It is my birthday today. I had promised myself the afternoon off. I went into work this morning to tackle on an enormous backlog (blood results, hospital correspondence, DWP reports, issues relating to patients with complex medical problems). My wife and I then met up for a birthday lunch, and my plan was to indulge myself and read Simon Schama’s Citizens this afternoon.
But then I saw a comment on this blog from David Read (see Home Page). He commented on 21/6/12, and ’Can’t think of a name’ replied on 22/6/12, to which David Read replied today. David Read takes issue with the fact that GPs earn, on average £106,000. (These are his figures, I don’t know what the true figures are). He is of the opinion, if I understand correctly, that GPs are actually not needed, that we could remove them from the system without losing a great deal (this is the line articulated by Matthew Parris in his article on 16 June, behind paywall; for a summary see here, and my reply).
There was some comment on last Thursday, 20 June, which was the day of ‘industrial action’* on the part of doctors. Some people were outraged about how much GPs earned.
I am aware that some GPs in England make a lot of money. But it is important to realise that the amount that GPs accrue as profit will vary widely. A significant factor is where the GPs are located. I am aware that a small number of GPs in the borough where I work have a profit which is more than twice ours. I don’t really understand why this is, our accountant understands these things. The issue of GP earnings probably needs some attention, because there is a narrative about that GPs are greedy bastards, look how much they earn. I might write a post about this, from my perspective, in the future.
However, for the moment, so that I can get a little time for reading on my birthday, I just want to say this: focusing on how much GPs earn is perhaps a red herring. Let me tell you how much we get to provide primary care services for our patients. I am using our 2010 accounts (the 2011 are pretty similar, but I don’t have them to hand). I looked this up 18 months ago because we had a complaint from a patient who thought it was outrageous that he/she could not be seen within 20-30 minutes on a Thursday morning, having developed symptoms the night before at 1 am. In his/her complaint, the patient alluded to all the money we had, and that we should be providing a better service.
Well the facts are as follows. We have 3,500 patients. Our NHS income is divided into Gobal Sum (which is a lump sum which covers a number of items, but is essentially for looking after people who present sick), QOF income (Quality Outcome Framework: this is for looking after people with chronic diseases, such as diabetes, COPD, asthma, heart disease, and others), and Enhanced Services (this covers services that are not covered by QOF, such as managing patients with substance misuse, terminally ill patients, running a patients participation group, and so on, more than twenty areas).
Our income, per patient, per annum, is as follows:
Global sum: £74
QOF: 18
ES: 23
Total: £ 113
This means that we provide primary care services for our patients for £113 per year. Some patients (a minority) will not come at all during the year; some will come a few times; some will come 4-5 times; some will come often. This includes visits to the GPs; the practice nurse; the nurse practitioner; the Health Care Assistant for the cardiovascular disease prevention programme; home visits; travel vaccinations; antenatal care; baby clinics; mental health; the list goes on and on.
The patient who complained (who was actually seen at 8:50 am that morning, the complaint was composed at the end of the day) had symptoms of cystitis. If you were to go to Medicentre, a private primary care walk in service which operates in various locations in London, the cost of the visit (at the time of the complaint) was £67, plus £9 for dipsticking the urine. Our patient had a urine dipstick and urine sent to the lab (which would have been an additional cost if done privately). That is one visit.
I met with the patient who made the complaint and explained how the system worked, what the limitations were. I outlined the resources, as above. He/she had spent a year or two in the US; he/she had paid in the region of $5,000 per annum for health insurance cover. Having had this explained, the patient withdrew his/her complaint.
The system in the UK is about covering the whole population. The cost is spread. I would suggest that £113 per head is not exhorbitant for providing all primary care services. Out of this we pay staff, utilities, and all other overheads. Oh, I forgot, rent and rates are not included; these are paid directly (£30,000, or £8-60 per patient).
*
*[Day of action: We took action which in fact had no impact on patients (we wore badges, and put up some posters in the waiting room to inform the patients as to why it was happening), but patients were seen as per normal.]
In other words, the taxpayer is paying less to insure me against primary care needs than insurers are willing to insure my cat for (I just got an online quote from Petplan and they wanted £16/month).
I wince at what my local GPs get paid (based on information the government has made public) but given that there are a number of trades/professions round here that pay more, I try to keep it in perspective. Who do we think should be paid more? Well, we all know who people are prepared to pay more – celebs, slum landlords and the guys who control their supplies of legal and illegal drugs.
I forgot to mention that without knowing anything about Petplan, I wonder whether they’ll be prepared to go ahead with the insurance once they find he’s got FIV, arthritis and cancer. Fortunately as a British human, I don’t have to worry about whether I’m insurable. (Once all three main parties have succeeded in privatising the NHS I expect that will change in England at least.)
GP pay average: £105,300 in 2008/09 according to the NHS Information Centre. So yes, GPs are trousering huge amounts compared to equivalent professions! That you don’t even know your own profession’s figures is rather illuminating. And that you attack the figure I quoted you, without even a moment’s googling to confirm its accuracy.
GPs are overpaid!
Do you remember 1948 when Bevan could only get agreement from the doctors to create the NHS by “stuffing their mouths with gold”. Similar unionised tactics have pushed their earnings higher and higher. How can you defend the latest industrial move to sure up gold plated pensions whilst every other member of their vastly poorer constituency is taking a hit on theirs time and time again.
http://www.hsj.co.uk/news/finance/gp-pay-revealed-by-nhs-information-centre/5019383.article
My landlord has 70 properties with an average of 5 flats. He doesn’t bother with the basics like gas safety certificates or sorting out the dry rot or fixing the communal fire alarms or stopping the rain coming in or stopping sundry ceilings falling down in various properties, but what can you expect of someone who’ll take in people on benefits. Well, he keeps me off the streets, but for more than ten times (after tax and labour) what my GP earns, he isn’t keeping me alive. (At home, it’s probably my gas and CO and smoke detectors that are doing that.)
It’s all relative.
Bullshit drs are paid far too much I know as I was working for a dumbo dr for 30 years they get paid for even farting prescribe a handful of memorized or just look in the mims medication they employ nurses to take bp n bloods funded by the government staff n rent is also paid by the government they only have to pay gas electric n telephone. Come to work 2 hrs am 2 hrs evening n still complain? They need to be shot we Dnt need drs Like them
absolutely drives me made how much gps are paid and for so few hours. the math is simple, if their salaries were halved, we could afford twice as many of them.