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A faulty production line

It’s time to discuss how much we earn

Dr Shaba Nabi

Despite having been born and raised in Essex, I have a somewhat bird’s eye view of Western culture as I am the child of an immigrant. This gives me the ability to muse over certain idiosyncrasies of the British – a peculiar one being a reluctance to discuss our earnings. I suggest any of you who are squeamish about this should now swap your copy of Pulse for Fifty Shades of Grey, and continue living happily in fantasy land.

So why am I discussing money so openly? Am I empowered by the BBC publishing the pay of its top earners, thereby exposing the gender pay gap? Surely I should be grateful for belonging to the top-earning quintile in the country? The answer is depressingly simple – a permanent GP practice role no longer pays.

Endless work has to be shoehorned into our days, which is not matched by the pitiful rises in funding per head we have been offered in recent years. This has a direct impact on salaried GP pay, because partners simply can’t afford to pay them more than they pay themselves. As the days get longer, we all take a pay cut by stealth, because it is far too vulgar to be paid by activity as opposed to a block contract.

Amid the spiralling workload and austerity, there is nothing like an indemnity crisis to focus the mind on what we are actually earning. In July I experienced a 40% hike in indemnity fees, leaving me with an hourly rate of just £25.50 before tax. I can assure you it wasn’t much more than this as a partner because of the endless management hours. This is significantly less than half the hourly rate for any other GP career choice: locum work, out of hours, education, commissioning, appraisal and medical politics. In fact, some of my non-clinical roles offer me more than three times this hourly rate.

So is it any wonder GPs are now choosing to RELP – retire, emigrate, locum or portfolio? Clearly, I have opted for the latter because the portfolio aspect not only nourishes me, but also offers me a fatter pay cheque. I do not wish to stop my salaried role as I value the continuity and training aspects, but I keep it to a minimum so that the majority of my income comes from other sources.

How did we end up in this dire situation where coalface general practice – easily the most demanding and emotionally draining of the roles – pays so little in comparison to all others? This insulting hourly rate (can’t wait for a Daily Mail reporter to get hold of that line!) speaks volumes about our self-worth and the price we put on the most challenging aspect of our role – seeing patients.

So let’s stop trying to be martyrs and running away from openly discussing our pay for fear of giving a bad impression to the public and suffering reprisals. Talking money appears to be synonymous with blasphemy in the upper echelons of the GPC and RCGP – and this surely has to change.

I’d much prefer my patients to have a GP they envy rather than no GP at all but if the clinical exodus continues there will be none of us left to see.

Dr Shaba Nabi is a GP trainer in Bristol

 

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Readers' comments (27)

  • We do publish earnings, on our practice websites.

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  • Cobblers

    Let's go the whole hog and follow ?Norway where one's tax returns are freely available? That would shine a light not just on the relatively poor pay of coalface GPs but on the other areas of society bankers, industrialists, University Vice Chancellors to name but a few?

    Those that set GP pay already know what GPs earn and couldn't care less. It might, and a very big might, be the case that showing earnings could add to the pressure on those people. Don't hold your breath.

    However the main thrust here I do agree with. The GPC needs to grasp the money angle and talk about it loudly and to anyone that will listen.

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  • Hi Shaba,
    I wonder if it's because we are brain-washed and our altruistic natures are taken advantage of by successive governments. Questioning the status-quo is seen as something that "good" doctors do not do.
    We sacrifice ourselves for little financial reward and are crucified if anything goes wrong.
    I have a friend who's an Emergency Medicine physician in the USA - his indemnity is ~5% of his income. I'm a locum GP currently doing 4 sessions a week - my indemnity is ~15% of my paltry income.
    This is one of the issues that has pushed me to leave GP - 11 sessions to go and counting - and set up a private business instead.
    I'll look into taking out insurance instead and engaging a solicitor as I need one.
    To think that 20 years ago, all I wanted was to be a partner!! Sad.

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  • Australia.... 1-2% of income.....

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  • Doctors have taken the biggest pay cut of all public service workers. Considering the complexity of our work, and responsibilities, and decisions that can cost lives, we are not valued.
    I blame the BMA and RCGP for not doing anything!

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  • National Hopeless Service

    In the (horrible) USA if doctors don't drive Porsches and live in big houses it means they cant be very popular and hence can't be very good.

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  • Profit per patient year in NI is £ 60.0, for 6 consultations [60% of workload] and 30 other contacts per year [ blood tests, prescriptions, letters, referrals etc] [40% OW].
    That is £6/ consult, £0.80/ other contact, each a medico - legal minefield.
    Publishing total earnings is no good, it is per item that is so poor. We should actively discourage GP land as a horror, because in the same NI, we GPs get 5.5% of NHS spend. We used to get 11% in 2004, for 3 consults.
    But, short of resigning, not much the BMA can do.

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  • Succinctly put! I too feel the financial disincentive to do more salaried GP sessions. My indemnity has trebbled in 3 years, despite never having needed to claim in my 20 years of practice. Although after some negotiations, my practice has kindly look at taking over payments, my hourly rate is currently closer to £20 per hour after expenses. As a portfolio gp I am currently working in back in hospital for a couple of sessions a week and it's interesting the different concepts of a working day. Don't get me wrong - hospital doctors work hard too, but a working day is 8 hours (or 9 if you're held up), not the 12 hour day we have come to accept as normal. Also people go for lunch breaks! In hospital, if you work longer, that's 3 PAs not 2... I do think it's time to look at comparable terms and conditions for general practice. If we were paid and worked true 4 hour sessions, the hourly rate would be more favourable. But while most of us work much longer sessions, it's likely to stay the worst paid option...

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  • Legally a session is no more than five hours, including all admin, etc. Otherwise we’re not properly indemnified, and this is dishonest as well as foolish. After five hours, we are into another session and should be paid and indemnified accordingly (if salaried).
    If it’s impossible to cater for demand within the indemnified hours, excess patients should be turned away, with emergencies sent to A&E. Anyone who regularly works more than five hours per session is shoring up an unsustainable, unsafe system and not doing themselves, or their colleagues, any favours.

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  • 'All-for-one'.... grab 'coalface' and come down under... I need a few good hands around here (About 5 or 6 actually), there is a lot of work to be done, but you get paid for every bit of it..... pay is about £19-20 per patient consultation

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  • Thats yours after after deductions, but before tax, you can comfortably see 4-5 per hour......1% indemnity..... so I wonder how many GPs NHSE will persuade to come back.... my prediction.... only if the GP already needs to come back for family reasons.... there won't be anyone going back because of their campaign...

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  • Vinci Ho

    Think about our wonderful health secretary, folks:
    How much did he earn last year as total income and how much was his SOS salary constituting as a percentage of this total? Where would your main interest and attention lie if you were him?
    Sign of the times as I always said.

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  • David Banner

    One of the big deterrents in discussing income is the vast difference between partners in different surgeries. A well run, fully staffed, dispensing practice in a leafy suburb will see partners far better off then the poor souls trapped in a failing practice in an inner city slum, bereft of partners and relying on expensive locum/salaried GPs (if available) just to survive on a pittance (or face bankruptcy shelling out on redundancies and lease payments). For polar opposite reasons they would both want to keep schtum.

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  • Macdonalds medicine - where do you work in Australia? (I'm in the process of looking into options).

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  • I am not sure all GPs would agree.I know of atleast 3 GPs locally who only do 1 session a week but because they have fingers in many "extracurricular" pies are earning in excess of £200,000/yr.Those are the ones that torpedo the public relations exercise for the rest of us.

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  • 'Genuine thought' Im in Tasmania.....not too hot.... four seasons, good vineyards, its a med climate, you do get frosts in the winter but usually blue skies most days..... they can't build proper houses when it comes to insulation, and they've no idea about double glazing but I'll be building my own in time..... some of the clinics are old and need revamping, but you are you're own boss. I earned £5.5k GBP before tax last week, on exceptional weeks over £6k (08:30-6:00pm ish). If you like to work harder than average and do the odd evening or weekend on a regular basis on top of 10 sessions a week you can take your salary to around £300k on current exchange rates. A lot of doctors aim for about £180k and the easier life 4 day lifestyle. Taxes work out higher, but indemnity is cheaper, petrol is cheaper, cost of living a bit more expensive than UK but more than offset by higher income. We're looking at demographic data to see if we can get a few more DWS passed as quite a few GPs retiring around here next 1-3 yrs. Canada is also very much worth looking at - cars are a lot cheaper there .... here they are a little bit more expensive than UK, but some Japanese / korean brands can work out cheaper. Australia will be closing the doors soon. New Zealand is a great family friendly option. Tasmania is the 'new zealand' but of Australia that everyone overlooks. Just 3 species of snake here...one antivenom..... simples! Last deadly bite was in the 60s or 70s- no-one can quite remember

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  • No Nonsense.... what are the extracurricular pies that are so lucrative in the UK? Botox?Medicals? not many public funded posts that pay so well.

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  • I think one problem is that many people work hard or feel they work hard for a lot less money than GPs so public sympathy is thin. When the system collapses then some sympathy may surface.
    It is difficult to demonstrate to the public how hard and stressful GP work is.
    Following a whistle blowing exercise and NHSE/ CCG investigation lasting 6 months it is clear we are at risk from complaints, legal claims, GMC, PAG, CCG, NHSE, the media and our own personal stresses from working in an unsustainable work situation.
    No other profession has so many lines of oversight
    We must take action and control our work which is impossible under the current contract

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  • No nonsense
    re "I know of at least 3 GPs locally who only do 1 session a week but because they have fingers in many "extra-curricular" pies are earning in excess of £200,000/yr".

    Good for them. If that's what they have to do to get a proper rate for the highest qualified,most in-demand and most risky role in the UK rather than £6 per consult then so be it.

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  • "I know of at least 3 GPs locally who only do 1 session a week but because they have fingers in many "extra-curricular" pies are earning in excess of £200,000/yr"

    Did you actually read this article?? If they are earning more than you for what you perceive to be work you could do easily, why the hell are you moaning about it here? More Fool you?

    Everyone has a choice. If you dont feel you earn what you deserve, no one is chaining you to your role.

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  • As Shaba has said and I have repeatedly said on SOME...we need to move to a contract that pays us by acitvity. This will then shut the public and media who say we are lazy as the harder your work the more you get paid. This linear relationship is easy to understand for public and also this an activity based contract will relegate the often criticised Car-Hill formla as no forumla is needed. Then if you drive a Porsche it's cause you work hard end off.

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  • Forget this ...going to USA where a GP earns £180k and better lifestyle

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  • Why do the medical defence companies not offer a no claims bonus scheme as with car insurance?

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  • If Defense unions start offering No claim discounts then doctors with claims will see their insurance massively going up,which may not be practicable

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  • just info re the defence organistations: they are not insurance companies

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  • I left my Partnership a couple of years ago after having to stop my pension contributions to be able to pay my mortgage! I am now a RELP (Portfolio) and earning twice what I was as a Partner. My eyes still water when I realise how much of my initial salary disappears into tax, pension and indemnity costs though. Any bigger squeeze could make things very difficult; I would certainly consider dropping my one day GP locum a week to avoid indemnity costs.

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  • CENSORSHIP?

    Hi Shaba...saw you in passing at the pulse live...
    the cartoon above doesn't do you justice
    You look much younger... ;-)

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