Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice (GenRet): a qualitative interview study.

Background: Increasing shortfalls in nursing workforces are detrimental to safety critical patient care. In general practice in England up to one-in-two nursing posts are predicted to be unfilled by 2030/31, with Wales similarly threatened. This is reflected internationally. Limited attention has been paid to how cultural and structural issues affect retention of nurses in general practice. The aim of our study is to understand factors that challenge retention and support nurses to stay in general practice.

Methods: We conducted an exploratory qualitative interview study with n = 41 members of nursing teams working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment was through professional and social media networks and snowballing techniques. Data were analysed following framework analysis and were collected between October 2023-June 2024. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained. The study was funded by the General Nursing Council Trust.

Results: Recognition of the value of nurses working in general practice was central to the retention of nurses at all levels of practice and was affected by structural and cultural issues and reflected in several themes: The essence of nursing in general practice; The commodification and deprofessionalisation of nursing in general practice; Opportunities for development; Employment of nurses outside of the National Health Service; Lack of voice, precarity of position and lack of recourse; Tipping points.

Conclusion: Cultural and structural issues impacted on retention of nurses in general practice. While some supported retention, others revealed deep-seated, complex issues which require addressing at practice, local and national organisational levels. Nurses in general practice experience factors which leave them vulnerable and underserved. Policy makers, employers and professional organisations need to work to support retention and enable nurses in general practice, not only to survive, but thrive.

Protocol registration: Open Science Framework ( https://osf.io/ ) Identifier: DOI https://doi.org/10.17605/OSF.IO/2BYXC   https://osf.io/2byxc/ . Protocol published: https://onlinelibrary.wiley.com/doi/ https://doi.org/10.1111/jan.16313.