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
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.]