I think you are forgetting that practic nurses, along with all other practice employed staff, are employed by the General Practice they work for and NOT by the NHS. It is up to the employer what he puts in the contract of employment/ job specification, apart from statuory stuff, and the employee to check this on or before commencement of employment. This applies to both occupational sick pay scheme which is in addition to statutory entitlements as well as salary issues. GP practices are not currently obliged to adopt Agenda for Change terms and conditions and there is nothing in 08/09 QOF at present, as far as I can see, to force them to.