Practice managers in Wales have said the absence of a financial agreement on the GP contract has made giving staff pay rises ‘difficult’ – triggering fears employees will leave general practice for better paid jobs in other sectors.
Contract negotiations between the GP Committee Wales (GPC Wales), the Welsh Government and NHS Wales ended without resolution in October.
Dr Gareth Oelmann, chair of GPC Wales, said the offer put forward from the Welsh Government was not ‘credible’ and wouldn’t ‘help to counter the damaging impact of soaring inflation on practice costs and staffing expenses’.
The current impasse has left surgeries in an uncertain financial position, with practice managers concerned about how they will plan ahead and meet ongoing cost pressures including staff pay, and other practice expenses, such as for equipment, consumables, drugs and energy.
Gareth Thomas, business manager at West Quay Medical Centre in Barry, warned that practices are finding it particulalry difficult to manage staff pay increases.
Some surgeries have approved pay increases since staff are on Agenda for Change contracts, he said, but it has placed ‘huge financial pressures and strain upon them’ and risks their financial sustainability.
‘We don’t offer the Agenda for Change pay element in our practice,’ he explained.
‘Ensuring the books balance at the end of the month is one of the most important jobs of the practice manager, therefore we are simply unable to absorb pay rises that are offered under Agenda for Change terms.’
Mr Thomas warned that not being able to compete on pay and other incentives means ‘general practice will start to haemorrhage staff to other sectors’.
Deborah Kalaji, practice manager at Canolfan Iechyd Amlwch surgery in Anglesey, told Management in Practice she has had to use up ‘rainy day money’ to afford pay rises – and limit them to only a handful of staff members.
She said: ‘One member of staff had an increase because of the new minimum wage, which meant I had to put up the pay of Band 2 staff to retain the differentials. So, this wasn’t a choice, it’s a case of being required to cover these pay costs.’
Ms Kalaji said that the rest of the practice staff team hadn’t received a pay rise ‘directly because of the lack of a financial agreement.’
‘Currently, we just have to hope that people stay in the job on the basis of goodwill and the belief we will sort the pay issue eventually and be able to back pay.
‘All of this risks recruitment and retention. A receptionist could go to Lidl tomorrow and earn more. A nurse could go into the hospital sector with ease.’
In the meantime, Ms Kalaji said the practice is having to ‘watch the pennies’ and put a pause on capital spend.
She added that the situation has left the practice manager community deeply frustrated and that she feared it could mean more walking away from their jobs – risking general practice becoming more destabilised.
‘The demands put on practice managers just keep mounting. The contract has shifted bureaucracy from GPs to us, so we are managing growing pressures without it being reflected in our pay.
‘Because PMs take pride in what we do we make things work, but increasingly some are finding job too stressful. If practices lose experienced managers those practices will be even more destabilised. ‘
Mr Thomas, who is also national lead Wales at the Institute for General Practice Management, said general practice in Wales has been extremely let down by the Welsh Government.
‘Rising costs and soaring inflation are taking an incredible toll on practice financial sustainability. Unlike Health Boards general practice is not in a position to overspend and receive bailouts, we ultimately answer to GP partners and our bank manager.
‘Yet we see no impetus from Welsh Government to protect struggling practices from these additional cost pressures.’
GPC Wales said it is still hoping that a contract upift can be negotiated although warned that, ultimately, a contract could be forced upon surgeries.
In October, the BMA published a ‘Mythbuster’ document summarising details around the negotiations.