In the driving seat

Having spent some time back in the driving seat recently in a busy practice, after a few years of being at home on the ranch, I realised that whilst the workload is changing all the time, I suspect that the employers’ attitude to their staff and their practice managers hasn’t changed that much. I’ve always been concerned about the adequacy of the salary practice managers are paid. But I’ve also worried about the workload, the stress, the lack of training and whether the expectations of what you and your staff can achieve are realistic. I recall an employment tribunal case involving a practice manager who regularly worked in excess of 48 hours per week, and her employer took little, if no, interest in her plight. The effects of working in a stressful situation eventually kicked in and she left claiming constructive dismissal. She won her case. An employer has a duty of care to take reasonable steps to safeguard the health and safety of staff, including a duty to control stress. I also recall a clever response from a colleague who said I made my own stress!

Do you need any help?

The case mentioned above, which happened over five years ago, brought to mind such issues as taking legal breaks and the problem of not being paid for additional working time. Personally, I found it impossible to help run a practice working, say, just 16 hours per week. I’ve worked in other practices for about three days or 21 hours per week and I found this more manageable, with the help of a good team of doctors and staff. But even for a full-time practice manager, are there ever enough hours in the day and do you actually have a strong and justified argument to employ a deputy or assistant?

Are you working part-time?

While working in a much larger practice with over 15,000 patients, eight doctors and 25 staff, even ten years ago, I found it difficult to do the job in a standard 37.5 hours. I often worked weekdays from 8am until 6pm plus Saturday mornings and I recall, much to my annoyance, being challenged if I arrived late or went home early: “Working part-time today, are you?” I’m sure that many of your reading this will have encountered similar rebukes.

No overtime payments?

In the NHS, senior managers aren’t permitted to claim overtime payments. This would include staff paid on AFC Pay Bands 8 and 9 (starting at £44,606 per annum from April 2019). But what if you’re contracted to a 37.5-hour week, but consistently work over 40 hours a week? How much income are you losing? Should your contract be formally adjusted to at least a 40-hour week and should you be paid accordingly? How many times are you asked to do work by some other body or authority that’s NOT your employer? My suspicion is that the answer to that question is ‘constantly’.

Oh no, not just a fuddle!

While looking at Practice Index threads over recent years, I’ve noticed there’s been mention of staff being paid a bonus. But, in reality, there does seem to be a reluctance to pay bonuses even though the efforts of practice staff have earned practices more money. It’s nice to have a thank you now and again, and maybe a party, a fuddle or a gift voucher. Once I witnessed a certificate of appreciation. But it hardly recompenses staff for the hard work and time they give to the practice.

Saying boo to a goose!

The answer, as I see it, is to start saying boo to geese. Not an easy thing to do with your employer. GP staff in the main don’t have advocates in the form of trade union officials – someone to shout for them. Nurses do; the RCN! Building an argument that you’re not being paid for what you do is tricky to say the least. So try this set of questions:

1. Do you regularly work more than 37.5 hours per week? (Yes)
2. Do you regularly work more than 40 hours per week? (Yes)
3. Do you regularly work more than 48 hours per week? (Yes)
4. Do you work on weekends? (Yes)
5. Do you work from home? (Yes)
6. Are your employers fully aware of your extended working hours? (No)
7. Are you paid for any overtime you do? (No)
8. Are you allowed time off instead of overtime? (Yes)
9. Do you take at least a 20-minute break every six hours? (No)
10. Could you manage your workload in less than a five-day week? (No)

Have you matched some or all of the answers in the brackets? These questions might help you to build your case. Keep a record of your hours and of the extra tasks you keep being asked to do and by whom.

Time managing, yes or no?

Managing your time and your workload is always a challenge and I’m sure we all develop techniques to cope with the onslaught. The use of ‘traffic lights’ was mentioned in a recent thread about signposting. I remember traffic lights on my boss’s door. Green meant go in, whilst red meant keep out, but amber meant wait. Of course, the use of emails has changed the way we work these days. ‘Red’ might be spam or junk, ‘green’ might be read it and do it, whilst ‘amber’ might be read it later or just file it.

Speak now, or forever hold your peace!

How much time do you spend communicating with your doctors and staff by word of mouth? How many meetings do you attend, and then spend (or waste) time writing minutes and reports? Who reads them? Perhaps we should find simpler ways to work?

Grumpy old man

Ultimately, you have to decide whether you can cope or whether enough is enough. I’m 68 years old this week and think I should leave the challenge to the younger and fitter ones among you, hoping you’ll be treated well, respected and paid what you’re worth. Make sure your employer is aware of what you’re being asked to do by outside sources. Isn’t it telling how many emails are directed to the practice manager? Do you and your employer understand exactly what you do and what you’re being asked to do (in your contracted hours)? Perhaps you should keep a record and then have a chat?