The debate about how much GPs earn goes on. Partners earn too much, locums are ‘milking it’, salaried GPs are the easy riders of the NHS. The headline of this article will probably be viewed by some as almost sinful, a stain on the holy shroud of selflessness worn by some in public services.
The sad truth is the NHS is grossly underfunded. Unless that changes (don’t hold your breath), there will be less and less money to justify the value of a GP. With the cost of living rising and GP salaries falling, my hunch is most of us are working harder than we did 10 years ago.
One way of looking at your income as a portfolio GP is not to just look at the gross salary or hourly rate but other nuisance factors such as travel time, crumbs of tasks such as email cluttering up your spare time and jobs with the expectation creep that you’ll consistently stay on and do a load of stuff unpaid because so-and-so is suffering etc.
Here are a few winners and losers when it comes to working efficiently as a portfolio GP in order to maximise income.
It sounds obvious but the pros of clinical sessions are still many: simply agree the structure of a session and bill your hourly rate. Choosing longer sessions eg 4 hours or full day rates are still the best ways of maximising income.
The downsides are that many practices now book locums for only 2 hours in order to economise. One GP gets around this booking 3 sessions in a single day. It’s hard to imagine this suiting all personality types as the stress of running exactly to time thrice is huge.
Some locums charge for admin time; others include this in their hourly rate. Sessions at struggling surgeries relying heavily on locums risk cumulating an hour or more of admin time chasing things up if you’re diligent and can’t bear to walk away leaving a haemoglobin of 10.5 not followed up – beware.
Apparently mentioning hourly rates is illegal and seen as ‘setting a cartel’ but anyone can read this article in GP Online which mentions that rates are generally £80 to £100 per hour.
Despite relatively low hourly rates, the longer shift times and ethos of shifts finishing at the allocated time means it is possible to earn more money, particularly if you have the nerves to work a double weekend shift back to back. This could mean, for example, you were paid for all 10 hours work instead of having a hiatus in the middle of the day in a coffee shop arguing with other GPs on Facebook in the forums.
Overnight sessions are usually a higher rate eg £90-£100 per hour, so with a shift from say, 11 pm to 8 am, you could earn £900 pre-tax.
Signing up with an out of hours provider who will cover your indemnity will incur a massive saving.
This looks good on paper at a payment of £500 per appraisal. Take 2 hours to review a portfolio and 2-3 hours for the appraisal itself including the write-up and ker-ching: £100 per hour.
The actual hourly rate is heavily dependent on your personality type and the appraisee. Some appraisers can be best described as ‘efficient’ (ever felt like your appraisal was an in-and-out job?). But a ‘challenging’ appraisal can end up chewing into hours of your time with disagreements over what constitutes a full portfolio and worse.
Add in travel time, payment rates static for years, unpaid mandatory training and updates and suddenly it seems not such a high earner.
This varies between CCGs but here’s an example:
CCG Cash-Strapped pays £600 per month for a commitment of 2 sessions. Sounds good? Much of the work can be done from home with time out for meetings and so-on.
What no-one told you is that the £600 includes both employee and employer pension contributions. Add in income tax and take home pay is now only 50% of the initial sum. Not all CCGs pay their clinical leads in this way – some do pay pension contributions – but it’s worth clarifying before you’ve waded in with your commitment.
“Sessions” can often break down into tiny chunks of almost-daily time answering emails, squeezed in between surgeries or squeezing in meetings leaving you more stressed and less focussed and adding up to a lot more time than 2 sessions for the meticulous or unwary.
Often bandied around as a sideways manoeuvre for the patient-weary.
Writing is a labour of love best left to those who just love their pen or have a cause they need to advance.
By the time you’ve had the idea, sharpened your pencil (or even filled the Mont Blanc), written a draft, crafted and re-drafted it, the hourly rate is pitiful and possible even neutral or negative in terms of cost to you.
As an example, an academic text book may not pay anything for your contribution; a mainstream book needing a health chapter may pay £200. In 2015, Pulse were offering £75 for a 550 opinion piece.
What’s the value then? Using your creative brain and, errr, prestige…
Clinical work is still the best payer but these days, very few of us have the patience, appetite or indemnity to cover us for 10 sessions a week.
Dr Claire Davies
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