Class, race, ageism and status shaping who stays in general practice, study shows

Posted on Wednesday 29 October 2025

Researchers from the University of York found that nurses working in GP surgeries often face challenges linked to class, ethnicity, gender, ageism and professional status. 

These factors leave many feeling undervalued, overlooked and excluded within their workplaces, ultimately influencing their decision to stay or leave the profession.

The study draws on interviews with forty-one participants including current and former nurses working in general practice across England and Wales. The research explored how professional identity and belonging are shaped in everyday practice.

Less valued

Many nurses described feeling "less valued" than doctors and other colleagues within general practice. Participants spoke about being made to feel ‘different’ - from accent and education to ethnicity, age or social class - which shaped how they were perceived and treated. 

Dr Helen Anderson, from the University of York’s Department of Health Sciences, said: “For some, these experiences eroded confidence and reinforced a sense that nursing in general practice sits at the lower end of the professional hierarchy.

“We found that this discrimination and exclusion most often stem from within professional and managerial structures, from employers, typically GPs and practice managers. While the public image of nurses as ‘doers’ and ‘helpers’ contrasted with doctors as ‘leaders’ and ‘experts’, which continues to shape how the wider public and healthcare systems value nursing work.”

Deep-rooted

The findings highlight the urgent need to look beyond traditional explanations for nurse shortages. Researchers argue that unless these invisible barriers are acknowledged, efforts to retain nurses are going to repeatedly run into the same challenges.

Dr Anderson said: “Tackling workload and improving pay alone will not be enough to solve the retention crisis. We need to address issues of the deep-rooted discriminatory practices influenced by race, gender, age and class, or risk losing more experienced nurses from general practice, with serious consequences for patient care and access.”

The study shows that change must begin with recognition and valuing of nursing in general practice as a specialist and skilled career in its own right, ensuring nurses have equal opportunities for leadership and development, and fostering inclusive workplace cultures that recognise the diversity of those delivering care.

The authors hope their findings will encourage NHS leaders and policymakers to consider how social and professional inequalities shape the nursing workforce. By bringing these hidden dynamics into the open, they say, the health service can start building a more sustainable and equitable environment for nurses and patients.

The study is published in BMC Health Services Research and funded by the General Nursing Council for England and Wales Trust.