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Gold, incentives and meh

Staff pay rise... GP pay cut

The balance between staff pay rises and partners' profits has never been so delicately balanced as this year, says Dr John Couch

This is the second year running that GPs have received no pay rise, but we still face a 1.9 per cent staff pay rise. (Overall, staff have received a 2.5 per cent award but this has been phased.)

In fact, once on-costs are included, the staff increase is around 2.35 per cent (3.1 per cent phased).

This second zero GP pay award means that for every extra pound paid to staff, partners' pay will fall by the same amount. With average staff pay of around £70,000 per full-time GP principal, the increase represents an average fall in profits of £1,650 per GP in 2007/8.

Remember also that this is a recurrent cost; from 2008/9 onwards the figure will be £2,170 a year lost profit.

It certainly looks like the Government

accountants were very smart when staff budgets were amalgamated into global sums and PMS budgets. Under the old system, even if GPs did not get a pay award, a Whitley award to staff would have been reflected in staff budgets.

So are you going to pay the recommended rise? The converse question is probably more appropriate. Can you afford not to? GP profits are still receiving bad press and it is likely that morale, performance and possibly even staff retention would suffer if staff pay is not increased.

We rely more than ever before on well-trained staff to ensure our performance-

driven NHS income is maximised. No pay rise now could have a greater knock-on

effect than the potential savings.

Severe problems

Practices that employ a relatively large proportion of salaried GPs face the most severe financial problems. There have been conflicting reports about the recommendation for salaried GPs. Some suggest a rise of £1,000 per FTE while others include them in the zero award for GPs.

On this basis some practices may refuse to pay any increase. But once again morale, performance and retention issues will need to be weighed carefully in this equation.

There are ways that a pay rise may be


First, you may be able to use staff more

efficiently, saving money as a result. A work study of every staff member's post should be undertaken. If you can reduce the need for overtime by increasing staff output this would certainly pay for this year's rise. Equally if efficiency savings allow you to avoid replacing a staff member who is leaving, or at least reduce the hours some staff members work, a similar result could be achieved.

Second, look at skill mixing. This clearly has much to offer. As each job is vacated, perform a task analysis to ensure an appropriate pay rate for each task. For instance, when a nurse leaves you may be able to replace her with a part-time nurse and part-time health care assistant.

Third, consider performance-related pay in future instead of a pay rise. Although you must ensure a lengthy consultation period, there is certainly time for it to be introduced next year.

This would need to be done carefully. But if targets are set carefully, the gains could make the scheme self-funding. Accepted models exist which you could use.

The only consolation for GPs is that the recommended staff award is relatively low. But if we face a third zero rise next year it will not be easy to exercise benevolence.

John Couch is a GP in Ashford, Middlesex

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