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The government has ordered the appointment of almost 500 managers on salaries of up to £50,000 to take charge of the new Primary Care Group. It has also authorised annual payments of up to £21,000 to part-time board members of the proposed Groups. Although the total could amount to as much as £60 million per year, Health Minister Alan Milburn insisted that there would be a net saving. The Department of Health has submitted written evidence to pay review bodies for doctors, dentists, nurses, midwives, health visitors and professions allied to medicine (PAMs). The DoH wants in particular to make progress on improving the starting rate of pay for nurses to complement other measures introduced to aid nurse recruitment. It is hoped that this will have a positive impact on the image of nursing, on morale and on recruitment. The government also intends to modernise pay structures for doctors and dentists. A strong theme running through the recommendations is the need for pay to be affordable. Review bodies have been challenged to produce recommendations that are fair to staff and affordable to the NHS, so that staging can be avoided.

The DoH maintains that nurses and doctors enjoy a secure form of employment overall and are, unlike many other professions, not vulnerable to slower growth in the wider economy. However, staff leaders and unions have called for inflation-busting pay rises for nurses and doctors to signal that the review bodies have not allowed the government to change their remit. They say that review bodies have a responsibility to recommend a fair rate of pay, and financial targets are the responsibility of the government. The BMA has already asked for a 10 percent increase for doctors and the RCN has talked of a 'substantial' award. An independent survey from the Institute of Employment Studies shows that 86 percent of newly qualified nurses believe that they could be making more money for less effort if they left nursing. An estimated 78 percent of employers find it difficult to recruit nurses and PAMs. This has led to a call for a £1.2 billion boost to pay; staff nurses would need a 17 percent increase to bring their wages into line with teachers' starting pay. Health authority and trust representatives warned that a large pay boost for nurses could lead to job losses. This view has been reflected by the two pay review bodies. They have written to the health minister rejecting any change in terms of reference unless these are agreed with the professions. Professor Booth, chair of the nurses' pay review body insisted that it must 'remain free to give equal attention to the evidence presented by all the parties and to recommend levels of awards which it feels are appropriate in all the circumstances'. He felt that it 'could not be constrained to a pre-determined envelope of money'. More discussion can be expected when the final figures are revealed.

Sources:Guardian 3, 17 October; Press releases (DoH); Health Service Journal 8 and 15 October


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