Scotland's practice nurses have faced a rising workload during the past five years, but numbers have not grown enough to ease pressure, a survey has shown.
One in three primary care consultations have been carried out by nurses since the new GP contract was introduced in 2004, with the Quality and Outcomes Framework (QOF) adding to their expected tasks.
The National Primary Care Workforce Survey 2009 found the number of practice nurses increased by 33% in the six years to 2003, but rose by a mere 6% during the following five years and four months.
It said there are 2,140 nurses working for Scottish health boards and practices, and Royal College of Nursing Scotland director Theresa Fyffe said the 2004 contract should have required a "steep increase" in nurse numbers.
Practice nurses "lead on delivering an increasing range of services to patients to support the achievements of GP targets through the QOF," she said.
"In return for the crucial role that practice nurses now have, all GPs should ensure that they meet best employment practice.
"Many should improve the terms and conditions for their practice nurses, including releasing them to undertake education, development and training on an ongoing basis."
Copyright © Press Association 2010
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"Practice nurses are overworked and underpaid, we have to take responsibility for everything, the blame always ends with us, whatever we do we are always in the wrong. Most of us feel isolated" - Patrice, London
"If PNs are unhappy working for independent GPs and feel they are overworked and underpaid then why not go and work back in secondary care or for their local PCT? Maybe we should think about what attracted most of us to primary care in the first place ... the better hours, no weekends/bank holidays etc. We can't have it all ways!" - Nurse Practitioner, Newcastle
"Having worked in general practice for the last 10 years I feel we are tarring all GPs as the same. We are four practice nurses who work for two GPs who treat us fairly and well. They realize we do work hard and pay us accordingly. I do not want to go under the NHS umbrella having completed a return to nursing course in 2000 I was appalled at the level or should I say lack of it of experience of some of the staff. Very soon practice nurses will talk themselves out of a job and will be replaced by HCA and AP for much less money and do not need much knowledge to tick boxes" - K Borg Costanzi, Manchester
"It's about time that the general practitioners recognised the hard work undertaken by their p/ns and rewarded them with the pay scale owed to them, annual leave entitlement and better education packages. Even some of the basic mandatory training is overlooked by GPs as they don't feel it necessary; every practice should have the same mandatory protocols and procedures. The government should bring them under the same umbrella" - J Bains, Birmingham
"The survey results are not surprising, however, I believe a survey was carried out some time ago where practice nurses were asked if they wanted to come under the umbrella of the NHS or stay independently employed. The results were that the vast majority of PNs chose to stay independently employed, not wanting the hierarchy of the NHS etc. This really surprised me at the time and as a Practice Development Lead for Primary Care the inconsistencies of skills amongst practice nurses is concerning. I believe in the role of the PN wholeheartedly and the range of patient care we deliver is phenomenal. GPs would not be generating the amount of income they do without the hard work and organisational skills of the PN but also PNs need to be clear about what they want in terms of employment" - G Towers, Bradford
"I have been a practice nurse since 1990, and before that, senior sister in the NHS. When I first started in general practice I was given a so-called G grade salary, and ever since then my salary has decreased because there is no pay scale that GPs must adhere to, no increments and less annual leave entitlement than our NHS colleagues! And more and more QOF demands to meet. I love my job, but whenever I mention that I get one week less AL and on average £6 less per hour than my colleagues I am told that I can leave if I want to! I feel really appreciated! Roll on retirement ..." - Practice nurse, Essex
"True practice nurses are over worked and underpaid, GPs are only interested in reaching their QOF targets lining their pockets. I agree that NHS should take over all practice nurses so we can have better working conditions" - Name and address supplied
"I also feel our pay and conditions are appalling. It is akin to asking the cat to give up his cream and then being surprised when he doesn't! Welcome back Whitley Pay Scale. I feel very strongly all nurses should be graded and pay rates increased annually and conditions governed by law rather than the ad hoc arrangements that we have in place at the moment" - Catherine Hodge-Moss, Hertfordshire
"I strongly agree that GPs should meet best employment practice and I must say that in some cases these are maintained; however, in my estimation these are few and far between. The new contract allows GPs to direct the PN to reach QOF figures while their expectations on the PN to complete this work and maintain all other patient-centred care is unrealistic. Added to these in the past 4 years have been HPV, H1N1 vaccines, other immunisation catch-up campaigns. It is quite obvious to me that the GP takes all the profit and the PN does the majority of the work. It would be far better for the population of UK in quality of care and financially if GPs and PNs were employed by the NHS and take away the excuse made in regulating PNs employment that GPs are independent employers. PNs would then have the backing of the NHS and would not have to battle on their own to achieve better working conditions and pay. After all, the GP practice is maintained out of the public purse, something I feel that they conveniently forget. Protect our PRACTICE NURSES. Primary care would be in dire straits without them" - Practice Nurse, South Wales
"As a practice nurse in Ireland, I found it very interesting, our workload is increasing every day, almost unnoticed by the GP" - Winnie McCabe, Ireland
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