The Taxpayer’s Alliance and GP’s pay: incompetent, malicious, or both

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I note the Daily Mail has produced the most ridiculous data on GP’s pay, and that the Taxpayer’s Alliance has responded in its usual unthinking fashion. What an unholy alliance! Especially as they’re both talking utter nonsense.

I have some interest and insight into this subject: I am married to a GP. I’d add she’s a partner in a GP practice. Like most partners in largish practices (there are 10 partners in her practice) she is responsible for employing a considerable number of people: more than 60 in all. That, you will notice is about 6 for each partner.

I have little doubt at all that the “incomes” to which the Daily Mail and TPA refer are in fact the payments made by Primary Care Trusts to partnerships divided by the number of partners.

Now it so happens that some partnerships do not just employ nurses, health care assistants, counsellors, admin staff, receptionists, IT managers and many more besides. They also employ doctors i.e. the service they supply is split between self employed doctors who run the practice and employed doctors who work for them and tend only to work on the supply of medical services, leaving practice management issues to the partners (who usually carry a similar medical work load and therefore work harder).

It’s not hard to find out that the going rate for a full time salaried doctor is about £80,000 at present. Include on-costs of pension and NIC and there’s not a lot of change out of £100,000.

So, with average GP partner pay at about £107,000 and with costs of all those other staff, premises, insurance, bank fees, consumables, and all those other normal overheads requiring expenditure considerably more than doubling this in an average bigger practice, and then assuming that some practices employ up to one doctor for each partner it’s incredibly easy to see how to earn £107,000 a doctor has to be ‘paid’ more than £300,000 to provide GP services.

But that total sum has got nothing to do with the pay they take home. To put it nicely the report by the Mail is scandalously wrong. They’re grossly misreporting the pay of the professional group with the highest user satisfaction in the UK.

Let’s also for a moment consider why that user satisfaction is so high. I hope my wife is going to forgive me for reporting this — but she is the best example I know. She notionally works three days a week. That is six patient sessions plus visits and phone calls. That will usually be at least 32 patients seen plus three visits plus numerous calls. All of which have to be recorded in detail, and follow up dealt with. Then there are the 60 staff to manage, the NHS to deal with, accounts to manage, and more. That’s her responsibility too — and if something goes wrong it’s her who ends up in court and her insurance that pays — even if she never saw the patient in some cases. It is not the NHS who pays.

To do this takes 12 hour days — and physically she can’t do more than that. A twelve hour day means just that — 12 hours, no breaks. The first patient is seen at 8.30 (and her practice offers 8am appointments every day). Her last yesterday was about 6.30 — just before the night service took over. She got home after 8.

And that’s not it. There is reading and research done at home on ‘days off’. There is the massive worry time — twice a week at least there is the threat of sleepless night worrying about a patient — which I bet the vast majority never know about or appreciate. How many people but doctors face this concern — that if they have go things wrong people die? Sorry — don’t offer lame excuses from elsewhere — the answer is not many.

Total hours for a three day week exceed 40 hours a week. Or more then 60 hours full time equivalent.

And not many professionals do work that long — I know. Civil servants don’t in the main. Nor do the vast majority of managers, or journalists. So the pay has to be seen in this context, and in the context of that risk.

It’s true though that doctors six years ago were paid about £70,000 a year — equivalent with inflation of course to about £80,000 now — what salaried GPs are paid at this moment. But you could not recruit a GP for love nor money to be a partner at that time. The risk and strain and hassle were not worth the reward. So pay had to be increased- and the joke that GPs could still cover nights and do 12 hour days as well had to end.

I contend that for the risk GPs are fairly rewarded right now.

But I’ll also contend this: that the system of GP serviced in the UK is fundamentally wrong. GPs are not self employed: they work for the NHS. GPs should not have personal risk for supplying a key government service — that should be the responsibility of the NHS. GPs should not be employing nurses and other staff — that’s the job of the NHS. GP’s should not be distracted by having to pretend they’re running businesses — which they are not — that’s the job of the NHS. GPs should not be given incentives to compete with their local hospitals — as they are in some aspects of services — this is ludicrous duplication with serious long term detrimental effects on health care because hospitals are being denied routine cases they need to say to ensure the next generation of doctors are properly trained. And GPs should not be rewarded for doing ‘procedures’ such as minor ops — they should be rewarded for providing continuity of care in the community and for keeping people away from the people in white coats in hospitals — where costs really escalate.

And maybe this means GPs should be paid as employees of the NHS. An integrated NHS that recognises primary and secondary care are integrated parties of a health system — not part of a completely phoney ‘health market’ which patients ‘consume’.

But let’s also note that will means GP’s will not have contracts to supply services which demand they work almost unlimited hours. GPs will work hours — and go home. They may be paid less on PAYE — and many might willingly do so for reduced cash if the risk was reduced as well. But have no illusion that this will save the NHS money. It won’t. It will probably increase costs because many more GPs will be needed to meet demand because GPs who are employees can and will walk out when they have done their job.

Right now GPs do far more than their jobs — unlike many in most jobs - which is one reason why the government was surprised when the new contract was issued and had to pay them more than expected — GPs simply delivered more value by the bucket load than the top brass realised — and it was value that had not been paid for before and which is still not being fully remunerated now.

There are serious problems with the current GP contract. But let’s not for a minute pretend GPs are paid out of kilter for the considerable risks they take: risks that I see my wife taking day in, day out, and for which I admire her enormously.

And let’s stop the nonsense from the Mail and Taxpayer’s Alliance. They’re either very, very incompetent or very, very malicious. You make the choice. But it is one or the other. Unless it’s both.