GPN Manifesto Roundtable: Wellbeing and professional development

Overview of the roundtable discussion

The manifesto for general practice nursing was launched by Nursing in Practice this year, to highlight key areas in which GPNs want to see improvements.

Nursing in Practice met with a group of the nurses behind our 10-point manifesto for general practice nursing as part of an exclusive roundtable discussion series focused on the mental health and wellbeing of GPNs, as well as their professional development and career progression.

Here we explore concerns of GPNs feeling burnt out, compassion fatigue and ‘squeezed out’ of their workplaces, and discuss why the workforce must be listened to, valued and given enough time to do their jobs properly and safely. We also hear about the ‘hit and miss’ nature of professional development of GPNs and the funding constraints that can block progression.

Why was this an important debate to have?

Our manifesto calls on GPN employers, primary care networks (PCNs) and others to support nurses with their health and wellbeing, so they can care for others. It also outlines the need for all nurses in primary care to be given the time and space for professional development to progress in their careers.

A recent report from the Royal College of Nursing (RCN) warned workplace issues and demands were contributing to a ‘mental health crisis’ among nursing staff across the UK. Figures from the RCN, published in September, showed a 79% rise in nursing staff seeking support from its advice service for suicidal ideation, compared to the same period in 2023.

Among those involved in this roundtable, it was agreed some GPNs are feeling ‘powerless’, and as if they are on an ‘escalator that never stops going up’.

GPNs need the time and space to do their jobs well and to feel good about their roles, while also being given the time to look after themselves and their own needs, our roundtable attendees suggested.

Calls were also made during the discussion for a move away from ‘short-termism’ and towards ‘long-term funding’ to support career development with general practice.

It was suggested that not all practices could see the value of advancing and enhancing their nursing staff and that some would ‘argue and push back’ against training for GPNs. This could be ‘very soul destroying’ for GPNs, the roundtable heard.

Starkly, above the need to develop and progress was the need for GPNs to be reassured that their roles will continue and are here to stay, amid what feels like a move to replace them with other clinical roles, attendees suggested.

Is GPN wellbeing a problem?

‘I think GPNs feel a bit powerless,’ said Rebecca Corneck, director of general practice nursing for the Southeast London Workforce Development Hub and a Queen’s Nurse.

She described workplace demands as if being on an escalator that ‘never stops going up’. ‘You think you’re getting to the top and you’re never there, which is exhausting,’ she said.

But on top of workload was a feeling of ‘despair and frustration at not being heard’ when trying to make the case for change in their practices.

‘No one’s got time to sort out problems that are affecting their day-to-day work,’ added Ms Corneck. She suggested there were cases where GPNs were told to focus on ‘what brings the practice money in’.

‘It just feels like quite a frustrating bounce back all the time of having to really swim upstream to make a difference and to be heard and it takes somebody else to properly champion them and push it and not there’s not enough of us out there to do that,’ said Ms Corneck.

There was an example of one nurse who has been qualified for nearly three years, having gone straight into practice nursing. ‘She’s already burnt out,’ explained Ms Corneck.

The GPN had said “I’m getting compassion fatigue. I’m just battered. My days are full, back-to-back, and there’s no time to breathe”, described Ms Corneck.

‘I had to really support her to try and step back. I thought, you’re not even qualified three years, and you’re already burnt out, because you give 150%, and they just take,’ she added.

GPNs feel ‘squeezed out and done to’

Jenny Aston, an advanced nurse practitioner working in a large primary care network outside Cambridge, said GPNs were feeling ‘powerless’.

‘Nurses are feeling squeezed out and done to a lot, because… all that matters is how many appointments you can cram into the day, and how fast you can get through your patient list,’ said Ms Aston. ‘And it just isn’t conducive to staff wellbeing.’

While some nurses like the ‘variety and the quick turnover’ that general practice can bring, Ms Aston suggested that ‘a lot of nurses get burnt out’. ‘Burnout is a huge issue,’ she said.

Ms Aston added: ‘It just doesn’t seem to matter that a happy workforce provides safe and effective care – it doesn’t seem to matter anymore. And we’ve become too tick-boxy.’

‘We’re the last ones to look after ourselves’

When asked if GPNs come to work when they’re unwell, Rebecca Shearer, lead nurse at Westwood Medical Centre and an advanced nurse practitioner (ANP), said: ‘We’re the last ones to look after ourselves and we look after everyone else first.’

She described examples where she felt like she had ‘abandoned’ her own family when they needed her, to ensure she got to work and that patients did not miss their appointments.

‘There’s nobody [there] to step up. And that really worries me that patients will be let down if I don’t go to work that day. I feel really strongly about that. So, I do drag myself into work,’ added Ms Shearer.

At her practice, Ms Shearer set up a health and wellbeing garden – a space for GPNs to ‘take a breather’.

But she said: ‘Nobody has time to go in there. It was meant to be somewhere where you could go out and have a breather. [But] it’s rarely used because nobody has time to go out there,’ she explained.

‘It wasn’t meant for an extended break. It was just somewhere for going take a breather, but you just can’t take a breather.’

What support do GPNs need?

While Ms Shearer feels ‘really well supported’ in her practice, she said this wasn’t always seen at higher levels, including at primary care network level or from the regulator.

Separately, Ms Aston said the support GPNs needed was ‘having enough time to do the job properly’.

‘I’d say it’s time, and time to grow and develop and do things, and being valued for it,’ she said. ‘It’s allowing people the time to do their job properly and safely.’

Ms Corneck added: ‘I totally agree – it is giving them the time.’ She urged practices to ‘stop taking time away’ and to listen and respect the nurses’ voice.

If a nurse says they need a double appointment for a patient, practices must respect that and give them the time they need to do their jobs properly, she suggested.

Ms Corneck said some practices ‘belittle’ their nurses and ‘treat them like schoolchildren’ by not listening to them.

‘So, I think it’s about treating them as adults and like they would the rest of their team,’ she said.

The professional development of GPNs

The current offer for professional development opportunities for GPNs was described as ‘hit and miss’ by Ms Aston.

‘I think the problem is we’re so dependent on short-term budgeting. There needs to be long-term funding to support career development within general practice rather than short termism,’ she said.

Ms Aston suggested that the training opportunities were there, and there was some understanding around the career development needed, but that funding was ‘never enough’.

‘I think for me, it’s that we know what training is needed. We know what good training looks like that’s not a problem. We’ve got some clear outlines of how to do it and what to do. There’s very good training usually in most areas available – it’s just the money,’ she added.

In 2019, what was then Health Education England – which has now merged into NHS England – announced £1,000 for continuing professional development (CPD) for every nurse over three years.

With this funding pot now having come to an end, attendees said they were waiting to see what was coming next.

Ms Shearer added that the ‘last-minute’ nature of funding for training opportunities was ‘absolutely ridiculous’.

‘I waited about 18 months to put two nurses through a clinical skills [course], and then funding came at the same time for them, which wasn’t ideal, but I didn’t dare miss out on the place on the course because I didn’t know when they’d get back on it,’ she told the roundtable.

Similarly, with the new RSV vaccination programme that has come into primary care this autumn, Ms Shearer said they were only given a matter of weeks’ notice for training courses for nurses on this.

There was ‘not one member of staff that I can send on that course, which is just ridiculous’, she explained.

‘It happens continually. It’s time and time and time again, this isn’t a new thing,’ she said.

Ms Shearer added that to ensure nurses get what they need, she makes sure ‘really comprehensive’ appraisals are carried out, which include a training plan.

‘It’s then harder for people to say, “no they can’t do that”, because it’s been identified as a training need for them,’ she noted.

However, Ms Shearer recognised that trying to give people training time in a fair way was ‘really difficult’.

Training should be seen as a ‘dual credit’

Ms Corneck hoped the development of nurses could be seen as a ‘dual credit’.

For example, she explained that an ANP course would be both good for the nurses’ career, as well as for the practice.

For the nurse, that ‘really enhances their role’, but practices don’t always see that and can sometimes push back, she suggested.

‘It’s not recognising that actually by valuing that nurse, and saying “we’ll back you in doing that because we think you’re really important”,’ said Ms Corneck.

‘They just argue and push back, and that’s very soul destroying for the nurses as well.’

Ms Aston added that some kind of standardisation was needed when it comes to professional development, and she stressed there ‘shouldn’t be an argument’ against it.

But she also felt that development needs to be ‘within the context of what’s needed’ at the practice.

‘It should be about practice and the individual’s needs not just “I fancy doing a course and there being no role for it”,’ she said.

‘It needs to be within the context of what’s needed, as well as what does the individual want because otherwise you do get people just training and disappearing.’

Is the GPN role at risk?

The introduction of new roles in primary care – largely through the additional roles reimbursement scheme (ARRS) – has seen an increase in GPNs feeling pushed out and sidelined.

Nurse leaders have often stressed that the registered nurse cannot be substituted or replaced by cheaper, less qualified alternatives.

A key concern raised during this discussion was around the role of the GPN being at risk.

Ms Aston said she felt the role was ‘threatened’.

‘The general practice nurse with experience and the very generalist skills is being squeezed out because we’ve got our healthcare assistants, or nursing associates, [and] we’ve got the community pharmacy taking away a lot of the easy work. And that actually fragments care,’ she told the roundtable.

‘And it doesn’t provide holistic or continuity of care, which is what general practice nurses should be valued for.’

With a new government now in power, Ms Shearer said she wanted ‘reassurance that our role will continue’.

‘It is a really valuable role and we seem to be getting replaced in different ways,’ she said.

‘So, is it here to stay?’

To which Ms Corneck responded: ‘We are here to stay because we are vital.’