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The hard truth about the fall in GP funding

Put down the Daily Mail. Ignore your complaining colleagues. If you really want an accurate picture of practice funding and GP pay, you need to read Investment in General Practice 2007/8 to 2011/12 and GP Earnings and Expenses 2010/11.

These two sober, considered reports from the NHS Information Centre, numbering 104 pages between them, offer an analysis of GP funding which is about as authoritative as they come, albeit one with a slight time lag.

Subject to rigorous scrutiny by the Technical Steering Committee, with representation from the four UK departments of health, NHS Employers and the BMA, the reports cover everything from the global sum to enhanced services, partner income to salaried GP pay, and compare trends with previous years. Pretty much without exception, the arrows point in one direction.

It’s important not to overstate the case. GPs are much better rewarded for a difficult job than they were in generations past. Some 200 lucky partners reported a before-tax income of more than £250,000 in 2010/11. But since a 2005/6 peak, the generous provision of the new GMS contract has been systematically eroded year on year.

Our story this week revealing how practices are having to chase around Mary Celeste PCTs to recoup enhanced services cash will resonate with many. But it is the inexorable rise in expenses that in the long term is likely to prove more significant – and will, despite GPs’ best intentions, have the greatest impact on patients. In our feature on small practice funding (page 44), Essex GP Dr John Cormack, who has claimed he runs the NHS’s worst-funded practice, puts it bluntly: ‘In 30 years in general practice I’ve never found it more difficult to provide even a basic service to my patients.’

One crucial figure buried in the reams of Information Centre data is the arcane ‘earnings-to-expenses ratio’ – the proportion of gross earnings taken up by expenses. In 2010/11 this rose to 60.9%, a record since the new contract. It has no doubt climbed again since. The blithe assumption behind successive pay freezes has been that GPs’ loyalty to patients will trump small business imperatives – and so far, GPs have consistently proved willing to take the hit in their own pay packets.

But with a new round of contract talks under way, the Department of Health would do well to consider how long that will continue, and how much more general practice can take. In the current environment, a significant uplift in practice funding may be too much to hope for. But at the very least, ministers must properly cover GPs’ rising expenses. Whatever fat there was has long since disappeared. It’s hard to see how further cuts can be made without hurting patients.


Revalidation costings kept under wraps

Revalidation is top of most GPs’ list of current concerns – and after 13 years of planning, starts in just two months. So how much will it cost?

The good news is, the DH probably has a pretty good idea. Work began in 2009 on a revalidation impact assessment, predicting the likely costs of improved appraisals, responsible officers, multi-source feedback, remediation and so on. The bad news is, you’re not allowed to see it – or at least, not until after the health secretary has formally given revalidation the green light.

Of course, Pulse has every confidence the impact assessment will show revalidation is entirely affordable and the benefits outweigh any costs, exactly as the GMC insists. But for the time being, you’ll just have to take their word for it.