More funding for GPs would ignore the need for fundamental reform

The Sunday Times reported yesterday that 800,000 patients were turning to A&E departments and walk-in centres because they are unable to get an appointment with a GP.

Predictably, the chair of the Royal College of GPs blamed a “funding crisis” and warned that the service was “teetering on the brink of collapse.”

With constant talk in the media of an NHS cash crunch/funding crisis (delete as appropriate), it’s important to understand some basics about the NHS budget and general practice.

Historically speaking, the NHS has received large, real term budget increases for a couple of years in a row, and then had a few years of lower spending. This changed around the turn of the century when the NHS was handed big budget increases throughout the 2000s.

According to the Institute for Fiscal Studies, between 1979 and 1997, NHS spending increased in real terms by an average of 3.2 per cent. Between 1999 and 2008, this figure was 6.3 per cent.

It’s hardly surprising that spending on healthcare has increased both in absolute terms and as a share of public spending as the population ages. It’s also hardly surprising that health spending isn’t being increased as aggressively as it was in the 2000s when it went up by 92 per cent in real terms.

So it’s disingenuous for GPs to complain that their funding has fallen by pointing out that as a percentage of the NHS budget, as it now represents 8.4 per cent rather than the 10.3 per cent it did in 2004. This just means they have a slightly smaller share of a much bigger pie.

Talk of a “cash crisis” isn’t anything new.  There were endless stories about impending financial disaster for the NHS during the years when it was handed unprecedented budget increases.

It’s hardly surprising that people struggle to get an appointment with their GP with the number of practices opening late or at the weekend falling.

The 2004 GP contract gave many GPs the ability to opt-out of providing out of hours care and many chose to do so. This trend has continued long after the contract was agreed, with a further 13.3 per cent fall in the number of GP practices offering weekend and evening appointments between 2009 and 2013.

The National Audit Office looked at the effects of the contract in 2008 and found that:

    • Between 2002-03 and 2005-06 the average pay of a GMS and PMS practice partner in England increased from £72,011 in 2002-03 to £113,614 in 2005-06 – a 58 per cent increase
    •  GPs are working on average seven hours less per week than in 1992
    • By January 2005, less than 10 per cent of GP practices delivered out-of-hours care under the nGMS contract. Out of hours is defined as the period from 6.30pm to 8.00am.
    • Practice nurses and salaried GPs, who form part of the practice team, have not benefited to the same extent with pay rises largely in line or indeed below inflation
    • 27 per cent of GPs work part-time

Simply put, in the UK we have a system which pays a small number of doctors a lot of money. Other developed countries have decided to pay their doctors slightly less, and have more of them:

    • The majority of GPs in the UK are self-employed. They earn 3.5 times the average wage in the UK, far more than in Australia (1.7) France (2.1) and Denmark (2.7). Along with Denmark and Poland, the UK is the only country in the OECD where GPs earn more than the average medical specialist
    • Consequently, we have fewer doctors than most developed countries, with 2.7 per 1,000 people. This compares to 3.3 in France, 3.6 in Germany and 6.1 in Greece

The other sacrifice we make is having less modern medical equipment than most other developed countries:

    • We have fewer MRI scanners per head of population than Slovenia, Estonia, Slovakia and the Czech Republic. Greece has four times as many
    • We have fewer CT scanners per head of population than every country in the OECD apart from Hungary and Mexico. Chile and Poland have more and Estonia has twice as many

If GPs' pay fell more in line with the likes of Australia and France, there would be more of them, more out of hours care available, and fewer people using A&E departments.

Before coming up with proposals to charge for visiting a GP or demanding more money from taxpayers, GPs need to explain why they deserve to be paid so much more than their international counterparts, and why their high salaries are preferable to having more doctors and more modern medical equipment.

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