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.

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.

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.

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.

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 ;)

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".'

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.

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

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.

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.