The urgent need to address disparities in nurse T&Cs

The disparities between the terms and conditions of nurses in general practice and in the secondary sector can only get worse following the increase in employers’ national insurance contributions – from which hospital employers are exempt, but general practice is not

I have worked as a general practice nurse (GPN) in a large, busy GP practice in South London for the past 25 years. I have particularly loved the flexibility of the role, with a civilised work pattern (no night shifts), excellent training opportunities and the privilege of providing care to several generations of the same family and working with a diverse patient population.

Over this time span, I have seen the clinical workload expand considerably for all clinicians, with an increased complexity to the care we provide, often managing people with severe co-morbidities, challenging social circumstances and poor mental health.

As we see more NHS specialist services being transferred to primary care, additional training and rigorous support is required. Now more than ever, we require a robust GPN workforce to continue to provide the excellent care our patients so rightly deserve in primary care.

It is a well-established fact that recruiting nurses into general practice (GP) posts is an on-going challenge. In the last 2 years, my practice recruited two outstanding nurses, new to general practice nursing and keen to develop their GPN skills: cervical screening, childhood immunisations, wound care, sexual health, treatment room, supporting our patients with severe mental health illness and much more. Considerable time and effort have been invested to ensure effective preceptorship and mentoring support for them both, developing new skills and confidence.

After much soul-searching, both nurses have made the difficult decision to leave their posts due to the startling disparity in working terms and conditions for primary care nursing teams (practice nurses, nurse practitioners, primary care assistant practitioners, nursing associates and health care assistants) compared with our nursing colleagues working in the acute sector and other community roles.

GPNs are directly employed by GP Partners, independent contractors, who devise their own working terms and conditions. They are under no obligation – and do not receive additional funding – to offer their staff Agenda for Change (AfC) terms and conditions, thus each practice will have a different provision.

Recruiting a younger workforce has highlighted to us the clear difference between what our GP colleagues receive in terms of maternity pay and provision for the nursing workforce. Since 2017, the BMA have secured funding to support GP maternity leave cover. Practice nursing staff do not receive any additional support, relying on statutory maternity pay (SMP) which means a return to work sooner than their GP colleagues. For context, SMP after the first six weeks is £184.03 per week. Assuming a maternity pay period of 6 months, a typical hospital or community nurse’s average monthly maternity pay over this 6-month period would be 80% of ‘normal pay’ before maternity leave. However, a typical GPN’s average monthly maternity pay over the same period would be 37% of ‘normal pay’ before maternity leave. Thereafter, both nurses would be on SMP of £184.03/wk. Or to put another way, in order to maintain a reasonable maternity pay of an average 70% of ‘normal pay’, a typical GPN’s maternity leave would be only 2 months, whereas a hospital or community nurse would be able to take just over 7 months maternity leave to achieve the same 70% of ‘normal pay.’

This clear disparity feels divisive, creating an ‘us and them’ mentality, with practice nursing staff feeling undervalued and unappreciated for the work and care they provide. Compounded by the consistent rise in the cost of living (food, housing, energy, transport and childcare) it is going to become more of a challenge to encourage younger nurses (the next generation) to join the GPN workforce. This trend is concerning as a large proportion of highly experienced GPNs approach retirement.

The RCN has joined forces with the BMA, Department of Health and Social Care, NHS confederation, Royal College of GPs and NHS England, as part of an expert advisory group, to examine the 2024/25 GP contract. The RCN pledged its support to GP nursing staff, and its stance is heartening: ‘We are fighting to ensure the negotiations include maximising pay, terms and conditions for nursing staff employed by general practice.’ This negotiation cannot come soon enough as we endeavour to recruit new staff and to be able to offer similar working conditions to those experienced by our colleagues in secondary care and other community care settings.