Nurses' leaders have reacted with anger to government plans to overhaul the GMS contract. Proposed revisions in England for 2013/14, include an evolution in the way practices are funded and significant alterations to the QOF.
The DH has, so far, failed to reach agreement with the BMA's GP's Committee, but indicates it 'may need to vary the contract without consensus', stating it has 'commenced a process that would, if necessary, enable it to do so.'
Under proposals, the overall size of the QOF would fall to around 845 points and upper thresholds would be harder to hit. Points for organisational tasks including staff training would be ended.
The QOF changes would incorporate all the new or replacement indicators recommended by NICE and new enhanced services that 'support quality improvement and promote innovation' would be introduced. These include new measures to improve care for patients with long-term conditions and prevent emergency hospital admissions.
All GP practices are to be moved towards 'equitable core funding' over a seven-year period from April 2014. The department proposes a 1.5 per cent uplift in GP practice income next year to allow for an average pay increase of up to 1 per cent for GPs and practice staff.
Norfolk advanced nurse practitioner (ANP) Jenny Aston said: 'We achieved too well when QOF came in and the DH wants to increase targets and is covering up by saying it's about delivering better patient care.
'We seem to have continuous increases in workload with ever-increasing demands from patients that we cannot deliver. The workload appears to be one-way: from hospital to GPs.
'The effect for nurses is more work but, as there is less income coming to practices, few staff will have pay increases. Training is likely to be harder to come by and there will be an increasing reliance on non-regulated healthcare assistants. We can't do more with less.'
Howard Catton, RCN policy director, said:'I would like to see this pay rise applied by all. A lot of the QOF requirements are the bread and butter of nursing staff and the news that the DH has clawed back a billion in NHS efficiency savings will stick in the throat across all disciplines of community staff.'