GPNs struggle to negotiate pay due to ‘discrimination’

Nurses working in general practice struggle to negotiate their pay, terms and conditions because they are constrained by ‘medical and managerial hegemony’ and a perceived lack of ‘capital’, a new study has suggested.

The paper warned the imbalance in voice was having a ‘negative effect’ on the retention of nurses in GP practices and that ‘structural and cultural’ action was needed to challenge misconceptions about the profession.

The research is the latest in a series by University of York research fellow and registered nurse Dr Helen Anderson, fellow researcher Dr Joy Adamson and NHS England’s primary care nursing lead Louise Brady.

Findings are based on interviews with 41 members of nursing teams working in or who have worked in general practice, as well as nurse leaders linked to the sector.

While the research team’s previous study, published in February, uncovered a practice nursing workforce that felt ‘undervalued’ and ‘pushed out’, the latest paper looks why general practice nurse (GPN) retention issues are difficult to fix.

It found that GPNs lack – or are perceived to lack – ‘social, economic and cultural capital’ and that this results in ‘perpetuation of social disadvantage, reproduces inequality, and contributes to the devaluing of nursing, ultimately contributing to attrition’.

The struggle to negotiate

Nurses contributing to the study described the particular challenges faced around negotiating their pay, terms and conditions with GP employers.

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Some said this was ‘challenging within the constraints of medical and managerial hegemony’.

The study said nurses ‘often lacked the symbolic capital to negotiate to strengthen their economic capital, and this had a negative effect on retention’.

One GPN said: ‘It’s staggering the way you get treated in primary care.’ The nurse said people ‘wonder why retention is poor’ but suggested ‘staff aren’t treated as well as they should be’.

Participants also described how nursing’s professional associations ‘did not hold the same social, cultural and economic capital as their medical counterparts, and this led to them not always feeling supported in relation to negotiation of pay and conditions’.

The study suggested that GPNs informing the study ‘often stressed that as nurses, remuneration was not their first priority, but rather they work in general practice for the benefit of patients and felt that negotiating for more money, or better employment terms and conditions, was contrary to their professional nursing identity’.

GPNs ‘discounted and diminished’

The study also pointed to specific issues such as gender, ageism, social class, race and ethnicity within general practice nursing and the need for employers and policy makers to develop strategies to address this.

GPNs told researchers how they experienced ‘discounting and diminishing from employers and sometimes from younger nurses’.

‘Older nurses often felt they were excluded from decision-making to a greater extent than their younger nursing colleagues highlighting the reduced symbolic capital held by older nurses,’ the study said.

‘Given that nursing in general practice is an ageing workforce with a depth and breadth of skill, knowledge and experience, it is necessary for employers, and wider healthcare organisations, to support more experienced nurses to remain in general practice and to avail themselves of this experience at a strategic and decision-making level.’

‘Women’s work’

Researchers also explored how nursing in general practice is seen as ‘women’s work and consequently not valued because such “pink collar work” is highly gender-segregated and poorly paid’.

Those contributing to the study reported being likely to work in general practice to help manage caring and family responsibilities – ‘which limited their freedom of labour and reduced their economic capital’.

In addition, ‘much of general practice nursing work could be understood as gendered in terms of provision of women’s health, cervical cytology, childhood immunisations and what could be seen as “lower status” non-acute, “softer skilled” work’, the study said.

‘This meant that nursing in general practice lacked symbolic and, as a con- sequence, economic capital. This could be considered to contribute to the lack of recognition of the value of this highly skilled and educated, but politically weak group,’ it added.

‘Nurses discriminated against because they are nurses’

Commenting on the findings, Dr Anderson told Nursing in Practice: ‘We found that preconceived ideas around gender, social class, age, race and ethnicity, and about nursing as a profession (and nursing in general practice specifically), and its relationship with medicine and management, intersected to maintain a lack [of] power which prevented the valuing and recognition of nurses as highly skilled and knowledgeable professionals.’

She added: ‘Nurses in general practice were not able to negotiate effectively, or contribute with parity, because they were discriminated against because they were nurses.

‘The perceptions that other professional groups, and society more broadly, held about nurses meant that they did not get the recognition they deserved.

‘This has led to devaluing of nursing in general practice and has applications to nursing more broadly.’

Dr Anderson said raising these issues to a ‘conscious level is the first step in challenging them’.

‘From this, structural and cultural level work to challenge these perceptions and misconceptions are required if the position of nursing in general practice, and consequently retention, are to be fully addressed for the benefit of patient care,’ she added.

A recent survey by Nursing in Practice found that only around a third of nurses and nursing staff working in general practice proactively try to negotiate their own pay rise every year.

The findings came as part of Nursing in Practice’s General practice nurse pay: A salary survey of the profession 2025 report – produced with our sister title Management in Practice – which provides exclusive data and analysis on the state of general practice nursing pay and conditions.