A year of the Nursing in Practice GPN Manifesto

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

This point was championed by Rebecca Corneck – a Queen’s Nurse and a director of general practice nursing for the Southeast London Workforce Development Hub.

A roundtable focused on this priority heard from GPNs 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.

One GPN said they had advised nurses to avoid a career in general practice if they were looking to start a family soon because ‘maternity pay is nowhere near what the trusts offer’.

‘That is so sad for our profession – that, as somebody who is the biggest advocate for practice nursing, I’m telling someone not to do it,’ she said.

It was recently announced that the government has planned to provide GPNs a 2.8% pay rise for 2025/26 – as per its evidence to the independent pay review body for general practice staff.

But as revealed by a Nursing in Practice survey last month, half of general practice staff across the UK are still waiting for a pay rise for 2024/25.

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

This point was championed by Joanna Vintis, a GPN of 13 years and lead nurse for Newcastle GP Services, a federation of GP practices in Newcastle.

In a roundtable with GPNs, those among the profession discussed the need to invest in the future workforce, alongside the need to value, reward and retain the existing workforce too.

Central to the conversation among the five nurses involved was that GPNs are the ‘cornerstone’ of the sector and that without them large proportions of primary care would likely ‘collapse’.

GPNs emphasised that it is vital that general practice is visible, attractive and accessible to those seeking a nursing career and that efforts are made to recognise, value and ultimately retain those in post.

In some areas it appeared more must be done to show nursing students that general practice is a viable, exciting and skill-driven career, from the outset of their registration.

But perhaps of greater concern was the funding barriers preventing students from being able to learn in a general practice setting in the first place.

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

This point was championed by Rebecca Shearer, lead nurse and ANP at West Road Medical Centre in Newcastle, and a Queen’s Nurse.

A separate roundtable saw nurses discuss the importance of considering the needs of patients from different areas and backgrounds, and explored initiatives that could help improve engagement with health services and health promotion.

One nurse had said there was a need to ensure the workforce was aware of different cultural needs, for example offering services in different languages.

In addition, she pointed to a programme for people from African Caribbean backgrounds with diabetes that focused on support with specific types of popular foods.

‘We [often] talk about Western food, but actually it is nothing to do with what they will eat. So, I think it’s making nurses more aware of that.’

Meanwhile, another attendee argued that GPNs often did not have ‘the time or space’ to ‘think, reflect and work out’ how they can meet the individual needs of patients from different backgrounds, wherever they are in the UK.

‘Often, if you are in quite an affluent area, you assume there is no health inequity, but there is if you look for it,’ she said.

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

This point was championed by Jenny Aston, a now retired ANP at Granta Medical Practices, Cambridgeshire, and a Queen’s Nurse.

A roundtable saw attendees asked if general practice was supporting the work of GPNs in long-term conditions – to which some responded with concern around the ‘skill mix’ of the workforce.

This included healthcare assistants (HCAs) and nursing associates doing what were described as ‘straightforward reviews’.

However, as pointed out by one attendee: ‘How do you know it’s a straightforward review until you have done the review?’

Concerns about skill mix and even the substitution of registered nurses with different and sometimes less qualified staff have been raised in recent months, including at this year’s Royal College of Nursing (RCN) Congress.

Within general practice specifically, nurse leaders have been sounding the alarm around nursing associates working in place of registered nurses – especially since the introduction of the Additional Roles Reimbursement Scheme, which funds the salaries of some roles, including nursing associates.

Earlier this year, the Queen’s Nursing Institute (QNI) also called for ‘clear guidance’ on the ‘scope and limits’ of nursing associates amid reports of those in post running independent clinics in general practice.

Ms Aston, who championed our manifesto point focused on reinstating time for GPNs to manage long-term conditions, said: ‘Part of the problem is it gets taken away from [nurses] because [practices] see that somebody cheaper can do it.’

Ms Aston also warned that the area of long-term conditions had been up against a ‘long term lack of investment in training and career development for nurses’.

‘A lot of nurses have been thrown into doing diabetes or asthma or COPD with almost no appropriate training,’ she suggested.

She added: ‘I think it’s an area where we need to be making sure there is enough training and not just the training, but the ongoing support for nurses, particularly in those key areas of asthma, diabetes, COPD, and cardiovascular disease, because nurses do it well.

‘It’s about training and it’s about career development, not just for the nurse but to have safe practice.’

‘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.’

This point was championed by Julie Roye, head of nursing for primary care at the East London NHS Foundation Trust.

As part of a roundtable event, GPNs discussed the action needed to support the profession and practices within public health promotion and disease prevention.

The topic of immunisations was a central part of this conversation.

One GPN talked about her area of Leicester and its large South Asian population and the need for accessible languages.

For example, a text message to some of her patient population about the need for a routine vaccine would not have the same impact as her delivering a consultation on the importance of the vaccine and its role in preventing serious disease, she explained.

Since the Covid-19 pandemic, had also noticed that among certain non-English speaking populations when using the word ‘booster’ for a vaccination, patients only think about Covid.

‘I have to invite children for preschool boosters, or a second dose of MMR, but if my admin reception staff use the wording as a booster MMR, they only think about the Covid vaccine, and they become so hesitant not to go for an appointment,’ she added.

It was also suggested that working with communities to promote public health and reduce vaccine or appointment hesitancy was the key.

‘A lot of the time the message about hesitancy needs to come from someone else, not from us. We’ll do it. We need to make it available and make it easy, but actually, the message of vaccination is good needs to come from their own community,’ said on ANP.

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

This point was championed by Dr Helen Anderson, research fellow at the University of York, and previously a GPN and ANP.

A recent report from the RCN warned workplace issues and demands were contributing to a ‘mental health crisis’ among nursing staff across the UK. Figures from the RCN, published in September, showed a 79% rise in nursing staff seeking support from its advice service for suicidal ideation, compared to the same period in 2023.

Among those involved in a roundtable discussed on this manifesto point, it was agreed some GPNs are feeling ‘powerless’, and as if they are on an ‘escalator that never stops going up’.

On top of workload demands was a feeling of ‘despair and frustration at not being heard’ when trying to make the case for change in their practices.

GPNs need the time and space to do their jobs well and to feel good about their roles, while also being given the time to look after themselves and their own needs, our roundtable attendees suggested.

There was an example of one nurse who has been qualified for nearly three years, having gone straight into practice nursing. ‘She’s already burnt out,’ said one GPN.

Another GPN described having set up a health and wellbeing garden – a space for GPNs to ‘take a breather’.

But she said: ‘Nobody has time to go in there. It was meant to be somewhere where you could go out and have a breather. [But] it’s rarely used because nobody has time to go out there.’

Attendees argued that the support GPNs needed was ‘having enough time to do the job properly’ and also for wider recognition of what they do, including from primary care networks or the regulator.

‘I’d say it’s time, and time to grow and develop and do things, and being valued for it,’ said one attendee. ‘It’s allowing people the time to do their job properly and safely.’

‘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.’

This point was championed by Jenny Bostock, a clinical director at Ramsgate PCN, an ANP at Dashwood Medical Centre in the town and a Queen’s Nurse.

At a roundtable held in the summer, GPNs described the current offer for professional development opportunities as ‘hit and miss’.

‘I think the problem is we’re so dependent on short-term budgeting. There needs to be long-term funding to support career development within general practice rather than short termism,’ said one attendee.

While it was suggested that training opportunities were there, and there was some understanding around the career development needed, it was the funding that was the issue.

In 2019, what was then Health Education England – which has now merged into NHS England – announced £1,000 for continuing professional development (CPD) for every nurse over three years.

With this funding pot now having come to an end, attendees said they were waiting to see what was coming next.

GPNs also raised concerns about the ‘last-minute’ nature of funding and opportunities for training.

‘I waited about 18 months to put two nurses through a clinical skills [course], and then funding came at the same time for them, which wasn’t ideal, but I didn’t dare miss out on the place on the course because I didn’t know when they’d get back on it,’ one GPN said.

Similarly, with the new RSV vaccination programme that came into primary care this autumn, the GPN said they were only given a matter of weeks’ notice for training courses for nurses on this.

A stark, but key issue highlighted during this roundtable discussion was around the role of the GPN being at risk.

One attendee said they felt the role was ‘threatened’ and that GPNs were being ‘squeezed out’ in place of other staff.

With a new government now in power, one GPN said she wanted ‘reassurance that our role will continue’.

‘It is a really valuable role, and we seem to be getting replaced in different ways,’ she said. ‘So, is it here to stay?’

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

This point was championed by Georgina Callard, a mental health nurse for 20 years and a Queen’s Nurse, who has recently been based in general practice in Northamptonshire.

During this roundtable discussion, concerns were explored around a lack of registered mental health nurses – especially in primary care – and the need to make mental health ‘everybody’s business’.

The GPNs involved suggested some among the profession can be ‘frightened’ of addressing mental health needs in patients, and that there this is a need for ‘more awareness and confidence building’ among colleagues.

Ms Callard told the roundtable: ‘We’re busy. I’m booked up four weeks in advance. It’s a really needed role. We have GPNs that focus on diabetes and other long-term conditions – I don’t see why we can’t have more [for] mental health.’

She recognised the wider lack of registered mental health nurses across the country and said she has had several conversations around getting more mental health nurses into practices, but was warned this could risk ‘robbing Peter to pay Paul’ by taking those nurses from other settings.

‘But it would be fabulous to have a mental health practitioner in every surgery,’ adds Ms Callard.

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

Ms Callard suggests there is room for ‘more awareness and confidence building’ among GPNs to help them to support patients’ mental health needs.

In recent months, Ms Callard has been working at a national level to develop a Level 6 module on mental health for nurses working in primary care. She said this has ‘come out of recognising that the GPNs and other clinicians just need a bit more information to build on that and then have that confidence to work with the patients the best they can’.

But she also noted the time pressures GPNs are under. ‘Another reason for GPNs to be a little bit hesitant with starting that conversation [about mental health] is because they’re pushed on time as well,’ she said.

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

This point was championed by Hina Shah, a GPN and lead nurse in immunisations for Spinney Hill Medical Centre in Leicester.

Our roundtable saw attendees highlight the importance of ‘building relationships’ with families and finding ‘innovative ways’ to run clinics to help tackle hesitancies and boost immunisations uptake among children.

There should be a focus on being ‘much more patient and mum driven’, as opposed to practice driven, they said.

Our manifesto warned of the ongoing decline in the uptake of child immunisations – with vaccine hesitancy, particularly post-pandemic, and inequality of access among suggested reasons for this trend.

Childhood vaccine uptake in England fell again across all 14 measures tracked by the NHS in the past year, according to an annual report published last month. No vaccines met the 95% target for coverage, the data for 2023/24 shows.

This further decline in uptake comes despite ongoing pleas from public health experts for parents to have their children immunised amid outbreaks of whooping cough and measles.

One attendee said the ‘key here is about building relationships with families, with mothers’.

It was also crucial that there was a nurse within every GP practice who is responsible for immunisations, including for managing audits, ‘keeping an eye on where the gaps are’ and finding ‘innovative ways’ of running clinics that fit in with families.

It was suggested that a lot of hesitancies around immunisations was down to a ‘lack of trust’, ‘within particular groups that are hard to reach’, including those who speak a different language or who have a different culture.

‘Somebody needs to be dedicated within the practice to take ownership of it – ideally, a nurse,’ said one attendee.

‘It’s about relationships and trust, much more than it is about numbers and about ticking boxes.’

Another issue raised during this part of the roundtable was around the lack of contact GPNs have with health visitors now.

Earlier this year, a report by the Institute of Health Visiting highlighted that capacity problems among the workforce could be helped by closer GP alignment.

Roundtable attendees discussed the need to get health visitors ‘back in the building’ in GP practices to help support with vaccination uptake.

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

This point was championed by Sara Baldwin, 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.

Turning to the digital agenda, attendees discussed our final manifesto point – centred on the need for GP practices to ‘continue to evolve to serve patients better’ by ‘adopting approved digital platforms and applications to improve patient care and outcomes’.

The GPNs suggested digital technologies and apps are being used a lot more – especially since the Covid pandemic – but they stress there is still ‘a long way to go’.

‘I think we are using a lot more because we have to, because the public expects us to. Covid pushed us into doing a lot more things,’ said one attendee.

For example, the use of Accurx for two-way conversations with patients, which she says ‘was very helpful’.

In terms of technologies used to assist patient care, one attendee said there had been ‘a revolution’ within diabetes care, through the use of sensors put into patients’ arms.

‘It has changed things out of all recognition,’ she added.

Patients like to be able to be ‘in control’ of their health and care, and some apps can help to support this and to keep patients ‘better informed’.

However, it was recognised that there are some challenges and confusion around patients interpreting the information some health apps provide them, and that this can result in patients ringing up to ask what they mean.

One GPN attendee said she saw the benefits of some apps for patients, but felt that ‘we’ve still got a long way to go’ and that progress around this agenda was sometimes ‘slow’.

She agreed it was important to think about ways to ensure patients understand what information the apps are bringing so they can engage with it.

Potential barriers with the use of digital platforms were also flagged, including language barriers.

‘Digital health works well in an English-speaking population but many of my patients do not have English as their first language,’ said one GPN.

Another agreed: ‘English isn’t people’s first language, and that’s an issue as well – making sure it’s suitable in all languages. It’s got a long way to go, but at least we’re thinking about.’

Nursing in Practice will continue to work to ensure the voices of GPNs and the calls behind this manifesto are heard.

We will be putting this project to those in positions of power during 2025, to help raise awareness of the profession’s needs and call for action to improve the situation for both GPNs and the population they serve.