Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Adequate Recompense
- sharat shetty (7 October 2005)
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Of course successful hard work deserves reward
- Graham Wheatley (7 October 2005)
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So what do GPs earn?
- Denis Colligan (9 October 2005)
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Do Chief Executives Deserve Their Pay Rises?
- Richard Rosin (9 October 2005)
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IBM replacing EBM
- GH Hall (9 October 2005)
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Do GPs deserve their recent press?
- Jonathan P Ireland (9 October 2005)
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GP Surgeries train junior doctors too
- Mourad Habib (12 October 2005)
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The wrong kind of quality?
- John Temple (14 October 2005)
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Excessive rewards
- David Timmonds (14 October 2005)
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Re: Excessive rewards
- Graham Wheatley (14 October 2005)
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Pay disparity
- Tom J Walton (15 October 2005)
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Pay disparity
- Graham Wheatley (16 October 2005)
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Is this GP recent pay rise deserved?
- Adamson S. Muula (28 October 2005)
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sharat shetty, forensic psychiatry norvic clinic nr70ht
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I still find it hard to swallow that the most hard working lot of the medical proffession have to justify their pay or a slight increase. Increasingly they take on roles which would have been 'tertiary' few years ago. New labour policies have raised peoples expectations of their gps and how they manage to deliver care for 40 patients a day is nothing short of a miracle. they deserve every penny they get and more. Competing interests: None declared |
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Graham Wheatley, GP Lincolnshire
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I read Timmins' thoughful article with the usual mounting frustration at this view, commonplace in some quarters, that if the targets are exceeded then no doubt they were too easy. Since 1997 funding for the hospital sector has grown quickly, with general practice funding becoming a successively smaller proportion of NHS spending. During this time hospitals have been adept at transferring responsibility for chronic disease management and follow ups to general practice, with no corrisponding transfer of funding. Now, when general practice has the opportunity to receive funding for this work, under a far more stringent and detailed performance management framework than has ever been accepted elsewhere the NHS, the idea that success in this framework might be due to good organisation, teamwork and hard work is simply not considered. Instead, the targets were just "too easy". A further misconception is that there is a simple relationship between this funding for additional work and pay rises for GPs. Practices have invested (often heavily) in additional staff, an investment made knowing that funding would only be forthcoming if the targets were reached. I'd suggest that this degree of business risk taking, with the personal financial risk to the GPs involved, is almost unknown elsewhere in the NHS, or in the the workplaces of the health economists quoted in the article. The idea of giving groups of clinicians extensive control over budgets and teamworking, carrying personal financial risk but also the possibility of reward for success, is not new or unique to British general practice. It is one of the ideas behind the success of the Kaiser Permanente health maintainance organisation in the US. Large numbers of NHS managers visited California to see Kaiser Permanente, but few if any have subsequently appeared to recognise or value the same features in British general practice. The success of GPs, when given the opportunity of funding to cover the cost of their work, isn't new. The 1990 Contract saw practices achieving coverage rates for immunisations and cervical screening well above those achieved by the previous regime of non-GP community services. So, why not be a bit more upbeat about how well at least one part of the NHS can perform, in a framework of 146 separate targets, if allowed modest but adequate funding support. Competing interests: None declared |
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Denis Colligan, gp whitley road medical centre, 1 whitley road, collyhurst, manchester, m40 7qh
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Surely there are many people out there (non-GPs), asking "so how much do GPs earn?" Vital information, to try and answer the question posed by the article. The answer is quite a lot. Full time GP principals in well organised practices would be disappointed to earn less than £100k per year for 2004/2005. The range can be considerable, given the differing circumstances in which GPs work; for full time pricipals it is approximatley £80-£120k. For 2006/2006 the quality points will be worth on average (depending on practice size)£120 per point as opposed to £70 this year. Don't forget GPs have dropped the 24hr resposibilty, and so are now working something in the region of a 45-55hr week. Denis Colligan GP Manchester Competing interests: None declared |
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Richard Rosin, Consultant Psychiatrist VA Medical Center Puget Sound, Seattle 98108
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This is a question which does not generate articles such as this describing detailed and arbitrary formulae and parameters for pay increases for absurdly overpaid CEOs in both the NHS and the private sector. How many grossly inflated severance packages have we seen in recent years given to people, self-important people, who have not infrequently received knighthoods for their financial prowess, but who have also presided, with their great acumen, over the failures of several important companies?The demise of Marconi resulted in a CEO leaving with several million pounds and a whole swathe of life-time perks lest we forget. Yet GPs who see 40 plus patients a day and have to tease out the minor from the major - and heaven help them if something is overlooked; which with that volume is a nigh certainty at some point - are subject to this thicket of performance parameters. Marx once said that he who controls the means of production controls the means of mental production in a society - i.e. the ideology. One thing is clear; doctors are certainly not in control of ideology related to their own profession. When a doctor fails he/she is subject to scrutiny and discipline and possibly worse. When a CEO fails, it is not failure and even if it is, well there's always the next trust or company to administer...and maybe even ruin. But then there's that richly deserved severance package. Competing interests: None declared |
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GH Hall, Retired physician EX1 2HW
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Which is: Income based medicine replacing Evidence based medicine. When GP's are more concerned about whether the BP is down to 140 systolic than whether the acute sciatica has subsided there develops a serious divergence between the priorities of the patient and the doctor. The government pays the piper, but we who pay the government can't call the tune. Competing interests: None declared |
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Jonathan P Ireland, General Practitioner Moulton Surgery, 120, Northampton Lane North, Moulton, Northampton. NN3 7QP
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Nick Timmins has taken a considered and generally positive view on the new GP contract and associated income. However to a working general practitioner the situation perhaps looks slightly different. It is generally accepted that GP income has lagged behind other professionals for a number of years and that an increase was overdue. The recent rise in income has to be set against this. How much is too much or not enough? Should a bus driver earn less than a pilot? Should a footballer earn more than a cabinet minister? As responsible professionals doctors have historically attracted a reasonable income which for general practitioners has been eroded. In addition the recent negotiations were undertaken against a background of failing recruitment with increasing demand and expectation from the government. The increases in income have been based on activity and data reporting above that previously required. There has been an associated increase in work, indeed this was a feature of the new contract, that income would reflect quality performance. There has been a cost in terms of higher workload, increased managerial scrutiny and loss of professional automony. Many GP's will have felt that at least some of this actvity was a public relations excercise to give a favouable consumer "spin". Baseline budget income has in fact not increased at all, even by inflation, despite staff wage rises. All the increase is in the quality and outcomes framework (QOF) and enhanced services. This is a concern as both these income streams are potentially moveable and removeable feasts. Mr Timmins feels that ministers will not try to clawback money but quality targets can and may be ratcheted up and enhanced services put out to tender. Given the failure to increase basic budgets this could undermine traditional general practice and the great advantages of holistic care. Also of concern is the continued infatuation with the idea that improvements in care can be translated to economic benefits. In 1948 ministers explained that the NHS would decrease in cost with improvements in medical provision and it was clearly a nonsense. It remains a nonsense. It is to applauded that the new contract has focussed attention on ensuring optimal care for chronic conditions. It is quite another thing to expect that this will reduce costs to the NHS. Even if complications from conditions such as diabetes are reduced this may only be a delay and inevitably other medical issues will arise at some time in an ageing population. In addtion where patients have open access to services with no direct pecuniary involvement there will always be substantial demand. There is persistent pressure to expand services by offering fringe alternative treatments. A defintion of what the NHS will and will not provide seems a financial necessity but a political pariah. Please do not blame general practitioners if health costs continue to rise. Competing interests: NHS General Practitioner |
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Mourad Habib, GP Registrar East Cumbria VTS Scheme
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GP Registrar has to complete a training programme in a GP setting lasting 12-18 months to be qualified as a GP, he has to submitt video tapings for a number of his consultations and should comlete an audit. Training hours are very important in the career life for any GP registrar. Video taping and auditing are use of the surgeries resources as well as time of trainers. Putting in mind that new private treatment centres have no incentive to train doctors, more training work loads will be put only on the NHS ones. To improve GP recruitment and retention and hence patients' service, training should be kept up to standards and continuously improving. I feel that this crucial point was completely absent in Timmin's article Competing interests: NHS GP Registrar |
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John Temple, Flexible Careers Scheme GP Derby Road Health Centre, 336 Derby Road, Nottingham NG7 2DW
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Nick Timmins’s article shares a worrying tendency for the quality and outcomes framework of the new GP contract to be regarded as a satisfactory measure of quality of care in general practice. Although practices have performed well in terms of the framework, it relates to only about a quarter of our work, particularly our care of some common chronic diseases. It’s also worth remembering that the financial rewards for clinical care are for practices’ diligence in recording specific data on computer, which may not accurately reflect the quality of care delivered. I have no doubt that many patients have benefited from the new contract, but one of its downsides is that it encourages the displacement of patient centred care by public health centred care. The financial incentives of the quality and outcomes framework push us towards spending more of our limited time focusing on patients’ smoking habits, blood pressure and chronic diseases, and less listening to their current concerns. There is, of course, no financial reward for the time-consuming task of trying to ensure that patients understand how likely (or otherwise) they are to benefit from the drugs we are constantly encouraged to get them to take for the rest of their lives. Equating the results of the quality and outcomes framework with overall quality of care in general practice is likely to be very detrimental to patient care in the long run. Competing interests: None declared |
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David Timmonds, Consultant Physician Edinburgh EH3
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Viewed from secondary care, GPs are undoubtably overpaid. Individually they are not culpable, and indeed must be congratulated for achieving and exceeding targets. The rewards for hitting the target are accepted to have been excessively generous, and it is disappointing that very few colleagues in primary care, both here and elsewhere have the good grace to admit this. Additional income should be, in part, tied to tangible patient care improvements. Competing interests: None declared |
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Graham Wheatley, GP Lincolnshire
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It is mildly amusing to be accused of poor grace from such a clear case of sour grapes! The above post could be slightly reworded to say: "Viewed from primary care, hospital physicians are undoubtably overpaid. Individually they are not culpable, and indeed must be congratulated for (sometimes) achieving and exceeding targets. The rewards for hitting the target are accepted to have been excessively generous, and it is disappointing that very few colleagues in secondary care, both here and elsewhere have the good grace to admit this. Additional income should be, in part, tied to tangible patient care improvements." ... but that would be unfair to the majority of hospital colleagues. Of course, colleagues in hospital medicine who believe the balance of work and reward in general practice to be over-generous are quite welcome to come and retrain as a GP. There are two registrar places currently up for grabs in my practice in February. You are more than welcome! Competing interests: None declared |
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Tom J Walton, Consultant rheumatologist Colchester CO4 0YP
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GPs should be congratulated on securing a pay deal that rewards them well for the work they do and despite the money it remains a very hard job to do well. Those of us in Hospital medicine should not have sour grapes about the matter but be pleased that at least one branch of the profession will be still able to recruit high quality applicants and pay them a generous wage. The problem lies in the disparity with hospital medicine in terms of income, length of training and quality of life. As I said recently when giving a careers talk to our first year SHOs, their choice at that stage lies between 2 career paths. The first offers 3 year training programme followed by an exam with a 70% pass rate then on to a job where you would realistically look to earn £130 to £150 k and if you choose to do on calls at £90 per hour. The second offers an 8-10 year training programme doing horrendously antisocial on- call patterns with 2 postgraduate exams with a 30% pass rate plus the need to obtain a further postgraduate degree in most specialities. You will then obtain a job paying £70 k per year with little/no opportunity for private practice and could look to doing on-call weekends/nights on a weekly basis that values your time at £1.50 per hour. It is not difficult to see which path is most attractive and this is already having a serious effect on hospital recruitment - reflected in the fact that at our last 3 SpR interviews for the deanery we had not one UK graduate apply. So I once again congratulate GPs but fear a future in which we in hospital become very much the poor cousins. Competing interests: None declared |
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Graham Wheatley, GP Lincolnshire
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Rumour, misconception and associated resentment abound on this contentious subject of doctors' pay, and what different doctors are worth. Special pleading to justify a greater net worth of one section of the profession over another can all too easily become patronising and inaccurate. Few would argue that GP registrars have been disadvantaged by a too-short training programme, and that the extra year provided by the F2 programme is not before time. Similarly, UK hospital training programmes are long by international comparisons and include a high proportion of service work rather than training. The MRCGP exam is recognised as being highly reliable, not least by the hospital Royal colleges who ask to observe it. Low exam pass rates in medical postgraduate exams are associated with both less reliable exams (as more have to fail to ensure that only the competent pass) and colleges that rely on exam fees from repeated attempts to boost their income. On the subject of numbers of doctors becoming GPs or consultants, the DoH publish manpower figures showing that in 1994, there were 15 638 consultants and 26 075 GPs in England (full time equivalents). By March 2005, the number of full time equivalent consultants had shot up to 27 597, whereas GP numbers had increased only marginally to 28 847. On these trends, within a year there will be more consultants than GPs. This certainly doesn't show that consultant body is being starved of new recruits due to an exodus to general practice - quite the opposite. A large proportion of new doctors have chosen hospital medicine over general practice, which has been seen as less attractive - something that the new GP contract is specifically intended to change. What reliable evidence exists that sheds light on the real situation on pay? The joint BMA/NHS Technical Steering Group estimated NHS earnings for the highest earning group of GPs (equity partners) to be about £83 000 in 2004. This gave a similar income to that of GPs in Portugal, Austria & Denmark and less than GPs in Holland and Germany. Earnings for salaried UK GPs would have been on average lower still. Several accountancy groups (such as AIMSA) reported that 2004/5 GP accounts showed non-NHS, private income of about £20 000, giving earnings for partners on average to be around £100k to £110k. How does this compare to consultants? The NHS employers' earning survey for August 2004 showed average NHS earnings for consultants of £94 700. The most recent BMA private practice earnings survey found earnings, when averaged across all consultants, of £31 442. Clearly not all consultant wish or are able to do private work, in the same way that not all GPs wish or are able to do private work either. This no doubt is a factor that individual doctors consider when choosing which job to select. So, the average consultant would be earning about £125k in 2004, compared to the average GP partner earning about £100k. It is not immediately clear how consultants are disadvantaged by this pay disparity! Competing interests: None declared |
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Adamson S. Muula, Lecturer Department of Community Health, University of Malawi, College of Medicine
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The recent pay rise for GPs in the UK seems to have caused ripples, interestingly, also among other doctors but from different specialties. However, what need to be discussed serioulsy are two things i.e. (1) whether the pay is deserved and (2)whether GPs' remuneration should be subservient to those of other clinical specialties. It is tempting to compare a GP to an orthopod and try to suggest that the orthopd should get more money than the GP (at least that is what is coming up from the debate). I guess instead of trying to think that GPs are overpaid, it may help to think as to how other specialties could also be better paid. If one is a doctor in a specialty other than general practice, do they have job satisfaction? Has then the job satisfcation evaporated just because the GP is smilling all the way to be bank? Would non-GPs rather have GPs poorly paid?
Competing interests: None declared |
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