This is the third article in a series of three looking at grading practice staff salaries. View part one and part two. 

Much is being written on the Practice Index forum about the plight of practice managers and their deputies. The discussion often centres around grading, working hours and workload. Principally, the size of a practice is a major factor in determining the salary of a practice manager. There’s no specific guidance on what salary ought to be paid. The Agenda for Change pay system hasn’t really been helpful and practices continue to do their own thing. This gives rise to great disparity between practices, and reduces the opportunity for career development.

Core duties and responsibilities

At face value, the ‘core’ duties and responsibilities of a practice manager are the same in every practice. It’s only a thorough and careful study of each practice that will reveal differences. As a PM, I’d expect to at least have access to bank accounts, payroll and practice accounts and be involved in the preparation of annual accounts. Here are some examples of differences that, in my view, will affect the workload and should affect the pay of a practice manager. 

Patients – the number of registered patients, and the breakdown of age and sex demographics.  

Manpower – the number of partners and salaried GPs and the overall number of WTE doctors.

Premises – the number and type of surgery premises. For instance, leasehold premises may result in additional management duties.

Staffing – the total number and type of practice staff and their whole-time equivalents. The practice might employ a varied range of clinicians to support the GPs, such as advanced nurse practitioners and pharmacists.

Services offered – the type of services provided and contractual arrangements entered into by the practice. The practice might, for example, provide out-of-hours or extended hours services for local practices.

Examples:

A practice might have 20,000 patients, be located in a university town, have two surgery premises, each with five consulting suites, employ 30 staff, and share premises with other practices. While another practice might have 4,000 patients and be located in a rural community, with a dispensary and patients scattered over a ten-mile area with little public transport, first responders and an air ambulance, with the nearest hospital being 35 miles away.

One way of grading posts

When looking at the results of a pay survey carried out in recent years, I came to the view that to manage core services, there needed to be a starting salary of around £20,000, but after that, an additional £2,000 would need to be added for every 1,000 patients registered with the practice. So, a manager working in a practice of, say, 8,000 patients would have a minimum salary of £36,000. (This salary is reasonably accurate in three practices I worked in recently.) This rough calculation does not take account of any special factors, such as being a training practice. Another example: a practice of 16,000 patients, with eight doctors and 25 staff, might have a minimum salary of £52,000. (Now, that might be stretching it a bit; eight years ago, in a practice of that size, my salary was £46,000, but the cost of living has risen since then.)

Factors to consider

It takes some thought to differentiate between practices and their managers, but suffice it to say that the greater the responsibilities, the higher the salary should be. The higher level of skills and knowledge required might set one post apart from another. Let’s consider some factors that might help to determine a higher salary.

Location – Does the practice pay staff London weighting? The suggested enhancement is 20%.

Financial management – Does the practice manager make payments?

Personnel management – Is the practice manager a decision-maker in all staff appointments?

Premises management – Is the practice manager a member of a management committee for leasehold and/or shared premises?

Practice meetings – Does the practice manager chair practice meetings?

Clinical Commissioning Group – Does the practice manager play a role in the local CCG, Primary Care Network or Federation?

Care Quality Commission – Is the practice manager the CQC-registered manager or a non-clinical partner?

Additional duties and responsibilities – Some practices provide services for other practices. These might include providing an out-of-hours or urgent care centre. The practice might act as a hub for extended-hours services. It might also offer minor surgery or minor injury services.

And that’s not all

The standard working week for NHS staff is 37.5 hours, normally spread over five working days. Recent surveys suggest that for practice managers the contracted working week might vary from 32 to 40 hours. However, again evidence suggests that the working week actually stretches well beyond a 40-hour week and may even exceed 48 hours. I know mine did! There are issues about not paying overtime, but offering time off in lieu (TOIL) instead. It begs the serious question as to when you’d actually take time off if your working week already exceeds 40 hours. There are managers who work a sensible week, maybe taking a half day just like the doctors. Maybe the manager is paid a worthwhile bonus, or receives an incremental increase each year in addition to a cost-of-living pay rise. But again, evidence suggests that there are still practices not giving an annual pay award.

Keep on trucking!

I have long held the view that, as a full-time practice manager, I should at least be on a par, salary wise, with the lowest-paid salaried GP or GP registrar. How can you be expected to manage employees who are paid more than you? So, if you’re a poorly paid PM, keep asking for a pay rise. Provide evidence of what other managers are receiving in practices of a similar size. Keep and show your employers lists of all the duties and tasks you carry out along with a complete record of the hours you work. Share information with your Practice Managers Group. Perhaps produce a report for circulation to the GP Employers in your area. Be aware that staff employed in CCG-run practices might be on NHS pay scales.