The row over GPs’ pay turned nasty yesterday as the Department of Health threatened to put a cap on how much they could earn.

The idea, floated by Patricia Hewitt, the Health Secretary, was welcomed by NHS Employers, which said it would begin work on a plan immediately.

The British Medical Association reacted with anger, saying that income increases had not been excessive and were the result of a contract agreed by both sides and based on a better quality of service by GPs.

“Patricia Hewitt is effectively saying she wishes GPs didn’t provide such high-quality care for their patients,” said Hamish Meldrum, the chairman of the BMA GPs committee. “Does the Secretary of State for Health really wish family doctors had performed less well on meeting the quality targets she and her predecessors agreed?” Ms Hewitt and the department are trying to make the best of a contract negotiation which rewards GPs with “quality points” for services they were already, for the most part, providing. It also allowed them to give up responsibility for out-of-hours care for a very modest sacrifice of income — £6,000 a year. The “quality and outcomes” framework greatly increased the total payments for most practices, from which a GP’s earnings are derived by subtracting from total income the costs of running the practice.

Ministers have been irritated by statistics suggesting that more of the increases went into GPs’ pockets than into improved services. But it is hard to sustain this argument when the increases were earned by meeting service targets that were jointly agreed. Ever since the effects of the contract became clear, the department has been trying to row back by offering lower cost-of-living increases and setting a cap on the increases in pensions that the new earnings will bring about. The pension row could yet end up in court.

Ms Hewitt emphasised that the new contract, negotiated under her predecessor Alan Milburn, had helped to overcome problems of recruiting and retaining GPs. Under the contract, average pay has soared 30 per cent to £106,000 a year, with some doctors taking home as much as £250,000.

Andrew Lansley, the Conservative Shadow Health Secretary, said that a cap on profits would be “unnegotiable”.

£100,000: Average salary under the new contract (varies, depending on surgeries)

£81,566: Average salary of GP in 2003-2004

£71,000: Starting salary for hospital consultants; can rise to well over £100,000

£19,166: Starting salary for nurses

Source: British Medical Association

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