Practices have suffered a double blow in the latest NHS pay awards, GP leaders have warned. As reported on Practice Index, most NHS staff, including practice nurses and salaried GPs, have been awarded pay increases of 4.5%. The pay award also recommends that NHS staff under the Agenda for Change (AfC) contract should receive a pay increase of ‘at least’ £1,400, backdated to April this year.

While this is well below the current soaring rate of inflation, GP partners have been told to stick to their contractually planned increases in funding, including a 2% allowance for their own pay increases. This has led to the BMA warning that practices will be left significantly out of pocket. Plus, as seems to be the norm these days, outside of salaried GPs and anyone on AfC, wider general practice seems to have been overlooked.

Other surgery staff not on Agenda for Change contracts – which is the case for numerous practices – are only able to access a 2.1% pay increase which was funded in the core contract uplift in April 2022 for practices in England. This increase was made when the new GP contract was negotiated in 2019. Despite the cost of inflation this month reaching 9.4%, this has not been renegotiated, and therefore all other practice staff have only been able to access a 2.1% pay rise – where practices have been able to afford to pass this on. Partners – some of whom are Managing Partners – receive nothing.

Pay the salary or cut services

“The sums just don’t stack up and the announcement leaves us Practice Managers stuck between a rock and a hard place,” one Practice Manager told us.

“We know people deserve a pay rise. We’ve just worked our way through one of the toughest periods most of us will have experienced and the cost of living is out of control. But how are we expected to pay for it? We’re left with a stark choice. Pay the money or cut services. It’s as simple as that.”

Accountants have warned that GP practices face losses of around £40,000 on average given the unfunded 4.5% increase in pay for salaried GPs and rises for other NHS staff, according to GP Online.

The cost of locums was a topic raised by another Practice Manager that we spoke to, who said the “ridiculous” situation was just another cash flow issue to add to the already long list.

“Locums, are in short supply and cost a fortune if you can get one,” they said. “The costs are just daft. Our energy bills are through the roof, we’re already being hit by rising employer National Insurance bills, it’s getting harder to bring money in from flu jabs because there’s so much competition from pharmacies etc. I can go on, but the fact is cash flow is struggling. It’s not like the squeeze is a new thing. We’re already running a lean practice and there’s not much more to cut.”

As the Institute of General Practice Management (IGPM) point out in their response to the pay award – read the full IGPM response here – this pay award ‘double whammy’ comes on top of many areas not receiving funding for enhanced services increases in line with inflation. Practices are therefore having to continue to provide services at an increased cost – not just in terms of staffing, but also in terms of utilities, consumables and transport costs – all for the same level of remuneration.

Then there are fuel costs. Clinical staff need to pay for fuel to carry out home visits, but the cost of fuel has dramatically increased to an average of well over £1.80 per litre, yet the HMRC maximum fuel reimbursement allowance has not moved from 0.45p per mile.

“I really worry about how we’re going to pay our practice staff any sort of increase, let alone the amount they deserve,” added a PM. “Those who aren’t NHS still expect a rise, and when they see figures of 4.5% being flung around, they get their hopes up. But where is the money going to come from?”

Communication is key

When asked how they can manage the situation with colleagues, the Practice Managers interviewed all say one thing. It’s all about honest communication.

“I think we have to have honest conversations, both with our GP partners and staff, where we lay all our cards on the table,” one PM said. “I’m sure some of us have been in a similar position, maybe not as Practice Managers, but in previous roles through various recessions. There’s usually a way forward, whether that’s staggering pay rises, providing one-off cost of living payments or just being honest and saying there’s no money. Honesty goes a long way.”

Mass exodus

Another PM told us that the situation has led to him “falling over the tipping point,” meaning he’s joining the growing list of resignations from the profession. “I’ve just had enough. It’s as simple as that. The pay rise isn’t enough given the Health and Social Care Levy and cost of living. And then being told to find the money out of a 2% funding increase demonstrates the contempt the government has for primary care.

“As Practice Managers we have transferable skills that the private sector is crying out for. The job market is buoyant, salaries are fair, and I can guarantee no job can be as stressful as this one. I’m sure I’m not alone in being pushed over the edge. I expect to see a mass exodus, not just amongst PMs but across nurses and salaried GPs. If I was a GP, I would become a locum and enjoy more money and flexible hours! And why anyone new would enter this profession is beyond me!”

Looking forward, the IGPM is calling on the UK government – in the devolved nations as well as England – to review their position on practice funding immediately. “We need to see an increase in core funding to enable us to remunerate hard working staff appropriately,” the group writes. “Only significant and continued investment in general practice will help recruit and retain staff going forward. Otherwise, we will see staff haemorrhaging from general practice, when we are already struggling to cope with unprecedented demand for our services.”

What do you think about the pay announcement? How will you manage the extra cost staff expectations? Let us know by commenting below or discuss it in the Practice Index Forum.