I am a partner (I’m not really, but for this exercise, just bear with me). And because I am not really a partner, I am going to (not really) be the Senior Partner. And I am going to be slim, handsome and young – just because I can be, even if it is for only a few minutes.

I am enjoying a nice cup of coffee in the box room used by my Practice Manager, and I can sense that he is not feeling at his best, standing on top of the filing cabinet while I take the only chair in what used to be our under stairs cupboard. Obviously, there is some kind of crisis of confidence going on with him, and he is in need of a bit of good old cheering up by me, the (not really) Senior Partner. Put on my best patient facing look, mentally rehearse my standard pep talk, get the smile working, muss the hair a bit (mine, not his) and in I plunge:

“Look Ringo, you are my practice manager. I employ you, but you don’t work for me – you work with me. We are a team, and you are my Captain. I come to your office when I need to speak to you. I don’t belittle you by getting you to come to mine – you are the manager for goodness sake, not me. I’m a clinician not a manager, and we both understand that fully. I close the door with you, and have regular confidential chats about the “team”. I let you know my innermost thoughts in relation to the other partners. We discuss my favourite sports and my children. I openly discuss my new car, the holiday home in Florida and just how good the food is at Le Gavroche whenever I pop in with the family. I tell you all about my personal problems, debts, loans, diet, fetishes (well, maybe not….) and we are, at the end of the day, not just master and servant – we are friends. Good friends. I love having my friends around me. I can trust them. I can rely on them and, of course, they on me. It’s what makes it all work, don’t you agree Ringo? “

“Well, Paul, that’s so kind of you to couch it all in those terms. You seem to have picked up that I am a bit off kilter at the moment. So, now that you are here, can I just raise the issue of pay, because I do an awful lot, as you say, to keep this little ship afloat, and I think my salary doesn’t really stack up against any of the figures I have seen, particularly that bloke in Lincolnshire who seems to find time to write all sorts of crap on my favourite website, whilst I am sweating my proverbials off just trying to keep my head above water”

“Ringo, Ringo, Ringo!? I am shocked that you value my friendship, no – our friendship – in monetary terms. That makes me sad. Very sad indeed.”

“Actually Paul, I am looking at this slightly differently. I am here at the crack of dawn and working flat out to keep the CQC at bay, the patients from you and your fellow partners’ throats, the staff from mutinying and the accountants happy with all of the claims and other stuff that has to be done. I normally don’t get out of here until well after you have all left and I think £10.23 an hour just doesn’t cover it. Sorry but there it is – I have said it and I feel so much better for doing so. Sorry for the tears, but if you can’t have a breakdown with your friends, when can you? ”

“Ringo, old buddy, I am so sorry that you feel that way, but I am so very glad that our friendship, our bond if you like, is strong enough to allow us to interact in such a positive, productive manner without rancour or anger. Our relationship is so much more solid than a mere question of a couple of quid a week, and I am so glad that you are my team Captain, my rock, my loyal and reliable friend, confidante and all round good egg and brilliant manager. I don’t know what I would do without you to be perfectly honest, and I know that everyone else feels the same.”

“Paul, you are making me feel really, really bad now as I hadn’t realised just how well thought of I am. But I really would like you to review my salary please”

“Actually, probably better if you stick to Dr McCartney…………and I have got visits to do now, Mr Starr…………”

I am not a partner now. Honestly. It wasn’t even much fun while it lasted.

The above is, of course, fictitious (I hope) but if you take it as the basis for not being duly and correctly rewarded, in many cases I suspect there may be just the merest hint of truth if not in the actual words, then possibly the situation. Nobody wants to rock the boat. Very few are comfortable discussing pay with their “friends”, the people that depend on them, share their innermost thoughts with them…….it’s a bit like being slowly put into a subliminal guilt trip.

And therein lays the real difficulty. The traditional problem with “pay related” discussions is that we are all absolutely brilliant in making the case for our teams – fearless to a fault, in fact. Tell it like it is, display all the figures, show how it stacks up against the baseline data, how little it will impact on overall profits, how much it will mean to Bessie on Reception to be able to feed both of her children every day rather than on alternate days – that kind of thing.

However, when it comes to us (well, you actually – I am frighteningly okay on the pay front, thank you very much) there is an element that disappears from the process. It is called “arm’s length”. All of a sudden it is personal, you are very close to the argument, and any conversation – rational or otherwise – becomes deeply wounding and unpleasant, particularly when it may not be going quite the way you expected, and the people that are not agreeing with you are……….your friends? The subliminal guilt trip thing kicks in again.

There is, however, a solution and, with a fair wind and a little bit of good faith, it could easily work to your advantage.

Well, what’s the magical solution to this then?

Simple – Job Evaluation!

Not the self-assessment twaddle put forward by the NHS, but proper honest to goodness, consultancy based, external stuff carried out by independent experts in the field who do it for a living and have oodles of experience and knowledge in this specific, niche, area of Personnel matters.

If you are confident that you are under-rewarded, and really believe that your partners are not “getting it” then you (and they) need to extricate yourselves from the process – ask if they would be willing to undertake a Job Evaluation Analysis through an externally accredited company that specialises in them. The benefits of this approach are:

• You and your employers are informants to the process – it is non-confrontational and you never look each other in the eyes throughout it. The “arm’s length” principal is established.
• It is not about how good, bad or indifferent you are at “doing” the job – it is aimed at evaluating the “job” and not much else.
• The analysis process takes all of the local, regional and national benchmarking data, comparators, sizing issues (not just practice list size, but everything related to variations on the “Practice Manager” role) into account. When it analyses the job, the process also benchmarks it against similar roles that are nothing like the one that you are doing – but carry the same basic responsibilities, risks, accountabilities and various other factors that are relevant.
• It is relatively quick, works to a standard set of criteria and is not that expensive in the wider scheme of things.
• The final recommendations (and that’s all they can ever be) are from an external, accredited, recognised source – and they will inform both you and your employers of the level of remuneration that the post should attract, or at the very least, the range of appropriate remuneration levels. However, do bear in mind that it is your employers that are commissioning the analysis, not you – and you may (just may) never see it – the Evaluator has no responsibility whatsoever to inform you of the results of their work.
• If your partners are content that you are privy to the report then all of a sudden the onus shifts to them in justifying any failure to recognise the results – after all, they have paid for the analysis, it has come from a credible source and is based on fact rather than any (even slightly) biased survey amongst disgruntled Practice Managers, or any other form of anecdotal information, urban myth or kite flying.

Well, that was easy and sounds like a plan. What could possibly go wrong?

Actually, quite a lot!

Your partners could, of course, refuse. That should tell you all you need to know, and might be the right time to consider your future in a different way.

However, let’s assume that they are as keen to get this wrapped up as you are – remember, it should work for them as well as you, as they are being given all the tools and information necessary for them to get their “key player” on side, rewarded and happy. (Alright, on side and rewarded then…….)

The rest is really down to you, and how you view the process. There are some things to remember, however, or it is all doomed to end very, very badly…..

• It is the “job” that is being evaluated (clue in the title and all that….) not you. You are incidental to the process – you just happen to be the current Job Holder, and will be making the case for the “Job”.
• Your Job Description (assuming you have one) needs to be quite clear and unambiguous – if the role requires the incumbent to be responsible/accountable for certain functions – this needs to be clear. If you are, on the other hand, assuming this level of responsibility when your Job description vests it in another (a Lead or Managing partner, for instance) then you may be on a hiding to nothing.
• Your personal qualifications are irrelevant, no matter how important you think they are, unless they were specified by your employers as being essential from the outset or at some later stage. A Ph.D. in Intergalactic Microbiology is all well and good, but most PM roles simply require a good basic education as essential – anything else is (possibly) desirable and may influence the recruitment process, but that may be all the sway it will carry. By the same token, if a qualification was “desirable” and you have it, and use it to full effect, that is a good thing.
• If the job required significant experience in a specific area, make sure that you (as the job holder) can demonstrate that you brought this to the job, and are required to use that experience. This is good as well, very good actually.
• The hours that you spend at work are irrelevant. Totally and completely irrelevant. That’s a “time and motion” issue, not related to your salary. Don’t even go there.
• The low-level stuff that we all do should never, ever be mentioned – plunging headfirst into a blocked toilet on a freezing Monday in December is obviously quite a bracing experience, but again not relevant to the evaluation process. In fact it will work against the evaluation – it is a caretaker’s job and they are on even less than you. Being responsible for ensuring……….now that’s a different thing altogether.
• Similarly deputising for receptionists, dispensers, administrators, car park attendants – don’t mention them. They will be seen as a part of the job that is “operating” rather than “managing”. Anything of that nature should be seen as “teaching” roles where you bring your vast expertise and knowledge to bear – and nothing else!
• You need to be able to demonstrate that through every stage of the “Job” the “Job Holder” (that’s you) is:
  • Responsible for ensuring that everything happens – in other words, carries the can. It doesn’t matter that you have deputies or others actually doing the donkey work – you still, ultimately, retain overall responsibility.
  • Taking significant responsibility for the work of others – this is a good thing. Doing their work for them when they are away – don’t even think about mentioning it – you are effectively saying that you spend a proportion of your time doing lower level work.
  • A decision maker in just about every area of the practice’s business – if not in an autonomous way, then certainly as a key element in the Practice’s decision making processes. This is a good thing. If you need the authorisation of the Senior Partner, through a committee, to order the loo rolls – not good.
  • Accountable – the buck stops with you for everything except clinical matters. Again, the fact that your partners also carry this burden as well is relevant but only in so far as to the point that they take ownership. The further in the distance their “acceptance” is – the better!
  • Dealing with higher (proper?) managerial issues – business development, strategy, policy, external matters, liaison with higher level bodies, representing the practice, signing serious documents on behalf of the partnership etc – all good.
  • Importantly, a key area to emphasise is always the consequences of you, the Job Holder, failing to do “the Job” properly – you might be amazed just how quickly you could bankrupt your organisation if you failed to press certain buttons on CQRS at the right time, or ensure that someone else did it………telling a patient the truth in a blunt way has all sorts of PR disaster issues attached to it ……failing to ensure that procedures and protocols are relevant and up to date……the list is endless and the consequences can, obviously, be pretty dire!

This is of course by no means all that there is to it – but the important thing is that as much as we may all believe that we are overwhelmed with “work” and under-rewarded, it will always boil down to the level of the work you are doing and the level of authority that you have in completing it. The simplest way of looking at this is to look at a relatively common task – like payroll.

If you process payroll, but someone else sanctions it – you are a bookkeeper, and will be evaluated (in that role) as such. If you process payroll and authorise it without further sanction from anyone else – you are a significantly higher being with all sorts of responsibilities that, if they went awry, could be disastrous not just for those that got under/overpaid – but also for cash flow and the continuing viability of the business. The differences, in Job Evaluation terms, are significant.

Three things to remember though before you plunge ahead with this – firstly, your employers will also be a significant part of the process. It is pointless telling the analyst that is working with you all sorts of things that, in discussion with your employer, are not the case. Payroll above is a good example of this. The role that has sanctioning and authorisation responsibility is the one that carries the can – not the processor of the data.

Secondly, ensure that your Job Description vests all sorts of responsibilities and accountabilities in you as the Job Holder. Remember, bog snorkeling is not in your Job Description. Being responsible for ensuring that the bogs are regularly snorkeled on the other hand probably should be.

Finally, and probably more important than all other points, is that the evaluation process itself may not come out in your favour at all, and there is always that danger.

What could possibly go wrong? As I said earlier – quite a lot!

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