Being a nurse in general practice usually means working with different terms and conditions than you would find in other areas of nursing. General practices are usually independent businesses and, although they hold contracts with the NHS, these contracts do not stipulate terms and conditions for their staff.
Many GPNs do not work under the Agenda for Change (AfC) pay scale, which was introduced in 2004 and is optional in general practice. Though this variation does bring with it some flexibility, it also means that practice nurses have been left with no clear pay structure and differing terms and conditions such as annual leave entitlement and sick pay.
I doubt that many of us chose to become nurses because of the money – but GPNs have told me that when they have felt underpaid in the past, they moved to different practices for a higher salary. This means they preferred to secure new jobs rather than approaching their current employer to see if there was any room for negotiation first.
Though these nurses were not unhappy in their previous roles, they felt underpaid and the extra income came in very useful in the current economic climate. They said they didn’t feel able to negotiate their pay and thought that if they tried it would only be met with negativity and they would be embarrassed.
Why do GPNs not feel able to speak with their employers?
Nurses need numerous skills to become registered and even more to become proficient GPNs, but business skills are often alien to us. Generally, nurses feel they don’t have the ability to negotiate with their employers who are more likely to be business-minded.
The nurses I spoke with said that negotiating is simply something they have never done. In services where AfC has been adopted, nurses do not require negotiation skills and simply apply for jobs in a higher band. Practice nursing does not work this way, which leads to GPNs moving around more. As a result, there is less continuity for patients and the practice as a whole.
I would guess that employers would prefer if nurses who want a pay rise to at least discuss their desires first rather than risk losing these staff – especially when the staff in question are embedded into their practice, known to their patients and competent in their role.
Even if the practice were not in a financial position to increase a GPN’s salary, it may have been possible for the practice nurses to negotiate other conditions – for example, annual leave or a plan to support a salary increase in the future.
If you think you are currently underpaid, where do you start?
Firstly, have a good think about why you feel you deserve an increase in pay: simply asking for a pay rise to do the job you have always done will probably not lead to success. You will need to evidence your increased value to the business as well as to patients and the wider practice team.
You should also ask yourself whether you’re being paid differently to your peers. This is a common subject. Though I am not suggesting you should find out how much your colleagues earn, there are several online GPN forums where nurses’ names are anonymised and subjects like this are often discussed openly and with great debate. You might find that the variation nationwide is surprising.
Your annual appraisal is a good place to start as a face-to-face approach is far better than negotiating by email or letter. All practice nurses should be having one and the Care Quality Commission will look for evidence that these are taking place when they inspect the practice. The appraisal, which may be with your nurse manager or practice manager, will give you a platform to discuss your achievements and goals. If it is with your practice manager, ensure you have an appraisal with clinical input too.
During the appraisal, remember to demonstrate why you deserve an increase in pay by highlighting your accomplishments, targets and what you have done differently to achieve them this year. Clearly evidence your clinical skills and how they benefit the practice and ask if there’s anything else you could do or any further training you can complete to support the team. It is worth auditing your work and using this data to show your impact on the practice and the patients. Ask yourself: can you run searches and is your coding always accurate to make auditing more straightforward?
It is also worth looking at your job description. If you think you are working above and beyond your role, write everything down and use this evidence to put your case forward. For example, you should mention whether you have taken on any extra responsibility such as leading an area for the quality and outcomes framework (QOF).
Introduced in 2004, QOF financially rewards practices for the provision of quality care and helps to fund further improvements in the delivery of clinical care. Have you undertaken training that benefits the practice and not just out of personal interest? For example, have you undertaken extra training to allow yourself to be involved in and heavily support the provision of new enhanced services?
During the negotiation, be sure to explain your thoughts and be very clear about what you want and why. Make sure you are always polite, calm and relaxed as you make your case. Stay objective and do not become emotional as being defensive will not support positive negotiations and may damage relationships going forward.
Asking for a pay rise isn’t easy but remember you are showing that you’re keen to stay in your current role and develop it rather than apply for a different job that may pay more. You’re showing commitment to the practice team and your population.
The nurse manager or practice manager will probably need to discuss your request further. This may be with the partners in your practice or the GP in a single-handed practice.
What if you are unsuccessful?
Don’t be disheartened – remember, this is a business decision, not a personal one.
To give you an idea of what you may need to do going forward, ask for feedback. You can work with your employer to develop the skills you may need to secure a pay rise in the future.
There might be further training you could source or other areas of work you could support, particularly those that could bring extra income to the practice or take some of the workload off GPs. Do you have any ideas to streamline processes that could be piloted and audited? It may just be that there isn’t enough money in the pot right now, but you may be able to discuss this again after an agreed period.
It is also worth bearing in mind that you could secure a post in a different practice and gain an increase in pay, but not be as happy as you are now. There is a lot to be said for being supported in a team that works well and cares for one another.
Zara Head is the lead nurse for primary care quality at Doncaster CCG. She has been in post for three years. Prior to this, she was lead inspector for primary and integrated care for the care quality commission and also a general practice sister for many years.