GP pay represents 0.003% of the Current PFI bill. It seems quite clear to me why the Government wants to distract you all onto GP pay, rather than concentrate on the amounts going to private companies.

JW, Notts,

Come on GPs, accept that you have lost this one! The governement stuffed your mouths with cash and are now using this to beat you with. 'Trojan' and 'horse' spring to mind. Like it or not, the public are well able to judge your service, so there's no point in bleating on about how hard you 'really' work. You are difficult to get to see - have you ever thought what it's like when ill to have to get up at the crack of dawn to phone the surgery at the exact moment the phone lines open, wait on hold/or use redial for ages and if you don't get through within 20 minutes find that all appointments for that day are gone? I repeat, when ill! What services to you use and pay for which treat you like that? Because you are 'general' practitioners it can take (literally) years of repeat visits for what turns out to be a fairly common condition to be diagnosed - I speak from experience. You might think that your service is wonderful, but it isn't. Govt spin doesn't work unless based upon some truth.

Clint, Stafford, UK

the media is full of half truths - so misleading. wouldn't know where to start. and the government are just spinning away colluding with this constant attack on GPs. I know many GPs who are thinking of retiring early, going elsewhere, going private - so don't shoot yourselves in the foot. This is the most cost effective GP service in the world believe it or not. GPs in France do nothing but sort our minor ills and they are completely free in how they work - there is no red tape and they can work 2 hours a day and have a 3 hour lunch break if they like. i've been a GP in France and the UK - and the quality of general practice here is second to none. all the rest is image without substance -

ann louise, brighton, uk

My GP works 9-5 with an hour for lunch, another two nearby work 9-12 and then 3-5. I dont know any other professional who works those hours and gets paid the same as GPs. I topped A Levels, went to uni did a BSc and MSc (5 yrs) and now studying for further professional qualifications while working 10-12 hour day - and dont get paid £100k a year. Gone are the days when doctors did it to save lives - most docs these days are in it for the money and prestiege so no wonder there is no respect for the profession. Nurses save lives too why do they get such low pay then? It seems that it isnt hard to become a doctor anymore seen as there are so many of them around and quite a few i've seen over the years are useless.

N, London, Mdx

The "it's my right" culture is partly to blame but also it's the ignorant attitude of some GPs. I know that it takes a lot of studying to be a medic but likewise it also does to be a scientist in the field of drug development where salaries are far lower.
Generally the GPs have it relatively easy especially with practises that have a manger to deal with all the "red tape". It's about time the GPs stopped bleating about their situation. They have a very high salary and can work flexible hours if they wish at an even higher rate of pay by being a locum.
If you don't like it come out of the protected GP field and work in the A&E department of a busy hospital. See what real life is like outside of your protected GP environment.

Nick, London, London

It is not what GPs are paid, it is how they are paid which is important.

I live in France. The first question a GP here asks, after the Bonjours are out of the way, is, "How are you going to pay me?" Most accept credit cards but cash and cheques are OK too.

Once the standard 21 Euro fee is handed over, the consultation begins. The State and top-up insurance reimburses this fee to the patient.

The more patients they see, the more money the GP gets. Patients can go elsewhere if the GP takes too long to see them , or if they are not happy with the consultation.

How to sort out the NHS - three words, "free market forces."

Healthcare in France is second to none.

John Bowman, Sarlat, France

Shafeena, Liverpool, UK: Please dream on. The GPs cover and resolve a lot more patient's problems and steer them away from the A & E departments. WIthout the GP's A & E would fail.

Wayne - 4 hours; please don't be persuaded by "Doctors" on TV. Most GP partners would be lucky to work less than 12 hours per day. GP workload has increased substantially over the period from 2002 to 2007 with the required provision of more services and GPs too have to deal with vast amounts of paperwork (in a similar way to the Police and hospitals - but there is no strong voice for GPs), lunchtime clinics and paperwork for target reaching, statistics on patient population.

Geoff - the GPs work to government timetables - the 48 hour appointments have resulted in worse availability for the patients. THE GPs CANT CHANGE THIS! Can't see a GP - because some patients come to the GP 3 or 4 times a week - "its my right" culture to blame. Go chat with your GP to get properly informed!

Neil, Birmingham,

100k a year, a Four hour working day, shares in the profits of the surgery with weekends off and sabatical leave too!
I value GP's but I don't think anyone should earn that sort of money.

Wayne, Brighton, Sussex

I was so surprised to read another headline bashing gps and their pay at a time when the government is "negotiating" a new contract. This government is always been about spin doctors and always will be. I work as a GP and accept about working longer hours, it is just the way the government is negotiating that is unacceptable.
The government is trying to move things into general practice because it is more efficient than in hospitals, mainly because there aren't 10 managers doing 1 managers job. This is because your GP is making these managerial decisions with a good clinical knowledge base and constant thoughts about the care of their patients.
The government is trying to open primary care so private companies can come in. I am sure they will be far more interested in clinical care than their profit margins.

Dr I, liverpool, uk

Dearest all,

I am not a GP but am a Doc.

To misjudge or undervalue the place of doctors in our society would be a very dangerous move.

It would certainly steer the best and the brightest away from medical school, thus decreasing competition for places and ultimately leading to less skillful doctors. People wrongly think that medical school is the end of a doctor's training but they would be wrong; it is just the very basic level of qualification. To be a GP it takes much more. GPs are the most important healthcare providers in the country and without them, the populous would be kicking up a far bigger stink than they are now.

If the system went private with corporate ownership, then the true value of doctors would be shown, which is far higher than what has been placed on them now.

Medicine can't be compared to business as some have tried to do here; a single error in the business world probably wont kill someone!!!

JS, London, UK

I am A GP.
All this propaganda of high pay for little work is really depressing and demoralising. I worked hard at my Alevels. Top in my class. I studied at University for 6 years - lots of late nights full of study, lots of debt, no pay and no holidays. I worked 100 hours plus per week as a junior doctor. My basic pay was less than a nurse's pay and my hourly rate of pay of around 2 pound per hour was the lowest in the hospital - less than all the staff in the hospital. I worked 36 hours non stop without sleep. I did exam after exam even when I was working as a doctor and had to study after finishing my shift in the hospital. Where were all the comments then that this was immoral and wrong ? Why did nobody criticise the government at that time? Now we supposedly earn more and we get criticised. Please just make all GPs salaried instead of being contracted to provide care and you will see how much productivity falls.

SV, Kenton,

Doctors, these people are in a profession which helps us with quality of life. You only understand what that is when you loose it. I received the best of care and attention from hospital doctors/ nurses, priceless. Superb treatment from my surgeon, who's operating skill was instrumental in taking away excrutiating pain, impossible to repay.
My GP, he was the one who identified my problem and set in motion everything to get me right, the NHS's invaluable assett.
Anyone who seeks to compare the so called Captain's of industry with our doctors / nurses is sadly lacking in the understanding of life and who and what is genuinely important to us.
I am a lttle tired of those who knock our medics.
Who are these people and what do they want ?
They can't know what they are talking about as if they did, they would never dream to.
Monetry value restriicton on health ?
Yes, they say (when one has it)
No, when you don't
Careful when calling for it, it is likely all may need help sometime

Roger, Plymouth, England

The whole health industry should be not be centrally controlled by a government.

GP's should get paid exactly what they are worth in the market. It might be more, it might be less, but we will never KNOW what they are worth until we allow the market to sort it out.

Free up the health care industry.

jesse, brandon, south dakota

As a GP I certainly dont earn £113K also our fulltme salaried Dr earns nearly as much as me with no responsibility .Regarding Out of hours the previuos arrangement was shown by the Carson report to be completely unacceptable & indeed unsafe consequently it was essential for the PCTs to take over provision of such services using appropirate technology & working practice which is certainly much safer for our patients .Our PCT is an example of good practice & should be looked at by the health authorities .

Tim Southwood, Nailsea, UK

Only business leaders and City traders should be paid this amount of money because they do more work are more productive and are more valued members of society.
Can't we put a windfall tax on GPs profits of perhaps 50% to bring their salaries down to acceptable levels?

dairy, london,

I was amused to read that GP's have the added "burden" of re-training constantly. It is common knowledge in NHS circles how "demanding" these courses are.
The salary hike given to GPs would be fine if hospital doctors weren't meted out the cinderella treatment.
Doctors in A&E specially, take considerable pressure off GPs over and above their main brief, but there is no dramatic hike in their salaries, and all they seem to be rewarded with are brickbats for delays! They also periodically attend courses which are far more demanding. If the GPs are getting paid for extra work/hours, so should hospital doctors.

Shafeena, Liverpool, UK

Its strange, these figures are not bared out by my experience. Despite working supposdly less hours the g.p's and hospital doctors I work with put in many extra hours just off the record. Many do OOH service as well. The wage is not what is qouted as average and most who reach or surpass that figure is via private work, not paid by goverment. Fewer doctors are able to become partners as well, many are salaried doctors earning significantly less.
I estimated the doctors in my G.P averaging 50-65 hours/week, as they often spent additional time doing QOF/home visits. Part of the problem is this ridiculous same day appointment system the goverment wants. It means many miss out consistently, unable to provide warning to their employer and get frustrated. The vast majority of G.P's (not all I admit) care about their patients and try to provide a quality service. This constant G.P bashing is mostly driven by stupid sensationalist headlines within the media supported by the goverment.

H, London,

I sincerely hope the great British public get what they wish for.

Alastair Ewen, Calgary , Canada

Michele, Bristol, England. 'Mass resignation' would be an interesting way to test the value GPs really offer. GPs often compare their position with dentists, but actually they are very different. Dentists on the whole offer a start to finish service. GPs, in contrast, are very often facilitators - between the patient and specialist care, between patient and pharmacist etc. The loss of GPs would without doubt present a major blow - not least to the government which relies upon them to ration access to more expensive care - but by allowing (and funding) patients to access services without going through a GP this could become an interesting battle of wills. Militant GPs would do well to look at how Thatcher starved out the miners in 1984, and to ensure that they have enough money to pay their mortgages etc if they find themselves without an income for months and months. I wonder how many GPs have contemplated the prospect of a county court summons to repossess their house!

Clive, Chichester, UK

I have no problem with GP's earning more- good luck to them. The issue for me is the incompetence of the Government who have completely under-estimated the costs of this new contract. I would like to be assured that someone's head is going to roll in the Department of Health and the Treasury for this fiasco.

I suppose it will just mean early retirement on full pension for the guilty parties and an MBE rather than an OBE. When will this Government start to realise that it is our money they are playing with and their disgraceful management of it is the reason for kicking them out at the next election.

Richard Wyld, Effingham, Surrey

Gary smith you have no idea, GPs don't work 9 to 5 the hours are in fact much longer. They also have to constantly re-train so that they are up to date with modern diseases etc. Get your facts right before slating the hard-working people who are there to save your life.

Francesca Allen, Leeds, England

In the US doctors are leaving the GP area in droves because specialists are paid so much more. You have the result that no doctor actually knows the whole picture of your health. Your partners' salaries are on a par with our GPs. What the regular GPs are paid: no one here would go through medical school for that.

Catherine, Chicago,

You have the answer in the sentence "The NAO report does not openly criticise anyone for the outcome which enriched GP Partners at the expense of almost everbody else" The NHS is huge and fully centralised so it is beyond the ability of Government to manage it effectively. The GPs can play the system, (which Government designed not them) and get bonus points by doing so many of this and so many of that etc. Absolutely out of control (in the sense of treating patients needs) and designed to fail however, much money we put into the NHS. The gap between Ministers (who are all "in transit") and the needs of the NHS patients would be frightening if it was just about making wiggets but when it is peoples health it is frightening!

John Beadsmoore, Cambridge,

Higher salaries draw smarter and more capable students into the medical profession. It's a simple case of "you get what you pay for." That's why US doctors are far superior to NHS doctors. US hospitals pay on average a factor of four times more! And as far as I'm concerned it's compensation well deserved.

I would suggest incrementally raising pay only for younger doctors with more current medical skills. In other words, put the pay increases where it will boost the quality of next generation physicians.

Greg , Berkeley, CA

The reason GPs are paid the amunt they are is that they take on a vast amount of responsibility in looking after peoples' health. To try and compare the work a GP does compared to that of a police officer or nurse is ridiculous - they do not have the responsibilities that GPs do and hence their remuneration is less. Healthcare is about a lot more than simply hours worked, although surgery times are only the tip of the iceberg in terms of the hours GPs work. I would think that most of the people who have commented here would not be able to cope with the stresses and strains of being a GP and would soon realise why GPs are worth the money they get (and possibly more) if they were to spend a few days in an average GP practice.

Sally, Manchester,

If judged against the NHS salary of a senior surgeon then yes, the G.P. is paid more. Whether this means that the NHS salary of consultants in U.K. hospitals is too low is another matter and arguably it is, judged by the numbers who are now being attracted to work in, for example Australia.
However, G.Ps should not be castigated for the ineptitude of
government negotiators.

Ashley Hoare, Cajarc, France

Sean wrote "WOW Mr MARK KLEIN, M.D.
Have you ever wondered how the remaining 98% of our population get by in the UK ?" Yes, Sean, I do wonder about how they get by without falling deeply into debt to pay daily expenses. Common to British novels are characters, often professionals, who depend on overdrafts. Last time I was in the UK several years ago was blown away by the prices. Came with my then 14 year old son. Went to local grocery one evening to buy him some cookies. When the cashier said they cost 90 pence, I exclaimed that was first time I'd paid less than a pound for anything in London. The folks behind me in the checkout line burst into laughter. UK prices were very different in the early 1960s when visited London on army leave from Germany. My $124/month army private's pay was sufficient to have a very nice time. (Recommend Martin Sheen's 1980 movie "Loophole" about a financially pressed UK architect and family man who turns to bank robbery to make ends meet!)

MARK KLEIN, M.D., OAKLAND, CALIFORNIA

I support Doctors in a local Health Authority. I am paid between 19k and 22k. I work with computers and I do OOH and overtime a lot.

HAving read this it made me sick to think that I have 3 regular Drs at my local Health Centre and they all earn up to what is qupted here.

I feel extremely hard done by and I provide a service that supports these GPs in the Field and also Drs here on site, who although they are not GPs they are also probably highly paid.

What an immoral system we live in. With someone would hurry up and sort it out.

YOU OUT THERE GOD??? Armageddon senario called for!

Loz, Southampton, Hants

So it is true. MPs do have a great deal in common with GPs in that they are prepared to take vast wage rises for doing much less work

John Eadie MacGregor, Doncaster, South yorks

Why is it that once again the government get the nations health cover completely wrong. A close friend who is a GP and partner in a local practice told me he could not wait for the change in policy last time around, it guaranteed him extra wages for less work and responsibility.
If GP's knew this was going to be the case why did the governent not know it ?
Who was responsible for this debacle and are they still in a job ? If they are they should be sacked, most people in private industry would be if they made such a catestrophic missjudgement.

These people should be named and shamed.

The levels of service offered by GP's is appauling, particularly if you require a doctor out of surgery hours.
The money given would have been better spent training NHS dentist as the need for dental care is ignored by this government. It should be mandatory for ministers to seek NHS care, perhaps then we would see an improvement to the services.

Robert Kelly, Guiseley,

just for the record (Gary Trumpeter) GPs work on average 48 hours a week, which is longer than hospital doctors who now do shift work and are covered by the European Working Time Directive (unlike GPs who GB kindly exempted.) That doesn't include the out of hours work they still do (who else do you think is doing it?) - they just aren't responsible for running OOH anymore. However all the pay figures quoted for GPs include that OOH work, private work etc, unlike comparative consultant pay quotes. GPs actually earn similar amounts to dentists when you break it down to like for like. The government is very good at spinning, don't forget! Just ask yourself why they are so keen to rubbish general practice in the UK, and look at what they are doing in England.

HE, Wales,

Gps are speaking more because of a continuous attack in the press. This is another example of spin to convince the public that Gps should be blamed for the failures in the nhs and enable the government can pursue its agenda of privatisation and force through polices dervied by people not working in primary care. Tax payers money, which was deducted from GP surgeries to manage out of hours services has been mismanaged, spent (not by the Gps) without benefit to services and then they try to hoodwink the public and blame the Gps. At the same time a great deal of work, tick boxes, enforced implementation of governement change after change, and work passed from secondary care to primary care has been placed on Gps and it a wonder why the Gp is booked up. Gps are working more intensively than other and it does not stop with the last appointment at night. Is it coincidental that ministers take up positions on private companies? If you wish all facts ask those on the coal face!

Ian, manchester,

Throw out the NHS. It was never a good idea. The hardline socialists of the 1930s hated doctors along with priests and other middle class representatives of the ruling classes, so they nationalised the doctors. The problem is, they were wrong. Doctors are essentially tradesmen, as are all professionals, and they are selling a service. In Australia we nationalised health insurance, not medicine, thus Doctors in Australia work for themselves. The income we earn is fee for service. The Government Health Insurance pays all the fee and we can determin how much we earn by how hard we work. Our medical system has problems, but mainly in the hospitals which are run by governments. We spend a bit more of GDP than the UK on Health Care and less than the US, and we have much better outcomes than both. There is are shortage of GPs too - this is worldwide. My patients don't mind my silver Mercedes, they see how hard I work to pay for it.
Tim Rankin Australian GP
PS. Any good Brit GPs need a job?

Tim Rankin, Bowral, NSW Australia

GPs are vastly overpaid - simple as that. Why do we pay them 3x as much as a Police Officer or Fireman, or 5x as much as a Soldier or Nurse. It is a scandal. GPs are worth no more to society than the others, in my view. I say introduce real competition in this sector and the taxpayer will save a fortune.

David, Cardiff,

How can GP's justify their grossly inflated income, and it is so difficult for me to get a GP appointment nowadays? I go to my local A&E and it's flooded with patients who can't get an appointment with their GPs. Who's suffering? The patients, and maybe the poor hospital doctors who are picking up all the cases that GPs would normally see. The nurses tell me that A&E visits have increased significantly since this new deal as no one can get appointments with their GPs. Surely that translates to GPs seeing less patients, despite their mammoth pay rises. I understand that the hospital doctors who work far longer and antisocial hours than the GP (and dare I say work harder due to the caseloads) earn far less than these overpaid GPs. It's time to recognise that the BMA will do whatever it takes to protect the pay deal, as they are represented by, gues who, GPs! Of course they will justify their pay increase. In my opinion (and a lot of others), GPs earn too much. Time for a correction!!!

Gary Trumpeter, Berkshire,

Simon Page, Southampton. Spot on! I've also noticed how many of our supposedly 'overworked' GPs can respond so quickly to stories of this type at all times of the day. If a lawyer billing a client on an hourly basis was to incorporate such irrelevant 'blogging' time into a client's bill (without disclosing it) then s/he would be commiting a criminal offence. Pity that no one seems interested in ensuring that taxpayers money isn't being wrongly paid out to GPs in the same way.

Clint, Stafford, UK

MARK KLEIN, M.D., OAKLAND, CALIFORNIA. I hope that you are really in California and so are understandably out of touch with the UK. If you can, have a look at some of the jobs pages in newspapers such as the Times, Telegraph etc. Typical salaries for many middle class jobs, middle and upper management etc range from 40-70k, ie not much more than half the reported income of a bog standard GP partner. GPs' pay is closer to that of very senior public sector workers - chief execs of some large local government areas, senior judges and the like. The cost of living in the UK is ridiculous, but most middle class families are having to survive on far far less than GPs' families - often for far more work.

George, Brighton, UK

WOW Mr MARK KLEIN, M.D.
Have you ever wondered how the remaining 98% of our population get by in the UK ?

Sean, Coventry, UK

Given the cost of living in Britain these physicians barely earn a middle class wage sufficient to support a family on a single income.

MARK KLEIN, M.D., OAKLAND, CALIFORNIA

I was under the impression that this contract was forced on GPs by the Government, which, as usual, did not listen. Result: a major mistake was made but rather than admit it, they immediately blame the GPs for doing more work than their "experts" (X = unknown; spurt is drip under pressure) had calculated!

The Government is at it again. Their contract and now they are trying to renege on it. Shades of the Police, the Manifesto promises for a referendum, single sex wards, etc. Other than spending public money on MPs expenses, IT catastrophes, NHS wastage, the Iraq war and all the other things that they have screwed up on, what have they actually got right? TIME FOR A GENERAL ELECTION; THE UK CAN NO LONGER AFFORD this lot.

I am NOT a doctor; this does not mean that I have no disagreements such as the Medically Correct Myth on cholesterol, statins and so forth.

I am trying again, this being a democracy though its clear the media does it best to protect Nulabour.

M. Cawdery, Portadown, UK

So many of our hardworking GPs are busy posting here! It makes one wonder! The BMA is like the old miner's union in its militancy, but I had sympathies for the hardworking miners.
They did not drive silver Mercedes, my GP does after the new contracts kicked in! Why should he have his old banger any more? I see him now in my local shopping precincts more in the evenings after my work. The poor guy has to do shopping at some time! It will be no surprise if I see his posting here. His secretary just left a message to me that he is fully booked for two days!

Simon Page, Southampton,

This is yet another example of how this administration wastes OUR money. Anywhere else and these incompetents, from ministers to civil servants, would be sacked, or the organisation would be bankrupt.

David Nammory, Liverpool,

To Dr J Ward of Burntwood, Staffs.

Being paid according to 'performance measures' does not automatically imply some hard nosed pay deal.

If my performance measures at work were to get out of bed, remember to have lunch, and sometimes switch on the computer - I could shout about having performance related pay all day, but it wouldn't cut much ice when people realised how little I was being expected to do.

The bottom line is that doctors in the NHS operate in a vacuum, totally immune from the effects of real competition due to the effective monopoly status they enjoy - thanks to lion's share of gdp that the NHS swallows (whilst troops on a peace time budget dodge bullets in Afghanistan).

Doctors have been in this special place for so long they have an inflated sense of their own self worth and are no longer able to connect with the outside world and comprehend how it works.

Peter, Guildford, England

I was under the impression that the Government more or less dictated the terms of the medical contract, forced it through and then claimed that they had done a wonderful job.
Now it seems that they made one hell of a mess and are trying to lay the blame of that mess on the doctors.

Why not face it, this Government could not properly manage a public convenience. Some suggest that their basic salary of £60K is inadequate. Conversely, I suggest that the salary of a public convenience operator would be more appropriate!

I am NOT a medical doctor and have my on disagreements with them of Medically Correct Myths such as cholesterol. But in general I have always found them professionlaly helpful and worthy of their pay!

M. Cawdery, Portadown, UK

Ben Bradshaw ....."Longer consultations, quicker appointments and being able to book ahead are improvements valued by patients.”
Yes Ben! When are you going to deliver?

Michael Kelly, Chesterfield, UK

At the next election you will have the chance to kick this bunch of incompetents masquerading as a government out of office. Alternatively you can sit around and watch them screw up the rest of our public services.

Andrew brown, derby, UK

Gary Smith, LONDON. Even worse than employing a spouse as practice manager is doing what at least some GP partners appear to do, 'employing' a spouse to do nothing at all. Essentially, this is a tax fiddle - give the wife a meaningless admin title and salary, to take more of the practice profit out of the 40% tax band. I'm sure MR B or Darling will be instructing the Revenue to look into this. Basically, those who talk about GPs as a self-serving monopoly are correct. We, the public, have just been suckered into accepting a sub-standard, outdated service for which we pay far too much for far too long. I bought a computer the other day for £400 which would have cost 10x that as little as 5 years ago. Competion works, it's about time that the medical profession had a taste of it.

Graham, Oxford, UK

"Mass resignation is coming and Darzi clinics and the other replacements will all have the usual gagging clauses in their contracts and so outspoken GPs will no longer exist."

On the last count, my young friend a highly qualified medical graduate who has no jobs to go to at present says that there are thousands like him looking for any jobs, not necessarily in the NHS. Well if mass resignation comes from the GPs who nurtured the monoploy culture so long, there is still hope for these bright young medical graduates to become GPs. My friend does not care if it is in a polyclinic as long as he looks after patients for which he was trained at tax payer's expenses.

'Outspoken GPs' on whose behalf they are speaking up, not like me who is sick and tired of their attitudes and the quality of services they provide. I know a friedly doctor in Lille, and if I need help I approach him. It is a short ride on Eurostar. I say ditch the NHS and welcome the French model.

Peter Evans, Crawley,

Of course the trumpeting of this old information on the brink of the GP voting deadline regarding extended opening hours is entirely coincidental.

There seem to be no depths that this governments briefing machine will not plumb, ever reliant on the pathetic critical faculties of journos looking for a slick headline.

Because of a government imposed deadline, the GPs of this country had to sign up to their new contract before any pricing information was available to them. That the same government seeks repeatedly to lambast these GPs with the success of their eventual performance related earnings is hypocrisy indeed. We did well, as was the intention, and reinvested in employing nurses and ancillary staff in order to make the improvements the DoH wanted. It all worked well yet still they kick us. Why? Because we are no longer exhausted and a danger from working all night??

Blair came in on the back of a promising soundbite "Joined up thinking" Not much of that about is there?

Adrian Butcher, Stoke on Trent,

Name and shame the moron who worked out this pay deal. I truly don't know how much doctors get now as I stopped believing in any Government release many years ago, but I do know it's a very unfair and dangerous system now at play in my local surgery. For an appointment you must phone up at 0830hrs. Not one second early as it's on the answering machine. Then it's engaged, engaged and engaged until finally you get through and all appointments have been taken for that day. Can you make an appointment for later in the week? NO, you must do it all again the following day. This cannot be right. It's a bit like contacting the Police, you just don't bother anymore.

Roger, Surrey,

As a GP my workload is going up and up, and the complexity of consultations is rising too. If practices lose the MPIG money then many practices will have to close.

This report does not reflect what is happenning on the ground.

Andy

andy Sommers, southwell,

It was the government who underestimated the amount of work GPs did prior to the new contract and it was Brown who signed off on it.

Brown is simply annoyed that he made a mistake and it is the governments aim to turn the public against GPs by highlighting cases and news reports like this in the media.

The government is quite happy to let the speaker of the houses wife spend £4000 of tax payers money on taxi services, and let MPs claim false expenses, but when it comes to GPs they are portrayed as money grabbing layabouts

simon, crewe,

If you've found a GP who offers appointments between 8am and 8pm and Saturday mornings, I'd like to meet them!

anita, cambridge, uk

I suspect that GPs around the country are getting their affairs in order.
If the population of this country [Great Britain] is happy to do without then they need do nothing.
If you are concerned about losing your GP then you will need to act now and contact your MP and the PM and voice your fears and if you can bear it read the NAO report in full and see the flawed premise writ large.
Mass resignation is coming and Darzi clinics and the other replacements will all have the usual gagging clauses in their contracts and so outspoken GPs will no longer exist. Think if this is important to you. If not, do nothing.

Michele, Bristol, England

The majority of any increases in funding of the NHS is now mopped up in supporting salaries and final salary pensions, especially wrt consultants, GP's and NHS managers. A relatively low percentage of the so called 'pledges' actually goes towards funding patient care in any form. It beggars belief that government representatives have actually 'negotiated' this state of affairs! In private industry these people would be quickly moved on.

P. Kelly, Beverley, UK

Do not forget the contract was required to deal with the number of GPs leaving and failure of new doctors entering the profession due to long hours and inadequate pay. Returning to that position by extending hours & cutting pay will cause another crisis in GP numbers. An average GP has around 2000 patients - meaning care is provided at a cost of approx. £4.70 per patient per month by my calculation - not a bad return.

Can I also point out that the average GP income figures above are now 2 years out of date and most GPs have seen their income falling over this time. The government has not increased the contract for the past 3 years whilst staff costs and inflation have increased.

I fear the underlying motive of this government-driven anti-GP media campaign. We will eventually look back on this time with regret when primary care becomes privatised (ie profit driven) which would appear to be the governments target - just remember what happened to nhs dentistry.

Andy, Bolton,

How odd all this controversy is. You would think that GPs did little work at all when visiting my surgery because the waiting room is invariably relatively empty (irrespective of time of day)
and yet we have to wait several days to get an appointment. I do accept that there is a lot of incompetence by the NHS staff whether they be managers or medics, but what happens behind the bureaucratic wall of administrators,clerks and receptionists when patients ask for an appointment or another service?

Rodney, Lincolnshire, England UK

I was not surprised that 'practice nurses actually saw a real terms decline in pay'
Is this fair when an increasing proportion of patients are dealt with by nurses, and that 34 per cent of consultations are by practice nurses?
These include the treatment and monitoring of many of the chronic diseases mentioned in the new doctors contract.
When questioning this imbalance in nurses and doctors salary, it was commented by the practice manager that doctors have more expences than nurses... like private education for their children... Jackie, Somerset.

Jackie Rymill, Bridgwater, Somerset

The manipulative government wants nothing better than the fight to be between the patients and the GP's, whilst they scribble away hatching yet more pretending-to-listen-to-the-public so called papers which have as much credibility as whistle blowing framework within the DoH. For some ignored rural areas ,out of hours use is a lifeline for families, if an avoidance pattern of a particular service is visible, rather than burying it the nearest hole guarded by executive salaries, perhaps some tightening up to stop the continuing mopping up of mistakes and neglect picked by other practices, out of hours, walk in clinics, casualty where extremely hard working GP's and medics to their bit. Or will communities have to sue collectively and then with the proceeds employ doctors who failed to get a job in last years rounds?

mary foord brown, suffolk coastal,

You can expect the GP brigade's patronising talk now about their professionalism and personal care for patients etc.. . which in my experience do not measure up to serious scrutiny. My GP works less number of hours- 'bankers hours', lets his secretaries to do the rude talking as he knows that the poor tax payer has to put up with the shoddy monopoly service that he provides. For this, he collects over £120, 000, employs his wife as practice manager and works 4 days a week from 9:00-5;00. Now the BMA his mother goose is saying that GPs previously were poorly paid and were leaving NHS. Where to is my question? The primary healthcare is a monopoly in this country, and GPs could not have left NHS to set up their private GP practices. If they did, they would have b een subjected to market forces and given quality of their delivery, would not have lasted very long!! Only NHS awards poor performance, no retraining and thanks to John Reid they get more for doing much less!!

Gary Smith, LONDON,

Next time a letter appears in The Times from a GP or the BMA accusing the government of wanting to 'privatise' GP services remember that these services are already privatised (the vast majority of GPs are independent contractors, albeit ones that get public sector pensions).

What they are objecting to is competition to their NHS supply monopoly.

HJ, Reading, UK

Two points:

GPs' incomes were deliberately held down for a number of years before the new contract, to make it appear more generous; this '58% increase' is really over about seven years, not three:

GPs' now have to pay 20% of their incomes back to the NHS as pension contributions, whereas it was only 6% before. This nets their pay increase down to about 34.5%* which, over seven years, is not spectacular.

The question we should ask is: how did Government planners get the figures so wrong? Or was it a deliberate error, so that we can now have a shock-horror 'GPs are overpaid' story?

*(No, it's not 44%, if you do the maths)

Frank Upton, Solihull,

Here we go again.... The figures quoted above are not like for like comparisons, pension contributions (20% of earnings) are included in the later statisctics and not fully in the earlier years. From 05/06 we've had two years of budget freezes and are now about to get a further budget cut of 07/08. Working on an annual basis, GP's will have had approximately an annual 5% rise in taxable pay over 5 years with the new contract.

So yes, this is good value for the tax payer, I work a lot harder during the day. I get to sleep at night so I'm more efficient and less likely to make mistakes. Almost all of my pay rise is made up of performance related pay which is liked to achieving targets which benefit patient care.

The productivity figures quoted are bogus, it is never going to be possible to match them because of the statistical analysis of hours worked/cost = productivity. It might work for some industry but it is a joke when applied to medicine.

Dr J Ward, Burntwood, Staffs

If you look at the report, in 2006 £104 million was overspent on GP's (£168 million because GP's did better than expected in reaching targets, but £64 million was clawed back elsewhere.) An aditional £32 million thould have been spent on premesis, leaving the actual net increase of cash into primary care at £72 million.

This is less than
-the PCO's "administered funds" overspent by £102million.
-Out of hours cost £78 million more than expected (no surprise there since the contracts mainly went private, rather than to the GP's who bid to do the work.)

These numbers are smaller than the £1.76 billion, since that was a three year figure.

The key recomendation in the report is a recomendation that future big changes are costed, wo the expensive walk in centers need to be put on hold until their true costs and benefits calculated.

But the focus of the ire once again is greedy GP's. Once again the GP's are blamed for the NHS's managerial incompetence.

Dr G rhys, Nefyn, Gwynedd

We have here some one sitting in New Zealand coming to the rescue of our 'hardworking GPs' who open their practices ' from 8:00 to 5:00PM and working on saturdays'. Is it in New Zealand?
I have not seen the GPs I had working even beyond 5:30 PM.
The previous GP I had works from 10:00-1:00 and 4:00-5:30, and thanks to the changes we had in the neighbourhood where shops have come in, he lost at least 50% patients in his list, his reception room is almost deserted every day since the last three years and he still collects a six figure salary! GPs are working ahrd indeed in New Zealand!!

Yong, LONDON,

I can't see where I've earned 58% more than before the new contract. The employers pension contribution now has to be shown in our accounts as income. This artificially inflated our pay by, I think, 14%.

Our real income is based on achieving government health targets. If we don't reach the targets, we don't get the money.

Our negotiators told the government what GPs actually did, but they didn't believe us. Frankly, they haven't a clue how much work we do: they thought we did much less.

I'm doing the same clinical hours as before but have to hit crazy targets. The amount of administrative work to be done has hence increased.

So that's money well-spent then.

Most GPs paid GP co-ops to cover their out-of-hours work, and re-couped that, if they wished, by working shifts. This used to cost me £10,000 p/a. The government said they could do it for £6000 p/a.

PCTs said we had to opt out as they needed our £6000 back to run the local out-of-hours service.

Do the maths.

Ian Rubenstein, Enfield, UK

I'm glad to hear that doctors are getting paid what they're worth at last, but my GP earns more like 50,000 not 100,000.

The government has wasted £12 billion on an failed hospital IT system - that could have paid the salaries of 24,000 extra GPs for 5 years.

The NHS spent £171 million on management consultants last year - that could have paid the salaries for 1,710 extra GPs this year.

Ian Williams, London, UK

Please remind me again how much this government has blown over the Northern Rock fiasco?

-Somewhere between £45 Billion and £100 Billion.

Add to this masses of multi-billion pound losses in failed IT systems, over-running and over-spending defence contracts, private finance initiatives which throw good money after bad and masses of admin and quangos.

This government has a reputation for squandering taxpayers money in this sort of fashion and I can't wait until they are voted out at the next election. It's not right to blame the GPs for this shambles- if you were offered a 60% pay rise for less work, how many of you would honestly turn it down? Instead, this government needs to take the blame and answer with their jobs.

Ben, Aldershot,

The government steamrollered this contract through, in the face of warnings from the doctors' negotiators that it may cost more than the government expected.

GPs historically do deliver services well in response to performance-related pay. They have done for decades. Nothing new there. The Quality and Outcomes Framework rewards measured quality and outcomes.

The headline figures for GPs' pay has been misleading because the "increase" now includes pension provision. GPs' pay has in fact fallen recently.

The figure of £1.7billion compares favourably with the £12.4billion being spent on IT by the NHS.

The current political GP-bashing campaign will result in a return of the recruitment crisis acknowledged above, closure of some GP practices and what Lord Darzi, a health minister, called the separation of the doctor-patient relationship.

Is that what people want?

Peter Gooderham, Cardiff, UK

Do hairdressers in Stourbridge offer appointments from 8 am until 8 pm, 5 days a week plus Saturday mornings? I think not.! I agree the 2003 contract may appear like money for old rope but would you have turned down a similar deal if offered to you? Most GPs work extremely hard and the main reason you cannot register with GP or get an appointment at your convenience is that many GPs are oversubscribed, not that they are lazy.

Jenny, Dunedin, NZ

So, the "way that Gps work" has changed? perhaps the BMA could explain exactly what benefit there has been for the average patient arising from the disgraceful milking of the system thatthey have indulged in? Wher eis the clinical evidence to support the "improvements in clinical care" that they claim? Wher is the evidence to show that any of this has happened as a result of the new contractual arrangements. Why are there areas of the country where patients still canot register with a GP practice? Why is it still almost impossible toget an appointment at the patient's convenience (GP practices, with all their PCT subsidised IT systems cannot achieve something a hairdresser with a diary and a pencil can) and why do this bunch of overpaid prima donnas still seem to believe their own publicity about being the most respected profession and worse still why do the governemnet also believe it and allow them to get away with it?

geoff rollason, stourbridge,