It was hardly earth-shattering news recently to hear that the late-lamented health secretary Andrew Lansley had written to the Doctors and Dentists Review Body advising that once again they needn’t make recommendations for next year as doctors’ pay rises would be capped at 1%, and the details of how this would apply to GPs would be thrashed out in negotiations with the GPC.
I can’t even remember when the DDRB was last asked to make a recommendation; less still when a government accepted it. Over the last few years the DDRB has seen less action than Michael Owen, who at least now has the consolation of a swansong transfer to Stoke City while the poor old DDRB appears destined to slide into oblivion.
The stark fact is that, since the heady days post-nGMS, general practice has been totally starved of any additional funding, let alone anything sufficient to be considered for a GP pay rise. Last year’s meagre 0.5% gross uplift was at least a minimal improvement on the several preceding years of zero growth, but still nowhere near enough to prevent yet another profit reduction for partners.
But despite its financial crisis, the NHS has still received annual funding increases with NHS employees – including all other doctors – receiving pay rises, albeit modest ones. As independent contractors, we have been singled out for discrimination, using the disingenuous argument that we can create pay rises for ourselves through better management and efficiency of our businesses.
The truth is different and the reasons clear. Firstly, while we may run small businesses, we are first and foremost doctors – professionals who happen to be the most effective and efficient way of providing NHS general practice. While a ‘normal’ business would deal with the economic situation by cutting services and shedding staff, we quite rightly and steadfastly refuse to take actions that will be detrimental to our patients. Staff redundancy remains a far less viable option for us than for larger organisations in the commercial world.
Second, given the cost pressures and cuts we struggle with, the idea that GPs can engineer pay rises through ‘efficiency savings’ comes from a fantasy world that the combined imaginations of Tolkien, Rowling and CS Lewis would struggle to conceive. The nGMS contract promised substantial rewards for hard work and achievement and, of course, ‘no new work without new money’. Yet the inevitable dumping of work from secondary to primary care has continued unabated – and has accelerated.
New work has been added to QOF each year with the most achievable indicators ‘retired’. More work-intensive, virtually unachievable ones have been added. The so-called QIPP agenda, a euphemism for rationing and cuts, has placed huge amounts of extra work on us as we struggle to care for our patients, despite service cuts, and pick up the inevitable consequences.
Meanwhile of course, funded GP work through LESs has already been cut, and will continue to be whittled down. Add to that, aging populations, rising morbidity, rising pension contributions, and rampant inflation. Then add CQC registration – a cost in terms of work required for registration and compliance, and with a yet-to-be decided registration fee which we will have to pay out of our own pockets. And then add revalidation – another real cost out of our own pockets with time required for preparation, enhanced appraisals, and multi-source feedback participation.
I haven’t even mentioned the CCG agenda yet: unfunded time, attending meetings, reading interminable draft constitutions, discussions with our partners, upcoming legal costs to get partnership deeds altered, and all before we get round to doing any actual commissioning.
All this represents our true ‘efficiency’ – a huge increase in workload for the same money. I could write a book on all the issues we face, but obviously I don’t have the time.
If we thought things have been bad up until now, we now have a perfect storm brewing that will hit next April and send practice costs into the stratosphere. There has been bullish talk that the negotiators will fight for a funding increase of ‘several’ percent to deliver the 1% pay rise. I’d suggest 10% as the bare minimum needed. Will they get it? Well I suppose it’s not impossible. But I’d bet more money on Michael Owen helping Stoke City win the Premier League this year.
Dr Robert Morley is a GP in Birmingham, secretary of Birmingham LMC and deputy chair of the GPC contracts and regulation subcommittee