Editorial Comment

COVID – Caring, Openness, Valuing, Innovation and Durability

COVID – Care for Your Staff

In these difficult and challenging times, I wonder whether there is a magic formula that creates a well run and happy workplace? I have been thinking about workplaces I have passed through during my working life and I tried to list in my mind what it was that made those places good places to work. In my first job away from home, in the 1970’s the key to my settling in to my new workplace in central London was a concern for my welfare. There was a Welfare Officer who arranged temporary lodgings for me and for the next five years watched over my educational needs. It involved introducing me to colleagues in the same boat, who soon became friends. I think the key to my settling in too was the warmth of the welcome. I don’t recall pay being an issue as we all enjoyed the same benefits of an NHS Whitley pay system. We felt like we worked in a ‘family’ practitioner service.

COVID – Be Open to Change

In those days, we did not have staff appraisal systems, but I do recall being thanked and being praised for my achievements. Being part of a team, was encouraged by the humour of office life, by the characters, some that you would like and others that you would be wary of. There was little time spent on discipline as later in my career I found that some employers were almost obsessed with the idea of a ‘disciplinary’. As the years progressed, I found that in general practice that when asking for incentives and improvements in working conditions the word ‘no’ became in common use and the use of ‘yes’ was more like pulling teeth. This change in attitude and approach seemed always to revolve around money or the lack of it. Annual increases in Practice income have been regarded as personal increases in GP Drawings not an increase in a Practice Budget. A controversial view, I know. Yet it had all started with the same system of funding, the Ancillary Staff Scheme. You have to ask the serious question as to where the money went.

COVID – Value Your Staff

We now live in a world of general practice that is controlled by Plans, Policies, Procedures and Protocols and if you haven’t got one of the four ‘P’s, then you have probably got a Risk Assessment to give you an excuse for not doing something. We now also have SOPs, Standard Operating Procedure – so are we administering or managing? This brings me to my fundamental point point. So what is the risk of not paying staff a decent living wage and of restricting their terms and conditions of service to minimal leave entitlement and to pay SSP only. It seems to be conveniently forgotten that Practice Staff Budgets were broadly based on a reimbursement system that paid 70% of staff gross pay plus the NHS pension and national insurance costs. Arguably, Practice employers only had to find 30% of gross pay, from the remainder of their NHS Income. The problem was that some less well off Practices took the view that the money was coming out of their profit or even worse their own personal pockets. But, I do accept that times and budgets have changed and the failure of the Government back in 2004 to reimburse the full staff superannuation costs was a major irritation. Being petty about staff pay and their terms and conditions does not bode well for a happy and content staff. So valuing your staff must be of the highest priority and importance.

COVID – Be Innovative

Nevertheless, what I find now is that the staffing of a general practice has extended far beyond the core staff of Receptionists, Secretaries and Practice Nurses, and you have to say how are the new compliment of health care assistants, Advanced Nurse Practitioners, and Pharmacists being funded. I might argue not out of the original budget. Money is too tight to mention, so instead we move to what I might impolitely call the ‘skinflint’ approach. I have every respect for Practices that find novel ways of rewarding their staff, and can only say that rewards need to be worthwhile and consistent. It’s no good just buying a box of chocolates or paying a small bonus now and again. One reward I watched being presented was a Certificate for Outstanding Performance. I could tell from the face of the recipient that the certificate had gone down like a lead weight. There are of course, the annual Christmas parties, but I suspect these are now being curtailed as unaffordable and last year, 2020 have not been possible at all.

Covid – Being Durable In adversity

The Covid experience has sadly highlighted for me the inadequacies of staff pay, terms and conditions of service in general practice. One significant point made during the pandemic was that GP staff could not be furloughed. However, some Practice staff are only paid the National Minimum or Living Wage and when off sick, are only paid Statutory Sick Pay. One has to ask why. What has happened to Budgets that were expected to cover fair and reasonable pay? What happens to GP Income uplifts intended to fund staff pay. Who has been employed to take the lions share of the budget and why? One maxim that does appear to be adhered to is robbing Peter to pay Paul. Practices always look for cheaper ways to provide the same service, let’s say by employing a health care assistant instead of a Practice Nurse or an Advanced Nurse Practitioner instead of a doctor. There is however thankfully in some Practices a striving to pay the going rate which might be higher that what is suggested on web sites like I have to say that the whole question of pay in general practice leaves me baffled! What has happened to the differentials between junior and senior staff. What has happened to incremental pay scales. Is it no longer obvious that a Receptionist should be paid a clerical salary. How is paying a Locum a higher daily rate of pay justified. What happened to NHS staff receiving NHS pay levels. Staff working in PCNs, CCGs and Hospitals are not paid a minimum wage. Is general practice taking advantage of staff because it is independent! What has happened to the warmth and kindness I experienced at the start of my career.

Robert Campbell – January 2021


Robert Campbell

By Robert Campbell<br><img src="" alt="Robert Campbell" class="avatar" width='50' height='50'/>

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.