Show me the money! What’s really going on with reported GP earnings?

Richard Armitage is a GP and Public Health Specialty Registrar, and Honorary Assistant Professor at the University of Nottingham’s Academic Unit of Population and Lifespan Sciences. He is on twitter: @drricharmitage

The Telegraph newspaper’s recent headline – “GPs given record pay rises in Covid pandemic: Wages hit a ‘difficult to justify’ level of £142,000 as patients were turned away from surgeries”¹ – refers to NHS Digital’s estimates of GP earnings and estimates, released on 1^st September 2022.²  Rather than being representative of all general practitioners, this before-tax figure applies to GP Partners in England only (the corresponding income for GP Partners in Scotland, Wales and Northern Ireland was £115,400, £122,500 and £112,000, respectively), incorporates earnings from both NHS and private work, and, crucially, makes no adjustment whatsoever for the number of hours worked to generate the reported income.  The same NHS Digital data reveal that the corresponding earnings for salaried GPs in England, that collectively constitute about 42.7% of the country’s GP workforce, were £64,900, yet this substantially lower figure went suspiciously unreported by The Telegraph’s health editor. 

The reported 16.6% year-on-year pay rise for GP Partners in England was depicted as truly undeserving and even deeply immoral as, purportedly, ‘surgeries closed their doors to patients’ during the COVID-19 lockdowns, and ‘GPs were paid for tasks they no longer had to do during the pandemic.’¹

While The Telegraph’s figures were selective (they failed to mention the corresponding yet dramatically lower year-on-year pay rise of 2.0% afforded to salaried GPs in England)² and misleading  estimates (GP partners constitute only 61.1% of the total GP workforce)³, they do appear to some basis in fact.  Accordingly, let’s explore what these higher-earning GPs have done, to deserve their pay rises.  It’s time to find out what’s really going on with reported GP earnings.  Show me the money!

Appointments in general practice

In the 18 months prior to the arrival of the COVID-19 pandemic (September 2018 to February 2020), an average 25,000,015 appointments took place each month in general practice in England.⁴  This figure dropped to around 16 million per month in April and May 2020 as general practice rapidly adapted to deliver patient care in a safe and effective manner that avoided viral transmission. However, standard general practice appointments rapidly returned to, and subsequently exceeded, their pre-pandemic levels (an average 25,982,726 appointments took place in general practice each month in England from September 2020 to July 2022).⁴  While also providing this above-baseline number of standard appointments, general practice has also provided an additional 63.5 million appointments for administration of COVID-19 vaccines since December 2020.⁵  The total work-output, or productivity, of general practice as a whole has therefore substantially increased over the last 2.5 years.

Appointments with GPs

But what about appointments with GPs themselves?  In the 18 months prior to the pandemic, 51.6% of total primary care appointments were conducted by GPs.⁴  This figure increased throughout the first national lockdown, peaking at 54.9% of total general practice appointments in April 2020, and has since averaged at a monthly figure of 51.0%, very similar to the pre-pandemic baseline.⁵  Simultaneously, the average monthly number of standard appointments conducted by GPs since the end of the first national lockdown in the UK (August 2020 to July 2022) was 13,017,165, a similar figure that in the 18-months prior to the arrival of the pandemic of 12,877,645.⁴  However, GPs were also hugely instrumental in the delivery of the 63.5 million vaccines within general practice, which were delivered atop the standard appointments that continued at pre-pandemic rates.  Accordingly, it is clear that the total productivity of the GP workforce has substantially increased over the last 2.5 years.

These figures are deeply impressive, especially in the context of multiple enormous pandemic-induced challenges to primary healthcare systems, clinical practices, and the physical, psychological and emotional health of frontline GPs.  However, these feats are rendered even more remarkable once additional factors are taken into consideration.

Number of GPs, trainees and patients

The number of full-time equivalent (FTE) fully qualified GPs practicing in England has dropped by 1,806 since September 2015.  Simultaneously, the number of GPs in training has increased over the same period by 2,723.³  While vital for the future workforce, this growing number of trainees is being clinically supervised by a shrinking number of GPs.  Since this supervision doesn’t replace GP clinical care commitments, this adds an additional burden to the growing GP workload.  Similarly, this smaller cohort of fully qualified GPs is looking a growing number of patients.  In the same time that the total number of FTE GPs reduced by 1,806, England’s population increased by 4.9 million, reducing the number of FTE GPs per 1,000 patients by 13.5% from 0.52 to 0.45.³  These shifts have seen a net loss of 1,152 practices since 2015, and a corresponding increase in patients per practice of 33.3% from 7,465 to 9,950.  While practice mergers explain a proportion of these changes, many practices also close due to staff recruitment and retention difficulties,⁶ reflecting the collapse of GP morale⁷ that both pre-dates and has been exacerbated by the pandemic.⁸

Other sources of pressure on GPs

In addition, a variety of patient factors (such as increasing complexity, continuity of care, and growing expectations), system factors (including new clinical services and primary healthcare integration with the wider health system) and supply-side factors (such as deepening complexities of funding and commissioning) conspire to generate not only an increased workload for GPs, but a workload of increased intensity and complexity.⁹  The speed of this change is profound and unprecedented, and has been accelerated, not simply triggered, by the COVID-19 pandemic.¹⁰

What’s really going on with reported GP earnings?

As such, the current situation is one of vastly increased pressures acting upon a shrinking number of GPs who are collectively producing more value than the profession has ever generated before.  Whether or not this landscape warrants the pay rise descrived in The Telegraph’s recent headline (and also those pay rises it opted not to point out) is for the reader to decide.  What is clear, however, is that the Government’s recent announcement of a 4.5% pay rise for some GPs (notably not GP Partners)¹¹ is far below current levels of inflation (which reached 10.1% in England in August 2022).¹²  Accordingly, the enormous volume of additional work conscientiously discharged by a contracting GP workforce is being effectively rewarded with a pay cut in real-terms.

Whatever the intentions behind it, The Telegraph’s headline is a successful instance of ‘click-bait’ that may enrage an increasingly frustrated public that often genuinely struggle to access and consult with their GP. This gives it an air of medical ‘fake news.’¹³  However, unlike the mischievous charisma of Jerry Maguire, whose powers of persuasion had this audience at “hello,” The Telegraph’s portrayal of GP earnings fails to withstand even a cursory review of publicly available data.  By provoking us sufficiently to dig a little deeper, the on-going heroics of contemporary general practice, the commitment and resolve of its world-leading workforce, and the need to further safeguard this precious institution, have only become clearer by showing us the money.

Conflict of interest statement

All the author’s clinical work is as a locum, with no partner or salaried components

References

1. L Donnelley. GPs given record pay rises in Covid pandemic. 01 September 2022. https://www.telegraph.co.uk/news/2022/09/01/gps-given-record-pay-rises-covid-pandemic/ [accessed 08 September 2022]
2. NHS Digital. GP Earnings and Expenses Estimates, 2020/21. 01 September 2022. https://digital.nhs.uk/data-and-information/publications/statistical/gp-earnings-and-expenses-estimates/2020-21 [accessed 08 September 2022]
3. BMA. Pressures in general practice data analysis. July 2022. https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis [accessed 08 September 2022]
4. NHS Digital. Appointments in General Practice February 2020. 26 March 2020. https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice/february-2020 [accessed 08 September 2022]
5. NHS Digital. Appointments in General Practice July 2022. 25 August 2022. https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice/july-2022 [accessed 08 September 2022]
6. J Kaffash and R Carter. Revealed: The GP practices that have closed for good and why they have closed. Pulse 29 August 2022. https://www.pulsetoday.co.uk/news/lost-practices/revealed-the-gp-practices-that-have-closed-for-good-and-why-they-have-closed/ [accessed 08 September 2022]
7. C Tilley. NHSE: Salaried model conversations ‘have contributed to low GP morale.’ Pulse 16 June 2022. https://www.pulsetoday.co.uk/news/workforce/nhse-salaried-model-conversations-have-contribute-to-low-gp-morale/ [accessed 08 September 2022]
8. Pulse. More than 75% of GPs say morale is worse than when they started practising. 28 February 2020. https://www.pulsetoday.co.uk/news/uncategorised/more-than-75-of-gps-say-morale-is-worse-than-when-they-started-practising/ [accessed 08 September 2022]
9. B Baird, A Charles, M Honeyman, et al. Understanding pressures in general practice. The King’s Fund. 05 May 2016. https://www.kingsfund.org.uk/publications/pressures-in-general-practice [accessed 08 September 2022]
10. The King’s Fund. Submission to the Health and Social Care Select Committee inquiry into the future of general practice. 06 April 2022. https://www.kingsfund.org.uk/publications/submission-health-and-social-care-select-committee-inquiry-future-general-practice [accessed 08 September 2022]
11. BMA. BMA’s England GP leaders condemn ‘derisory and divisive’ pay award and consider action. 22 July 2022. https://www.bma.org.uk/bma-media-centre/bma-s-england-gp-leaders-condemn-derisory-and-divisive-pay-award-and-consider-action [accessed 08 September 2022]
12. Bank of England. When will inflation start to come down? 17August 2022. https://www.bankofengland.co.uk/knowledgebank/will-inflation-in-the-uk-keep-rising [accessed 08 September 2022]
13. Treharne T, Papanikitas A. Defining and detecting fake news in health and medicine reporting. Journal of the Royal Society of Medicine. 2020;113(8):302-305. doi:10.1177/0141076820907062

Featured photo by Mathieu Stern on Unsplash