Primary care nurses undervalued and underpaid

Thursday 24th January 2008

Staff shortages, frozen PCT (Primary Care Trust) posts, an increasing workload and little recognition of the value of their role have left many primary care nurses disillusioned with the state of their profession.

That is the stark conclusion of one of the largest surveys of nurses in primary care ever carried out in the UK, with over 1,400 respondents in a survey conducted by Nursing in Practice.

Earlier this month Prime Minister Gordon Brown announced a raft of new health initiatives, including better access to primary care and health screening for all. Nurses are central to the delivery plans. So it's bad news for the government plans that the survey reveals 62% of health visitors describe their current morale as low, 36% feel the amount of work-related stress they experience is "unmanageable", and more than half – 60% – would not even recommend a career in the primary care sector.

Unite/CPHVA Acting Lead Professional Officer Cheryll Adams said: "It is enormously worrying, but predictable, that 60% of those polled would not recommend a primary care sector nursing career – and this is a searing indictment of very poor NHS management philosophies which have allowed this culture to develop." Unite/CPHVA (Community Practitioners' and Health Visitors' Association) is a section of Unite, the third-largest trade union in the NHS.

Survey results also showed that it is not just health visitors who are feeling discontented – 55% of district nurses and 45% of community nurses would also describe their current level of morale as low.

Lynn Young, Primary Care Adviser at the Royal College of Nursing, is not surprised by the survey results: "Community nurses and health visitors are tired of constant organisational change, which in itself achieves little improvement in patient care. In fact, quite the reverse – public funds are used to support irrational change, rather than frontline services."

For practice nurses, the ticking-box process involved in achieving QOF (Quality and Outcomes Framework) points – the annual reward and incentive programme detailing general practice achievement results – was the biggest complaint.

One practice nurse described how "number-crunching has taken emphasis away from giving the patient quality care", while another expressed disgust that, to achieve maximum points, "a patient should be rung up by a HCA [Health Care Assistant] and asked if they are feeling suicidal, or when they last had an epileptic fit".

Pay was another emotive subject, with most primary care nurses feeling underpaid and undervalued:

•    64% of district nurses felt their remuneration was "unfair" and that, as specialist practitioners being shouldered with more and more responsibility, they should be on Agenda for Change (AfC) band 7 or even 8, earning the equivalent salary of a head-of-year teacher or police sergeant.

•    56% of health visitors said they were paid an unfair wage and that, considering the responsibility and accountability that came with the job, all health visitors should be AfC band 7.

•    52% of community nurses considered their remuneration to be "unfair", with most feeling that AfC band 6 would be more appropriate for their level of responsibility.

•    53% of nurse practitioners in primary care considered their remuneration "unfair". As one nurse practitioner said: "I see patients with undifferentiated and undiagnosed conditions, I am a nurse prescriber and I do not think AfC pay bands reflect clinically on this level of work." Most were looking to be on AfC band 8.

However, in contrast, and perhaps because they are not paid by the NHS (they are paid directly by GP employers), 61% of practice nurses felt that their remuneration was "fair" and reflected their current workload and level of responsibility.

"Comments made [in the survey] by PCT-employed nurses on pay are harsh, making the RCN even more aware that a 2008 pay deal needs to be far more generous than that awarded in 2007," said the RCN's Lynn Young.

This was echoed by Nursing in Practice Editor-in-Chief Elaine Linnane: "We are keen to investigate our readers' views and feelings and to represent them and their interests in our media and the media at large. That's why we took advantage of our large readership to canvass their opinions in the survey and obtain a true representation of them.

Click here to read the survey article in full.
Click here to download a pdf of the survey article in full.

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