GPs are paid way too much!

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.]

15 Responses to GPs are paid way too much!

  1. Can't think of a name says:

    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.

  2. David Read says:

    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

  3. Can't think of a name says:

    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.

  4. Zee says:

    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

  5. adii says:

    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.

  6. D morgan says:

    Whomever is to blame, the patient isn’t concerned with whom, all they know is the GP system is often failing for them as a system, out of the 5 visits I’ve made to a GP in last 15 years, I would not consider I got £1600 worth of treatment ? 100k a year on average seems excessive. The field of medicine imo relative to the issues that people have, is till in its infancy regardless of the all knowing 1950’s parent aura that some Gp’s seem to exude. The box of cures rattles half empty it seems, except for elements of physical surgery, The box of treatments is stuffed with chemical imbalancing, side effect causing, mediocre treatments that sometimes successfully alleviate symptoms, but often leave the patient worse off in the long run. The 1920’s colonial from 12 feet viewed, style of symptomatic visual diagnosis is completely out of date, I’d rather have as much scientific testing / screening done as possible by a machine, and leave the rest that cant be done by a machine or is of immediate urgency done by doctors, its not good a doctor seeing the quantity of people they try to get through in a day, if he wants push those cases to some useful form of health resolution for each individual patient. Id rather a system in which surgery’s/GP’s were paid for treatments, consultations, and outcomes, the current whether government engineered or gp engineered system, seems to lead to a situation in which gp’s profits are created by deferring people from visits or treatment, as they make a greater profit from the total they are given if they spend less themselves on the patient, GP’s should be paid on a time / healthcare outcome basis, especially since the falsely perceived vocational element seems to have gone completely or lost all of its respect, I think that respect for gp’s has died with the complete cultural fragmentation of our culture down to the bedrock of monetary divide, this situation only wasn’t so … for a brief period of time post the formation of the NHS, in its heyday 1948-1976. If healthcare were private completely in the UK, it would be a form of healthcare ransom shakedown / robbery as it is in America, whereby people who work in healthcare even in relatively basic posts are excessively wealthy compared to to other people around them in culture, which leads as always to further divide and erosion of trust, and leads to the standard situation found globally, which is also true in Britain but not as excessively so. If your poor, you die earlier, and you will often lead a less constitutionally sound life, for those years in which you are on a doctors books.

    If like me you live in urban poor outer london, this will be the scenario: the appointment delay is 2-3 weeks in being seen, you will get 15 minutes of someones time who is being paid 100k a year, who will make short shrift of you and your ailments and persuade you in general to take a form of painkillers or antibiotics if your lucky and say come back in 2 weeks, or if your really lucky put you forward to a specialist who is equally overloaded, the only time a gp will push your case forward is when he’s reminded of your case when staring at the computer screen in that 15 minutes you might be able to book once every 2 weeks, other than that your healthcare is your own affair, The system mainly revolves around waiting for something to break major style, heart attack etc and going to A&E to get something done about it, rather than preventative care to catch complex subtle illnesses that go on to kill later, The GP profession in my poor area seems mainly loaded with foreign asian doctors whom turn over more frequently than my visits, or locums. and sadly reception staff who have lost any sense of care due to them at them being at a frontline of a system that seems perpetually under collapse, I’m sure as always its mainly the sharp operator Gp’s who benefit the most from the system, by placing their own financial comfort first, rather than their patients. The NHS should employ NHS only Gp’s recruited directly and pay them on the basis of hours and outcomes, and make sure they employ a range of native people, who understand its a vocation, but at the same time do not exude any ego, and are completely honest and clear about the failings of medicine currently, and where it has domain over ailments and where its understanding is currently sparsely informed and lacking, because allot of the time a patient gets a diagnosis that has little or no cure and limited treatment, arriving at this point is no doubt a written down in reports as successful resolution and diagnosis of an issue, but doctors should start to be very clear with patients that naming and recognise some ailment doesn’t mean doctors understand anything useful about it, and is only the beginning of the journey of medicine.

    The prescription systems needs complete overhaul the idea that to renew a prescription in this day and age, one has to hand a scrip form in at the surgery and then wait 2 working days (meaning over bank holiday weekends (5 days?), illness doesn’t take a break on “non work days” and then return to the surgery to pick up the scrip then go to the chemists to pick it up, is archaic ? If amazon can like clockwork, deliver a vitamin to my door once a month on time, then why not the NHS ? this to me seems like a lack as usual with the NHS of getting with the technological times and putting in place the infrastructure to make things happen ? Amazon could certainly do the delivery to peoples door better than the NHS will ever manage.

  7. Kaz P:ort says:

    GP’s are grossly overpaid. People are dying because they are misdiagnosed. They are useless poison pill pushers. Their training is out of date. They need to be trained to treat the whole person.It’s about time they were taught how to treat fibromyalgia. In the USA there are clinics that treat fibro and CFS all over America.

  8. Oli says:

    GP’s are massively overpaid and most of them are Arrogant, patronizing and utterly clueless. Nowadays all they do is type your symptoms into a computer and prescribe whatever pills the screen tells them to. Spending 20 hours a weeks doing this for £105,000 must be the world’s cushiest job. It really annoys me when I hear GP’s in the news moaning. They should shut their whining mouths and concentrate on actually treating patients for a change or maybe learn some decent people skills which so many of them are completely lacking.

  9. RMN says:

    I have been involved in a number of commissioning meetings over the past 3 months and have discovered just how much GPs are paid to deliver basic healthcare. It’s too much and every suggestion about how to make improvements is met with complaints about how much time it might take and bleating about how they are now businesses and need to be paid for any additional activity. The needs of the patient are rarely even mentioned.

  10. Mills says:

    You are all right and you are all wrong. There are some really great GPs, (often young doctors who understand the concept of reviewing their practice to identify what they do well, and where they need to improve). There are some poor GPs (often older and slow to adapt to new expectations), Finally there are a lot of reasonable doctors.

    However almost every single GP make fewer mistakes than the majority of senior bankers, politicians, journalists and lawyers.

    The NHS needs to engage more with nurses,pharmacists, and other healthcare professionals to meet the needs of the modern era

  11. First of all thanks for explaining how GPs get their (make their) money- could not find the name though.
    At the current rate the way GPs conduct their practice I do perhaps arguably agree with Matthew Parris. This is a direct contrast to what I experienced a few years ago. At our practice we had been told that if you need to see a doctor for a sickness you have to phone at 0800h and get an appointment on the day [I presume this goes from the Gobal Sum. However, it is impossible at 0800 O’clock to get through and when eventually get through the answer we get most of the time is that we are fully booked. Next is going to a walk in centre, the nearest is ~7miles away. Waiting time could be at least 2 hours. If you have to go to the A&E, unless it is an absolute emergency waiting time could again range from 2 hours upwards (my last experience was at least 6 hours) before a medically qualified persons sees you.
    GPs main aim currently seems to be how they manage their ‘business’ rather than patient care. Why pay that much if patients are not able to see them when they need to. It is not possible to book an appointment in advance either. One cannot phone and book an appointment in advance. Phoning has to be done only 4 days in advance [That is bizarre too].

    As GPs are providing a service paid for by the tax payer, tax payers should be able to see verified stats for each surgery. This can even be displayed in the reception area so that people would not complain that much if everything is acceptable. These stats should be randomly audited to make sure that they are accurate. Authority by the patients should be given to the authorities to check the validity of claims by the GP.

    They should clearly display how one can see a doctor and the alternatives available.

    A transparent booking in system should be introduced for each surgery, so that it can be either checked on line (or by telephoning) at any time. This will prevent potentially prioratising treating your ‘chums’ at the expense of others.

    Is there any standards related to the minimum number of Doctors/Nurser a practice must have to provide the service they are paid for.

    How many GPs are there in England and Wales per 1000 people?

    Do GPs take a risk for them to make money as a business or the risk is taken by the patients/tax payers?

  12. Gp in London says:

    I am a GP. I love my job. I am not complaining. But these comments are very demoralising. These false beliefs are more and more widespread. This allows the government to push more and more work onto us for less and less resources. The £105,000 is average gross profit per partner. It is not net profit. As any buisness person will tell you gross profit means nothing. From this we pay all the overheads. My take home is closer to 55-60k which I am very happy with. And don’t feel guilty about. I have spent a total of 14 years training and studying to become a ‘clueless GP’ I have debts nearing 80k. I work from 7am until 8pm every day and every other Saturday. The job isn’t just seeing patients. It’s the rest, the paperwork. Although typically I’ll see 40-50 patients per day. My morning surgery is 5 hours long then there are home visits then a 3 hour afternoon surgery. Then admin. Running the business (which could be a full time job in itself) etc. this isn’t a ‘moan’ I love my job it’s what I’ve always wanted to do. But why do people who work their entire lives with all the sacrifice that entails get so much stick from the people they’re trying to help.

    • ancientscreamer says:

      I think half the issue in London revolves around these four points.
      Delay in being seen : can be 2 weeks easily in my area
      Continuity of care : The Docters in the surgery seem to change too regularly to develop any sense of relationship with a doctor esp in poor areas.
      Number of appointments : It is pointless for the patient for the Docter to see 50 or so patients a day if the quality of the care is dropped to such a low ebb to acheive those numbers.
      The number of actual tests and treatments available in the surgery means that doctors are effectively conducting a form of observance and triage.

      On the whole a good job but I think some serious illnesses can slip through the net in the current system, due to the strain on it, we are also acutely more aware of the limitations of medicine, since so much revolves around treatment rather than cure. And that drugs seem to be used as a testing method before cause is often fully understood etc. it’s a complex subject – and I would say the ideas doctors are paid too much, is not because they are not working hard enough obviously the hours are allot, its because overall it doesn’t seem so effective a setup for the patient, and this makes whatever the price appears – less valuable. I think we need more doctors full stop conducting more in depth – in surgery testing, to get the real root of a patients health issues without the inevitable use of specialists appointments.

  13. The Voice of Reason says:

    Wow… so many of these comments are extremely misinformed, some ridiculously hateful (“GP’s should all be shot”… really?)

    People need to stop reading the daily mail, look at the REAL income figures (i.e. net income after employer & employee pension contributions, professional indemnity costs, business costs), divide that by the number of hours most GP’s work (which is NOT 2 hours for morning surgery and 2 hours for afternoon surgery, as one commenter here seems to think), calculate the hourly rate, and ask themselves, is this actually too much?

    Considering the amount of training, sacrifice and personal risk involved in the work, and especially when compared to other highly educated and responsible public sector workers, any reasonable person would more likely come to the conclusion that GP’s are in fact very much underpaid.

    But that’s too much work for most people, it’s easier just to have a moan about GP’s because you couldn’t get an appointment when you wanted. It is so obviously a political problem, NOT a clinical one, that is ruining primary care and the NHS in general… it’s just really dismaying to see that so much of the public still believes the rhetoric.

  14. Mustak Ahmed says:

    I fully agree and support the GPs in this aspect but what puzzles me is that if the income is so low – how is it that all the GPs get paid more than £50000 per annum?

    If the GP systems are paid so low and they are hurting and all that is said above is true then their salaries should now be minimum. Or does the Government pay their salaries directly?

    Can someone clarify this for me?

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