General Practitioners – briefing
20 October 2010
Note: This paper is intended as background information for the
media. It is not intended as a comprehensive BMA policy paper.
This briefing paper includes information on:
Types of GP
The work of a GP
The GP contract
How general practice is funded
How individual GP pay is set
GP pay figures
There are 41,349 GPs working in the UK.
Number of GPs according to nation
Northern Ireland 1,128
UK-wide 34,081 are GP partners, sometimes known as 'principals' or
Number of principals according to nation
Northern Ireland 1,128
There are also up to 7,267 sessional GPs (salaried and locum GPs).
Number of sessional GPs according to nation
Scotland 452 (excluding locums, for whom there are no figures
Northern Ireland No figures available
There are 10,112 GP practices.
Number of GP practices according to nation
Northern Ireland 358
GP practices are run as small businesses, which are contracted to
NHS Primary Care Organisations (PCOs). Contracts are held by the
practice rather than individual GPs. The practice is contracted to
provide care for patients between 8am and 6.30pm Monday - Friday.
The move from contracts held by individual GPs to contracts held
by practices was a major change that took place as part of the
introduction of the current GP contract (nGMS) in 2004.
Types of GP
GP principal or partner: GP partners run the practice. Sometimes
there is only one GP partner (known as a single-hander), but more
often than not, a number of GPs group together in a multi
partnership practice. Many single-handers also work closely with
neighbouring colleagues. As well as seeing patients the GP partner
is responsible for running the business side of the practice.
Sessional GP (non-principal): A salaried GP is employed by the
practice and receives a salary for a fixed number of hours worked.
A GP locum is essentially a freelance GP who mostly works
independently or through locum agencies. A locum GP is employed to
cover leave or sickness and to back-fill a practice GP attending a
meeting or activity outside the practice.
What a GP does
The nature of a GP's work has changed significantly in recent
years, particularly since the introduction of the current GP
contract. As well as treating the sick there is also now more of a
focus on preventing people becoming sick in the first place
through the structured management of the long-term conditions
which are becoming ever more prevalent in society. Many of these
problems were traditionally managed in hospital but are now taken
care of at the GP surgery, at greater convenience to the patient.
Because it is common for patients to have more than one long-term
condition - for example, diabetes, high blood pressure and heart
disease - the nature of a GP's work has become more complex and
the intensity of the work during consultations has increased.
Outside of the consultation room GPs do home visits and a large
amount of paperwork relating to their patients' care. They also
attend PCO meetings and maintain their training and education. A
significant minority also undertake shift work for the local out-
The GP contract
The current national GP contract was negotiated between the BMA
and NHS Employers (with representation from the devolved nations)
and introduced in April 2004 with the full agreement of all
parties, including the Prime Minister's Office and the Treasury.
It was brought in because there were serious recruitment and
morale problems within general practice and pay had fallen behind
- before 2004 the UK's GPs were among the worst paid in the
All parties agreed that GP pay needed to be better linked to GPs'
workload and responsibilities. The planned pay increases in the
new contract were intended to reflect this.
There are four types of contract. They function in broadly the
same way, but with some key differences:
General Medical Services (GMS) contract - the GMS contract
has nationally agreed terms, negotiated between the
Departments of Health and the BMA. Sixty per cent of GP
practices in the UK hold this contract.
Personal Medical Services (PMS) - the PMS contract is locally
negotiated and is more flexible than the GMS contract in
responding to local situations. It lacks the protection of
nationally negotiated funding flows and is financed through
the local PCO budget. These are known as 17C practices in
Alternative Provider Medical Services (APMS) - the APMS
contract allows PCOs to contract with a wide range of
organisations to provide GP services. These can include the
private sector. APMS contracts tend to run for five years,
compared to GMS and PMS which often run for 25. These do not
exist in Scotland.
Primary Care Trust Medical Services (PCTMS) - the PCTMS
contract allows PCOs to provide services themselves by
directly employing staff. Very few of these now exist - the
majority have moved to APMS contracts. These are known as 2C
practices in Scotland.
How general practice is funded
Almost all funding in the current contract is practice-based. This
means that payments are made to the practice and not to individual
GPs. Expenses - for example, rent, utility bills and staff wages -
are taken out of this funding pot and the amount remaining, after
the cost of providing clinical services has been taken out, makes
up the pay available to the GP partners.
The funding formula is extremely complex and funding is
distributed to practices according to the weighted needs of their
population - for example a practice with a large elderly
population, and therefore a greater workload, will get more
funding than a practice with a relatively young, healthy
GP practices receive their funding through several major streams,
though the main ones are the Global Sum, the Quality and Outcomes
Framework (QOF), and Enhanced Services:
Global sum and MPIG
Typically, just over half the money a practice receives is in the
form of a 'global sum'. The exact amount a practice receives is
calculated based on the workload theoretically generated by each
of its patients. This was a change from the old contract, where
payment was based on the number of doctors within a practice, and
was intended to distribute funds more fairly to areas that needed
it most. However, when the new contract was introduced, 90% of
practices found that the redistribution led to a significant drop
in funding. To ensure this did not happen, a correction factor was
applied to the global sum so that in instances where this happened
income would be restored to at least 2003 levels. The resulting
combined amount became known as the Minimum Practice Income
Guarantee (MPIG). The value of correction factor has since been
significantly reduced and is now a relatively small amount
compared with overall global sum and is now only paid to a
minority of practices.
The Quality and Outcomes Framework (QOF)
The QOF was introduced as part of the 2004 GP contract. It
contains groups of evidence-based indicators, against which
practices can score up to 1000 points according to their level of
achievement. It ensures that the provision of care across the UK
is more systematic and that it is always evidence-based. The QOF
has continued to evolve since the inception of the contract, being
amended as new evidence becomes available, to improve the
diagnosis and management of some of the most prevalent chronic
One example of the success of QOF has been in the improvement of
diagnosis rates for diabetes. The 2008 DH report; Five Years on:
Delivering the Diabetes National Framework shows that as a result
of the QOF the number of patients diagnosed with diabetes is
approximately 2 million, up from 1.3 million in 2001. This not
only means more patients are being diagnosed, but more are also
benefiting from improved care which helps them manage their
diabetes. There is also evidence to show that the QOF has narrowed
health inequalities by cutting hospital admissions and deaths from
heart disease, especially in deprived areas. Read the research
Enhanced services are provided optionally by practices to cover
services not regarded as 'essential' under the contract -
essential services are covered in the global sum. There are two
main types of enhanced services:
Directed Enhanced Services (DESs) - These include services
such as flu and childhood immunisations, and although
practices are not contractually obliged to provide them, most
do. These services are commissioned according to a national
specification and price.
Local Enhanced Services (LESs) - These are services provided
according to a specific local need or initiative. Rates for
these services are negotiated locally with the PCO and may
vary. For example, a PCO with a high number of homeless
people, who will have specific needs, may wish to introduce a
service aimed at improving their care.
Some GPs receive seniority payments which reward experience and
are based on the GP's number of years of reckonable service to the
The amount of premises funding that a practice may receive will
depend upon the value of the premises. Many GPs work in PCO or
third-party owned buildings and these practices will receive some
rent reimbursement to cover their expenses.
How individual GP pay is set
Every year the independent Doctors' and Dentists' Review Body
(DDRB) reviews the pay of all doctors who have nationally agreed
contracts and makes recommendations to the Prime Minister and the
Secretary of State for Health, and their equivalents in Scotland
and Wales. The BMA, along with other organisations, submits
evidence about the pay of all doctors to the DDRB. Because of the
way general practice is funded the DDRB also takes evidence about
practice expenses into account when it comes to making
recommendations about GP partner pay. The government does not have
to accept the DDRB's recommendations and in 2006/07 and 2007/08 it
decided to freeze practice income, as it attempted to claw back
money it perceived it had lost as a result of the current
contract. However, practice expenses continued to rise and this
meant that individual GP pay fell.
There are significant differences in how much GP partners earn,
with extremes at both ends of the scale. This can be because, for
example, spending on staff varies - some may have relatively few
staff, others may have staff that are more expensive. Other
factors such as building costs can be taken into account. Some GPs
also run a dispensing service, which in effect means they are
operating two businesses. The BMA estimates that around 1500
practices in the UK - about 15% of all practices - do this,
serving approximately four million NHS patients. They tend to be
in rural areas where there is no other pharmacy in easy walking
distance. Quite often high-earning GPs have more than one practice
and some GPs employ other doctors in practices that they run
GP pay figures
Every September the NHS Information Centre publishes data, taken
from the HM Revenue and Customs tax database, about average GP
earnings. This includes NHS and private income earned, both of
which could be earned as part of the practice or external to it.
On average approximately 9% of GP income will come from outside
the NHS. NHS income is known as superannuable income. These
figures are generally almost two years out of date when they are
published because of the time it takes to compile them.
The latest available data about GP partner earnings shows that
their pay has fallen for three consecutive years.
In 2008-09 a typical GP partner, who runs a practice on a national
contract, and does not dispense, earned £95,900. The BMA estimates
that since 2005/06, the income of these doctors has fallen by
The average pay for a salaried GP in 2008-09 was £57,300, an
increase of 2.7% on the previous year. The difference in earnings
is largely related to a greater proportion of salaried GPs working
part-time compared with partners but is also a reflection of the
additional responsibilities borne by GP partners.
The table below gives information about how the pay of non-
dispensing GMS GP partners has changed since the start of the
contract and shows how expenses have risen.
Financial Gross income % Expenses % Net %
Year (including change change income change
04-05 198,675 n/a* 106,491 n/a* 92,184 n/a*
05-06 214,069 7.75 111,421 4.63 102,648 11.4
06-07 215,945 0.88 116,365 4.44 99,580 -2.99
07-08 213.718 -1.03 117,529 1.00 96,189 -3.41
08-09 220,100 3.0 124,200 5.7 95,900 -0.3
*Pre 2004/05 two categories were used to describe non dispensers -
"non dispensers with help" and "non dispensers without help".
Therefore figures for All Non-Dispensers for these years are not
available. Therefore the % change for 04-05 is n/a.
More detailed information about GP pay and expenses, including
average earnings by country, can be found on the NHS Information