14 | Nursing in Practice | Winter 2023
ANALYSIS
2024 will be ‘ the making
or the demise ’ of general practice nursing
In an exclusive interview , Royal College of Nursing primary care lead Heather Randle discusses with Megan Ford her concerns over the growing threats to the general practice nursing workforce
The Royal College of Nursing ’ s primary care lead doesn ’ t hold back in issuing a stark warning for the profession when she sits down with Nursing in Practice to discuss the future of the general practice nurse role .
The next 12 months will be ‘ the making ’ or ‘ the demise ’ of general practice nursing , Heather Randle tells us , insisting the profession may not survive without urgent action . She highlights the challenges and risks ahead for a workforce that she says feels ‘ invisible ’.
While this year has been ‘ a lot more business as usual ’ for general practice nurses ( GPNs ) following the Covid-19 pandemic , demands have been ‘ a lot higher ’ and patients are presenting with ‘ later disease ’ than before , she says . In addition , concerns over pay and employment conditions have ramped up this year , while GPNs have felt increasingly undervalued by the wider system .
Among the main challenges currently faced by GPNs is the effect of the additional roles reimbursement scheme ( ARRS ) – an initiative that Ms Randle says has seen nursing associates and other roles increasingly being used in place of GPNs .
Coupled with ongoing concerns over GPN recruitment and retention , the ARRS runs the risk of eroding practice nursing altogether , she warns .
‘ Substitution of GPNs ’ Concerningly , GPNs are increasingly being substituted with the ‘ cheaper alternative ’ of nursing associates , in a move that is ‘ devaluing ’ the profession and its skills , Ms Randle tells Nursing in Practice . This situation has worsened since the introduction of the additional roles programme in 2019 , and the college is now seeing it happen ‘ a lot ’, she says .
The ARRS programme allows primary care networks to claim reimbursement for the salaries of some roles in practices , including pharmacists and physiotherapists . While the scheme covers nursing associates and advanced nurse practitioners , it does not include GPNs – something Ms Randle insists must change .
While stressing that nursing associates do ‘ have a role ’ in general practice , Ms Randle adds : ‘ We need to be making sure that they aren ’ t replacing the general practice nurse .’
Ms Randle says the way ARRS is used in primary care is ‘ devaluing GPNs as the skilled workforce they are ’.
‘ Nursing associates have their role , but they don ’ t look at the whole person , that is not what they are trained to do ,’ she says . ‘ They are not trained to do that autonomous assessing . They are trained to complete those tasks that are in front of them .’
Ms Randle suggests there is too much focus on ‘ task orientation ’ in practices , instead of on using the skills of GPNs , who build relationships with their patients and look at healthcare holistically . Having worked in general practice for 30 years , Ms Randle says : ‘ Some of the most important conversations I ’ ve ever had with patients have been chance conversations , because there ’ s a relationship there .
‘ The lady that ’ s walking out the door and says to me “ I ’ ve had this funny thing on my breast for a couple of weeks , could you have a look ”.’
But Ms Randle warns practices are moving away from this and towards ‘ you need to do this many blood pressures today ’ or ‘ let ’ s go back to task orientation , instead of using that skill ’.
‘ Too much compromise is needed ’ The number of GPNs in post is not increasing in line with rising demand and Ms Randle says an underlying issue is that to become a GPN , nurses have to compromise ‘ too much ’ on the pay and conditions enjoyed by colleagues in trusts .
Latest figures show there were 16,968 full-timeequivalent nurses working in general practice in England in October 2023 – just 198 ( 1.2 %) more than a year earlier . Meanwhile , the overall headcount in that period has actually decreased by 0.3 % to 23,355 .
‘ We ’ re not seeing the numbers go up at all ,’ says Ms Randle . The ‘ biggest issue ’ is that not enough thought has gone into why nurses are not coming into general practice . Being a GPN is an ‘ amazing career ’, she says , and a ‘ unique role in nursing because of the experience and knowledge you need to have across the system ’, from cradle to grave .
‘ The role is something that should attract people to it , but the compromise is too much ,’ she says . This includes sacrifices on maternity pay , sick leave , salary and study release , she notes .
‘ Pay is my first priority ’ Ensuring GPNs are given the 6 % pay rise they were promised this year by the government is Ms Randle ’ s number one priority as 2023 comes to an end . Ongoing concerns around funding of the uplift – which could see some GPNs get less than the full rise – have seen the RCN promise to ‘ step up ’ its pay campaign for the sector .