General Practice Around the World: Part 2 – Funding and Pay

Recently there have been some new studies published which shed light on how General Practice in the UK compares to other countries. In this second part of our report, we crunch the numbers around funding and pay.

Recently there have been some new studies published which shed light on how General Practice in the UK compares to other countries, using many interesting metrics. In this second part or our report, we crunch the numbers around funding and pay.

How GPs get paid

Remuneration of healthcare professionals is often cited as one of the key elements that need to be improved in order to both recruit and retain staff in this country, and stop them either leaving the profession or moving abroad to continue to practice.

Just 23% of GPs in the UK are very or extremely satisfied with their pay – only Australia has lower satisfaction, with 17%, leaving the UK ninth out of the ten countries. But if we compare the situation of GPs in SwitzerlandSweden and the Netherlands (with 40% very or extremely satisfied) we can see quite a significant gap.

However, UK GPs rank better when it comes to how closely their remuneration matches the national average, especially that of GP partners. Only Germany outperforms us, but GPs there also work longer hours and have worse morale.

Funding mechanisms

No discussion of primary care and its challenges in the modern era is complete without looking at the mechanism(s) by which it is funded.

As Professor Roger Jones points out in his article for the Royal Medical Benevolent Fund, “the small business model we have in the UK, where you become a fully-fledged partner/shareholder in the practice and the property, is fairly unusual. In many countries GPs are simply employed by the health authority or the state to work in premises they have no interest in and with staff they don’t control. The UK GP partnership model is pretty unique.”

The Health Foundation report notes that across the world, there are combinations of various models in evidence, including capitation, fee-for-service and pay-for-performance schemes. Levels of health insurance vary too, which also impact the demand on primary care services. For example, in most western European nations, general practice is free at the point of need. However, some countries ensure that moneys are diverted to doctors by way of insurers. In France, the state runs an insurance scheme which aims to cover most of a patient’s fees – the rest will be picked up by employer-based insurance. In Germany, citizens join a health insurance provider known as a Krankenkasse and contribute monthly payments to them (around 15% of gross income). Ireland have a system whereby families on a low income, the elderly and some children are given free state-funded healthcare. The USA, of course, is famous for its system of insurance-based healthcare and the inequality and coverage gaps that creates, and there are many who are calling for a hybrid model to address this problem.

But as Professor Jones points out: “It is difficult to generalise about this. In the USA for instance, ready access to specialists has driven up the cost of care enormously and encouraged more defensive medicine, to reduce the risk of litigation. However, in France, unregulated access to specialists has produced no significant differences compared with the UK in terms of cost or health outcomes. This suggests that differences in the overall structure of care, in themselves, may not make a big difference. It seems to depend more on the context.”

Other metrics

Data from The Kings Fund shows that the UK lags behind many of its peers when it comes to the number of GPs and nurses per head of population (3 doctors per 1k people where the average is nearer to 4, and 8.5 nurses per 1k people, where the average is around 11). In some countries a low score for either doctors or nurses is balanced out by a higher score for the other, but in the UK both are below average.

Data Limitations

It is crucial to remember that data such as that discussed in this article does have its limitations. Not only does the role of GPs and primary care differ, but it is also fast-changing and not always current. It also necessarily relies on a certain amount of self-reporting which may affect accuracy and consistency. In addition, the response rates for these types of surveys are often quite low (22.4% for the Health Foundation report) and the sample sizes may be relatively small too.

Good news

However, the UK performs well in terms of providing universal healthcare generally, and there is a relatively low level of private spending on health costs.

In addition, the UK also ranks better in terms of administrative spending (which is lower than average) and also scores well in the rate at which we prescribe generic (cheaper) versions of medications.

So to sum up, the UK performs favourably in a few important areas against our counterparts, but scores poorly in many more key respects. When it comes to hardworking staff who strive under incredible pressure to do the best thing for patients day in, day out, surely none can outrank the UK. What needs addressing is for the system and tools that they have to work with to be invested in properly, and staffed sustainably.

Sources and further reading:

Created by Jonathan Finch
Jonathan Finch
Jonathan is the Web Content Editor at FPM Group. He writes about issues affecting the UK health and care sectors, and maintains resources and services that make healthcare professionals' lives easier.


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