David Rose
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Changes to GPs’ working arrangements and a generous pay rise for doctors have cost the Government £1.8 billion more than ministers bargained for, new figures have revealed.
The introduction of performance-related pay in 2004 has led to average GP wages rising by 30 per cent, with some earning up to £250,000 a year.
The cost of the high wage bills and of allowing doctors to stop providing care at evenings and weekends has been blamed for NHS deficits and cost-cutting in recent years.
Between 2003-04 and 2005-06, the Government spent £20.5 billion on GPs – 9.2 per cent more than it promised under the gross investment guarantee when the new contracts were introduced, a report by the NHS Information Centre said yesterday.
This equates to £1.7 billion more than was expected in England, plus overspends of £41 million in Wales and £68 million in Northern Ireland since 2003.
There are no comparable figures available for Scotland.
While doctors now make less in basic pay – about £55,000 on average – for the past three years they have been able to top up their earnings by hitting targets under a performance-related bonus scheme.
The contract also allowed doctors to opt out of providing night and weekend care. About 90 per cent took up the option, leaving it to local Primary Care Trusts to employ private companies, groups of independent doctors and other health staff to provide cover. The changes have been the subject of mounting controversy, with patients struggling to get through to doctors’ out-of-hours and for Saturday surgeries. Meanwhile, the average GP’s total wages have risen to more than £100,000.
Gordon Brown said this week that resolving the lack of out-of-hours care was a priority for the Government, but ministers last night insisted that the extra investment had “improved the range and quality of services” provided by GPs.
The Conservatives said that the figures showed that the Government had crucially underestimated how hard doctors would work under the performance-related pay system.
Andrew Lansley, the Shadow Health Secretary, said: “The extent to which Labour has mismanaged NHS money is shocking.
“An unforgivable lack of understanding of what GPs do on a daily basis has led to £1.7 billion of taxpayers’ money being spent when it could have been saved because this Government badly negotiated the GP contract.
“It’s incredible that ten years after promising to save the NHS, Labour are still out-of-touch with health professionals and the work that they do.”
The British Medical Association, which has opposed any renegotiation of the contract, said that it had repeatedly advised the Department of Health that GPs would peform well under the contract at extra cost.
Laurence Buckman, Cchairman of the British Medical Association’s GPs’ Committee said: “These figures reflect the Government’s wish to invest in general practice by introducing performance-related pay (PRP) for GPs, linking practice resources to the quality of service provided for patients.
“Family doctors rose to the challenge of PRP and delivered higher quality care than the Government anticipated. This is why the gross investment guarantee – a guaranteed minimum spend – was exceeded.
“The figures quoted also include the extra money Primary Care Organisations asked for in order to provide out-of-hours services, as well as a number of other costs that the NHS had to meet that were not due to GPs,” he said.
Ben Bradshaw, the Health Minister, said: “Almost all patients are now seen within 48 hours compared with just half ten years ago and when a patient does need to see a GP they now spend more time with them.
“We remain committed to ensuring that this investment in general practice is matched by further improvements in services for patients,” Bradshaw added. “We are taking steps to tie GP income more closely to patient experience so that further investment leads to greater access and patient choice.”

Doctors have released details of a technique that will allow human eggs to be grown in the laboratory from ovarian tissue samples. The procedure is being pioneered by two British fertility clinics, The Daily Telegraph reports. It would allow women to delay motherhood by “banking” frozen ovary tissue, containing thousands of immature eggs, until they wish to start a family. Hormone chemicals would be used to grow the immature eggs to maturity ready for IVF treatment. The technique is expected to be available for use within five years.
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I have a great idea, offer them a new contract , but deduct 6% of their basic, tell them they can earn more if they work really hard( but assume they can't). If you are right, claim it as your great idea to "rationalise" the system .If it fails blame them that they are too lazy and gready.
phil, manchester,
Dear JP...You can tell you're living in the clouds.
There is no problem in earning, if you work for your money. But quite frankly, these guys dont. And there are many other careers which require the same amount of training and dedication, but just dont pay.
Oh, and another thing, I live part of the year in Spain. Spanish GPs dont get anything like the salaries Uk GPs get, and I guarantee you, they are better trained and equally devoted!
simon wade, Newcastle, UK
If a slightly smaller rise had been given more doctors could have been employed which, would have meant better service and less work load for the doctors.
Such a shame for a missed opportunity to improve things for all
concerned.
These contracts could and should have been for a trial period.
After all we all need medical support at sometime in our lives.
John Caspall, Portsmouth, UK
Don't get sick on a weekend. Inform all infecting microbes and toxins to come back next Monday
John, Welwyn Garden City, Hertfordshire
Rose, Farnborough, the 5 x GPs at my surgery are only available for a maximum of 4 mornings a week (0900 - 1300), 1 afternoon a week (1300 - 1600) and 1 evening (they call it ) (1600 - 1730) a week with no call outs, no Saturday surgery and generally one or more of the 5 are on holiday, often abroad, at any one time. Frankly any and all politicians need to get off their fat backsides and see what people have to do on the minimum wage of £11,500 per annum, and the general conditions in some companies, really see what our servicemen and women do for their £13,000 - £18,000 a year, see what many people have to do in industry and commerce on a production line for their wages. And, PCSOs by the way are paid less than Policemen and women, it is called policing on the cheap! However, I agree that targets and statistics are a farce as is the paperwork associated with any form of performance-related pay because many people fill it in themselves and cannot but fail to meet targets.
Kenneth, Suffolk, England
By the way Rose (Farnborough) ...I think Browns time would be far better spent in a factory, on a production line with a guy that earns 12.000 pounds a year and does 12 hour days (or nights),......and, of course, as it is a private setor company ....fills in an awful lot of forms to justify that he too meets production targets.
Or better still, you spend a day or night with him, and then you might get an idea of how the other half live!!
simon wade, Newcastle, Uk
I tried to make the case that the new doctors contract was generating pay income of as much as 250,000 per annum for doctors earlier this year but The Times refused to put the comment up on its web site.
If a manager of any private business made such a mess of negotiating a contract, they, (and probably their entire department with them), would have been thrown out on the street. More probably, the private business would have become bankrupt and the cost to the customer, (in this case the taxpayer as someone else has already pointed out), would have immediately stopped. The contract would have closed with the bankrupcy of the business and the whole process would have been taken up by a free competitive business better able to write a contract.
The Department of Health should be closed down immediately and the whole re-formed with new staff. The contract would become moot, thus replicating a bankrupt private business and we could start again using better principles.
Chris Coles, Medstead, Alton, United Kingdom
It didn't 'cost the government' anything but it did 'cost the taxpayer' - when will you get the reporting correct ?
Arthur
Arthur Edwards, Princes Risborough, UK
Why is it such a problem that GP's earn a good salary. The work and commitment involved in qualifying and the ongoing dedication to their profession warrants a retainer of this size.
I'm an Airline Captain, I earn £100k. Being a GP is far more worthwhile....
JP, Herts, UK
now, in a month when gordon got his sums wrong at the bank of england are you saying he got his sums wrong on doctors pay.
michael joseph heavey, cahersiveen>adams towns, madness
GPs and the services they provide are very good value for money. It costs only 20p per patient, per day, to provide all general practice services. Routine appointments have never been available in the evenings or at weekends and if the government wants this then further investment will be required. GPs have effectively had a pay cut over the last 3 years as there has been no increase in contract payments while they have had to fund staff pay rises and other inflationary costs out of their own pockets.
Dr. J.P Taylor, Burnley, UK
I would like Gordon Brown to spend a day and an evening with my husband who is a GP. He would then see the amount of paperwork and form filling designed to meet the government's targets. When will this governement see we are not fooled by statistics they produce with regard to public services - PSCOs for police and unqualified teaching assistants taking the place of teachers. What next?
Rose, Farnborough,
What a joke.....less medical cover.....less work ....higher salaries......you can certainly tell that the doctors in this country are far more inteligent than the politicians!!
But dont worry, I've had a new idea, lets set up a hugely costly review of the sistem (to show were worried) which will undoubtedly improve things beyond our wildest dreams.....(and quick, lets announce it now because the elections are just around the corner and we can trick the voters into voting us in again).......las if we have any decent alternative!!!
simon wade, Newcastle, Uk