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Short changed: the practice manager pay divide

17 February 2017

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Are female practice managers valued less than their male colleagues? Alice Harrold investigates the gender gap in practice managers’ pay

Practice managers across the UK may be tasked with the same daily challenges of running a busy GP practice, but when it comes to pay, they’re better off being male than female.

The latest salary survey, published on 22 November last year, reveals that female practice managers earn 10% less a year on average than their male colleagues. This is despite the fact that seven out of 10 practice managers are women.

And it’s not only the female professionals who are suffering. The same survey by First Practice Management (FPM), an advisory service for practice managers, found that the average salary in the sector has fallen by nearly 3% since 2005 and pay rises are rare.

Practice managers have described the findings as ‘insane’, but many blame the discrepancy on the lack of a national pay structure, meaning that individual GP practices set their own rates and there is no way to check that both genders are on an equal footing.

Lack of structure

The Practice Manager Salary Survey had more than 1,520 responses from 202 clinical commissioning groups (CCGs) in England, health boards in Scotland and Wales, and social care boards in Northern Ireland, and studied income received between 1 April 2015 and 31 March 2016.

It found that male practice managers earned on average £42,636 in 2015, whereas their female colleagues earned £38,421 – a difference of 10%.

“It’s insanity,” says Amanda Sayer, a practice manager and partner at Lighthouse Medical Practice in East Sussex. “You [should be] paid for the job you do.”

She says the lack of a specific structure or a practice manager regulator means that those who move into general practice from other sectors tend to enter at a higher pay grade.

When she became a practice manager in 2004, a lot of female practice managers had worked their way up from reception, whereas a lot of the male practice managers tended to come from other businesses.

Jan Harley-Doyle, practice manager of Somerford Grove Practice in north London, entered practice management in 1990 when the recruitment route was changing. The introduction of fundholding created a higher demand for commercial and financial experience. “That is when we first saw men coming into the fold. I only knew of one male practice manager prior to that,” she says.

Harley-Doyle agrees that women are more likely to have worked their way up within the practice, putting them at a disadvantage against their male colleagues.

“Twenty years ago, when more people worked their way up, practice managers weren’t taken terribly seriously,” she says. “Because we were predominately women, working part time, without specific qualifications, and there was nothing you could look to to define what a practice manager was.”

However former practice manager Jennifer Gosling, who carried out her own research on pay within the profession, argues that even women who come into general practice from other professions still earn less than their male colleagues.

“I’ve learned that women tend to get paid less than men so I wasn’t surprised to see the results of the survey,” she tells Management in Practice, “but I was definitely disappointed.”

Gosling, who carried out her survey of GP practices in London in 2000, found that on average female practice managers earned £5,000 less than male practice managers. When the results were moderated for size of practice, women were still paid less.

The results showed that 31.5% of male practice managers who came in from other positions in the NHS were paid more than £30,000, compared with just 13% of women.

“What I wasn’t expecting was that the women coming from outside general practice, who had had other jobs, were still getting lower salaries than the men,” she adds. “It’s slightly depressing.

“I would say that the learning curve is steeper for the manager coming into general practice from outside,” Gosling says. “I met several managers who had come in from outside who left quite quickly because it wasn’t the environment they were expecting it to be in.”

Practice managers also blame the gender divide on the range of responsibilities in the profession, with some working as administrators and some as business strategists, meaning that a difference in pay can be justified.

The practice list sizes can also vary dramatically – ranging from just hundreds to over 25,000, which could affect the practice manager’s salary.

Practice managers’ pay

·      70% of practice managers are women

·      £5,000 gender pay gap in 2000

·      £4,215 gender pay gap in 2016

·      26% of practice managers received a bonus last year

·      £1,200 was the average bonus

Fiona Dalziel, who holds the role of general manager of a 10,000-patient practice and works as a practice management consultant, argues that male practice managers tend to work in larger practices.

“You can have somebody in a tiny practice with two GPs who is called a practice manager, but they may not be involved in strategic development. That person is most likely to be a woman,” she says.

“Then you get somebody managing a practice with 25,000 patients and they are also called a practice manager. Most men are much more likely to go for the larger job in the larger practice.”

She is still surprised, however, by the gender discrepancy. “The majority of GPs are women – so why are they paying men more?”

Gary Hughes, manager of The Waterfield Practice in Bracknell, Berkshire, agrees that salaries should reflect the roles and responsibilities and the size of the practice, “not where you’ve come through or your gender”.

But he argues that a standard pay across the profession would never work. “We are private organisations, so I don’t see how you could build standard pay – and personally I don’t think it would be a good thing either,” he says. “It is up to employers to make sure they are paying responsibly.”

Decreasing salaries

But while standard pay could benefit female managers, it is questionable whether it would make a difference to overall pay as the same salary survey showed that average earnings have fallen across the profession.

The average earnings for practice managers, practice business managers and operations managers in the UK are £37,323, down 2.57% on 2015’s figure (£38,306) and 4.85% from 2014’s average (£39,225).

And the survey reveals half of all practice managers did not receive a pay rise between April 2015 and March last year and 79% of those whose pay remained stagnant were women.

The lowest full-time-equivalent annual salary reported was £17,363 in south England and the highest was £81,000 in London, both for non-partner practice managers.

Many practice managers work longer than contracted hours because of the heavy workload, the survey also found. Each week in 2015, 39% of managers worked one to five hours overtime, 8% did 10-15 hours overtime, and 3% did more than 30 hours overtime. Increased workload and decreased pay are contributing to burnout and 32% of survey respondents attributed low motivation to ‘lack of recognition’ by GP partners.

Commenting anonymously in response to the salary survey, one practice manager says that workload has “increased massively with no recognition of this by partners, the CCG or NHS England. The next crisis will definitely be in practice management.”

Another says: “Having not received any increment for eight years I feel
I deserve a decent pay award. This year is pivotal and if there is no significant pay increment I will be looking in a new direction.”

So can practice managers expect to see any change in their salaries this year? Gosling insists there is a need for “education” among GPs about the importance of practice managers.

“I think overall GPs recognise their value but that doesn’t always translate into a commensurate monetary value.”

However, lack of investment in primary care over the past few years has meant that many GPs’ salaries have also failed to increase.

Steve Williams, co-chair of the Practice Management Network, says he is hopeful that the GP Forward View will produce the necessary investment in non-clinical staff. He argues the £6 million earmarked over four years for practice manager development should upgrade skills and qualifications, meaning there is a greater opportunity to change practices and earn more.

But he also argues that a formal pay structure for practice management is long overdue. “As good employers we should be looking at the pay scales in the Agenda for Change,” he says.

Applying Agenda for Change (AfC) could put practices back with the Whitley Council pay scales and grading levels, he adds.

Harley-Doyle agrees. If practices were to set their pay rates by AfC without the grading terms and conditions, it could be possible to make pay more standardised and give a framework of roles across the country.