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At the heart of general practice since 1960

Can you afford to let partners do hospital work?

GPs who do hospital work should decide whether it is

still worth their while, writes

Dr Peter Saul

Large numbers of GPs currently do hospital work, typically as clinical assistants or hospital practitioners working with consultants in a hospital specialty or providing support in GP-led community hospitals. Such work, though often considered vital, has been consistently undervalued financially. With the increased demands and potential rewards for practices under the new GMS contract perhaps now is the time for partnerships to think again about hospital commitments.

Pay rates for GPs employed by trusts have moved little over the last decade. Clinical assistants' annual pay is £3,970 per session of four hours, hospital practitioners range from £3,885 to £5,235 after seven years. Pay rates for those working in community hospitals are currently under review but work out even worse.

Because of their experience GPs are particularly efficient and effective in a hospital situation and their salary levels are looking increasingly out of step with consultants' recent pay increase.

To these economic factors you need to add the time and hassle of getting to a different place of work.

Given these financial rewards, and the fact that GP time in practice is valued in excess of £125 per half-day session (try getting a locum for less than this), we must ask how long GPs can subsidise the hospital sector.

The contract has highlighted the need for practices to focus on delivering a quality service as well as encouraging longer appointments and better access.

Additionally there are opportunities to develop new services at the practice and gain additional quality points. These are likely to be more rewarding financially than hospital work.

This needs to be considered not just by GPs whose earnings go into the practice pool but also for those who work on their free days.

But hospital work has rewards other than finance. On a recent postgraduate course I was surprised to find not one fellow attendee worked exclusively as a clinical GP. All of them had alternative roles including teaching, hospital work, occupational health and child care commitments.

Clearly many of us need an outside interest, perhaps to maintain or develop specialist knowledge, work in a different environment or just meet and work with a different crowd of people. It is clear that combining the consultation and patient management skills of primary care with specialist knowledge can be very rewarding. Patient care would take a serious knock if GPs pulled out of the work.

So what is to be done? GPs and practices need to recognise the patients at the surgery are increasingly their 'core' business. The pay for hospital work must be examined, but part of the equation is job satisfaction. Now may be an opportune time to talk with hospital management about appropriate salary level.

I have a colleague who is paid three sessions for an acknowledged two-session commitment, and trusts also have the opportunity to set their own pay rates.

Alternatively, you could talk to your PCO to see if your expertise might fit in with the commissioning of locally enhanced services. You could then end up doing similar work, such as a dermatology or back pain clinic in a practice setting for more money.

Being happy at work is the most important factor, but perhaps now is the time to reappraise what the practice as a whole thinks about hospital work, and that hospital management are giving you appropriate financial rewards.

Peter Saul is a GP in Rhos, near Wrexham

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