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Scottish practice nurses to be ‘expert nursing generalists’

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A new general practice contract being proposed for Scotland will offer “new opportunities” for nurses working in primary care, with more roles coming their way, according to documents released today.

There will also be agreed role definitions for practice nurses and other advanced nursing roles in primary care settings, which will be supported by a “robust” career and educational framework, said the documents published on a proposed new contract for Scottish GPs.

“The contract will support general practice nurses to focus on a refreshed role”

Contract proposals

The contract, which is due to be introduced over the next three years from April, promises to refresh the role of practice nurses and turn them into “expert nursing generalists”, and is underpinned by what ministers view as the need to tackle the “growing workload” faced by GPs.

Billed as the “biggest reform of GPs services in over a decade”, the 2018 general medical services contract in Scotland has been jointly drawn up by ministers and the British Medical Association specifically for primary care staff in Scotland.

The contract will replace the 2004 general medical services contract, which was UK wide and introduced the controversial quality and outcomes framework.

The new contract offer proposes a “refocusing” of the GP role, with the aim is of primary care doctors “to do the job they train to do and enable patients to have better care”.

“This refocusing of the GP role will require some tasks currently carried out by GPs to be carried out by members of a wider primary care multi-disciplinary team,” stated the contract proposals.

“It is critical that there are agreed role definitions supported by a robust career and educational framework”

Contract proposals

The proposed contract offers new opportunities for clinical and non-clinical employed practice staff, including general practice nurses and practice managers and receptionists, stated the document.

“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,” it said.

In addition to the contract, the Scottish government has also announced an extra £30m over three years to help cover the costs of GP premises and improve practice sustainability.

The contract proposals noted that practice nurses played a “key role” in the achievement of QOF points under the former 2004 GMS contract.

However, it highlighted that many felt that QOF greatly increased bureaucratic workload and had a negative impact on consultations, supporting a “box ticking” culture.

“The new general practice landscape in Scotland will enable general practice nurses to have more meaningful person-centred consultations,” said the document.

“The 2018 GMS contract will support GPN to focus on a refreshed role in general practice as expert nursing generalists,” it said.

“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,” it stated.

“Our aim was to reduce workload pressures, reduce individual risk and stabilise practice income”

Alan McDevitt

The contract proposals said that, as a result of the challenges facing primary care, the “role and career pathway of general practice nursing will need to adapt and evolve”.

It accepted that 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.

“At the present time, variation in terms of both job titles and training is evident within general practice nursing,” stated the proposals.

“To support an enhanced role safely integrated into general practice, it is critical that there are agreed role definitions supported by a robust career and educational framework,” it added.

The document includes examples (below) of how the activities of the practice team might be expected to change in the next three years, they it said they were “indicative only, not exhaustive”.

Role change of general practice nurses 
 2017  2021
 Treatment room services  Minor illness management
 Chronic disease monitoring/management  Chronic disease management
 Vaccinations  Supporting GP to deliver care planning
 Minor injury, dressings  Monitoring lab results

The document also highlighted that an expert group had been established by the Scottish government in 2017 to “refresh the role and educational requirements of general practice nurses”.

The work of the Transforming Roles General Practice Nurses Group would now be “taken forward” by the Scottish government’s primary care and chief nursing officer directorates during 2017-18.

“These changes will give patients the right care in the right place”

Shona Robison

The group will also oversee the funding of training for practice nursing to enable the ongoing development of “this critical workforce” over the three-year contract transition period.

“This training will enhance the skills of general practice nurses so that they are better equipped to meet the increasingly complex needs of patients,” it said.

The government had previously invested £2m in 2017-18 for extra training for practice nurses in “recognition of the importance of this role”, noted the contract document.

Meanwhile, it said demand for nursing staff in the community would “increase” and it expected the nursing workforce in primary care to be employed by both NHS boards and GPs going forward.

It added: “There will also 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.”

GPs have been given between 7 December and 4 January 4 to take part in a poll on whether to accept the new contract, which will come into effect on 1 April 2018.

SNP

Shona Robison

Shona Robison

Scottish health secretary Shona Robison said: “GPs tell us they want to spend more time with patients with undiagnosed illness and less time on bureaucracy, while patients say they want better access to GPs when they really need them.

“We have listened and, I believe, achieved that balance,” she said. “These changes will give patients the right care in the right place, and give those who need to see GPs the most the time they need.

“Patient safety is at the very heart of this agreement and is the central principle guiding how changes will be implemented,” she added.

Dr Alan McDevitt, Scottish GP chair of the BMA, said: “I truly believe that we have negotiated a contract that will make general practice sustainable for the future.

“Our aim was to reduce workload pressures, reduce individual risk and stabilise practice income, and these are all addressed in this contract,” he said.

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