To achieve this level of precision, the clock ticks from the GPS satellites must be known to an accuracy of 20-30 nanoseconds. However, because the satellites are constantly moving relative to observers on the Earth, effects predicted by the Special and General theories of Relativity must be taken into account to achieve the desired 20-30 nanosecond accuracy.
Because an observer on the ground sees the satellites in motion relative to them, Special Relativity predicts that we should see their clocks ticking more slowly (see Lecture 32). Special Relativity predicts that the on-board atomic clocks on the satellites should fall behind clocks on the ground by about 7 microseconds per day because of the slower ticking rate due to the time dilation effect of their relative motion.
Further, the satellites are in high orbits, where the curvature of spacetime due to the Earth's mass is less than it is at the Earth's surface. A prediction of General Relativity is that clocks closer to a massive object will seem to tick more slowly than those located further away (see Lecture 20 on Black Holes). As such, when viewed from the surface of the Earth, the clocks on the satellites appear to be ticking faster than identical clocks on the ground. A calculation using General Relativity predicts that the clocks in each GPS satellite should get ahead of ground-based clocks by 45 microseconds per day.
The combination of these two relativitic effects means that the clocks on-board each satellite should tick faster than identical clocks on the ground by about 38 microseconds per day (45-7=38)!
If so, they may not agree on simultaneity. 
