‘As politicians we cannot afford to ignore the plight of general practice nurses’

Edward Morello, Liberal Democrat MP for West Dorset, sets out why he is lobbying the government for better pay, terms and conditions for general practice nurses and shows his support for Nursing in Practice’s How Nurses Count campaign.

As politicians we cannot afford to ignore the plight of general practice nurses, given how integral they are to the continued operation of primary care in this country. But poor pay, terms and conditions – and a lack of advocacy for the profession – means the viability of general practice nursing as a career choice is at risk.

As a Member of Parliament one of the most common complaints raised with me by constituents is access to GP appointments. We all know about the huge pressure faced by GP surgeries, the NHS, and pharmacies. Successive governments have sought to shift the problem around, most recently with ‘Pharmacy First’, without addressing the fundamental issues in the system.

Ultimately the general public do not care about the details, they just want to be able to see a GP. The current government is so focused on hospitals that it is largely ignoring the problems in primary care. Despite the fact that it is the doorway to NHS. 90% of all patient contact with the NHS happens in primary care, yet general practice receives less that 10% of total NHS funding.

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While the general public might understand GP practices purely as the doctor they see, the reality is a surgery is about so much more than seeing a doctor, and instead about a whole multi-disciplinary team. Sadly this misunderstanding also extends to policy makers and regulators, who consistently fail to mandate beyond the GPs themselves.

For example, the Doctors and Dentists Review Body (DDRB) only reviews pay for doctors not general practice nurses. The government expects that practices will pass uplifts on to all non-doctor staff, but there is no requirement to do so. In fact, a 2024 Royal College of Nursing (RCN) survey found that less that half of general practice nurses received the uplift intended by government. A report by Nursing in Practice this yeay found the average salary of a full-time (or full-time equivalent) general practice nurse in the UK is £35,057. Significantly below NHS colleagues. It also raised serious concerns about the lack of maternity, paternity, and sick pay. With most in the sector getting nothing above the statutory requirements.

Additionally the government has created a model whereby funding is based entirely on registered patient numbers, with no consideration of staffing levels. Creating the perverse incentives to maximise patient numbers and minimise staffing numbers in order to maximise profits.

At risk here is the viability of general practice nursing as a career choice. It is clear that a number of policy adjustments need to be made it assure the continuation of primary care. We need to recognise that service that non-doctor staff provide.

The establishment of a ‘Primary Care Review Body’ to replace the DDRB, with a remit to look at pay levels for all staff, not just doctors, would be a good start to changing the current system for nurses. Pushing for ring-fenced uplifts for practice nurses and non-GP staff, would also ensure that money is distributed more fairly.

More generally a more equitable funding formula that recognises workforce costs, and not just patient numbers would give GP surgeries more confidence in increasing staffing numbers to reflect need and undoubtably result in better working conditions and patient outcomes.

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As politicians these are areas where we can, should, and in many instances are, lobbying Government.

However we also need general practice nurses to be arguing the case for reform.

Nursing in Practice is running its How Nurses Count campaign – a movement to champion the profession, share best practice and innovation, and encourage learning from each other. This is an initiative general practice nurses must get involved in. We need government to see the work you do, front and centre. By sharing the vital role you play, you can help build the case for change and prove why ministers must do all they can to protect this workforce.

On the other side of the coin, we need stronger advocacy from a professional body for better worker rights, working conditions, or benefits from employers. There is no one body speaking for GP nurses. The RCN’s remit extends to GP nurses, but does not speak for them exclusively and it might be reasonably argued does not give them equal preference to its other members. There is no one for the government to sit down and negotiate with, there is no one demanding the government meet with them. This lack of advocacy is seriously harming the chances of progress.

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As politicians we have to start championing the value of general practice nursing and highlighting the need to improve their terms and conditions, given how vital they are to primary care in this country. However it is equally important that the sector organise. Whether it be a College of GP Nursing or equivalent, general practice nurses need a body advocating for them, to ensure that their voice is heard.

Until the government has someone it can sit down and negotiate with, improving pay and conditions will continue to be an uphill struggle. I hope the sector will pick up this challenge and get organised. You will find supporters in Parliament.