Analysis

The gender divide in general practice nursing

Why are there so few male nurses in general practice and how do we encourage more male nurses to move into this field?

Why are there so few male nurses in general practice and how do we encourage more male nurses to move into this field?

Male nurses are in the minority and, while in recent years it has become more common to see them working in hospitals, their visibility in general practice is limited.

In the UK, it is estimated that 11% of nurses and midwives are male. However, in England this percentage falls to 1.9% for male nurses working general practice (GP Workforce Team and NHS Digital 2017). 

Undertaking female examinations, such as smear tests, is often cited as one of the reasons that hiring male nurses into general practice can be problematic. But, as the role is so varied it is important to look at the bigger picture. 


Gareth Johnson

The nursing workforce fails to mirror the country’s ‘50/50 population’ split, as Porter Brook Medical Centre’s practice nurse Paul McGrath says. A newly qualified nurse who started in October 2017, he has had a few male patients who have discussed erectile dysfunction and ‘wonders would they have discussed it if I were female’.

11%

of nurses and midwives are male in the UK

Given that consultation rates in general practice are 32% lower in men than in women across the UK (Wang et al 2013), could having fewer male nurses be one of the reasons why men are less likely to seek help?

Male patients becoming more forthcoming

Gareth Johnson, a practice nurse from Amherst Medical Practice in Kent, who has specialised in diabetes and worked in general practices since June 2015, has seen an increase in male patients being more forthcoming with their health concerns.

He says: ‘I remember one patient I saw who is diabetic. He was 28 and wasn't coming to terms with his diabetes and we had a conversation about the complexities of his condition.


Paul McGrath

‘A couple of weeks later I had an email from his GP saying: “I don't know what you said to him, but whatever you said has worked because he's completely changed his life around and has taken everything on board. I cannot thank you enough because I've been trying to get through to him for five years”.’

Mr McGrath, whose role also takes him to Student Health at Sheffield Hallam University, says that male students often request a man. ‘It often tends to be men who feel more uncomfortable about seeing a female nurse than a woman seeing a male nurse.’

Occasional female refusal

However, some female patients have refused to have Mr McGrath when he first started and would sit in on consultations with a female nurse.

If the female patients were having symptoms in their private areas, the nurse would ask if Mr McGrath could observe. Often, the response was no, he says. ‘I could be wrong, but I think it’s because they didn’t want an audience; they didn’t want a second person staring at them, not because I’m a man.’


Courtney Davies-Phillips

Since then, Mr McGrath has seen female patients on his own and hasn’t had anyone refuse his care. ‘They've come in and said, “I think I've got thrush” and they've asked to be examined.’

Courtney Davies-Phillips, practice nurse at Talybont Surgery in Swansea recalls a time when a patient declined to see him. 

‘She had booked in and refused to tell the receptionist what for and therefore I had no idea either,’ he says.

‘She walked into my room and froze. Her words were: “Erm, I want a female nurse, not you.” A little taken aback, I explained that she should have specified that when she had booked as she had originally declined to explain her reason for booking. Luckily my female colleague and I were able to swap patients for her to be seen.’

These three nurses provide a snapshot, but they could only see feminine care as a reason why practices might be hesitant to hire male nurses, especially in smaller practices. But, Mr McGrath says that 'practices should look at what we can do, not what we can't'.

'No longer a female dominated environment'

Royal College of Nursing general practice nursing forum chair, Marie Therese Massey, welcomes everyone to the general practice nursing workforce

She says: ‘One of our key strategies is to support building the workforce in general practice. So as part of that strategy, I encourage all nurses, including male nurses, into general practice.’  

As general practice is changing, Ms Massey believes that more male nurses might want to join it. The skill mix is changing and there are now more male associated roles among community practitioners.

‘We’ve got pharmacists, physician associates and emergency care practitioners working in general practices. Male nurses might see that this as no longer a female dominated environment.'

 

Mr Johnson who became a nurse in 2011, previously worked in an acute ward where it is ‘now normal to see male nurses’. His practice has found ways to manage patients’ expectations when booking appointments.

1.9%

Of nurses are male in general practice across England

‘The reception staff put it as a positive. They say: “You can see Gareth our male nurse. He's free this afternoon. Whereas the female nurse’s earliest availability is next Friday.” Most people will say it is the same as seeing male gynaecologists.’

Pay is a deciding factor

Why are there so few male nurses in general practice and how do we encourage more male nurses to move into this field? The female dominated environment is one of the reasons, according to Mr Davies-Phillips, and he is often asked: ‘Are you happy being a nurse or are you going to train to be doctor?’

He also suggests that pay may be a large contributing factor. He says: ‘I believe many males are still seen as the breadwinner for the family. It is a well-known fact that surgeries do not offer the benefits of the NHS.

‘If there was a general contract that surgeries followed for pay, such as maternity and sick pay, I think that would help with bringing more nurses in general practice, including male nurses.’

But despite there being a limited number of male general practice nurses (GPNs), the overwhelming feeling from the three nurses interviewed is that there needs to be a push to increase the workforce, regardless of gender. 

32% lower

GP consultation rates in men than in women in the UK

Increase publicity

To support male GPNs, he thinks there needs to be more publicity about ‘the excitement of our role, give students an insight and show how important it is to have that variety of males and females in primary care.’

Mr Johnson, who started as a healthcare assistant in 1999, sees universities as vital in encouraging more nursing students, both male and female, into general practice placements.

Mr McGrath also proposes that there could be a campaign to encourage male nurses into general practice and suggests that to encourage both male and female nurses into this field, 'it needs to be made a bit sexier'.


References

NHS Digital (2017) General and Personal Medical Services, England and March 2017.

Wang Y, Hunt K, Nazareth I et al (2013) Do men consult less than women? An analysis of routinely collected UK general practice data. BMJ Open. doi: 10.1136/bmjopen-2013-003320

 

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