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Concerns over pay and conditions for general practice nurses (GPNs) are constant and appear to have reached a worrying peak.
GPNs are working in demanding, high-pressured environments but feel undervalued and left behind when it comes to their pay.
That’s why Nursing in Practice and Management in Practice sought to uncover the state of GPN pay in 2024/25 with our new and exclusive report.
Based on a survey of more than 550 general practice nursing staff, our report adds weight to concerns that many GPNs are not receiving a salary that they believe reflects their complex roles and responsibilities, or an annual pay rise.
The situation is understandably impacting recruitment and retention efforts in GP practices and our report reveals a worrying trend in those looking to quit within the next year.
Our report provides a breakdown on the salaries of those across the general practice nursing team, as well as across different Bands. Importantly, it also covers the disparities between the pay and conditions of nurses working in general practice compared to those in the NHS.
It explores the most common employee benefits GPNs receive, including an NHS pension and free parking. However, it also points to low levels of enhanced maternity and sick pay and what this means for recruitment and retention.
Positively, our findings revealed fairly healthy job satisfaction levels among the profession, and that patient care and continuity of care were aspects of their job they valued highly.
Our survey largely suggests a relatively small percentage of GPNs negotiate their pay, and so this report also offers practical guidance from sector leaders and practice managers on how to do this in a meaningful way.
For this report, we teamed up with our sister title Management in Practice in the hope of giving insight to practice managers about pay levels received by GPNs and bringing about more support for the profession in the workplace.
Nursing in Practice is often told by those among the profession that GPNs do not shout loud enough about the vital role they play in general practice or their concerns about their employment conditions. We hope this report goes some way in doing that.
Megan Ford, Nursing in Practice news editor and report co-author
Our survey of 552 general practice nursing staff found:
Our survey shows, unsurprisingly, that the vast majority of GPNs (95%) are women.
The biggest group of respondents (31%) are working at the equivalent of Band 6 under the Agenda for Change job categories and 20% are working at the equivalent of Band 7.
And the majority have been working in their current role for four years or more, with 18% having clocked up more than 15 years.
There is almost a clear split among our respondents when it comes to holding prescribing qualifications. A total of 44% are qualified prescribers.
Finally, the majority of GPNs show a commitment to undertaking training and personal development. A large majority – 82% – devote an average of between one and five hours a week to this, demonstrating their professional engagement and their passion for delivering high-quality patient care.
More than half (56%) of respondents hold the role of practice nurse/general practice nurse, while just under a fifth (19%) are working as advanced nurse practitioners/advanced clinical practitioners.
Our findings show that a clear majority (64%) of respondents are based in a single site surgery. Only 12% are based across multiple locations.
Meanwhile, 40% have said they are nurse trainers too. Of those, the biggest group spend an average of two hours a week training other staff, although almost a fifth (19%) spend between five and 10 hours on training duties.
Our survey shows there isn’t much appetite for becoming a trainer among GPNs, with the vast majority (66%) of respondents saying they are not considering it.
Some commented that a key factor putting them off is receiving no extra pay for the additional work involved.
There is almost universal agreement among general practice nursing staff that their workload is ‘somewhat intense’ or ‘very intense’.
And busy workloads have also meant that on average, GPNs are working above and beyond – doing, on average, at least 3.5 hours above their contracted requirements per week, our survey revealed.
Some of the comments provided valuable insight into how the role is changing, with respondents describing how their workload was ‘increasing every year’ and that they were seeing more patients but with no extra staff.
One respondent said: ‘The role of practice nurses has massively changed in the last five years or so.
‘We have taken on loads more responsibility, manage very complex cases, deal with almost all of the chronic disease management… and yet our pay and terms and conditions are dreadful in comparison [with secondary care].’
Meanwhile, GPNs have reported a trend to working in a more solitary way, with almost half (47%) saying they are working ‘a bit more’ or ‘far more’ on their own compared with two years ago.
A smaller percentage – 42% – of respondents said the level of teamworking is similar to the way it was two years ago. And far, far fewer say teamworking has increased.
This finding is significant given that working as part of a team is ranked highly by general practice nurses as an aspect of the job they most enjoy – see Chapter 7 on job satisfaction.
The average salary of a full-time (or full-time equivalent) practice nurse in the UK is £35,057, our survey has found.
This number comes in lower than the government’s National Career Service salary estimates – which are calculated at £37,000 for a new starter GPN and rise up to £53,000 for an experienced GPN.
But even for advanced nurse practitioners within our survey, the full-time average salary came out at just £49,203.
Nurse team leads and nurse specialists earn on average a salary of around £41,000, while enhanced level practice nurses receive, on average, a salary of £39,034.
Analysis of our pay data according to job Band (as categorised by Agenda for Change) shows that for those working at Band 5 level (across all job roles) – typically those towards the beginning of their career – the average salary is £28,686. For those in Band 6 level positions, the average salary is £34,849. Typically GPNs work at Band 5 or 6.
However, the vast majority of respondents (at least 86%) are not on Agenda for Change (AfC) contracts.
As such, the findings show that GPN pay lags behind the earnings of their hospital counterparts who are on AfC contracts – even at the entry level rates.
For example for 2024/25, those working at Band 5 on AfC were on a minimum of £29,970 rising to £36,843. Rates for Band 6 were £37,338 to £44,962 and for Band 7 £46,148 to £52,809.
Our results also showed that those who are prescribers, or working towards this qualification, earn higher salaries on average – at £44,239 and £37,250 respectively. This was compared with an average salary of £33,947 for non-prescribers across all job titles.
Across all nursing job roles, those who are trainers also earn more on average – £40,085 compared with £37,660.
As part of our analysis, we explored regional differences among those respondents who described their role as a practice nurse/GPN.
Data was limited so we only calculated averages in areas where there were eight or more respondents, which came to a total of 174 practice nurse respondents across 10 counties.
Based on our data, the highest average full-time salary overall is in Warwickshire, at £38,000.
And average full-time earnings are lowest in Lincolnshire at £31,750.
Only around one in 10 (11%) respondents said they receive a monetary bonus in addition to their salary. A clear majority of 86% said they did not.
Of those that do receive a bonus, for most it’s performance related.
The top three factors linked to bonus awards are:
A total of 44% of respondents who receive a bonus said it wasn’t linked to any criteria. In these instances, it seems likely they will be receiving a perk such as a Christmas bonus, which not all employers offer but where it is provided it’s usually given to all staff regardless of role.
One GPN noted that bonuses can sometimes fall short of expectation: ‘I sometimes get a bonus at Christmas, which is added to pay and then taxed, so I end up with very little of what’s offered.’
Almost a third (30%) of those who received a bonus said it was less than 5% of their salary. A small number (6%) said they received 6-10% and an even smaller percentage (2%) received 11-15% of their salary.
Around a quarter (26%) said they received an ‘agreed fixed amount’ instead of a salary percentage.
Some respondents said they received a bonus of as little as £20 to £50, while another said they were given a bonus equal to one weeks’ worth of their wage.
At the time of our survey in autumn 2024, half of general practice nursing staff had not received a pay rise for 2024/25. Of those who had received an uplift, only around one in six (16%) were awarded the 6% recommended by the government in England.
This has obvious potential consequences for retention and job satisfaction, which we look at more closely in Chapter 7.
As, one practice nurse respondent said: ‘I have been nursing for over 45 years, and I have never felt so undervalued as I do now. I have not received a pay rise for over two years, so I am worse off than I have ever been.’
An advanced nurse practitioner also said they had been told their practice was ‘intending’ to give the 6% rise but added: ‘We have not seen an uplift in our general pay for a few years, so have fallen behind nurses in secondary care.’
And worryingly, one nurse team lead reported having been told that ‘only salaried GPs will receive a pay rise’.
Of the 45% of respondents that had been awarded a pay increase, a majority (74%) were given less than 6%. A third (33%) had received an increase of 2% or less, and almost half (46%) received a rise of 3% or less.
Jane Coomber, a GPN, in south London, questioned whether the profession needed to ‘shout more’ about their concerns over pay and the lack of a pay rise for 2024/25.
‘Some of us are really angry about this; a lot of people are going to be taking their pensions and going on Bank or into private healthcare to earn more,’ she says.
‘If you are living independently and not in the advantageous position of having someone else pay your bills; you’re like me, feeling the pinch, of course you want to shout a bit about this subject. It feels very unjust.’
Ms Coomber said it was ‘appalling’ that a pay rise for GPNs was not guaranteed in the same way it is for Agenda for Change NHS nurses.
‘There is no legislation currently that supports the way in which GPNs are paid that keeps in line with our NHS hospital/community colleagues, and quite frankly I find this appalling.
‘Our nursing colleagues in hospital settings had their pay increased. My newly qualified Band 5 friend in hospital showed me her pay slip. Where’s ours?’
In December 2024, the Royal College of Nursing (RCN) used Nursing in Practice’s survey data in its evidence to the independent pay review body for GPs and called for its future recommendations to ‘expressly and explicitly’ include the nursing profession.
In its submission to the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) for 2025/26 – which in recent years has made recommendations on pay that have been applicable to employed general practice staff, including nurses, alongside GPs – the RCN flagged the volume of GPNs that have gone without a pay rise for the last two years.
The RCN’s own survey of GPNs in February 2025 revealed almost a third of the profession was still without a pay rise for 2024/25.
RCN national officer (employment relations) Jeni Watts and RCN professional lead for primary care Kim Ball, said while general practice nursing staff are ‘central’ to the success of the wider NHS, they are ‘repeatedly being left behind in matters of pay’.
‘Differences in how pay, terms and conditions are applied have led to inconsistencies in what general practice nursing staff receive,’ they said.
‘Without national bargaining structures, many general practice nursing staff are left to negotiate for themselves, which adds to the disparity. Even when the government provided funding intended for practices to uplift staff pay, we know many are still not receiving the pay increase this promised.’
They stressed that employers have a ‘responsibility to pay their staff fairly for the work they undertake’.
‘They should acknowledge the value and worth of their nursing workforce and this should be reflected in pay that is commensurate with the level of work, skill, knowledge, and experience required,’ they said.
‘Paying staff fairly for the work they do helps create trust. It’s a sign the employer respects and values its workforce.’
Our findings on GPN pay and pay rises – and the fact they are lagging behind hospital nurses’ earnings – are a major barrier for practices in their efforts to recruit a greater number of the profession.
A separate survey of 640 practices carried out by Management in Practice which informed Cogora’s workforce white paper earlier this year, showed that 23% currently report vacancies in practice nurse roles.
Practice managers and GP partners said they are finding registered nurses ‘particularly difficult to recruit’, largely because of core funding constraints that mean practices cannot keep up with pay and conditions given in other settings, especially in secondary care.
Our survey suggests only 36% of general practice nursing staff proactively negotiate their own pay rise every year, versus 63% who said they do not.
Respondents were asked what particular factors they felt strengthened their case for a pay rise.
The top result was ‘gaining additional qualifications’, such as in prescribing, public health or a specialist clinical area (52%). Other factors included ‘demonstrating outstanding performance’ (47%) or the number of years they had clocked up in their role at the practice (43%).
One tip that 38% thought was useful is gathering information about pay levels at other nearby practices or at PCN level. This was the only factor mentioned that doesn’t involve taking on extra duties or professional development.
In recent years, the RCN has issued a template letter that general practice nursing staff can use to send to their employers if they weren’t receiving updates on pay rises or if they felt there was a lack of transparency about the pay they should receive.
The RCN previously suggested that some GPNs had been able to achieve more than they expected after ‘asking and pushing’ their employers about a pay rise and it has been encouraging the profession to set out their expectations on pay early.
The following boxes set out expert views and advice on how GPNs can best negotiate their pay with employers. We have sought guidance from both the Royal College of Nursing (RCN) and a practice manager in the hope of giving both perspectives and the best chance for success.
Asking any employer for a pay rise isn’t easy particularly if you work in a small practice and you are part of a tight-knit team. But it should feel like a normal part of the workplace routine and you should feel confident speaking about up about it. Here are some effective ways to start the process:
1. There is great strength and benefit in solidarity – talk to colleagues about the rising cost of living and pressures on pay
Speak with colleagues about pay to establish some common ground. Your voice is stronger together – that’s the message at the heart of being part of a union. Organise your colleagues to talk to your employer about pay, terms and conditions. Experience shows that a pay claim is more likely to be successful when it comes from more than one member of staff. Ask your colleagues about how they are feeling – are they experiencing increases in the cost of living? Identify six things that have gone up in price in the last year, e.g. your gas bill, school meal charges, bus fares, or your shopping basket.
2. Think about the evidence
Nursing staff in general practice should have received a pay rise in the last year. You are owed this and should feel confident in asking for it.
Are others in the practice receiving an increase in their pay? Is funding being spent on services and not on staff? What are the impacts of pay limitations in your practice – are people considering leaving, or is morale low? All these are powerful tools for you.
3. Health and social care is about people
A machine can’t do what you can do. It’s your experience and skills that keep your patients healthy or deliver the care they need. Remember your value to the practice, you are an important part of the team, and many workplaces could not operate effectively without you.
Through it all keep in mind that negotiations do not have to be adversarial – with the right preparation and boundary setting they can be positive conversations.
When you are ready, make it a formal process and ask to speak to your employer, do not have this conversation around the water cooler or in a break room. Even in a small practice, this is important. Then, in writing formally request details on your pay, and the funding the practice receives from the government.
Keep it respectful; know your value and be prepared to stand up for what you are worth.
Jeni Watts, RCN national officer (employment relations) and Kim Ball, RCN professional lead for primary care
Practice manager Pete Woodward describes six key tips for success when it comes to requesting a pay increase from your employer:
1. Understand the context you’re working in – practices have suffered years of real terms cuts to funding with increases lagging behind inflation. You should still negotiate for your raise but keep this in mind.
2. Start your negotiation as soon as possible. It’s incredibly difficult to budget due to constant uncertainty around government funding, and what increases will be given when. However, if the practice knows what rise you are looking for, it’s easier to try and plan for this where possible.
3. Avoid having a discussion by email, it’s better to have a face-to-face conversation. Although this can be scary, sometimes the nuances are lost over email and body language is important. For example, wording that you think sounds calm and reasonable in an email can come across more direct or demanding than you intended.
4. Clearly set out the reasons you deserve a pay increase. What have you done or achieved that is over and above the normal requirements of your job and that has helped make the practice more money/improve patient services? For example, have you completed some training to see a new cohort of patients? Has your work led to improvements in a particular QOF area, or a locally commissioned service?
5. Linked to the above, also outline your aims/goals for the next year and how they will contribute to the success of the practice. Practice managers tend to be more persuaded by staff who want to make the running of the practice easier. How have you contributed to in the last year, and how could you do more of this in the future? Could you take responsibility for a particular area taking pressure of others, for example?
6. Steer away from sounding like you’re trying to hold the practice to ransom. This can cause practice managers and partners to ‘dig in’ and create what feels like a ‘win, lose’ situation, which is unhelpful since nobody wants to feel like they’ve lost! The focus should be on win, win.
Pete Woodward is managing partner at Cheadle Medical Practice and Alvanley Family Practice in Stockport, and runs Woodley Village Surgery on a consultancy basis.
It’s no surprise that the most common employee benefit for general practice nursing staff is membership of the NHS pension scheme – 91% of respondents said they have this.
Also in the top five most popular benefits are free parking, a summer or Christmas party and protected time off for study.
However, our findings suggest very few general practice nursing staff are given maternity pay beyond statutory (5%) and less than a third (32%) say they are given occupational sick pay above statutory levels.
One nurse team lead says: ‘We have just lost a valued member of staff due to a poor maternity leave offer. Staff morale is low regarding pay.’
Another GPN responding to our survey says that moving from an NHS role into general practice was a ‘shock’ because of the disparities in benefits. ‘I did not realise that much of the benefits from the NHS are not reflected in general practice jobs. Benefits such as maternity leave, sick pay and bereavement leave. There is no one rule for all, but rather GPs manage their team as they see fit, which can be so inconsistent when you look at other practices.’
Flexible working conditions also appear relatively low (20%) according to our survey, as well as opportunities for career progression (16%).
Overall, the findings show that GPNs are on fairly standard employment packages, with few enhanced benefits unlike under Agenda for Change terms and conditions.
Chair of the Institute for General Practice Management Kay Keane says this is unsurprising since practices’ funding is so tight.
She says: ‘We would love to offer enhanced terms and conditions for practice nurses and wider allied health professionals, as well as admin and clerical teams. Sadly, we are simply not funded to do so.
‘Any practice that offers more is in the minority, unfortunately. Unlike NHS Trusts, which receive centrally allocated funding linked to Agenda for Change (AfC), GP practices do not, meaning we often can’t match AfC pay scales or enhancements such as unsocial hours payments or high-cost area supplements.’
Ms Keane admits this lack of parity creates inequity and makes it harder to attract and retain practice nurses, especially where trusts can offer more attractive financial packages.
But she points out what the benefits primary care has to offer. ‘For those looking for a better work-life balance and the opportunity to deliver continuity of care in a holistic, community setting, general practice nursing is a deeply rewarding career. Practice nurses work with a high degree of autonomy, and many go on to specialise in clinical leadership, chronic disease management, or advanced clinical practice.’
Ms Keane, who is practice manager at Urban Village Medical Practice in Manchester, adds: ‘Many practices, ours included, strive to offer non-financial enhancements too — such as cycle to work schemes or season ticket loans.
‘More importantly, we offer a bespoke career pathway, with the chance to become an expert in long-term condition management and to build real, lasting relationships with patients.’
Concerningly, more than a quarter (28%) of general practice nursing staff indicated they are considering leaving their jobs within the next 12 months. Dissatisfaction with pay and feeling undervalued are among the key reasons for this.
Of those wanting to leave their role in general practice in the next year, the top five reasons cited were:
Other concerns include a lack of career progression opportunities (29%), feeling isolated in their role (26%) and the impact of the ARRS (15%).
Just under a quarter (24%) of those thinking about leaving say they plan to retire.
Meanwhile, as we already saw in Chapter 4 on ‘Roles and responsibilities’, an overwhelming vast majority of GPNs reported that their workload was ‘very’ or ‘somewhat intense’.
They also described the ‘constant pressure’ they are under, as well as the sometimes unsafe conditions they are working in to meet increasing demands.
One GPN commenting in the survey says: ‘Practice nursing has become relentless. We have little or no say in our list size and at times I feel we work unsafely with no support from GP.’
Another nurse in London points to covering two practices with populations of 10,000 and 5,000: ‘All the liability of all things nursing relies on you, eg immunisations, infection control, smears, diabetic physical checks, wound dressings, stock, fridge responsibility.’
Nadine Laidlaw, a lead practice nurse in Newcastle, says she is ‘single handedly managing chronic diseases with some of the most complex patients in our practice’, including patients who ‘speak no English and have no health literacy, let alone any idea how to navigate the healthcare system’. This involves ‘following national guidelines, address holistic issues with social care or domestic issues’, alongside ‘”routine jobs” like cervical screening, immunisations and health promotion’.
Further analysis showed that of those who said they are thinking of leaving their role in general practice in the next 12 months, the highest percentage describe their workload as very intense (53%).
Comparatively, of the respondents who said they are not thinking of leaving their role in the next 12 months, only 30% described their workload as very intense.
One ANP respondent commented: ‘I’m not thinking, I am definitely leaving. Burnout, fatigue and no pay rise and lack of employer appreciation has made this decision.’
Another nurse added: ‘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.’
Looking beyond the next 12 months to the medium term, the outlook for general practice nursing becomes even gloomier. Only a third (35%) of respondents said they thought they would still be working in general practice in five years’ time.
More than a quarter (26%) say they would be retired and a further 7% indicated they plan to be working in a role outside of nursing.
However, on a more positive note, it seems many GPNs do want to stay in their roles – with 35% of respondents stating they aim to be working in general practice for the next five years.
And while there might be a significant number of those looking to quit their jobs, when it comes to job satisfaction, a majority of 62% said they are ‘fairly’ or ‘very satisfied’ in their role.
Survey respondents were asked to rank the parts of their role they enjoy the most. Unsurprisingly, the elements linked to patient care were rated highest, although job characteristics such as good work-life balance are also clearly valued.
Employers will want to take note of these when developing their retention strategies.
What is also noteworthy for practices aiming to enhance job satisfaction is that while working as part of a team is ranked second by general practice nurses as the most enjoyable part of the job, our findings suggest it may be on the decline. A total of 47% said they are working in a more solitary way than they were two years ago.
This shift can be attributed in part to the additional roles reimbursement scheme (ARRS), which was introduced in 2019 and brought in many new team members to general practice – so the focus was less on the traditional nursing and GP roles.
The general practice workforce white paper Nursing in Practice contributed to showed that in England, practice nurses made up 26% of practice clinical teams in 2019 compared with 18% in 2024.
One nurse in general practice, who has been practising for four decades, highlights the effect of that as making her job a more solitary one. ‘There used to be time for nurses to meet up in peer groups. Now, often, there may only be one nurse in a practice along with ARRS staff. The nurse might be doing mostly cytology and baby immunisations. Long-term conditions will be delegated to the physician associate or nursing associate, who will not have the clinical knowledge like I would do.’
The changing of ARRS to include more nursing roles may reverse this trend but it is something that should be monitored.
What cannot be ignored even despite the positive findings on job satisfaction is the feedback that pay is lacking. Several comments highlighted the conflict between these two issues.
One practice nurse said: ‘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.’
Another also said: ‘Love the job but not the responsibility compared to pay.’
Our findings showed significant levels of job dissatisfaction too. Almost one in five (18%) said they are ‘fairly’ or ‘very unsatisfied’.
The reasons for this link back to the familiar themes of pay, workload and stress as mentioned above (see Graph 33).
Practice nurses described how being ‘short staffed, on low wages and overworked’ and having a ‘lack of support and heavy workload’ – as well as the consequences of that on patient care – are contributing factors to feeling unhappy in their work.
As one respondent says: ‘There are so many constraints on time you feel that you cannot give the care patients truly deserve.’
And another commented: ‘The workload is increasing without any recognition of the impact of the nurse role in general practice.’
It is not at all surprising that GPNs are feeling disillusioned about working in general practice.
General practice as a whole is struggling with increased workload and ever-changing expectations with less resources both physical and financial.
Many nurses came into general practice when things were much less pressured, and they could really enjoy their work and feel they were providing a good patient experience.
Now, nurses are being asked to do more with less time and less money. They are also feeling threated by other roles taking away the ‘simple’ tasks and also face a lack of career development and support for training.
Pay is a big issue as it is one way nurses can feel valued. In the past, GPNs may have been given bonuses or reasonable annual pay uplifts, but that is much rarer today due to financial constraints.
For many nurses it is not just the pay – it is the terms and conditions such as sick leave, holiday or maternity leave, which is often much less generous than what is given to those in hospitals or in the community on Agenda for Change.
I believe there needs to be a stronger push to promote fair pay for GPNs, in the same way there is for GPs.
Jennifer Aston, Queen’s Nurse and advanced clinical practitioner ambassador for Cambridgeshire and Peterborough Training Hub – and recently retired from clinical practice
Almost a third (31%) of practice nurses say their role has ‘somewhat’ or ‘dramatically’ changed for the worse since the additional roles reimbursement scheme (ARRS) was introduced in 2019.
Nursing leaders have warned that the scheme has sparked ‘a lot of role substitution’ between nursing associates and GPNs, and that nurses had been expected to supervise ARRS staff while on lower pay.
The scheme – which is used by primary care networks (PCNs) to fund the salaries of a range of primary care roles – had until recently excluded GPNs, instead including nursing associates, advanced nurse practitioners and then last year, the enhanced level practice nurses.
However, in March it was announced that GPNs (both experienced and new) and consultant nurses have now been added to the scheme for 2025/26.
Practice nurses commenting in our survey expressed fears that ARRS had ‘deskilled’ the profession.
‘Some of the GPN skills have been taken away and done by others,’ said one nurse team lead.
Another practice nurse admitted they thought the scheme is ‘dumbing down our profession’. These comments obviously pre-date the latest changes that incorporate GPNs into ARRS. Still, the scheme has evidently eroded job satisfaction for a significant portion of nurses, and it will be important for practices to monitor this to minimise attrition or a fall in morale, as the scheme continues to evolve.
That said it is worth noting that half of our respondents (50%) said the ARRS had not changed their role for the better or worse. And some 18% said it changed their role for the better.
How will the extra nursing roles being added into ARRS affect pay at practice level?
The maximum amounts that PCNs can claim to fund hires under the scheme are based on Agenda for Change pay scales, which practice-based pay largely lags behind when it comes to nursing roles.
In theory, this could create competition between the two organisations, making it even harder for practices to hire and keep nursing staff.
Kay Keane, chair of the Institute for General Practice Management, admits this is a risk but says there are caveats in place. For example, GPNs cannot be hired under ARRS if they have held a post in their current PCN or any other member practices in the last 12 months. ARRS funds also cannot be used to subsidise practice-funded GPN or nurse consultant roles that existed before 1 April 2025.
She adds: ‘On the ground what I am seeing is PCNs not funding full-time ARRS roles since sharing of staff doesn’t always work well.
‘And the reimbursable amounts available to PCNs include on-costs such as for pensions and National Insurance, which has risen from this April, and even might have to be allocated for development opportunities, making less money available for actual salaries.’
‘In reality, funding pressures on PCNs is similar to that on practices. PCNs are expected to set pay that is fair, competitive and that aligns with the role and experience, but they can technically pay less or more than AfC rates as long as it’s within the total reimbursable envelope.’
To help practice managers navigate any potential conflict, she says the IGPM advocates:
The organisation also calls for greater investment from government into the core contract so practices can retain experienced staff, including nursing staff, and not rely on PCN structures.
Indeed, in recent months, sector leaders have accused the government of failing to address long-term pay disparities faced by GPNs by instead directing funding through the ARRS.
The RCN says practice nurses are not ‘additional roles’ but ‘a core part’ of the general practice nursing workforce, and that ARRS contracts risk ‘unstable employment’, creating temporary roles that are ‘subject to available funding’, rather than permanent.
RCN director for England Patricia Marquis told Nursing in Practice in February: ‘There must be, as a minimum, an equitable and stabilising approach to general practice nursing employment.
‘Nursing staff working in primary care need to see funds ringfenced specifically to cover pay. This must, at minimum, reflect NHS pay, terms and conditions.’
Nursing in Practice ran on online survey of general practice nursing staff from 20 September until 18 October 2024, collating responses using the SurveyMonkey tool.
A total of 552 general practice nursing staff responded to these questions from across the UK, with the majority within England.
We are very grateful to Teresa Kopp who provided additional analysis of our findings.
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