50% tax rate - unexpected consequence

I don't think that the change to the Tax rate makes any difference to whether or not Doctors do on call. It was an enormous mistake to ever make it optional, and now the amount of money on offer to encourage them to do it is to low as a proportion of their total income to encourage them to do so.

MollieO - I don't blame your GP. I would not work extra hours on Sunday and pay a marginal rate of (income tax + NI) of 60%. Above a cetain level of basic pay a lot of people just say my free time is worth more than that and I do not need the extra money.

That is what Labour never understand. By imposing high taxes on rich people it just makes them leave a country and well paid people who have to work will only work up to the marginal rate which makes it worthwhile working.

Net result, is that high tax reduces incentives to work and invest. The tax take actually falls when very high marginal tax rates are imposed.

And yes, choices come into it, but I don't think that you can extrapolate that because someone has chosen a specific career that they are;
less/more intelligent
working less/more hard than someone else
deserve a higher/lower pay

PPP - yes, I got 4 offers for medicine at uni, and got the grades to take them up, but changed my mind about what I wanted to do.

Worth remembering that high payments to doctors stem from the very earliest days of the NHS:

(from wikipedia, but a fair summary, and the famous quote)
'Doctors were initially opposed to Bevan's plan. Bevan had to get them onside, as, without doctors, there would be no health service. . . On this subject he stated, "I stuffed their mouths with gold".'

FF - yes - the fault was the governments, but it has not done GP's reputations any good. I always imagine that the negotiation went like what would happen if you were offered a job and were thinking "Well I'll go in at 30k but I'm not settling for less that 27". And then there opening offer is 50k ;)

I agree. At the moment the GPs have an element of risk and uncertainty in their pay, which can lead to them being paid a lot, but they do not have a guaranteed take home pay.
I would be paid more if I was a GP, but I would not want to be, partly because of the business aspects of the role. It seems reasonable to me then that they would be paid more than me.

The increase in the cost would be huge if you did that. Waste in PCTs is enormous, as is the disorganisation. They are the ones currently responsible for running the OOHs service, and that is a complete shambles.

Far better that GPs remain directly responsible for their patients as they are now and employ their own staff to assist with running the practise. All the GPs I know spend 6+ hours per day actually seeing patients in surgery or on call - you would not see an improvement on that if they were salaried to the PCT.
What you would see is a great big bill for all hours on top of that that the average GP does in running the practise, because those tasks would be done by still more staff employed by the PCT.

Put the GP's on salaries, and roll the practices into the PCT or whatever succeeds them as the 'next up' level of authority in the NHS. All other organisations cope with variations in the demographic. The Doctors can then spend their time being Doctors.

Ooojimaflip and bigstipe. I understand what you are saying (have GPs far closer in family than perhaps I am letting on). However, I still do and have thought since change of contracts, that the public get a raw deal and that GPs get too good a deal. Whether we call it overtime, two contracts or whatever - it doesnt alter the fact that for most highly paid jobs paid for by the taxpayer (whether PAYE or self employed) there is an expectation that you work a lot of hours and do what is required. For GPs that is not the case - the unsociable hours are paid extra for. IMO the government was wrong to give GPs the choice to opt out and the public pays for it. You are right in a sense that it is not the fault of the GPs but I think some respect for them by many people was lost and they were seen as greedy when they were not before. There is a lot of talk and moaning about GP salaries now and I certainly didnt hear any a few years ago. Indeed until the opt out, I think most people thought they were hard working and deserved a good salary as 'they have to work all hours!' Just my opinion - but then I can remember the new contract and the smiles on the faces at dinner! It was considered too good to be true and the reality is that it was.

The huge advantage is that they can be flexible to the needs of their patients. Even within the area covered by one PCT there will be enormous variation in the demographic and therefore the services required.

What would you propose as an alternative?

Alibaba - "nurse practioner who will have had far less training and have far less breadth of knowledge is somehow a better option is stretching things." but it IS for MOST things. For most things most people got to the doctor for it makes no difference if you see the Nurse or the Doctor - as they will do the same thing. So it's better for the Nurse to be used as it costs less for the same outcome.

Alibaba - "But the GP has always been self-employed, always" Why? What benefit does this provide? Why does this need to remain the case?

frogetyfrog

The situation that you describe, with GPs on a rota provding OOH care is what used to exist.
The government decided that providing OOH cover was only worth 6K per year and then allowed GPs to opt out of it. Not really the fault of the GPs.

ooojim - I am very sure that there are incompetant doctors, I know some. I think though that to suggest that a nurse practioner who will have had far less training and have far less breadth of knowledge is somehow a better option is stretching things.

FrogetyFrog - It's not and never was overtime - it is effectivly a choice of contracts. Effectivlty we said "You can pick one of two jobs, 50 hours a week for 60,000 or 75 hours a week for 66,000" (numbers made up), and were then surprised by how many people said "Well actually I think I'll be OK on 60k ta"

But the GP has always been self-employed, always. It is increased red-tape that has made the running of the business harder and harder, which is why all practices now have a Practice Manager who is often a partner in the practise too, to manage all the administrative side - HR, tax, adhering to regulations etc.

Alibaba - I would also question that all doctors have a full range of knowledge and have been taught to think. There will be the full range from the incompetent, to the very skilled, from the conscientious to the downright lazy. You don't know what you are getting as a patient you don't know what you are getting.

Overtime may be the wrong terminology for it in the normal sense. But those GPs doing the OOH are getting paid for it. Presumably on an additional contract of payment. If GPs were not getting overtime (as in the service not the individual GP who can either take the extra payments and work for the OOH service or not) then they would be providing the OOH service themselves for their normal salary. If I worked as a nurse and my contract was for 9 - 5 at £30k that would be my wage. If then I chose to work an evening shift I would get paid extra - in a sense overtime (although it may not be overtime in the normal sense). What I am trying to say is that we, the public, are paying extra for OOH work that on a GPs salary should be done as part of the job on a rota basis and not paid or considered as a form of overtime.

my husband HAS to be on call 24 hours a day every day of the year by law

it blights your life

i can see why gps choose not to do it

Alibaba - That's what you might WANT, what you need most of the time is to go back to bed and wait for whatever it is to get better on it's own. What we can afford is another matter all together.

Why we are paying technical specialists to run businesses is another question.

frogety - you are missing the point. GPs do not get overtime. When their contract was last re-negotiated there was an option in it for GPs to take a £6k per year paycut and to not have to do OOHs. The vast majority took that option.

I personally would rather see a doctor than a nurse

ooojim - the whole point of a Dr is that they are trained beyond protocols. Protocols are the domain of the Nurse Practicioner and their ilk.

When I am ill I do not want to see someone who has been taught to follow a protocol, I want someone who has a full range of knowledge and who has been taught to think.

Edgar - they do get overtime of sorts because around here they do not provide an OOH service - it is provided by an on call service which the NHS pays extra for.

If they were doing overtime for no pay we would be seeing our own GPs on evenings or weekends but we dont and cant (not that I would want to but that is beside the point).