Some nurses ‘cannot afford’ to work in general practice

Practice nurses and a practice manager have placed a stark lens on the ‘inconsistent’ approach to nursing pay, as part of an exclusive Nursing in Practice conference.

Concerns were raised around the level of disparity faced by general practice nurses (GPNs) when it comes to their pay and it was discussed that, in some cases, ‘people just can’t afford to work in general practice’.

Speaking during a pay panel discussion at a Nursing in Practice event in Birmingham last week, Peter Woodward, practice manager at Cheadle Medical Practice, described the current approach to pay in general practice as ‘very patchwork’ and ‘inconsistent’.

Mr Woodward was joined on the panel by Dr Helen Anderson, registered nurse and research fellow at the University of York, and Sara Baldwin, clinical transformation lead and Royal College of Nursing (RCN) General Practice Nursing (GPN) Forum member.

He said that the approach to pay in general practice was ‘to everybody’s detriment at the end of the day, but certainly everybody in this room as well’.

‘A lot of the time when these calculations are made as well, they’re based on some quite outdated assumptions about how general practice works.’

And he pointed to the disparity between pay for nurses and doctors.

As part of the 2025/26 pay review process, the government accepted a 4% uplift for GPs and a 4% uplift to the pay element of the GP contract.

It is understood that this should be passed on to uplift the pay of GPNs and other employed practice staff by 4%, but this has not always been the case for many GPNs in recent years.

Related Article: Three-quarters of public say nurses should be paid more

The government has also been recently criticised by the Royal College of Nursing (RCN) for its lack of ‘clear messages’ around the pay uplift for GPNs this year.

Separately, nurses on Agenda for Change contracts – which largely covers those working for the NHS – have been given a 3.6% pay rise for 2025/26. It is understood that a 3.6% pay rise should also be applicable to additional roles reimbursement scheme (ARRS) staff in GP practices, but there has not been any additional funding confirmed to support this.

Speaking during the panel session, Mr Woodward said: ‘From my perspective, there isn’t really a clear and obvious reason why, for instance, the recommendation on pay for doctors is different to the recommendation on pay for nurses, but even for a whole host of other roles within general practice as well.

‘What you’ve got is a very patchwork, inconsistent approach across all of those things.’

How to advocate for a higher wage?

Demonstrating where the money to fund a higher wage could come from can ‘really help’ when advocating for a pay change, Mr Woodward told conference attendees.

‘For instance, if a nurse could upskill in areas such as minor surgery, minor illness, coils – these kinds of things – there are specific monetary values attached to each of these that can increase the practice’s outcome,’ he suggested.

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.

Nurses need to feel valued

Dr Anderson said giving nurses appropriate pay was key for retention and also for ensuring nurses feel ‘valued’ and ‘respected’ in their profession.

She stressed that nurses need higher pay to keep up with the cost-of-living crisis and that ‘some people just can’t afford to work in general practice’.

Nurses need ‘remuneration commensurate with the level of practice and the knowledge and skills’ that they have, she added.

Appropriate pay is also seen as a ‘mark of professional respect’ because if nurses’ level of practice was ‘recognised and acknowledged, then the employers would be compelled to pay them appropriately’.

Dr Anderson recently completed a study alongside Dr Joy Adamson and NHS England’s primary care nursing lead Louise Brady which heard from nurses warning of a ‘deprofessionalisation agenda’ and increasingly precarious position in primary care. 

The findings revealed that GPNs have ‘very little experience’ of negotiating pay and conditions and didn’t want to ‘cause tensions’ with their employers, Dr Anderson said.

She suggested nurses wanted to prioritise their patients and not ‘ask for too much’ from employers who were also ‘under strain’.

Related Article: ‘Record’ NHS investment unveiled in government spending review

‘But actually we’re really valuable and knowledgeable and skilled people,’ she added.

When asked why nurses stay in general practice despite poor conditions, Dr Anderson said it was ‘difficult’ for nurses to leave primary care, especially if they have chosen their role to balance alongside wider caring responsibilities and the need to be based in a specific local area.

‘And employers know this,’ she noted.

Doing more with less 

Dr Anderson’s concerns were shared by Ms Baldwin who said she was seeing an unprecedented level of disappointment among GPNs.

‘I’ve worked in general practice for 20 years. I have never seen or felt the level of dissatisfaction and sadness within nursing across the whole of the country,’ Ms Baldwin warned.

She described how nurses were having to do more work with less pay, and said this ‘breeds resentment’ and ‘upset’ within the role.

‘Unless the GP partners actually embrace the fact that they are dealing with highly clinically sound and autonomous practitioners, then they’re going to keep losing more and more [nurses],’ said Ms Baldwin.

‘We’ve been haemorrhaging staff for the last five years from primary care, and it’s desperate to see that happen.’

Given the scale of challenges GPNS are facing, Ms Baldwin said nurses should be ‘proud’ that they are still ‘fighting forward’.

‘If we go, general practice and primary care will fall apart,’ she concluded.

Related Article: NHS nurses to ‘give verdict’ on 3.6% pay uplift

Last month, the Institute of General Practice Management urged the government to create a separate pay pot for general practice to ensure GPNs and other staff receive pay rises equivalent to their NHS counterparts.