Survey of workload and remuneration of medical managers in primary care - Report
August 2006
Summary
- This report presents the results of a survey of medical director/PEC chair/clinical governance lead in all PCTs across England with regard to the recruitment and retention of medical managers.
- Two in five respondents are currently employed as medical director and almost half are employed as PEC chair. The majority of respondents are GPs. Three quarters of respondents are male and the vast majority are of white ethnic origin.
- Respondents were asked to quantify the time contracted to undertake management duties. A third of respondents reported this in terms of hours: average of 27 hours and the remaining respondents reported their contract commitment to management duties in terms of sessions: average of 5 sessions.
- The majority of respondents report that they work extra hours in addition to their contract hours on management duties. In most cases these extra hours are worked every week, or at least most weeks.
- Three quarters of respondents are currently responsible for managing poor performance in general practice and three out of five are responsible for performance management of GMS/PMS quality and outcomes framework. More than half are responsible for performance management of GMS/PMS quality and enhanced services and 60 per cent of respondents are currently responsible for GP appraisal. Three out of five respondents are currently responsible for clinical governance, largely in relation to general practice.
- Around a third of respondents report having a job plan, which on the whole covers management duties. Less than two-thirds of respondents have had or expect to have an annual job plan review.
- Half of respondents are on contract for their management work only and a fifth have an additional contract for management work. Of those respondents on a management contract, half are based on an NHS management contract.
- Three-quarters of respondents report that their management pay has been increased annually. This increase is largely on the basis of the general NHS pay award. The basis for remuneration has not changed in the last 12-24 months for the majority of respondents.
- The average estimated gross pay for management duties is £46,758, but varies from an average £37,747 for PEC chairs to an average £56,000 for medical directors. Two-thirds of respondents continue to have clinical responsibilities in a GP practice, in addition to their current management duties.
- Two out of five of respondents report that their management responsibilities have an impact on the partnership agreement. Such impacts include shared income with the practice and management work undertaken in practice time, resulting in reduced clinical sessions.
- In half of cases, locums are required to cover respondent’s absences from their practice whilst undertaking management duties. In two-thirds of cases, locum costs (average is £603 per week) are met by the organisation for whom the management duties are being undertaken.
The changes to the consultant and GP contracts and increasing workload have highlighted the fact that pay arrangements for medical managers need to be formalised. At present remuneration for medical management work varies considerably between organisations. Last year the Clinical and Medical Directors Subcommittee conducted a survey of clinical and medical directors pay in the hospital sector. This reinforced the impression of the Subcommittee that the circumstances in primary care were quite different and that a separate survey needed to be undertaken.
This year, the Subcommittee has worked with the BMA’s Health Policy and Economic Research Unit on a survey of medical managers in primary care. The questionnaire was sent to the medical director/PEC chair/clinical governance lead in all PCTs across England. A total of 58 completed responses were received. Whilst the results of the survey are useful in identifying key trends and patterns, the respondent sample is small and the results should be regarded as indicative, rather than representative of medical managers in primary care. The following is a summary of the key results.
Results
Respondent characteristics
Two in five respondents are currently employed as medical director and almost half are employed as PEC chair (table 1). A further 5% report working in other roles including senior medical advisor, GP lead in mental health, assistant director in primary care and director of first degree care and director of primary care and development. The majority of respondents are GPs (88%) and the remaining respondents specialise in public health or general medicine. Three quarters of respondents are male (76%) and the vast majority are of white ethnic origin (95%).
Table 1: Current job title
| Frequency | Per cent | |
| Medical director |
25 | 40.3 |
| PEC chair |
29 | 46.8 |
| Clinical governance/MCN lead |
3 | 4.8 |
| Other |
5 | 8.1 |
| Total | 62 | 100.0 |
Note: Four respondents classify themselves as both medical director and PEC chair. In order to provide a more accurate analysis of the trends impacting on each of these groups, these 4 respondents have been counted twice in some tables (once as medical director and once as PEC chair).
Workload
Respondents were asked to quantify the time contracted to undertake management duties. A third of respondents (n=18) reported this in terms of hours: average of 27 hours (range 2-46hrs). The remaining respondents (n=40) reported their contract commitment to management duties in terms of sessions: average of 5 sessions (range 2-10). The majority of respondents (90%) report that they work extra hours in addition to their contract hours on management duties. In most cases these extra hours are worked every week, or at least most weeks (table 2).
Three quarters of respondents are currently responsible for managing poor performance in general practice and three out of five are responsible for performance management of GMS/PMS quality and outcomes framework. More than half are responsible for performance management of GMS/PMS quality and enhanced services and 60 per cent of respondents are currently responsible for GP appraisal. Three out of five respondents are currently responsible for clinical governance, largely in relation to general practice (table 3).
Around a third of respondents report having a job plan, which on the whole covers management duties (table 4). However, this varies somewhat according to job title: around half (54%) of medical directors report having a job plan, compared with only a third (32%) of PEC chairs. Furthermore, whilst most medical directors report that their job plan includes management duties, this is the case for less than half of PEC chairs (43%). Less than two-thirds of respondents have had or expect to have an annual job plan review (figure 2). Whilst most medical directors (86%) have had or expect to have an annual job plan review, this is the case for less than half (42%) of PEC chairs.
Table 2: Whether work additional hours in addition to your contract on management duties and how often
| Whether work additional hours | Frequency | Per cent |
| Yes |
51 | 89.5 |
| No |
6 | 10.5 |
| Total |
57 | 100.0 |
| If yes, how often? |
||
| Every week |
40 | 78.4 |
| Most weeks |
9 | 17.6 |
| Rarely |
2 | 3.9 |
| Total | 51 | 100.0 |
Table 3: Current responsibilities
|
Frequency |
% of total | |
| GP appraisal | 34 | 58.6 |
| Managing poor performance in General Practice | 45 | 77.6 |
| Professionally responsible for : | ||
| GPwSIs |
25 | 43.1 |
| Out of Hours |
21 | 36.2 |
| Intermediate/Transitional care | 13 | 22.4 |
| Clinical governance | 35 | 60.3 |
| Specialties : |
||
| GPs |
46 | 79.3 |
| Community pharmacists |
21 | 36.2 |
| General dental pharmacists |
22 | 37.9 |
| Optometrists |
20 | 34.5 |
| Community nurses |
6 | 10.3 |
| Allied health professionals |
7 | 12.1 |
| Out of Hours |
21 | 36.2 |
| Other | 9 | 15.5 |
| Management of primary medical performer’s list | 26 | 44.8 |
| Performance management of GMS/PMS: | ||
| Quality and outcomes framework | 35 | 60.3 |
| Enhanced services | 32 | 55.2 |
Table 4: Whether you have a job plan and whether the job plan covers management duties
| Whether have a job plan |
Frequency |
% of total |
| Yes |
22 | 38.6 |
| No |
35 | 61.4 |
| Total |
57 | 100.0 |
| Whether job plan covers management duties |
||
| Yes |
20 | 90.9 |
| No |
2 | 9.1 |
| Total | 22 | 100.0 |
Figure 2: Whether have, or expect to have, an annual job plan review (%)
Remuneration
Half of respondents are on contract for their management work only and a fifth have an additional contract for management work (table 5). Respondents working as medical directors are more likely to be on contract solely for their management work (60%), compared with PEC chairs who are more likely to have an additional contract for management work or a responsibility pay/allowance.
Of those respondents on a management contract, more than half are based on an NHS management contract and a fifth on the 2003 consultant contract (table 6). Forty-three percent of PEC chairs report some other form of management contract including locally ‘agreed rate’, PEC/PCT chair contract, PEC chair allowance or remuneration rate.
Table 5: How remunerated for work as a medical manager (%)
| Medical directors | PEC chairs | Total respondents | |
| Only on contract for management work | 60.0 |
32.1 | 47.5 |
| Additional contract for management work |
16.0 | 28.6 | 23.0 |
| Responsibility pay/allowance |
- | 28.6 | 14.8 |
| No special arrangement |
8.0 | - | 3.3 |
| Other |
16.0 | 10.7 | 11.5 |
| Total |
100.0 | 100.0 | 100.0 |
| N | 25 | 28 | 61 |
Table 6: Basis for management contract (%)
| Medical directors | PEC chairs | Total respondents | |
| 2003 consultant contract |
31.6 | - | 20.5 |
| NHS management contract |
63.2 | 57.1 | 59.0 |
| Other |
5.3 | 42.9 | 20.5 |
| Total |
100.0 | 100.0 | 100.0 |
| N | 19 | 14 | 39 |
Three-quarters (75%) of respondents report that their management pay has been increased annually, although this varies slightly according to job title: 83% of medical directors and 66% of PEC chairs report an annual increase. This increase is largely on the basis of the general NHS pay award or DDRB award for consultants, in the case of some medical directors (table 7). PEC chair allowance is a further means of increasing management pay for this group of respondents. Among those respondents who report not having an annual increase in their management pay (27%), most had received some increase in the last 1-3 years. The basis for remuneration has not changed in the last 12-24 months for the majority (87%) of respondents.
Table 7: Basis upon which management pay has been increased (n=45)
| Medical directors | PEC chairs | Total respondents | |
| DDRB award for consultants |
26.3 | - | 11.1 |
| General NHS pay award |
57.9 | 57.9 | 62.2 |
| Other |
10.5 | 31.6 | 17.8 |
| Don’t know |
5.3 | 10.5 | 8.9 |
| Total |
100.0 | 100.0 | 100.0 |
| N | 19 | 19 | 45 |
The average estimated gross pay for management duties (excluding any deductions for locum costs) is £46,758, but ranges from £13,000 to £100,000
(figure 3). This varies according to job title, from an average of £37,747 for PEC chairs to an average of £56,000 for medical directors.
Two-thirds of respondents continue to have clinical responsibilities in a GP practice, in addition to their current management duties (table 8). Figure 4 illustrates the variation in estimated gross pay for management duties between those respondents with on-going clinical responsibilities and hence, possibly part-time management responsibilities and those who are undertaking management duties on a more full-time basis. The average estimated gross pay for management duties for those respondents who continue to have clinical responsibilities in a GP practice is £37,780, compared with an average of £57,726 for those respondents with no additional clinical responsibilities. The average estimated gross pay for management duties for those respondents who continue to have clinical responsibilities in other areas (including hospital and community) is £70,000 The number of respondents in each of these sub-groups is small (n=34,13,7 respectively), hence some caution should be taken in interpreting these results..
Figure 3: Estimated gross pay for management duties (excluding any deductions for locum costs)
]
Table 8: Whether continue to have clinical responsibilities in addition to current management duties
[| Frequency | % of total | |
| GP practice |
43 | 82.7 |
| Hospital |
2 | 3.8 |
| Community |
1 | 1.9 |
| Other | 6 | 11.5 |
Figure 4: Estimated gross pay for management duties (excluding any deductions for locum costs) according to type of continued clinical responsibility
Two out of five of respondents (39%) report that their management responsibilities have an impact on the partnership agreement. This is more likely in the case of PEC chairs (50%), compared with medical directors (29%). Such impacts include shared income with the practice and management work undertaken in practice time, resulting in reduced clinical sessions. In half of cases (51%), locums are required to cover respondent’s absences from their practice whilst undertaking management duties. In two-thirds of cases (66%), locum costs (average is £603 per week) are met by the organisation for whom the management duties are being undertaken.
Many respondents comment that the current remuneration does not reflect the level of responsibility, the increasing workload and the expanded role expected as a manager in primary care. The perceived insufficient locum allowance is also a key concern for many respondents.