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Our nurses would quit if they felt ripped off

Accusations over nurse pay have been angrily rejected by most readers – but a few GPs agree

• From Dr Laurence Buckman, GPC chair

The Department of Health's claim that GPs are cutting practice nurse pay is mischievous and misleading.

The figures in its evidence to the Doctors and Dentists Review Board come from research done by the Personal Social Services Research Unit (PSSRU). But the department has clearly not understood what these figures represent. When Agenda for Change was introduced (and resisted as unfunded by most practices), practice nurses were placed within band 6 on the advice of the RCN, the BMA and the Agenda for Change job analysts.

However, the PSSRU has since looked again at its assumptions of what a practice nurse costs and has decided that the role of the practice nurse should fall into band 5, not band 6. In practice, if GPs took any notice of Agenda for Change, this means new nurses will fall into band 5 – which does have a lower basic salary.

However, existing practice nurses would stay within band 6 and will continue to progress upwards within that band. The department has looked at the PSSRU's re-banded figures and assumed this means practice nurses have had their salary cut – that is categorically not the case. Does anyone imagine that our valued nurses would stay with us if we reduced their pay?

• From Dr Peter Coleman, Ventnor, Isle of Wight

It is clearly rubbish to say that practice nurse pay is being reduced. This would not be tolerated by nurses and they would be walking away from jobs, not flocking to them from hospitals, as is happening.

It is obvious that the average income for practice nurses has reduced because practices are employing more nurses, including lower-grade staff in line with department policy (with nurse consultants replacing doctors, for instance). If the department wanted to it could easily have worked this out for itself, but that wouldn't suit its current crusade against doctors and obvious desire to undermine our public and professional support. Shame on them.

• From Dr Phil Dommett, Cornwall LMC

I believe it is right and proper that practice nurses should get an excellent package of benefits, including pay, for what they do. This should rise with additional skills and responsibilities and should lead in return to a feeling of joint ownership of the good work practices are doing.

However, very few practice nurses run the business or enter into the risks that partners do. Nor is there the short-term contract mentality of the rest of the business world, and very few practice nurses are treated with the contempt that many hospital nurses are.

Some practice nurses do appreciate that because they are not partners or shareholders in a business, they have no right to expect dividends if the business does well, unless that is part of their individual deal. They gain security of tenure.

We need to resoundingly rebut the notion that GPs are creaming it in at nurses' expense. Many new posts have come about (four in our practice) simply because of the QOF. Most of this is low-level data collection and testing, not high-level decision making. It is not therefore a surprise that the average pay is lower.

Rather than this continuous knocking of ‘the fat cats', why not trumpet how general practice has thrived in the past three years, as one would with other businesses doing exactly what they were asked to do.

• From Dr Ken Holton, Coventry

So practice nurses are wanting to mount a pay claim based on envy and greed? Certainly my definition of covetousness would comprise the desire for something that somebody else has. Or perhaps they want their pay to be restructured as performance related, but only so long as it goes up but doesn't come down?

Practice nurses should be properly remunerated, trained and have employment conditions in relation to the knowledge and skills required for their job, and not the terms and conditions relating to somebody else just because they envy it.

Agenda for Change is a great improvement on its predecessor and GPs should instate their nursing staff as professional employees within this framework.

• From Dr Jose Quevado, Skegness, Lincolnshire

Practice nurses are employees of the practice. They have a signed contract and a job description. They are not responsible for any complaints generated from the QOF, nor for organising all the administration it generates.

If my practice has practice nurses, it is because of the QOF, and the money coming from the job done by the nurses just pays their salaries. I don't share profit with employees; I just pay their salary. If you want a share of profit you need to be a shareholder.

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