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What do points make ... prizes for practice nurses?

Marilyn Eveleigh
Consultant Editor

New areas of clinical activity cover dementia, depression, chronic kidney disease, atrial fibrillation, palliative care, mental health, obesity and learning disabilities. The majority of the additions require the development of a register of patients - very like the original 10 clinical domains three years ago.

It's good to see screening for depression included in the care of CHD and diabetic patients. Evidence had shown a validated screening tool is successful in identifying depression in patients with a chronic disease. PNs will rejoice that the physical and mental wellbeing of these patients are being managed together - and it acknowledges the challenge in caring for patients who often have poor motivation to manage their disease.

I for one was pleased to see the nGMS Contract in 2003. The vast majority of targets were not new for general practice, but they did need to be organised and owned by the whole team - and organisation is what nurses do well. Unlike the 1990 contract, GPs had PNs in post this time to help determine what the practice team could deliver on. When I reviewed the contract targets one by one, I estimated that nursing could substantially contribute or single-handedly achieve almost half of the 1,050 points. Sure enough, GMS achievements exceeded all expectations, with practices being paid an extra £10 million for their efforts. The variety of rewards that were showered on PNs for their contribution reflected the diversity of pay scales used by independent contractors - some nurses were given a profit share, others a month's salary, others got a box of chocs and some got nothing! Though I do not want to detract from their massive achievement in reaching QOF targets, I admit to a sense of disappointment with my nurse colleagues in not looking outside the clinical domain of the QOF. For in the organisational domain there are key areas that nursing should lead on; in reality, I suspect that practice managers have led on them.

Though there are far more examples, I suggest the following QOF organisational targets (18 points in all) are nurse-led:

  • Equipment has to have regular inspection, calibration, maintenance and replacement under a system with a named responsible person. Nurses are responsible under the NMC Code of Professional Practice for the equipment they use.
  • Drugs and equipment to manage anaphylaxis has to be systematically organised with a named responsible person.Immunisation and vaccinations are often the catalyst to an anaphylactic reaction. It is a NMC requirement for the administration of medicines that nurses can manage an adverse reaction.
  • Child protection procedures need to be in place; nurses see a lot of children, so child protection is our responsibility.
  • Practice nurse appraisal and professional development plans are required annually and carry five points for achievement.
  • Six significant-event reviews that are shared with the whole practice team is a target that is well suited to nursing - recording such events is a requirement of the NMC under PREP.
  • Instrument sterilisation requires verification - standards are the responsibility of nurses as users.

We owe it to patients that they are in place. It worries me that often PNs were not at the PCT verification visits to the surgery.
nGMS is a practice contract, it is three years old now and practice nurses must take a business approach in support of patient care. If PNs are not seen as fundamental to QOF verification in their surgery, I doubt they'll be invited to be part of practice-based commissioning (PBC). Practice nurses please prove me wrong!