50% tax rate - unexpected consequence

[MollieO]

Ds not well so we ended up at the OOH service this afternoon. As it happens we saw our usual GP - knew that he did Saturdays OOH but didn't realise he also did alternate Sundays. He said he won't be doing them for much longer because of the 50% tax rate and associated loss of the basic rate personal allowance. Apparently 16 out of the 20 GPs who cover OOHs are also quitting. This is because doing OOH work puts them just into the 50% bracket but because of the tax effect sees them actually being paid nett very little for the work they do.

It means that we will lose an excellent local facility and see it replaced with locums (at least I assume that is what will happen at best, at worst the facility will be reduced). Unlike the current GPs the locums will have no connection with the existing GPs surgeries and I can only see that as a bad thing.

I'm not against the 50% rate (never likely to affect me) and had assumed it is only the 'very rich' who are affected. However the impact of its introduction will perhaps have a far wider effect than we like to think.

I think that many doctors would like to see more doctors around, with the possibility to work fewer hours for a corresponding pay cut.

The problem is that as already mentioned there is an imbalance between supply and demand. Some well paid posts are empty because no-one will apply to do them. So other doctors work more hours than they ideally want to rather than see patient care suffer.

GPs do not get paid overtime. They are given an amount of money by the PCT with which they run their practice.
Out of this money they pay all staff including nurses, pay building rents and maintenence, pay for staff training, pay for locums to see their patients while they are completing their complusary training (which they also pay for) and all other costs associated with running the practice - for example my practise subsidise counselling for their patients as there is none available on the NHS locally.
They are able to attract top-up money for reaching government targets on things like vaccinations.

Once everything has been paid for, then the GPs in the practice divide what is left as their salary. There is no 'per hour' rate, the money is what it is, but the GP must work until the job is completed. There is no-one to delegate to, no-one to push back on and say sorry this workload is too high I refuse to do it - because they are essentially self-employed and running their own business. So it is very misleading to talk about hourly rates and how many hours a GP might or might not work.

In lots of areas useage is very high - eg. areas with large proportion of ageing population, or deprived areas where general health awareness is low. GPs in those kind of areas are taking home much lower salaries than those who have practises in largely middle-class areas where useage is relatively low.

whatname - doctors hours, see my post above for a typical day for my dh. However some docs only work part time, or do some specialist surgeries (eg one of DH's colleagues does a knee clinic) - as with many jobs there's no standard week, which is why the assumption that they're uniformly earning 250k is daft.

frogetyfrog if you geniunely feel that your GPs are dangerous, why haven't any complaints been made about them? You shouldn't put up with care that is genuinely substandard.

PPP - What do MOST doctors spend MOST of their time doing? Making life or death decisions that stretch their abilities to the limit? No. It will be applying protocols in the same set of situations over and over and over again. The same as the rest of us.

Even doctors who routinely work with life threatening illnesses will see the same things over and over again.

We shouldn't need to pay them that much to do that. They shouldn't be reward extra for running surgeries, because I don't WANT them to run surgeries I want them to work in them.

We need more 'levels' of expertise - Nurse Pracitioners are a step in the right direction. But these are seen as Nurses Plus, we also need some Doctors Minus.

"puts them just into the 50% bracket"

if they are hust in it, how much of their wage would actually be taxed at 50%?

if they were earning £150,001 for example?

just not hust!

JJ - the hours you mention seem perfectly reasonable for the 76k ish that is the average salary of GP's.

GPs do not get paid overtime

this is the norm for a professional job.

Jumpjockey - our GPs are inadequate. It is recognised locally and complaints have been made. However, in truth, it is difficult to prove GP mistakes and none have stuck as I understand it (although rumour is that one warning was given recently and there has certainly been some improvement in attitude by GP concerned which suggests it may be true). To be honest we all have ways to adapt around the problem such as our excellent nurse practioners. Also there is the OOH service where you see a gP from another practice or whereever, so a lot of us deliberately go OOH if seriously worried about something or feeling very ill (particularly with children - we always use the OOH or wait till the weekend to use the on call service). Where theres a will there is a way. But it is frustrating that they are paid so much for a totally inadequate service.

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).

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.

I personally would rather see a doctor than a nurse

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.

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.

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

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.

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.

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.

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"

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

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.

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

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.

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?

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.