Yesterday’s announcement on the proposed pay increases for NHS staff, as well as other public sector workers, has been met with disappointment and anger by those of us working in general practice.
The recommendation of a 4.5% pay uplift for salaried GPs is well below inflation and in real terms represents a pay cut. This uplift is not funded through the core GP contract – therefore individual practices will need to meet the cost themselves.
Other surgery staff not on Agenda for Change contracts – which represents many practices in the UK – 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.
Practices have also had to fund this year’s increase to national insurance contributions themselves – no additional funding has been passed on to support this, despite the rise in contributions being aimed at increasing the health and social care budget. GP practices have not seen any of this money.
On top of this, many areas have not seen funding for enhanced services increase 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.
Those practices who do adopt Agenda for Change will have to increase staff salaries in accordance with yesterday’s decision, but again there is no funding provided to support this. Once more, the costs will have to come from the practices themselves.
In England, staff employed via the Additional Roles Reimbursement Scheme will have their maximum claimable amounts increased, but the corresponding budget envelope to pay for these staff will not rise to match it. This means staff will be expecting an increase, but PCNs will have to fund it from other income streams.
This presents a significant problem for general practice.
Staff who are on the lowest wages are suffering the most as the cost-of-living spirals around them and their wages are unable to rise to meet this. This leads to increased turnover as they leave to find employment in other areas where the pay is better. This in turn affects patient access as it becomes harder to get through to surgeries or book appointments with clinicians. It also puts general practice in competition with Agenda for Change employers – effectively robbing Peter to pay Paul in our healthcare services.
Many practices are already struggling due to increased running costs, high locum rates, estates challenges etc. We are struggling to recruit and retain staff as it is. To pass on increased rates of pay is something we would all want to do, but in some cases to do so would mean to financially destabilise practices and may lead to more practice closures. Many practices have seen gas and electricity prices double, or triple. Our clinical staff need to pay for fuel to carry out home visits, but the cost of fuel has dramatically increased to an average of £1.88 per litre[1] and yet the HMRC maximum fuel reimbursement allowance has not moved from 0.45p per mile.
All of this feels a far cry from the gratitude and applause that NHS staff were given at the start of the pandemic. Since then practices have continued to do their best to support their patient populations. Staff have worked over and above their normal hours to keep services running and cover unavoidable absences as well as support the mass vaccination programme. We have seen more patients in the last year than ever before. To not fund the proposed pay-uplift appropriately and then to recommend only a 2.1% feels like a total disregard for all hard working and dedicated staff working within general practice.
The IGPM calls 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. 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.
