2024’s 10-point manifesto for general practice nursing

Here are the 10 points of key priorities for general practice nursing for this year, forming a manifesto for the profession. 

We hear from many general practice nurses (GPNs) who aren’t happy with the direction of travel at their practices or the progress of the profession. So we asked 10 nurses to share their top priorities to create a manifesto for general practice nursing.

Workforce shortages, soaring patient demand, and pay and conditions that fall far short of those on offer to nurses working in secondary care are just some of the ongoing issues faced by GPNs.

Nurses, though, are developing new and innovative ways to respond to these challenges and improve patient care, from a one-stop health shop to tackle health inequalities, to a project to encourage more student nurse placements.

GPNs are making their own recommendations for tackling the difficulties in the sector. Here, within their contributions to the manifesto, nurses share the actions they believe could be taken by practices, PCNs, the wider NHS, the government – and GPNs themselves.

We know that this is only the start of the conversation about challenges in general practice – please join in and share your views if you can.

The ten points of the manifesto will be launched one by one, giving the opportunity for discussion on each point.

We will return to these important topics often during 2024.

Writer: Kathy Oxtoby

This manifesto point was championed by Rebecca Corneck

#1 IMPROVE EMPLOYMENT TERMS

‘The government should ensure general practice nurses have the same pay, terms and conditions as their secondary care colleagues’

Rebecca Corneck is a Queen’s Nurse and a director of general practice nursing for the Southeast London Workforce Development Hub. She also works in general practice one day a week, specialising in diabetes. She is passionate about the inequity of GPN pay, terms and conditions compared with nurses in NHS organisations.

Ms Corneck was one of a group of nurses who wrote to their PCN last year to ask that it mirror the maternity leave conditions received by GP colleagues – a request that has since been met. But there are many more GPNs across the country who only get statutory maternity leave or sick leave – who are only able to take the bare minimum amount of leave, and whose salary is far below that of nurses doing the same work.

GPN pay, terms and conditions ‘is a postcode lottery’, says Ms Corneck. ‘Some practices, for example, pay some nurses £19 an hour, while others pay £12 an hour – so there are massive disparities.’

This is having a major impact on GPN recruitment and retention, she warns. ‘There are nurses who’d love to come into general practice, but simply can’t afford to.’

GPNs are specialist generalists and deserve the same pay, terms and conditions as secondary care colleagues, she says ‘GPNs are very skilled – they see patients from birth to death and play an integral role in their lives.

‘They need recognition, and the security of knowing they are recognised in Agenda for Change terms and conditions. And GPNs need to fight for their worth.’

This manifesto point was championed by Joanna Vintis

#2 TAKE ACTION ON WORKFORCE

‘The NHS, practices, universities, and other stakeholders need to change the narrative, to encourage more nurses to choose general practice.’

Joanna Vintis, a general practice nurse for 13 years and lead nurse for Newcastle GP Services, a federation of GP practices in Newcastle, leads a pilot project to develop more student nurse placements within the city, encouraging more newly qualified nurses to consider primary care as a first-choice career destination.

As part of the project, Ms Vintis guides a cohort of nursing students through placements, and there are also opportunities for student-led clinics within practices.

The scheme is ‘changing how newly qualified nurses perceive general practice’, she says. ‘There’s a lack of exposure to general practice. I’m passionate about making sure students see the amazing career we have. It’s a joy seeing a cohort of students fall in love with practice nursing.

Ms Vintis also supports all those working in nursing teams in general practice in Newcastle, including with career development advice and mentoring. ‘A big problem for a lot of our new nurses was that access to training and support varied from practice to practice.’

To attract more nurses into general practice, and to retain them, ‘we need to raise the nursing voice, and make sure we’re part of the conversation’, she says.
‘I also speak at universities and go to career events to raise the profile of practice nursing.’

She wants universities to ensure general practice nursing is included in curricula, and for practices to be given more remuneration for hosting student nurses.

 It’s important that people ‘understand what general practice nursing is about’, she says. ‘If GPNs felt valued and recognised we wouldn’t lose them.’

And GPNs need to ‘open their door to learners’. ‘If we can change the culture – even just allowing a student into a clinic for half a day to see what GPNs do – we’d see a huge difference in recruitment.’

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This manifesto point was championed by Rebecca Shearer

#3 TACKLE INEQUALITIES

‘Practices, PCNs, the NHS, and government, should do more to promote the health of our less well-off families.’

Rebecca Shearer, lead nurse and ANP at West Road Medical Centre in Newcastle, and a Queen’s Nurse, has been providing a ‘one-stop health shop’ from a local foodbank-turned welfare hub, as part of her ongoing drive to tackle health inequalities.

‘People can drop in to discuss any aspect of health, including family health,’ says Ms Shearer. ‘A lot of my work is around respiratory conditions and going back to basics with patient education, such as using inhalers properly and smoking cessation advice.’

Without the time limits of general practice consultations, Ms Shearer can ‘deliver key health messages in a more relaxed environment’. She feels the scheme has been ‘really making a difference’.

The work is part of a project she is leading on health inequalities, funded by the Queen’s Nursing Institute.

Using that funding, she set up an initiative to help patients with long-term conditions better understand their annual results letter. Many do not have English as a first language, so she made the letter more accessible, cutting back on written text and adding images.

Ms Shearer underlines the importance of tackling inequalities: ‘If people don’t understand their conditions this can result in A&E presentations, and outcomes won’t improve if we don’t address social issues,’ she says.

And all practices can do more to address inequalities. ‘For example, by investing time in patients the first time you meet them, you could save on frequent contacts over the coming months. And through patient education you can improve health outcomes,’ she adds.

It’s important for GPNs to share with others the work they are doing in this area. ‘I’ve learned that innovation projects can provide an opportunity for collaborative working,’ she says. ‘So, shout about what you are doing. There will be others with similar interests, so join forces and tackle health inequalities together.’

This manifesto point was championed by Jenny Aston

#4 REINSTATE TIME FOR LONG-TERM CONDITIONS

‘Practices and PCNs need to free up time for GPNs to empower patients to manage their long-term conditions, including diabetes, asthma and COPD.’

Nurses are ‘very innovative, and there are many different approaches to supporting patients in managing their long-term conditions’, says Jenny Aston, advanced nurse practitioner (ANP) at Granta Medical Practices, Cambridgeshire, and a Queen’s Nurse.

Ms Aston has set up group consultation clinics for patients with diabetes, to help them better understand and manage their condition. She says these group clinics show ‘the power of patients in a group being guided by a facilitator and then having their own questions and concerns addressed by a clinical expert’.

‘Patients say the consultations are helpful, that they understand more about their condition, and don’t feel so alone.’

She also believes GPNs are well placed to offer holistic, person-centred guidance to patients about managing long-term conditions. ‘A well-trained, experienced GPN will have a rounded approach to helping patients with asthma, for example.

‘And if GPNs can manage long-term conditions well there will also be fewer patients in A&E because their condition has not got out of control,’ she notes.

But Ms Aston says time pressures can make it challenging to deliver this care and support. Practices and PCNs ‘need to acknowledge that you need enough time to deliver patient-centred care to help patients manage long-term conditions’, she says. GPNs ‘need to be involved in planning the appropriate types and length of clinic appointments to benefit patients’.

She adds that nurses require ‘appropriate training and regular updates’ to manage long-term conditions, as well as to ‘understand and deliver individualised, patient-centred care’.

This manifesto point was championed by Julie Roye

#5 PRIORITISE HEALTH PROMOTION

‘NHS England, PCNs and GP practices should ensure GPNs have the time and resources to carry out their crucial role in public health promotion and disease prevention.’

Julie Roye, head of nursing for primary care at the East London NHS Foundation Trust, and a Queen’s Nurse, has brought together a multidisciplinary team, admin staff and population health leads to co-develop improvements to cervical screening uptake in a diverse patient population.

Ms Roye has recruited more nurses, opened evening sessions in response to feedback, enabled women to book their preferred appointment time and nurse via a text link – increasing their autonomy – and made sure texts and letters are delivered in appropriate languages for non-fluent English speakers. She has also ensured inclusivity for trans men and non-binary people.

Just nine months after the scheme started in August 2022 at Cauldwell Medical Centre in Bedford, uptake among 25- to 64-year-olds had increased from 52% to 80%.

Ms Roye’s efforts – which earned her a national award in 2023 – show the powerful impact nursing can have on health promotion and disease prevention.

‘Nurses are well placed to do this work,’ she says. ‘They have such an influential voice – and the power to change health outcomes for patients. For example, they can help people with diabetes and hypertension to manage their condition by advising on diet and exercise.’

‘It also means a lot to patients when nurses take time to talk about how to change and improve their health.’

But Ms Roye cautions: ‘GPNs need the time and resources to make sure health promotion and disease prevention isn’t forgotten.’ And it is vital they feel ‘appreciated, cared for and valued’, she says. ‘Your skills are important. You’re improving outcomes and going above and beyond to make a difference for patients.’

This manifesto point was championed by Dr Helen Anderson

#6 SUPPORT WELLBEING

‘GPN employers, PCNs and nursing bodies need to support nurses with their health and care, so they can care for others.’

Dr Helen Anderson RN, research fellow at the University of York, and previously a GPN and ANP, recently led a study on the experiences of nurses working in general practice during the Covid-19 pandemic. The work has a particular focus on nurses’ health and wellbeing – an area she feels strongly about.

Analysis of the study’s findings was based on a report in 2020 by The King’s Fund, whose premise was that for nurses’ wellbeing needs to be met, they need to experience autonomy and a sense of belonging, and to feel they are making a valuable contribution – ‘all needs that were challenged by the pandemic’, says Dr Anderson. Many of the nurses she spoke to said that even before the pandemic they felt ‘invisible’.

Workload ‘significantly increased over the pandemic, and seems not to have subsided’, she says. ‘Even those working 30 years or more in general practice are saying they’ve never seen the level and complexity of this workload before.

‘As a consequence, nurses are suffering from anxiety, stress, and burnout, and some are leaving the profession.’

Dr Anderson wants GPNs included in higher-level decision making. Employers and practice managers need to remunerate them appropriately, she says, and general practice colleagues and the public need to be more aware of the highly skilled work they do.

‘Their role is often overlooked, which is not good for anyone’s wellbeing or, ultimately, for the future of general practice nursing.’

‘We need to strategically consider how GPNs are to be supported,’ she says. ‘We’ve reached crisis point. If we lose more GPNs this is going to have a significantly negative impact on general practice. And these nurses will be sorely missed.’

This manifesto point was championed by Jenny Bostock

# 7 FOCUS ON PROFESSIONAL DEVELOPMENT

‘All nurses should be given the time for professional development to progress their careers. NHS England, PCNs and practices should encourage and support the GPN and ANP roles to grow in general practice.’

Historically, general practice nurses have had little or no opportunities for career progression. But all that is changing. ‘Now there are career pathways for GPNs where they can increase their knowledge, skills and training,’ says Jenny Bostock, a clinical director at Ramsgate PCN, an ANP at Dashwood Medical Centre in the town and a Queen’s Nurse.

She says many practice nurses ‘want to develop their role and to become, for example, ANPs, or nurses specialising in a particular chronic disease’.

But she says those who choose a career in practice nursing can feel isolated. Particularly for those new to the profession, a lack of support can be ‘a big issue’.

‘It’s important they feel supported, and that if they have any issues, they are able to talk things through,’ Ms Bostock says.

ANPs do ‘complex work and may need support from a senior clinician if, for example, a patient presents with a condition that is not textbook clear’, she says. Without such support, ‘ANPs can’t increase their scope of practice’.

The business needs of practices can prevent GPNs carving a career pathway of their choice, Ms Bostock says. For example, if a practice has two nurses in respiratory care, a third may not be required. To help address this, she says, ‘practices within PCNs need to work together to share staff resources’. This would allow nurses to develop their skills across practices, rather than be restricted by the needs of a single surgery.

‘General practice is great for career development,’ she says. ‘But nurses need support and time for training, and those who enter general practice should be encouraged to put themselves forward for leadership positions to help to shape and develop general practice nursing.’

This manifesto point was championed by Georgina Callard

#8 ADDRESS MENTAL HEALTH

‘It is important for general practice nurses to consider parity of esteem – valuing the patients’ mental health needs equally to their physical health.’

A mental health nurse for 20 years, Georgina Callard had always worked in secondary care. But since 2018, Ms Callard, a Queen’s Nurse and a professional nurse advocate, has been based in general practice in Northamptonshire.

She sees adults experiencing the full range of mental health issues, such as anxiety, depression, psychosis and mania, and suicidal ideation. GPNs refer patients to Ms Callard and signpost their concerns to her. Equally, she refers patients to GPNs at the practice to look at physical health needs such as asthma reviews.

Ms Callard has provided refresher training to GPNs at the practice on mental health issues, and nurses can seek her advice about their patients’ mental health.

Her role helps to ensure patients receive an early diagnosis. Feedback from the local mental health team is that referrals to secondary care have reduced since she joined the practice.

Feedback from GPNs and patients at the practice has also been positive, she says. ‘Patients appreciate there is someone there for their mental health issues, and nurses appreciate they have a practitioner they can refer patients to relatively quickly.’

She says it’s equally important for GPNs to consider patients’ mental health as their physical health. ‘Our mental health and physical health go hand in hand. For example, when people are anxious it can impact on their physical health.’

She acknowledges that ‘time, workload pressures and confidence’ can be barriers to considering patients’ mental health needs. But she says it’s important for GPNs to have the knowledge and understanding to signpost patients experiencing mental health issues to the right support, and that basic mental health training can help.

‘And it’s also about GPNs feeling confident to ask patients, “Are you OK?” “What can I do to help?”.’

This manifesto point was championed by Hina Shah

#9 TARGET IMMUNISATION UPTAKE

‘GPNs need to play an important role in overturning the decline in childhood immunisations uptake.’

Uptake of child immunisations is declining, with vaccine hesitancy, particularly post pandemic, and inequality of access among the reasons for this trend.

GPNs can play a key role in reversing this decline. For Hina Shah, a GPN and lead nurse in immunisations for Spinney Hill Medical Centre in Leicester, getting to the heart of why vaccination appointments were being ignored or refused has helped boost uptake.

In just five months – between April and September 2021 – Ms Shah and her colleagues cut the practice’s child immunisation target list from 330 to zero.

To achieve this, locum nurse support has been extended to make vaccination appointment times more family friendly and to increase access to the service. Parents who decline vaccine appointments several times are contacted by the practice team and are offered face-to-face appointments, at which Ms Shah can address their concerns and reassure and educate them about the benefits of vaccinating their children.

She believes it’s vital that GPNs work to address the decline in childhood immunisations uptake. ‘Many diseases can be prevented by vaccinations. If we don’t overturn this decline, children are potentially at greater risk of diseases, and there will also be an impact on healthcare, including secondary care.’

GPNs ‘can make a real difference to improving uptake’, says Ms Shah. ‘But they need to be persistent and, if necessary, put in the extra effort and make that extra call, to find out why parents are refusing immunisation for their children.’

This manifesto point was championed by Sara Baldwin

#10 ADAPT TO DIGITAL HEALTH

‘General practice needs to continue to evolve to serve patients better, adopting approved digital platforms and applications to improve patient care and outcomes.’

Sara Baldwin is a general practice nurse manager, co-chair of the primary care nursing shared professional decision-making council, an advanced clinical practice champion and a Queen’s Nurse. For the last two years she was also digital place lead for central Lancashire – one of five leads across Lancashire and South Cumbria.

Working across 194 practices, the digital place leads brought in a local intranet, introduced video group consultations and training, and installed a digital champion in every practice to help enable necessary changes. They implemented ‘front door’ triage with different platforms, increased the use of digital learning solutions to identify IT skills gaps in the workforce, and supported practices to ensure their websites complied with data regulations, increasing compliance from 21% to 92%. They increased the use of apps among practices and the number of practitioners signposting patients to apps for support with healthcare needs.

Ms Baldwin says the digital place project has received ‘a lot of positive feedback’, and shows primary care has ‘an enormous appetite to use IT in a really beneficial way’.

She says IT and digital in general practice can improve patient outcomes and help general practice deal with growing demand. ‘We’re working at a higher rate than ever, in more trying circumstances, and digital is helping meet those challenges.’

People can find initially digital daunting ‘because it’s new and challenging’, she says. ‘But if you are part of the conversation right from the beginning when you’re trying to embed digital, and you’ve had support, the whole process becomes easier, and people are more accepting of it.’

It’s important for all practices to embrace digital technologies, she says. ‘Digital is going to keep growing within general practice. But if staff are to keep up to speed with these changes, there needs to be training and support.’

Look out for Nursing in Practice’s ongoing series of roundtable discussions with nurses, based on the manifesto points.