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Are female GPs really treated as second-class citizens?

General practice is rife with discrimination against women, if a new Government report is to be believed. Allegations that female GPs are deprived of contractual rights, are denied maternity support and miss out on leadership roles have prompted calls for a ‘step change’ in attitudes. But what do GPs think of the report and will its recommendations bring improvements?

By Lilian Anekwe

General practice is rife with discrimination against women, if a new Government report is to be believed. Allegations that female GPs are deprived of contractual rights, are denied maternity support and miss out on leadership roles have prompted calls for a ‘step change' in attitudes. But what do GPs think of the report and will its recommendations bring improvements?

What is the new report?

The report Women doctors: making a difference was prepared by a Department of Health working group set up to improve representation of women in partnership roles and senior positions. The group was established after chief medical officer Sir Liam Donaldson's 2006 annual report found women were still struggling to reach leadership positions despite the increasing numbers in the profession. The working group was given a remit to ‘think outside the box'.

The new report's author is Baroness Deech, a fellow of the Royal Society of Medicine, and among those on the committee were Professor Steve Field, RCGP chair, and Dr Clarissa Fabre, GPC member and president-elect of the Medical Women's Federation.

What are the main findings?

General practice's employment rights are heavily stacked against women, the report finds. The financial burden placed on practices when a GP goes on maternity leave means they are often ‘unable or unwilling' to cover locum costs, forcing many female partners and salaried GPs to make up the difference themselves. The prohibitively high costs of childcare can prevent female GPs coming back from maternity leave or force them to work in part-time, salaried positions, and could lead to a workforce crisis in the coming years, the report adds.

It also says discriminatory practices, such as deliberately offering women short-term salaried contracts to deny them full NHS entitlements, are rife within the profession, and female GPs are woefully under-represented among partnerships and in leadership roles at the BMA and RCGP.

What evidence is there to back up the claims?

Figures from the NHS information Centre show the proportion of women in general practice has risen from 36% in 1999 to 45% in 2008 and the Royal College of Physicians estimates that by 2013 more than half of GPs will be women. Yet a Pulse investigation last year, spearheaded by guest editor Dr Fay Wilson, showed the proportion of women on GPC, LMC and RCGP committees and the GMC council had risen from only 26.1% to 26.5% over that period.

The report notes the BMA has never had a female chair and all of its most influential committee leaders are male, with only three female chairs out of 19, one of whom is co-chair.

Perhaps the most controversial claim is that practices ‘commonly' offer short-term contracts of less than one year to avoid having to offer full NHS maternity entitlements.

It also reports ‘stories of practices not employing females of child-bearing age, or being unable or unwilling to cover the costs of maternity leave'. Similar accusations by the Medical Women's Federation were reported in Pulse recently.

A female GP partner who spoke to Pulse under condition of anonymity – one of a number who contacted us this week – says she had been made to pay the cost of her maternity leave while working as a salaried GP.

She says: ‘At my practice I didn't get my whole payment from my PCT and I had to make up the cost from my salary. There was an assumption that as a married female GP, I had a partner who could support me.'

Dr Sylvia Kama, a GP in Sheffield, supports moves to provide maternity cover. She says: ‘I've just started as a salaried GP at a PMS practice, but my previous NHS experience has not been counted.

Understandably, the practice is reluctant to offer more than the basic allowance.'

But even Baroness Deech says barriers to progression are not the sole reason for women's lack of representation in senior roles: ‘There was a suggestion short-term contracts are more likely to affect women than men. But some women said they were perfectly content being a step below where they might have reached because they did not have responsibilities and had more face time with patients. Others did feel there were barriers in their way.'

What does the report recommend?

The report recommends giving women GPs a raft of new employment rights. These include the DH making all PCTs contribute the full £1,500 a week for the cost of locum cover if a GP takes maternity leave. At present, how much to pay towards locum cover, and indeed whether any contribution is made at all, is left to the discretion of PCTs. ‘Contractual changes' should be made to ensure this is consistently enforced, it says.

Women GPs should be able to pay for childcare from their gross earnings, it recommends. This would effectively act as a tax break, allowing GPs to treat childcare costs as a business expense and pay tax and national insurance on their earnings after childcare is paid for.

The report wants an increase in women on the committees and boards of the BMA and RCGP, and for more women to deliver talks at BMA and RCGP conferences. It says committees should avoid meeting times ‘when family duties may prevent attendance'.

It calls on NHS Employers to draft guidance for PCTs on the additional provisions they should make for childcare allowances, to prevent women GPs working unsocial hours.

What has the reaction been?

Many female GPs have warmly welcomed the report but, as perhaps might be expected, male GPs have not responded quite so enthusiastically.

Dr Clare Gerada, vice-chair of the RCGP, believes it is time for ‘radical' change. ‘There's an urgent need to look at the feminisation of the workforce,' she says. But she stops short of supporting all of the recommendations, saying: ‘It would not be right to single out doctors when you have other professions in the same boat. There should be universal measures.'

Professor Bhupinder Sandhu, chair of the BMA equal opportunities committee, says more needs to be done to improve female GPs' career prospects: ‘We've come a long way in the past decade and that is extremely positive, but our journey is by no means over. There needs to be a change of culture to enable female doctors to reach their full potential.'

But Dr Colin Paget, a GP in Stockwell, south London, is one of those who wonders whether the recommendations are realistic. ‘I wish those of us whose lifestyle choice is to not have children were as comprehensively supported,' he says.

‘I should like tax breaks and PCT-funded pay for my lifestyle choices too. I would accept this work-life balance was my choice and not something that merited special legislation.'

How likely is the report to change things?

The Department of Health now has to consider the recommendations and publish a response outlining which ones they will implement and the deadlines for meeting them.

Sir Liam has promised to make it his personal responsibility to act on those commitments, and will head up annual meetings to review progress and identify organisations that fail to comply.

Each PCT has to appoint a local champion with responsibility for workforce planning, giving women GPs advice and handling their complaints. Baroness Deech is also keen for these local champions to encourage women GPs who feel they are being discriminated against to take up the issue with the Equality and Human Rights Commission, which may also step in to force major medical institutions to increase access for women GPs.

But the authors are clear it would require a ‘significant departure from current Government policy' to effect profound changes. Forcing through recommendations is likely to bring a familiar battle between the DH, Treasury and PCTs.

The DH will have to demonstrate that doctors are a special case by virtue of the length and unpredictability of their working hours, and present a business case to the Treasury as part of the next Comprehensive Spending Review, to come into effect by 2012.

Given the current financial constraints on public spending, getting additional funding for maternity leave contributions, tax breaks or ringfenced funding for childcare will be a huge task.

But shying away from enforcing the changes would make the DH guilty of ‘short-termism', the authors argue, as in the worsening economic climate the NHS can ill-afford to lose the £250,000 it costs to train each GP – male or female.

Dr Clare Gerada

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