Despite having been born and raised in Essex, I have a somewhat bird’s eye view of Western culture as I am the child of an immigrant. This gives me the ability to muse over certain idiosyncrasies of the British – a peculiar one being a reluctance to discuss our earnings. I suggest any of you who are squeamish about this should now swap your copy of Pulse for Fifty Shades of Grey, and continue living happily in fantasy land.
So why am I discussing money so openly? Am I empowered by the BBC publishing the pay of its top earners, thereby exposing the gender pay gap? Surely I should be grateful for belonging to the top-earning quintile in the country? The answer is depressingly simple – a permanent GP practice role no longer pays.
Endless work has to be shoehorned into our days, which is not matched by the pitiful rises in funding per head we have been offered in recent years. This has a direct impact on salaried GP pay, because partners simply can’t afford to pay them more than they pay themselves. As the days get longer, we all take a pay cut by stealth, because it is far too vulgar to be paid by activity as opposed to a block contract.
Amid the spiralling workload and austerity, there is nothing like an indemnity crisis to focus the mind on what we are actually earning. In July I experienced a 40% hike in indemnity fees, leaving me with an hourly rate of just £25.50 before tax. I can assure you it wasn’t much more than this as a partner because of the endless management hours. This is significantly less than half the hourly rate for any other GP career choice: locum work, out of hours, education, commissioning, appraisal and medical politics. In fact, some of my non-clinical roles offer me more than three times this hourly rate.
So is it any wonder GPs are now choosing to RELP – retire, emigrate, locum or portfolio? Clearly, I have opted for the latter because the portfolio aspect not only nourishes me, but also offers me a fatter pay cheque. I do not wish to stop my salaried role as I value the continuity and training aspects, but I keep it to a minimum so that the majority of my income comes from other sources.
How did we end up in this dire situation where coalface general practice – easily the most demanding and emotionally draining of the roles – pays so little in comparison to all others? This insulting hourly rate (can’t wait for a Daily Mail reporter to get hold of that line!) speaks volumes about our self-worth and the price we put on the most challenging aspect of our role – seeing patients.
So let’s stop trying to be martyrs and running away from openly discussing our pay for fear of giving a bad impression to the public and suffering reprisals. Talking money appears to be synonymous with blasphemy in the upper echelons of the GPC and RCGP – and this surely has to change.
I’d much prefer my patients to have a GP they envy rather than no GP at all but if the clinical exodus continues there will be none of us left to see.
Dr Shaba Nabi is a GP trainer in Bristol