Unpaid hours ‘normalised’ in general practice nursing

General practice nurses (GPNs) are ‘routinely’ absorbing extra patients and workload amid a culture where care that extends ‘beyond safe and contracted boundaries’ is normalised, a leader among the profession has warned.

Vice chair of the Royal College of Nursing (RCN) GPN Forum Penny Sibthorp took to the stand at this year’s RCN Congress in Liverpool to join a discussion on unpaid hours.

She 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.

‘There’s a culture within general practice nursing of normalising work that extends beyond safe and contracted boundaries,’ said Ms Sibthorp.

‘Nurses are routinely absorbing extra patients into already full clinics under pressure from reception teams, clinical colleagues, management, relatives, or the patient themselves the familiar “while I’m just here, could you” becoming an expectation rather than an exception.’

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She added: ‘Breaks are shortened or missed altogether. Meetings are squeezed into lunch hours. Many nurses start early and stay late simply to keep up with an unmanageable workload.’

In addition, mandatory training, CPD, and service updates are ‘increasingly completed in personal time or even annual leave, because protected learning time no longer exists in practice’.

GPNs are also ‘expected to cover sickness and staffing gaps without any realistic adjustment to workload or recognition of the clinical risks involved’, added Ms Sibthorp.

For nurses working in lead or management positions, ‘the pressures can continue long after the working day ends’.

‘Emails received late into the evening, days off interrupted for ‘quick calls’ or meetings, and being constantly available becomes normalised over time,’ she said.

Ms Sibthorp warned that if unpaid work continued to be normalised ‘we risk both losing our workforce and the quality of care our patients deserve’.

She said the situation can take a ‘serious toll on mental well-being – contributing to chronic stress, emotional exhaustion, burnout, and guilt when boundaries are attempted’.

‘We must stop confusing dedication with limitless capacity, compassionate care cannot come at the expense of safe care,’ she added.

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.

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Other nurses also joined the discussion at RCN Congress, including one care home nurse, Ginikachukwu Oduah who warned of the challenges of being the only nurse on duty.

‘If anything happens as a care home nurse, you’re the only one there. If there’s an emergency, even if you’re on break, they have to call you out, and you have to handle the emergency to the end,’ she explained.

Ms Oduah added: ‘Missed breaks, staying late, coming in early, finishing documentation unpaid – what was once occasional has now become expected.

‘Nurses do this not because of anything, but because we care. But caring should not cost us our health, well-being, or personal time.’

She also warned of the risk of nurse fatigue, burnout, staff sickness and the potential for nurses to leave the profession altogether.

‘I’ve heard people say “I’m leaving bedside nursing because of the burnout and the stress”.

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‘We must stop normalising unpaid labour and feeling guilty around taking breaks or leaving on time.

‘If work cannot function without nurses working for free, then the problem is not the nurses, it’s in the system.’

On Monday, RCN Congress attendees voted to challenge the Nursing and Midwifery Council (NMC) on its annual registration fee rise, while RCN chief executive and general secretary Professor Nicola Ranger urged advanced nurses to ‘wear their title with pride’ amid controversial comments from the British Medical Association.