I was recently gossiping with an ex-colleague of mine, who works as  a NHS manager. We were talking about colleagues we both knew (in management) who were well known to take their jobs very lightly – they used  to take time off without documenting it, and were often “working from home” and uncontactable during office hours. I asked whether the recent austerity had changed anything, and apparently the answer was “no”. I wasn’t surprised – the NHS locally has never been good at managing its employees, at least the senior ones. There weren’t very many of them doing that, but some seemed to get away with a very easy lifestyle. I compared that to a GP’s lifestyle – the workload GPs have is fixed by demands of the patients and they are effectively self employed, so it is not easy to get away with being unavailable or not pulling you weight. She was less than impressed however.

A little later on we were talking about the recent OECD  report “UK GPs among best paid in developed countries’ and my friend said yes GPs really are overpaid fat cats aren’t they? ” That does seem to be the impression most people and especially managers and hospital staff have of GPs. GPs are supposed to earn more than consultants according to these figures.

But it isn’t quite so simple .

GP pay in this survey includes professional earnings from ALL sources, NHS or private. Consultant earnings are from the NHS ONLY. That is because it is difficult to collect figures from self employed GPs and therefore they take overall earnings rather than from the NHS.

Also the job is very different in different countries. German GPs for example don’t do Gynae, psychiatry or see kids under 4, GPs in the Netherlands don’t deal with depression (they send patients to psychiatrists and psychotherapists). GPs in the UK  do a lot more chronic and acute disease management than GPs in other countries, so the job is broader in its scope and responsibilities. In many of the comparator countries GPs are more of a sorting house where they either send everyone off to a hospital or deal with less severe acute self-limiting illnesses. So it’s a different job.

According to this survey GP partners in the UK earned 3.4 times the average national wage. This compared with those in Ireland, Canada and the Netherlands who earned three times the average.  But UK salaried GPs earned 1.9 times the average wage, the figures showed, and there are getting to be far more salaried doctors under the recent changes to the GP contract.

According to a GP negotiator. GPs hours are much longer, and pay when stripped back to 40 hrs pw, is now an average of  £55K after all expenses of employing staff paying employers’ and employee’s superannaution, and defence costs paid by the doctor, are removed.  Many managers earn far more than this.

Doctors on a chat site were angry that the survey misrepresented them.

One doctor, having worked for many years in Canada said that the pay was over twice as much, the hours the same and the quality of life so much better, both at work and at home. Unfortunately he  had to come back to the UK for family reasons and now hates every second of it!  One doctor quoted from an email from a recruiting company in Australia (said in this survey to pay GPs only 1.7 times the average wage), “The average annual income for GP’s working for this company ranges from $200,000 – $350,000 (£135,000- £236,000) per annum –in a fee for service system”.

Possibly the average wage is much higher in Australia, and we know that the cost of living is higher in many areas of the UK. Another doctor speaking to a GP from Belgium said that his income, before tax, is 14000 euros a month.

This post isn’t going to convince many of the British public who now really do see GPs as fat cats. But the NHS, more than most other countries, has to ensure that GPs do a proper job, that is dealing with the many conditions that can be safely dealt with in primary care, and not sending everyone to hospital where the care may be excellent, but sometimes unnecessary. Our taxes are going to spread to looking after everyone as efficiently as possible. Morale is very low amongst GPs at the moment, and fewer and fewer young doctors are training to be GPs – they are all piling into the hospital system. So we either pay GPs adequately or we really are going to have to add our own money to the cake to pay for all this extra hospital care.  What would that do to the cost of living I wonder?