The value of our practice nurses was brought home when one of them was headhunted by another local practice to lead their nurse team. This made us realise how vulnerable practices are in the current primary care environment. We also realised that the practice nurses were increasingly influential in the strategic development of the practice.
In our practice, the development of chronic disease management (CDM) services within our PMS contract resulted in the setting up of a nurse-led CDM team with dedicated administrative support. This has demonstrated the nurses’ ability to manage and deliver high-quality services when supported by investment in their training and personal development.
In late 2003 when we were preparing for the quality frame-work, the idea of creating an incentive scheme led to us discussing the possibility of nurses becoming partners alongside the GPs.
Our nurse practitioner Kathryn Taylor and senior practice nurse Jane Higginson are now profit-sharing partners, but initially not all the GP partners were convinced that this was the appropriate way forward.
In addition, Ms Taylor and Ms Higginson had reservations about moving from the comfort zone of employed status to the uncertainty of being self-employed.
The cultural shift was gradually resolved over a period of months. We had regular meetings and ‘away weekends’ at which concerns were aired.
Once we had committed ourselves to having nurse partners, the task of formalising the new arrangement began. Negotiations on profit sharing took place at a time when we knew that practice income would rise through the quality framework, and we agreed that the nurse team headed up by the nurse partners would have responsibility for delivering the quality framework.
Our first principle was to maintain our current incomes and then agree a target income for the nurse partners over the first year of partnership. Then we calculated the value of their target income as a percentage of current profit. The percentage profit share is now established for all future financial years.
We involved our practice accountants from an early stage and took advice regarding the effect of the partnership change on our tax liabilities, particularly for the new nurse partners. Letting the PCT know early about the intended changes to the partnership was important in respect of superannuation payments.
Despite the nurses having formally become partners in 2005, we have only recently signed the agreement. This process involved numerous meetings with our practice solicitors and entailed rewriting the document. This was because we only had our existing agreement for GP partners on which to base the new agreement. This proved inadequate in a number of areas.
We also had to address the issue of professional indemnity for the nurses because their self-employed status meant they were no longer covered by their Royal College of Nursing membership. However, indemnity was arranged at relatively low cost through the Medical Defence Union.
The practice is already seeing benefits from the move. Last year the practice achieved 1,043 quality points compared to just under 1,000 in the previous year.
The implementation of the new quality framework domains that were added this year have been well organised, with the nurse partners providing a monthly performance report to the practice’s management team. The nurse partners are actively involved in developing services to guideline standards.
The practice’s strategic development within a primary care environment has benefited by having partners with a different view of healthcare and an equal voice in its development and delivery. We are excited by some of the ideas Ms Taylor and Ms Higginson are bringing forward around practice-based commissioning.
As far as the GPs are concerned, despite the time and money involved, we all agree that delivering the best primary care service we can in an increasingly competitive environment means looking beyond individual professional boundaries.
Dr Wilkinson is a GP in Oldham, Lancashire
Reasons for making nurses partners
- Well-trained practice nurses and nurse practitioners are a highly prized practice asset.
- Nurse-led services in chronic disease management and the quality framework are vital to practice income.
- Protecting the asset of nursing staff and the practice’s investment in their training may mean going beyond incentive bonus schemes.
- Partnership allows committed, experienced nurses the opportunity to influence practice development positively.