Hundreds of GPNs warn appointment times are only ‘sometimes adequate’ for safe care

Hundreds of general practice nurses (GPNs) believe patient appointment times are only ‘sometimes’ adequate for safe practice, according to a new report which spells out the additional time nurses feel they need for specific conditions.

The Queen’s Institute of Community Nursing’s (QICN) International Community Nursing Observatory (ICNO) has published a new report – General Practice Nursing Today – setting out a general practice workforce that is delivering ‘complex, high‑volume care under increasingly unsustainable conditions’.

Authored by Professor Alison Leary, former director of the observatory, and informed by a survey of just over 1,000 GPNs, the report found that only a third (32%) of respondents believed their appointment times were adequate to provide safe care to their own professional standards.

More than half (55.4%) said appointment times were ‘sometimes’ adequate and 12.7% did not believe their consultation times were adequate.

How much additional time do GPNs say they need?

GPNs were asked how much additional time they needed for specific appointments and results varied from an extra five minutes to as much as an additional 30 minutes in some cases.

Wound care was one of the areas of least concordance with time allocated – with nurses reporting needing between 15-30 minutes extra per appointment.

For chronic obstructive pulmonary disease (COPD), childhood immunisations and cardiovascular disease, GPNs reported needing an additional five to 10 minutes.

For diabetes care, GPNs felt an additional five minutes was needed, for asthma care an additional 10 minutes, and for travel health an extra five to 15 minutes.

Three-quarters of GPNs doing unpaid overtime

Overall, respondents recorded completing about 20 to 29 appointments per day on average, with long‑term condition management, results reviews, clinical procedures, and immunisation forming the largest components.

Over two-thirds (69.1%) said they only had ‘some’ time allocated to complete all their tasks in the day including handling samples, CPD, practice meetings, audits, and equipment/stock checks. A total of 12.9% said they did not have time allocated.

A potential consequence of this meant 77% of GPN respondents said they routinely undertook unpaid overtime, averaging 3.14 hours per week.

This is equivalent to an estimated 255,000 hours of unpaid labour annually across the national general practice nursing workforce in England.

GPNs recently spoke out about ‘routinely’ absorbing extra patients and workload amid a culture where care that extends ‘beyond safe and contracted boundaries’ is normalised at this year’s annual Royal College of Nursing (RCN) Congress in Liverpool.

Vice chair of the RCNs GPN Forum Penny Sibthorp warned many GPNs are starting early, finishing late and missing breaks to ‘keep up with an unmanageable workload’. Importantly, she stressed the ‘serious toll’ that these pressures and unpaid additional hours was taking on the profession’s mental health.

A recent Nursing in Practice report revealed that busy workloads in general practice mean that GPNs are working several hours above their contracted requirements every week. One nurse responding to our survey said ‘there is always more to do than hours to do it’, while another described supporting almost 150 patients every week to manage complex chronic conditions.

‘System failures and lost clinical time’

More widely, the QICN report highlighted ‘system failures, lack of protected time, and pay inequity’ contributing to ‘significant risks for workforce retention and patient safety’ within general practice nursing.

Those informing the report described ‘substantial clinical time lost’ due to IT failures, including incorrect or inappropriate appointment booking, lack of administrative support and platforms not being fit for purpose.

Clinical time was also being lost because of equipment failure and inadequate estates, the report said.

The research suggested that respondents estimated that 1,897.9 hours per week were spent on work that should not fall to them.

Report author Professor Leary said: ‘General practice nurses are delivering complex care at scale, often under significant pressure and with limited support.

‘This report shows the extent of that workload but also highlights how much valuable clinical time is being lost to system inefficiencies.

‘Without action, there is a real risk to both workforce sustainability and patient care.’

The report calls for investment, leadership development, standardised employment frameworks, and improved infrastructure to secure the future of general practice nursing in the UK.

GPNs working under ‘increasingly difficult conditions’

RCN’s professional lead for primary care Kim Ball added: ‘General practice nurses are central to the delivery of care in the community, particularly for people living with long-term conditions.

‘This report makes clear that they are working under increasingly difficult conditions, and that greater investment, support and recognition are needed to ensure the workforce can continue to deliver safe, high-quality care.’

Chief executive of QICN Steph Lawrence added: ‘These are highly skilled professionals delivering essential care, often in very challenging circumstances.

‘There is a clear need for consistent employment standards, improved infrastructure, and a stronger focus on workforce development to secure the future of general practice nursing.’