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GPs go forth

How much are GPs really worth?

Dr John Couch says GPs are well worth the money they earn – especially when compared with politicians

Historically, when health ministers make statements about GPs to the press, the comments are invariably negative. From Ken Clarke's 'doctors feeling for their wallets' remark in the 1980s to Patricia Hewitt's plan to consider capping GP profits, ministers have been remarkably consistent.

We have been 'jewels in the crown' but this was only once and, it seems, conveniently forgotten.

After denying us a cost-of-living pay rise for two years and a threatened cap on pension increases, Mrs Hewitt obviously feels we should be punished even more. Clearly any GP's view, including mine, is bound to be biased – but really it is not difficult to justify the current average GP partner salary which is reported at over £100,000. However, it seems that MPs need more convincing so, for them only, I will make our case.

As the average GP is at least 28 before they can go on a PCT list, having undergone 10 years of training, we easily compare with other professions such as accountancy or law where six-seven years is more normal. Our training is certainly longer than that for MPs, where I believe the requirement is zero.

Improvements long overdue

In the years before nGMS we had fallen well below equivalent-aged accountants and solicitors. It had also become extremely difficult to recruit GP partners at all. Why work harder, do out-of-hours calls, administration and take on the risk of buying premises when a newly qualified and non-principal GP could earn within £10,000 of the then average GP principal income? Improved conditions and pay for principals was long overdue.

In fact, if we use the current market average rate for GP locums of £70 per hour, a principal, working 36 hours a week on NHS activities (excluding private work) should earn £131,000, much more than the current average. Accountancy and solicitor partners in their 40s and 50s earn between £100 and £250 an hour. Compared to this, GP principals are very good value.

A point already made several times is that the new contract was negotiated in good faith. NHS employers have no moral grounds to say they did not expect GPs to do so well with QOF targets. We are improving patients' health – are ministers saying that patients do not deserve this?

It is also interesting that Government advisers should now feel that out-of-hours was under-priced. I totally agree with this. It was under-priced for more than 40 years, but whenever GPs tried to achieve more realistic pricing this was refused. Strange that it is only 'under-priced' when the Government finally have to pay the market rate.

No precedent

If we look at the principle of capping profits, I can think of no precedent for this. Who would trust any government prepared to take this action? To be egalitarian, Mrs Hewitt would have to apply the same action to private companies that the Government has been attracting into both primary and secondary care. If she did this, plans for competition within the NHS would fall flat.

And I wonder what those MPs who earn many times more than the average GP's income from non-executive directorships would say if this precedent were established?

John Couch is a GP in Ashford, Middlesex.

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