At least two family GPs are currently being paid around £500,000 a year by the NHS, while another 161 are earning a salary of more than £200,000, according to a report today.

One doctor, who owns two practices in West London, declared annual earnings from the NHS of £507, 241, and has earned more than £1.2 million in total over the past three years. The second GP, who runs two surgeries in Birmingham, is said to have earned over £1 million in only two years, the Daily Mail* reported.

This compares to the Prime Minister who earns a salary of £142,500.

Pay for family GPs has increased dramatically in recent years, since the Labour party introduced a new contract in 2004 that allows doctors to ‘top up’ their earnings. For example, GPs who offer out-of-hours care, something they were previously expected to provide for free, are now paid huge sums in overtime. And agreeing to treat certain conditions, such as asthma and diabetes, will earn them bonuses.

The British Medical Association (BMA), which represents doctors, claim only a very small number of GPs are high earners and maintain that large pay packets are a proper reward for GPs who have achieved entrepreneurial success while maintaining patient care.

The coalition government however imposed a pay freeze on GPs earlier this year as part of plans to make large scale public sector cuts. The government has also promised there will be a better link between pay and the quality of patient services provided.

But what do you think? Are GPs being paid too much? Or do they offer good value for money? Doctors do after all save lives.

And if GPs are given the huge responsibility of handling the £80 billion NHS budget** do you perhaps think they deserve a pay rise?

*http://www.thisismoney.co.uk/home/article.html?in_article_id=513693&in_page_id=1&ct=5
**http://www.citywire.co.uk/money/can-doctors-run-the-nhs-and-save-the-government-billions/a414168#comments

When the new G.P. contracts started my G.P.'s practice increases were published in the local press. They had an extra £30,000 each, while at the same time stopping all out of hours care. Nobody can blame them for accepting more money for less work. It was the fault of the previous government, who had no idea that most g.p.'s were already doing the extra services which the new contracts paid them a bonus for.The contract needs to be reviewed.

I go to see the doctor with a simple ailment and am given a variety of tests I see no need for. Why is this? It seems that the doctor's practice has been given an incentive through targets and payments to undertake these tests, whether it is to weigh me, or to test my blood pressure. It doesn't take up too much of my time or the doctors and I suppose in some cases it might catch something serious.

However how large are these payments? Is this not the same problem that US doctors have with undertaking extraordinary numbers of tests at great cost - in the US from the patient and their health care provider, but in the UK from the State.

Why have I taken out private health care?

There is no doubt that the BMA professional negotiators ran circles round the Civil servants over the new contracts, and the huge leap in salaries for less work is due entirely to the incompetence of the Labour Government. In the market place, there was no shortage of able canddates applying for medical training so there was no need for such a large increasein salaries, and the long term problem of large salaries absorbing the bulk of the additional investment and making the NHS in it's present form unsustainable. The BMA are a greedy trade union and have done the people a disservice.

George

Fully agree with Malcolm Martin! I was employed in the NHS and privy to the negotiations on the alterations to the Out of Hours service which operated perfectly well and cheaply when run by local GP's. GP's were, as I recall, railroaded out of this operation despite strong opposition from the majority of local doctors many of whom argued that the service would deteriorate and become far more expensive to operate! How right they were! Treated with utter contempt by the Labour Govt, I do not blame them one iota for making financial hay, despite the fact that this has proved a very costly experience for the taxpayer of which I am one!

I have no doubt howeve, that these very attractive contracts will be renegotiated as they are unaffordable in the current economic climate.

Surely the GPs are just trying to keep up with the dentists?

Which civil servants were responsible for drawing up these contracts? Are they accountable to anyone?

IM

Ken, quite so. Doubling the training places and having the medical profession paid sensibly would be a step forward.

Another heinous evil in the current system is that it has sucked in vast numbers of health professionals from the deeply impoverished developing nations that have paid to train them .... leaving few behind to care for their own populations. Resolve this mess and cuts to overseas aid budgets would be far less of a big deal!

Meddling politicians and civil servants with their intended consequences.

Yes, they are way overpaid - in many cases they just perform an administrative function. My recent experience of GPs has been woefully inadequate - they have failed to do anything other than refer me elsewhere, they have never made a decision of thier own that they might get blamed for and they certainly dress well and drive nice cars! We need to stop the 'reverence' bit - its got completely out of hand - in Germany its not uncommon for medical doctors to become computer salesmen because the money is better - there they have the sense to train enough of them (and there is no shortage of would be medical Doctors in this country) and then let them decide if the vocational call, rather than the financial one, is strong enough for them to keep doing the job. They have a better and cheaper health service as a result.

A minority? not how I read most of the posts here. You may have missed the points that I was trying to make, ie the extremely large incomes are somewhat atypical and represent a tiny proportion of GPs who generally earn less than half of the figures quoted, that GP income figures are artificially inflated by including the employers superann contribution, (and in fact also usually are before expenses eg defence union subs) so are again incomparable directly to consultants NHS pay or other professions, but yes as a profession we are quite well paid.

Your somewhat rose tinted view of the 'gold-plated, state-funded final salary kind' when referring to pensions again displays a very common error - GP pensions never have been final salaty versions, and with regard to anything being goldplated and guaranteed in this day and age is clearly out of touch. I can bore you of the details or the recent changes if you like, but employees contributions went up by 25% a few years ago with no extra benefit whatsoever in future pension provision. You may or may not be aware that currently HMG profits from the NHS pension scheme (ie receives more than it pays out) and whilst this is a recent feat, with current contributions it is forecast to remain that way.

There are of course a few other points in the posts above worth mentioning-

'I'd rather they focussed solely on the needs of their patients'- Agreed. Which is why GPs will usually employ a practice manager to deal with all of the premises, staff wages -including sickness/maternity- equipment costs, phone/electricity bills etc along with the staff management etc. Now we could centralise that bit and have staff chosen and allocated and managed and buildings repaired from a separate more unwieldy management structure but a slimmer more immediate structure seems to be rather more responsive and interested in the day to day needs of the business and having worked in impersonal hospitals and larger health centres know that a tight knit focussed team is somewhat preferable. Which means I can concentrate on the patients.... I don't know whether your use of the word 'needs' was accidental or deliberate, but it is honestly the most important word in that sentence. There will always be potential for a mismatch, but 'wants' have been suggested as 'rights' by the previous govt which has completely distracted us from being able to focus on needs.

Out of hours is interesting. From the occasional call and rare out of bed visit, the blurring of emergency and urgent and want and 'right' led to most GPs forming cooperatives which on the whole worked very well, so that at least a GP had the chance to work a defined 'shift' in the evening or weekend such that sleep and family life became possible and the GP you saw in the daytime was unlikely to have been on duty for the previous 56 hours (eg weekends). I honestly don't know why the govt decided to make it virtually impossible to continue to provide OOH on a practice by practice basis, but can tell you that the increase in OOH volume was such that when offered a pay cut of £6000 it was a no-brainer to hand over OOH to the PCT. You may be aware that in many areas the OOH providers are still run on the same basis as before and local GPs continue to do shifts as they do feel responsible for their local patients. But OOH providers can also be run as businesses, making profits for their owners. Importing cheaper foreign docs (like from Germany where it pays better to sell computers...?) led to several errors, some sadly fatal.

We can debate the merits of getting more into the profession for ages- I don't think it's rocket science to work out how many hours GP provision is needed and then do a little number crunching wrt number of women (and men) likely to drop out/work part time, how to get adequately trained given the EWTD, how many training places there are, what the likely future need is and then alter the numbers of applicants getting into med schools. Although this does have a 10 year lag to get another GP, there are finite numbers of med school places, the debt med students acquire is a major barrier etc etc. You may be aware of MMC (modernising medical careers) and the recent bulge in med school graduates- who suddenly found there were NO training spaces available in ANY specialty and thanks to MTAS those that got the posts were certainly not always those who were/would have been the best docs...But I'm a GP and not interested in quangos or peerages so the common sense approach falls by the wayside...

Merit awards are nothing to do with GPs- we are not worthy...

The quantity/quality argument is the real nub of the problem- and how 2 (or more) people would judge the same scenario. If I get all my smokers to quit, but am known as 'Dr Grumpy' by the patients am I better or worse than Dr Cardigan who's manner may be gentler and cuddlier with higher patient satisfaction scores but with <50% quit rates? Or when I treat a depressed patient and get them better- challenging, time consuming, rewarding and with a great outcome for the patient, does the fact that my QOF point score is lower than the next practices (and therefore possibly down the league tables) matter as I overlooked filling in a PHQ9 (google it) questionnaire and thus lost 'points' whilst the practice up the road got the questionnaire filled in and thus the points, but spent less time dealing with the causes of depression thus their patient remains depressed?

Dr Grumpy :-)

Different perspectives are very important- but provide much of the challenge of day to day GP especially with the baby boomer population who know their rights, are prepared to shout and complain until they get what they want (not need) and back it up with sheaves if internet references (variably appropriate...).

The oldies are great (dont ask for enough often) and the kids are fantastic (it's just their parents), and most of those in between are a pleasure to care for, but the increase in worried well who know their rights and 'deserve' an appt within <48 hours cos that's what the govt say you must do to address their sore toe they've had for 6 months is a challenge the NHS cannot afford- sadly politicians know this demographic votes and chooses on a somewhat more selfish level than the rest of society so until the NHS gets out of short term political control and develops longer term strategic aims we will remain with dodgy incentives to change GP behaviour.

The notion of reducing GP pay and increasing their numbers is interesting. The main barriers I see are that it's very difficult to vote to slash your income when a certain standard of living is attained- I do not see this as only applicable to GPs! Some GPs work extremely hard and yet take home significantly less than others- we know that's an oddity, evening out would be a reasonable long term prospect but may stifle the entrepreneurs and to be honest we do know that this is the case when we head towards a particular job. The bigger problem with more GPs is that it will cost the NHS more; assuming more GPs = easier access = more patients seen, then referrals will rise, hospitals will be busier and the NHS will cost more. And not always with a corresponding improvement in objective health measures, or reported patient satisfaction outcomes...


Until then I am happy to remember that a GP visit is the most cost effective part of the health service; more efficient and cheaper than NHS direct, walk in centres, pharmacy advice, a+e, or an outpatient visit so by all means carry on bashing all GPs and the poor service they provide- after all, it's still free at the point of use and still unmetered....