Impact of the 2004 GMS contract on practice nurses:

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Abstract
The new GMS contract has led to practice nurses playing an important role in the delivery of the Quality and Outcomes Framework (QOF). This study investigated how practice nurses perceive the changes in their work since the contract's inception. A qualitative approach, sampling practice nurses from practices in areas of high and low deprivation, with a range of QOF scores. Glasgow, UK. Individual interviews were conducted, audiotaped, transcribed, and analysed using a thematic approach. Three themes emerged: roles and incentives, workload, and patient care. Practice nurses were positive about the development of their professional role since the introduction of the new GMS contract but had mixed views about whether their status had changed. Views on incentives (largely related to financial rewards) also varied, but most felt under-rewarded, irrespective of practice QOF achievement. All reported a substantial increase in workload, related to incentivised QOF domains with greater 'box ticking' and data entry, and less time to spend with patients. Although the structure created by the new contract was generally welcomed, many were unconvinced that it improved patient care and felt other important areas of care were neglected. Concern was also expressed about a negative effect of the QOF on holistic care, including ethical concerns and detrimental effects on the patient-nurse relationship, which were regarded as a core value. The new GMS contract has given practice nurses increased responsibility. However, discontent about how financial gains are distributed and negative impacts on core values may lead to detrimental long-term effects on motivation and morale.