General practice is a business

If GP expenses continue to rise while earnings flatline, more doctors will be forced out of the health service, warns Dr David Turner

‘You do realise that general practice is a business, don’t you?’

That was the first thing the GP I was assigned to on my first primary care attachment at medical school said to me. It’s now my opening gambit to all medical students.

I’m amazed at how many students don’t realise that most GPs are independent contractors who don’t work for the NHS directly in the way that consultants do.

I’m less amazed at the similar ignorance there is among the public about our employment status.

Media reports along the lines of ‘GPs instructed to…’ and ‘GPs salaries to be…’ infuriate me. I always try to remind my non-medical friends and family that we do not ‘work’ for the NHS, so we can’t be ‘instructed’ to do anything. We have a contract to provide care and, if they would like to change it, we would have to renegotiate. Also, we don’t get a salary, but a profit share (that is, whatever is left over after we have paid everyone else).

Yes, we pay for every table, chair and paper clip out of our practice income. People have grown up thinking that the welfare state is one big bran tub of money, into which we dip our hands when we need to buy something. They look at me with shock and disbelief when they learn about the reality.

I was reflecting on this recently while reviewing our end-of-year practice accounts. The overlying message is that income is flatlining and expenses are increasing.

A recent report by the BBC found that nine in 10 NHS dental practices across the UK are not accepting new adult patients for treatment under the health service ­– this should be a warning about how general practice could be a few years from now. It appears that dentists have a fixed income for all their NHS work, which means that they get paid no more for taking on additional patients and doing one filling or 10. This model clearly isn’t going to be attractive to any business and, inevitably, dental practices are choosing to do more private work.

With soaring costs and little chance of a hike in NHS income, we in general practice are going to have to come up with other ways to generate income outside of the health service.

Unfortunately, it isn’t going to be possible to make up the shortfall between escalating costs and diminishing NHS income with private work, so many more practices will continue to merge or fail. The sad news about The Lakes Medical Practice in Cumbria having to hand back its contract is testament to how general practice is subject to the same economic pressures as any other business.

New prime minister Liz Truss should make this issue a ‘priority’, as MPs are fond of saying. Otherwise, NHS GPs could soon become as rare as NHS dentists.

Dr David Turner is a GP in Hertfordshire