GPs in the United Kingdom have an image problem. Despite performing well in international comparisons, achieving high levels of patient satisfaction and delivering over 300 million consultations each year on only around 8% of the NHS budget, we find ourselves constantly under attack from the media, politicians and managers.
So it is little surprise that one of Jeremy Hunt’s aims for the new GP contract was for every practice to publish a net or average salary from April 2015 onwards as part of new transparency measures included in the GP contract deal. GPs will not be expected to publish their individual earnings, but I believe we should.
GPs in the UK work hard, and efficiently. In recent years, we have taken on additional tasks such as commissioning health services with little extra funding. In fact, the proportion of the NHS budget spent on primary care services has been declining despite the increase in the volume and complexity of GPs’ workload.
Organisations such as the BMA and the RCGP have tried hard to make a case for general practice and argue for increased resources but, thus far, have had little success. All we get is money shuffled from one part of the primary care budget to another with the result that we take on even more tasks and increase our workload even further without any real increase in funding. Consequently, our practice expenses have been increasing and our income has been declining for many years.
The real-terms pay of UK GP partners peaked in 2005/06 and, by 20011/12, average pay had fallen to £103,000. It’s likely that when more up-to-date statistics are published, we will find that pay has fallen even further because of the on-going squeeze on GMS and PMS budgets (particularly in England); and the continuing rise in GP expenses. Furthermore, the fact we pay our own pensions contributions and medical insurance makes partners’ salaries (as reported by the Health and Social Care Information Centre) seem artificially high.
Salaried GPs earn even less than partners, around £57,000 on average in 2011/12. Hence, for most GPs, their earnings from the NHS are not vast and not out of line with what other NHS doctors earn, particularly when GP income is calculated in a comparable way to the pay of NHS employees.
One concern that many politicians, NHS managers and the public have is that, if the resources allocated to primary care are increased, a significant proportion of this additional investment will be used by GPs to increase their income rather than to improve primary care services.
For example, GPs’ pay improved after the introduction of the 2004 GP contract (although GPs will argue they also delivered higher quality care).
To counter these adverse perceptions, GPs should publish details of their pay, after subtracting for employers’ pensions contributions and medical insurance fees.
As well as increasing public transparency and financial accountability, this would also help convince politicians and managers that additional resources for primary care were being invested in improving our management of patients’ health needs and their access to services, not just going directly into our pockets.
Details of individual GP and practice income should be accompanied by more public data on GP workload. Currently, the NHS publishes little information on either on our work volume or its complexity. For example, there is little routinely available information on the number of GP consultations either at national or at practice level so the public are unaware of the pressures on general practices, particularly in contrast to, for example, emergency departments (statistics about which are regularly presented in the media).
What proxy measures we do have for GP workload suggest this has increased substantially in recent years – for starters, the number of prescriptions issued by GPs increased by 62% between 2002 and 2012.
If details of GP pay were published – at both individual GP and general practice level – this would allow us to kill off many of the myths about GP pay and show the value for money that UK general practice offers.
It would also allow us to measure the productivity of individual general practices, reassure the public that investment in primary care goes to frontline services, and help reduce the variation that currently exists between different practices.
Professor Azeem Majeed is professor of primary care and head of the department of primary care & public health at Imperial College London, and a GP partner at the Manor Health Centre in Clapham, London.