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CAMHS won't see you now

Study contradicts NICE veto of BP therapy combination

While GPs in Gloucestershire and elsewhere wait until January 4 to opt out of out-of-hours (yes, the 4th ­ we can't end our responsibility on a weekend or bank holiday!), the major problem we now face is schedule D tax. If a GP is taxed as an independent self-employed practitioner (as most of us are) then the current in-year assessment is a major problem.

Since there will be a pay rise from the new contract regardless of the OOH opt-out, then any money from OOH will represent a further pay rise. Any pay rise in year under schedule D is now taxed at 60 per cent (40 per cent for the pay earned plus a further 20 per cent on account in the January). In addition, most PCOs are not paying the employer's superannuation contribution which effectively takes another 14 per cent of the money earned.

Personal superannuation will take

6 per cent, and employer's national insurance another 3 per cent or so.

The end result is that about 83 per cent of any money earned for OOH will go back to the Government as tax, national insurance, or superannuation in year one. At £50 per hour a GP will end up about £8.50 in pocket. It simply isn't worth it. Even at £100 per hour it doesn't look good! Lifestyle and time off will win the day.

There will then be ongoing cash-flow problems compounded by the lump-sum payment for Q&O. Doctors will need to be aware of the tax bombshell, which will also be added to by a similar large lump sum demand for superannuation from the doctor himself. (Practice drawings will have to account for this.)

It is soon going to be time to ask ourselves whether we can afford to continue as independent self-employed practitioners or should move to a salaried service as consultants in primary care medicine.

Tax allowances are still available under schedule E. Premises can be leased back to PCTs or they just take over existing rent for leased buildings. Pay rises will be taxed at 40 per cent with employer's superannuation and national insurance paid by the PCT.

State indemnity would be available. Private practice would be possible, as for consultants. There would be more flexibility of careers. Part-time work would be more easily accommodated. Sick pay, maternity pay and so on would be ours as of right.

Part of the OOH problem is the increasing number of women doctors who inevitably put fewer total years into the NHS, because of child rearing. There are also many part-timers. It is all in all little wonder that PCOs are struggling to fill OOH shifts.

Our PCTs are shaken by the number of GPs who say they don't want to do OOH shifts at any price. I think myself that market forces will prevail, and if enough is offered then more GPs will come forward.

The important thing we have estabished is splitting the contract with the end to 24-hour responsibility and the ability to have a civilised working week. That paves the way for a salaried service on acceptable terms.

Dr Peter Fellows

GPC member, Avon and Gloucestershire

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