Category Archives: Editorial Comment

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)


In Preparation

Currently the author of this web site is working on a Training Manual  for Practice Staff aimed at Reception staff. It will cover confidentiality, reception and telephone skills, medical records, and registering patients. It is likely to be published in August 2017.


What is an Excellent Service?

There was a time when GP practices were expected to provide a service that was convenient to patients. Yet in some quarters I now read that patients may have to wait three days not two for repeat prescriptions when it is actually possible to issue repeat prescriptions in hours not days. I also read that patients wanting to be seen today may have to be challenged by a health professional to justify their request and that this ‘service’ will be CCG wide.

What then happened to putting patients first or the customer is always right. In recent months I have had the privilege of attending a large hospital where the doctors are thorough, the information is solid and tine is spent explaining what is a worrying  procedure at the best of times. The nurses too spend time with patients, give support and are always available later on the telephone to provide additional support.  When someone is ill, it can be life threatening, a patient does not want to be overly questioned and challenged other than by the medic they want to see.

Always some health professionals are better than others at putting patients at ease, giving injections and treatment without causing hurt or harm. Some health professionals are better at talking on the same level as patients. It does not hurt to show kindness and sympathy. Patients can be worried, frightened and actually feel very ill although on the surface it may not be obvious. A trained professional should be able to elicit this, not someone who’s only purpose is to prevent that patient from being seen today.

So when you are planning and managing your services always thing of how you would like to be dealt with and expect no less for the patients you provide a service for. Think twice before cutting services to fit the cloth. A health service should be a little more than that.