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Banquo's Ghost
01-12-2007, 14:09
Among the many problems facing a modern healthcare-for-all system as found in the UK, is this little gem (http://news.independent.co.uk/uk/health_medical/article2145148.ece).

It appears that general practitioners have taken advantage of an idiot government to line their pockets whilst reducing their commitments. Add that to private finance initiatives where companies take advantage of an idiot government to fleece the taxpayer for profit and one can begin to see why an idiot government shouldn't have any responsibility for public finance past buying the odd sandwich from the tea-lady.

Sick pay: Massive rise in GPs' salaries worsens NHS cash crisis

The average GP now earns £118,000 a year. This is a staggering rise of 63% in three years. And it gets better: instead of having to care for patients all day, every day, they are now just responsible during office hours (weekdays only). Is it any wonder the NHS is unwell?

By Jeremy Laurance, Health Editor
Published: 12 January 2007

Family doctors are lining their pockets in an unprecedented bonanza as they take an increasing share of the NHS's extra billions while wards close and services are cut back.

GPs' average earnings for last year (2005-06) rose to £118,000, according to estimates by the Association of Specialist Medical Accountants, a 63 per cent increase in three years. The average family doctor now earns, including private income, more than the Lord Chancellor, ministers of state, senior civil servants and circuit judges.

The soaring salary levels of doctors are worsening the NHS cash crisis. Two-thirds of NHS trusts are in deficit and have cancelled operations and extended waiting times. Primary care trusts, including those in Yorkshire, Sheffield, Norfolk and Surrey, have ordered GPs to delay referrals to save money.

Leaked documents published last week show the Department of Health is planning to shed 37,000 posts this year in an effort to balance the books.

Ministers have accused GPs of helping themselves to a bigger slice of the NHS cake under their contract introduced in 2004. Figures show the amount they pocket has increased from 40 per cent of the gross sum they are paid to run their practices to 45 per cent, leaving less for patients.

They are not passing on the full NHS funding increase to patients, at the same time as their workload has been reduced, ministers say. Until 2004, GPs took responsibility for their patients 24 hours a day, seven days a week. Their out-of-hours duties have since been reduced and they are contracted to be responsible for patients from 8am to 6.30pm on weekdays.

The shadow Health Secretary, Andrew Lansley, said yesterday: "The Government underestimated the cost of the GP contract to the tune of £200m in the last year alone. This has punched a black hole in primary care trust finances at a time when financial pressures through ministerial incompetence have hit an all-time high."

The Government defended the contract and blamed GPs for taking more than their due. A spokesman for the Department of Health said: "We invested extra funding in GP services in good faith to improve services and reward GPs. The money was not intended just to boost GPs' profits. We expect a higher level of these profits to be invested back into their businesses to bring about further improvements in services such as longer opening hours."

David Clough, chairman of the Association of Specialist Medical Accountants, said the pay bonanza was triggered when GPs scored twice what was expected on quality targets set under their new contract, such as the proportion of patients whose blood pressure was monitored. "That was wholly unexpected so primary care trusts were left struggling to pay", he said.

A member of the association, who did not wish to be named, said some GPs were earning twice the average income. The accountant said: "At the top end I have come across a few in the £200,000 bracket. The most profitable are the dispensing practices. If you have a dispensing practice you are running two businesses - a GP's surgery and a pharmacy. That really is a licence to print money."

GPs' rising salaries are part of a dramatic increase in spending on NHS pay. Last year, 47 per cent of all the extra spending on the NHS (£5.5bn) went on higher pay - for doctors, nurses and other staff. Hospital consultants earned £109,974 on average, up 27 per cent in three years. Nurses averaged £27,868, a 12 per cent rise over the same period.

Yesterday, James Johnson, chairman of the British Medical Association, defended doctors' pay rises as he warned the Government had "one more year" to save the NHS. Speaking at a press conference held at BMA House, Mr Johnson said doctors had worked harder than the Government expected and would fight any attempt to claw back their pay rise.

"One thing we will not tolerate is having these contracts whittled away. We will take an extremely strong line on a below-inflation rise for next year and we will not accept it."

Surveys show most patients are satisfied with the care they get from their GP but complaints are continuing about access. Difficulty getting appointments at convenient times is a problem. A survey by the Healthcare Commission found more than half of patients said they had difficulty getting through to their practice on the telephone.

The BMA defended GPs' pay rises. It said the Association of Independent Medical Accountants dealt with "blue-chip" GPs who had higher earnings than average. Hamish Meldrum, chairman of the BMA's GPs committee, said: "GPs are earning more but I still believe they represent very good value for money. The country gets good value out of its primary care services."

How doctors came into the money

* GPs have been enriching themselves by increasing the proportion of their budget they pay themselves and decreasing that spent on practices. They are paid a gross sum to run practices - hiring staff and buying equipment. What is left after paying these expenses is their "profit".

* In 2003-04, GPs earned a"profit" of £82,019 - 40 per cent of their gross earnings of £203,613. But in 2004-05, the first year of their new contract, this grew to 45 per cent.

* Between 1998-99 and 2004-05 the amount they spent on their practices declined from 62 per cent of their gross earnings to 55 per cent while the amount they took as income for themselves increased from 38 per cent to 45 per cent, figures from the NHS Information Centre show.

* Private earnings - fees for medical examinations, travel vaccinations, etc - amounting to a few thousand pounds per head, are included in these figures.

* NHS Employers, the body that negotiated the contract, admitted it was "disappointed" that the contract had "resulted in such significant increases in individual GP incomes".

* Changes in the way employers' superannuation payments (pension contributions) were made reduced the real rise for GPs by 5-6 per cent in 2004-05, and the proportion of their earnings taken as income by 1.2-1.5 per cent, the NHS Information Centre said.

* Gross earnings for 2005-06 are not yet available but average income for GPs is expected to be £116,000-£118,000, a 44 per cent increase in two years, according to the Association of Independent Medical Accountants, which provides financial services to 7,000 GPs.

* In 2002-03, average income was £72,324, according to the NHS Information Centre. The increase to £118,000 in 2005-06 is a rise of 63 per cent in three years.

rory_20_uk
01-12-2007, 23:31
Yes, the governments were idiots. Not managing to work out what a pay rise will cost?? Someone's head should roll.

Let's compare to the best lawyers and accountants. Suddenly we're massively underpaid.

GP's pay was low compared to other doctors. In hospital SpRs earn £80k+. So, their pay has been increased, but much was required. GPs are consultants. Why are they paid any less?

Targets were set. GPs met them - horror of horrors!! Is that a fault?

NHS pay has increased as a cost. Doctors hours have decreased from over 100+ per week to now 46.5 (my hours). So they need far more staff - as we have a decent life now.

Private earnings are included!!?!? What the hell has that to do with the NHS?? GPs are entitled to earn as much as they want in private earnings, and that's no one's business - and to be honest distorts all the figures.

City types earn far, far more. And guess what? Doctors are generally more qualified and have more ability. Personally I'm going to get a decent job out of the NHS. £100k isn't enough for me to go after long term.

~:smoking:

Scurvy
01-13-2007, 01:03
Yes, the governments were idiots. Not managing to work out what a pay rise will cost?? Someone's head should roll.

Let's compare to the best lawyers and accountants. Suddenly we're massively underpaid.

GP's pay was low compared to other doctors. In hospital SpRs earn £80k+. So, their pay has been increased, but much was required. GPs are consultants. Why are they paid any less?

Targets were set. GPs met them - horror of horrors!! Is that a fault?

NHS pay has increased as a cost. Doctors hours have decreased from over 100+ per week to now 46.5 (my hours). So they need far more staff - as we have a decent life now.

Private earnings are included!!?!? What the hell has that to do with the NHS?? GPs are entitled to earn as much as they want in private earnings, and that's no one's business - and to be honest distorts all the figures.

City types earn far, far more. And guess what? Doctors are generally more qualified and have more ability. Personally I'm going to get a decent job out of the NHS. £100k isn't enough for me to go after long term.

~:smoking:

what he said :2thumbsup:

Duke of Gloucester
01-13-2007, 13:03
Let's compare to the best lawyers and accountants. Suddenly we're massively underpaid.

Anyone (except, possibly, David Beckham) can do that: find someone whose pay makes it look as though you are underpaid. Your example is not a good one in any case. If you think lawyers and accountants are the right people to compare with, then you need to compare to the average, not the best for a like-for-like comparison. I think this would show that GPs were overpaid. Not that I think GPs are overpaid, and I don't blame them for getting the best possible deal out of the government contract. I would do exactly the same. The blame lies with the Government. In a democracy the voters need to take their share of the responsiblity too.

I do have a problem with what Rory says about private earnings being irrelevant. If someone is able to earn a lot of money out of normal working hours, it suggests that their job is part-time and the renumeration level should be decided accordingly. My sympathy for GPs evaporates when I read that James Johnson has said "One thing we will not tolerate is having these contracts whittled away. We will take an extremely strong line on a below-inflation rise for next year and we will not accept it." The rest of the public sector are going to get pay rises below inflation. Why should GPs, whose income has grown enormously recently, be treated better than the others?

rory_20_uk
01-14-2007, 13:34
The number of Doctors is extremely carefully monitored. There are few places that do medical degrees. Comparing to lawyers that went to the best unis would be a fair comparison.

If a GP is earning (to pluck a figure out of the air) £25 an hour on the NHS and works 3 days a week, he gets paid for that. If he then works privately the other 2 days and earns £100 an hour his pay will be over the year far higher than quoted - but he's not a full time NHS GP. Much better to quote the pro-rata rate for a fair comparison for the hours he works for the NHS, else such people are distorting the figures for those that aren't increasingly opting out of the NHS

After all, the point was how this is doing the NHS out of money. If it happens that these massive salaries are mainly as GPs are slowly leaving the NHS yes that is worrying

Is the person you quote some type of union member? If so every union thinks their members deserve at least 10% pay increase and to hell with everyone else. Being belligerently unreasonable is their job (and to be honest one that we don't need).

~:smoking:

Duke of Gloucester
01-14-2007, 14:09
Almost all top UK universities offer degrees in medicine. Whilst it is one of the hardest courses to get admitted to, this shouldn't be the only thing that determines pay. You need to pick some occupations you think are roughly equivalent in terms of responsibility, demand on time, demand on personal skill and knowledge and then make average with average comparisons.

I generally agree with your second and third paragraphs. The only problem I have is about demand for private health care. If the NHS works efficiently, the demand (and hence doctors' earnings) will drop. Even if the government ran the thing properly, there would still be problems because those at the top rely on an element of failure for their livelyhood.

According to the article, James Johnson is chairman of the BMA. Is that a Union? In view of his comments, I say yes. He may have a different opinion.

KukriKhan
01-14-2007, 17:08
So, newly-fledged UK GP's must put it time with NHS? Or can opt to go totally private?

Are insurance rates for potential mal-practice suits a factor in determining "fair" compensation for GP's? Does NHS (i.e. the gov't) pay out any malpractice awards, shielding GP's?

Sorry for all the questions - just rying to learn how this works there.

Idaho
01-16-2007, 13:11
Yes, the governments were idiots. Not managing to work out what a pay rise will cost?? Someone's head should roll.

Let's compare to the best lawyers and accountants. Suddenly we're massively underpaid.

GP's pay was low compared to other doctors. In hospital SpRs earn £80k+. So, their pay has been increased, but much was required. GPs are consultants. Why are they paid any less?

Targets were set. GPs met them - horror of horrors!! Is that a fault?

NHS pay has increased as a cost. Doctors hours have decreased from over 100+ per week to now 46.5 (my hours). So they need far more staff - as we have a decent life now.

Private earnings are included!!?!? What the hell has that to do with the NHS?? GPs are entitled to earn as much as they want in private earnings, and that's no one's business - and to be honest distorts all the figures.

City types earn far, far more. And guess what? Doctors are generally more qualified and have more ability. Personally I'm going to get a decent job out of the NHS. £100k isn't enough for me to go after long term.

~:smoking:
Ahhh... poor doctors struggling to make ends meet on £100k+ when their tittle-tattle dinner party rich-boy friends in the city have just got £300,000+ bonuses. It's just not fair (stamps feet) :laugh4:

English assassin
01-16-2007, 15:10
So, newly-fledged UK GP's must put it time with NHS? Or can opt to go totally private?

Are insurance rates for potential mal-practice suits a factor in determining "fair" compensation for GP's? Does NHS (i.e. the gov't) pay out any malpractice awards, shielding GP's?

Sorry for all the questions - just rying to learn how this works there.

I don't think they MUST, but the number of GPs with an exclusively private practice is very small.

GPs are technically not NHS employees, so IIRC they do not fall within the NHS's self insurance scheme. AFAIK they have to pay for their own professional negligence cover, although bearing in mind that they are in promary care, and that our damages awards do not match yours, the cost of the cover should be relatively modest by US standards.

I love the comparisons with lawyers and accountants. The average salary of a solicitor in private practice is about £50K, according to the law society (the average solicitor earns less, once the public sector is factored in). The average GP will earn about £95,000, according to the BMA. And unlike doctors, lawyers have to pay their own way through law school, we have to be nice to clients no matter how annoying they are, and if we have no work we don't get paid.

So, yeah, no one needs to be crying too much about poverty stricken lawyers, but dont kid yourselves doctors have it harder.

Banquo's Ghost
01-16-2007, 15:37
So, yeah, no one needs to be crying too much about poverty stricken lawyers, but dont kid yourselves doctors have it harder.

You also have to put up with many more jokes. :beam:


Two doctors boarded a flight to Manchester. One sat in the window seat, the other sat in the middle seat. Just before takeoff, a lawyer got on and took the aisle seat next to the two physicians.

The lawyer kicked off his shoes, wiggled his toes and was settling in when the doctor in the window seat said," I think I'll get up and get a coke."

"No problem," said the lawyer, "I'll get it for you."

While he was gone, one of the doctors picked up the lawyer's shoe and spat copiously into it.

When he returned with the coke, the other doctor said, "That looks good, I think I'll have one too."

Again, the lawyer obligingly went to fetch it and while he was gone, the other doctor picked up the other shoe and spat in it. The lawyer returned and they all sat back and enjoyed the flight. As the plane was landing, the lawyer slipped his feet into his shoes and knew immediately what had happened.

"How long must this go on?" he asked. "This fighting between our professions? This hatred? This animosity? This spitting in shoes and pissing in cokes?"

rory_20_uk
01-16-2007, 16:37
Doctors have to be at ledical school for 4 to 6 years. Unlike lawyers who can be funded by firms who then pay, Doctors pay for it all themselves. During the clinical yeras, they get 4 weeks hols a year, so no chance to do a part time job.

GPs are senior doctors, so comparing them to all layers is not like with like. My salary is way below £50k, closer to £30k. And there are a lot of junior doctors. So Doctor pay is a lot less than GP average pay.

Doctors have to be nice to clients. We don't get to choose who they are, and as far as we are concerned a complaint can equal 6 months whilst the tribunal sorts things out. Anyone can come into the ward and give us a mouthful of abuse, but we have to take it, as we are "Professionals" and although there's zero Tolerance there's no security around. Compare assaults on doctors compared to lawyers. Managers can tell us we don't need any more staff even when we tell them we do. Oh, and if we have no work we don't get paid either.

~:smoking:

Idaho
01-16-2007, 16:57
Go and do a different job then :shrug:

rory_20_uk
01-16-2007, 17:00
Will do. 2 years I'm a GP Registrar. Fingers crossed year afterwards I'm going to be a Pharmaceutical Analyst in the City/ Pharmaceutical drug trial employee.

More money, less hours, less aggravation.

~:smoking:

Big King Sanctaphrax
01-16-2007, 21:01
And unlike doctors, lawyers have to pay their own way through law school

Erm, the ~60K worth of debt I'm going to be in 5 and a half years from now begs to differ with the 'unlike doctors' bit.

BDC
01-17-2007, 00:44
Erm, the ~60K worth of debt I'm going to be in 5 and a half years from now begs to differ with the 'unlike doctors' bit.
It's horrible isn't it?

6 years at ~£9k+ a year...

rory_20_uk
01-17-2007, 11:24
Lawyers can be funded. If you're viewed as an investment, you will be supported. Doctors aren't. Ever. Hence the difference. A sample of 1 isn't relevant.

~:smoking:

English assassin
01-17-2007, 13:57
Lawyers can be funded. If you're viewed as an investment, you will be supported. Doctors aren't. Ever. Hence the difference. A sample of 1 isn't relevant.

~:smoking:

Although this is in danger or turning into a spat between two highly priviledged and respected professions, or rather one highly priviledged and respected profession and the legal profession, law school, a compulsory year of training before articles, (two years if you don't have a law degree) is subject to no state support at all. The student has to pay full fees and support him or herself, as well as deal with the debt accumulated on the three year undergraduate course.

Some do get sponsorship, but to say a doctor isn't supported at the equivalent stage when his course fees are subsidised from state funds and he has state provided subsidised loans to cover the balance and living expenses is just incorrect. Please can you tell us in which year, between enrolling as a fresh faced undergraduate and turning out at the end of foundation year two seven years later, a doctor has not been supported from public funds? (To be fair FT 1 and 2 are salaried posts, but then so is articles)

OT, are people really leaving uni with 60K debt now? Good grief. We had it easy in my day.

Big King Sanctaphrax
01-17-2007, 14:24
Well, the only reason it's that high is because it's a 6 year course (5 years of med + 1 year intercalated BSc,) and I'm in London.

For a normal 3 year undergraduate degree outside the capital, it'd probably be substantially less.

BDC
01-17-2007, 15:15
Well, the only reason it's that high is because it's a 6 year course (5 years of med + 1 year intercalated BSc,) and I'm in London.

For a normal 3 year undergraduate degree outside the capital, it'd probably be substantially less.
Which uni are you at? I start medicine at UCL next year...

Big King Sanctaphrax
01-17-2007, 15:20
See you on freshers' week, then. ~;)

BDC
01-17-2007, 15:44
See you on freshers' week, then. ~;)
Great minds... :)

KukriKhan
01-17-2007, 16:05
According to this USA Today article (http://www.usatoday.com/money/perfi/general/2006-02-22-student-loans-usat_x.htm), US students, and particularly medico's, are carrying debt at about BKS's cited rate here, as well.

InsaneApache
01-17-2007, 16:07
BKS should buy you a beer. ~:cheers:

Big King Sanctaphrax
01-17-2007, 16:25
Beer? On Freshers' week?! That's crazy talk! ~;)


On July 1, the rate on new federally guaranteed student loans will hit a fixed 6.8%, the highest rate since 2001.

Ouch. They're actually in a much worse situation than me, since the rates of interest on my loans are linked to inflation, meaning they're basically interest-free in real terms. Furthermore, if at any point I'm not earning more than (I think, could be less) £15K, repayments are suspended.

King Henry V
01-17-2007, 17:41
Go and do a different job then :shrug:
Yeah, I mean who needs doctors?

Scurvy
01-17-2007, 18:24
Yeah, I mean who needs doctors?

:laugh4:

Idaho
01-17-2007, 21:54
Yeah, I mean who needs doctors?
Are you telling me that the whole nation is relying on Rory for it's medical cover. Jebus, I didn't realise the health service was in such pickle :laugh4:

King Henry V
01-18-2007, 21:23
One of the many problems of the NHS is that there aren't enough doctors. Saying "well if you don't like the work conditions, then change jobs" is not the way to improve matters.

Idaho
01-19-2007, 11:32
One of the big problems is that doctors can use NHS equipment and hospital space and time to run their private racket. Deliberately slowing down waiting times to encourage people to pay them privately to jump the queue. Corruption basically.

rory_20_uk
01-19-2007, 11:59
One of the big problems is that doctors can use NHS equipment and hospital space and time to run their private racket. Deliberately slowing down waiting times to encourage people to pay them privately to jump the queue. Corruption basically.


[Sigh] Evidence?

I know of none. Nor do I think many private patients would accept the shoddy state the NHS rooms are in.

Private companies are now selling their service back to the NHS, so much equipment isn't even owned by the NHS in the first place!!!

Oh, but you must be right... Heard it off someone selling Socialist worker... :laugh4:

~:smoking:

Idaho
01-19-2007, 16:52
[Sigh] Evidence?

I know of none. Nor do I think many private patients would accept the shoddy state the NHS rooms are in.

Private companies are now selling their service back to the NHS, so much equipment isn't even owned by the NHS in the first place!!!

Oh, but you must be right... Heard it off someone selling Socialist worker... :laugh4:

~:smoking:

Compared to whatever facist rag you read these sources probably do seem like the Socialist Worker - not much I can do about that:

Canadian Medical Association Journal (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1487523)

Observer article (http://observer.guardian.co.uk/nhs/story/0,,628437,00.html)

Those two articles took me.. oh.. 30 seconds to find. Try harder Rory - I thought you medics were meant to be the clever ones.

BDC
01-19-2007, 17:17
The Royal Marsden gets almost a quarter of its income from private patients.

So basically private patients are paying for the rest to get any beds at all...

Scurvy
01-19-2007, 18:21
Nor do I think many private patients would accept the shoddy state the NHS rooms are in.

Agreed. :2thumbsup:


So basically private patients are paying for the rest to get any beds at all...

and so they should :2thumbsup:

rory_20_uk
01-20-2007, 21:05
Oh dear oh dear...

So, the hospital itself is running the service! The hospital even says the money finances the rest of the hospital.

Oh the scandal! Just like you said "private racket". :laugh4:

It seems us doctors are the clever ones if you can use that to back up your statement.

Perhaps next time cutting and pasting some puff from two sites might not be the best idea??? Or perhaps such sweeping statements aren't such a great idea.

~:smoking:

Idaho
01-20-2007, 21:58
So you think it is a good thing that in order for the hospital to operate, they need to create waiting lists to push desperate paitents to stump up extra cash :confused:

rory_20_uk
01-20-2007, 22:03
So, you've deftly avoided addressing the fact your links had nothing to do with what you were saying.

Instead, attempted to distort what I said to something completely different...

If you read the articles you yourself posted you'd read that one stated they'd happily do more NHS work if they were paid to do so!!! :wall: :wall:

I think that the NHS is a badly thought out and badly run white elephant that since being created has lurched along from one disaster to the next. I am so sick to my stomach that I have already expressed my desire to leave it.

Clear?

~:smoking: