The new GP contract for England is the biggest change to GP services since 2004. We look at the changes that will directly impact the work of practice nurses over the next five years, and the future of the profession
More nurses working within general practice
The contract commits to increase funding to the core practice contract by a total £978m by 2023/24, which the BMA says will help increase the number of practice nurses.
Guaranteed placements in primary care for undergraduate nurses
The contract references Health Education England’s work to ensure there are more opportunities available in general practice for student nurses. There will also be apprenticeships opening within these settings, which aims to help make primary care nursing more accessible to a wider range of potential recruits. If it all bears fruit, primary care networks will see an increase in the number of trainee practice nurses taking on workload.
Efforts aimed at retaining existing practice nurses
The Royal College of Nursing’s advanced level nurse practitioner qualification will be credentialed, allowing experienced nurses to gain official recognition for their extended skills. Those considering retirement will be offered the chance to ‘broaden their role’, including education, mentoring and leadership roles.
Expansion of the primary care workforce
Although the contract states its intention to increase nurses working within primary care, it also accepts that there has been ‘an absence of sufficient levels of GP and nurse supply’, leading to practices to create other roles to fill the void.
In agreement with NHS England, there will now be funding for five additional roles within primary care: pharmacists, social prescribing link workers, physician associates, physiotherapists and community paramedics.
These roles were picked not only because there is a demand from practices, but because ‘it is possible to demonstrate additional capacity, unlike GPs and practice nurses’.
By 2024, these roles will become ‘an integral part of the core general practice model throughout England’.
The intention is for the extra roles to ease the workload of GPs, but it may also see practice nurses being triaged patients more appropriately.
Practice nurses have traditionally seen their insurance costs covered by the practice. The new agreement will see all NHS GP service providers, including out-of-hours, become eligible to have their indemnity costs covered by NHS England. It means practices will no longer have to cover practice nurse insurance payments out of their own income.
The knock-on effect of this is that there is, in theory, more money to fund an increase in staff pay for 2019/20, including that of practice nurses, which the British Medical Association’s general practice committee recommends should rise by at least 2%.
Changes to QOF
The QOF changes proposed by NICE last year will come into effect from April 2019. Namely, new indicators on glucose targets for frail patients with type 2 diabetes, the reintroduction of the HYP003 code that insists patients under 79 with hypertension are controlled to 140/90mmHg, age-appropriate cervical screening advice, pulmonary rehabilitation offered to patients with COPD, and focusing on weight management for patients with schizophrenia or other psychoses.
Exception reporting will also be amended so that practice nurses can choose from one of five reasons a patient is removed from an indicator.
In an effort to fulfil the vision set out in the Long Term Plan, the contract makes explicit that all patients will have the right to online consultations by 2021. The agreement does not specify whether certain members of the practice team can perform online consultations, and with the underlying theme of expanded primary care teams reducing the burden on GPs running through many parts of the contract, practice nurses should expect to be delivering online consultations in two years.
The seven national service specifications
The formation of primary care networks, and the subsequent extension of the core GP contract with the network contract, will see seven service specifications introduced as a way of fulfilling the requirements of primary care contained within the Long Term Plan.
The seven specifications are:
- Structured medications review
- Enhanced health in care homes
- Anticipatory care requirements
- Personalised care
- Early cancer diagnosis
- CVD prevention and diagnosis
- Tackling neighbourhood inequalities
These will start to become formal requirements from 2020/21 onwards, rolling out in phases over the years thereafter. Many of the specifications will fall upon the shoulders of practice nurses to perform and carry out. In particular, the contract states that the care homes specification will be led by named GPs and nurse practitioners and will involve a ‘comprehensive weekly visit’. Anticipatory care requirements will also involve input from community health providers. And although not directly named, practice nurses are likely to pick up much of the work on CVD prevention, as they do now.