At long last nursing pay is to be rightly increased!
The Government announcement recognises that healthcare workers have bravely borne the austerity of the past eight years. A 14% loss in nursing pay has resulted in declining staffing levels, eye-watering nurse vacancies and loss of public confidence that could not continue.
However, the pay reward is only for NHS staff on the Agenda for Change national contract. Over 300,000 nurses and midwives employed in the NHS will be paid more by virtue of their collective union negotiation and national leadership.
The 55% of nurses who work outside the NHS will not automatically get a pay increase – any matching of the offer will be up to their individual employers. Nurses working in general practice, nursing and care homes, private businesses, charities, local authorities and pharma companies will be hoping their employers will do the decent thing and match the new proposed NHS salaries.
But there is absolutely no obligation for those employers to do so. Nursing chat rooms and social media comments, in particular, bemoan the exclusion of general practice nurses from this pay award.
This includes over 23,000 general practice nurses who constitute the backbone of primary care. General practices are virtually all private businesses, with the GP partners receiving payment under a government contract for managing the care of NHS registered patients.
GP employers cannot ignore NHS pay levels if they wish to attract nursing staff. Indeed, practices can, and do, offer whatever incentive they choose to secure suitable nurses. As a consequence, practice nurse salaries are variable, confusing and often highly secretive – unlike in the NHS where there is clarity about pay linked to competency and role. Everyone knows what everyone else is paid under Agenda for Change!
Anecdotal evidence and long-term experience working as, and with, practice nurses indicates to me that salaries and terms and conditions do not generally match NHS colleagues. Bandings are not always recognised and a set salary is offered instead.
Practice nurses do not automatically have increments; salary increases are often dependent on practice profits or bonuses paid for achievement. Many practices have individual pay arrangements with the nurses and the salaries enjoyed are not always the same across roles, responsibilities and competencies. Many are historic, especially if the nurse was appointed in the late 1990s when nurses often got the pay they asked for.
Despite nursing salaries being the single highest practice cost, most practice nurse team leaders do not know what their nurses are paid. I am aware of practices that forbid nurses to discuss their individual remuneration. This divides the team and makes a stronger, united approach to the employer for a pay increase, extremely difficult.
The funding of this NHS pay increase is coming from an injection of additional cash and not from NHS efficiency savings. However, I doubt GPs will be allocated cash for increasing staffing salaries and they will need to make any staff uplift from practice funds. In a small practice team where everyone is all too aware of the financial pressures, this creates an awkward situation for practice nurses to ask the partners for a salary increase. Many a nurse will be told that the ‘practice can’t afford it’: it becomes too personal to pursue. Where nurses are acting individually, it can become impossible.
It’s predicted that the pay offer will improve NHS recruitment and retention; with an impact on primary care where a third of experienced practice nurses are over 55 and could retire. I really hope somehow, either individually or collectively in the practice, with or without local CCG nurse leaders, practice nurses make their voices heard to secure parity of pay – and reflect their worth.
Marilyn Eveleigh is a nurse adviser and independent trainer in East Sussex
