Why is pay for practice nurses so variable and what can they do to negotiate a raise?
It’s safe to say that nurses don’t become nurses for the money. They are motivated by their desire to care for others and improve lives.
But in an increasingly squeezed healthcare system, practice nurses’ salaries are decreasing in real terms, professionals are being priced out of owning their own homes and financial distress is becoming part and parcel of the profession. To add insult to injury, many practice nurses feel like they either can’t or don’t know how to negotiate a pay increase.
Practice nurses’ pay scales are hugely individual and negotiated personally with their GP employers. In the 1990s, GPs were given funding to pay practice nurses, but those funds have since been rolled into their general income. Therefore, if the practice needs to employ more nurses, their salary now comes out of GPs’ pockets.
Independent nurse consultant Marilyn Eveleigh says: ‘GPs pay what they want to practice nurses. This is often determined by historical factors, profits or desperation. It often follows the way GPs pay themselves.’
As a result of differing salaries, it is not uncommon for practice nurses in a team to be unaware of each other’s earnings, or forbidden to discuss them, says Eveleigh. Ignorance of others’ pay in the wider world is also extremely common. ‘I often raise the subject of remuneration with groups of practice nurses and am amazed at the variation in pay,’ she says. ‘For example, I’ve heard
of quality and outcomes framework achievement rewards ranging from nothing to a pot plant to a month’s salary.’
Time for change
Since the Whitley Council pay scales were replaced by Agenda for Change in 2004, practice nurses have been left with no exact pay structure and vastly varying working conditions.
Since then, some practices have used Agenda for Change pay scales for their nurses, but not the terms and conditions. Nurses working in surgeries have to negotiate their own terms, such as holiday pay, sick leave and parental leave. Salary increases are mostly the result of either practice profit or individual performance.
Rhona Aikman, a practice nurse at Gourock Medical Practice in Inverclyde, Scotland, describes the mood among practice nurses when Agenda for Change was brought in for NHS employees but excluded most out-of-hospital staff.
‘It was a double-edged sword,’ she says. ‘There were going
to be winners and losers because there were definitely practice nurses being paid a generous grade in comparison to the Agenda for Change criteria and then there were those of us who felt short changed because we were working at a higher level than our pay.’
Victoria, a practice nurse in Wiltshire, says that practice nurse pay is not reflective of their responsibilities. She is minor illness trained and undertakes smear tests, baby immunisations, treatment room services and dressings, as well as giving health and safety advice. She is also the mental health lead for her surgery.
She tells Nursing in Practice: ‘Salaries are not in line with the national standard, and are nowhere near reflective of our responsibilities. We seem to be doing more duties, with less reward. Last year, the increase in national insurance meant I took a pay cut of £25 per month even after I’d had a 1% rise (equivalent to an increase of £1 per hour). The rise was 1% practice-wide and was non-negotiable. I didn’t consider leaving because I love the job I do, and there are other advantages to working in primary care, including not working on bank holidays.’
The inconsistencies in the way practice nurses are paid can make it more difficult to ask for a higher salary. But it’s time to say that enough is enough. Nursing in Practice has investigated the best ways to ask for a raise and better terms and conditions. The key is asking for the right things at the right time, and having the confidence to do so. Our experts will show you how. Read on for instructions on how to get the wage that you deserve.
How to get a pay rise
1 Point out your strengths
Before asking for a pay rise, think very carefully about the reasons you can cite to justify one.
Victoria says: ‘If you feel you are being underpaid, gather evidence about what your peers get paid who do similar jobs, and ask for a pay rise. If you can justify a rise, and you ask, you may get one. I did.’
Jayne Harrison, partner and employment director for Cleggs Solicitors, agrees. She advises practice nurses asking for a pay increase to present their request in a ‘concise manner with a clear rationale’ for the rise. You need to consider your current employment terms and compare these against what you expect to receive, she says.
Harrison advises that nurses asking for a rise update their job description to reflect the experience, knowledge, skills and responsibilities required for their job. And if their job expectations have grown, they need to highlight what new duties they have taken on. It is a good idea to identify and match your job to an equivalent Agenda for Change job profile, and to compare your terms and conditions with other practices, she says.
Victoria says it’s best to be proactive: ‘Talk to your colleagues and management about any pressures or unacceptable conditions you are under to try and find solutions. Practice nurses are a rare breed, it seems, so I doubt [your employers] will ignore concerns,
as they would not want to lose a good practice nurse,’ she says.
2 Assert yourself in writing
A survey by the Queen’s Nursing Institute (QNI) found that nearly 20% of practice nurses are not given regular annual appraisals by their employer. There is no rule that requires an employer to use an appraisal system, Harrison says. However, she stresses that ‘it is good practice and can be very useful for both employee and employer’. Moreover, the Care Quality Commission expects practice nurses to have an appraisal every 12 months.
If you are not given an appraisal, Harrison advises that you persist in asking for one. Even if there is not an official system of appraisals, you should ask to speak with your manager about your concerns. If this fails, you can list your concerns in an email or letter.
Harrison explains: ‘It would be hard for an employer to ignore written requests as if you are raising anything that could be a complaint, your employer should regard this as a grievance and use their own grievance procedure, or, as a bare minimum the Advisory, Conciliation and Arbitration Service (ACAS) Code of Practice of Disciplinary and Grievance Procedure.’
3 Stand up for your rights
Louise Brady of the General Practice Nurse Network and practice nursing adviser for the NHS Alliance, says that a lot of nurses are ‘told by practice managers that they can’t bring up pay and terms and conditions at their annual appraisal because the appraisal is only for educational and professional development’.
According to Brady, nurses are then forced instead to write a letter to the practice outlining why they deserve a pay increase. This can ‘create a barrier because they are not tying in knowledge, skills, dedicated commitment with pay,’ she says. ‘It’s a way of putting off a difficult conversation that employers don’t want to have.’
But Harrison is clear that employers limiting what topics can be discussed in an appraisal is wrong.
‘By its very name, an annual appraisal is assessing how the year has gone. Therefore, quite naturally pay and conditions are part of this.
‘You should not be put off talking about pay and conditions and, indeed, asking for an increase,’ she stresses.
4 Negotiate an improvement in terms
If your practice maintains that a pay increase is unlikely for any reason, you should consider focusing on negotiating better terms instead.
‘Pay is more difficult to negotiate than other terms and conditions because they don’t think of extra holidays as costing them money,’ Aikman says.
Most practices only offer nurses statutory annual leave. However, this is negotiable and could provide a satisfactory compromise between yourself and your employer if a pay rise is definitely not an option.
5 Look at entitlements before accepting a position
If your employer is still reluctant to improve your pay or conditions after lengthy negotiations, it may be worth looking for a new job. When looking for a new practice nursing position, it’s always better to know of any differences between the pay and conditions of your current job and your next one.
Practice nurses need to ‘be careful’ when changing job, Aikman warns. ‘Those of us who have been in place for a long time have entitlements. For example, we get six months’ full pay and six months’ half pay if we are on long-term sick leave,’ she explains.
‘There have been incidents of practice nurses moving posts and making assumptions that they will have those benefits when they don’t. I knew of someone who resigned from her job and started
a new one. After a few weeks when she got her contract, she discovered that she had nothing like the same sick leave. Her holidays and her pay were good, but she discovered too late that if she was ever off sick, she did not have the same entitlement to paid leave as she did previously.’
Most importantly, Aikman says that nurses should never be afraid to negotiate their terms and pay before they decide to take on
a role, rather than afterwards.
‘At the interview, if they really want you, there is obviously room for negotiation. If they’re swithering, it’s up to you to decide if you’re happy to take out private sickness insurance, for example,’ she says. ‘But that’s where you have to be very careful to ask the right questions and be prepared to negotiate.’
You should be absolutely clear when you are given a job offer what terms and conditions you are expecting upon your acceptance, and make sure that this is put in writing.
Above all, when negotiating over pay and conditions, it is important to keep in mind that the practice you work for needs you as much as you need them.
As Harrison puts it: ‘A practice runs the risk of losing skilled staff if they do not value and recognise the skills or money that nurses bring into the practice.’
Nursing In Practice wants to know more about your pay and conditions. Go to tinyurl.com/practice-nurse-pay to take our survey.