Former health minister Ben Bradshaw said he expected the new centres to have nine nurses to every three GPs.

Some observers argued that the resulting demand for nurses would bring better terms and conditions for staff.

Many also expected that ‘nurse-led’ centres would offer primary care nurses unprecedented levels of responsibility.

But, in the event, none of the new centres is led by its nursing team, and RCN primary care adviser Lynn Young said nurses have reported employment terms ‘less than AfC’.

Unite nursing lead Barrie Brown said the centres seemed to be offering similar terms to existing GP practices, most of which pay less than AfC rates.

‘In the current climate, where GPs are seeing themselves lose money, nursing pay is likely to stay stationary at best,’ he said.

He said it was too early to say whether the new centres were allowing nurses to expand their roles. Even if they were, he added: ‘We're not over optimistic that it'll be reflected in pay.’

One northern RCN representative said that he struggled to think of any new centres that were offering AfC terms. ‘There may be some, but I think they'd be the exception.’

He said that the generosity of the AfC terms - and particularly of NHS pensions - made it hard for providers from outside the health service to compete.

Dr Nigel Watson, a BMA GP committee member, said the requirement to have a GP on-site at all times may also block nurses from taking on senior roles at the new health centres.

‘Nurses may have more responsibility at existing surgeries where GPs can leave nurses to work on their own,’ he said.

jonn.elledge@haymarket.com

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