Headlines: February 2nd, 2007



A leading academic claims today that doctors’ self-interest has seen big increases in earnings for consultants and GPs with little improvement being achieved for patients. Alan Maynard, Professor of Health Economics at York University sets out the argument in the BMJ but it is countered by London GP Laurence Buckman, who says proper pay and conditions are the right of everyone – even in the public sector.

The BMJ says recent press coverage has suggested that the level of doctors’ pay is responsible for the NHS financial crisis so it has challenged the two experts to examine whether the remuneration is the source of the crisis. The article comes in the week that the British medical Association wrote to GPs with what it called ‘a rallying call’ to counter threats facing the profession, including local NHS deficits, private sector encroachment and “an unprecedented volume of misinformation, including, what appears to be, politically-inspired doctor-bashing.”

In today’s article, Professor Maynard says doctors’ self interest shows itself through increasing personal income and fiercely protecting clinical autonomy and the right for doctors to do what they think is best for their patients. The first of these, he writes, has enhanced average UK earnings to more than 100,000 pounds for both general practitioners and consultants, with little observable improved activity or patient outcomes. Pay increases have inflated NHS expenditure with too little benefit to patients or taxpayers, while giving more general practitioners incentives to deliver what good practitioners were already providing. It is understandable that doctors want to do the best for their patients, he says, but this can lead to inefficient practice that ignores the opportunity costs of decision making.

In reply, Dr Buckman says demanding and getting proper pay and conditions is not evidence of self interest. Self interested doctors would go and work elsewhere, he writes. Until 2003, GPs worked long hours, including nights and weekends with low pay for out-of-hours working. The new contact was an attempt to correct this by setting limits on what a practice could be asked to do. He points out that the most important source of extra income came from the quality and outcomes framework. The Government was claiming that GPs’ pay had risen unexpectedly, but this was not the case as the BMA had accurately predicted the increases.