By Robert Campbell

On the Practice Index website, I read about the problems practice managers experience when trying to reconcile staff contract terms to the raft of UK employment law. These terms include requirements for annual leave, a National Living Wage and numerous employment rights that bring in extra expenses. It’s a nightmare – and one that can alter with every new piece of legislation and ‘change of Government’.

Unaffordable for small businesses

Whilst I believe that all practice staff should enjoy the same salary system and contract terms as the rest of the NHS, I agree that, as a ‘small business’, general practices find it difficult to comply without the Government injecting cash, specifically to spend on staffing costs. In my view, it’s wrong that practices have to find the money for additional staff, such as nurse practitioners and phlebotomists. This wasn’t what practice budgets were intended for.

CCG staff are ‘better off’

Often, nowhere to be seen is a staff contract that resembles mainstream NHS staff contracts, although staff employed by the local CCG enjoy better salaries and terms and conditions than practice staff in their area. CCGs use the official Agenda for Change NHS pay scales… Something isn’t quite right. So are the benefits of extra funding simply going into drawings and doctors’ pockets? Sometimes, yes. Other times, practice staff are lucky enough to enjoy bonuses and handouts from QOF successes and from running Enhanced Services, but there’s no consistency. Frequently no generosity is shown towards the staff who have actually done the job, with no extra pay and no extra hours. Instead money is wasted on employing locum doctors, when practice doctors retire or fall ill. What’s to be done?

Independent pride

There’s a pride in the independence of general practice. At least there was. Sadly, more and more doctors want to work part-time, be salaried, work as locums, and retire. So, what proportion of GPs still want to run/own a practice? In my experience, one or two doctors in a practice take a real interest but if those doctors leave, who takes over? Small and single-handed practices surely are the ones at greater risk of simply folding up. You’ll have seen numerous reports about small practices struggling financially and closing, sometimes due to the wrath of a CQC inspection.

The devil and the deep blue sea

Being between the devil and the deep blue sea, practice managers will need to know what the norm is for themselves and their staff, particularly in terms of staff contracts. Here are some examples of the problems:

• There is already legislation about annual leave – 28 days, but should this include bank holidays? The surgery is closed on a bank holiday so why should I use my leave?

• You don’t have to pay me whilst I’m off sick, but you must pay SSP. But what if I was a nurse or ex-PCT employee who had NHS sick pay and generous annual leave? Would you sensibly take the job? Other practices might pay six months’ full pay and six months’ half pay, which can be devastatingly unaffordable.

• Should a receptionist, secretary, healthcare assistant and pharmacy assistant be paid a fixed salary or just the National Living Wage when most receptionists in the hospital service are paid higher salaries on an incremental scale? Why should I not get a reasonable cost of living increase each year, just like the rest of the NHS?A recent Practice Index survey demonstrated that fixed pay rates and payment of the NLW are more common than you’d expect.

• When I had to carry out jury service I had to pay back my allowance for loss of earnings to my employer. Yes, I’ve come across that one!

• ‘Uneconomic’ practices are trying to merge and are expecting to reduce staff terms and conditions to those of the lowest ‘paying’ practice. How fair is that? Thankfully, the Transfer of Undertakings Regulations come into play, but as some of you know they’re still trying it on and there are stories of practices imposing new contracts, without consultation.

Continuing to give freedom to general practices to make their own rules about staff pay and conditions brings discredit to the profession. In my view GP contracts need to lay out what practices should pay their staff and what terms and conditions should be offered. If patients became aware of what practice staff put up with, the backlash could be painful.

Promote a level playing field

As a practice manager, you’re both an employee and a representative of the ‘management’. Let’s promote to all PMs the idea of a consistent pay system for staff along with consistent terms and conditions of employment. It doesn’t have to follow the NHS contracts under Agenda for Change, but there does need to be a level playing field. It would be interesting to hear the views of managers regarding what a Pay and Terms and Conditions Handbook for practice staff should contain! I worked as a practice manager for around 25 years, at a time when NHS pay rates and terms and conditions were respected. As a lifelong trade unionist, I was part of a culture that ensured the NHS had the best pay and terms and conditions possible. However, I did accept that sometimes weaker terms and conditions existed in a small business, but I for one never agreed that pay should be lower. I’d argue that the funding was and is there, and I’d seriously question where else it’s being used.

By Robert Campbell