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Pain ahead on pay raises stakes for GPC

It is tempting to wonder if GPs will ever see a pay rise again.

It was bad enough that the Government was looking to apply its two-year public sector pay freeze to general practice, on top of four pay freezes for most GPs in the last five years. But we now learn the Department of Health has suspended the normal pay review process for the next two years, denying the profession any say about what kind of uplift would constitute a pay freeze, given rising expenses, and how it should be applied.

It is looking increasingly likely that a freeze in pay will be absolute, and will be imposed in whatever way health secretary Andrew Lansley sees fit.

The DH is gambling that morale within general practice is sufficiently healthy to absorb this repeated assault on pay, and that the profession is well enough remunerated to remain attractive to trainee doctors. The jury is still out on the first of those assumptions, but on the second, ministers have surely miscalculated.

A Pulse investigation this week finds the number of young doctors applying to become GPs has plummeted by almost 40% in the last two years. And the effect of those long years of pay squeezes is already filtering through into the jobs market, with practices finding fewer and fewer takers when they advertise GP jobs. General practice is becoming a pariah profession.

Presumably the Government is hoping that handing GPs sweeping commissioning powers could make the profession sexy again.

But with core GP income under such pressure, the stakes could hardly be higher as the GPC enters talks with the Government. It is imperative that negotiators secure a good enough deal on commissioning to allow the profession to take it on with enthusiasm.

That deal must, as GPC chair Dr Laurence Buckman rightly insists, secure sufficient funding to cover the cost of commissioning for practices.

But it must do more than that. It needs to deliver genuine incentives for those GPs who take an active role in commissioning, and the guarantee that GPs will not begin their careers as commissioners saddled by the debts run up by the previous regime.

On this, the GPC's negotiating stance seems less promising.

Dr Buckman acknowledges how worried many GPs are at the possibility they could take over deficits in areas where PCTs have failed to stay within budget. He argues commissioning will never be a success if GPs have to take on the debts run up paying for pet political projects such as PFI schemes and Darzi centres.

Fair enough, but Dr Buckman also makes a rather remarkable concession. He claims he would not have a ‘huge problem' with saddling GPs with the more routine historical debt that ‘inevitably occurs as a result of managing patients'.

That is likely to be the majority of debt in most areas, and many GPs will have a huge problem if that debt becomes their responsibility, particularly if it makes it harder to secure the incentives available for staying within budget.

General practice can't look forward to a pay rise any time soon. But at the very least, GPs must not be financially penalised for the mistakes of the old regime.

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