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Practice nurse numbers in decline

The results of the latest NHS Information Centre's annual census have been collated and show a fall in the number of NHS practice nurses.

The figures have drawn criticism from the Royal College of Nursing (RCN) - especially in light of the fact that staffing levels for the service in other areas have reached a record high.

Staffing numbers reached an all-time peak of 1,368,200 in September 2008, in contrast with a 3.6% annual fall in the number of practice nurses, and a 6% drop in the number of nursing assistants and auxiliary staff.

The data revealed that the total number of managers working for the service was increasing three times faster than the total number of nurses.

RCN spokesman Dr Peter Carter said: "We welcome the fact that there are more staff working in the NHS, but we know that 200,000 nurses are due to retire in the next decade.

"Our own research shows that one in three community nurses are over 50 and one in five practice nurses are over 55. Government must invest in nursing if it's going to be a more attractive career option because in the coming years we're going to need more rather than less practice, district and community nurses."

Copyright © Press Association 2009

NHS Information Centre

Your comments (terms and conditions apply):

"The above comments speak volumes about the poor working conditions of many practice nurses. Fortunately, this isn't always the case - my experience as respiratory practice nurse who has worked in around a dozen practices over the past few years is largely positive. This could of course be due to the fact that practices which employ cover in times of staff shortage
(eg, maternity leave) are taking care to prevent a backlog of respiratory work building up. What I find strange is Peter Carter's statement about practice nurses - the RCN has given minimal support to practice nursing - as exemplified at the RCN PNA conference in 2009 where a practice nurse described her difficult working environment was simply advised to leave" - Catherine Gleeson, West Yorkshire

"I had worked as a practice nurse for four years and it was the most unrewarding job I have ever done. The GP is only driven by money and, as a result, patient care is poor. You work constantly with little breaks and over time without recognition. You are also asked to do tasks that are beyond your contractual agreement, some of which are unsafe. I do not think any nurse should take  the role of a practice nurse as a career, as long as GPs remain the main employers" – MH, Birmingham

"Sadly, GPs have been thrust into management positions that many were neither trained for nor want. Constant change in government targets and priorities mean that income can no longer be predicted long term. This impacts on patient care and continuity. There is certainly a reluctance to pay for or support training that may produce a skill that becomes 'surplus to requirements' in 12 months' time. As a nurse practitioner I am totally fed up with targeted care, financial scrutiny and working with a totally demoralised team (including GPs). There needs to be a huge rethink about all our skills and what we are spending our time doing. What happened to holistic, quality care?" - Pat, Telford

"Do you think the numbers are falling because there are more nurse practitioners and healthcare assistants in general practice? I feel saddened by reading the experiences of some of my practice nurse colleagues. There are some good GP employers out there and we shouldn't put up with the bad ones – voting with our feet might help!" - Jackie Jones, Cambridge

"I qualified as a nurse in 2004. It does not surprise me that there is a shortage of practice nurses! I have since been in two junior practice nurse positions. The first practice I worked in was diabolical. I never had a proper break and felt unsupported. One of the partners made my life a misery. I left two months later.
Although I had a negative experience, I was determined not to be put off, so I decided to give practice nursing another go. Again I encountered the same set of problems in relation to working conditions: no proper breaks, saw 24 patients in one day, had to come in on a Saturday (in my free time) to write my notes! The practice manager was a always trying to save money, hence the resus bag was in shambles when I started, I immediately purchased some paediatric resus equipment out of my own pocket. I stayed in that position for 6 months. My stress levels were extremely high, I often used to wake up in the morning dreading the day ahead. From my personal experience practice nursing leaves you in all sorts of dilemmas, you have to be very, very clear with your own limits of practice, you are constantly reminding the GPs and the admin staff what you can and can't do, they expect so much of you even though I was a junior practice nurse! My CV looks a little bit disjointed now but it also speaks volumes too" - Shereen Toner, London

"The new non-GMS contract is the way to pocket money. Quality is not maintained, with overseas non registered doctors and overseas students as healthcare assistants without any medically recognised qualifications and overseas not fully registered nurses in place to replace qualified nurses. Few part time places, employing more on temporary where they do not need to give benefits (holiday/sick pay, pension, NI contribution), no time given as break or to do paper work 9-1pm will be 9- 1pm just patients fully booked, not a minute free to spare but expected many tasks in between patients, appointment timings are reduced to 10 minutes too as not understood the meaning of access, do not pay for study days or give time off. They treat nurses as highly paid jobs and curbing everywhere and putting the patiens at risks, 2009 staff job satisfaction survey should involve non-GMS staff as audit tool too. GPs doing out of hours and claiming for the time but taking another day as time off. General practice standards should be set nationally, not as private contractors to enjoy public money." - Name and address supplied

"GPs need educating. Many GPs and practice managers are still advertising for 'an experienced practice nurse' at level 5 or Grade D/E/F. I believe more managers are being taken on because the focus of many GP practices is generating money. I have worked for 'a professional practice' where the GPs were just not interested in the bullying and exclusion I was experiencing from the practice manager because they saw her financial stake in their practice as more important than either my wellbeing or my clinical input. The GPs and practice manager where I now work do not provide breaks for their full-time reception staff, nor do they provide the 4 weeks paid leave to new staff. How can any system be expected to run properly when when we have people in charge of an NHS-related 'business' who do not themselves have to have any management skills or ethical conscience? Also, as a practice nurse, I am told I should be prepared to professionally develop my practice to provide better services for patients, yet it the GPs who employ me that control my career progression ... so I am stuck, and with no 'support' because everything goes back to what the GP thinks is the way forward." - Name and address supplied

"I totally agree, there is too much investment in the huge management structure and very little on the 'shop floor'. Higher wages needed and nursing back to modified 'old system' with hands-on training from the start. Keeps keenness and ongoing commitment for life." - Margaret Hughes

"I would agree that this is so. Something must be done to prevent this. It would seem where a problem exists in the NHS, employ a manager and this will be solved. Nursing should be better promoted to attract the right persons for this very demanding role." - V Henry

"A few times I have invited my colleagues from the hospital to apply for practice nurse positions. They turned the post down due to the fact that they would need to lower their grade and salary to take up the positions. The government talk about expanding the role of nurses and for them to improve the quality of care. However, GPs are not obliged to pay nurses the
salary which they deserve." - Name and address supplied

"I agree, more practice nurses are needed. I am 56 now and have been a practice nurse since 1990. I am seriously looking to change my job because of poor working conditions (working in portakabins) and not allowing sufficient time for consultation. There is a lot of inequality in gerneral practice, with pay strutures and bonus payments, or lack of. Job satisfaction is
poor when I speak to colleagues. GPs need to wake up and look seriously at their nurses and their working conditions." - Name and address supplied

"The bursary amount is not good enough, my husband got made redundant and we could not claim as I was on a bursary. Please let clever Gordon Brown know." - I Jones

"Could this be due to the fact that more and more practice nurses are becoming nurse practitioners in general practice?" - Wendy Hook, Lincolnshire