Four in 10 practice nurses try to negotiate their own pay rise every year

More than four in 10 nurses working in general practice are proactively trying to negotiate their own pay rise every year, a new report has shown.

Royal College of Nursing (RCN) director for England Patricia Marquis said negotiations were often complicated by the fact that nurses have to have these conversations with a colleague, and stressed that general practice nurses (GPNs) should not have to ‘make the case for an increase in pay’ every year.

The Nursing in Practice report – General practice nurse pay: A salary survey of the profession 2026 – highlights the scale at which GPNs are ‘forced into negotiations with their employer when it comes to pay’.

Based on a survey of almost 900 general practice nursing staff and informed by expert opinion, including from the RCN, the report focuses on GPN basic pay and salaries, annual pay uplifts, pensions, employment benefits, the additional roles reimbursement scheme and more. It follows on from our 2025 version of the salary survey and report.

Results for 2026 show that around four in 10 (41%) nurses in general practice say they proactively try to negotiate a pay rise every year, compared with 56.5% who say they do not.

This marks a slight change from our 2025 report, which suggested only 36% of general practice nursing staff negotiated a pay rise, versus 63% who said they do not.

For 2025/26, our findings suggest a third of GPNs went without a pay rise.

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Of those who did try to negotiate a pay rise, 56% were successful, our latest survey also found.

One practice nurse who falls into this category is Wendy Older, who works in East Sussex.

She told Nursing in Practice that the key to successful negotiations was being ‘proactive, prepared and confident’ in the value she brings, though she recognised that this is not always easy.

Crucial to her negotiation approach is to map her skills against recognised frameworks which demonstrate her expertise and the level at which she is working.

‘For example, I was able to show my contribution through diabetes audits, service improvements, teaching, and quality‑improvement projects that I was leading, yet not adequately recognised in my pay for this type of work,’ she said.

Ms Older’s top tips for successfully negotiating a pay rise can be read in full in the report here.

Despite the slight increase in those trying to negotiate their own pay rises this year, several GPNs told Nursing in Practice they had ‘given up’ or that they felt it was ‘pointless’ trying. One advanced nurse practitioner (ANP) says: ‘It never goes well and leaves me feeling demoralised.’

Some say they felt their asks fell on ‘deaf ears’, while one nurse said they felt ‘too embarrassed’ to bring it up. Other nurses raised concerns that their pay and conditions are ‘reflected by [their] ability to negotiate and not by nursing expertise’ and that while colleagues in secondary care benefit from ringfenced annual uplifts, those in general practice are ‘expected to beg for our pay rise’.

In recent years, the RCN has provided GPNs with a letter template that can be used to send to employers if they were not receiving updates on pay rises or if they felt there was a lack of transparency about the pay they should receive.

The RCN has also been fighting for a place in official negotiations on the GP contract.

For 2026/27, the British Medical Association (BMA) lost its space as the sole negotiator of GP contract terms for the financial year, and other organisations, including the Institute of General Practice Management (IGPM) and Royal College of General Practitioners (RCGP), were given a place at the table. However, the RCN was excluded.

One nurse working in general practice, Laura Hopwood, said her recommendation ‘would be to act as one in your team’.

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In recent negotiations at her practice, she said she and a colleague leading the talks made sure ‘we had all the nurses on board’ to ‘ensure we were speaking with one voice’.

She also recommended that nurses used the readymade RCN templates and to ‘actively make your primary care employers aware of the national pay award recommendations to give you a baseline expectation and negotiation tool’.

She added: ‘Our management are very open to our suggestions, but we actively make them aware of what the national recommendations are.’

Meanwhile, Jeni Watts, RCN senior national officer, said that while the college works towards its aim of hoping a place in official, national negotiations, it also wants to ‘support the reality for general nursing staff which is that they negotiate directly with their employers’.

‘The thought of negotiation may feel uncomfortable, particularly if you work in a small practice, however, if done in the right way it can be a positive experience for all involved,’ she said. In our report, Ms Watts offers practice advice for GPNs on negotiating their pay, which can be read here.

And in a foreword to the report, RCN director for England Ms Marquis said: ‘We know many staff are now forced into negotiations with their employer when it comes to pay, often complicated by the fact that same person is also a colleague.

‘Done right negotiation is a valuable tool, but we should not be in this place every year with staff needing to make the case for an increase in pay.’

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She urged the government and employers in general practice to ‘show they value their staff’ and said this ‘starts with paying them fairly without the need the for back and forth that negotiations create’.

Echoing the calls of the RCN, the Nursing in Practice report makes three recommendations, including the need for a nursing seat in negotiations.

Our report, launched last month at our Nursing in Practice London event, was welcomed by RCN chief executive and general secretary Professor Nicola Ranger, who stressed that GPNs were not being paid their ‘value and worth’.

Other findings within the report showed that almost a third (32%) of nurses working in general practice are considering leaving their role in the next year, and that nurses working in general practice are earning thousands of pounds less than those in secondary care on AfC terms.