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Should GP pay be published? Yes

Professor Azeem Majeed argues GPs publishing their pay would kill off myths about our income and show GPs’ value for money

GPs in the United Kingdom have an image problem. Despite performing well in international comparisons, achieving high levels of patient satisfaction and delivering over 300 million consultations each year on only around 8% of the NHS budget, we find ourselves constantly under attack from the media, politicians and managers.

So it is little surprise that one of Jeremy Hunt’s aims for the new GP contract was for every practice to publish a net or average salary from April 2015 onwards as part of new transparency measures included in the GP contract deal. GPs will not be expected to publish their individual earnings, but I believe we should.

GPs in the UK work hard, and efficiently. In recent years, we have taken on additional tasks such as commissioning health services with little extra funding. In fact, the proportion of the NHS budget spent on primary care services has been declining despite the increase in the volume and complexity of GPs’ workload.

Organisations such as the BMA and the RCGP have tried hard to make a case for general practice and argue for increased resources but, thus far, have had little success. All we get is money shuffled from one part of the primary care budget to another with the result that we take on even more tasks and increase our workload even further without any real increase in funding. Consequently, our practice expenses have been increasing and our income has been declining for many years.

The real-terms pay of UK GP partners peaked in 2005/06 and, by 20011/12, average pay had fallen to £103,000. It’s likely that when more up-to-date statistics are published, we will find that pay has fallen even further because of the on-going squeeze on GMS and PMS budgets (particularly in England); and the continuing rise in GP expenses. Furthermore, the fact we pay our own pensions contributions and medical insurance makes partners’ salaries (as reported by the Health and Social Care Information Centre) seem artificially high.

Salaried GPs earn even less than partners, around £57,000 on average in 2011/12. Hence, for most GPs, their earnings from the NHS are not vast and not out of line with what other NHS doctors earn, particularly when GP income is calculated in a comparable way to the pay of NHS employees.

One concern that many politicians, NHS managers and the public have is that, if the resources allocated to primary care are increased, a significant proportion of this additional investment will be used by GPs to increase their income rather than to improve primary care services.

For example, GPs’ pay improved after the introduction of the 2004 GP contract (although GPs will argue they also delivered higher quality care).

To counter these adverse perceptions, GPs should publish details of their pay, after subtracting for employers’ pensions contributions and medical insurance fees.

 

As well as increasing public transparency and financial accountability, this would also help convince politicians and managers that additional resources for primary care were being invested in improving our management of patients’ health needs and their access to services, not just going directly into our pockets.

Details of individual GP and practice income should be accompanied by more public data on GP workload. Currently, the NHS publishes little information on either on our work volume or its complexity. For example, there is little routinely available information on the number of GP consultations either at national or at practice level so the public are unaware of the pressures on general practices, particularly in contrast to, for example, emergency departments (statistics about which are regularly presented in the media).

What proxy measures we do have for GP workload suggest this has increased substantially in recent years – for starters, the number of prescriptions issued by GPs increased by 62% between 2002 and 2012.

If details of GP pay were published – at both individual GP and general practice level – this would allow us to kill off many of the myths about GP pay and show the value for money that UK general practice offers.

It would also allow us to measure the productivity of individual general practices, reassure the public that investment in primary care goes to frontline services, and help reduce the variation that currently exists between different practices.

Professor Azeem Majeed is professor of primary care and head of the department of primary care & public health at Imperial College London, and a GP partner at the Manor Health Centre in Clapham, London.

Readers' comments (10)

  • Bob Hodges

    @ve got nothing to hide, but I really don't care what people think to be honest. If NOT publishing my pay irritates the Daily Mail, then that's an excellent reason NOT to do it.

    Is it legal for GPs to be singled out and stripped of our right to privacy?

    We're independent contractors. You want to publish MY pay like you would an employee???

    Then give me SICK LEAVE, MATERNITY LEAVE and FUND OCCUPATIONAL HEALTH SERVICES for me.

    Otherwise SOD OFF and lave me in peace to do my job.

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  • Bob Hodges

    If they really want to compare practices, why not divide the NHS income for a practice (which THEY know) by the list size and publish 'funding per patient' lists. They don't need permission or a contract change to do that.

    That might be interesting, and lead the debate about where funding is best directed. It will alos show just how astonishly good value General Practice is. Perhaps people will start asking 'why does my rabbit cost £100 to insure when my GP gets £80.

    My Income, as Grant says, has nothing to do with healthcare.

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  • Yes - like all public sector workers - why do you think you should be exempt?

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  • It is a very strange idea that persons paid with taxpayers money should be able to keep the sums secret. Politicians, soldiers, even nurses do not have that right - what makes GPs special?
    If some GPs are embarrassed about the amount that they are paid, then it is all the more reason to publish the data.

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  • No problem. Profit per patient here in NI is £60. 60% of workload is consultations approaching 8 on average a year. £ 4.50 per consult. Take home pay £ 2.25 per consult. Don't believe me ? Try it in reverse at an easy £3.00.
    40 consults a day x 3 = 120. add 80 for paperwork = 200. x 20 days = 4000 x 2 [ tax /NIC] x 12 months = £ 96000.

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  • Also NHS management consultants, magistrates, judges. legal aid payments etc

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  • Stating GP Practice income will be helpful in giving transparency to the detail of work we do.
    I often ask acquaintances what they think GPs should earn on average per patient annually taking into account that patients have potentially unlimited access to GP and Nurse appointments including telephonic advice, phlebotomy, minor procedures and home visits. One family member who thought we were overpaid suggested £500. I asked our Community Matron while discussing some of our patients uncovered by Risk Stratification and she said £1500!
    To be transparent:- GPs are allocated just 8% of the NHS Budget. The average GP gets just £59 per patient per annum net of Practice expenses. They are paid £130 gross but average expenses run at 57% of income. Included in that £130 figure is £20 for QOF (Quality Outcomes Framework). The problem with QOF is that it is about money that achieves Government targets rather than a resource used for acute patient care. How hard GPs work for their income and the value this provides is reflected in that £59/annum figure (£4.92/month or £1.13/week). Fulltime GPs will take home less than half this amount after taxation and pension contributions that have doubled over the past several years though providing a lesser end benefit.
    Our biggest concern however is whether with the resources at hand and the ever increasing amount of work we are expected to do for the same income, we can continue to provide quality care to all, including the growing population of older complex frail patients with increasing co-morbidity.

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  • FYI anonymous 11.35 (not that it is particularly relevant to this debate!), magistrates are volunteers so they aren't paid at all...

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  • Bob Hodges

    "Yes - like all public sector workers - why do you think you should be exempt?"

    Are you stupid?

    Try reading the the posts above - we are NOT public sector workers, we are INDEPENDENT CONTRACTORS.

    We don't receive the other 'benefits' that a public sector workers do (occ health, sick leave, paid holiday) and any comparison will be meaningless due to the complexities inherent in the system.

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  • Azeem Majeed

    Pulse is reporting that NHS England will publish information about individual practices’ gross income this summer and GPs’ net pay at a later date. It's important that any statistics on GP net pay are accurate and comparable to NHS employees' pay (i.e. remove employers pension contributions, practice expenses, non-NHS earnings etc.).
    http://goo.gl/qssP15

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