GP nursing: how pay is decided and what we’re calling for

How is general practice nursing pay decided?

General practice nursing pay is decided and funded differently to NHS pay.

In all four UK countries, general practice nursing staff are primarily employed directly by their practice where they’re subject to practice-to-practice decisions on pay, terms and conditions. But general practices are publicly funded, and general practice nursing staff deliver NHS services.

Differences in how pay, terms and conditions are applied have led to inconsistencies in the pay, terms and conditions general practice nursing staff receive.

There are no national bargaining structures for general practice nursing staff. That means many nursing staff negotiate their own individual employment contracts. This leads to variation in pay and conditions.

General practice care is funded centrally by government, which enables people eligible for NHS care to access services in their community. This funding primarily comes from what’s called the global sum. 

What is the global sum and how is it used to decide pay?  

In the UK, the global sum is the primary payment method for GP practices, representing a significant portion of their funding for essential services like core contract delivery and staff pay. This payment bases funding on the population that a practice serves.

The global sum is calculated quarterly using the Carr-Hill Formula, which weights each patient on the list to account for factors that influence health such as age, gender, and unavoidable costs like rurality, creating a weighted patient count.

This payment ensures funding reflects the perceived patient workload and costs, rather than actual service delivery.

Do GP nursing staff get annual pay awards, like nursing staff on NHS terms and conditions?

The Review Body on Doctors' and Dentists' Remuneration (DDRB) makes UK recommendations on annual pay uplifts for general practice nursing staff that are employed directly by GP practices.

These recommendations are then considered by governments; all four UK countries have different mechanisms for agreeing and ensuring pay uplifts are handed on to staff.

In June 2025 the DDRB recommended a 4% uplift to general practice salaries for the 2025-26 financial year. In the summer, the Westminster government confirmed this pay uplift should apply to all salaried practice staff. General practice employers should be speaking with staff about this award and implementing it.

However, these uplifts are often passed on inconsistently. At the start of 2025 we surveyed thousands of members about pay in general practice across the UK.

Only 20% of respondents in England said they received the full 6% pay increase the Westminster government promised in the 2024-25 financial year. This was a slight improvement on the previous year, but it’s still nowhere near enough.

The RCN wants the needs of general practice nursing staff acknowledged and considered by all decision makers. That’s why we’ve written to the DDRB setting out our goals and raising the issue that nursing pay in general practice is often overlooked and requires attention.

What are we doing to fight for fair pay across the UK?

Each UK nation is in a different phase of influencing on general practice nursing staff pay, terms and conditions.

In some countries general practice nursing see their pay increased annually with more consistency, while in others government has mechanisms to retract funding from practices if it is not used for staff pay as intended.

Unfortunately, in England, general practice pay, terms and conditions are the most inconsistent across the UK. Nursing staff in England are writing to their MPs to raise this issue.

You can find out more on what action we are taking in each country here.

What action can you take to best advocate for yourself?

1. Refresh your negotiating skills. Watch RCN national officer Jeni Watts' masterclass on negotiating pay.
2. Write to your employer. Tailor the RCN letter templates and raise pay issues with your employer.

Remember…

Speak to your colleagues about pay. Your voice is stronger together – that’s at the heart of being part of a union. Around 35,000 of our members are employed in general practice so you're in strong company.