Are GPs overpaid? Ms Alice Thompson has no sympathy for General Practitioners.

In The Times 28th May 2014 Alice Thompson opines: These overpaid doctors must stop whingeing

Ms Thompson opines and I have no doubt her view will increase the correspondence to “the Thunderer.” GPs put the individual patient in front of them first, and their first duty as a doctor (GMC) is to put their patient at the centre of their concern. The plural, patients as citizens, and communities, is for the government to put first. The greatest good for the greatest number is a utilitarian duty of government, and only becomes the duty of a doctor in wartime or in a crisis. Perhaps she is arguing that we are in a similar catastrophic situation? There is certainly no NHS from the point of view of one who lives in Wales and wishes to exercise choice. In Wales, where there is no aspiration, there is unlikely to be excellence, and recruitment (strangely it seems to the politicians in Wales) is a problem. Would Ms Thompson opine on why General Practice, once the jewel in the crown, and certainly the one aspect of the Regional Health Services that most Ministers of Health in the world would like to emulate, is now finding it hard to recruit enough doctors?

With apologies I reproduce the article in full:

GPs profess to put patients first but they need to modernise and adapt to increasing demand, not just lobby for money

In our house there is a box of wooden bricks played with by generations of children. It was given to my great-grandfather, a GP in Manchester, in return for nursing, for free, a child through whooping cough. We also have a miniature Victorian doctor’s bag that a cobbler made for him after he stayed up all night to save the man’s wife and baby during a complicated birth, refusing to take any payment.

The British used to revere their GPs. During the Second World War when British bombers bombarded the continent with copies of the Beveridge report, the idea of free GPs obsessed those who read it, according to a new book by John Micklethwait and Adrian Wooldridge The Fourth Revolution: The Global Race to Reinvent the State. Everyone dreamt of free access to their doctors’ words of wisdom and, after the war, NHS GPs became the envy of Europe.

As the royal family, politicians, teachers, journalists, vicars and bankers seemed to lose their way, GPs were the one profession that, until the turn of this century, were still trusted by more than 90 per cent of the population. The family doctor remained the linchpin of the community.

Now GP leaders say the service is “teetering on the brink of collapse” and that the government needs to “save general practice”, and they have launched a poster campaign showing queues of patients waiting outside surgeries. The Royal College of General Practitioners suggests that GPs will soon have to treat people on a first-come first-served basis or that patients will have to wait three weeks for an appointment. They say that they need to increase their funding by 11 per cent in the next two years, almost £3.5 billion, and they want all their patients to sign a petition backing them.

A decade ago there would have been huge sympathy for these poor put-upon professionals, up half the night, struggling through the day on mediocre pay, keeping the NHS going. But not now. Most people don’t feel GPs are hard done by any more. They have done pretty well, even during the recession. In 2004, partners managed almost to double their pay, suddenly earning on average £113,000 a year, while often cutting back dramatically on their workloads. They were no longer expected to be responsible for out-of-hours care. More than a quarter now work part-time to their own schedule.

There are exceptions, those who are seeing up to 50 patients a day, but most cannot be said to be under undue pressure. According to a McKinsey report published in 2010, GPs spent an average of 22.5 hours a week face-to-face with patients. Locums, NHS Direct, the new 111 system, the ambulance service and A&E have had to pick up the pieces in the evenings and at weekends. At the same time, British GPs have become the highest paid general practitioners in the world, according to OECD figures, earning more than the average medical specialist; they just spend less on equipment than they do in other countries.

The posters are part of the royal college’s “Put Patients First” campaign but it has become clear that it is the GPs who now come first. They have designed a system that suits them, not the public. When they stopped doing out of hours, I wrote a piece about how my youngest son nearly died from meningococcal disease when he fell ill one Sunday evening and NHS Direct suggested a purple stain on his stomach was just a bruise. I received letters from devastated parents whose sons or daughters had not survived after their GP had been unavailable for a consultation when their child fell ill. I received even more correspondence from the elderly or chronically ill, explaining that they see a different GP every time they visit, which they often find confusing and embarrassing.

More than 34 million requests for GP consultations will fail to be met this year, according to the GP Patient Survey, while hospitals are inundated by those with coughs, stomach bugs, ingrowing toe nails or migraines, and those requiring repeat prescriptions that they can’t get at their doctor’s. A&E staff see four million more patients a year since GPs changed their contracts in 2004.

Meanwhile other healthcare professionals are increasingly angry at GPs’ special pleading. Emergency staff, neurosurgeons, paediatricians and gynaeocologists may be on the same pay but are working longer, more variable hours.

GPs can’t carry on whingeing. They are desperately needed to help shape reform. David Cameron has pledged that an extra 1,147 surgeries will open between 8am and 8pm seven days a week. This government has already increased their number by 1,000. Ed Miliband, too, has promised that if Labour gains power he will provide the money for patients to be guaranteed an appointment in 48 hours.

The NHS budget is still ringfenced. The amount given to GPs since 2004 has risen from £7.2 billion to £9.2 billion, slightly more than inflation. Last week when the possibility of charging for appointments was raised, many GPs shouted it down without suggesting any alternatives.

The royal college is supposed to focus on training and education. It should be discussing how to modernise and adapt to increasing demand rather than continually lobbying for extra money — and working out where it can take the strain from A&E and be at the forefront of preventive medicine. “For we have agreed”, as Plato once said, “that a physician, strictly so called, is a healer of bodies, and not a maker of money, have we not?”

Update 30th May 2014 … Times correspondence:

Funding is falling, patients are getting older and iller, GPs are feeling the strain

Sir, I have been a GP in Devon for 22 years. The first 20 years were very rewarding, but the last two have been different (Alice Thomson, “These overpaid doctors must stop whingeing”, May 28). I work from 7.30am to 6.30pm without a break. The consultation rate has increased from 3-4 contacts a year to 6-7. Our population is getting older and more frail, further adding to workload. Increasingly our time is taken up by paperwork. The work transfer from secondary to primary care has been huge in the past few years.

Yes, GPs are well rewarded but we are also at point of collapse. We are asking for more money to pay for more doctors so we can offer a safer and better service to our patients.

Dr Elizabeth Brown

Teignmouth, Devon

Sir, Alice Thomson is correct that I see patients for about 24 hours per week but I spend at least that long again on filing, visiting patients at home and running a business (my surgery). We are being paid less and less for doing more and more work.

It should be pointed out that people need to take more responsibility for their own health. A&E departments are full of people who’ve drunk too much. Obesity is causing ever greater problems.

Dr J Hobman

Roundhay, Leeds

Sir, The workload has risen beyond recognition during my years as a GP. My practice’s funding is being cut by one third, yet I will still have to give the same level of care to the same number of patients (12,500).

All the Royal College of General Practitioners asks is that primary care is funded sufficiently so that there are enough GPs to see the patients, to ensure the recruitment crisis stops, that GPs don’t retire on grounds of ill health due to burn out.

Dr Michele Wall

Colchester

Sir, If general practice really is such an easy ride for overpaid GPs, why are older doctors retiring early in droves and why are young doctors shunning it in favour of working in hospitals or going abroad?

The numbers of young doctors choosing to become GPs went down 15 per cent last year. To quote Dr Chaand Nagpaul from his recent conference speech, “these doctors are not shunning the discipline of general practice, but the intolerable pressures that GPs are subject to, together with relentless attacks that devalue what we do, and which has butchered the joy and ability of GPs to properly care for our patients”.

Virginia C Patania

& Dr Naomi Beer

London E1

Sir, We should be sceptical of the RCGP’s demands for more money. British GPs are paid 3.4 times
the average wage in the UK, compared to 3 times in Canada, 2.7 times in Denmark and 1.7 times in Australia.

The National Audit Office found that between 2002 and 2006, GP partners enjoyed an astonishing 58 per cent pay increase despite working seven fewer hours a week than they did a decade earlier. Having such highly paid GPs means we can afford fewer of them.

In England we have 6.8 GPs per 10,000 persons compared to 20.2 per 10,000 persons in Australia.

It’s no wonder that it takes
people so long to get an appointment, a situation which is only exacerbated by the lack of GPs working at weekends and in the evenings.

Alex Wild

Update 1st June – Letter from Dr Maureen Baker RCGP and Patricia Wilkie NPA from 31st May 2014:

Investing in general practice will enable surgeries to deliver shorter waiting times

Sir, Further to Alice Thomson’s blistering critique of our call for more funding for general practice (“These overpaid doctors must stop whingeing”, Opinion, May 28, and letters, May 30), we are not asking for higher GP pay. We are asking for an increase in the proportion of NHS funding for general practice so that more GPs and practice nurses can be employed. In recent years there has been a cut in funding to general practice — to 8.39 per cent of the NHS budget — while the population is increasing and ageing, leading to higher demand for GP services in particular.

Investing in general practice will enable surgeries to deliver shorter waiting times, longer consultations and better continuity of care.

Workloads for family doctors are ballooning, and 84 per cent of GPs worry that they might miss something serious in a patient. According to a poll in March, 62 per cent in Britain think GPs’ workloads are a threat to standards of care.

Dr Maureen Baker

Royal College of General Practitioners

Dr Patricia Wilkie

National Association of Patient Participation

Update 2nd June 2014. Times letters:

Sir, Virginia Patania and Naomi Beer (letter, May 30) ask why older doctors are “retiring early in droves”. Part of the answer lies in a pension provision which is excessive by many standards and unaffordable by the nation. The solution lies not in paying doctors more, which would allow even earlier retirement, but in training more doctors and paying them less.

About 30 per cent of doctors in the NHS qualified abroad, rising to 50 per cent in the hospital service. In some parts of the country even locums are unavailable to fill service gaps. This is a shocking failure of leadership in what used to be a fine service.

Professor Michael Joy, FRCP
North Curry, Somerset

Sir, I strongly disagree with the claims made by Alex Wild of the TaxPayers’ Alliance (letter, May 30). At the moment there are advertisements for GPs in Canada (Alberta) for £162,000 to £270,000 per annum and Melbourne (Australia) for £140,000 to £220,000 per annum. Open the BMJ and British Journal of of General Practice to see the constant advertisements for overseas jobs.

Its no wonder that Australia has 20.2 GPs per 10,000 people and we have only 6.8, given the poor remuneration that is evident on an international scale.

Carry on complaining and you will speed up the retirement and emigration from — and loss of — new entrants to the specialty.

John B Ashton (retired GP)
Norton sub Hamdon, Somerset

We have to plan for “overcapacity” in all medical specialities because of drop out and emigration. It is common and appropriate for doctors to get experience abroad. This helps their overall development and if they return to UK is of benefit to us all. However, we can reduce the risk of permanent emigration, and of the drop out rate, by training less undergraduates and more graduates. Graduates with debt are really focussed and few drop out or emigrate. They are equally likely to be men as women (c.f Undergraduates) where women dominate. Overall they will give more service to the Regional Health Services, but they will tend to concentrate on attractive popular areas with good schooling. Regions with poor attraction to the profession (e.g Wales) need additional policies of help recruitment, possibly with housing and education subsidies….