Exclusive: GP profits per consultation down 30% in 10 years, accountants warn

GP profits per consultation have slumped by a third and dependence on unreliable enhanced services income has soared in the past decade, data from specialist medical accountants reveal.

The findings show how much harder GPs are having to work now to maintain profits than they did a decade ago - and the resulting drop in morale could prove 'terminal' for the profession, they warned.

Figures from practices represented by specialist medical accountants Ramsay Brown and Partners show that profit per GP consultation fell to £11.80 in 2015 from £16.52 in 2006.

Profit per patient dipped from £50.91 in 2006 to £41.18 in 2015, while the proportion of core income practices received from enhanced services rose from 12% to 17% over that period, the figures show.

Map: GP income postcode lottery

Laurence Slavin, a partner at Ramsay Brown, said practices represented by the company have bucked the national trend of falling GP profits. Practices the firm works with have managed to maintain profits per partner - averaging £131,202 for 2014/15, slightly up on the £126,652 figure for 2005/6 - but the figures show GPs are working far harder to achieve this.

A more than three-minute rise in the average length of consultations - possibly reflecting rising complexity - and an increase in numbers of consultations per patient meant GPs were working significantly harder now than in 2006, Mr Slavin said.

'There is a universal feeling that the fun seems to have gone out of being a GP or a partner. Profits [among our client practices] are going up year on year but what isn’t factored in is how hard they are having to work to maintain those profits,' Mr Slavin told GPonline.

'More money has been pushed into enhanced services, which offers less of a stable base to build a practice. This income could be taken away - you can’t assume it’ll be there, if you're employing staff and building a business.'

Low GP morale

Mr Slavin warned that if falling morale among GPs was allowed to continue, it would be a 'terminal event in general practice'.

'I have had three meetings this week with practices that are thinking of closing,' he said. 'They have 6,000, 11,000 and 5,000 patients. If the prac just closes, patients fall into the next nearest practice and if they can’t recruit they also struggle.'

Mr Slavin told GPonline that in a presentation last week themed 'how to survive next five years', he warned practices they need to look very carefully at the work they take on.

'If it doesn’t contribute to wellbeing and profits they shouldn’t do it. I was at a practice this week where they spend £35,000 a year on counsellors. They are reasonably well funded and think it is a good service to patients. But if they lose PMS money they will have to stop it.'

Another practice with a travel clinic that turns over £100,000 a year will have to close the service, he said, because the service cost more to run than it attracted in income.

'It's about looking smart at what you are doing and whether you should be doing it,' he said.

Considering federation or mergers could also offer solutions for some struggling practices, Mr Slavin argued. Federations could bring in more resources to member practices, while mergers were a better option for practices than closure because they avoid redundancy costs and the cost of disposing of premises.

But he warned that larger GP provider organisations were not a panacea. 'There is an ultimate size where practices are efficient,' he said. 'Practices serving tens of thousands of patients may not be efficient.'

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