‘Optimistic’ projection

The analysis suggests other, less pessimistic scenarios, too. Its ‘optimistic’ projection points merely to a chance of slow growth in GPN numbers.

Whichever way the next decade pans out, RCN professional lead for primary care Heather Randle says there is ‘a huge crisis’ now in recruitment and retention. ‘We’re not able to get nurses into the profession, and we’re not recruiting nurses to replace those retiring.’

The crisis certainly is not new, but it has escalated since COVID-19.

Health Education England associate dean for wider workforce South Yorkshire, Marie Therese Massey says: ‘The pandemic made many nurses think about retirement or decide to find a less pressured job.’

Practice nurse Naomi Berry, based in Bradford, describes the scale of the staffing shortage as horrific. ‘It’s taken nine months to employ two new part-time nurses at my practice. The staff shortage has affected patient access and our workload.’

And advanced nurse practitioner Jenny Aston describes the impact on colleagues at her Cambridge practice. ‘We are constantly short-staffed and currently short of three full-time GPNs. Burnout is a real issue, and more nurses are experiencing health problems,’ she says.

More placements needed

More GPNs will retire early or reduce their hours, she predicts, and if she is right, the Health Foundation’s more pessimistic projections become more likely.

At the heart – and the start – of the problem is that when nurses are making career choices early in their careers, they often have little or no experience of general practice.

‘There are not enough placements,’ says newly qualified GPN Imogen Woolf, based in Lincolnshire. ‘It’s a big leap if you’re going into general practice nursing with no knowledge or understanding of how it works,’ she says.

Ms Massey agrees students’ exposure to the specialty is patchy. To address this, ‘raising the profile of community nursing in general in the undergraduate curriculum is key,’ she says.

Queen’s Nursing Institute (QNI) chief executive Crystal Oldman wants experience of general practice to be mandatory for nursing students, and for more GPNs to teach students about the specialty in universities.

‘It’s wrong that nurses don’t have exposure to general practice, because GPNs are a fundamental part of their communities. A greater focus on general practice nursing is needed for students, so that from early on, they learn about the possibilities of serving their communities,’ she says.

Working with universities to increase general practice placements can help recruitment, says Ms Aston. ‘In Cambridgeshire, having general practice placements has meant we are now seeing a rise in nurses considering primary care as a career once they’ve qualified.’

‘There’s a perception that the job is for nurses who are retiring’

Lee Collins (pictured) qualified as a general practice nurse (GPN) in July and is based at a practice in Cornwall. He says: ‘I’ve always enjoyed general practice. I love looking after a wide range of patients – the saying “from cradle to grave” is true of general practice.

‘I started as a receptionist in general practice in 1998. Four years ago, I took the plunge and studied to become a nurse. In my final year, I was approached by the practice where I used to work to take up a GPN post.

‘The lead nurse at my practice is leaving, and we’re trying to recruit, but haven’t found a replacement yet. I can see a potential staffing crisis soon when GPNs at my practice retire.

Tackling stereotypes

‘The perception of the specialty is one of the reasons there are recruitment issues. At the end of my third year when I told other nursing students I was going to be a practice nurse they were surprised – there’s a perception that the job is for nurses who are retiring and that it’s their final career destination.

‘Practice nursing is still perceived as being female dominated. But it’s not about being male or female, it’s about being a nurse. We should be promoting practice nursing and tackling stereotypes at local and national level, through student networks and social media.

‘I had no exposure to general practice as a student. Practice placements are limited because surgeries are understaffed. But without that exposure, it’s difficult to recruit – it’s a vicious circle.

‘General practice nursing is a fantastic specialty. But to keep me, I will need a career pathway that keeps me learning, potentially specialising, and always moving forward with my professional development.’

Challenging environment

But with general practice staff so stretched, adding a student to that environment can be a challenge, Ms Randle points out. In recognition of this, she wants better funding of clinical placements, and equity between nursing student placements and those for medical students.

The value of the GPN’s role also needs to be promoted, not only among students, but across the nursing profession, to tackle misconceptions and negative stereotypes among other nurses.

‘The practice nurse is hidden – when you think about primary care you think about a GP. There’s also a myth that nurses only go into general practice before they retire – that’s not the case,’ says Ms Woolf.

While recruiting nurses from secondary healthcare would help to address the GPN staffing shortage, this is no quick fix. These nurses need time and resources invested in them.

Perhaps because of this, nurses who lack experience of primary care can find they do not get called for interview. As Ms Randle explains: ‘Some practice managers don’t see the transferrable skills that nurses working in acute settings can bring to general practice.’

And Ms Aston says: ‘We need the right resources to upskill these nurses and embed them in general practice.’

Projections for the general practice nursing workforce in England

Picture credit: SPL

One quarter of practice nursing posts could be vacant ten years from now, although an even more pessimistic scenario suggests the shortfall could grow to almost half of full-time equivalent posts. The Health Foundation findings conclude that:

• » GP shortages are projected to get substantially worse in the next decade

• » Action is urgently needed to retain existing practice nurses

• » Integration of allied health professionals into general practice teams would help reduce pressure on nurses and GPs

• » Investment in buildings and equipment is needed

Source: Health Foundation (2022)

Mandatory nursing voice

Nurses from the NHS who make the move into general practice may be taking a substantial pay cut to do so. But while pay is a crucial issue for GPNs, their terms and conditions are equally, if not even more important.

While NHS staff have Agenda for Change – which includes sick pay, holidays, maternity/paternity leave, continuing professional development (CPD) and an NHS pension, GPNs are reliant on the terms and conditions set out by general practitioners, whose contracts are negotiated without nurse involvement. A nursing voice should be mandatory in this process, insists Ms Randle.

Terms and conditions for GPNs vary greatly. Ms Randle acknowledges some larger practices have adopted NHS pay and terms and conditions and offer staff training programmes.

But some GPNs earn much less than their NHS counterparts and have to pay for their own CPD. They may not even receive sick pay.

Ms Randle wants GPNs to have the same pay and terms and conditions as their NHS colleagues.

‘This would reduce the sense of being invisible and would entice younger nurses into the profession who would lose so much by choosing a career in general practice, such as sick pay, maternity/paternity pay, annual leave and release to study,’ she says.

The disparity in employment conditions and rewards for GPNs has become even more apparent since allied health professionals, such as pharmacists and paramedics, were recruited to general practice. This has created resentment, says Ms Randle, an assessment borne out by Ms Massey, who says some GPNs ‘feel sidelined, leading to a reduction in job satisfaction and self-worth.’

Earlier this year, Skills for Health published a career and core capabilities framework for GPNs. This should make general practice roles more attractive to nurses keen to plot their career development.

And all GPNs should have access to clinical supervision, which is currently patchy, according to Ms Massey. ‘Clinical supervision should be seen as an essential part of a GPN’s role throughout their career – just as it is for GP registrars,’ she says.

Funded mentorship

NHS England’s general practice fellowships programme, a two-year programme of support, is available to all newly qualified nurses working in general practice. The scheme offers funded mentorship as well as CPD opportunities and rotational placements in primary care networks.

Nurses should take every opportunity to raise the profile of general practice, says Ms Massey.

As Ms Aston puts it: ‘General practice is still one of the best places to work, because we’re able to provide such a wide range of care for patients.

‘Our work is rewarding. We need to hold on to that.’

This is an abridged version of an article at rcni.com/GPN-shortfall

Find out more

GPN Student and Nurse Network twitter.com/gpnsnn

Health Foundation (2022) Projections: General Practice Workforce in England

King’s Fund (2022) Integrating Additional Roles Into Primary Care Networks

NHS England (2021) General Practice Fellowships Programme

NHS England: Expanding Our Workforce england.nhs.uk/gp/expanding-our-workforce

Queen’s Nursing Institute qni.org.uk

RCN: General practice nursing forum. General Practice Nursing Forum

Skills for Health (2022) Primary Care & General Practice Nursing Career & Core Capabilities Framework