GP Earnings and Expenses Estimates, 2021/22

Arrangements in place between April 2021 and March 2022

Most contractual elements returned to ‘normal’ for the majority of 2021. With QOF, IIF and DES suspensions coming to an end on 31 March 2021. However, suspension was reintroduced later in the year to provide additional support to the ongoing Covid vaccination programme.

The Quality Outcomes Framework (QOF) was partially suspended from December 2021, in order to increase capacity for the ongoing vaccination programme.  Payments for suspended indicators were paid based either on 2018/19 achievement levels or paid in full, adjusted for changes in point value. Indicators related to pandemic related priorities remained active.

Income protection for the Minor Surgery Direct Enhanced Service (DES) was enacted from 1 December 2021 until 31 March 2022 – and deferral of some health checks for those practices participating in the vaccination programme.

The Dispensing Services Quality Scheme was also amended to reduce the requirement for medication reviews from a minimum of 10% of dispensing patients to a minimum of 7.5% for 2021/22:

NHS England » Temporary GP contract changes to support COVID-19 vaccination programme

From December 2021, the PCN Investment and Impact Fund (IIF) was partially suspended, with the exception of three flu immunisation indicators.  The remaining funding was split between a ‘PCN Support Payment’ (£62.4 million) and a new binary indicator based on whether all practices in the PCN being signed up to ‘Phase 3’ of the Covid vaccination programme (£49.7 million).

Additional funding was provided to general practice in 2021 via the extension of the Covid Capacity Expansion Fund.  £120m of funding was provided between April 2021 to September 2021 Coronavirus » Supporting General Practice: Additional £120 million funding for April to September 2021 (england.nhs.uk).

In August 2021, NHS England also announced £43m of new funding for PCN Leadership and management support: B0828-i-gp-contract-letter-pvns-21-22-and-22-23.pdf (england.nhs.uk)

Some additional mitigations also came into effect during July 2021, with funding for PCN Clinical Directors increased from 0.25 WTE to 1 WTE where at least one Core Network Practice is signed up to the COVID-19 Vaccination Programme Enhanced Service, and the introduction of a new £30 million ‘Long Covid Enhanced Service’ on 1 July.

Most importantly, many contractor GPs worked evenings and weekends to deliver the vaccination programme. Whilst it is not possible to quantify the average number of additional hours worked, this is likely to be a significant factor in average net earnings increases. As, unlike Agenda for Change and other NHS staff – average net earnings for both contractor and salaried GPs include pay for additional hours worked, as well as an increase to the rate of pay.

In 2021/22, there was also an increase in expenses; mostly due to increases in employee costs. There are many reasons for this, not least the cost of delivering the COVID vaccination programme itself, alongside the impact of Brexit (increasing workforce shortages), and the growing impact of inflation, which was starting to impact in this period as well (RPI inflation was 11.1% in the year to April 2022 and CPI was 9%). All of these are likely to have had an upward pressure on staff pay and other practice costs.

The Winter Access Fund provided £250 million of additional funding aimed at increasing access to primary care services.

General Practice continued to be the central route for most covid vaccinations, with many of the LVC sites being ‘mothballed’ during this period.  Practices continued to be required to work in groupings (mostly in line with their existing PCN group), although logistics for the vaccination programme, such as transport and delivery of vaccines eased compared to the initial year. This will, however, have continued to require additional admin/management support, primarily at a PCN level (recognised by increased PCN Clinical Director funding). 

In England in March 2022, there were 1,660 patients per fully qualified GP (2,217 per FTE) compared to 1,580 patients (1,942 per FTE) in 2015. However, the number of patients per direct patient care staff, including GPs, fell slightly from 776 to 753 (from 1,057 to 1,034 per FTE).

The number of GP contractors has fallen from 24,491 (21,655 FTEs) in 2015 to 19,766 (16,957 FTEs) in March 2022 which means a smaller pool of GP contractors to draw from the practice profits from this one-off event, i.e. COVID vaccinations¹

¹ https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis

Table 1.1: GPMS contractor GPs - mean earnings, expenses and income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. Statistical significance relates only to the fact of a year-on-year change in income before tax. See 'Statistical significance explained'.}

Dispensing and non-dispensing GPs

Table 1.2: GPMS dispensing contractor GPs - mean earnings, expenses and income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. Statistical significance relates only to the fact of a year-on-year change in income before tax. See 'Statistical significance explained'.}

Table 1.3: GPMS non-dispensing contractor GPs - mean earnings, expenses and income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. Statistical significance relates only to the fact of a year-on-year change in income before tax. See 'Statistical significance explained'.}

Median gross earnings, total expenses and income before tax

Table 1.4: GPMS contractor GPs - median earnings, expenses and income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. The median figures are lower then the mean figures in Table 1.1. The higher mean values indicate that there is a relatively small number of high-earning contractor GPs increasing the mean figures.}

Breakdown of expenses for contractor GPs

Table 1.5: GPMS contractor GPs - breakdown of mean expenses by contract type, England, 2021/22

Table 1.6: GPMS contractor GPs - breakdown of mean expenses by dispensing status, England, 2021/22

^Note:

^{1.Further expenses breakdowns are published in the Excel Time Series, available under Resources on the Overview page.}

Table 1.7: GPMS salaried GPs - mean earnings, expenses and income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. Statistical significance relates only to the fact of a year-on-year change in income before tax. See 'Statistical significance explained'.}

Table 1.8: GPMS salaried GPs - median earnings, expenses and income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. The median figures are all lower than the mean figures in Table 1.7. The higher mean values indicate that there is a relatively small number of high-earning salaried GPs increasing the mean figures.}

Table 1.9: GPMS combined GPs - mean earnings, expenses and income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. Statistical significance relates only to the fact of a year-on-year change in income before tax. See 'Statistical significance explained'.}

Table 1.10: GPMS combined GPs - median income before tax by contract type, England, 2020/21 and 2021/22

Note:

^{1. The median figures are all lower than the mean figures in Table 1.9. The higher mean values indicate that there is a relatively small number of high-earning salaried GPs increasing the mean figures.}