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At the heart of general practice since 1960

Pay squeeze forces GPs to expand lists

By Steve Nowottny

Thousands of GP practices have begun moves to expand their lists as financial pressures force them to compete for patients, a Pulse investigation reveals.

Practices have been forced into drastic action after three successive income squeezes, with three quarters of GPs taking a pay cut this year and many pruning staff costs.

The findings come as figures from the Information Centre show GP vacancies have plummeted by over 60%, and practice nurse vacancies by 40%, in just a year.

But it is the finding that practices are being forced into competition with one another that will most alarm GP leaders – and most cheer the Department of Health.

Four out of ten practices told Pulse they had already begun proactively trying to expand their lists – two months after ministers announced the MPIG would be scrapped to force GPs to ‘to attract more patients'.

Dr Guru Singh, a GP in Loughborough in Leicestershire, said his practice had been left with no option but to attempt to attract new recruits. ‘At a time when list sizes should be coming down to give better and more holistic care to patients, GPs are busy increasing their list sizes.'

The financial situation is also having a major impact on recruitment, our survey of more than 100 practices reveals.

Almost two thirds of respondents said they could not currently afford to replace a partner and would not do so if a vacancy arose. One Hampshire practice reported having already replaced two outgoing partners with salaried GPs.

The Information Centre figures show only 0.3% of GP vacancies are now open for three months or more in England, down from 0.8% last year and 2.4% in 2005.

There were 0.3 practice nurse vacancies per 100,000 patients in England this year, down from 0.5 last year and 0.8 in 2005.

GPs reported cutting a variety of non-essential work, including stopping free immunisations and refusing PCT data requests.

But the biggest impact of the pay freeze is being felt in GPs' own bank balances, with many telling Pulse they had ‘taken the hit'.

One Warrington GP claimed a 32% fall in income, while a GP in Essex said he had had to put £20,000 into his practice in order to keep it open.

One in four GPs had had to take on additional work such as out-of-hours shifts, lecturing or a clinical leadership role in order to pay the bills.

Dr Krishna Chaturvedi, a GP in Westcliff-on-Sea in Essex, now does occupational health work and mental health assessments to supplement his practice income.

He said: ‘Patients still think GPs are getting £250,000 all the time. They are absolutely not aware of the reality.'

GPC deputy chair Dr Richard Vautrey said: ‘The vast majority of GPs – if not all GPs – have seen their pay drop in recent years.

‘One of our chief concerns is that this continuing uncertainty about pay arrangements leaves practices in a position where they're not able to replace doctors or make long-term commitments.'

The GP 'credit crunch'

How GPs are coping

74% have taken cut in income
50% are working longer hours
40% have proactively tried to increase their list size
27% have cut utility costs
23% have cut administrative staff or reduced hours
10% have supplemented their income with non-medical work

Source: Pulse poll of 110 GPs


How jobs are drying up

62% - fall in GP vacancies open for over three months between 2007 and 2008
40% - fall in practice nurse vacancies between 2007 and 2008

Dr Krishna Chaturvedi: 'Patients still think GPs are getting £250,000' Dr Krishna Chaturvedi: 'Patients still think GPs are getting £250,000'

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