Contribution of GPNs ‘a well-kept secret’, report finds

Nurses are ‘the backbone’ of primary care but their contributions remain a ‘well-kept secret’ and more work is needed to remunerate their worth, new research has found.

The findings come from the third ‘Leading the Way’: The role and value of nurses in general practice in England report, published by the consultancy group Sonnet Advisory and Impact CIC on behalf of NHS England (NHSE).

The latest research, informed by a survey of GP practices from July to August 2023, warned that general practice nurses (GPNs) are still working in environments which prevent them from reaching their full potential and fail to provide the appropriate pay and conditions.

It follows from previous Sonnet analysis taken place during 2022 and 2023, which also explored the role and value of nurses in general practice.

The latest findings are based on a survey shared to general practices across England, with invitations to complete the survey also shared by organisations including the Royal College of Nursing (RCN) and the Queen’s Nursing Institute (QNI).

The survey had 905 respondents, representing approximately 14% of all practices in England.

Pay and conditions

The report details how the ‘full value’ of a highly skilled GPN workforce is ‘significant’ for practices, patients, communities and the NHS.

But it added that ‘if we want to ensure that this value is realised and that nurses are able to reach their full potential, we need to make a range of changes to support them’.

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Listing ‘recommendations’ for change, the report called for the remuneration of GPNs to align with ‘scope of practice and career progression’.

And it stressed renumeration should be made ‘consistent’ across primary care and general practice.

It also asked for a review into terms and conditions in primary care, to ensure these are consistent and comparable with those working in the NHS.

In fact, only 19% of GPN’s who responded to the report’s survey agreed that the GPN role is ‘well understood’ by colleagues and patients and less than half (49%) of respondents ‘strongly agreed’ with this statement.

Training and education

The report highlighted the need to ‘ensure the sustainability of education and training budgets so that recruitment and retention of general practice nurses are supported and sustained’.

Employers must also commit to releasing nurses from their everyday work to complete training.

Alongside this, the report called for more ‘easily attainable’ general practice nursing placements for students, and for GP practices to be given more access to the resources they need to provide such placements.

This comes as many newly registered nurses are struggling to see primary care as a ‘viable place’ to start their careers, with most placements being offered within secondary care environments.

Leadership and recognition

Nurses must also be ‘represented and empowered at every leadership level in the NHS’, the report added, with ‘a key influencing and decision-making role in policy, practice, and education at every leadership and managerial level’.

And it outlined how nurses ‘need’ to be part of decision-making forums, at practice level, primary care network (PCN) level and integrated care board (ICB) level, as well as in national forums.

Survey findings showed that in 86% of practices, nurses ‘take clinical ownership’ on diabetes treatment, and in 85% nurses ‘lead or take ownership’ over respiratory conditions.

In general, in practices where nurses lead on cardiovascular health, the likelihood of nurses leading in clinical and non-clinical roles is also higher, according to the research.

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The report also suggested that where GPNs are valued better, they are also entrusted to do more.

The report also called for ‘greater research’ into general practice nursing, urging NHSE and integrated care systems (ICSs) to engage with findings from research studies into the GPN nursing profession.

It described the contribution of nurses in primary care as ‘something of a well-kept secret’ and ‘only partially seen’.

The skills and knowledge of GPNs are ‘often downplayed, are poorly understood and are rarely articulated’, the research added.

Workloads and workforce

The report explained how the ‘unsustainable’ workloads of GPNs could be faced by creating ‘more capacity’ for nurses to supervise staff working in primary care and general practice, and to ‘better implement’ primary care nursing teams into the NHS Long Term Workforce Plan.

Of practices who responded to the Sonnet survey, 68% involved practice nurses in the management of team members, including continuing professional development (CPD).

Slightly fewer practices (60%), used GPNs as a ‘point of contact’ for staff within practice to raise issues and concerns to.

Going forward, the Sonnet researchers believe health systems should ‘explore collaborative ways of working across primary and secondary care’, to make more use of nurses’ expertise and deliver more innovative ways of harnessing nurses’ skills and expertise.

Writing in the foreword to the report Paul Vaughan, deputy director of Primary Care Nursing and NextGen Nurse at NHS England, said: ‘In the rapidly evolving landscape of healthcare, the role of GPNs has never been more critical.

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‘As the backbone of primary care, GPNs serve not only as caregivers but also as leaders, innovators, and advocates for community health.’

He added: ‘It is essential to acknowledge the dedication and expertise of GPNs. Their commitment to improving population health and their ability to adapt and innovate in the face of challenges make them invaluable to our healthcare system.

‘This report is a testament to their vital role and a call to action to ensure they receive the support and recognition they deserve.’