Practice nurses call for Agenda for Change terms and conditions to ‘feel safer’

Only around one in 10 (11%) nurses working in general practice report being on Agenda for Change (AfC) terms and conditions – but more than a third (37%) say they would like to be, a Nursing in Practice report has suggested.

The General practice nurse pay: A salary survey of the profession 2026 calls for all nursing staff in general practice to have their pay, terms and conditions set at least in line with those on AfC.

The report says this is vital to help ‘stamp out pay inequity within the profession and ensure GPNs have access to timely, annual pay uplifts and above statutory employment benefits’.

Based on a survey of almost 900 nurses in general practice and informed by expert opinion, including from the Royal College of Nursing (RCN), Nursing in Practice’s report focuses on GPN basic pay and salaries, annual pay uplifts, pensions, employment benefits, the additional roles reimbursement scheme and more.

Importantly, the report dedicates a chapter to AfC terms and conditions – given to NHS nurses, but not the majority of GPNs.

Our data suggests only around one in 10 (11%) nurses in general practice are on AfC. Yet, more than a third (37%) say they would like to be.

The exclusion of GPNs from AfC means their pay levels are falling behind their NHS secondary care colleagues who do have AfC terms, the report said.

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For example, data analysis showed that AfC NHS nurses at the top end of Band 5 are earning over £1,000 more than practice nurses at Band 6.

Perhaps more striking is that AfC nurses at the top of Band 6 are earning almost £5,700 more than practice nurses at Band 7.

Being on AfC also means that NHS nurses are guaranteed an annual pay rise, while those in general practice often miss out or wait in hope that they will receive an uplift if their practice passes it on.

One nurse team lead responding to the survey said: ‘The nurses and healthcare assistants in general practice are the main income to the practice in the work they deliver.

‘However, they are often paid lower than they should be. Making GP practices adopt Agenda for Change and having a structure for practice nurses to fit the banding would help and make it fairer.’

A practice nurse added that they would ‘feel safer’ with AfC terms and conditions, especially when it comes to sickness or holiday entitlement. The report suggested that the majority of GPNs do not receive above statutory sick pay or maternity leave pay.

Another nurse added: ‘Our pay would be better if we were on Agenda for Change conditions. It makes recruiting GPNs difficult as there are huge implications when accepting a job.’

Issues around a lack of AfC prohibiting recruitment was discussed by other respondents too, including one nurse who said: ‘Nurses don’t want to leave Agenda for Change for less pay. This was reflected in our recent advertising – it took 18 months to recruit.’

What has the ARRS meant for nurse pay?

The report highlighted how the pay situation in general practice nursing is made more complicated by the introduction of additional roles reimbursement scheme (ARRS) nursing posts.

The scheme – which is used by primary care networks (PCNs) to fund the salaries of a range of primary care roles – had until last year excluded GPNs, instead including nursing associates, advanced nurse practitioners and, in 2024, the enhanced level practice nurses.

The maximum amounts that PCNs can claim to recruit and onboard roles under the scheme are based on AfC pay scales – but these are higher than practice-employed nursing roles, the report noted.

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For example, in 2025/26, a PCN could claim £44,940 for a Band 5 GPN who was new to general practice, rising to £54,077 in inner London areas.

However, our survey suggested an average GPN is earning £35,884 – falling to £29,980 among those at Band 5.

A practice nurse responding to our survey highlighted the disparity between ARRS staff and those who are practice-employed: ‘I feel GPNs should be on the Agenda for Change pay scale – it is so disheartening when you have to negotiate pay annually and there is no guidance on what pay is appropriate for your skills. I also feel very undervalued when working alongside PCN staff who are on NHS pay and conditions.’

Another practice nurse described concerns around ARRS roles at lower bands being paid more than them.

‘I have worked all of my adult life, 35 years for the NHS. I earn less now than I did 15 years ago despite upskilling. I see other healthcare professionals doing lesser jobs for more money around me because the “pot is there” for ARRS, but not nurses and not even AfC level pay and terms are available – feeling undervalued.’

A nurse team lead added that they felt the role of GPNs was being ‘eroded by the ARRS scheme and the rise of nursing associates’.

Professor Azeem Majeed, a GP and head of the Department of Primary Care and Public Health at Imperial College London, recognised that nurses in general practice have ‘variable conditions’ and stressed that funding for ‘pay parity’ with AfC is needed for the profession.

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‘We need a funding mechanism that allows for nurses working in general practices to have pay parity with NHS Agenda for Change scales,’ he said in the report.

‘If we want a primary care-led NHS, we must ensure that the nurses delivering essential care in areas such as vaccination, sexual health and the management of long-term conditions are compensated in a way that reflects their professional standing and the complexity of their work.

‘Currently, as they are not NHS employees, general practice nurses can have very variable conditions of employment and this needs to be addressed.’

To view the General practice nurse pay: A salary survey of the profession 2026 report and its full recommendations click here.