Nurses in general practice continue to face unfairness, injustice and devaluing

Dr Helen Anderson reflects on the recent findings of a Nursing in Practice report focused on practice nurse pay, terms and conditions, and how this mirrors recent research she has carried out. Importantly, she considers what the findings could mean for the future of general practice nursing.

Research carried out by myself and colleagues following the Covid-19 outbreak suggested nurses working in general practice experienced significant negative challenges to their wellbeing during the pandemic, and they felt they were treated poorly, which consequently impacted on patient care, intention to quit and retention.

Concerningly, the new Nursing in Practice General practice nurse pay: A salary survey of the profession 2026 report indicates that these issues continue to remain problematic for nurses employed in general practice.

Our studies used West et al’s framework of core work needs – autonomy, belonging and contribution – that was found to promote nurse wellbeing and enable nurses to flourish. ‘Autonomy’ relates to justice and fairness, as well as working conditions and schedules, while ‘belonging’ points to feeling valued and ‘contribution’ focuses on workload.

It’s interesting to also map how Nursing in Practice’s findings relate to these core work needs.

Related Article: ‘Practices can’t commit to a pay rise for nurses that they can’t afford’

Autonomy and belonging

In Nursing in Practice‘s report, the average full-time salary of a general practice nurse is £35,884 and more than a third (34%) of nurses employed in general practice did not receive a pay rise for 2025/26. Of those who did, the average pay rise was less than 3% (2.76%). Significantly, this is below the 4% government recommended pay rise.

This follows a pattern of recent years. In our studies, nurses reported feeling that employers actively did not want to pay them what they were worth, and this directly influenced their intention to quit. One nurse said that even if they did receive a pay rise in line with government recommendations: ‘I’d still get underpaid’. They added: ‘I don’t feel valued at all… I will not be going anywhere close to primary care unless there is [improved] pay and conditions.’ Participants did not feel they were treated fairly or that they were valued.

The Nursing in Practice report also found that only 11% of nurses surveyed were on Agenda for Change terms and conditions. Some 32% received above statutory sick pay and only 5% reported receiving above statutory maternity pay. This perceived unfairness was reflected in our studies with one participant stating: ‘Practice nurses are treated inequitably to all other members of staff in NHS… and frankly it’s not good enough.’

We also found inequity occurred between nurses and those employed under the Additional Roles Reimbursement Scheme. This led to a sense of injustice and the misalignment of another of West et al’s core needs; feeling valued. One participant said: ‘[A paramedic] told me how much he was going to make… more than the nurses were on…you do feel a bit like “you’re not valuing me, what I’m doing here?”.’

In our studies, pay, terms and conditions were intrinsically linked to feeling valued. As one nurse puts it: ‘[You] don’t even get offered a pay rise. You’re doing this massive important role, and you get very little recognition.’

Participants felt their skill and level of practice went unrecognised and this negatively impacted recruitment and retention. This is again reflected in the Nursing in Practice report findings. Almost a third (32%) of nurses said they were considering quitting in the next year – largely because they felt their pay is not keeping in line with the cost of living (60%) or because they felt their pay doesn’t reflect their responsibilities and workload (57%). Concerningly, a further 43% of those wanting to leave cited feeling undervalued in their job.

In our studies, pay, terms and conditions were also seen as both financially important in a cost-of-living crisis, and as a marker of professional respect. Despite this, participants often stressed that, as nurses, pay was not their first priority.

Some felt that negotiating for more money, or better employment terms and conditions, was contrary to their professional nursing identity, but this left them feeling that their worth was not recognised. ‘Money has never been a driver for me as a nurse. As long as I can live to my means… it didn’t bother me until I started to feel like it was being taken advantage of,’ said one participant.

Related Article: ‘Person-centred care must never mean placing GPNs in unsafe situations’

However, this potentially has serious long-term consequences, with nurses not feeling able to negotiate effectively and sometimes having to forsake longer term benefits for shorter term needs. For example, in the Nursing in Practice report, 7% opted out of a workplace pension scheme, either because they could not afford the contributions or because they wanted to have the money to spend now. As one nurse leader in our study warned, poor pay, terms and conditions, and problematic pension issues, had serious repercussions for their future for nurses in general practice: ‘[They] are the people that are going to be living in poverty in retirement, it’s terrible.’

As well as poor pay and terms and conditions, such as maternity and sick pay, and pension issues, nurses in our studies often faced other inequities and unfairness. For example, some discussed not having access to wellbeing support such as daily huddles and clinical meetings, and feeling as if ‘our mental health doesn’t matter’. This reflects 22% of respondents in the Nursing in Practice survey who did not have access to workplace mental health support, with a further 54% stating they have worked while feeling mentally unwell.

Contribution

In terms of West et al’s ‘contribution’ need, the majority (96.5%) of nurses surveyed in the Nursing in Practice report described their workload as intense and reported working on average three hours extra per week above their contracted hours.

For some nurses in our studies, workload and complexity had become intolerable and unsustainable, with one participant saying: ‘I’m working harder now than I’ve ever worked with 40 years plus of nursing.’ While others predicted a bleak future for the nursing profession: ‘Would I recommend someone to go into nursing?… It’s not safe out there now and, everyone I speak to, it feels endemic… and it makes me frightened for the future.’

Our studies, combined with the recent Nursing in Practice report confirms that, for a significant proportion of nurses working in general practice, their wellbeing needs are not being met.

Related Article: Top tips for nurses in general practice on how to negotiate a pay rise

Nurses in general practice continue to experience inequity, unfairness, injustice, devaluing, and poor working conditions.

West et al predict this has negative long-term consequences for the nursing profession and unless serious steps are taken to address these issues, the future of nursing in general practice could be severely challenged.

Dr Helen Anderson is a registered nurse and research fellow at the University of York