Analysis: Where is the focus on GPN retention?

It is often the case that a focus on recruitment to fill workforce gaps can mean efforts to retain GPNs are not given the same level of attention.

For example, funding has been given to support the introduction of additional nursing roles into practices, but at the same time national GPN retention and education schemes have been withdrawn.

We have reported how practices are struggling to recruit GPNs – largely because of poor pay and terms and conditions on offer.

And this latest analysis will explore the risk of GPNs walking away from the sector – and perhaps nursing altogether – for the very same reasons.

This article draws on the findings of our publisher Cogora’s General Practice Workforce Whitepaper which was launched in Parliament earlier this year.

A Nursing in Practice survey used in the whitepaper reveals as many as 28% of general practice nursing staff are considering leaving within the next 12 months. Completed by more than 500 nursing staff last year, concerns over pay and feeling undervalued were among the key reasons for this.

One advanced nurse practitioner says: ‘I’m not thinking, I am definitely leaving. Burn out, fatigue and no pay rise and lack of employer appreciation has made this decision.’ Another nursing respondent adds: ‘I’d love to stay where I am, but I just don’t feel my role is appreciated or understood and the pay is dreadful compared to the stress and levels of responsibility.’

Of those wanting to leave their role in general practice in the next year, the top five reasons were:

• Feeling undervalued in my job (68%)
• GPN pay in general is not keeping in line with cost of inflation (67%)
• Pay at my practice doesn’t reflect my responsibilities and workload (60%)
• Workload is too high (48%)
• Job is too stressful (45%)

And just under a quarter (24%) of those thinking about leaving say they plan to retire.

Looking slightly longer term, only one-third of general practice nursing staff say they plan to still be working in the sector in five years’ time. Meanwhile, 26% say they will be retired.

Some 6% say they will be working in a ‘different nursing role in the NHS’ and 7% say they plan to leave nursing altogether in this time.

Almost one in five (18%) GPNs say they are ‘unsatisfied’ in their role – with many citing staffing, pay and workload among the key issues. One practice nurse describes being ‘short staffed, on low wages and overworked’, while another warns of ‘a lack of support and heaving workload’.

‘There are so many constraints on time you feel that you cannot give the care patients truly deserve,’ says one GPNs. Another says: ‘The workload is increasing without any recognition of the impact of the nurse role in general practice.’

While the numbers seem more positive – with 62% of respondents saying they are ‘fairly’ or ‘very satisfied’ in their roles – the comments accompanying this are still rather negative, and again centre on pay.

As one practice nurse says: ‘The practice is very supportive and a great team. I feel able to progress in my career and complete training, but the pay does not match this. I feel we are pushed to improve our knowledge and skills with little reward through pay/conditions.’

Researchers from the University of York say there is a level of ‘precarity’ around general practice nursing that is impacting retention.

Dr Helen Anderson and Dr Joy Adamson, alongside NHS England’s primary care nursing lead Louise Brady, recently explored the cultural and structural issues impacting the retention of GPNs.

By interviewing 41 nursing staff within general practice, their findings mirror much of our survey results. This included a workforce that is feeling ‘undervalued’ and ‘pushed out’.

Researchers heard about a ‘reduction of care to tick box exercises and pressure from employers to do more with less’.

‘This contributed to what some saw as the commodification of nursing in general practice and the shift towards a deprofessionalisation agenda, which was considered to be negatively implicated in retention,’ the study, which has not yet been peer reviewed, says.

Our publisher Cogora has this year released its General Practice Workforce Whitepaper, which assesses the current workforce crises across the sector.

The report suggests that while there are ‘national plans’ to improve retention for all primary care staff, they ‘fall short’. And it warns that ‘moves to improve retention will fail if the day-to-day work in general practice is not improved, yet this can only be remedied through an expansion in the workforce.’

It points to the 2023 NHS Long Term Workforce Plan which was ‘aimed at making the NHS more inclusive for the high percentage of staff who are overseas graduates, or strengthening staff’s freedom to speak up’.

‘Laudable though these initiatives are, they largely targeted the NHS as an employer – which, in general practice, it is not,’ the whitepaper says.

‘For example, an emphasis on the ‘freedom to speak out’ is very different for small organisations like general practices compared with the wider NHS as an employer. These measures do not appear to have been developed with the important goal in mind of stemming the flow of leavers from general practice.’

For nurses, the whitepaper suggests ‘the situation is bleaker’. It points to cuts made by NHS England in 2024 for a national fellowship scheme designed to improve retention. Under the move, funding for GPN fellowships and associated programmes no longer come centrally from NHS England and are instead at the discretion of integrated care boards (ICBs) as to whether these schemes continue.

At the time, Queen’s Nursing Institute chief executive Dr Crystal Oldman said: ‘There is a plethora of evidence of the benefits of the GPN fellowship in recruiting and retaining registered nurses in general practice, which should make continuing the funding via an ICB irresistible to the commissioners.’

Our survey findings alone paint a picture of a workforce feeling undervalued, underpaid and overworked. It’s clear policy makers, leaders and stakeholders need to take action to reinstate programmes to support the retention of GPNs and to ensure they are paid fairly – especially with so many looking to leave.

One thing set to change in the coming months is that both GPNs and newly-qualified GPs will be included in the ARRS in 2025/26 – a scheme used by primary care networks (PCNs) to fund the salaries of some practice staff.

For nurses, it is limited to those who have not held a previous post in their current PCN or any other member practices, in the last 12 months.

But it’s unclear whether the addition of GPNs will be a good or a bad thing for retention or recruitment.

While some say it’s a ‘small step change’ for the profession, others are concerned it could ‘destabilise’ the workforce and ‘deplete’ practices of nurses altogether.