In Practice Nursing in 2018, an article entitled ‘Recruitment and Retention in general practice nursing: What about pay?’ was published (Ashwood et al, 2018). What has happened in the two years since? We are now into a new decade, with a new government whose manifesto pledges great things for nursing: to deliver 50 000 more nurses and to partially reinstate the student nurse bursaries axed two years previously.
The General Practice Nursing 10 Point Plan (GPN10PP) (NHS England, 2017) has helped to create a more formalised structure and subsequent career pathway for primary care nursing. Lead teams, though many and varied in approach, are now coming together and with funding support from Health Education England (HEE), are able to train nurses new to primary care and develop them on their way to Advanced Clinical Practitioners. However, as with many other key documents and tools, the GPN10PP omitted any reference to pay, terms and conditions.
Availability of training placements
Recruitment into primary care remains slow with the number of nurses wanting to make the move out of the acute and community sectors generally outweighing the ability of general practice teams to provide training placements. This is mirrored in a paucity of undergraduate placements not nearly matched by the number of universities' requests. The reasons for this are varied; placement tariffs are woefully low; nursing teams are generally small in number so adding a trainee impacts considerably on workload; GPs understandably prefer new nurses to be experienced and able to achieve across all target driven domains.
However, this does not bode well longer term. According to the Queen's Nursing Institute (QNI), 33.4% of GPNs are due to retire by the end of this year (QNI, 2016). Newly registered nurses deciding whether to make the move to primary care will factor in what their pay progression will look like, what their sick pay entitlement is and what maternity benefits they can expect. If these requirements are not addressed, we cannot expect to fill these vacancies.
The role of the Primary Care Network
So perhaps we can look to our newly formed Primary Care Networks (PCNs) to improve recruitment. It would make sense to provide training placements for both undergraduates and new recruits within these organisations to offer a more varied experience, sharing the supervision and assessment and reducing the impact on a single practice. However, there are potential threats to the traditional role of the GPN ahead. Under the General Practice Forward View (NHS England, 2016), significant funding is being prioritised to new roles, for example: 1 000 more physician assistants and 1 500 clinical pharmacists.
PCNs will see the advent of paramedics and physiotherapists employed in general practice. Alongside this is the expansion of the numbers of nursing associates. While there is more than enough work for all, these new roles will have a financial impact on the nursing role. Nursing associates are set to replace the ‘treatment room’ nurses of old and will do so for less pay. Future general practice nurses will therefore need to rapidly progress on the pathway to advanced roles to secure their future and this can only happen with continued educational funding and support. If funding for undergraduate nurse placements does not increase, there will be little incentive to offer student nurses a taste of primary care and the potential for a subsequent career in the speciality.
Opportunities for improving pay
However, the new Allied Health Professional (AHP) roles offer a potential opportunity for the pay, terms and conditions of primary care nurses as we are for the first time joined by colleagues exiting acute and community sector Agenda for Change contracts for the non-standardised contracts on offer in general practice. Perhaps these professionals will add weight to our claims for contracts which are more allied to those of non-medical staff employed in the main NHS.
Nurses in primary care should not view 2020 as the dawning of a decennium horribilus as the profession is in many ways more robust than it has ever been, with support and recognition being given for the significance of our role and the need to align us more closely to career pathways across other sectors. Clinical Commissioning Groups (CCGs) across the country have devised their own versions of recommended pay, terms and conditions and the Local Medical Committees (LMCs) are working on a Good Employment Guide for primary care employers into which a recommended framework will be incorporated.
Conclusion
The expansion of Agenda for Change into primary care continues to be a highly debated issue and one that is currently unaffordable for GPs to implement without central funding. Indicative of pay differentials then will be the ability of primary care to recruit and retain nurses. For now, it is up to us as individuals and teams to fight our corner for improved remuneration and pay progression.
KEY POINTS
- The General Practice Nursing 10 Point Plan (GPN10PP) (NHS England, 2017) has played a critical role in helping to create a career framework for primary care nursing
- Recruitment into primary care is slow, given the fact that the number of nurses choosing to move from community sectors outweighs the ability of general practices to provide training placements
- Providing training placements for both undergraduates and recruits within Primary Care Networks is logical as it will offer a more varied experience, shares the supervision and assessment, and reduces the impact on a single practice