The GP gender pay gap

Female GPs are statistically less well-paid than their male peers, and many say maternity pay isn’t adequate. Eliza Parr looks at how systemic sexism affects women in general practice. Read more from the investigation here

It’s not easy to get to the root of cultural or everyday sexism. Female GPs may be suffering the emotional toll of sexist comments from patients, they may be dealing with more women’s health issues than male colleagues, or they may feel their career is hampered by their family commitments. Evidence of this is sometimes limited to anecdote. On pay, however, the data is clear – female GPs are paid less than their male counterparts.

In 2020, an independent review revealed that GPs have the highest gender pay gap among doctors working in the NHS. Payroll data revealed that the basic gap was 33.5%, and when adjusted for hours and experience, the gap remained ‘substantive’ at 15.3%.

While almost all of the gender pay gap in hospital trusts could be explained away, the Government-commissioned review found that around half of the gap in primary care is not predicted by typical factors. ‘We cannot discount the possibility of direct pay discrimination within individual practices’.

The BMA welcomed this review but suggested that Government funding is key to addressing unfair pay, rather than correcting individual practice management. The union said that closing the gender pay gap is ‘dependent’ on practices having enough funding and staff to achieve ‘greater equality’.

Unequal footing

But GPs on the ground are nevertheless experiencing inequity when it comes to pay. A Pulse survey of 700 female and marginalised gender GPs found that over a third say they have been paid less well than their male counterparts for doing the same role with the same level of experience.

As a salaried GP, Dr Stephanie deGiorgio felt the sharp end of the gender pay gap. ‘I found out that a male GP who joined just after me was being paid more than I was.’ She says this has happened to other female GPs, and may be down to having less confidence ‘to negotiate’ – or just ‘good old workplace misogyny’.

‘My situation was sorted out very quickly when I explained that I was aware, but it shouldn’t have happened at all,’ Dr deGiorgio adds.

Dr C, a GP who wishes to remain anonymous, says that her 15-year partnership with a male colleague repeatedly left her on an unequal footing. ‘We were superannuated on a 2:1 split, but what we actually worked was about 50/50. So basically, I worked for 15 years and didn’t get superannuated for a significant portion of what I did.’

She says this inaccurate split meant she ‘didn’t get the pension rights’ she should have from the partnership – ‘I missed out on employer contributions’.

Negative experiences of partnership are certainly not limited to female GPs, but some issues may be compounded by gender dynamics between partners. Dr C reflects on this: ‘I do think, if that was a guy, would you be expected to accept that?’

Later, when the partnership broke down over a dispute on locum use to cover her male partner’s ‘other activities’, she says things ‘got really messy’. ‘I went to the health board and said he was literally refusing to see patients. I felt like I was being told to just “roll over”.’

Structural problems

In fact, the 2020 review – ‘Mend the Gap’ – backs up these experiences, and was emphatic in its findings. Professor Dame Jane Dacre said ‘a combination of family and structural factors’ resulted in female doctors having less experience generally. But specifically on general practice, she commented: ‘Workplace culture plays a substantial role alongside these factors, in accounting for the lower level of experience among women GPs.’ The report called for ‘more structure and greater transparency’ in GP pay setting, as local practices ‘can increase gender pay gaps’.

Pay inequality is felt more acutely by some GP groups than others. The BMA pointed out in 2021 that the gender pay gap among salaried GPs (22.3%) is three times the gap experienced by GP partners (7.7%). Locum GPs, meanwhile, appear to experience no pay gap.

Dr Ben Molyneux, a former BMA sessional GP committee chair, says there are lots of reasons why women experience a pay gap: ‘They are less likely to negotiate hard, they’re more likely to be in jobs for longer and therefore not move around and shop around for the better rates, because they’ve got caring responsibilities.’

According to him, the gender pay gap for GPs was not usually as ‘overt’ as a female salaried GP being paid less than a male GP in the ‘next room’ – instead, GPs often noticed the difference anecdotally when they asked around about salaries. ‘It just generally tends to be that male GPs are getting paid more.’

Dr Molyneux adds: ‘There’s lots of reasons for that. It makes it harder if you need to stay in a certain geography and you need flexible working to then negotiate hard on your salary, because those are felt to be net benefits to your conditions by employers sometimes. And the practice would say “well, okay, I’ve given you flexible working, therefore I’m not going to pay you as much”. And you can argue the rights and wrongs of that, but it is the case for a lot of people.’

Back in 2021, his committee targeted one of the ‘fundamental’ reasons for the pay gap and successfully lobbied for enhanced shared parental leave for salaried GPs.

‘The reason for doing that was because the gender pay gap starts for most people when they have children. And women usually never recover from that point. So we wanted to make that differential as small as possible.’

Maternity leave

Beyond salaries and partner drawings, female GPs may also face discrimination if they choose to have children and take maternity leave. Of the female GPs with children who responded to Pulse’s survey, a third said the way GP practices have dealt with their maternity leave has been unfair. And over 40% felt maternity pay in general practice is inadequate.

Medical Women’s Federation president Professor Scarlett McNally says parental leave is a ‘right’ and childcare is a ‘commitment’ – ‘both are more often required by women doctors for a short phase of their career’.

‘It is appalling that one third of women GPs had difficulty arranging these working arrangements, when this is what retains staff and allows decades of good practice after this phase.’

Determining maternity leave, especially for partners who are independent contractors, can be complex. The length of leave a GP takes is based on an agreement within their salaried contract or their partnership agreement. The pay itself is determined by a combination of ICB reimbursement and what GP partners choose to pay on top of this.

Dr Farzana Hussain, a GP in Newham who worked as a single-handed principal for 21 years, says she was ‘very fortunate’ during her first pregnancy as she was able to negotiate a package of nine-months’ leave with full pay. ‘That was kind of unheard of,’ she adds.

But she says the reimbursement from ICBs is ‘simply not enough’ meaning partners have to dip into their own pockets to cover maternity leave. ‘It’s not that the partners are trying to be difficult. It’s a bit like the locum situation we’re seeing now – if there isn’t enough money in the GMS budget, you can’t afford those locums or you can’t afford to give maternity pay.’

Instead of blaming individual practices for inadequate maternity pay, Dr Hussain points to wider, structural issues. ‘I would say this is systemic sexism rather than individuals. Why can’t we make this more palatable for 50% of the population?’

GP funding pressures – which have reached a crisis point in recent years – may put a squeeze on the level of maternity pay partners can afford to provide. And of course, blame cannot be placed squarely with male GPs when 46% of partners in England are female themselves.

Direct discrimination

But a sexist culture within a practice can contribute to discriminatory working conditions for female GPs. Dr D, a GP partner in London who wishes to remain anonymous, experienced a shocking example of this in the late noughties. She took up a salaried role at a practice while pregnant – when she informed the male partner of this, he said ‘I’ll need to think about it’.

‘He obviously went away and looked up the legality of this, and they did end up offering me the job. But the other salaried GP at the time was also pregnant. The partners looked at their funding and decided they wouldn’t be able to get reimbursement for both of us. They decided to make me redundant.’

Dr D took the case to the BMA, and the practice was forced to settle based on discrimination. ‘The only reason they were making the post redundant was because of my pregnancy.’

While clearly an extreme example of a discriminatory maternity policy, this perhaps points to a wider issue of ‘affordability’ getting in the way of gender equity. GPs across the country are crying out for sustainable funding, and practices certainly don’t have spare cash. But fair pay and maternity leave for female GPs should surely be non-negotiable.

However, former BMA GP Committee England chair Dr Farah Jameel says the ‘duty’ lies outside the scope of individual practices: ‘My view is that the Government and NHS England, when they know that the majority of this workforce is women, has a duty of care to secure fair rights. And to ensure these rights remain the same across the NHS, whether you’re working in a hospital trust, or whether you’re working in general practice.’

But Dr Jameel, who is also a council member of the Medical Women’s Federation, says those leading the profession have a duty too.

‘I genuinely feel like we are, collectively as a profession, failing a generation of women by not having negotiated and secured the right type of settlement agreement for them for maternity.’

Pseudonyms have been used throughout this article to protect anonymity