Should GPs earn more than bankers?

'YES' - Dr Paul Charlson says there is no reason why GPs should not earn what bankers earn.

Financial reward is a key driver for GPs. Of course looking after our patients well is paramount but making money does motivate a majority of us.

Quality and scope of primary care are variable. Yet it is not always those who provide the best care who earn the most money.

QOF started the process of rewarding quality care but it has not gone far enough. Increased income as a result of providing better care should be the central plank of a new GP contract.

More than average patient face-to-face time, especially at unsocial hours, providing phlebotomy, ECGs, minor surgery and so on should be realistically remunerated. Some practices do not provide these because frankly it is not financially worth it. This has to change.

Similarly it is not good enough to say GPs should not be responsible for managing healthcare budgets. It is not a sustainable situation and it is far better that we decide which patients get priority. Of course you have to guard against penalising those who need care but if dealt with in a mature fashion with good governance it can be done. Again those who are prepared to put in the effort should be rewarded.

I see a world where practices which provide top-notch care with good access to appointments and a wide range of services together with a well managed budget could earn far more than those that do not. Not just slightly more, but much more.

Entrepreneurial GPs will of course be looking to develop new services which will improve quality of care in a community setting for less cost and taking a share of the significant financial benefits achieved. Patients, taxpayers and GPs will benefit. A win-win situation.

Rewarding those providing excellence at least partially to the detriment of those who do not is both reasonable and sustainable.

There is no reason why GPs should not earn more than bankers but they have to deliver and work hard for it. The opportunities are there now and a few adjustments will set the system free.

'NO' - Dr Vijayakar Abrol says high-paid GPs are more like company CEOs

It seems to me that some of these high earners think of themselves as CEOs of their surgeries. GMC, please take note. You have guidelines for Good Clinical Practice for doctors, but have you drafted any guidelines for these people who want to retain the privileges of being a doctor but would like to have the rewards of a CEO?

Some GPs hide behind practice-based contracts for their entrepreneurial qualities. But who monitors the practice-based contracts? If monitoring does take place, what is the quality of the monitoring? I would like to ask these CEOs to look into the statements they made in their application forms to get into medical school and see if there is even an iota of that statement which reflects their present thinking.

Practices run by high-earning GPs should be audited to see what is going on, who is providing the care and who is getting the money.

What we have now in high-earning practices is a culture of '10-minute one-symptom consultations' by salaried/locum GPs or nurse practitioners, preventive medicine being a 'tick-box' exercise, high out-of-hours attendance at A&E and so on.

I believe I should provide the best for the patient, either personally or get the best for the patients if I cannot provide it because of my clinical or contractual limitations. These days you have to ruffle a lot of feathers to get good care. I could not do all that wearing a CEO/entrepreneurial hat and scheming my next million.

Dr Abrol is a singlehanded GP at the City Road Practice in Edgbaston, Birmingham