New contract reduces quality of patient-nurse relationship

Derret and Burke raise important questions about the future for primary care nurses and health visitors and the potential for negative effects on patient care.¹ We recently carried out a small study on how practice nurses perceive the changes in their role since the introduction of the new General Medical Services contract. Nine practice nurses were interviewed individually, from practices in areas of high or low deprivation in Glasgow (upper and lower fourths of practices in greater Glasgow, based on Scottish index of multiple deprivation) achieving high or low points on the quality outcomes framework (upper and lower fourths of total points on the quality outcomes framework per practice in greater Glasgow) in 2004-5. Transcripts were transcribed verbatim and analysed by using a thematic approach.

The results indicate that practice nurses generally feel that their professional roles and status are developing under the new contract. However, views on incentives (financial reward) were mixed, with many (even from practices scoring high in the quality outcomes framework) feeling under-rewarded. All reported substantial increases in workload, with a much greater use of information technology and less time to spend with patients. All but one nurse (who had negotiated 30 minute appointments) felt that the new arrangements damaged the nurse-patient relationship, and most nurses reported a decrease in job satisfaction.