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Joint General Practitioners Committee/Royal College of Nursing letter regarding nurses in general practice and agenda for change

23 November 2004

Please find below, for your information, a joint General Practitioners Committee/Royal College of Nursing (GPC/RCN) letter regarding nurses in general parctice and Agenda for Change.

As an important stakeholder, we are keen to pursue work with the RCN where GPs and nurses have a shared agenda. It should be noted that the compulsory implementation of Agenda for Change by practices is not GPC policy.

Dear Colleague

We are all well aware that General Practice is going through significant change, driven in part by reform and developments within primary care, demographic changes and consumer demand, but also from the medical profession itself. There are increasing demands being placed on GPs, both as service providers and as employers.

The RCN and GPC have agreed that it is important to highlight the need to seriously consider the terms and conditions of all staff employed by GPs. This letter, for obvious reasons focuses on the nursing workforce and how it links to the delivery of the quality and outcomes framework and other key elements of the new General Medical Services (GMS) Contract.

In the near future the recruitment and retention of experienced nurses into General Practice may well prove to be challenging, particularly in South East England, simply as a result of demographic trends – indeed, many of you are already experiencing difficulties in recruiting appropriately skilled and knowledgeable Practice Nurses. The nursing population as a whole is ageing, but practice nurses in particular have an older profile with 46 per cent of practice nurses currently over the age of 45. It will be essential to recruit and retain nurses of all ages within this sector if a staffing crisis is to be avoided. The RCN and GPC believe that a key element to solving the recruitment and retention problem will be to provide practice nurses with a pay, conditions and career package, which is competitive with their NHS colleagues.

While efforts are being made at national level to ensure that there are more flexible ways of nurses entering the community following qualification, general practice will still need to be an attractive and fulfilling place for nurses to work if it is to successfully recruit and retain experienced nurses.

The NHS modernised pay system, Agenda for Change aims to provide a career and pay structure for nurses that will reward and therefore encourage them to choose to remain in nursing. At the same time, nurses will be appropriately rewarded for enhancing their skills and knowledge so that patient services can be improved.

The RCN and GPC wish to advise GPs that while they have the choice on whether or not they implement Agenda for Change they will be competing for a shrinking number of nurses who, in the future may be better rewarded in their local NHS organisation.

Agenda for Change replaces the current Clinical Grading and Whitley terms and conditions systems, which many GPs currently use as the basis for employing nurses. Come December 2004, Clinical Grading will no longer be used within the NHS and as such GPs, as employers will need to consider alternative mechanisms on which to base the rewards for practice staff. It is therefore timely for GPs to look at the terms and conditions of their practice nurses, consider the benefits to them and their practices that Agenda for Change will bring and agree with their staff on the best possible way forward. Much work has been done by the Health Departments, RCN and GPC on developing guidance for GPs and their staff on implementing Agenda for Change. The RCN guidance on Agenda for Change “Nurses employed by GPs - RCN guidance on good employment practice” is available through the RCN website .

We are fully aware of the constraints that GP practices now work under with fixed budgets and the difficult decisions they have to make when it comes to deciding upon staff costs, but the new GMS Contract refers to the principles of Agenda for Change (para 4.19) and the GPC and RCN believe that GPs should seriously consider trying to implement these principles when making decisions on their future nurse staffing arrangements.

Yours faithfully
Hamish Meldrum
Chairman
General Practitioners Committee

Beverly Malone RN, PhD, FAAN
General Secretary
Royal College of Nursing