Practice nurses and the effects of the new general practitioner contract in the British NHS: The advent of a professional project?

In the light of changes to the GP Contract in the U.K. which were implemented in April 1990, health promotion was introduced into General Practice and was encouraged through the financial elements of the contract. This paper seeks to illustrate some of the outcomes of the changes, in particular the extent to which activity in relation to health promotion has been passed to practice nurses. The paper explores the perceptions of the practice nurses to their new activity and examines the implications of that change. The argument is presented that health promotion activity has provided an impetus for the attempts to develop a professional project on the part of practice nurses. The outcome of that professional project and the possibility of more development of the terms of the GP Contract could lead to unintended consequences of change in General Practice and the paper argues the need for more evaluation and debate of the developments.