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A faulty production line

Massive variation in GP expenses to earnings ratios revealed

By Gareth Iacobucci

Exclusive: The proportion of earnings GPs plough back into their practices varies hugely even among close neighbours, a Pulse investigation reveals.

Detailed figures for 102 practices collected from a single PCT – NHS Leeds – uncover stark variations in their expenses to earnings ratios.

The average practice invests 59% of its earnings in paying expenses. But the Leeds figures reveal a wide spread, with one practice investing 82% of its earnings but another just 35% - a 2.4-fold variation.

GP leaders warned the Government would use examples where GPs had not invested sufficiently in their practices to justify clampdowns on pay.

In 2007, then health secretary Patricia Hewitt incurred the wrath of the profession after accusing GPs of taking too much money out of their practices since the new contract started in 2004.

And the Department of Heath's recent evidence to the pay review body calling for a GP pay freeze controversially claimed the overall average figure for earnings invested in practices – 59% - remained ‘below traditional levels'.

The figures, collected under the Freedom of Information Act, show even greater variation between practices in the ratio of GP partners to registered patients. One practice had 1,190 patients registered for each GP partner at the practice, while another had 4,333.

Dr Michael Dixon, chair of the NHS Alliance, said the only way GPs would attract investment from the Government and PCTs was by publishing their practice accounts, and being honest about the few practices investing ‘unacceptably low' levels.

‘We don't want to punish people for making profits, because they've worked hard and very efficiently,' he said. ‘But the only game is to show up those who aren't working hard, not giving a decent service and are pocketing the money. There aren't many doing that, but those that do give the rest of us a bad name.'

Dr Clare Gerada, RCGP vice-chair and a GP in Lambeth, south London, warned that practices investing noticeably smaller amounts in their business would increasingly be held to account under new models of working in primary care.

‘Ones who aren't [investing] are going to be in a minority, and I don't think PBC groups and new polysystems will allow it.'

But Dr Richard Vautrey, GPC deputy chair and assistant medical secretary of Leeds LMC, warned against drawing hasty conclusions from the latest figures.

‘You may spend a lower amount in staffing, you might have more expensive staff, and you may have more building costs,' he said.

The proportion of earnings GPs plough back into their practices varies hugely even among close neighbours The proportion of earnings GPs plough back into their practices varies hugely even among close neighbours Guest editor The great divide

59% Average reinvestment

82% Top reinvestment

35% Lowest reinvestment

Source: NHS Leeds FOI response, DH

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