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Framework for Nursing in General Practice



About the Framework

Why Develop A Framework For Nursing In General Practice?

The New GMS contract
The new GMS contract is not purely a contract for GPs, but a contract for General Medical Services, provided by a whole practice team. This shift in emphasis creates significant potential for nurses to take on new responsibilities and develop new roles, including potentially developing nurse partners, nurse led practices or the possibility of replacing GP posts with nurses. Implementing the new contract will provide an opportunity for many practices to reflect on staffing and skill mix and plan future service delivery in ways that better meet the needs of their patients. A framework will help inform that debate and support their decisions.

Emphasis on Clinical and Organisational Quality
The emphasis on quality through demonstrating organisational and clinical standards in the GMS contract creates a new focus on good employment practice. The framework will be a means of helping practices achieve those standards in relation to practice nursing. Linking the framework into the RCGP's Practice Accreditation and Quality Practice Awards could potentially set a model of good practice in practice nursing that was aspired to by practices and was beneficial in supporting their recruitment of nurses.

Agenda for Change
The implementation of Agenda for Change for NHS employed staff will create an expectation from practice employed nurses that their knowledge and skills will be similarly rewarded. The framework should provide a means to support practices that wish to implement Agenda for Change.

Purpose Of The Framework

The purpose of the framework will be to:

  • support the development of nursing services and roles within general practice in response to changing need
  • ensure the safety of practice nursing services by identifying the competence required by nursing staff at all levels
  • support changes in skill mix where appropriate, including nurses taking responsibility for current medical duties, development of enhanced nursing roles and the appropriate use of skills within the nursing team
  • support the local implementation of Agenda for Change principles by practices
  • enable practices to ensure that their practice nursing workforce is fit for its new purpose
  • support and promote professional education, including, where appropriate multi-professional education.
  • support effective links with the academic sector by ensuring that competencies underpin future education provision
  • Support good employment practice in primary care


It is intended that the framework is something that practices and practice nurses will find useful in developing local services. It will be produced as a resource for practices to support their implementation of the new GMS contract. In order to be effective, the framework:

  • must support flexibility and local development rather than being in any way prescriptive
  • should form the basis for future educational developments
  • must not cut across local flexibility and integration within primary care nursing teams
  • should form a basis for future development post implementation of the contract
  • must be valued by both practices and practice nurses.

Content And Format

The framework should be clear, concise & easily accessible. It should provide a high level framework rather than being overly prescriptive, but should provide sufficient detail to be of value in supporting local developments. Key elements of the framework are likely to include:

  • clarification of the definition and purpose of practice nursing
  • a framework of competence which clarifies the baseline for entry to safe practice and supports the expansion of roles in response to need
  • a framework of governance covering issues such as clinical supervision, appraisal, development plans, access to education, safety to practice and accountability.

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