The GMS contract allowed us to opt of out-of-hours in exchange for giving up 6 per cent of our income. The house of commons Public Accounts Committee now suggests that this amount was too small.
I believe at the time that the government’s negotiators accepted this because it was the figure at which they themselves had valued out-of-hours under the previous contract. If we paid too little to give up out-of-hours, we must have received too little for this work during the preceding years.
We are now in the third year of the contract, and a great many GPs still require the MPIG figure for basic remuneration. The contract has protected the government from paying the annual cost-of-living increases to our employed staff, as this money has to be found from our global sums.
Most of us pay our staff incremental increases within the range for the grade at which they are employed, so that — unless all staff happen to be on the maximum for their grades in 2004 — these are also deducted from the global sum, and therefore the GP’s take-home pay.
The increasing workload involved in caring for a population getting older, heavier, druggier and less active is forcing many of us to expand our staff, particularly in the area of nursing. Again, these workers are paid out of the original MPIG figure, and do not cost the government anything.
In the third year of the contract, therefore, savings to the government are considerably more than just the average £6,000 taken back in the first year — I should have thought that these would more than offset the £70 million shortfall on funding centrally provided out-of-hours cover noted by the Public Accounts Committee.
The government must be very content with the contract; it may have given GPs an income boost to sweeten its first year, but the take home pay of most GPs will go on falling.
Dr James Barbour