Individual General Practitioners in the UK currently have, on average, about 1800 patients registered under their care. They almost universally work within a business structure, being contracted by the State to provide certain core medical services for the patients on their list. A typical GPs day usually takes the form of a 2-3 hour surgery in the morning, and another in the afternoon. These surgeries may be by appointment, or open access at the GPs choosing. On average, each patient spends between 5 and 8 minutes with the GP at each such consultation. After morning surgery, UK GPs usually perform home visits, to which patients no longer have an absolute right but which remain the only practical way to deliver healthcare to many of the old and immobile. On average, there are around four of these, per GP, per day.
Following home visits most GPs now run special clinics of one form or another during the afternoon: diabetic, hypertensive, child surveillance, ante natal clinics and so on. The core service also includes an obligation to provide 24 hour, 7 days a week, 365 days a year emergency medical services, at the patient's home should they so require ( 2003 contract will change this) . GPs may delegate some or all of this 'OnCall' commitment to colleagues, or deputies, but remain ultimately medico-legally responsible for the actions of their stand-in. On average, a GP works around 70 hours a week in 1995. Malpractice Insurance remains the responsibility of the individual GP, and costs £2165 in 1999.
Remuneration of GPs is complex ( 2003 contract will change this). General Practitioners, as they did before the NHS, generally work in partnerships of some 3-5 doctors. The greater part of a partnership's income now derives from fulfilment of their NHS contract. The bulk of the income comes from multiplying the total number of patients cared for by a fee per patient (known as the capitation fee):
Capitation Fees (March 1999 figures):
* Patient under 65 years of age: £17.65
* Patient between 65 and 75: £23.25
* Patient over 75: £45.05
...and then adding on the Basic Practice Allowance which is linked to the absolute number of patients:
Basic Practice Allowance (March 1999 Figures)
* For first 400 patients (minimum qualifying list) £3,440 lump sum
* next 401-600 patients £8.60 per patient
* next 601-800 patients £6.88 per patient
* next 801-1000 patients £5.16 per patient
* next 1001-1200 patients £3.44 per patient
* more than 1200 nil extra
Capitation fees and Basic Practice Allowance alone would give a GP with a typical age:sex mix and list size an income of around £66,280 gross a year. In addition to this income, however, almost all practices elect to provide a range of optional additional services (not compulsory under the contract) for which there are additional payments available from the state on a fee-per-item basis. For example, some of the more common 'extras' and the payment GPs received in March 1999 for each patient so treated:
* Contraceptive advice or treatment £16.40 per year per patient
* Complete ante-natal and intra-partum care £205 per pregnancy
* Minor Surgery £128.25 per five cases
* Child Health Surveillance £12.75 per child under five years old
* Temporary Resident (up to 15 days) £10.40 per patient
* Temporary Resident (more than 16 days) £15.60 per patient
* Training Grant (for training GP Trainees) £5,645 per Trainee
There are also a number of Health Promotion activities for which GPs receive payments provided they reach various uptake targets in their population:
* Childhood Immunizations (higher target) £2,580 (lower target) £860
* Pre-school Boosters (higher target) £765 (lower target) £860
* Cervical Cytology (higher target) £2,865 (lower target) £955
...and then there are deprivation payments, if your practice area is considered to be particularly poor (and the morbidity consequently higher), Rural Practice Allowances (to cover the additional costs of driving around remote areas), Seniority Payments etc. etc. etc. This baroque arrangement requires much chasing of paper, and permanent uncertainty regarding your final income. A significant number of GPs intermittently question whether it would be simpler to become a salaried service, directly employed (rather than contracted) by the State in the same way as Consultants. Opponents of this idea say that it would prevent keen, dynamic GPs from being able to increase their individual incomes through hard work.
From this grand total of income from all sources, the expenditure of the practice such as on buildings and staff must first be deducted, and the remainder is income for the Partners. GPs can also earn additional money through private, i.e. non-government, medical work (e.g. Occupational Health for a local Industrial Employer, medicals for insurance companies). Some practices share equally the pooled private incomes of all the partners, whereas in other practices the individual partners retain whatever they earn in addition to NHS income.
This payment scheme suggests that the more work GPs do, the more they earn over and above the capitation fee payment. Whilst this is broadly true for an individual practice, it is not true for the combined income of all GPs - the total amount earned annually by all GPs in the NHS. This is because the money paid out each year - both for honouring the contract and as fees for all the optional sections - actually comes out of one big, but finite, pot of money. The size of this pot is calculated precisely in advance, on an annual basis, by choosing a sum of money which is considered an appropriate annual income for an average GP in the coming year. This 'average gross intended remuneration' figure is then multiplied by the number of GPs in the country to arrive at the total budget for GP services which the Government expects to pay during the following year. All the various fees - capitation, basic practice allowance, item of service fees etc. - are then reverse-engineered from this sum.
The 1999 figure for average gross intended remuneration stands at £75,892. This figure often appears in the popular press as evidence that GPs are fabulously well paid, considering they spend all day on the golf course. Of course, this gross figure is before the GP has paid any of their staff.
In 1999 The Department of Health reckoned that it costs £24,700 per GP in a practice to cover the practice expenses, a figure calculated by the DoH randomly selecting a small group of 'typical' practices annually and, from their accounts, calculating an average expenditure. Thus the total practice income, before expenses, should be the number of GPs multiplied by £84474. After the expenses are met, however, the Government intends each GP to take home an average net intended remuneration of £61218 on which the GP subsequently pays income tax and so forth (currently about 30%).