Pay ‘instability’ within primary care risks losing practice nurses for other sectors and could ‘worsen the crisis’ across GP practices, the Royal College of Nursing’s (RCN’s) director for England has warned.
Patricia Marquis told Nursing in Practice that general practice nurse (GPN) pay discrepancies were not only damaging retention and recruitment efforts but could also lead to more people visiting A&E to access care.
‘Worsening the crisis in general practice’
While an ageing workforce could see many GPNs retire in the near future, Ms Marquis also said nurses were ‘increasingly looking for other jobs or leaving general practice nursing’.
‘This instability over their pay, and what has now become very obvious to them that their pay is not keeping a pace with others, particularly Agenda for Change, means there’s a real risk of losing people, but also not being able to attract people to replace them, which will just worsen the crisis in general practice,’ she told Nursing in Practice.
She added that if nursing posts are unfilled, patients could face long waits to access an appointment and may subsequently end up calling on emergency care services for help.
Many GPNs without pay rise
Her comments come after an RCN survey revealed that almost a third of general practice nursing staff in England have still not received a pay rise for 2024/25.
The survey – completed by over 1,600 general practice nursing staff between December and January – also found almost half (45%) of respondents were given an increase of less than the 6% promised by the government and just 20.9% said they were given the full 6% or more.
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It was her view that GPs could do more to support GPNs in getting a pay rise and she warned that many practices were not having a ‘transparent conversation’ with their nurses around pay.
‘Transparency is key’
‘Transparency is critical, and we know that at a local level it’s a very mixed picture,’ she said.
Ms Marquis added that while GPs and the British Medical Association (BMA) ‘collectively’ understand that more money should be ‘passed on’ to GPNs, more work is needed ‘at a local level’ to ensure this actually happens.
‘The transparency is critical, because if there’s not transparency then there is mistrust… and I think more of them [GPs] do need to pass on more of the money,’ she said.
She added that the increased funding given to GPs for 2024/25 should have enabled more practices to pass on the 6% pay rise to nursing staff.
A survey by Nursing in Practice last autumn showed that more than a quarter of general practice nursing staff were considering leaving their role within the next 12 months.
In December 2024, the RCN used Nursing in Practice’s survey findings 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.
Earlier that month, the government announced its proposal for a 2.8% pay rise for GPs and salaried practice staff in 2025/26.
The 2025/25 GP contract
Last week the BMA announced it had agreed a deal ‘in principle’ with the government over the 2025/26 GP contract.
The new contract – which is yet to be published in full by NHS England – will see practice nurses added to the main ARRS scheme, but limited to those who have not held a previous post in their current primary care network (PCN), or any other member practices, in the last 12 months.
The scheme, introduced in 2019, allows PCNs to reimburse the salaries of some staff, including nursing associates, advanced nurse practitioners and pharmacists.
Related Article: ‘A small step change’: Nurse leaders respond to ARRS update
The enhanced practice nurse role was added to the ARRS as part of last year’s contract, and is designed as a role that delivers ‘enhanced clinical care’ and to act as a ‘clinical role model’ for evidence-based practice.
‘Only a short-term fix’
Ms Marquis told Nursing in Practice that the new contract and associated funding is only a ‘short-term’ solution to an ongoing crisis in practice nursing.
‘Whilst it may create more choice for patients it is unlikely to do anything to boost the capacity of an already overstretched nursing workforce in general practice,’ she warned.
She added that the union ‘must be involved’ in any future negotiations around funding and contracts in general practice, and is ‘seeking clarification’ on ARRS and GPN roles.
‘There must be, as a minimum, an equitable and stabilising approach to general practice nursing employment,’ said Ms Marquis.
‘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.’
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Writing on X after news of the 2025/26 GP contract, Louise Brady, national primary care nursing lead at NHS England, said the confirmed introduction of GPNs into the scheme was a ‘small step change’ in the ‘long overdue’ recognition of practice nurses and their expertise.
She suggested a ‘long journey continues’ adding that she wanted to see ‘fairness, parity and equity’ for all nursing staff.
Also in January, an exclusive white paper published by Nursing in Practice’s publisher Cogora revealed that GP practices across England were struggling to recruit much-needed nurses because they are unable to match salaries given elsewhere.
