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Download: Our nurses project

General practice has changed out of all recognition in the last decade. The most important change has been in response to the now infamous GP ‘contract’ of 2004.

Most GPs would recognise that primary care is a team effort and that there has been a huge growth in the role of our practice nurses and healthcare assistants. Practice nurses now form the largest non-medical clinical profession in primary care.

As independent contractors to the NHS, we as GPs have the responsibility for the employment and clinical management of our nursing team. Funded by the City and Hackney PCT, The Hoxton surgery has had an opportunity to concentrate our energies on our nursing team.

We focused on our role as managers of our nurses both clinically and as employers. The project was born out of our problems in recruiting and retaining practice nurses. We were able to examine our failures and poor practices. Like many practices, we were found wanting in our clinical management of practice nurses. We found that, like all too many practices, we did not offer the clinical support our practice nurses and healthcare assistants require in their burgeoning role.

The project enabled us to put some of the necessary support mechanisms in place to ensure a safer practice. The lessons we have learned over the two year life-span of the project are relevant to GPs, the PCT and to nurse educators. A supportive educative environment for practice nurses is necessary for our future survival in general practice.

In summary we found:


  1. Nurses are increasingly important in the provision of primary healthcare.
  2. In order to offer a primary care service that meets the demands placed on general practice, we need to ensure we have a safe and efficient clinical environment for nursing teams as they take on more and more work in primary care.
  3. We need to improve our management of nursing teams by ensuring good employment practices, better clinical supervision and mentoring.
  4. In order to avoid a recruitment and retention problem with practice nurses, City and Hackney will need employment conditions and development opportunities that are competitive with their NHS colleagues and practice nurses in other areas.
  5. We are responsible for educating and training our nursing workforce.
  6. With increasing emphasis on productivity and tightening of resources, we need to improve performance management of our nursing teams.
  7. In order to be able to respond positively to the changing landscape of primary care, we need to be better at planning our workforce for the future. In each case there are implications for us as GPs, and for the PCT in its strategic role.

Click here to download our full report

Dr Julie Sharman and Dr Jenny Darkwah are GP partners at the Hoxton Surgery, east London