Speaking to GPonline ahead of International Women's Day on 8 March, BMA representative body chair Dr Helena McKeown called out 'unacceptable' gaps in pay between men and women working in general practice.
In some cases, individual GP practices were reported to be discriminating against women in salaried roles by paying them less than their male counterparts, Dr McKeown said - but disincentives for women to take on partnerships that must be tackled through contractual reform were also to blame.
A report published earlier this year by the IPPR think tank found that the gender pay gap in general practice 'now stands at 35% - the fifth largest pay gap of any profession in the UK'.
General practice is not struggling to attract women into the profession - the latest GP workforce data from NHS Digital show that 55% of headcount GPs in England are women, and this looks set to rise given that 62% of registrars are women.
But women are more likely to work less than full time and less likely to be in partnership roles - both key factors identified in the IPPR report as drivers of the GP gender pay gap.
Men make up just 43% of headcount GPs overall - but 55% of partners are men. Women, meanwhile, make up 72% of headcount salaried GPs. And although women are significantly in the majority in terms of headcount GP numbers, they account for just 51% of the full-time equivalent workforce.
Dr McKeown says she wants to see changes to the GP contract and in support for general practice to reduce these differences - and bring down the pay gap.
Part of the equation relates to what employers look for when they advertise a job. As recently as 2018 a poll by employment law firm Slater and Gordon found a third of employers admit they have or would reject female applicants for jobs if they suspect they 'might start a family soon'.
There is every chance that some GP practices discriminate in a similar way. But Dr McKeown says: 'Not only is it illegal, it is short-sighted of a partnership to offer only sessional jobs to women who they perceive might take maternity leave, particularly in a time of workforce crisis.
'Everyone knows you get lots out of partners. If practices have women who want to be partners, employ them - otherwise you're missing out on a large pool of talent. The available pool of GP talent is 55% women - imagine the reduction in the talent pool if you don't take women on as partners - it's very foolish employment practice.'
Meanwhile, men in general practice now, Dr McKeown adds, are 'just as keen as women' to work less than five days a week. 'It's for lifestyle reasons. Because the 13-hour day in general practice is incredibly hard. I asked a room of 40 GPs recently and the majority of the room - male and female, of different ages - were working less than eight sessions a week.'
Breaking down the reluctance of employers - including GP practices - to take on women in key roles also depends on levelling the playing field. That's where changes to the contract come in, says Dr McKeown.
When she first became a partner herself - in the late 1990s - practices received no extra reimbursement at all to cover maternity pay for partners. As a result, most partners took a financial hit if they went off on maternity leave - meaning that for women there was 'a huge incentive to be salaried'.
Maternity leave is now fully reimbursed - although this hasn't been the case for long, and Dr McKeown suggests the impact of this change may not have fully filtered through. Nevertheless, she says it's time for the next leap forward.
'Junior doctors managed to negotiate shared parental leave in their contract last summer,' she said. 'We don't have that yet in our GP contract.'
Shared parental leave
For juniors, the change means parents who choose to split a year of leave between them no longer lose out financially, because parental leave is reimbursed at the same rate as maternity leave - rather than at a lower, statutory pay level.
Dr McKeown said: 'The theory is that if you can get the right for men to take shared parental leave - and men choose to take that leave - women's pay doesn't fall behind, which it does when they take maternity leave. Shared parental leave is seen as a big mechanism to get rid of the gender pay gap - but we don't have that in general practice. It needs to be reimbursed completely for partners through the GP contract.'
Asked whether she was confident that this could change at the next opportunity - in the 2021/22 GP contract - Dr McKeown added: 'I have every faith in the negotiating team.'
Another change the Wiltshire GP would like to see is funding for childcare. 'It's a long-burning issue of mine,' she says.
'When I first went on my LMC in 1998, I went on because I was having to pay for childcare for my two- and my three-year-old, as a single parent, when I went out on call. As a partner there was no reimbursement for that and clearly it was part of a partner's duties.
'I resented that, having to pay for childcare - I wanted to have childcare reimbursed. We still don't have that. Unfortunately there are many women for whom this is the issue that stops us progressing and stops us from being partners, doing the extra meetings in the evenings. It is really difficult to get the kind of childcare you need to be a GP partner. It's no mean feat if you have a student loan and a mortgage to pay for the most expensive childcare in Europe.'
Funding for childcare is another change Dr McKeown would like to see tackled through the next round of GP contract talks - and she says the change could go a step further, with surgeries that have space providing NHS-funded nurseries. 'It's a bit of a dream, but it isn't impossible,' she says.
The theme for International Women's Day 2020 is #EachforEqual - with this year's campaign arguing that it's time to build a gender equal world.
Gender equality 'is essential for economies and communities to thrive', the campaign argues. At a time when general practice is struggling to cope - and losing partners faster than any other part of its workforce - embracing this message may never have been more important for the profession.