General practice nursing is as diverse in job description as it is in the diversity of patients and conditions dealt with. It can be argued that a GPN is simply a nurse working within a general practice surgery or health centre (NHS Health Care Careers, 2020). Job descriptions are hard to standardise in general practice, given the nature of each practice operating as a single provider of NHS care: one city may have over 75 individual providers of GP care (Sheffield CCG, 2020). Despite working within an NHS remit and providing NHS services, it could be said the GPN is employed by a privately run company, and because of this, many different job titles and descriptions are used for the same role. GPNs can be known as the following: practice nurse; treatment room nurse; advanced nurse practitioner (ANP); advanced clinical practitioner (ACP); trainee ANP or trainee ACP; nurse practitioner; nurse manager; sister; or GP matron. For the purpose of this work, we have defined that a GPN is a Nursing and Midwifery Council (NMC) registered nurse working in a general practice setting.
Perceptions of general practice nursing from both the general public and other professions
Anecdotal evidence from students wanting to work in general practice points to GPNs being viewed as lower skilled, with nurses making the move to have a quieter job role, with more social hours.
When looking into the workforce in general practice, it can be seen that 20% of nurses are advanced nurse practitioners (NHS Digital, 2020), so there is considerable opportunity for career development and progression, but a distinct lack of understanding of roles. Can and should nurses working in general practice change this perception of what they do? The nurse role is now extensive, with a wealth of knowledge and experience, and in some cases, it is the doctor seeking advice from the nurse on the complex management of the patient with a chronic disease, or for routine enquiries about vaccinations.
2020 was the International Year of the Nurse and Midwife, and nations came together to celebrate these two professions, recognising the sacrifice and contribution they are making to the health and wellbeing of the people they care for. 2020 was a once in a generation opportunity to raise the profile of the GPN within the general population: we need to ensure the right messages about what we do, our expertise and diversity of roles are understood and valued. The lack of standardisation of pay, terms and conditions in general practice has led to a lot of confusion and disappointment within the profession. For years the GPN has tried to engage with employers and unions to improve these conditions. Joining the NHS pension scheme over 20 years ago (This Is Money, 2019) seems to have been the last major hurdle achieved in improving the situation for GPNs, so change is very much overdue. The Royal College of Nursing's (RCN's) 2020 campaign for fairer pay unfortunately missed out the 25 000 nurses working in general practice to further compound the issues faced, further entrenching the lack of equity between GPNs and registered nurses in secondary care (Queen's Nursing Institute [QNI], 2015).
Changing dynamics of the workforce
In 2015, it was widely discussed that 33% of GPNs were due to retire by 2020 (QNI, 2015). However, has this been seen in the figures? In their September 2020 report into NHS staffing levels, NHS Digital confirm there to be 23 941 (16 774 full time equivalent [FTE]) GPNs currently working in England. Compare this to 2010 where we saw 21 325 headcount of Nurses (13 167 FTE GPNs). This indicates something positive – a higher headcount – but breaking down that number does lead to more questions on the future of general practice nursing.
We now find ourselves at this juncture, midway through one of the largest pandemics seen in the modern world. How we adapt the GPN workforce to be sustainable for the future is central.
Forward planning is important when scrutinising workforce information. Whether or not we see an issue now, is this going to be the same going forward? Using the data from Figure 1, it is clear to see that the GPN workforce is going to face major problems over the coming years. There is an ageing workforce, requiring younger nurses. One could argue that this demand can be met from nurses moving from secondary and primary care roles into general practice, but we will struggle to attract them from the contracts they currently have: better pay, terms and conditions in comparison to general practice. The general practice workforce is a rich and diverse one, but is it reflective of nursing as a whole in the UK? Using the NMC workforce report (NMC, 2020), nursing as a whole sees a gender split of 89% female, whereas in GP it is 97% female. It is clear then that the GPN workforce is out of step of nursing as a whole in the UK, being vastly more female, and generally older. Diversifying this workforce must be of paramount importance to GP employers up and down the country.
Figure 1. Headcount by age band and gender
Gathering data
With a need for diversifying the workforce and making it more attractive to work in, we decided to embark on a data gathering task, to gauge what pay, terms and conditions GPNs work under. With the lack of standardisation of job roles and titles, the variety of terms and conditions and the differences in expectations, it was decided that data would be collected locally from GPNs. Through social media interest this was then opened up to national levels, maintaining strict anonymity. Respondents were encouraged to share their local clinical commissioning group (CCG) or health board so that data for each area could be collated. When looking at gathering data, it was decided to use a questionnaire with a mixture of quantitative and qualitative data collection methods. This included closed and open questions and subjects included:
- Whether they have an Agenda for Change (AfC) contract
- Unions
- Rate of pay
- Annual leave entitlement
- Sick pay entitlement
- Maternity pay
- Whether they are planning to stay in their role
- CCG location.
These questions allowed for comparable data to be collected from around the country, to not only compare and contrast but to highlight where nurses feel things are going right in pay, terms and conditions. If GPNs in a certain region or CCG were on better rates of pay, with more standardised terms and conditions, is there a system in place to guide employers on what contracts to offer GPNs?
Preliminary results
The questionnaire is still open for responses (Box 1). So far there have been over 1200 responses which exceeds expectations, but is not enough to be used to help guide next steps. Some highlight response statistics are as follows:
- We have found that the vast majority of GPNs are not on AfC – only 7.6% are
- Of the responses 4.6% wouldn't like to be on AfC
- 7.6% would be worse off if they moved to AfC
- 62% do not feel confident discussing pay and conditions with their employer
- 41% only receive Statutory Sick Pay
- 71% do not feel they are being paid an adequate amount for the job they do.
Box 1.Pay, terms and conditions surveyTake the survey here: National General Practice Nurse and HCA Survey - Terms and Conditions: https://forms.gle/J4B1NutkiCWDkf7u9
Conclusion
So far only preliminary results exist, which will be published once the questionnaire is closed. The hope of this questionnaire is to drive change, and inform the unions that represent GPNs about the real life feelings and experiences of GPNs. Often a forgotten voice in healthcare, we hope to empower nurses to begin to enact change across the UK, and bring in standardised guidelines for pay, terms and conditions of GPN contracts.