BMA warns of crisis in community hospitals

GPs working in Community Hospitals Community Hospital GPs are underpaid and feel undervalued and exploited, says the British Medical Association (BMA) in its evidence to the Doctors' and Dentists' Pay Review Body (DDRB). It calls for immediate action to resolve the issue across the UK.

"The current pay of GPs working in community hospitals does not reflect their workload, skills, commitment, clinical responsibility and clinical leadership which they bring to the job. This has resulted in depressingly low morale that in turn is leading to a recruitment and a severe and very urgent retention crisis" says the BMA evidence."

A survey of 192 GPs working in community hospitals forms part of the DDRB evidence. It shows the GPs are working long hours and that the work is disruptive to practice commitments and personal life.

• Over two thirds (68%) provide 24 hour care for their unit, the remainder providing 10 to 12 hour day cover.
• On average GPs are specially recalled to the hospital 4.3 times a week
• The majority (85%) deal with calls outside their normal community hospital sessions - up to 80 calls made in a week and up to 160 calls received.
• Most of the GPs (83%) undertake work without any clinical supervision from consultants and carry the ultimate clinical responsibility for resident patients.

"In advance of formal negotiations to review the pay and career structure for this important group of doctors, a recommendation from the Review Body for a significant uplift for 2005-6 would help to prevent a recruitment and retention crisis occurring in the short term" says the BMA evidence.

GP Trainers
In its evidence to the DDRB, the BMA calls for a dramatic increase in the GP Trainers' grant to meet the true costs of training tomorrow's GPs. Dr Hamish Meldrum, chairman of the BMA's General Practitioners Committee said: "Without an increase of at least threefold the current grant of £6,385, GP trainers will vote with their feet in 2005. The essential work they do is unrecognised and undervalued. The reality is that with impending changes to the way we train doctors, the UK is in more need of GP trainers than ever before."

For this year's evidence, focus groups were held with UK trainers (see Appendix I).The results show that training work is becoming more demanding and is displacing more and more surgery time. The focus group trainers spent approximately two hours per week on formal training and one hour per day on informal training, with administrative and preparatory work in addition to this. "The recruitment of GP trainers is becoming increasingly pressing and urgent" says the BMA evidence.

GP Educators who teach medical students in a primary care setting did not get a pay uplift this year (from April 2004). New medical school courses have placed "new and significant demand on teaching practices" and this should be reflected in their pay, says the BMA.

GP Registrars
A call for a substantial increase to the level of pay for GP Registrars comes in the BMA evidence to the DDRB. The Association wants to see their pay more closely aligned with their specialist registrar colleagues in hospital. For junior doctors working in hospital, transferring to a GP Registrar post is still financially less attractive than staying in a hospital training post says the BMA. Given the acknowledged shortage of GPs, the BMA argues the barrier to recruitment must be removed. It is seeking an increase to the Registrar supplement from the current 65% to 70% to provide appropriate parity.

PMS GPs
PMS GPs are being treated unfairly with regard to some payments compared to GMS practices, says the BMA. It spells out the inequalities over issues such as employer superannuation costs and says: "Support from the Review Body to highlight the importance of treating GMS and PMS practices equally when distributing national funding arrangements and of ensuring that practices receive the funding due to them would be very welcome."

The GP section of the BMA evidence to the DDRB also calls for increases for salaried GPs, a better deal for academic GPs and covers sessional fees for doctors in the community health service and other fee areas.