At first glance, the changes to the GMS contract, unveiled last month, provide grim reading for nurses working in general practice.
In the renegotiated GMS contract for 2012/13, GP pay will be frozen, thresholds for the QOF will increase and changes will be made to the rules around practices boundaries.
GP practices in England will agree with their PCT an 'outer boundary' within which they will continue to look after patients (where clinically appropriate) who have moved out of their normal practice catchment area. 'Two or three cities' will take part in a one-year pilot offering wider choice of practices. Patients will be able to visit participating practices as a 'non-registered out-of-area patient' or as a 'registered out-of-area patient'.
Meanwhile, the contract states that all practices must join clinical commissioning groups (CCGs) once the Health and Social Care Bill becomes law.
Negotiators are also to discuss possible changes from 2013/14 to the Carr-Hill formula used to calculate practices' global sum payments, to give greater weight to deprivation.
Opportunities for nurses
But according to a number of leading nurses, contract changes may bring opportunities as well as challenges, enabling nurses to oversee QOF changes and to get involved in commissioning decisions.