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New Scottish GP contract to support GPNs as 'expert nursing generalists'

The new general practice contract for Scotland plans to 'refresh' the role of practice nurses as 'expert nursing generalists'.

The practice nurse role will be expanded to include more patient care planning, with fewer 'tick-box' requirements. They will also be given greater access to advanced training, with opportunities to 'take on new roles' both in general practice nursing, and advanced nursing practice.

The 2018 General Medical Services (GMS) contract in Scotland also includes plans to reduce overall bureaucracy in practices and ease the GP recruitment crisis.

The contract states: ‘The proposed contract offers new opportunities for clinical and non-clinical employed practice staff, including general practice nurses and practice managers and receptionists.

'The contract will support general practice nurses to focus on a refreshed role as expert nursing generalists, providing acute and chronic disease management, supporting people to manage their own conditions where possible.'

The changes are due to take place over three years beginning in April 2018. 'The proposals represent both significant investment in primary care and significant change,' the contract says.

'At the heart of any change must be the core principle of patient safety. That is why our planned approach is of a three year transition with changes to services only taking place when it is safe, when it is appropriate, and when it improves patient care.'

2017 GPN role 2021 GPN role
  • General practice nurses employed by the practice
  • Treatment room services
  • Chronic disease monitoring/management
  • Vaccinations
  • Minor injury, dressings
  • General practice nurses employed by the practice
  • Minor illness management
  • Chronic disease management
  • Supporting GP to deliver care planning
  • Monitoring lab results

Practice nurses are integral to the running of the surgery, the GMS says, providing 'general nursing skills as well as extended roles in health protection, urgent care and support for people with long-term conditions'.

The contract also acknowledges the key role that nurses have played in the achievement of QOF points as part of the 2004 Scottish GMS contract. However, it states that 'many in the profession felt that QOF greatly increased bureaucratic workload and had a negative impact on consultations, supporting “box ticking” rather than facilitating holistic and person-centred consultations.'

It continues: 'The new general practice landscape in Scotland will enable general practice nurses to have more meaningful person-centred consultations. With a dedicated community treatment and care services delivered through Health and Social Care Partnerships, the 2018 GMS contract will support GPN to focus on a refreshed role in general practice as expert nursing generalists.

'They will provide acute and chronic disease management, enabling people to live safely and confidently at home and in their communities, supporting them and their carers to manage their own conditions whenever possible.

'To fulfil the challenges associated with the increasing complexity and demand of primary care in Scotland the role and career pathway of general practice nursing will need to adapt and evolve. A "one size fits all" approach may not be appropriate for all posts, but there will be a common pathway to a lead general practice nurse or advanced nurse practitioner careers.'

The GMS aims to reduce variation in practice nurses jobs and titles by implementing 'agreed role definitions supported by a robust career and educational framework'.

The contract concludes that practice nurses need access to 'appropriate structured education and training'. The Scottish Government has invested £2 million in 2017/18 for additional training for general practice nurses, which will be overseen by the Transforming Roles General Practice Nurses Group over the three-year period.

Demand for nursing staff is expected to increase. The GMS states: 'There will be opportunities, if individuals wish, to change roles to take on new opportunities in the community treatment and care services; in general practice nursing, and in advanced nursing practice.'

Rhona Aikman, lead practice nurse at Gourock Medical Practice in Inverclyde said that the contract looks 'promising for the future of practice nursing'.

'The continued move away from tick box exercises to more patient centred care is very welcome. The funding for additional training for practice nurses is in place and it looks more promising that a career pathway will evolve for practice nurses wishing to work at an advanced level,' Ms Aikman said.

'Demand for these nurses will grow and there is a need to ensure there is funding to pay them at the appropriate grade after undertaking training for the extended role. If as stated the GMS aims to reduce variation in practice nurse jobs and titles by implementing "agreed role definition supported by a robust career and educational framework" they also need to look at equity of salary grading and terms and conditions.

'The Transforming Roles General Practice Nurses Group will oversee how the proposed £2m funding for education and training is spent and practice nurses need to get involved if they want to make the most of these opportunities.'

The new GMS contract also stated that full-time GP partners in Scotland will be paid a minimum income of £80,430 a year, including pension contribution. There are no plans for a specific increase to nurse pay.