The Core Issue: Employment Contracts

The 3.3% Agenda for Change pay rise applies to staff employed directly by NHS trusts under the NHS Terms and Conditions of Service (the AfC Handbook). This covers nurses working in hospitals, community NHS trusts, mental health trusts, ambulance services, and most other NHS employer organisations.

GP surgeries in England are not NHS employer organisations in the same sense. They are independent contractor businesses that hold a contract with NHS England to provide primary care services. This means:

• The GP surgery is your employer, not an NHS trust
• Your employment contract is typically negotiated between your surgery and you (or set by individual practices or PCN frameworks)
• The Agenda for Change pay structure does not automatically apply unless your employer has chosen to adopt it
• When the NHS Pay Review Body recommends a pay rise, it does not legally bind GP employers to pass it on

This is not a new problem. Practice nurses have been excluded from automatic AfC pay awards for many years. But the exclusion became more visible in 2026 because the announcement was unusually high-profile and the structural reforms for NHS England nurses (Band 5 Role Review, graduate pay reform, national preceptorship) were widely covered — all of which also excluded practice nurses.

What Do Practice Nurses Actually Earn?

A 2025 salary survey conducted by Nursing in Practice — the largest survey of its kind for general practice nurses — found the average full-time equivalent salary for a GPN in the UK was £35,057.

This is higher than a Band 5 entry point (£32,073 from April 2026) but lower than the Band 6 entry point (£39,959). In practice, there is enormous variation:

Salaries vary significantly by region, the size of the GP practice, and whether the employer has chosen to adopt AfC-equivalent terms. Some larger practices, particularly those running directly as NHS bodies or within Primary Care Networks (PCNs), do pay on AfC-equivalent scales.

The average of £35,057 masks the fact that many GPNs earn significantly below this, particularly those in smaller practices or rural areas where there is less competition for nursing staff.

The Additional Roles Reimbursement Scheme (ARRS) — A Partial Exception

The Additional Roles Reimbursement Scheme (ARRS) was introduced to fund expanded roles in Primary Care Networks. Some of these roles — including practice nurses employed directly through ARRS funding — are required by NHS England to be paid at AfC-equivalent rates.

However, ARRS covers specific named roles and the funding is channelled through PCNs, not individual GP practices. A practice nurse employed directly by a GP surgery outside of an ARRS arrangement is not covered.

If you are employed under ARRS as a PCN-employed practice nurse, you should have received the 3.6% uplift in 2025/26 in line with AfC, and the 3.3% in 2026/27 should also apply. Confirm with your PCN manager if you have not received this.

What the Government Has Said in 2026

When the 3.3% award was announced on 12 February 2026, the government’s primary communication focused on AfC staff. Practice nurse pay was not mentioned in the main announcement.

Nursing in Practice reported that “the announcement sparked disappointment among primary care nurses who say an essential part of the nursing workforce has been excluded, and that doing so could damage recruitment and retention efforts in general practice.”

A Department of Health and Social Care spokesperson said: “A new substantive GP contract — due by 2028 — could address practice nurse terms and conditions.”

This means any formal improvement to practice nurse pay structures is potentially two years away, subject to GP contract negotiations. This is not a firm commitment — it is an acknowledgment that the issue exists.

The Review Body on Doctors’ and Dentists’ Remuneration (DDRB) — which covers GPs and salaried practice staff — had not published its 2026/27 report as of March 2026. Practice nurse pay recommendations, where they exist, typically come through DDRB guidance to practices rather than binding national pay awards.

Historical Approach: Asking GPs to Pass On Pay Awards

In recent years, NHS England and the government have periodically asked GP practices to pass on AfC-equivalent pay awards to their practice nurses as a gesture of good faith. This is not a legal requirement — it is guidance.

In practice, compliance has been inconsistent. Some forward-thinking practices proactively align GPN pay with AfC scales. Others give a smaller increase. Many give nothing unless the nurse negotiates individually.

The Nursing in Practice survey found that a significant proportion of GPNs felt their pay had not kept pace with the AfC equivalent. This is consistent with the pattern of partial or no pass-through of AfC awards in many practices.

The Recruitment and Retention Consequences

The exclusion of practice nurses from AfC awards is not just a pay fairness issue — it is directly harming recruitment into general practice nursing.

The vacancy rate for GPNs across England was running at approximately 8–10% as of early 2026, with worse rates in rural areas and parts of the North and Midlands. A newly qualified nurse who is considering hospital vs. primary care employment can compare:

• Band 5 hospital nurse (AfC): £32,073 entry, guaranteed annual progression, defined pension, sick pay, maternity pay, unsocial hours enhancements, career framework
• GPN equivalent: variable salary, no automatic progression, pension depends on employer, no unsocial hours enhancements in most practices, no national career framework

The only advantage that GPN roles typically offer is more regular hours and often greater clinical autonomy at a relatively early career stage. For some nurses, this is sufficient. For many — particularly those with student loan debt who need maximum salary early in their career — it is not.

What Practice Nurses Can Do Right Now

1. Know What You Are Worth

Research what AfC Band 6 salary looks like in 2026/27 (£39,959 – £48,117). If you are performing specialist nursing roles, nurse-led clinics, running chronic disease management, or working independently in areas that would be Band 6 in a hospital setting, that is the comparator you should use in any salary discussion with your practice manager or GP partner.

2. Request a Formal Salary Review

Many GPNs are on salaries set years ago that have never been formally reviewed against market rates or AfC equivalents. You are entitled to request a pay review. Put it in writing and cite the AfC comparator for your level of responsibility.

3. Explore PCN Employment Options

If your practice is part of a Primary Care Network, ask whether there is scope to be employed through the PCN rather than directly by the practice. PCN employment models are more likely to offer AfC-equivalent terms, particularly for roles that fall within the ARRS framework.

4. Check Your Pension Entitlement

Even without AfC terms, many practice nurses are eligible for the NHS Pension Scheme through the NHS primary care pension arrangements. If you are not enrolled in the NHS pension, speak to your practice manager — you may be missing out on a significant benefit.

5. Contact Your Union

The RCN, UNISON, and the Royal College of General Practitioners’ nursing leads are all actively campaigning for improved GPN terms and conditions. Being a union member means access to representation if you need to negotiate individually and a voice in the wider campaign for reform.

The Bigger Picture: What Needs to Change

The fundamental issue is structural. Practice nurses are employed within a GP contract framework that was not designed to incorporate nursing workforce development. Until the GP contract itself is reformed to include enforceable national pay standards for practice nurses, the problem will persist.

The government’s suggestion that the 2028 GP contract could address this is better than no commitment at all. But 2028 is two years away, and in the meantime, every year that AfC increases outpace GPN pay makes it slightly harder to recruit and retain nurses in general practice.

The RCN’s formal position is that all nurses should be paid on nationally agreed AfC terms regardless of their employer. This remains the long-term goal for the profession.

Frequently Asked Questions

I work in a GP surgery but I’m on AfC terms. Will I get the 3.3%?

If your contract explicitly states you are on AfC terms and conditions, you should receive the 3.3% from April 2026. Confirm with your PCN or practice manager.

My employer offered me a 2% rise for 2026/27. Is that legal?

GP practices are not bound to match AfC awards. They can legally offer any pay rise (including no increase), provided it does not take your pay below the National Living Wage. Whether it is fair is a different question.

I’m thinking about moving from general practice to a hospital nursing role. Is the pay difference significant?

If you are currently on £35,000 as a GPN and move to Band 6 in a hospital trust, your starting salary would be £39,959 — a difference of nearly £5,000 per year. Factor in the pension, sick pay, and progression structure too.

Is there any sign that things will improve before 2028?

The DDRB report for 2026/27 has not been published as of March 2026. Watch for it — it may include specific guidance to practices on practice nurse pay that is stronger than previous years.

Summary

Most practice nurses employed directly by GP surgeries are not on Agenda for Change contracts and do not automatically receive the NHS Agenda for Change pay rise. The 3.3% award announced on 12 February 2026 and effective from 1 April 2026 does not apply to the majority of GPNs. The government has pointed to the 2028 GP contract reform as a potential long-term solution.

In the meantime, practice nurses should understand their market rate, request formal salary reviews using AfC as a comparator, explore PCN employment options where available, and engage with union campaigns for national GPN terms and conditions.

Based on the 2026/27 NHS pay announcement, Nursing in Practice GPN salary survey 2025, and Department of Health and Social Care statements. DDRB 2026/27 recommendations for primary care staff not yet published as of March 2026.