GP practice nurses earn less than hospital colleagues

Nurses working in general practice are earning thousands of pounds less than those in secondary care on Agenda for Change (AfC) terms, a report has found.

The exclusive report by Pulse’s sister title Nursing in Practice focuses on general practice nurse (GPN) basic pay and salaries, annual pay uplifts, pensions, employment benefits, the additional roles reimbursement scheme and more.

Based on a survey of almost 900 general practice nursing staff and informed by expert advice, including from the Royal College of Nursing (RCN), a key focus of the report is that the exclusion of GPNs from AfC means their pay levels are falling way behind their NHS secondary care colleagues who benefit from AfC terms.

For example, the data suggests AfC NHS nurses at the top end of Band 5 are earning over £1,000 more than practice nurses working at Band 6. Furthermore, the report shows that AfC nurses at the top of Band 6 are earning almost £5,700 more than practice nurses working at Band 7 (see table below).

Being on AfC also means that NHS nurses are guaranteed an annual pay rise, while those in general practice can often miss out – as evidenced in the report’s data. It also has implications for employment benefits, which again are further explored in the report.

The analysis gathered data for different nursing roles within primary care, including GPNs, advanced nurse practitioners, nurse specialists, nurse team leads, enhanced level practice nurse, and nursing associates.

And according to the survey, the average salary of a full-time (or full-time equivalent) GPN in the UK is £35,884.

Significantly, this comes in lower than the Government’s National Career Service salary estimates – calculated at £40,000 for a new starter GPN and rising up to £57,000 for an experienced GPN.

But even for advanced nurse practitioners (ANPs) respondents to the survey, the full-time average salary came out at £49,321.

Data also showed that:

• Those with a GPN job title at Band 5 earn an average salary of £29,976,
• GPNs at Band 6 earn an average salary of £36,443
• GPNs at Band 7 are being paid an average salary of £40,892.

These salaries are again lower than the government’s National Career Service expectations, and also much lower than the AfC pay levels.

Average pay for GPNs not on AfC versus pay band ranges for nurses on AfC:

Source: Nursing in Practice survey and data from NHS Employers

Many nurses responding to the survey raised concerns that their pay does not reflect the work they do, including one GPN who said: ‘Practice nurses don’t get the recognition we deserve. We are highly skilled nurses who work autonomously but are an integral part of the wider team. We deserve the same pay scale as nurses working in secondary care, to reflect our hard work and expertise in general practice. We are the “forgotten nurses”.’

The issue of not having AfC terms and its impact on recruitment was discussed by several respondents, including one nurse who said : ‘Nurses don’t want to leave Agenda for Change for less pay. This was reflected in our recent advertising – it took 18 months to recruit.’

Another added: ‘Our pay would be better if we were on Agenda for Change conditions. It makes recruiting GPNs difficult as there are huge implications when accepting a job.’

As highlighted in the report, the RCN has called in the past for GPNs to be aligned to AfC, as well as for ringfenced funding to support general practice nursing and for a nursing seat on government negotiations.

Nursing in Practice has echoed these calls, backed by the evidence set out the report, and has made three key recommendations:

1. The government must introduce ringfenced funding for general practice nursing – to ensure practices have adequate funds to provide their nurses with fair pay, terms and conditions that reflect their highly skilled, complex, and vital roles.
2. Nursing staff in general practice must have their pay, terms and conditions set at least in line with those on Agenda for Change, to help stamp out pay inequity within the profession and ensure GPNs have access to timely, annual pay uplifts and above statutory employment benefits, such as maternity and occupational sick pay.
3. The nursing voice must be represented in national negotiations in relation to primary care and general practice, including the GP contract. The RCN has stressed it stands ready to be that voice and to ensure nurses are heard at every level.

Dr Sarah Jacques, co-GP lead for Doctors’ Association UK, said the exclusion of practice nurses from AfC means their pay ‘sits within a very different system to hospital nursing’.

She said GPNs are ‘absolutely central to the delivery of modern primary care’ and that GPs and practices ‘rely on their skill, continuity and patient relationships every day’. However, she says ‘financial pressures’ present challenges for partners when it comes to practice nurse pay.

‘The reality is that practice nurse pay sits within a very different system to hospital nursing. GP practices are independent businesses operating under contract, and partners are responsible for balancing staffing costs against a fixed and often constrained funding envelope.

‘Unlike Agenda for Change roles, there is no nationally mandated pay scale or automatic uplift, which creates variability and, at times, inequity.

‘The challenge for partners is not a lack of willingness to reward staff, but the financial pressures practices are currently under.’

Dr Jacques stressed that despite the constraints, ‘the intention across general practice is clear: to retain and support valued nursing colleagues’.

To view the General practice nurse pay: A salary survey of the profession 2026 report click here.