The Royal College of Nursing’s (RCN) new professional lead for primary care Kim Ball sits down with news editor Megan Ford to discuss her priorities coming into the role, the challenges ahead and her hopes for the future for general practice nursing
Exclusive Fair pay, ring fenced funding and greater leadership opportunities for general practice nurses (GPNs) are among the top priorities for the RCN’s new professional lead for primary care, Kim Ball.
In her first interview with Nursing in Practice since she took up the position in September, Ms Ball says she recognises the ‘precarious position’ general practice nursing is currently in and is committed to bringing a ‘renewed focus’ on the profession.
Ms Ball has 10 years of experience working as a registered nurse in general practice, including in a variety of clinical and leadership roles. She has previously also worked as an associate lecturer and nurse educator.
‘I’m really excited to be joining this role and want to bring a renewed focus on general practice nursing – it is something I am really passionate about,’ says Ms Ball.
Having spent most of her career in general practice, she says she has had a long-standing focus on improving working practices for GPNs, while ‘trying to raise the profile’ of the profession.
General practice nursing is in a ‘precarious position’
‘I think I’m coming in at a really critical time. I think general practice nursing is in a really precarious position at the moment, and has been for the past few years,’ she says.
‘We definitely get a sense from our members that it’s tough out there, and the kind of pressures that we saw building throughout Covid have remained, and those pressures have increased.
‘With nurses leaving the profession and more programmes of care being delivered at a practice level, it’s really important that we address some of the key issues that are affecting the recruitment and the retention of general practice nurses.’
A recent Nursing in Practice survey revealed more than a quarter of general practice nursing staff across the UK are considering leaving their role within the next 12 months. Our findings suggest concerns over pay and feeling ‘undervalued’ are to blame for GPNs wanting to walk away from primary care.
Ms Ball echoes concerns that many GPNs are feeling undervalued and warns of the risk of some feeling isolated in their roles.
‘I think there’s been a lot of change in general practice in terms of having more of a multidisciplinary team and nurses feel that they’re being excluded from discussions about service provision,’ she says.
‘They’re not being invited to have a seat at those appropriate tables, and whether that be on a very local practice level or as part of a wider sort of network or system approach, they’re just not getting the seat at those tables.’
She also warns that ‘it can be a very isolating role in general practice’.
‘That can be really tough to overcome, and will ultimately, if they don’t feel supported within their role, will also lead to them leaving,’ she adds.
‘Funding for nurse pay must be secured’
On top of this, Ms Ball says pay is a pressing factor – especially after a Nursing in Practice survey found that half of GP nursing staff in the UK have not yet received a pay rise for 2024/25.
At a recent RCN pay webinar, ‘there were lots of nurses talking about their experiences, of how undervalued they felt’, she adds.
‘It’s not all about pay, terms and conditions, but it definitely makes a difference in making them feel valued and fulfilled, and then motivated to keep working through these increasing demands,’ she says.
It is among the priorities of her team at the RCN to have pay and conditions for GPNs in line with Agenda for Change – typically received by NHS staff – as a minimum.
‘We want to see that there is equitable treatment for our nurses… to give them conditions that are equal to those working in secondary care, so that they don’t feel that if they want to start a family, or if they are concerned about their long-term health, that the financial constraints of being employed on a general practice contract are contributing to those reasons for leaving,’ says Ms Ball.
She also wants to see ‘ring-fenced funding’ for nurse pay rises in general practice, to ensure they are passed on by GP partners.
As revealed this week, the RCN has asked the independent pay review body for GPs to explore the reasons why many GPNs are not being given a pay rise and to ensure its future recommendations ‘expressly and explicitly’ include the nursing profession.
This year the government committed an extra £311m to help surgeries cover the extra cost of a 6% increase for employed general practice staff, including GPNs. The extra money was due to be paid to practices via the global sum in September.
In August, NHS England also made clear that it ‘firmly expected’ GP partners to use the income boost to fund a pay rise for practice staff in full, backdated to April 1.
It has been argued in the past that because of the complex funding system in place in general practice, some practices may receive enough to pass on a full 6% salary uplift, while others will not.
‘We want to make sure that funding for nurse pay rises is secured,’ says Ms Ball.
The RCN has been working ‘more closely than ever before’ with the British Medical Association (BMA) over the last year on issues such as pay and funding.
The unions have issued joint statements on the need for nurse pay rises in general practice, and the BMA has explicitly urged the government to ensure a ‘fair deal’ for GPNs.
‘It’s really positive to see the unions working together to try and address some of the challenges that affect general practice as a whole. Rather than an individual approach, we’re having more of a joined-up approach… which will hopefully lead to better outcomes,’ says Ms Ball.
‘Greater leadership opportunities needed’
Another priority at the RCN is around leadership opportunities for GPNs.
‘We want nurses to have greater leadership opportunities, so that they are invited to those seats at the right table, so that they can share their views and opinions and have a voice within their local and even regional systems,’ says Ms Ball.
This year saw the addition of the enhanced level practice nurse to the Additional Roles Reimbursement Scheme (ARRS) – a role which was mooted as a leadership opportunity for the profession.
There has been some confusion over the new role – which can be recruited by PCNs using the ARRS to support employment costs – since its introduction in April.
The role has been described as one that delivers ‘enhanced clinical care’ and that acts as a ‘clinical role model’ for evidence-based practice.
Ms Ball says the post has led to recognition of nurses working in general practice at ‘a more senior role’.
‘Within my local area, there have been some examples of where that role has been taken up really well and to focus on chronic diseases, however, I think there’s still lots of unknowns regarding the enhanced nurse,’ she adds.
A key message
On taking on her new role and as 2024 comes to a close, Ms Ball was asked for her ‘key message’ to the profession.
She says: ‘The key messages is that general practice nursing is a very highly rewarding career; that there is a renewed focus on change, both from the government and from the work that the RCN is doing and other unions; and that the most important thing for those who are joining primary care is to is to not work in isolation, to be able to have a peer support network or have an ally that they can speak to.’
Ms Ball replaces Heather Randle in the RCN primary care lead role, who last year warned that 2024 would be ‘the making’ or ‘the demise’ of general practice nursing.
