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Keeping the ship afloat – Practice staff costs

Keeping the ship afloat - Practice staff costsBy Robert Campbell

The most essential resource

The most essential resource for a GP practice, apart from its clinicians, is its staff. The staff budget can account for over one third of the cost of running a medical practice. Before 2004 the value of a staff budget was relatively clear, as 70% was reimbursed by the local PCT. GPs had to fund 30% of the gross pay. Now it can be expensive and challenging to drawings levels, especially if a practice decides to employ ‘new posts’ not originally funded by the Ancillary Staff Scheme, such as healthcare assistants and nurses.

Employing ‘new posts’

Originally the funding for practice staff was intended to cover only the ‘core’ posts, such as receptionists, secretaries and nurses. Now practices employ a practice manager and many new support staff including data clerks and phlebotomists. Whilst GP Fundholding has provided some additional money for new posts, practices have tried to fund new roles by giving up others, or by using their ‘profits’ and reducing drawings.

Pensions

The inclusion of practice staff in the NHS Pension Scheme in 1997 came as a shock as GP Employers had to find the employer’s contribution. Now employers are generally required to provide Workplace Pension Schemes, though these are comparatively inexpensive compared to the former employer’s contribution.

The impact of legislation

All employers are affected by UK/EU employment legislation, with its requirements to work family-friendly hours, and to allow paternity as well maternity leave, for example. Legislation is also prescriptive regarding annual leave, sick-leave payments, etc. It seems like a minefield and small employers can often take the view that legislation works against them.

Employing part-time staff

Small employers try to minimise expenditure whenever possible. Tactics include employing part-time staff to help reduce National Insurance and pension costs. Another tactic would be to pay overtime beyond the standard working week at a standard hourly rate with no enhancement. Employers might also not stick rigidly to ‘statutory’ payments for absences.

Staff absences

Of course, employing part-time staff may offer more flexibility for covering staff absences than employing full-time staff. But it is important to ensure that working arrangements are flexible in the initial contract of employment. Offering flexible working hours with varying starting and finishing times, however, can be almost impossible to manage in general practice. Clearly for those staff who work additional hours but are not full-time, it is reasonable to pay only a standard hourly rate and not an overtime rate. But staff working alone or working unsocial hours should probably receive some additional recompense.

Job-sharing

Job-sharing can avoid problems during holiday periods or when staff are sick. In effect, a shared post is full-time with each person working half-time. The only problem is filling the vacant half-time element if one person leaves. Of course a handover period might be necessary for the two job-sharers when changing shifts.

Pay scales, increments and pay rises

Increments and cost-of-living increases can be problematic for a new practice manager. Records need to be kept of individual incremental dates, and of both hourly rates and annual salaries paid to each member of staff. Have pay scales been kept up to date in your practice? In fact, have any known pay scales ever been used? Are only fixed hourly rates used? What are the overtime rates? New practice managers need to be aware!

‘Overpaying’ staff

Sometimes there can be significant and unjustified salary extremes amongst staff, making the staff budget far too expensive to manage. Occasionally each staff member seems to have their own pay deal! It is essential to monitor the staff budget and manage additional hours and overtime carefully. Set up Local Pay Scales that are openly available to staff and successor managers. The terms of payment for overtime, sick leave, maternity and paternity leave, jury service and compassionate leave should be clearly stated in contracts of employment.

In summary

Your staff project the image of the practice, so treat them well.  Ensure you have a record of how they are paid, pay scales, increments, and cost-of-living increases. Then manage what is paid carefully, paying attention to UK employment legislation and avoid pay systems where staff can be overpaid or paid unfairly.

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Robert Campbell

Former GP Practice Manager with over 25 years experience working in Upton, near Pontefract, Seacroft in Leeds, Tingley in Wakefield, Heckmondwike and more recently Cleckheaton, West Yorkshire. www.gpsurgerymanager.co.uk

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