses working in PMS pilots. London: HSMC; 2001.