Simply put, the new contract’s formula appears to reward demand – not need
ANEURIN Bevan, the Labour leader who founded the NHS, famously said of consultants that he had “stuffed their mouths with gold” by allowing them to continue to treat lucrative private clients while also working inside the health service.
The same might be said of offering a majority of GP partners the chance to boost their take home pay by an average of £10,200 a year if they accept a new contract – the first since 2004 – despite reservations among some that it will gradually erode their autonomy by eventually handing health boards responsibility for employing practice support staff, and lead to a “salaried service by stealth”.
Those are issues for another day, however. What the current situation illuminates is the mixture of benefits and pitfalls inherent in the GP independent contractor model – another of Bevan’s concessions which allowed family doctors to continue operating their practices as small businesses – or “partnerships”.
On the one hand, it leaves GPs free to set some of their own priorities: creating a minor surgery clinic on site, or hiring specialist support staff such as mental health workers and physiotherapists so that patients can avoid lengthy hospital waiting lists.
But it also enables GP partners to maximise their own income by minimising such expenses instead.
Understandably, nurses, paramedics and cleaners may well feel hard done by comparing their own pay rises to the potential windfall for those in general practice.
But this should not be a race to the bottom. Most GPs are working 50 to 60 hour weeks with a huge responsibility for patient care. While a few enjoy salaries in excess of £250,000, some are earning as little as £60,000.
The gulf between average GP earnings and those of consultants has also widened hugely, and is a major factor in the declining appeal of general practice. In the past, 50 per cent of medical graduates chose to become GPs; that has dwindled to 11 per cent.
On that basis, it is imperative that the Government make a career in general practice more attractive, and a cornerstone of that is better pay. However, the concern is that it will not flow to where it is needed most: rural practices haemorrhaging GPs to early retirement, and Deep End practices where average life expectancy can be as low as 61.
Is it fair that a practice with large numbers of people in their 80s and 90s – itself a mark of affluence – get more out of the formula simply because they have more doctors and more “worried well” seeking appointments. Simply put, the formula appears to reward demand – not need.
The BMA dispute that the £10,200 figure is absolutely accurate. But The Herald is aware of individual GPs set for £16,000 uplifts, so it is probably not far off.
Hundreds of GPs may be “winners” next week – but ultimately, general practice itself may be losing.
This illuminates the mixture of benefits and pitfalls inherent in independent contractor model