General practices are organisations with contracts with the NHS, and are generally independent partnerships which have to adhere to the requirements of these contracts.
This does not include following mainstream NHS employment terms and conditions although, as with all organisations, practices must conform to employment law and should follow best practice in human resources (HR).
Funding for practices has become increasingly constrained over recent years, coinciding with increasing financial demands in areas such as health and safety, infection control, security, governance, etc. Partnership incomes are dropping and requests for pay rises are likely to be viewed with dismay.
So how do you tackle the problem if you feel that you are underpaid?
Understanding the financial contributions of nurses
The first step is to understand how you contribute to the practice’s income. Before the current quality and outcomes framework (QOF) and enhanced services, practices submitted individual item of service claims for procedures such as immunisations. Practice nursing grew as these extra services supported the employment of nurses.
The introduction of targets, and the computerised extraction of data for much of QOF and the enhanced services have resulted in further growth in practice nursing requirements. However, this
is only sustainable from a business and financial perspective if the nurses involved offer value for money and support this income stream.
Example: Jenny, a practice nurse for more than 20 years, is vastly experienced, hugely popular with patients and regarded as the practice’s shoulder to cry on when things get tough. However, she is the despair of the practice manager who cannot persuade her to use the computer properly and to record data correctly. Jenny robustly claims that patients are more important than money and is apparently oblivious to the adverse effects that she has on targets and income.
Increasing your value
In order to increase your worth to the practice you need to consider your existing value. Do you understand the various financial requirements and update your records to ensure that these are addressed? Are you a team member who tries to work to practice aims or an individual who feels that only their clinical contribution matters? Are you the delight or despair of the management?
Difficulties arise when practice-employed nurses believe that they are answerable only to their professional bodies or the NHS, and that practice-specific needs are irrelevant.
To increase your value to the practice, you need to be able to demonstrate your ability to:
- Enhance your clinical skills in line with practice requirements rather than your own preferences.
- Engage with practice meetings and educational events.
- Keep up to date with changes to your practice IT system and associated changes in working practices.
- Understand the importance of correctly coding computer entries.
- Learn how to do computer searches and audits so that you can monitor your own work.
- Request feedback on any problems that may arise with your work.
- Become indispensable as a committed team member rather than just a dedicated clinician.
If you contribute to the business of the practice as well as to the medicine, you are doing what you were employed to do. It is then up to you to demonstrate how you are performing above and beyond this remit to be able to present a case for enhanced payment.
How best to negotiate your pay rate
Negotiating a pay rise should be a business encounter. You have a contract with the practice to provide services in return for payment and you are seeking to renegotiate the terms of this contract.
You need to calculate your value in relation to others. This does not necessarily mean trying to find out what your immediate colleagues earn but perhaps venturing further afield on online forums where such matters can be discussed more openly behind disguised user names. However, the main comparison is between what you do for the practice and what you could do.
One complication you may encounter is that your employers will probably believe that they are already paying you adequately for what you do. Asking for a pay rise for doing what is effectively your job is not a good starting point.
You need to have done something different and beneficial that is outside the scope of your current role, or be planning on doing something substantially different. Minor alterations to your job description or working hours are not usually grounds for a pay rise but are part of the everyday evolution of jobs.
Example: Raj has been a practice nurse for five years. He is very interested in computers and has become increasingly involved in training not only his nursing team colleagues but, more recently, new GPs and locums.
He wants his training role recognised and produces a report showing the amount and type of training that he has done in recent months and a proposal that he spend part of his time on data quality and training.
This will enhance QOF and enhanced service records and thereby increase income, and he suggests a revised rate to reflect this role. The practice manager, after discussion with the partners, offers an alternative rate for time spent on training activities only, to be done for a limited number of hours each month.
Preparation for alternative outcomes
Because pay rate negotiations should be about work and not personalities, you need to consider what will happen after you have raised the subject with the practice manager or nursing lead.
For the negotiation itself, you should consider giving them notice of the subject matter and arranging a meeting rather than just dropping it into an informal encounter. This enables both sides to be prepared and demonstrates your professionalism in this area.
Prepare your evidence (never exceed one side of A4 paper) and state what you do above and beyond what might reasonably be considered part of your role. Have a realistic figure in mind and be prepared to justify it.
With any such meeting, it is easy to imagine it going according to plan and then being back-footed if this fails to happen. Instead, think through all the objections or counter-arguments that might be raised and consider how you would address these.
Try not to become defensive, indignant or upset: you have a right to ask but the other side has the right to refuse your request. If the meeting does not go according to plan, have an exit strategy ready, such as: “Perhaps we could meet again next week when you have had a chance to consider my proposal.”
If your proposal is not successful, decide in advance how you will deal with this. You might choose to accept a lesser offer or, in the event of no offer, ask what you could do to achieve the required increase over the next year.
Finally, be discrete. If you are given an increase, reward the practice by making it clear that you will keep this matter private.
You may feel bad for your colleagues but you were the one who took the initiative and prepared your own case. In the event of a refusal, behaving unprofessionally (by sulking or going off sick) will only prove to the practice that they were right to reject your proposal.
Going elsewhere, although sometimes an option, does not guarantee you a better future. You might get paid a better rate initially if the new practice is struggling to recruit but subsequent pay rises might be slow to follow if you were paid over the expected rate initially. Instead, consider helping your practice improve its income, hone your negotiating skills and try again next year.
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