The EveryDoctor team have been moved to write aresponse to rank inaccuracies within an article entitled: “Generous GP pay isn’t working for patients” (The Times, 27th August 2021), authored by JamesKirkup from The Social Market Foundation, a right-leaning think tank. Factual inaccuracies and negative characterisations in pieces such as these cause untold damage to doctor-patient relationships and propagate mistruths, harming both medical staff and the populations they serve. Given the rising tide of physical and verbal abuse directed at NHS staff, we are extremely concerned ofthe potential impact of such poor journalism from institutions like The Timeson the safety of NHS staff.
The general tone of the article is one of cynicism towards doctors’ priorities; and the blame for grave systemic problems of unequal national healthcare delivery and health inequity is laid at the door of individual GPs, who are presented as fundamentally self-interested. Mr Kirkup begins by opining that “the power of money creates big problems”, and he’s absolutely right. The public purse hasbeen squeezed beyond recognition by this government, and doctors, other NHS staff and their patients have suffered immeasurably as a result. Departmental spending has been cut by upwards of £40 billion by government since 2010. The result? An understaffed NHS workforce teetering on the brink of exhaustion,widening health inequalities, and the longest waiting lists in England since NHS records began. The health services in Wales, Northern Ireland and Scotland are also experiencing enormous pressure, andstaff are working harder than ever to keep patients safe.
In describing patients’ increasing difficulty to access a GP, Mr Kirkup ignores the enormous concomitant rise in GP workload (caused by a combination of burgeoning demand following COVID-19 and the need to care for complex patientssuffering at the end of record-breaking waiting lists for hospital care). GPs are juggling complex clinical risk profiles for large groups of aging patients, an extraordinary feat, and are forced to triage the patients most at risk on a day-by-day basis in order to keep their patient groups safe. This restricts access for patients with non-urgent problems but keeps those who are most vulnerable from falling through the cracks. Doctors’ first priority is to keeppatients safe, and this is what they are doing, in the face of extraordinary challenges.
NHS England have revealed that GP practices delivered 1 million more GP appointments perweek in January 2021 than in January 2020, before COVID hit. This in the face of a workforce crippled by mandatory self-isolation, reeling from the deaths of colleagues, and learning to function within new limitations brought on by new standards of infection control. GPs aren’t slacking, Mr Kirkup,they are working harder than ever before.
The Times’ article fails to explain the way that NHS GPs work; focussing solely on the contracted hours of one group of GPs. GPs fall into two categories; those who run a GP practice (partners) and those who are salaried to work in a practice but do not manage the operations (“salaried GPs”). A salaried GP is contracted to work a number of sessions per week. A GP partner has no limit on their working hours. However, regardless of whether a GP has a contracted expectationof their hours or not, the current workload is forcing GPs currently to workhuge numbers of unpaid hours in order to keep patients safe. One GP who is an EveryDoctor member described that while she is contracted and paid as a GP partner to work part-time (35 hours a week), she is forced to work 65 hours aweek at present to keep patients safe. This extra 30 hours aweek is unpaid work. She does this week in and week out, out of concern for her patients.
When discussing GP pay, Mr Kirkup has cherry-picked figures from a 2019/2020 document released by NHS Digital. He states that GPs have “average earnings of £100,700”. This is not the UK average, but the figure for full-time GPs in England (the figure is lower for Wales, NI and Scotland). It certainly is not accurate for the part-time salaried GPs Mr Kirkup has been using as his case study in other parts of this article (by comparison, the same NHS Digital document states that a full-time salaried GP in England earns an average of £63,600). Indeed, on the subject of pay, Mr Kirkup fails to mention the drastic reduction of NHS workers’ pay in real-terms since 2010. The Nuffield Trust reported in July that the average real-terms drop in pay since 2010 for doctors is 9%. For some senior doctors, the drop is up to 28.6%.
Mr Kirkup does discuss pensions; questioning whether doctors are provided for in an over-generous way, allowing them to retire early. Most senior doctors pay around 14% of their earnings as contributions. NHS pensions are linked to a person’s State Pension age; anyone deciding to take early retirement faces steep financial penalties. It is worth noting that anyone born after April 1970 will be expected to work until they are 68 to access their full pension.
Despite the factual inaccuracies within his article, Mr Kirkup does raise some important questions: Why is there a staffing crisis in the NHS? And what can be done to improve health provision for NHS patients? Both questions are at the forefront of doctors’ minds every day as they battle through the most challenging period of their careers. The answer,however, is not to blame NHS staff, who have endured as much as any during this pandemic, who remain working in an underfunded healthcare system buckling underthe strain, and who turn up for their patients day in, day out, even as they watch their relative pay packet shrink year on year. We must instead ask ourselves bold questions: how highly do we value a public healthcare system? How highly do we value our nation’s health? EveryDoctor’s work is to speak to doctors and to the public every day. The message is clear: everyone wants things to improve. The answer, therefore, is simple. This government must invest in the health of the nation; funding services, funding staff training,and supporting those staff who hold our precious NHS together every day and areproud to dedicate their lives to serving patients.