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Preparing ourselves for more changing times

Marilyn Eveleigh
Editor

The new GP Contract goes much further than the 1990 contract, which triggered the employment of practice nurses on a grand scale. Practice nurses were then needed to deliver the requirement for health promotion and disease prevention in a GP's caseload. They were crucial to the proactive and organised approach to chronic disease management.
There were around 3,500 practice nurses in 1990 - today there are over 18,500. Practice nurses now constitute the largest of any nursing discipline. The vast majority are employed part-time, and practice nurses have pioneered independent negotiating over their own contracts and roles.
Recognition of the importance of the staff supporting the GP is embodied in the new Contract - the allocation and flexibility of using funds to support staff development through personal development plans, appraisal and appropriate employment rights will secure the role and status of practice nurses even more.
In the new Contract, GP partnerships will no longer have individual personal lists but will have amalgamated practice-registered patients.
Practices will provide different levels of patient care - from basic as we now know it to enhanced services that may include anticoagulant or endoscopy investigations. The practice will decide what they can do, and it is highly likely that those providing enhanced services will be giving it to patients registered in another practice. The bulk of the funding for GP services will be paid "up front", no longer being paid on items of service and targets. Nurses will not only be the key to the GP's achievements but will also be fundamental to the level of services the practice will be providing.
As we go to press, GPs have voted to accept the Contract subject to an agreement on the specific funding amounts. We await the outcome of those negotiations as to whether and when the Contract will be implemented - the outline date is 2004. Meanwhile, Nursing in Practice has highlighted some of the main points of the Contract (see page 175).
While we wait, it would be a good time to debate within your practice what level the practice might take on and how the service will be provided. Nurses need to be involved in this debate from the outset - its success depends on their clinical, visionary and organisational skills. Go on - the proposal is another great opportunity for primary care nursing.

• It is appropriate, given the topicality of the GP Contract, that the theme of this bumper issue is "Teamwork in Practice". The core contents contain a wealth of clinical and allied information on a range of topics, particularly key therapeutic areas. The features are designed to appeal to both practice nurse and GP alike and to inform and encourage mutually rewarding and effective multiprofessional practice in today's primary care surgery.