Politics in the GP workplace
In September 2014, in preparation for the GP contract for the year 2015/16, negotiators for NHS Employers on behalf of NHS England had only one item on their agenda for discussion in determining the changes in the GP contract. One would think this might be adding some important clinical improvements, like enhancing the care of vulnerable patients, or perhaps some new targets for reducing serious infections, or possibly incentives to improve the care of those suffering from cancer, but no, the only new thing they wanted in the GP contract was an entirely political one, and it was that the salaries of GPs be exposed to the public. Therefore, according to our contract, average GP earnings must be published. The reason cited for this move is 'transparency', yet we are not seeing similar transparency being applied to every NHS worker or even other 'public servants' (although paid from the public purse and widely considered to be public servants, GPs are actually independent contractors to the NHS).
Consequences of such actions
Such a single-minded determination to do this clearly betrays the contempt in which GPs are held by those in power. This directive would have only come directly from the government; a government which has been intent (along with previous governments) on destroying the very fabric of General Practice and with it, the rest of the NHS. Unintended (or some would say intended) consequences of publishing income include, making it more difficult for practices to recruit doctors, continuing the downward pressure on salaries, widening inequalities between practices, localities and regions, further increasing the risks to the very business of General Practice and paving the way for an invasion of profiteering private enterprise (initial forays into this area by some such providers have already been proven to provide a poorer quality service, and contracts are often terminated early, leading to patients suddenly being without a GP).
General Practice At Risk
The single greatest asset of any workforce is actually its workers, and particularly more so with the NHS, which largely runs only because of the goodwill of its doctors, nurses and other hardworking staff. However, as aptly illustrated by its recent approach with the junior doctors, the way the government is treating its crucial staff reveals its true intentions towards the NHS.
As of March 2016, almost 300 GP surgeries in England face closure because of financial pressures and nearly half have doctors planning to leave the NHS; in total more than 900 GP practices are in a weak financial position. This is about 1 in 10 of all practices. There is therefore a very real risk that many thousands of patients will be left without a local GP surgery that can deliver the care that they need.
If you are at all concerned about the future of the NHS, and especially General Practice, widely considered to be the cornerstone of the NHS, you can write to your local MP or to the Health Secretary. As GPs we have already repeatedly made our feelings known, in last ditch attempts to get the message across to politicians and the public about what is happening to General Practice. As patients, but also as voters, you may wish to do the same. You can find details of your local MP at www.theyworkforyou.com
Some Perspective and actual Transparency
Publicly available figures show that Baddow Village Surgery receives £89.88 of funding to care for one of our patients for an entire year. For this, any patient can see us as many times as they need, including face to face, telephone or home visit encounters. Our patients see us, on average, about six times a year, with some vulnerable patients each seeing us 15 or more times a year.
From this £89.88 figure, as with other GP practices, we pay our heating, lighting, cleaning and maintenance, staff wages, training, insurance, buy all our consumables (couch rolls, gloves, envelopes etc) and anything else that is required for providing care and running a practice. What is then left over is shared between the partners who own the business.
Also bear in mind that with this level of funding (which realistically would only provide for two consultations in a year if paid at normal market rates), GPs do not aim to simply provide basic low rate care. The vast majority of GPs provide not only high quality care and but also, more importantly, safe care, whilst also working towards difficult and often irrational government targets; all of this is often at immense personal cost to themselves and their families. Regardless of what you might read in the papers and what you might hear from the mouths of politicians, GPs are dedicated professionals who have an innate sense of striving to do their best to help people.
Comparing the annual costs of everyday items:
- £89.88 is the cost of medical care for you for one whole year
- £150 is the price of the cheapest 4G phone contract
- £170 is a trip to the cinema every fortnight
- £179 is how much a monthly haircut would cost
- £209 is an average bottle of wine every two weeks
- £240 is the cost of a basic Sky TV package
- £339 is the average cost to insure your dog
So now you know, but more crucially, you now know why...
Acknowledgements to Ivy Grove, West End and St James Surgeries