Government accused of ‘avoiding’ practice nurse pay disparities

The government has failed to address long-term pay disparities faced by general practice nurses (GPNs) by instead directing funding through the additional roles reimbursement scheme (ARRS), nursing leaders have warned.

In a new policy briefing, the Royal College of Nursing (RCN) has called for an ‘equitable and stabilising’ approach to general practice nursing employment and sets out its concerns around the government’s intention to add GPNs to the ARRS.

The ARRS was introduced by NHS England in 2019 and allows primary care networks (PCNs) to claim reimbursement for the salaries of specific roles within multidisciplinary general practice teams, including nursing associates.

It was expanded to include enhanced practice nurses in April 2024 and in December, the health secretary said it was consulting with the British Medical Association (BMA) on its plans to add GPNs to the scheme under the next GP contract.

But the RCN says it fears that patient safety, GPN pay and stable employment could all be at risk if the move is ‘implemented badly’.

It explains that practice nurses are not ‘additional roles’ but ‘a core part’ of the GPN workforce.

‘They are not additional roles and positioning practice nursing roles within this scheme puts establishment staffing at risk,’ the briefing reads.

The union also warned the scheme does not address the ‘root cause’ of the nursing shortage in general practice or provide a long-term solution to this problem.

The RCN believes including GPNs in the scheme could cause ‘unstable employment’ for practice nurses, with employment contracts ‘subject to available funding’, rather than permanent.

It also has concerns over pay – including that while ARRS employment contracts are often aligned to Agenda for Change pay and conditions, ‘there is no consistency or additional funding to support nursing staff employed on ARRS to receive or maintain fair pay, terms and conditions’.

And more widely, the RCN suggested the scheme had so far meant that ‘long-term’ issues related to GPN pay had been ignored.

‘By channelling additional funding to general practice through ARRS, government has avoided addressing the long-term inequities and pay disparities in general practice nursing,’ it said.

An exclusive Nursing in Practice survey revealed last autumn that half of general practice nursing staff across the UK had not yet received a pay rise for 2024/25.

The RCN’s briefing comes as a proposed change to the GP contract for 2025/26 could see GPNs included within the ARRS.

As part of the proposals any new ARRS role would not be allowed to replace an existing role within a PCN.

The proposal is now dependent on agreement by the BMA and could see changes introduced without the involvement of the RCN, or other nursing bodies.

Overarchingly, the RCN said it wants to see ‘an equitable and stabilising approach to general practice nursing employment to create a sustainable workforce that supports high-quality patient care’.

‘This would include ringfenced funding to employ general practice nursing staff on permanent contracts with at least equivalent pay and conditions to NHS Agenda for Change staff.’

And it said that if additional nursing roles are added to the ARRS, ‘this should be done to support core practice nursing staff for example focused on quality improvement or mentorship or reintroduction of the GPN Fellowship Programme’ which was closed at a national level last year.

Last month, Nursing in Practice heard how the introduction of GPNs into ARRS could cause ‘significant instability’ and ‘deplete’ practices of nurses.

In August, an exclusive Nursing in Practice snapshot survey found that almost two-thirds of primary care and community nurses believe GPNs should be included in ARRS.

In January 2024, a report from the Queen’s Nursing Institute (QNI) found that almost half of GPNs were expected to provide education and supervision for staff employed under ARRS, despite often being paid less and given free development opportunities.

Meanwhile, a new analysis series by Nursing in Practice has been exploring the negative impact of the ARRS on GPNs since its introduction in 2019.

The government has been approached for comment.