August 2023
Has a decline in Practice Income caused a decline in Staff Pay?
I have been pondering what has been happening to general practice finance over the last 20 years and why there is so much disparity between practices in the Drawings taken by individual doctors from the Practice each month, and the levels of salaries these Practices pay their staff. It’s probably nigh impossible to extract publicly any solid and reliable information from Practice web sites and other NHS sources as to whether there is any real consistency between GP Earnings and Practice Staff Pay. I believe that there was a time prior to the abolition of Whitley Councils when Practices followed NHS pay scales, because they knew that there would be at least 70% reimbursement. Nowadays, a Practice Index Poll suggests only a relatively small percentage (6%) of Practices fully use NHS pay scales. I suspect that the inadequacy of Practice Budgets, the expense of locum clinicians and the use of the National Living Wage has contributed to a decline in Practice Staff Pay. I also take the view that the ‘pay’ issue is complicated ever more by the advent of PCN staff and salaried GPs, whose pay is somewhat pre-determined.
Is there a lobby for Practice Staff pay?
Perhaps too, it’s because there is no substantial lobby seeking to improve practice staff pay. The Royal College of Nursing fights it’s corner for those who benefit from NHS Pay Scales, but other than that for other Practice Staff trade union membership is and always has been extremely low. In the past, I with others have looked at encouraging Staff to join the defunct ANHSO union, which merged with NALGO and which then became UNISON. The trouble here was that Practices remained independent contractors and individual employers and it was almost impossible for a trade union to represent literally thousands of different employers of general practice staff. You could, therefore, argue that Practice Staff pay has fallen behind mainstream NHS staff because there is no strong body of opinion to argue otherwise and perhaps there is a body of opinion that expects that surgery staff are paid well. There might be another point and that is the question should Practice staff ride on the backs of trade unions and the BMA not being members of those organisations. It is often left to a Practice Manager to straddle both sides of the fence of the employees and the employer to request a pay rise and to put the case for their staff. Will it actually be 6% this year or will it be something else?
But, there is another side to the fence!
Let’s turn tails a bit and try to make some sense of what GP Practices are, albeit reluctantly, publishing on their websites about their Net Average Earnings. My limited research looking at over 30 Practices scattered around England suggest that the Net Average Earnings published on Surgery Websites fluctuates significantly by indicating average monthly Drawings ranging from around £2,000 per month to over £12,000 per month, although the average monthly Drawings is around £6,400 per month. My recollection of Drawings taken each month in the Practices I have worked in have ranged from £6,000 to £9,000 per month depending on whether income tax had been applied. I do think that a laxity on the part of the PCSE and some doctors to deal promptly with changes in partnership shares and the comings and goings of GPs has caused a crisis in cash flow in many Practices as well as inadequate budgets. I have known a number of Practices where some months Drawings have not been taken. I’m sure you have too. I can see why there is an argument that some Practices cannot afford pay rises if GPs cannot afford to pay themselves. But then perhaps they need to study their expenditure more closely, ensure that all appropriate NHS income claims are submitted and where budgets are inadequate – challenge! Perhaps there also needs to be more control over the payments made to Locums.
There has been a sea change!
The selection of Practices I homed in on were in Inner London, the central and sWest Midlands, West Yorkshire, Greater Manchester and Cumbria. My experience of working either in or with GP Practices was that Practices comprised of a partnership of mainly full time GPs, sometimes with salaried GPs, retainer GPs and one or more trainee GPs. That was 20 years ago. Times have changed quite dramatically. I looked at 33 Practices but in 3 cases the details published on the Practice websites were lacking. However, 30 Practices had published details of the Net Average Earnings of GPs working in their surgeries. It included the number of full time and part time GPs, plus the number of Locum GPs. Of these 30 Practices, 10 (33%) no longer had a full-time partner and 7 (23%) only had one full time GP. 66% of Practices had one or more Partners. Out of 208 GPs working in 30 Practices, 50 (24%) were full time, 129 (62%) were part time and 24 (11%) were Locum GPs. I found these results quite surprising and perhaps they explain why many general practices are managing with a majority (73%) of part time doctors and Locums. In one of the sample Practices, there is one full time GP, two part time GPs and 4 Locum GPs and a list of just over 8,000. I suspect this breakdown of medical manpower is fairly typical. It can also be said that many Practices now employ Nurse Practitioners and Practice Pharmacists to help Practices remain stable. Apart from PCN funding, it seems to me that some Practices are having to make serious choices about how their NHS Income is spent and not making the improvement of Practice Staff pay a priority.
And now, over to you!
Out of interest, you might look at the websites of Practices in your area and see how the Net Average Earnings compares with your Practice. What else do you think is affecting the income and expenditure of your Practice? Is it a falling list size? Is it running branch surgeries? Are your telephone costs going sky high?Are drawings too high or too low. Have you not had a cost of living increase for some time and wonder why? And finally, who in your Practice negotiates a cost of living pay rise? Is it you, the Practice Manager? If you do, what do you look at? Is it the percentage rise in the National Living Wage, the Consumer Price Index, the annual increase in NHS and State Pensions, the percentage increase in your Practice Budget or just a figure plucked out of thin air! Thinking caps on!
Robert Campbell
August 2023
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