GPN pay: A reflection on the last 12 months

Kicking off 2024, the then Conservative Government announced on 11 January it was consulting on the ‘risks and benefits’ of a separate pay spine for NHS nurses in England – excluding GPNs.

Questions were quickly raised over what a potential new pay structure for nurses working in the NHS would mean for those in primary care, and sparked fresh calls for ‘fair pay’ for GPNs.

Later in the month, a report from the Queen’s Nursing Institute (QNI) warned almost half of GPNs were being expected to provide education and supervision for staff employed under the Additional Roles Reimbursement Scheme (ARRS), despite, in many cases, being paid less and given fewer development opportunities.

The research warned the ARRS – which provides funding for primary care networks (PCNs) to employ some roles, including nursing associates – was leaving GPNs feeling ‘pushed out’ and at risk of ‘disappearing’ altogether.

‘GPNs were expected to support and supervise ARRS colleagues, for lower pay,’ the report said.

‘They also had less access to developmental opportunities and paid time for learning compared to ARRS colleagues.’

On 1 February we reported calls on then prime minister Rishi Sunak to ensure GPNs in England received ‘the pay rise they were promised’, amid ongoing concerns that many GPNs had not received a 6% rise for 2023/24 as pledged by the government.

Just a week later the RCN revealed 44% of GP nursing staff in England did not receive any pay rise in 2023.

The survey of almost 1,500 nursing staff employed by GP practices found more than three-quarters (77%) did not receive the full 6%.

Later that month, the RCN announced it was working to ‘find allies’ across primary care as part of its ongoing fight to secure better pay for GPNs.

RCN director for England, Patricia Marquis, said the union was looking to work with GPs, local medical committees (LMCs) and chief nurses in integrated care boards (ICBs) to create a ‘collective narrative’ around nurse pay.

In March 2024, ministers were accused of ‘passing the buck’ over GPN pay funding gaps.

Dame Andrea Leadsom, who was primary care minister at the time, reiterated that the government expected all practices to pass on a 6% pay rise to GPNs and insisted that the government values the GP nursing workforce ‘hugely’.

However, RCN director for England Patricia Marquis responded by accusing ministers of ‘repeatedly failing to understand or address’ problems faced by GPNs.

‘There is a significant gap between the value ministers say primary care has in our communities and how general practice is funded,’ Ms Marquis said.

Attention then shifted to the 2024/25 pay round in April, as unions and key stakeholders began submitting evidence to the independent pay review bodies for GPs (and general practice staff) and the NHS.

At the time, NHS England warned against a pay increase above 2% for GPNs and other practice staff for 2024/25.

In its evidence to the Review Body on Doctors’ and Dentists Remuneration (DDRB), NHS England advised that any pay awards higher than the funding settlement from the Treasury will ‘put further pressure’ on the NHS budget.

This could impact on ‘staffing numbers’ and delivery of NHS activity or ‘service improvements’, the national commissioner warned.

After news of a UK general election broke in May, the RCN began working on its calls and priorities for candidates and parties.

The college stressed that nurse pay and patient safety must be ‘central’ to the election debate in the weeks that followed.

And excitingly, May 29 saw the publication of our Nursing in Practice roundtable – discussing challenges around employment terms and workforce for GPNs drawn from the GPN Manifesto 2024.

Our exclusive roundtable event heard from GPNs who agreed that some form of standardised pay guidance, in line with competencies, was required to help stamp out discrepancies and inequities across the profession.

Some argued that being employed independently meant they had been able to negotiate their pay to their advantage, though it was also recognised that not all GPNs had the confidence to do this.

The GPNs also stressed employment terms, including sick and maternity pay, were not in line with that typically offered in secondary care.

At the beginning of June, the RCN launched its general election manifesto, with calls for a ‘substantial’ pay rise for all nursing staff among its key policy demands.

Later in the month, the BMA urged practice nurses to be part of the ‘discussion’ and ‘solution’ in its campaign for improved funding for general practice. This came as the BMA organised a GP vote for collective action – which was passed later in the summer.

Meanwhile, an exclusive survey of almost 200 nursing staff saw calls for GPN recruitment and improved pay to be at the top of the new government’s priorities.

With a new Labour Government elected, July became a big month for pay news.

It started with the RCN exclusively revealing its campaign for GPNs to have their pay and conditions in line with those working in the NHS ‘as a minimum’.

Towards the end of the month, it was announced that the government had accepted recommendations of the NHS Pay Review Body to award NHS staff on Agenda for Change (AfC) contracts in England a 5.5% pay rise for 2024/25.

And in an immediate response, the RCN committed to making ‘urgent representations’ to ensure GPNs were given a pay rise in line with the 5.5% announced for those working in the NHS.

The next day, it was confirmed that an uplift to the GP contract this year should be used to cover a 6% pay rise for GPNs in England.

The government had accepted the recommendations of the DDRB to give a 6% uplift to all GPs, both salaried and partners. It added that the pay element of the GP contract would be increased by 6% on a consolidated basis – made up of a 4% increase on top of the 2% interim uplift in April.

And it was then confirmed that this award is intended to also cover a 6% increase for salaried practice staff, including GPNs.

GPNs were quick to rightly raise concerns and questions over whether they would or would not receive a pay rise this year – following confirmation that the 6% uplift to the GP contract should be used to increase the salaries of GPNs.

At the start of August, those among the profession in England warned practice nurse pay was ‘broken and in need of an overhaul’.

But the next day, NHS England doubled down and said it ‘firmly’ expects GP partners to award practice nurses and other practice staff a full 6% pay rise.

Later in the month, the government confirmed it would increase funding for general practice in England – known as the global sum – by 7% to fund pay rises for GPNs and other practice staff. But concerns continued around whether this will be enough to fund the 6% rise recommended.

Following big pay updates from ministers in the summer, Nursing in Practice launched its GPN Pay and Workforce Survey to father information and views from across the sector on all things pay, recruitment, training and job satisfaction.

Early findings were teased in the later months of the year, while more detailed data will be published in a full report produced with our sister tile Management in Practice in early 2025.

On the last day of the month, the government kickstarted the 2025/26 pay round, asking the independent pay review bodies for nurses and doctors to deliver their recommendations ‘at the earliest point’ to help speed up pay awards for the next financial year.

October saw more support for practice nurses from the BMA – with the publication of a blueprint which stressed that having more practice nurses in post and a ‘fair deal’ for the profession was essential to saving general practice.

And with ongoing concerns over GPN pay rises for 2024/25, the profession was urged to write to their employers asking for confirmation of a 6% pay rise. The RCN issued a template letter that GPNs could use to send to their GP practices to seek clarification on their pay.

In November, Nursing in Practice revealed that half of general practice nursing staff across the UK have not yet received a pay rise for 2024/25.

This was according to the findings of our survey, which also found that of those who have received an uplift this year, only around one in six (16%) were awarded the 6% recommended by the government in England.

Our survey of more than 550 nursing staff working in GP practices – including general practice nurses (GPNs), advanced nurse practitioners, nursing associates and others –added weight to ongoing concerns over poor pay and conditions.

GPNs told us they continued to feel ‘undervalued’ and that their pay had ‘fallen behind’ colleagues working in secondary care.

And in the final year of the month, news on pay and the ongoing fight for GPN pay rises – both for this year and next – have ramped up.

December 10 was a big day. It started with a joint statement from the RCN and BMA urging GP partners in England to pay their nursing staff a 6% pay uplift for 2024/25.

While recognising increasing costs and funding constraints, the unions said they are in agreement that nurses in general practice should be given ‘a fair pay settlement that rightly recognises their core and essential nursing role’.

That evening the government revealed its submissions to the pay review bodies for the 2025/26 pay round and announced it had planned for a pay rise of just 2.8% for nurses working in general practice and the NHS for the next financial year.

On 16 December, the BMA revealed its own submission to the pay review body, which included a call for GP practices to be given an adequate uplift to resolve nurse ‘pay erosion’ and support strong recruitment and retention of the profession. The BMA told the DDRB practices needed an ‘adequate resourcing uplift’ in 2025/26 that would ensure ‘staff pay awards and rising costs can be met in full’.

The same week, the RCN exclusively revealed to Nursing in Practice its own submission to the DDRB. It asked the pay review body to investigate the reasons why GPNs are not being given a pay rise and to ensure its future recommendations ‘expressly and explicitly’ include the nursing profession.

In its evidence submission, the RCN used the findings of our survey which showed the volume of GPNs without a pay rise for 2024/25 and that concerns over pay and feeling ‘undervalued’ were pushing GPNs to consider walking away from the sector.

The RCN said: ‘When looking across this financial year and the patterns demonstrated in the prior to financial years, it is clear the uplift that you recommended, that was intended to include other staff expenses including GPNs, is not being applied and distributed equitably by general practices in respect of our GPN members. This is unfair and inconsistent.

‘Whilst our GPNs spend their days delivering nursing care on behalf of the NHS, large numbers of those same staff now find themselves further away from the pay, terms and conditions of their peers who are directly employed in the NHS.

‘This is clearly unfair and unsustainable within the context of the wider health service and is likely to lead to more GPNs leaving general practice to seek more favourable employment and better pay elsewhere.’

And (at the time of writing this round-up), our last story of the year centred on pay was an interview with the RCN’s new professional lead for primary care who said fair pay and ring fenced funding were among her top priorities coming into the role.

In her first interview with Nursing in Practice since she took up the position in September, Kim Ball said she recognised the ‘precarious position’ general practice nursing was currently in and was committed to bringing a ‘renewed focus’ on the profession.

With GPN pay rises for 2023/24 and 2024/25 still not sorted, it begs the question of what will come in the 2025/26 pay round. The government says it has ‘set aside’ raises of 2.8%, and while the DDRB will make its recommendations next year, it will ultimately be in the government’s hands. And as we’ve seen from previous years, recommendations and government promises do not always bear fruit.

Look out for our exclusive pay report early next year with our sister title Management in Practice