Primary care careers: working in a GP practice or PCN

Primary care used to mean GPs, practice nurses and receptionists. It does not any more. General practice now employs pharmacists, paramedics, physiotherapists, mental health practitioners, social prescribers, care coordinators, physician associates and nursing associates, and a great deal of that expansion has happened through primary care networks. For clinicians looking for a change from hospital work, it is one of the largest and least understood sources of jobs.

How general practice is organised

Most GP practices are independent businesses holding a contract to provide NHS services, rather than being part of an NHS trust. That single fact explains most of what feels different about working in primary care.

It means the practice is your employer, not the NHS. Terms and conditions are set by the practice, not by Agenda for Change, although many practices choose to mirror it. It means practices vary enormously in size, culture and how they are run, from small partnerships to large multi-site organisations. And it means the people who run the business are usually clinicians, which has advantages and disadvantages you will recognise quickly.

Practices are grouped into primary care networks, which are collaborations covering a local population. Networks receive funding to employ additional staff across a range of roles, and this is where a substantial number of newer primary care posts sit. A network role may mean working across several practices rather than being based in one.

The roles

**Practice nursing** remains the largest registered nursing role in primary care. It covers chronic disease management, immunisation and vaccination, wound care, cervical screening, travel health, sexual health, health promotion and much else. It is one of the broadest generalist roles in nursing.

**Advanced nurse practitioners and advanced clinical practitioners** see undifferentiated patients, assess, diagnose, prescribe and manage, working at a level that overlaps considerably with GP work.

**Clinical pharmacists** have become central to general practice, running medication reviews, managing long-term conditions, handling repeat prescribing and dealing with the enormous volume of medicines work that used to fall to GPs. Pharmacy technicians work alongside them.

**Paramedics** in primary care typically do home visits, urgent same-day assessments and telephone triage, using assessment skills built in ambulance work in a different context.

**First contact physiotherapists** see musculoskeletal problems directly without a GP referral, which is a substantial change to how those patients are managed.

**Mental health practitioners**, including nurses and other registered professionals, provide assessment and support within the practice.

**Social prescribing link workers and care coordinators** address the large proportion of presentations that are social rather than medical: isolation, housing, debt, bereavement, inactivity. These roles do not require clinical registration and have opened primary care to people from entirely different backgrounds.

**Healthcare assistants and nursing associates** carry out observations, phlebotomy, ECGs, health checks and increasingly more, and primary care is one of the better settings for progression from a support role.

**Practice management and administration** is a career in its own right, and practice managers effectively run small businesses.

What working there is actually like

**The pace is different, not slower.** Appointments run to time slots that are frequently too short for what walks through the door, and the volume of contacts in a day is high. There is no team of colleagues around you in the way there is on a ward; you are often alone in a room making decisions.

**Autonomy is higher and support is thinner.** Most primary care clinicians describe this as the biggest adjustment. You will not have someone to look over your shoulder, and you will need to know when to ask, which requires being comfortable interrupting a colleague who is also running behind.

**You see people over years.** Continuity is the thing hospital staff most often say they had not appreciated. You watch conditions develop, you know the family, and the relationship does the clinical work in ways an episode of hospital care cannot.

**Undifferentiated presentation is the skill.** In hospital, most patients arrive already sorted into a specialty. In general practice they arrive with a symptom, and working out what this is, and whether it is serious, is the core competency.

**The hours are usually better.** Most primary care roles are daytime, with extended hours commitments in some services and some weekend working, but night shifts are rare outside urgent care. For people leaving shift work, this is often the main attraction, and it comes with the loss of unsocial hours enhancements, so check the numbers.

**The administrative load is real.** Documentation, results, letters, referrals and prescription requests continue after the clinical sessions finish, and the day rarely ends when the last patient leaves.

Pay and terms

Because practices are independent employers, pay is negotiated rather than banded. Many practices benchmark to Agenda for Change equivalents, some pay above, some below.

The critical thing to check is the pension. General practice staff can usually access the NHS Pension Scheme, because practices are recognised employers for that purpose, but you should confirm it explicitly for the specific post. Some network-employed roles and roles with third-party providers may differ.

Also check annual leave, sick pay, whether NHS continuous service is recognised, and what happens about study leave and funding, since these vary far more than in a trust.

How to move into primary care

• **Look at network roles as well as practice vacancies.** They are advertised differently and often less prominently.
• **Get the qualifications that gate specific roles.** Practice nursing usually expects or supports specific competencies such as immunisation, cervical sample taking and long-term condition management. Some are trained on the job; having them already makes you far more employable.
• **Consider prescribing.** For nurses and allied health professionals, independent prescribing substantially widens what is open to you in primary care.
• **Ask about induction and mentorship.** This is the single most important question for anyone moving from secondary care. Practices that recruit hospital clinicians without a proper induction lose them within a year. Good practices have structured support and will describe it readily.
• **Talk to the practice before applying.** Practices are small and culture is everything. A conversation and a visit tell you more than any advert.

Who it suits

It suits clinicians who want breadth over depth, who like continuity, who are comfortable with uncertainty and with making decisions alone, and who want daytime working. It suits people who want to see the social context of illness rather than just the episode.

It suits less well people who want a large team around them, who prefer defined specialist work, or who need the structured supervision and education infrastructure of a large organisation, particularly those very early in their careers.

For information about roles and the funding arrangements behind network posts, NHS England publishes guidance on primary care networks and the additional roles they can employ, and individual practices and networks advertise their own vacancies.

This guide is general information, not legal, immigration or medical advice. Always confirm current requirements with the relevant official body.