Health Secretary Andrew Lansley has refused to rule out increasing GPs' pay as discussions over their new role in handling the NHS budget continue.
Doctors are in the best position to know what treatments and services patients require, according to Mr Lansley, and he believes they will show leadership in the new role. The coalition government's plans will see approximately 80% of the NHS budget, which is in excess of £100bn, put under the control of GPs.
The plans signal the end for PCTs and strategic health authorities, which currently handle commissioning. Mr Lansley believes the NHS is moving to a simpler, de-layered management structure.
Speaking to MPs at the Health Select Committee, he said: "We have a body of evidence that is clear about the benefits associated with practitioner-based commissioning."
Asked about the GP contract in 2004, which resulted in doctors seeing their pay rise substantially, Mr Lansley declined to discuss how the British Medical Association (BMA) would now be prevented from "running rings" around the government when it comes to pay.
He said: "You will forgive me if I don't. One of the principles of negotiation is not to pre-empt and pre-judge them – as it were show one's hand in the financial aspects of the negotiation.
"I think the last negotiation leading up to the contract in 2004 in a substantial measure failed."
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Your comments (terms and conditions apply):
"I think Mr Wiffin's [comment below] practice is an exception! Which practices these days open at 10am?! If his GPs work those hours then good for them but he should not put it across that this is the hours that all GPs work" – Name and address withheld
"It depends on the way in which the commissioning is organised. I suspect that there will be a commissioning 'board' made up of the best business-orientated GPs supported by the usual back room functions of HR, Finance and IT etc. The managment of the individual GP contract will be, as usual, done in the surgery but if GPs are looking for extra cash for their own pay in this financial climate they will be stripping out costs to find it. The biggest cost in practice is the wages bill so take heed those who are hankering after more money, you may be looking at reducing your staff to manage it" – Name and address withheld
"Practice managers should be paid more as they are the ones who seem to take more of the workload with more to come!" – R Emmonds, North Lancs
"Where does Mr Wiffin [below] find GPs working from 10am to 6pm? Our GPs work from 8.30am to 07.00pm or later if their surgery overruns, which it frequently does" – Allan Stewart, Wirral
"I am stunned by the comment from Jack [below] – to portray drs as only working from 10am is simply not an accurate reflection of what I see. Surgeries 8.30am-8pm routinely, plus visits from 8am, and their salary is larger than most but compares to other professionals who take the level of responsibillity that GPs do. What we need to do is press for better salaries for practice managers and the like – I will certainly be asking for a substantial rise given the extra responsibilities I have taken on this year and those that will come with the government changes – I too often work 8.30am–8pm" – Name and address withheld
"Sorry, but the GP role has risen dramatically over the last six years and pay has been clawed back over the last four years. The problem is not how much more we will pay GPs, it is where will we as practices ever get the time to handle the extra workload. GPs I work with start at 8am and often take work home when they leave at 7pm. Mr Wiffin [below] has no idea. Any extra money would have to go to paying other staff to take on the commissioning role, not as 'GP Pay'. I am a practice manager" – David Doig, Derbyshire
"There is going to have to be a very tight structure in place regarding GP pay when they get their hands on this massive budget. There are quite a few GPs who firmly believe that they are underpaid now for the 'work' they do and would first and foremost ensure that their pay was substanstially increased to accommodate this new responsibility" – "Nurse", Lancs
"No, I don't believe they should be paid more as they earn a very substantial salary at present. Their workload has significantly decreased in the past 10 years as they operate a basic 10am to 6pm workday and locums do the night call outs. So I think they are well rewarded at present" – Jack Wiffin, Tyne and Wear