Dr Helen Anderson led a recent study about cultural and structural issues affecting the retention of nurses in general practice. Here she discusses the findings, and suggests how retention issues of nurses could be addressed.
Imagine working in a general practice where GP employers proactively rewarded nurses with pay, terms and conditions that matched their abilities as highly skilled and knowledgeable professionals? Where employers awarded nurses a pay rise without asking, because they recognised the work of nurses in general practice?
That would be great, wouldn’t it? And some practices do, but still more require nurses working in general practice to actively negotiate their pay terms and conditions on an individual basis. These negotiations are difficult for nurses for a number of reasons and requests are sometimes declined, despite the contribution nurses make.
Why is this important?
Pay and conditions, such as adequate sick and maternity pay and leave, are obviously central from a cost of living and wellbeing perspective, but in our recent study about retention of nurses working in general practice nurses also told us that recognition of their hard work and level of practice was an important factor in them feeling valued and a marker for professional respect. Having to justify a pay rise after completing extended training and education, or developing new services for patients, or new ways of working for practices, left them feeling devalued and unrecognised for the level of contribution they make. Furthermore, Nursing in Practice reported that half of GP nursing staff across the UK had not yet had a pay rise for 2024/25.
Related Article: General practice nurse pay: A salary survey of the profession 2025
Nurses told us that recognition of their hard work and level of practice was an important factor in them feeling valued and a marker for professional respect
While we know that finances are currently difficult in general practice, we also know that nurses working in general practice have always received less favourable terms and conditions than Trust employed counterparts, even when primary care was relatively well financed. The reasons for this are complex and we write about this in our up-and-coming paper around gender, social class, ethnicity and ageism underpinning issues related to retention.
So, what helps and hinders nurses to stay in general practice?
In our study, nurses told us several factors affected retention. They valued the variety and continuity of care in general practice and development of therapeutic relationships, as well as the complexity of their role and being able to provide holistic care. The also appreciated flexibility of working arrangements, lack of unsocial hours and opportunities to develop. These all supported retention.
Participants felt that care was being reduced to a series of tick boxes, and they were increasing expected to do more with less
However, participants felt that care was being reduced to a series of tick boxes, and they were increasing expected to do more with less. There were often also problems with development opportunities, such as difficulties getting placements, or being expected to learn in their own time. This negatively affected retention, as did the introduction of ARRS [Additional Role Reimbursements Scheme] roles and the increased development and expansion of support roles such as nursing associates and health care assistants which was felt to negatively impact on patient safety, reduce care to task-based competencies and devalue to registered general practice nurse role.
New roles were thought to be a cost saving for practices in a difficult financial climate, with nurses being expected to supervise those working in these roles. General practice nurses (GPNs) in our study also felt overlooked when compared to advanced nurse practitioners, who were often better paid and whose job description aligned more closely with GPs. GPNs felt they could only progress to a certain point and again that hindered retention.
Nurses in our study also did not feel that they were heard or had a seat at the decision-making table. They felt that lip service was paid to their views, and they felt their position in general practice was precarious and subject to change on the whim of their employers. This was partly due to lack of standardised HR procedures and policies, with employers seeming to devise policy off-the-hoof on a case-by-case basis.
Nurses felt they had to keep their head down and know how to ‘play the game’ because challenge could lead to negative consequences and sometimes bullying. Because of this they picked their battles, which usually meant they would stand up for patient care but paid less attention to their own needs. Participants also felt their professional associations did not adequately represent and stand up for them and this too left them in a precarious position.
Related Article: Practice managers pushing for separate funding stream for GPN pay rises
They felt their employers were ‘wilfully blind’ as to the level and nature of nursing’s contribution to general practice
As a consequence of all these factors, nurses reached ‘tipping points’ where they felt pushed to look for employment elsewhere and sometimes left general practice, and nursing, all together. They felt their employers were ‘wilfully blind’ as to the level and nature of nursing’s contribution to general practice.
Pay and conditions are an important factor in retention of nurses in general practice, and nurses ought to be recompensed appropriately. There are, however, additional issues that practices and employers should also address to retain this knowledgeable and highly skilled group of professionals: involve nurses in decision-making in a meaningful way and recognise the value of this to the practice; proactively acknowledge their worth rather than making nurses ‘prove’ it; support flexible working; less ‘taskification’ and devolving of work; support for continuing education and development; focus on the aspects of general practice that nurses value – continuity, variety, complexity and therapeutic relationships – in order for nurses to feel valued and seen.
Finally, let’s recognise the value of nurses in general practice, and not be ‘penny-wise but pound foolish’.
Helen Anderson is a registered nurse and research fellow working at the University of York and is a former general practice nurse and advanced nurse practitioner. Helen’s research focuses on healthcare workforces with a particular interest in primary care nursing workforces. She has led studies on the wellbeing of nurses in general practice during the Covid-19 pandemic, GenCo Study – wellbeing paper, the experiences of nurses in general practice using remote working GenCo Study – remote working paper, and has recently led a study about cultural and structural issues affecting retention of nurses in general practice GenRet Study Paper – Findings Overview
If this study and the comments here resonated with you, or you would like more information on the study, please contact Helen at [email protected]
Related Article: Welsh GP practices will be asked to confirm pay uplift is given to nurses
Reference
Anderson H, Brady L, Adamson J. Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice (GenRet): a qualitative interview study. BMC Prim. Care 26, 114 (2025). https://doi.org/10.1186/s12875-025-02813-1
