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A tricky time to make the case on GP pay

By Steve Nowottny

Here's a headline you won't be reading in the Daily Mail anytime soon – since 2008, a quarter of GPs have taken a pay cut of more than 10%.

GP leaders and medical accountants have been warning for years of the effect of successive pay squeezes and spiralling expenses. Now it seems the GP pay crunch is well and truly upon us.

Pulse's State of the Profession Survey estimates an average decline in GPs' take-home pay of around 4% over the past three years, and some accountants believe the fall could be even greater. What's more, it's going to get worse – particularly if Government plans to double GP pension contributions go ahead.

In the broader scheme of things, of course, GPs are paid relatively well, as they deserve to be. But practices have suffered unprecedented attacks on their income from all quarters in recent years. What other profession has had to take six successive cuts in take-home pay?

What can be done? Well, the obvious answer – campaigning for a significant uplift in next year's contract deal – may be a non-starter.

Against a background of across-the-board public sector cuts, squeezing a net pay rise out of the Government was impossible this year – and is only going to get harder. GP negotiators are committed to arguing the case, but are understandably pessimistic about achieving much as the NHS strips itself bare to balance the books.

They're savvy enough, too, to realise that too much trade union posturing may play poorly with patients. As GPC negotiator

Dr Peter Holden puts it: ‘The public aren't going to get their violins out.'

Commissioning is the big game changer as far as GP pay is concerned. No one really yet knows how the NHS reforms will affect GPs' personal pay packets. And of course if – and it's an increasingly big if – Andrew Lansley's health bill proceeds as planned, then GMS and PMS contracts will be replaced by a single national GP contract.

But there are a couple of things GP leaders can do now.

Firstly, they must be robust in fighting stealth raids on other GP income streams.

Tellingly, accountants attribute the recent dip in earnings not just to rising expenses but to clawbacks in other areas, such as QOF prevalence losses, the patient survey debacle and cuts to enhanced services budgets. Elements of this year's contract deal such as the 37% pay cut for extended hours are having a similar effect.

Even if it proves impossible to negotiate an overall uplift to the GP contract, the GPC should be doing everything it can to resist ministers and managers chipping away at its edges.

And secondly, GP leaders must somehow seek to challenge the unfair narrative around GP pay which has dominated the national media and set the framework for talks with ministers ever since the 2004 contract.

As practice income has fallen, most GPs have chosen to take the hit themselves – reducing their drawings in order to protect staff salaries and the standard of care they provide to patients. It's time to bury the myth of the fat-cat GP once and for all.

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