An MPs report has claimed that the new GP contracts have made it easier for doctors to earn high salaries through performance-related pay.
Ever since the contracts were introduced four years ago, GPs have been able to opt out of providing out-of-hours care in return for a £6,000 drop in salary – although practices can earn extra cash through the Quality and Outcomes Framework.
The changes have seen average GP pay rise above £100,000. The performance-related pay structure has meant practices can earn extra cash and no cap has been placed on the proportion of income GPs can take as profit.
The House of Commons Public Accounts Committee's report said that the contract had led to some improvements but was so far failing to live up to expectations.
"Points" are earned by doctors for reaching a range of targets, including patient satisfaction and managing long-term conditions such as diabetes and asthma. These points are then converted into cash.
A report earlier this year from the National Audit Office found that productivity in relation to GP services has fallen by an average of 2.5% a year.
Tory MP Edward Leigh, the committee's chairman, said: "The new contract has not led to general practices being opened longer or at more convenient times for patients and has failed to improve services for deprived areas."
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Do you think your GPs are earning more for doing less work? Your comments: (Terms and conditions apply)
"I agree with an audit of GPs’ lifestyles and investments. GPs are supposed to give care, not to manage money; instead, they try to grab what they can before the law changes. Some GPs hardly spend time at their practice – 12 hours is too much for them. Nurses don’t have time to breathe as all the workload is on them and they are never given time for development. The whole system has to be changed. GPs should spend 40 hours at their practice and not give private care during that period. They shouldn't get payment for out of hours care, it should be built in; unqualified health care assistants ticking the boxes should be not allowed and GPs of that kind should be removed from the contract. The money-making system should be replaced by one that provides cost-effective care. Nurses are better managers than doctors and they can balance both clinical and general admin." - Name and address supplied
"Yes they are. Most of the the QOF work which increases their income is done by practice nurses. Although my practice claims that it implements the Agenda for Change system it is difficult to have time off for CPD. In my view practice nurses' pay and conditions should come directly from the PCTs and not be set by the GPs themselves." - Jane, London
"Who trusts MPs' opinions these days? MPs have lost credibility and the trust of people they represent. They remind me of the aid workers trying to sign you up to a charitable cause. They get very well paid for doing their job. Sadly they make bad decisions and we all suffer. They apologise and it doesn't make a difference in their lives. Why don't the MPs decide to tell us where they have put their money? How are they managing if their assets are no longer available. No MP is going to reveal their financial postion." - Carl Curtis, London
"Doctors have become the new elite, with massive pay packets and mostly the lifestyle that goes with it. And don't get me started on their new pension rights. Yes I know 'some' of them work hard but bloody hell others them are on a par with estate agents, known for greed and grasping. The new contract was a mistake on a massive scale. Some of the GPs where I work as well as having every w/e off, take a further 1/12 during the week and other days for training. No wonder the walk-in centres are full." - Marie, Manchester
"Yes. I am disgusted with the amount GPs' earn. I work in a GP practice and feel underpaid and undervalued. Nurses are managing long-term conditions. GPs get paid for every review nurses carry out. We also do the bulk of the flu vaccinations and don't get any increase - it all goes to the GPs. I feel very angry. I have noticed in the last 2 years that we are expected to do more GP-oriented tasks and no increase in our salary." - Alison Cant, Edinburgh
"Yes - that's why I left the NHS! Nurses have more responsiblity and less pay. Why do we put up with it?" - Jennie McKay, Northampton
"Definitely! The practice nurses are doing the work to earn the points and in our practice we even had to ask for a pay rise. We cannot even see where there has been any money reinvested in the practice." - Anne Watkinson, Birmingham
"The bulk of this target-based work is done by practice nurses who often get nothing or very little for their increased workloads." - Valerie Rogers, Newcastle
"If the work is done correctly it's a lot of hard work by doctors and nurses. Any GP who is making money easily from QOF is doing something wrong!" - Heather Francis, Hertfordshire
"Yes. I am in a new job where I'm only allowed to work 30 hours a week. There's another nurse who works 12 hours and then the rest of the week she works in hospital, and one other who is still learning and only works one day. I have to see patients in 10-minute intervals (mostly) during which time I have to meet all QOF points. I also have to do all the ordering and stocking in all rooms, between two surgeries. Yet I'm not allocated time for that! I've tried to mention this but it's as if it's not heard! The doctors even do extended evening and Saturday hours. I've got to pay a mortgage and sometimes I wonder if I'll have enough to see me through the month." - Name and address supplied
"This is so typical! The only reason GPs are doing well is the fact that they and their practice nurses are working harder than ever. Do MPs have any idea what it is like in general practice any more? Perhaps they would like to spend a week in surgery and find out for themselves. Practice nurses do a lot of the QOF work – without them targets would be a lot lower. Perhaps MPs should look at how they justify their wages and bonuses for doing what looks like very little, instead of constantly having a go at general practice." - Fiona Johnson, Derby
"Yes definitely. Nurses tend to earn the majority of QOF points for their GPs; these are the same nurses who are not included in Agenda for Change, who have problems updating their skills and accessing ongoing education within work time, and who are excluded from PCT interprofessional learning." - Lynne Blears, Trafford PCT
"I think they do work hard but what everyone forgets is that the nurses and HCAs all contribute to earning the points too, which the GPs could not do without us, but we never see that reflected in our pay. Some practices reward their staff with a bonus or gift vouchers for working hard to get the points, and I think this should be happen in every practice, not just those who think about the hard work that their staff put in." - Angela, Wallasey
"Generally yes, but you cannot paint all with the same brush. From my personal experience I feel I work very hard caring for my patients. QOF points are achieved because on the whole it benefits patients, yet the nurses and the receptionist have not seen a bonus at all despite the income we generate. Funnily enough I have a meeting today to look at how they can reduce my salary as things are much harder than they used to be!" - Name and address supplied
"Yes, I think they are so overpaid for what they offer and do. Most GPs work a 4-day week and no evenings and weekends. Some GPs send a locum doctor out to do home visits. As a district nurse it is difficult to get hold of a GP, let alone get them to do a home visit. They are paid a vast amount of money compared to the hours they put in." - Nicola Visagie, Merseyside
"So the MPs think that GPs earn easy money do they??! As I am finding it hard to think of one MP who is worthy of the enormous amount of taxpayers' money they are able to claim in salary, expenses, second homes, staff expenses and the like, how about we get rid of them altogether? I know who I would rather put my trust in, and it wouldn't be those warmongering, self-serving, snivelling liars in Parliament. As the average doctor cares more for the wellbeing of their patients than MPs do about their constituents, we could then plough all the money into patient care and proper pay for nurses. The MPs could then go and crawl back into whatever hole they all came out of." - Name and address supplied
"I can only speak for my doctors who have had a pay drop 2 years in succession despite getting full points both years. The constant drive to get more money in is driving us to stretching point and most of the extra work seems to be coming to the practice nurse! We have increased our population from 3,000 to 7,500 in 7 years and our nursing staff has increased from two fulltime nurses to two fulltime nurses and one healthcare assistant! Although to be fair we now have a locum for holidays and are trying to recruit another HCA (luxury)." - Linda, King's Cross, London
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