As a general practice nurse in a Primary Care Network (PCN) Stephanie Hassanali has a rare insight into the challenges facing GPs.

She has been a nurse for 12 years and in general practice for the last eight of those, working across 11 practices as part of two PCNs in London.

Q. What is the main difference working for a PCN rather than being attached to a single practice?

A. I work one day a week in a permanent practice and the rest of the time, I work for two PCNs. I have also worked in a number of practices as a locum. Because of that, I get to see the variation between GP practices, and that can be quite stark even when you have two practices which are located right next to each other.

Within a PCN, there is a grouping of local practices, led by the PCN lead GP, who works within one of those practices within the network. The practices come together to decide centrally which services they want to deliver. For example, many of the PCNs now run a Saturday service. One PCN runs a routine nurse clinic, which is located at a different practice each week within the grouping, called a host practice. Another PCN I work with runs a “same day access” programme for cases that do not require a visit to A&E or Urgent Care Services at the hospital, but also can’t wait two to three weeks for a routine appointment. This will be conditions such as minor illness or a flare up of a long-term health condition.

Q. What are the challenges that you have seen practices facing?

A. Most GP practices are in converted houses – they are not purpose built. That was fine when they first started, but as the population has grown and medical needs have become more complex, this isn’t appropriate anymore. For example, you have GP practices with stairs, which creates access issues for people with mobility issues or parents with pushchairs. You can’t put in a lift, because there is no space for one, so staff have to keep swapping rooms, which is nonsensical.

The lack of space can create issues you might not even think about. For example, you have to be careful how many staff you have on at any one time, because you might be able to offer an extra shift due to demand for appointments, but physically have no space to accommodate them.This is particularly an issue with students. We get paid to take on students and we want and need to take them on because they are the future of the service, and we want general practice to survive and thrive. But often we actually can’t take them on because there’s no room for them.

Sometimes the rooms are so small there is not enough storage space, so you end up with boxes everywhere. This creates its own issues, but there is nowhere else for things to go. You have to be careful how much stock you order, which potentially hinders the service – you don’t want to run out but you also need to be able store it all.

One practice I worked for did some remodelling. They managed to get some funding, but also put something like £1 million in themselves. They couldn’t build sideways because the practice was in a terrace, so they had to go back into the car park – and they still don’t have enough space, even after all that work and all that financial outlay.

Q. What impact do these issues have on you and your colleagues?

A. Retention in general practice is very poor. It’s difficult across nursing, but particularly in general practice. One of the reasons for this is you either have to grow a thick skin and learn to be resourceful, or you leave. I think the ones that stay have just got used to it. They think ‘it is what it is’ and we’ll do our best, but we have to make do.

Q. What is the answer?

A. I like the idea of polyclinics, where you have everything in a purpose-built building. But these have their own issues. In London, for example, where would you find the space? How would you afford it – who’s going to fund and pay for it?

I always think when they build these new flats and they put in a gym, and have a concierge, they should add something like a polyclinic. You’re essentially building houses, so why not build something that supports the residents’ health?

The future for general practice is PCN working – that’s where the funding is going. You could even have a PCN in one building instead of lots of little general practices, but that then raises issues with travel and access.

It’s a really complex issue.