General Practice nursing has reached something of a hiatus: the ten point action plan published in 2017 has expired and as it stands there appears to be nothing new taking its place.  At the same time the Primary Care Networks (PCNs) dominating much of the general practice agenda make relatively little mention of the nursing workforce.  So where does this all leave general practice nursing?

At the time of the publication of the General Practice Forward View in 2016, along with the subsequent 10 point action plan for general practice nursing, there was a gentle optimism that the problems within the general practice nursing profession were finally being recognised, and action was being taken to resolve these.  But fast forward to five years later and it seems the situation remains critical.

While the numbers of nurses attracted into general practice has risen over the last few years (NHS Digital data reports just over 24,000 nurses in 2020 compared to c15,000 in 2015), the fundamental problems in relation to retention of these nurses remain.  The aging workforce, the lack of career opportunities, and the generally poor support for nurses all contribute to the retention challenge.  General practice nurses are funded via the core general practice contract, have no direct influence on the contract negotiations and are not part of agenda for change, and the inequity of pay this generates is the source of much frustration.

PCNs have not helped.  Many nurses are angered by the lack of mention of general practice nursing in the PCN documentation, in particular in relation to the additional roles coming in via the PCNs.  It makes already undervalued nurses feel even more underappreciated, while other professions brand new to the sector receive all the support and attention.

Nurses have provided the frontline of face to face care in many practices during the pandemic.  While many clinical staff were able to function through the use of remote consultations, it was often nurses who had to continue the face to face work such as immunisations and vaccinations, right at the time when the situation was at its worst.  The Queen’s Nursing Institute’s General Practice Nursing Report published last year includes many individual examples of this, and there is no doubt that many GPNs felt exposed to increased risk compared to other workers.

Where does all of this leave the profession now?   Ironically, the introduction of the other roles, and the challenges associated with this, has reinforced for many GPs the value of GPNs.  It is a source of frustration for GPs as much as the nurses that they cannot use the ARRS funding to strengthen this particular workforce.  Despite this, there should still be a place within PCNs for practices to consider how they are supporting their nurses alongside the other roles.

The nurses themselves also have a role to play.  Mel Lamb, a recent podcast guest, describes the need for a change in mindset from the nurses themselves to be more proactive about the opportunities that do exist, and to take more of a leadership voice in how general practice operates.  We have seen the emergence of the Institute of General Practice Management in the last year creating a national leadership voice for practice managers, and it does seem that a similar kind of unifying impetus is needed for GPNs.

National support and action is also required.  It is impossible to look at where we are now, review the progress made over the last five years and decide the job is done.  It cannot be left to the discretion of local areas to determine whether any more action is taken.  There has been some great work started via training hubs, federations and other organisations and these need to continue to be supported and funded, alongside a proper focus on how this critical staff group can be retained, to ensure any gains made are not lost in the next five years.