General practice nurses (GPNs) have warned of a ‘deprofessionalisation agenda’ against them as some practices favour ‘tick box’ care and other roles, according to a new study.
Researchers from the University of York, Dr Helen Anderson and Dr Joy Adamson, alongside NHS England’s primary care nursing lead Louise Brady, have explored the cultural and structural issues impacting the retention of GPNs.
The study interviewed 41 members of nursing teams working in, or who have worked in, general practice as well as nurse leaders linked to the sector.
Findings point to a workforce that is feeling ‘undervalued’ and ‘pushed out’, and researchers have warned of a sense of ‘precarity’ around the role of the registered nurse in general practice.
‘Deprofessionalisation of nursing’
Researchers heard about a ‘reduction of care to tick box exercises and pressure from employers to do more with less’.
‘This contributed to what some saw as the commodification of nursing in general practice and the shift towards a deprofessionalisation agenda, which was considered to be negatively implicated in retention,’ the study, which has not yet been peer reviewed, said.
Those interviewed also linked the deprofessionalisation of nursing with the introduction of new roles into primary care nursing through the additional roles reimbursement scheme (ARRS).
Some felt that practices were using ARRS roles ‘rather than employing registered nurses, as it was less costly’.
‘This was considered another factor negatively affecting nurse retention as it highlighted a perceived lack of recognition and value of experienced and knowledgeable registered nurses working in general practice,’ the study said.
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Some respondents also described how nursing associates and healthcare assistants were taking on work that was previously reserved for practice nurses.
The situation had led to some registered nurse participants ‘feeling pushed out of general practice, with participants unsure whether this is an unintended consequence of poor policy, or a deliberate attempt to undermine nursing’.
Interviews for this study took place before plans were announced for GPNs to be included in the ARRS towards the end of 2024.
The scheme, introduced in 2019, allows primary care networks (PCNs) to reimburse the salaries of some staff, including nursing associates, advanced nurse practitioners and pharmacists.
Last December, the Department of Health and Social Care (DHSC) announced that the ARRS will expand to include practice nurses as part of the updated GP contract for 2025/26, pending a consultation.
Terms and conditions
The study also revealed the ‘pushback’ that some GPNs face from employers when asking for better terms and conditions – a challenge which again sees practice nurses feel ‘devalued’, the authors warned.
‘When they stepped outside of demarcated boundaries by, for example, asking for a pay rise, they faced negative consequences,’ the study said.
The research also pointed to a ‘wilful blindness’ by some employers in their ‘lack of recognition of the level of practice and complexity of work of nurses, in order to avoid commensurate remuneration and professional terms and conditions’.
Some participants also flagged a lack of ‘good will’ given to them as nurses, despite contributing many years to general practice.
For some, this had led to them ‘reaching a tipping point which impacted negatively on retention’.
One retired GPN and advanced nurse practitioner (ANP) informing the study said: ‘The final straw was being expected to arrange my father’s funeral for a day off, so that the surgery didn’t lose out… I’d been there for so long and the relationship I supposedly had with the GPs… What annoyed me was all the stuff I did for them when I could have been picking up my kids from school… and instead I was studying to get another course because [the practice] needed that.’
GPNs in a ‘vulnerable position’
Speaking to Nursing in Practice, study author Dr Anderson, who was also previously a GPN and ANP, said she had been ‘distressed’ by some of the negative experiences that participants had described.
The study calls on employers and professional associations to develop strategies to meet the needs and support retention of the GPN workforce, with Dr Anderson warning that GPNs are in a ‘vulnerable position that needs addressing’.
‘Our findings indicate that even when relationships with employers were cordial, there was an underlying awareness that this was precarious, and participants needed to consider this in their everyday actions,’ Ms Anderson explained.
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‘I think it’s the precarity of their position in general practice. There needs to be consideration at an employer’s level, a policymaker level and professional organisation level,’ she said.
Dr Anderson also suggested that GPN work was often dismissed as being on the ‘more feminine end of nursing work’, with clinical insight and expertise often being overlooked and undervalued.
‘Nursing is seen as women’s work and working-class women’s work. This is particularly for nurses in general practice, because it’s seen to be at the more “feminine” end of nursing work,’ she said.
‘The therapeutic relationships, negotiation, and rapport required for nursing in general practice are seen to be softer, more feminine skills, and they’re less valued as a whole.’
There were some examples of positive factors that supported GPN retention noted within the study, including variety, continuity of care and working hours.
Those interviewed said they valued the ‘diversity and variety’ of their work and providing care across the lifespan of their patients, the study said.
‘Participants enjoyed the challenge of their complex workload, and this was considered central to retention, even if this level of practice was not always recognised,’ it added.
But overarchingly, the study concluded there were several ‘cultural and structural issued’ identified which negatively impacts nurse retention in general practice.
‘While some supported retention, others challenged it and revealed deep seated and complex issues which require addressing at practice, local and national organisational levels,’ it said.
‘Nurses in general practice experience factors which leave them vulnerable and underserved.
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‘Policy makers, employers and professional organisations ought to work to support retention and enable nurses in general practice, not only survive, but thrive.’
