A year in review: What did 2025 bring for nurses? 

We began 2025 with a series of exclusives from the General Practice Workforce White Paper, authored by our sister title Pulse’s editor-in-chief Jaimie Kaffash and launched alongside the Rebuild General Practice campaign. The report exposed the depth of the general practice workforce crisis – revealing a 23% registered nurse vacancy rate across practices in England, alongside a 16% shortfall of GPs and 32% shortfall of pharmacists.

Our own exclusive GPN survey that month echoed workforce concerns. More than 500 GPNs described ‘constant pressure’, rising demand and sometimes unsafe conditions in practice. On average, respondents were working 3.5 hours of unpaid overtime per week simply to keep up.

January also brought significant developments affecting the future nursing workforce. We reported on proposals to close Cardiff University’s nursing school – part of a wider consultation triggered by financial pressures and plans to cut 400 staff. While the university later paused the proposal to consider an ‘alternative plan’, the episode underscored the fragility of training provision at a time of acute shortages across all areas of nursing.

Meanwhile, annual survey data from the Institute of Health Visiting (iHV) revealed the extent of the strain within health visiting services. Among 1,392 respondents, 58% reported work-related stress, 54% regularly worked unpaid hours, and 40% said they intended to leave the profession within five years. Many cited retirement, lack of career progression and fears that the role was drifting from its preventative public health roots.

In February, we began our reporting of a pay dispute in Scotland where two district nurses (Shona Middleton and Cathy Fugaccia, both with NHS Tayside in Angus) threatened strike action and continued their long-running battle for a long-overdue role regrade and associated pay rise first proposed seven years earlier.

Their dispute would ultimately lead to strike action in early April, despite Scotland’s First Minister John Swinney urging that the matter ‘be resolved’ and pledging to raise it with their employer.

The month also saw new survey findings from the Royal College of Nursing (RCN), revealing that almost a third of general practice nursing staff in England had still not received a pay rise for 2024/25.

Of more than 1,600 respondents, 29.7% said they had received no uplift at all, 45% received less than the government-promised 6%, and only 20.9% received the full amount or more. A further 4.4% were still waiting for confirmation.

February also saw early reports that a chickenpox vaccination programme could be introduced next year as part of the new GP contract. This was confirmed later in the year.

February ended with a significant contractual development: the British Medical Association (BMA) confirmed that practice nurses would be added to the Additional Roles Reimbursement Scheme (ARRS) as part of negotiations for the 2025/26 GP Contract.

NHS England’s (NHSE) national primary care nursing lead, Louise Brady, welcomed the move as a ‘small step change’ in recognising GPN expertise, while cautioning that gaps in equity remain between nurses employed directly in single practices and those working across primary care networks (PCNs).

March opened with our deep dive analysis into the evolving landscape of primary care nursing, as we clarified which nursing roles now fall under the ARRS. We outlined what PCNs can claim for each ARRS-funded nursing post and clarified the responsibilities associated with the expanding suite of roles.

Our coverage detailed which nursing roles were now included in ARRS: consultant nurse (primary care), advanced nurse practitioner, enhanced practice nurse, experienced general practice nurse, new-to-general-practice nurse, nursing associate and student nursing associate. We set out how each role is defined, the bands they typically work to, and the reimbursement levels available to PCNs.

That same week, Patricia Marquis, the RCN’s director for England, warned that pay ‘instability’ across primary care risked driving practice nurses out of the sector altogether.  Speaking to Nursing in Practice, she highlighted how persistent pay discrepancies for GPNs were undermining recruitment and retention efforts and could ultimately push more patients into A&E for basic care.

Halfway through the month, attention turned to the government’s announcement that NHS England will be dissolved and brought back under the Department of Health and Social Care (DHSC).

The move is intended to cut duplication and redirect funding into frontline care. In the weeks that followed, we explored the implications of this change, including caution from Professor Nicola Ranger, general secretary and chief executive of the RCN, who stressed that reforms must deliver meaningful improvements for staff and patients.

March also saw early findings from our exclusive GPN pay report unveiled at the Nursing in Practice 365 event in London, prompting strong reactions from attendees who echoed concerns about pay and working conditions.

A snapshot from our survey, supported by our sister Management in Practice, revealed how few practice nurses had received a pay rise in the past year, and how many are considering leaving the profession.

Also in March, the QNI updated its name to the Queen’s Institute of Community Nursing (QICN). At the time, the outgoing chief executive Dr Crystal Oldman said: ‘Our new name, The Queen’s Institute of Community Nursing, more accurately reflects our mission and the vital role community nurses play in delivering high-quality patient care.

‘This rebrand – an evolution not revolution – is a testament to our dedication to supporting and empowering community nurses and the individuals, carers, families and communities they serve,’ Dr Oldman noted.

This followed the QICN’s announcement that Steph Lawrence would replace Dr Oldman as its new chief executive.

Later in the month, the Nursing and Midwifery Council (NMC) published a new definition of advanced practice in nursing and midwifery – forming part of its ongoing work to regulate this level of expertise.

The updated principles reaffirm the four established pillars of advanced practice as clinical practice, education, research, and leadership/management, alongside professional and public-facing definitions.

• Professional definition: An expert nurse or midwife with postgraduate education and experience, able to lead, influence and deliver safe, effective care while managing risk, uncertainty and complexity.
• Public definition: A nurse or midwife who has completed additional post-qualification education to provide expert, higher-level care.

Source: The NMC

April saw the publication of the full findings from our exclusive Nursing in Practice and Management in Practice salary survey report, offering one of the most detailed pictures yet of GPN pay in 2024/25. Drawing on responses from more than 550 members of the general practice nursing workforce, the report reinforced long-standing concerns that many GPNs still feel their salaries fail to reflect the complexity of their roles, their responsibilities, or their expectations of an annual pay uplift.

The report breaks down pay across the general practice nursing team and by Agenda for Change Band, while also highlighting the persistent gap between the pay and conditions of nurses working in general practice and those employed directly by the NHS.

Some of the findings were particularly stark. The survey showed an average full-time GPN salary of £35,057, while Band 6 GPNs reported an average of £34,849. The report also found that only 5% of general practice nursing staff are given maternity pay above statutory levels, while less than a third (32%) say they are given occupational sick pay above statutory levels.

Despite these challenges, the data also underscored the strong professional commitment within the GPN workforce. A significant 82% of respondents devote between one and five hours a week to training and personal development.

May saw a wave of significant policy developments for the nursing and social care sectors, with long-debated legislative changes finally moving through Parliament.

The month opened with a controversial government announcement: the planned end of overseas recruitment for care workers, unveiled as part of its new Immigration White Paper.

Put forward as an effort to reduce ‘historically high’ net migration, the policy will see social care visas closed to new applications from abroad.

Nursing and social care leaders were swift and united in their criticism, describing the move as ‘pandering and scapegoating’ amid ongoing workforce shortages.

In contrast, news of a separate long-awaited legislative change was widely welcomed. Marking International Nurses Day, ministers confirmed that the government will introduce new protections for the title ‘nurse’, ensuring that only professionals with recognised qualifications and NMC registration can legally use it.

The announcement followed years of campaigning by nurses and the persistent advocacy of Labour MP Dawn Butler.

Meanwhile, debate around the Terminally Ill Adults (End of Life) Bill intensified as it progressed to its next stage in the Commons.

An exclusive Nursing in Practice survey of 280 general practice nursing staff highlighted the complex emotions many nurses feel about the debate. Almost half (48%) felt GPNs or community nurses should have a role in raising the possibility of assisted dying with palliative patients if the Bill becomes law. Some 38% said they would personally be willing to take part.

District nursing also came into sharp focus. Early findings from a Nuffield Trust report revealed a stark 43% fall in district nurse numbers in England between 2009 and 2024, a decline mirrored in reverse by a 43% rise in adult hospital nurses over the same period.

Not long after the figures were released, the Department for Education announced it would withdraw funding for Level 7 apprenticeships for those aged 22 and over from January 2026. The decision, part of a wider rebalancing of apprenticeship funding, immediately drew concern from sector leaders who warned it would shut down a vital career pathway.

Speaking at the time, RCN general secretary and chief executive Professor Nicola Ranger said the move ‘not only shuts off an important career route for staff but also undermines the government’s own ambition to shift care from hospitals to the community’.

At the beginning of June, the QICN unveiled its new Faculty of General Practice Nursing, billed as a ‘professional home’ for nurses working in primary care. At the launch, then-outgoing QICN chief executive Dr Crystal Oldman said the initiative reflects growing recognition that GPNs are ‘at a disadvantage’ compared with NHS colleagues, particularly in terms of access to professional development.

The faculty is intended to serve as a central reference point for the profession, offering resources, guidance, a dedicated webpage, and a programme of webinars and events tailored to GPNs.

Also in June, the health and social care secretary, Wes Streeting, said nurses should be ‘leading’ the government’s new neighbourhood health services as part of a radical reform of the NHS.

Mr Streeting said the NHS ‘should not be bound by traditional expectations of how services should be arranged’ and that incoming reforms would have ‘radical implications’ for health services, as the government shifts care closer to home.

Later in the month, Nursing in Practice exclusively reported on concerns that England could exhaust its domestic supply of learning disability nurses by 2028 unless ‘drastic action’ is taken. This early reporting was followed up in October with an in-depth feature, including several exclusive interviews with registered learning disability nurses (RNLDs) working in general practice

At the beginning of July, we launched the How Nurses Count campaign to highlight strong examples of the impact nurses have in general practice, from patient consultations and clinics, to team meetings, leadership roles, prescribing, advocacy, and everyday problem-solving.

Nurses’ involvement in the government’s new neighbourhood health service was also confirmed, with Prime Minister Keir Starmer announcing that they will work alongside health visitors, palliative care staff, doctors and other professionals in the planned neighbourhood health centres.

The neighbourhood health service is core to the government’s 10-year plan for the NHS, which was also published in July and was based around the key shifts from hospital to community, sickness to prevention and analogue to digital.

The plan includes other significant developments for nursing, including more nursing apprenticeships and expanded advanced practice roles.

The month also saw the release of the first Nursing in Practice podcast episode, which explored how the government’s 10-year health plan could reshape general practice nursing, while also introducing the How Nurses Count campaign, and examining the latest updates on GPN pay.

The episode included interviews with Kim Ball, professional lead for primary care at the Royal College of Nursing, and Frances Baverstock, lead nurse for primary care at Betsi Cadwaladr University Health Board and member of the RCN General Practice Nurse Forum. Both discussed the newly launched 10-year plan and the need to properly recognise the expertise GPNs contribute to primary care.

We also reported exclusively that the government has signalled potential changes to general practice nurse terms and conditions as part of a new GP contract expected before the end of this Parliament.

August brought a series of significant developments for the nursing workforce across the UK, with fresh announcements on training pathways, new schemes for graduates, and growing unrest among district nurses.

Early in the month, the government set out further details on Level 7 apprenticeship funding. While ministers reaffirmed support for master’s-level apprenticeships that include district nursing, they notably excluded several other specialist practice qualification (SPQ) routes, including general practice nursing.

In the middle of August, attention turned to the transition from training to employment as the government launched its new ‘Graduate Guarantee’ for nurses and midwives. Promising to create more opportunities for newly qualified staff, the scheme includes plans to convert existing healthcare assistant vacancies into registered nurse posts. Nursing in Practice published an in-depth explainer examining how the guarantee will be funded, how employers are expected to implement it, and how long it might remain in place.

Writing exclusively for Nursing in Practice, the health and social care secretary, Wes Streeting, said that ‘if you train to be a nurse or midwife there should be a job waiting for you’ and he pledged easier job access for newly qualified professionals at an increasingly tough time for the workforce.

But while Westminster focused on future supply, long-standing dissatisfaction among district nurses in Scotland came to the fore. Around 130 nurses protested outside NHS Greater Glasgow and Clyde headquarters, frustrated by delays to a job evaluation request submitted in 2023. The dispute centres on pay and grading, with nurses saying they have been left waiting too long for answers.

As the month drew to a close, wider concerns over nurse job security intensified. The RCN warned that the threat of redundancies, coupled with uncertainty around incoming cuts to integrated care boards (ICBs) in England, was adding further pressure to an already stretched workforce. The union cautioned that instability at system level risks ‘undermining the delivery of vital nursing functions’ at a time when demand for services continues to rise.

September brought a focus on recruitment, training and the evolving role of general practice nurses. The second episode of the Nursing in Practice podcast explored new approaches to attracting nurses into primary care and strengthening preceptorship, while also reflecting on the impact of the publication’s How Nurses Count campaign.

Guests included Steph Lawrence, chief executive of the QICN, and Angie Hack, lead of the QICN’s GPN Network. Newly qualified GPN Felicity Weaving also shared her experience of stepping into general practice immediately after university, offering a first-hand look at the transition into the profession.

That same month, Nursing in Practice reported on an exclusive roundtable examining recent changes to the childhood immunisation schedule and how falling uptake might be reversed. The discussion came against a backdrop of growing concern about vaccine coverage and the pressures facing primary care teams delivering these programmes.

Further analysis arrived with The Power of Practice Nurses, a major report based on a survey of more than 600 GP nursing staff. The report was written by Cogora’s director of content and editorial, Gemma Collins, and  underscored the expanding clinical influence of GPNs: 49% were now prescribing, 70% carry out regular reviews across multiple clinical areas, and nearly half are adjusting medications or dosages when required.

Closing the month, our publisher Cogora released a second white paper calling for a fundamental shift in how general practice staff are funded. It urged the government and the British Medical Association (BMA) to introduce a centrally funded staffing model (moving away from the ARRS framework) and to ringfence staffing budgets with money distributed directly to practices. The paper argued this approach would allow investment in the workforce without being mistaken for a pay rise for GP partners, while still enabling larger groups of practices or PCNs to share staff across wider populations.

From October 1, all GP surgeries in England were required to keep online systems open for patient requests between 8am and 6.30pm for routine enquiries.

This triggered concern from unions including the BMA GP Committee (GPCE) which has publicly opposed the move, warning that current booking systems cannot reliably distinguish routine and urgent issues, meaning patients with serious conditions risk being overlooked and entered a formal dispute with the government over the issue.

Also in  October, Nursing in Practice exclusively revealed the NMC’s controversial plan to raise its registration fee after a decade-long freeze. The announcement sparked immediate backlash from the profession, with readers describing the move as ‘disgusting’ and ‘abysmal,’ while the union Unison warned it could place an ‘extra financial burden’ on the workforce.

Plans for a consultation on the move was approved during an extraordinary NMC Council meeting on 21 October, chaired by Rob Barclay-Smith. The regulator has now launched a 12-week consultation, with any fee increase expected to take effect from 1 October 2026, pending final Council approval.

Later in the month, the government outlined plans to integrate menopause-related questions and support into routine NHS health checks for women over 40 across England. Officials described the move as a ‘landmark step forward’ for women’s healthcare, potentially benefiting nearly five million women. The questions are being developed in consultation with health experts in the coming months.

Meanwhile, the Care Quality Commission (CQC) raised fresh concerns over the impact of district nurse shortages. The watchdog warned that staff pressures are driving ‘task-based’ care and risk undermining the government’s strategy to shift more services from hospitals into the community.

The warnings were followed by a report, commissioned by the QICN and carried out by the Nuffield Trust, which raised serious concerns about an ‘undervaluation’ of district nursing, as well as skill shortages and widening regional disparities in district nurse access across England.

The month ended with the government announcing its plans for a 2.5% pay rise for nurses across general practice and the NHS for the next financial year. In its submission to the pay review bodies, the DHSC noted that any recommendation above 2.5% would require careful consideration of affordability within existing budgets.

November brought fresh insights and ongoing concerns about the pressures facing the nursing workforce. A survey by Pulse and Management in Practice highlighted the growing administrative burden on non-GP clinical staff, with nurses and pharmacists spending an average of 42 minutes a week implementing new online access systems. The findings were based on responses from 431 GPs and practice managers across 412 practices, underscoring the quiet but persistent strain on frontline staff.

The month also saw warnings about the future of the nursing workforce. The RCN cautioned that tens of thousands of international nurses could leave the UK if the government plans to double the qualifying period for Indefinite Leave to Remain (ILR) proceed.

Meanwhile, a report from the QICN revealed that experienced nurses were increasingly forced into lower-paid roles to access flexible working or escape toxic workplace environments. Over 80% reported career regression, with 61.5% having more than 20 years on the NMC register.

November also saw the publication of the latest report from the UK Covid-19 Inquiry which concluded that the response to the outbreak was too delayed and that early inaction meant mandatory national lockdowns were ‘the only viable option’.

The government also set out its Autumn Budget, promising to reinvest savings from AI, automation, and the scrapping of NHS England into efforts to recruit more nurses. While the measures signal recognition of the challenges, many in the profession argue that deeper structural reforms are needed to secure lasting change.

On December 1, the government issued new guidance for parents and carers of children to help them understand the introduction of the new combined MMRV vaccine, which protects against measles, mumps, rubella and chickenpox.

The start of the month also saw the NMC releasing its latest mid-year data which revealed that there had been an almost 50% collapse in the number of international professionals joining the register, marking the lowest six-monthly intake of international professionals for five years.

The third episode of the Nursing in Practice podcast was also made live and hosted a conversation with advanced nurse practitioner Ruth Bailey. The latest episode explores the planned introduction of menopause questions into routine health checks and takes a deeper look at how nurses can provide more inclusive practice across the UK.

We also celebrated the success of primary care nurses at the General Practice Awards where Dr Jennifer Loke was named ‘nurse of the year’ for her innovations including the introduction of joint consultations which brings staff together to deliver longer, more holistic appointments for patients.

Latest data from the Universities and Colleges Admissions Service (UCAS) also showed a small decline in the number of students accepted onto UK nursing programmes compared to last year.

We also published an analysis piece including exclusive interviews with community nursing teams, discussing how hospice funding constraints are seeing district nursing teams increasingly caring for more patients who are at end of life and who have complex needs, without hospice services to turn to when in need of support or specialist advice.

The winter months have all been marked by a worrying rise in flu cases and flu-linked hospitalisations. In December, an ‘unprecedented wave of super flu’ has prompted a fresh appeal to the government to improve nurse staffing levels and increase bed capacity in hospitals.