Worth its weight in gold – weighing up the cost of childcare?

Nada Khan is an Exeter-based NIHR Academic Clinical Fellow in general practice and GPST4/registrar, and an Associate Editor at the BJGP. She is on Twitter: @nadafkhan

It’s a cost that many working parents will know, but the heavy financial burden of childcare was recently laid bare by the results of Coram Childcare’s annual survey of childcare provision in the UK.  The spring budget includes a ‘childcare revolution’ to increase the provision of free childcare, but what are the real time costs of childcare, and the impact on working GP parents and their decisions about working patterns?

Any working parents will tell you the importance of reliable and affordable child care, but the results of Coram Childcare’s survey highlight the increasing costs of care provision.  The average full time (50 hours a week) childcare cost for children aged under three in the UK is now £13695 per year (or £285 per week), with some regional variation; the highest costs are in Inner London (£373 per week) compared to East Midlands (£241 per week).  Because all children aged three and over will be eligible for some funded early education, the cost goes down to £117 per week on average in England, again with wide regional variation – the costs are 69% higher in London compared to the East Midlands.  The costs of childcare are increasing, with a price increase from 2022 of around 6% for children two and under and 5% for three and four year olds.  When the bell rings at the end of the school day, those working full days will need childcare for school age children as well, and the cost of afterschool clubs averages out at £67 per week (£2629) to cover 39 weeks of term time.  Is anyone else doing the maths here for parents needing to juggle childcare costs for one or more children?  Coram warns that the results of their survey should ‘ring alarm bells for policy makers’ as working parents increasingly struggle to meet the rapidly increasing costs of childcare.¹

What happens when the cost of childcare outstrips salary?  Nursery fees are already topping out over 80% of the average UK wage.  Although I’m aware that many GPs will be earning far above that average UK wage of £1735 per month, many of the issues impacting on childcare costs are intertwined with pay, and may disproportionately affect younger GPs and GP registrars with young families.  The recent junior doctor strikes for pay restoration reflect the difficulties some trainees are facing with cost of living and childcare costs. GP registrars struggle with juggling finances and childcare when returning to work after a career break.² Alongside trainees, some GPs might decide to go part-time, or not to work at all in the early years when their children are young, sometimes in order to balance their career with family responsibilities, but then face the problems of working out flexible sessions or paying for childcare when on a reduced income.³  These issues do affect the GP workforce.  The iNews website has been running a series on ‘How I manage my childcare’ and spoke to a GP in Scotland juggling childcare, nursery fees and pick ups who echoed the sentiment that some GPs feel that they would be better off financially if they didn’t have to work.  The pull to a vocation will keep many GPs in work, but these sentiments are worrying in the context of a retainment crisis in UK general practice.

The cost of childcare is an issue that affects all parents of young children, but there is a known career disparity between male and female doctors in parenthood.  More women than men will choose to work less than full time to support young families, which can slow down career advancement and reduce take-home pay amongst women in the workforce.⁴  A recent report by the Department of Health and Social Care (DHSC) looking at gender pay gaps in medicine described a hefty ‘motherhood penalty’ for female doctors.  Compared to male doctors, more women see a lack of affordable childcare as a barrier to career progression because it is a factor in deciding to drop working hours to avoid increased childcare costs.5

So, what are the solutions?  Jeremy Hunt’s ‘childcare revolution’ in the 2023 spring budget promises 30 hours of free childcare for every child over the age of 9 months, with support available for every eligible parent by September 2025.⁶  If affordable childcare is a barrier to career progression, especially amongst women, increasing provision of free childcare may help to reduce disparities amongst working parents, especially when a lack of career progression compounds pay disadvantage.  There are specific return to work schemes for GPs who decide to take time out of work to support young children, and the Return to Practice Scheme offers up to £2000 towards costs of childcare for children aged under 11. And, at a practice level, allowing GPs to work more flexibly or choose sessions that match nursery or afterschool club provision can reduce childcare costs by matching work patterns to the specific days children are in childcare.  For those GPs with parental responsibilities who want to return to work but are doing the maths around their take home salary and nursery fees, simplifying the equation to make a return to work more financially viable may well help with our current workforce and retention crisis.

References

1. Jarvie MS, S.; Kunwar Deer, L.; Goddard, E. Childcare Survey. Coram Family and Childcare; 2023.
2. Gardiner PC, Kerton E, Fowler D, Ringham S, Calogeras A. Can improvements be made to the Supported Return to Training (SuppoRTT) programme for General Practice (GP) trainees in Wessex? Educ Prim Care. 2022;33(6):357-9.
3. Evans J, Goldacre MJ, Lambert TW. Views of UK medical graduates about flexible and part-time working in medicine: a qualitative study. Med Educ. 2000;34(5):355-62.
4. Frank E, Zhao Z, Sen S, Guille C. Gender Disparities in Work and Parental Status Among Early Career Physicians. JAMA Netw Open. 2019;2(8):e198340.
5. Dacre JW, C.; Atkinson, C.; Laliotis, I.; Williams, M.; Blanden, J.; Wild, S.; Brown, D. Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England. Leeds: Department of Health and Social Care; 2020.
6. Chancellor unveils a Budget for growth: HM Treasury; 2023 [Available from: https://www.gov.uk/government/news/chancellor-unveils-a-budget-for-growth.

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