As a practice manager, you have a foot in two camps. You’re normally an employee and, as such, expect to be paid a reasonable salary for what you do. You need to fight your own corner; but in the absence of any staff representation, apart from a few members of trade unions and nurses who are members of the RCN, you may be the only person who can represent the staff when it comes to pay settlements and setting pay rates for individual posts. Your employer may simply say no to pay rises, stick to their guns and leave you with no say, no power and no alternative. But you’ll still get earache from the staff. In my experience, ex-NHS employees are often the most vocal and are keen to maintain their pay in line with NHS pay bands.

National Living Wage

However, there’s another spoke in the wheel, namely the National Living Wage, due to increase again on 1^st April 2021 with an increase of 2.2%. Employees aged 23 and over will be legally entitled to an hourly rate of £8.91. For whole-time staff, this equates to almost £17,425 per annum..

In the NHS, the three-year pay deal provided a 3% rise in 2018, 1.7% in 2019 and a further 1.7% in April 2020. In April 2021, it’s anticipated that the NHS Pay Review Body will recommend a rise of around 3%. Under the 2020/2021 agreement, the lowest hourly rate was £9.23 (£18,005 per annum), whilst the National Living Wage (NLW) for 2020/21 was set at £8.72 (age 25 and above). Clearly, the NLW is lower than the lowest hourly rate paid to mainstream NHS staff. Be warned that failure to pay or update the National Living Wage might result in a fine of up to £20,000 per employee.

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Dilly-dally on pay increase and back pay

Bear in mind that a provision is made in the budget paid to practices for ancillary staff pay. However, GP Employers, in my experience, like to wait to see any uplifts in their budget sitting in their bank accounts before agreeing to any staff cost-of-living increases. This also gives rise to the question as to whether a cost-of-living pay rise is backdated to 1^st April each year with the appropriate back pay being paid. Whilst GP Employers can dilly-dally with general cost-of-living increases or back pay and choose not to pay any, this isn’t the case with the NLW, which needs to be paid in a prompt and timely manner.

Pay drift

The problem that arises by only paying the NLW increases is that the differential between pay for staff on higher pay decreases. I’ve been exploring the gaps between pay bands used in the NHS as well as the percentage pay increases offered over the years. Reviewing my pay as a clerical officer, aged 16, compared with what I’d now receive as a NLW, it would have taken an annual percentage increase of around 8% to reach today’s NLW. Looking at the NHS pay bands (April 2020) between Band 2, used mainly for clerical and reception staff, and Band 8B, used for some senior practice staff, there’s an increasing percentage difference between the bottom of each band, rising from almost 10% to 16%. As the NLW creeps up higher, the beneficial difference between bands or grades continues to reduce. The difference between the bottom of one band and another, ranges from about £1 to £3 per hour.

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Fixed pay and incremental pay scales

Another consideration is that of fixed pay rates or incremental pay systems. Increments based on age are no longer considered appropriate because of pay equality laws, but strangely the NLW is still age based. Many GP employers use fixed salaries and even the NHS pay system has reduced the number of stages in its incremental scales for lower bands to as low as 2 increments and 4 increments for higher bands. The argument about increments is to do with length of service and the development of expertise.

What to make of it all

Practice managers, as I said at the beginning of this piece, are in that invidious position of falling between two camps – the staff employed and the GPs employing them. In my mind, it’s important to try to remain impartial, but to aim to be dealt with in a fair and reasonable manner by your employer. Review your pay system. Do your research. Look for anomalies, where some staff might be earning more than others without any logic to it. Are nurses tied in with NHS pay bands but the rest of the staff are not? You might need to take into account recruitment problems or staff retention issues. Is staff turnover a problem? Do you need to look at London weighting or regional differences in pay? And so it goes on! Don’t forget COVID-19 either; do you think your staff should earn more, at least this year? Fill in this poll on the forum on pay within your practice.

Author – Robert Campbell