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Should GPs publish their practice accounts?

Being open about pay - and how much GPs invest in their practices - is essential to regain the trust of the public, says Dr Michael Dixon. But Dr Krishna Korlipara warns publishing practice accounts would lead to unfair comparisons of GPs working different hours and funded by different contractual models

Being open about pay - and how much GPs invest in their practices - is essential to regain the trust of the public, says Dr Michael Dixon. But Dr Krishna Korlipara warns publishing practice accounts would lead to unfair comparisons of GPs working different hours and funded by different contractual models



I want to argue GPs should voluntarily make their accounts available - not be made to do so. But the latter might be a consequence if we fail to be more transparent. That is, if we fail as doctors and business people, by not being clear about what we receive, what we put into the practice, what we take home and how hard we work for it.

My case for transparency is based on three whys. The first is - why now? General practice has a serious public image problem - worse than at any point I can remember during my career. We are regarded as more technically competent than our forebears, but too many also regard us as uncaring, overpaid, lazy and complacent.

Newspapers have given patients the impression we are fat cats earning in excess of £150,000. This is not a simply a case of being bad for our image. It is bad for our relationship with patients and therefore bad for patients themselves.

The next why is - why not? What have we to hide if public opinion is as I have described? Surely it is best to get things out in the open. To explain the average income may be a little over £100,000 but 50% earn less. To explain the average GP may earn £70,000-£80,000 for their medical work - their face-to-face consultations and looking after a sizeable list of patients - and that the rest comes as part of being a partner in a business and the time, trouble and financial risk this involves.

We also need to explain that much of what we receive from the Government goes into our practices and therefore into patient care. Most of us have a strong case in this respect, though some do not offer as good a service as others. Why should the majority protect those who do not work particularly hard and do not put a significant amount of money back into their practices? It is these few who taint the majority of committed and appropriately paid GPs. If we can square our pay with our consciences, surely we have nothing to fear?

Transparency is inevitable. We have seen it with MPs' salaries and we will see it increasingly with bankers' bonuses. Why should we become a profession of King Canutes rather than being proactive? As carers, we should provide an example and try to explain why we are paid as we are and what each practice contributes.

The final why is - why should we? The answer is that as GP practices increasingly work together and extend their role as providers, they need to be seen as ethical, open and trustworthy users of public money and bona fide partners for primary care organisations. Transparency of accounts can only contribute to such trusting relationships and help practices win business.

If we keep our cards close to our chests, we risk seeming shifty and suspicious to patients and commissioners. In time this might taint the GP brand and we could lose our reputation as trustworthy, altruistic and community-minded professionals.

So we now have the choice. Shall we join the bankers, MPs and others, who are seen to be exploiting the average person and care little for ordinary people? Or do we want to be seen as caring compassionate doctors, who want to work in partnership with our patients and local population? Our job is surely to inspire our patients and our communities to something better. Something that lies above and beyond self, money and personal ambition. If we cannot justify our pay then we shouldn't be receiving it. By being transparent, we can show that we have nothing to hide.

Dr Michael Dixon is chair of the NHS Alliance and a GP in Cullompton, Devon


It is suggested GPs should publish their accounts on the web so the public can see how much doctors earn, how much staff are paid and how much investment doctors make in their practices. Some people argue this would be in the public interest, but in my view nothing is further from the truth. Publication of doctors' earnings and staff pay would be an invasion of privacy and directly against the public interest.

It has become fashionable for some commentators to demand publication of all public figures, following the release of MPs' expense claims and the scandal of huge bonuses paid to the bankers for taking enormous risks with public money and leading the country into the worst financial crisis since the depression of the 1930s. Those calls have included GPs even though, as people who run small businesses, our individual salaries and earnings should be of no public interest.

Each year, GPs' fees and funding are agreed nationally by the BMA with the Government, and this publicly available information forms the basis of doctors' salaries. There is no provision in the NHS for doctors to make extravagant expense claims as some MPs did or receive bonus payments like bankers.

Stories in newspapers like the Daily Mail, claiming some doctors earn up to £380,000 a year, help only to arouse unhealthy curiosity among some members of the public about what doctors earn, even if the truth is that no more than a handful receive this kind of money. But it is possible for doctors to enhance their earnings through sheer hard work by taking on extra commitments such as working out-of-hours sessions at nights and weekends while others choose to spend their time with their families and friends.

An average GP partner working 40 hours a week earns around £105,000 per year, but those willing to work weekends and out-of-hours attract much higher rates of pay. Publication of GPs' earnings can only lead to unfair comparisons and could discourage some from taking on this extra work. Without these experienced doctors willing to work unsocial hours, out-of-hours companies might have to close or depend on foreign doctors to see patients, with sometimes disastrous results for patients, as we already know.

Then there is the question of including information about the level of investment groups of GPs make in their practices each year. This is complex and if raw figures

were published they could easily mislead members of the public. There are many types of practice premises and different ways of funding them. There are also a variety of different ways in which GP contractual payments are made. Polyclinics run by private companies are likely to receive massive funds from the PCTs, but do not necessarily provide better care than seen in practices of small groups of doctors - and certainly won't provide the same level of personal care. So the quality of care provided by a practice cannot be captured by a raw investment figure.

Comparing salaries paid to staff would be potentially harmful, as it could lead to unfair comparisons, unhealthy competition between practices to keep staff, and low staff morale. Some staff may feel dissatisfied and unsettled if they refer to a league table of salaries elsewhere. The fact that members of staff, even under the same job title, may have different levels of experience and expertise is unlikely to quell unrest and the demand for higher salaries.

The result would be that staff salaries would go through the roof. This would be a recipe for disaster, leading to inflated salary costs and hence less money available for patient care. That cannot possibly be in the public interest.

Dr Krishna Korlipara is a member of Bolton LMC and a local GP

Should GPs publish their practice accounts? yes no

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