Practices must be given ‘ringfenced and direct’ funding for nurses, says report

GP practices should be given ‘ringfenced’ and direct funding to support the cost of employing practice nurses, a new major report has recommended.

A new white paper launched today by our publisher Cogora has urged the British Medical Association and the government to consider ‘central funding’ of all general practice staff, including nurses – with the money given directly to practices as part of the next contract negotiations.

The report, authored by Pulse editor-in-chief Jaimie Kaffash, is centred on the topic of general practice access and how this has become the major issue within health, heaping significant pressure on practice teams.

Based on a survey of more than 2,000 primary care professionals, including around 500 practice nurses, the report is being launched during an event at the Labour Party Conference this morning.

The paper found that the majority of the measures around good access are predominantly depending on systemic issues, such as funding, recruitment, deprivation and patient demographics.

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As part of this, the report explored the Additional Roles Reimbursement Scheme (ARRS) – used by primary care networks (PCNs) to employ general practice staff – and the issue of staff funding more widely.

It suggested there were issues with the ARRS scheme which meant it ‘might not have improved all aspects of access’ and that its current structure was sometimes problematic.

‘The structure of the scheme is an issue – ARRS staff are often shared across practices, which could dilute any improvement of access – while the scheme’s salary bands cause a problem, being too high or too low for some roles,’ it said.

The paper added: ‘There is a strong feeling among primary care staff that the ARRS funding would be more effective if given directly to practices, rather than to PCNs.’

Crucially, it recommended that the next GP contract should move away from the traditional ARRS model and ‘see staff costs ringfenced, with the money given directly to practices’.

It suggested this would enable ministers to increase funding to general practice ‘while removing the fear that this will be interpreted as a pay rise for individual GP partners’.

Under a directly funded staffing model, the Cogora paper said larger groups of practices ‘could still hire staff to work over a larger population, through PCNs or neighbourhoods’.

A separate and direct funding stream to support staffing costs – including that of practice nurses – has been long called for by the Royal College of Nursing (RCN) and more recently by the Institute of General Practice Management (IGPM).

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This is in part because many general practice nurses (GPNs) employed directly by GP practices have missed out on annual pay rises due to the complicated funding formula currently used and because this is not ringfenced for staffing costs. Concerns also continue to be raised around a lack of enhanced maternity, paternity or sick pay for practice nurses.

In February, the RCN accused the government of failing to address long-term pay disparities faced by GPNs by instead directing funding through the ARRS.

While practice nurses – who were previously excluded from the scheme – were added in April 2025, the RCN warned GPNs were not ‘additional roles’ but a ‘core part’ of the GPN workforce.

Importantly, over the summer, the government hinted to Nursing in Practice that a new GP contract, due before 2028, ‘could address’ practice nurse pay and conditions.

This followed concerns from England’s lead primary care nurse Louise Brady suggested an annual pay rise and above statutory terms and conditions should be delivered to GPNs nationally as part of the GP contract and that this ‘must be a priority for patient safety’.

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Nursing in Practice’s General practice nurse pay: A salary survey of the profession 2025 report – produced with our sister title Management in Practice in April 2025 – found that GPN pay lags behind the earnings of their hospital counterparts who have the benefit of being on Agenda for Change contracts, and that this was a ‘major barrier for practices in their efforts to recruit greater number of the profession’.

A previous Cogora white paper, focused on the general practice workforce, also revealed that GP practices across England were struggling to recruit much-needed nurses because they are unable to match salaries given elsewhere.

The paper also explored the negative effect the ARRS, and nurses’ exclusion from it, had had on the profession.