Author Archives: Robert Campbell
Robert Campbell

Robert Campbell

About Robert Campbell
Robert Campbell

Started work writing medical cards in 1966 at Staffordshire Executive Council. Have worked at Inner London Executive Council, Hertfordshire Executive Council, Lambeth Southwark and Lewisham FPC, Birmingham FPC, Dudley FPC and Wakefield FPC and Family Health Services Authority. I was seconded to the NHS Appeals Unit and have worked as a full time GP practice manager since 1992 until 2010. I was also an AMSPAR trainer at Park Lane College, Leeds. Now I work as a freelance author.

As a New Year Approaches

From the retired perspective, I now see general Practice more from the outside than in, principally as a patient.

I have seen great variances in the promptness and quality of services offered. I have met with complications and delays caused by the Electronic Prescription Service. When it works it’s wonderful but does it go to the chosen pharmacy and if it does is that pharmacy well stocked.

I have had the unfortunate need to use hospital services and have been knarked to see huge numbers of ambulances idle outside a major hospital yet I paid an enormous sum to park my car in the multi-storey car park.

Having said that I have been impressed at the promptness I have been seen at an out-patient appointment even in one occasion almost an hour early. The consultants were information, thorough and did not rush. There are good experiences in the NHS even though you are ill.

I have both experienced long delays for a GP appointment and very prompt consultations – again I was made to feel that I had not wasted anyone’s time and a prompt referral was made.

I also have to comment that some NHS services can be lacking – Physiotherapy in general Practice can be left wanting offering patients instruction sheets to read and exercises to do rather than hands on effective treatment.  Private physios working either in the NHS or independently can be relied on for a much better service.

So what can we expect in 2017, fewer GPs, linger waits to see a GP and to see a consultant. Longer distances to travel for out of hours care and hospital services. What about more charges not just the hospital car park. Buy your own routine medicines over the counter. Do it yourself consultations using the NHS Choices web site or any reputable site. The only thing is that your symptoms might match both the most serious and least serious medical events in your life and have you paid into that funeral plan.

A happy and and healthy new year to one and all.


How on earth do Practices Afford it?

We Employing additional staff in new, special and unusual roles in general Practice always begs the serious question as to who pays for it. For example, in a Practice that was a ten mile round trip to the nearest hospital pathology department I always thought that it was an important service to offer phlebotomy at the surgery. But this post was not funded by the Practice. It was initially funded by the GP fundholding initiative and after the demise of fundholding the hospital continued the service until the hospital accountants stepped in to stop the service. After that funding was intermittent as PCGs and then PCTs offered various degrees of funding for a phlebotomist.

The basic Practice budget allows for reception staff, medical secretaries and practice nurses and you could argue that is all that it is for. Any additional posts come from either the Practice or any special funding initiatives that have taken place over the years. Newly appointed Practice Managers may not be aware of the history of funding ancillary staff. Fundholding practices received growth money and this was used to fund posts such as a salaried GP or a nurse practitioner. There were also savings but the money would be a one off income not a permanent one. There have been other funding initiatives. But what if that money is clawed back. Who pays then. Beware too of the cost of redundancy and the rising cost of pensions. Be aware too of the potential employment tribunal costs of terminating staff unfairly!

Practices of course are free to use their budgets as they see fit, but to make a long term commitment to fund say a nurse practitioner instead of a GP still assumes that the fund will be consistently available. What if the list size is falling? What is QOF income is reducing? What if MPIG has bitten harshly. What if the scope to increase Enhanced Services Income is minimal and unreliable? I have to say that having run five medical practices over 25 years I do wonder why Practices get into financial scrapes and do not cut their cloth accordingly. That said there are disasters that beset Practices, such as theft, and fraud. Since 2004, the staffing element of the budget never matched the original cost once you factor in superannuation. The need for Locum cover presents a major headache for those trying to balance the books. Cutbacks in budgets, the MPIG and changes to QOF all add up to a financial nightmare.

I also found that moving to privately built premises which were under a lease to the Practice became a burden. The leasing companies seem to keep a tight reign on maintenance costs and insist on their own contractors providing services, whereas Practices that own their own premises would be unlikely to set up high cost maintenance services for their buildings. So when it comes to funding ‘new’ staff posts one can understand the desire to employ two health care assistants instead of a nurse practitioner. But let the buyer beware.

Here are ten keys points to bear in mind:

Is funding guaranteed for the post or posts you propose?

Have you assessed the actual full costs, including superannuation, national insurance, professional fees and medical indemnity?

Are you getting value for money?

Would the money be better spent on something else (Opportunity Cost)?

Are you going to be tied in to a long term commitment that is difficult to get out of?

What happens if funding reduces or is withdrawn?

Beware of ‘flavours of the month’!

Listen to your accountant not the CCG idealists!

Always have reserves and know you can pay the bills, particularly Inland Revenue?

Beware of GPs too keen to take high drawings!


Gender Pay Gap or Pay Inequality?

What is a Pay Gap?

Gender Pay Gap

Arising from the BBC’s recent statutory declaration of salary ranges for its highest paid talent, the concept of the Gender Pay Gap has shot into the public eye yet again. The gender pay gap simply put is the difference in average pay between men and women. In 2016 for full time workers the gap was 9.4%, and when part time workers were added in it became 18.1%. (Source – the Guardian)

General Practice Employment

I think it would be fair to say that general practice is predominantly an employer of female practice staff and female doctors. In fact, in 2014, Pulse reported that 50.7% of general practitioners were female. This was the first-time female doctors had been in the ascendancy. As far as Practice Staff are concerned in the five GP Practices I worked in, around 8% of the staff employed were male. This 8% included me and one other but only in two of those Practices. I was often the ‘lone’ male employee. I cannot say that I noticed any particular differential of pay between male and female practice staff. However, at the ‘top of the office’ from a Practice Manager Salary and Workload Survey I carried out in 2015, of Practice Managers were Male. The salaries of all the respondents ranged from below £25,000 to over £50,000 pa, although I did not look at gender differences in relation to practice size, I did wonder whether there were factors at play that meant that some ‘staff’ (male or female) were not on comparable salaries.

Equal Pay for Practice Managers

Looking at these figures again, I can say that some 37.5% of Practice Managers worked part time and almost 27% earn less than £30,000 per annum. So is it more a question of Pay Inequality rather than just a gender pay gap. Unequal pay has been illegal for 45 years. The Governments own web site cites the following reasons for the gender pay gap. It says that a higher proportion of women choose occupations that attract lower pay and a higher proportion of women choose to work part time. It also claims that women are less likely to climb the career ladder. I am not sure that is the case in general practice, but is there a Gender Pay Gap in general practice or it is simply Pay Inequality? For Practice Manager’s you could argue that the NHS Agenda for Change pay system is a hindrance rather than supportive. In the original set of pay scales and the advice that went with it, a Practice Manager in a small practice would be placed on Scale 5 – currently this scale ranges from £22,128 to £28,746. It might also be worth highlighting that since 2004, GP Practices have taken on QOF, CCGs and the CQC and dare I say Practice Managers have taken the ‘brunt’ of the workload, often without recognition and recompense.

Independent NHS Employers

The problem for GP Practice staff is the independence of their GP employer from the mainstream of the NHS. Unless, Practice staff are directly employed by an NHS Trust, NHS England or an CCG, an employer with less than 250 employees would not be required to publish the Gender Gap differential. If Practice Staff were employed by one employer and not by independent GP Practices, there is little doubt in my mind that pay inequality would be demonstrated absolutely. In fact, since the NHS Agenda for Change Pay System replaced the NHS Whitley Councils pay system, practice staff pay has fallen behind the rest of the NHS by more than 10%. The use of the National Living Wage and fixed hourly rates is widespread in general practice and therefore, Practice Staff can be paid less than the lowest Agenda for Change pay point for NHS staff which is above the National Living Wage.

Narrowing the Pay Gap

The Government also claims that it is taking action to deal with the Gender Pay Gap and this includes requiring large employers (not general practices) to publish their gender pay gap. It is offering 30 hours free child care for families with 3 or 4 year olds. It is also encouraging girls to consider a wider range of careers. It has already extended the right to Flexible Working Hours, and introduced Parental Leave. You could argue that the National Living Wage is also an attempt to manage the gender pay gap. The problem for small employers such as in general practice is the affordability of allowing staff flexible hours or parental leave when shifts and surgeries have to be manned. Surgeries need to be open from 8.00am until 6.30pm – a period of 10 ½ hours. Now that is a long shift. When I carried out a pay survey recently, it was clear that there are different approaches to paying overtime or rewarding staff for working extended and unsocial hours. I wonder too, how many Practices pay an annual cost of living pay rise, or reward staff with a bonus.

Same Job for the Same Pay

Inequality in pay is another subject altogether and I suspect that it would be easier to demonstrate pay inequality across the whole of general practice rather than in individual practices. Pay Inequality between the genders simply put is where the rate paid for two different people in either the same or a similar job no matter the job title is unequal. For instance, are two receptionist staff paid different hourly rates for no apparent reason. Are two practice nurses working the same hours and seeing the same number of patients paid differently for no apparent reason. You can bet your life that excuses will be found. There is always a secrecy about pay and pay slips. No one likes to think that someone is getting more than they are for the same job. For instance, there needs to be absolute clarity of wording in contracts of employment about the award of annual increments. Staff might receive extra for an additional task that is specific to them. Staff might receive an on-call allowance or an unsocial hour’s payment. But strictly speaking if doing the same job at the same time the pay should be the same.

Proving a Case

Bearing in mind the secrecy that surrounds the content of a pay packet it might be difficult for an individual employee who is concerned that someone else is earning more than they are for the same job to develop and lodge a case with their employer. The task in hand would be to present a comparison of two or more posts where the ‘applicant’ considers there is an unfair pay differential where the duties and responsibilities of the post held are in the applicants view the same or similar. The claim should list all aspects of pay and describe the duties and responsibilities for both the claimant and the comparator person/post. If the claim fails with the employer, the next step is to lodge a claim with an Employment Tribunal. A useful web site to look at is Information can also be found on the ACAS web site, and the Governments own web site,

And Finally

As a Practice Manager, it is important to be aware of the risk of claims of unequal pay, if staff are employed on conflicting pay, terms and conditions. My view is that it would be wise, particularly for a new Manager to review staff pay, terms and conditions and job descriptions as a priority and to record and draw to the attention of the GP employer any anomalies or concerns that are found. Beware of the perennial argument ‘We can’t afford it’.

Author – Robert Campbell (August 2017)


Practice Survey

Just a simple survey looking at the problems making life difficult for GP Practices. If there are other issues you would like to include in the list please email me –

What factors is causing your Practice the most problems? - Choose five

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