With the announcement of pay rises for doctors this year, what does this mean for our practices?

Well, that very much depends on where you’re sitting. The DDRB recommendations vary according to type of doctor and where in the country your practice sits. What the DDRB said was:

• Contractor GMPs in Scotland, Wales and Northern Ireland: 6%
• Salaried GMP pay ranges: 6%

Uplifts should be consolidated and back-dated to 1st April as necessary so that they would be paid in full for the 2023-24 financial year.

You’d be forgiven for thinking this sounds quite straightforward, if a bit on the expensive side, as a practice. Is it really all that easy, though?

What really gets my goat is that despite the announcement, which will send our staff into a frenzy about when they might be able to spend some of their hard-earned cash, we don’t have any visibility about how we might be able to pay for it.

I’m in England and, generally, we might expect to see an uplift to the Global Sum, but the SFE (2013) says this about how they calculate it:

Staff Market Forces

B.12. The staff Market Forces Factor has been informed by analysis of the New Earnings Survey, and reflects the geographical variation in contractors’ staff costs. The estimation methodology is the same as that used for general NHS allocations.

B.13. This element of the formula has been given a weighting of 48%, as this is the average proportion of the global sum accounted for by staff expenses.

So, am I expecting to see the full 6% increase? I suspect not. But, more to the point, if staff are to get the full 6% in their pockets, what about my uplift for additional on costs? The DDRB isn’t giving any recommendations about this, save to say that the full uplift should end up in the pocket of our staff.

In 2022, the DDRB recommended 4.5%, the funding uplift was announced as a headline 2.5%, but the Global Sum uplift was actually around 3%. So, which figure might I use to get an idea of just how big the financial black hole is? I think your guess is probably as good as mine!

I did read the DDRB report in more detail than I might usually, just because I wanted to see how they’d arrived at the headline figure of 6%. The report says:

Since written evidence was submitted by the governments and health departments, three of them (DHSC and the Scottish and Welsh Governments) have made significantly enhanced pay offers for NHS staff for 2022-23, 2023-24 or both. We discuss these in detail in Chapter 2. In England and Scotland, this comprised staff on the Agenda for Change contract only, but in Wales this also included some groups within our remit. All three also included consolidated elements that would be carried into pay bills going forward. None of the three governments explained how these pay offers, all of which represent substantial increases to NHS pay bills during a time of pressure on services, will be funded, or how they will affect the affordability context for our recommendations this year. In particular, we note that DHSC’s offer to Agenda for Change (AfC) staff included a consolidated pay uplift for 2023-24 of 5 per cent, despite them having submitted evidence to NHSPRB that said that 3.5 per cent was available in current budgets to fund pay increases for 2023-24 just a few weeks earlier. This suggests either that the UK, Scottish and Welsh Governments are expecting to provide more funding to their health systems than was previously outlined, or that existing funding has been redirected towards increasing AfC staff pay and less funding would then be available to spend on services or service development, or some combination of these. Whichever of these is the case, these pay offers call into question the integrity of the affordability evidence that they have previously provided to us and make it difficult for us to know what the true affordability picture is. [Practice Index emphasis]

They also said:

We note that health services remain under considerable strain, as a result of long waiting lists and demand growth. Addressing this requires a workforce that is sufficient to meet demand. It is therefore increasingly important that staff are retained and motivated to perform. In this context we note with concern the GMC’s observation that the number who left the medical register in 2021-22 was higher than previous years, though they said that it was not yet clear whether this represented decisions to leave that were not taken during the pandemic or an increase that would be sustained into future years.

In general medical practice, despite welcome increases in the size of training intakes, the effective size of the GMP workforce is stagnant, once falling participation rates are taken into account. Despite positive trends in the use of non-medical clinical staff, evidence suggests that practices and their GMPs are struggling to meet demand, and access is severely challenged.

Without a doubt, circumstances are as challenging as they have ever been and at times it feels like the system is only calibrated to work against us.

Further into the DDRB report, I spotted this:

We also note that the BMA and BDA jointly published the paper Report into the Failings of the Pay Review Process for Doctors and Dentists 1, which called for a number of changes to how the DDRB process operates.  

I understand that the DDRB are somewhat stuck between a rock and a hard place – asked to make pay recommendations, but told from the outset that whatever they recommend needs to be affordable; having to acknowledge that the only way that the current system works is fundamentally for everyone to be slightly dissatisfied with the results, which surely is what compromise looks like.

I’m always staggered at how little say general practice actually has when it comes to what affordability looks like.

As independent contractors in England, we agreed a five-year pay deal, which started just before the world seemingly tilted on its axis. The post-Covid, post-Brexit economy, with incredible levels of inflation, in no way reflects the picture we saw in 2019. In 2021/22 the Primary Care budget made up 8% of NHS spending, and yet, the only representation for general practice is via the BMA GPC, which is representative of doctors, rather than primary care organisations as employers. Where are the non-GP partner employers’ voices heard? The DHSC and both NHS Providers and NHS Employers all get a seat at the table.

More concerningly, amid the lack of any official information, at the point when I’m writing this, the Government announcement had this to say:

How is this being funded?

The government will fund this pay award through prioritisation within existing departmental budgets, with front line services being protected.

More borrowing would add pressures on inflation at exactly the wrong time, risking higher interest rates and higher mortgage rates.

The government plans to increase the main rate of the Immigration Health Surcharge – to ensure it covers the full healthcare costs of those who pay it, having been unchanged for the last three years despite high inflation and wider pressures – to at least £1,035, and the discounted rate for students, their dependents, those on Youth Mobility Schemes and under-18s to £776.

In written and oral evidence to the Pay Review Bodies, the government set out what was affordable within the NHS’s Spending Review settlement. The Pay Review Bodies have recommended pay awards above this level.

Accepting the full DDRB recommendations is the fair and reasonable way to determine pay for doctors and dentists across the country.

The final kicker, though, is this:

The GP contract will be uplifted to provide funding for salaried general practice staff. This funding will be backdated to April 2023 and it is our expectation this funding is passed on promptly to all salaried general practice staff. As self-employed contractors to the NHS, it is for GP practices to determine uplifts in pay for their employees.

Given the pressures we’re facing in practice, with budgets being squeezed beyond belief when it comes to our heat, light and power accounting lines, amongst all the mounting additional costs across the board, just how are we supposed to give our staff some clarity, when we’re not sure ourselves, and when the financial settlements directed are so out of kilter with the funding coming in?