The pay freeze for GMS practices in 2007/8 announced this month was labelled a ‘black day’ for general practice by the GPC.
Rising costs for practices, including inflation and staff pay rises, mean this is undeniably a pay cut in real terms. This is compounded by the fact that it follows a 2006/7 settlement that froze all elements of GMS pay at 2005/6 levels, although in 2006/7 opportunities to boost income were available through a range of directed enhanced services, linked to DoH policies such as Choose and Book.
The cuts are aggravating for GPs because they seem to amount to overt clawing back of pay rises agreed under the new contract, which the DoH now believes were far too generous.
But GMS principals are not the only part of the GP workforce entitled to feel hard done by. For salaried GPs, registrars, educators, trainers and GPs working in community health services, low pay rises or cuts in pay mean business as usual.
Cut in recruitment
GP leaders say the poor rises will cut recruitment into general practice and leave the goodwill of practices that take part in training hanging by a thread.
Supplements for GP registrars have been cut from 65 per cent to 55 per cent of their basic salary, although this will apply only to new registrars — existing supplements will not be cut.
In addition, they have been awarded a flat rate £650 increase to basic pay instead of an inflationary increase — a pay cut in real terms.
The DoH mooted the possibility of cutting the supplements in evidence for the 2004/5 pay review, but the DDRB resisted its calls until this year.
The reduction is a bitter pill given that BMA calls for significant increases in the supplement were ignored both in 2004/5 and 2005/6. The BMA called for 80 per cent supplements in 2004/5, and 70 per cent in 2005/6.
In evidence for the 2006/7 round, it said 65 per cent was the minimum acceptable supplement. Supplements are therefore unchanged for a fourth year.
The GPC pointed out that this was unfair at a time when the costs of training were increasing.
Salaried GPs working for primary care organisations (PCOs) will receive £1,000 increases to the top and bottom of all pay bands, a rise the GPC says is worth less than 2 per cent.
Seniority pay has been frozen for the second year running.
GP educators and trainers received 2 per cent rises in 2007/8, fractionally less than the 2.2 per cent they received last year. Last year’s award came on the back of the rejection of BMA calls for a 15 per cent rise in 2004/5, a year in which they were given just 3.225 per cent.
In addition, the 2007/8 uplift will be staged — trainers and educators will receive 1.5 per cent until November, the other 0.5 per cent also kicks in then.
County Durham GP Dr Stewart Findlay told GP his practice had given up training several years ago.
‘The demands on trainers are becoming ever greater — there is more regulation and scrutiny,’ he said. ‘In many ways it is becoming a job that is more trouble than it’s worth.’
Not cost effective
Dr Findlay said the low pay increases would make it even less cost effective: ‘It becomes a cost to the practice because you spend a lot of time on training that you could spend time doing something more lucrative.’
Wessex LMCs chief executive Dr Nigel Watson said he did not think there would be an exodus from training or education work at this stage.
Oxfordshire LMCs chief executive Dr Paul Roblin agreed: ‘This smacks of preying on GPs’ goodwill. When you go into a job like training, you do it mostly for quality of life and variety of work, but salary tends to be a factor. Some will take umbrage, and start to get resentful if they are financially taken for granted.’
He pointed out that the gap between what GPs could earn from locum work and income as a trainer or educator would grow so large that GPs would be drawn away from education.
Dr Roblin pointed out that because the retail price index (RPI) — a measure of inflation — was at 4.2 per cent, pay rises below this figure were a pay cut in real terms.
However, he pointed out that the RPI was higher than it had been for several years and that cutting public sector pay was a means of trying to slow inflation.
He said if the low rises were matched across the civil service then they would be more palatable and pointed out that general practice was ‘still an attractive package overall’.