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Undervalued nursing staff doing “box-ticking” exercises forcing them out, say researchers

Posted on 20 May 2025

A lack of recognition and the de-professionalisation of nursing is driving many to leave the profession in significant numbers, according to the findings of a new study.

Researchers identified common factors impacting retention.

If nurses continue to vacate jobs in general practice at the rates they are doing, then by 2030/31 as many as one in two nursing positions may be left unfilled, according to The Health Foundation.  

This shortfall is significant as NHS England estimates that nurses in general practice deliver 84 million patient contacts per year.

In a study of more than 40 nursing staff working at general practices in England and Wales, researchers at the University of York identified common factors impacting retention. These included the lack of understanding of  the complexity of  role that nurses play in caring for patients, and the increasing number of people being employed with lower qualifications.

Less qualified

In general practice there’s a growing trend of using less qualified and less experienced staff to do the work that registered nurses used to do. This is partly to cut costs, and address employment gaps, but the perception is that nursing  is being de-professionalised. 

Many nurses in general practice are not employed directly by the NHS, but hired by individual practices, often on worse pay and with fewer rights or benefits than NHS-employed nurses. Researchers have shown this typically means that nurses experience difficulties negotiating pay and conditions and  don’t have a voice in decisions that impact them.

Dr Helen Anderson, from the University of York’s Department of Health Sciences, said: “We found that many nurses feel their jobs are insecure, and that they don’t have many ways to challenge unfair treatment. 

“All of these pressures can build up, pushing many nurses to a breaking point where they feel they have no choice but to leave general practice altogether, and this shortfall is having, and will continue to have, serious consequences for patient care.”

Some positives

The study, however, also highlighted the areas that kept nurses motivated to continue in their careers, which included the variety of the work, the continuity of meaningful patient relationships, and leading roles in health promotion, vaccinations, women’s health, and Long Term Condition management, such as managing the care of people with diabetes, cardiovascular disease and respiratory conditions. 

Many feared, however, that these strengths are under threat, with nurses warning that growing pressure to meet targets and to do more with less is turning their work into a “box-ticking exercise.” This shift, they say, risks undermining the profession and driving experienced staff away from general practice.

Researchers highlight that aspects such as flexible working hours to support personal needs, and schemes to encourage professional growth should be prioritised to create a more positive working culture.

Increasing workload

Dr Anderson said: “Participants in the study appreciated the wide range of work, including caring for people of all ages with many different health needs. They felt that general practice nursing plays a key role in promoting health and preventing illness, for example, through vaccination and screening programmes. Nurses often led on areas like women’s health, travel advice, wound care, and managing long-term conditions, all of which they valued and enjoyed about their work.

“It was clear, however, that these valuable aspects were being lost due to increasing workload pressures and a focus on meeting targets rather than providing quality care. Some felt this was leading to a loss of professional identity and making it harder to keep nurses in general practice.

“It is important to reflect that these shared experiences likely resonate with more nurses than we spoke to in this study, and this collective voice should be drawn on to inform future policy and practice.”

The research, funded by the General Nursing Council for England and Wales Trust, is published in the journal BMC Primary Care  GenRet Study Paper - Findings Overview

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