Dr Phil Hammond, broadcaster and GP returner in Bristol

As a GP, people often ask me "What have you got in your big black bag?" So let's open it up and have a look. Here we are ... Two hundred and fifty thousand in cash... In my dreams.

I make £40 an hour – which I think is quite reasonable – but to take home a quarter of a million a year, as the BBC has suggested, I'd have to work 120 hours a week, every week of the year. I tried this when I was a junior doctor and I was knackered.

Back in the community, I do know one GP who earns £250,000 a year, but he also owns a chain of nursing homes – and good luck to him.

The most annoying thing is the media reaction to all this. Just about every paper had a "Is your GP worth a quarter of a million?" debate, swiftly followed by "If they're earning that much, why don't they ever smile?"

It was with some trepidation that I took part in Radio 4's The Now Show, a news satire presented by Steve Punt and Hugh Dennis, but they took a very unexpectedly supportive line on GPs' pay. Outrageous, isn't it? In a world where footballers can earn a quarter of a million a month, TV celebrities can earn tens of millions for suggesting a talent competition, barristers earn fortunes for helping people claim they didn't realise a cup of coffee would be hot, why shouldn't doctors get paid well in return for 7 years' training and a hugely responsible job affecting thousands of people?

What irritates me even more is the assumption that lots more money is going not just to GPs, but to general practice.

The vast majority of the NHS budget still gets sucked into secondary care and while Tony Blair remains obsessed with getting waiting times down, it is hard to see the trend changing. Politicians shouldn't be in charge of the NHS because they rarely see beyond building spanking new white elephant hospitals and cutting the wait for surgery.

But the vast majority of healthcare occurs in the community and, if money truly followed patients, that's where the funding should be too.

Of all the guff to come out of the Department of Health in the past 9 years, 'Healthcare Outside Hospitals' is the only one that has the potential to reform the NHS.

But it's far too late. If Labour had been brave and built superb community services from the start, it would have been far easier to close or merge surplus hospitals, and create fewer, larger, better resourced centres of excellence.

Ninety nine per cent of healthcare could have happened closer to, or even in, people's homes. Alas, stopping fund holding and then reinventing it 9 years later looks like a panic measure, as does closing hospitals at a time of debt. It's too late now to reform the NHS, and we should all be bloody angry at the huge waste of our money.


Guidelines in Practice, May 2006, Volume 9(5)
© 2006MGP Ltd
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