Page last updated at 14:36 GMT, Tuesday, 28 June 2005 15:36 UK

Do GPs provide value for money?

GP and child patient
Family doctors are earning up to 180 an hour for treating patients out of hours, but do they provide value for money?

Scottish health board figures released under the Freedom of Information Act have detailed pay received by GPs.

They show that one GP in Dumfries and Galloway earned 6,500 for a week's work out-of-hours over Christmas.

Do you think the cost justifies the service provided? Is your GP value for money? The following emails reflect a balance of the comments you sent us.

Working like a dog to get the necessary grades at A Level, struggling 5 - 6 years through one of the toughest university courses, all the while accumulating 20K +/- of debt. Then looking forward to working weeks more antisocial than most other professionals and up to 10 years of higher training in highly stressful environments. Yes, GPs definitely deserve the sort of pay seen by other high level professionals and indeed it is time to recognise that GPs are not the only doctors that work this hard but the legions of hospital doctors, if anything, have to put up with scarier stuff than seen in a typical surgery.
Mark Petersham, exeter

The local GP, here in Alliston, Ontario who turns up at the local emergency dept. of our cottage hospital receives a payment of $75.00 or the equivalent of just short of 30 for the 1st half hour he is in attendance and then the rate drops to a more manageable rate per hour. Doctors in this community do not make house calls and they work specific office hours, a total of 32 - 40 hours plus on total of hospital visits an additional 8 hr. per week ( about 2 hrs. per day). Perhaps the Scottish NHS is too generous with the number of hours that can be worked by the doctor and subsequently claim over time for it, while over worked and stressed, professionals frequently perform at a less than acceptable level of delivery. For comparative purposes airline pilots and truck drivers, who have our lives in their hands and are required to make life changing decisions are normally limited to the number of hours they can either fly or drive before being pulled over. Perhaps the same should apply to the stressed out doctors.
Gordon McInnes, Ontario, Canada

One GP in Dumfries and Galloway earned 6,500 for a week's work out-of-hours over Christmas. An average Premier League footballer earns 20,000/wk anytime of the year. There is something amiss here. Food for thought.
ED, Leeds

Your report is very skewed, taking extreme cases as examples for all, and presenting them as the average. Also if you research it a bit further, your annual salary estimate is an English figure, the level has always been lower in Scotland
Paul, Glasgow

This report cynically takes the extreme and presents it as the norm. Doctors are not earning 1,000s per week, it's a fallacy. The recent GP contract simply gives them the rights that the rest of us enjoy and a fair wage for a very difficult job.
Steven Robb, Dumbarton

Most GPs will tell you an awful lot of out-of-hours work could have safely waited till the next day or could have been dealt with earlier during normal hours. Perhaps the government should be educating the public not to call for minor problems out of hours and to have a bit more common sense. Then we wouldn't need so many out of hours doctors, supply could meet demand and the tax payer could save a lot of cash. Even at the rates currently being offered doctors are being flown in from abroad to cover some shifts.
c stewart, irvine scotland

I presume Bryan from Stirling and Graeme from Glasgow and Jim from Lanark would still be complaining about the "public sector gravy train" and these "uncaring self centred egotists" if one of these " overpaid doctors were to save their life. Doctors are worth every penny and considering the contribution they make to society I'm not sure they are paid enough.
Keith Brockie, Dunfermline, Fife, Scotland

You can't compare the work of doctors with those of nurses or paramedics. We all have completely different and valuable roles but, at the end of the day, it is the doctor who is ultimately responsible. There are also many misunderstandings about the pay we receive. I earn around 45,000 before tax as a Senior House Officer, for being the most senior person in my department out of hours with all the responsibility for every patient (up to 200 of them), having spent six years at university studying. We also work more hours than anyone else in the hospital. This week, I will be working 80 hours in total as well as coming home to study for essential post-graduate exams. Let's also remember all the other people, such as porters, lab technicians, and radiographers, in the hospital who are so essential to the running of a hospital yet get paid a pittance and don't get the sympathy and support from the public that nurses do.
A junior doctor, Scotland

I am a GP trainee and I am proud of the recent developments. For too long doctors, nurses, and other health care staff have been underpaid by the government. Nobody bats an eyelid when lawyers get paid 500 an hour or politicians itinerary runs into hundreds of thousands of pounds, or when footballers get paid millions, but when a GP working at 2am in the morning to see an elderly lady with chest infection gets paid 100 an hour the sharks circle for the kill. If you want to be treated by doctors and not poor substitutes you must be ready to pay for it. Training nurses to play the role of doctors is not the answer. Training more doctors paying their wages is the solution. Already more and more nurses are leaving the profession because they cannot afford a mortgage because of low salaries. Presently the NHS is surviving on GPs and Primary health care. I wonder how the country will be if they are to go on industrial action for one week?
Akin, UK

The pay rates for NHS doctors on call are clearly correct. Perhaps the cost to the NHS should be passed on to those who make frivolous call outs to prevent excessive use of the system.
Alistair Thomas, Edinburgh, UK

My father is a GP and is due to retire next year after 40 years service. He has saved more lives than any of these sceptics can shake a stick at, has delivered more people into the world than most people could count, and has relieved more pain, suffering and anxiety than anyone else I know - yet the first hint of reward for this (and they are still a very underpaid profession compared to others of their capability) and people are up in arms about it. They have the most responsible role in public society - keeping us all alive and healthy. There is no greater stress in any profession, and sceptics should wake up to this. I'd like to see any of them do the job. They need to be educated and may then realise their manners, say thanks to their local GP and admit that their GP deserves far more than they will ever earn for the service they provide.
Alasdair, London

GPs, like any other worker, are essentially commodities, if the price is right they are available, and the price is set by market forces. People wouldn't pity GPs who were paid less due to excessive numbers of GPs fighting for work, but there are not enough GPs so the price to employ one is high. Simple economics. If street cleaners were in short supply, they would be paid similar rates.
Mike, Liverpool

Ahh, the good old public sector gravy train just keeps on rolling. Presumably they'll still get that extra fee for writing a prescription or referral to the private sector on top of the 6,500. Wonder if it's pensionable - now that would be a perk. If you're going to draw comparisons with lawyers, accountants etc. just remember it's not the individual that earns 180+/hr - it's the firm.
Bryan, Stirling, UK

Your article "Doctors cash in on new pay deal" (28/6/05)states that "Earlier this year, a survey of 10% of GPs suggested that their earnings had risen from an average 85,000 to nearly 100,000." This was a survey of 10% of GPs (presumably in the whole of the UK). This is not representative of all GPs in the UK. The average UK GP salary is nowhere near these figures, and when it is higher than average, it is due to the greater extent and quality of services offered to the patients, as per their contract with the local Health Boards. GPs are self-employed. They are highly intelligent and highly trained. They are worth valuing. In the increasingly rights-based society that we live in, patients should reconnect with the respect we used to have for family doctors. All GPs could use their ability in other fields. If we continue deriding them and underpaying them, few medical students will aspire to being a community based family doctor. That will be a loss.
Gordon Drysdale London

GP Doctors were not value for money before the changed working hours came in. Now as I have always suspected they have been shown to be no more than uncaring, money grabbing, self-centred egotists that think they are worth every penny! In any dealings I have had with GPs, I already knew the diagnosis, or had previously had it diagnosed by a nurse. It is elitism which artificially restricts the number of doctors and thus ensures inflated salaries. The politicians could easily legislate to destroy this enclave and allow more practitioners and thus increase availability and drive down costs like has been done every where else!
Jim, Lanark

When will the public ever realise that nurses are NOT the same as doctors and should NOT be on comparable salaries!!!
Julie, Glasgow

To Julie, Glasgow. Indeed nurses are not the same as doctors but the average nurse earns 20-22k/year, 4-5 times less than a doctor. Do we see this gap in other public sectors - I think not. Can you imagine the uproar if teachers earned 60k/year all because they are not the same as classroom assistants and should not be on comparable salaries!!
Charles Best, Cumbernauld, UK

Looks like we have a new breed of fat cats - no wonder the NHS is short of money!
Chris Smith

Pay deals have to be honoured. Should the present deal seem generous, or open to abuse, then it should be renegotiated. Whether doctors or consultants realise it - the fact is many are being perceived by the general public (who are supposed to be their customers in modern parlance) as using their position/s to effectively hold the general public to ransom. This perception needs changing.
William Wood, Stonehaven

GPs earning 180 an hour - they are certainly not earning it. Looks like we have a new breed of fat cats. No wonder the NHS is short of money!
John, Dundee

Aside from the payment for out of hours work the fact that the average GP now earns 100k sickens me. There is no doubt that they provide a valuable service to the public and have a stressful job, but so do many other people and I guarantee that they earn no where near 100k.
Chris Smith, Glasgow

Has anybody made the connection between GP's cutting their hours and paramedics receiving extra training to deal with all sorts of conditions at the patients home? It seems to me that the ambulance service is picking up where the GP out of hours service have left off. I wonder if the paramedics who will end up doing what GP's used to do will get any where near the earnings of these doctors?
Brian Nuth, Bracknell

For the headline 6,500 do we know how many hours that GP worked, how many patients he or she managed, and - most valuably for the NHS - how many people were prevented from becoming hospital cases by delivery of that most difficult of medical tasks, accurate diagnosis? Can we afford not to have a quality emergency service?
Colin Brown, Paisley

This simply goes to show how undervalued GPs were when they were expected to provide their own out of hours cover
Tony Robinson
West Midlands

Dr's have always been amongst the highest earners in our society so nothing has changed. However, I am sick and tired of their whinging. They have group practices, practice managers and practice nurses, yet the moan constantly about their work load and responsibilities. There are many who work just as hard and would like just a whiff of their money, status and prestige.
Iain Buchanan, Cumbernauld

The government priced the GPs out of hours opt put at approx 6,000 per year for a full time GP. This means that before the new contract came about, GPs were getting paid 1 per hour for out of hours cover. I didn't hear a public outcry about slave wages for GPs. The rates being paid now are a true reflection of the work and expertise required for out of hours GP work which involve both anti social hours and a high level of clinical decision making.
Dr John I, Glasgow

Most of the family doctors who still help the out of hours service do it because they think that it's right to do so, not to extort the country. The rates of pay are only at extortionate levels for periods which are difficult to cover and most of the shifts are at the lower rate most of the time. I already work 8am to 7pm most days, so an evening shift at our OOH centre takes my day from 0800 to 2330.Please don't tell me that I'm not working hard enough.
A doctor, Inverness

There are at least two sides to this issue. A comment, especially to the anonymous midwife, you should really re-evaluate your own pay negotiation before signing the contract. It's not going to help midwives or nurses pay/conditions by lowering the GPs. I recommend that, if you want to improve your conditions, fight for yourselves. It'd worsen your own position if you takeover some of the GPs duties.
Julia Ting, Copenhagen

This simply goes to show how undervalued GPs were when they were expected to provide their own out of hours cover. The idea that it was only worth an average of 6,000 per GP was always laughable. Now that market forces apply we are seeing the true cost of providing this service. Rather than having a go at "profiteering GPs" those of us who used to provide the cover pre the new contract should be praised and thanked for having subsidised the service for so many years.
Tony Robinson, West Midlands

Try getting a lawyer over Christmas - even for 6,500!
Dr. S. C. Martin

Yes doctors get paid a lot more for out of hours work compared to nurses and Joe Bloggs, but they have the responsibility of peoples lives to deal with every day. The buck stops with them if things go wrong. It must be one of the most stressful and demanding jobs around, so yes they deserve to earn decent rewards for it.
Andrew Hagerty, Glasgow

I find it a bit frustrating and ironic that many of the media and individuals who complain about the health service being under-funded and its staff under-paid are now complaining about GPs actually being paid to fulfil a vital service! Doctors are people with bills to pay, families and personal lives. Why shouldn't they be compensated for spending weekends, nights and public holidays working? Surely its not much of a price to pay for universal access to healthcare based on need and not ability to pay?
Neil, Scotland

I believe that doctors should be paid for providing out of hours cover. The problem is that because they are being such vast sums per hour, then people's perception of doctors as healers of the sick will rapidly change to one of money grabbing exploiters and damage their hard earned reputations.
Iain Anderson, Rosyth

At the end of the day if GPs are not contracted to work those hours then appropriate incentives have to be offered. Considering that they are in short supply and have to train for as long as accountants and lawyers (both of whom have similar hourly rates) then this seems the correct pay rate.
Gordon Shannon, Glasgow

GP's used to do out-of-hours for free. Some of your correspondents don't seem to realise that. Try getting a lawyer over Christmas - even for 6,500!
Dr. S. C. Martin, Suffolk

Maybe police officers and air traffic controllers should also be paid at similar rates for working shifts. I would have thought that night cover was part of a GP's occupation, and should be mandatory, fairly rostered and compensated for by shift allowances paid as part of the salary. Why are doctors treated differently?
Graeme, Glasgow

Worth every penny - the alternative is to have no medical cover
Michael Gilliver

I am not a doctor, however why after years of technical training and hard work should we expect such people to turn out at all hours of the day and night for the same money as a policeman or train driver. I wouldn't.
Derek, Brecon Powys

It is absolutely disgusting that such people who are in effect paid by the tax-payer receive so much money. It must seem like an insult to many of the people that they are treating who may have to work a 40 hour week to earn just over such a figure. It must also be an insult to the many other nurses etc who have to work alongside. It wouldn't be so bad if they weren't then supported by such fantastic perks and pensions. Matt, Nottingham

The average take-home pay for GP's in the NHS is in the order of 20 an hour, after the expenses of running a practice are taken into account; for a complex job involving scientific and people skills with never any slack periods, this must be staggeringly good value for money!
Dr Peter Robinson, Preston

6,500 is a lot of money for one week's work. But when you consider that plumbers can make similar amounts during a thaw when there are lots of burst pipes, it makes you think that maybe a doctor who gives up his or her Christmas time to visit patients in remote rural areas is worth every penny.
Ally Binns, Glasgow

Incredible! Whilst conditions for most staff in the NHS continue to fall, GPs are allowed to sign a contract which is not inclusive of out of hours working commitments. We are being taken for a very expensive ride at others' detriment.
Gail McMillan, Aberdeen

Worth every penny. The alternative is to have no medical cover. Take your pick!
Michael Gilliver, Coatbridge

The doctors are holding the government to ransom
Fiona Hamilton

For that kind of money - they SHOULD be working hard. We've heard them complain before about their hours - but if this is the rate of pay - I've no sympathy. No, it's not value - but a service must be maintained. I bet nurses don't see that rate of pay.
Jim Ellis, Rugby

Fair enough people should be paid for out of hours work: but GPs are stretching the limits. They have us over a barrel and are quite cynically exploiting it.
Andy, Larbert

I think it's ridiculous that doctors are getting paid such extortionate amounts for out of hours work. Every doctor that is practicing today knew what was involved in becoming a doctor, and that includes night work. The doctors are holding the government to ransom.
Fiona Hamilton, Edinburgh

Doctors cash in on new pay deal
28 Jun 05 |  Scotland

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