GP salaries up by average of 58% as working hours fall

Summary

Each year general medical practices provide some 290 million consultations. The new contract which was implemented in April 2004 (increased spending began in April 2003) changed the basis for commissioning primary care services. Instead of contracting with individual General Practitioners (GPs), Primary Care Trusts (PCTs) commission services from some 8,325 GP practices with around 33,000 GPs.

'NHS Pay Modernisation: New Contracts for General Practice Services in England' (HC 307) examines the negotiation and implementation of the new contract and how well it is working in practice.

In the first three years the PCTs spent £1.76 billion (9.4%) more than the minimum committed by the Department. Mostly this was due to an underestimation of the amount that GPs would earn from the pay-for-performance scheme, the Quality and Outcomes Framework (QOF), and the additional cost of providing out-of-hours care (most GPs have opted out of providing this service).

The National Audit Office's conclusions include:

GPs' salaries have increased by an average of 58%; practice nurses have not benefited to the same extent.
While the number of consultations with patients has increased these are not in proportion with the increase in costs and productivity has fallen by 2.5% per year.
GPs are working less hours.
Some progress has been made in: extending the range of patient services; reduced administration; high quality care; linking pay and performance; and staff satisfaction and morale.
Progress has not yet been demonstrated in productivity and re-designing the services around patients.
The contract has contributed to improved recruitment and retention of GPs.

The National Audit Office's recommendations include:

The Department should develop a strategy for yearly negotiations on the QOF, which should be based more on health outcomes.
PCTs should provide more services based on local needs and review the number and skills of staff employed to commission and performance manage GP services with the aim of improving local commissioning.

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Law-Making Explained

This is a House of Commons Paper (HC 307): it is a Report from the National Audit Office.

Find out more about House of Commons Papers.

How does it affect me?

If you are a practicing GP, a patient or are interested in pay modernisation within the NHS, this may be of interest to you.

Dr Laurence Buckman, Chairman of the British Medical Association’s GP Committee, has challenged the National Audit Office's conclusion that productivity has fallen. Dr Buckman said, "General practice has changed and primary care is now provided by a whole team working in the surgery. The number of consultations has gone up, the time spent with the patient has increased and the work GPs do is more complex. In fact the entire way GPs work has changed so it’s meaningless to talk about productivity in the way the NAO has done."

Alastair Henderson, acting director of NHS Employers, suggested that some of the figures quoted in the Report were 'misleading' but expressed support for the National Audit Office's recommendations.