GP Earnings and Expenses Estimates, 2021/22

Arrangements in place between April 2021 and March 2022 

Enhanced Services:

Practice income for services that were relaxed, was guaranteed until 30 September 2021 at levels equal to activity during 2019/20. Practices are required to demonstrate a minimum level of activity for the service over the 12 month period 1 October 2020 to 30 September 2021. The payment guarantee ensured practices continued to receive payments based on the highest level of activity in the corresponding quarter in 2019/20.  In receiving the higher of guaranteed payments or claimed activity for the 12 month period, practices will not be entitled to more than 100% of the payment for the care of the patients had the guarantee not been in place.

Quality Assurance and Improvement Framework (QAIF)

Only active clinical indicators (FLU001W; FLU002W; DEM002 = 48 points), two QI projects from the original QI basket (125 points) and the cluster indicator requirements (CND015W, CND016W = 105 points) which have remained active, will be measured for achievement at the end of the current QAIF cycle (i.e., 30 September 2021).

Despite the payment protections offered by the Welsh Government, the fluctuations in workforce and workload during the Covid pandemic resulted in increasing expenses during 2021/22 and a reduction in contractor income. There are various reasons for this across practices which include increased staff absence through sickness/isolation resumption of annual leave, and increased travel costs.

Additionally, the relative decline in the numbers of Covid vaccinations being administered in general practice will have led to a tapering off of that income stream during the financial year.

In Wales, Health Boards were formally responsible for delivery of the Covid-19 vaccination programme. Welsh Govt official data, at 20 April 2021, shows that all (392) of the 392 active practices in Wales were delivering Covid-19 vaccinations under a Primary Care Covid Immunisation Scheme (PCCIS) from their local Health Board (HB). Although approaches varied by Health Boards, GP practices were usually vaccinating priority groups 1-5; with the rollout to others being at HB operated Mass Vaccination Centres. By July 2021, Covid vaccinations were only being delivered at 51 GP practices according to Welsh Government data. 

The collaboration between Welsh practices under the Primary Care COVID-19 Immunisation Scheme and the strategic variation between areas continued to be instrumental in this effort, maintaining both flexibility and thorough coverage across different population cohorts. Of the approximately 14 million vaccines administered by GMS, over half were conducted between April and September 2021. This means that half of the extra income associated with the immunisation drive will likely be attributed to the 2021/22 financial year.

Differences in vaccination programmes account for part of the differences we see particularly between England and Wales – as whilst Welsh practices were heavily involved under the Primary Care Covid Immunisation Scheme, Health Boards were ultimately responsible for the vaccination programme and approaches to the rollout varied between areas, with certain cohorts being vaccinated in non-primary care settings.

Table 3.1: GMS contractor GPs - average earnings, expenses and income before tax by dispensing status, Wales, 2020/21 and 2021/22

Notes:

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

^{2. No PMS contracts exist in Wales, so all results shown relate to GMS GPs only.}

^{3. Income before tax estimates have increased each year since 2014/15, while average total expenses have been increasing since the time series began in 2002/03.}

^{4. Results for dispensing GPs are based on a small sample and so should be treated with caution.}

^{5. Average total expenses for non-dispensing GPs are considerably lower than those of dispensing GPs, which is to be expected since the costs for drugs are included in the total expenses estimates.}

Median gross earnings, total expenses and income before tax

Table 3.2: GPMS contractor GPs - median earnings, expenses and income before tax, Wales, 2020/21 and 2021/22

Note:

^{1. The median figures are all lower than the mean figures in Table 3.1 which indicates that there is a relatively small number of contractor GPs with high earnings increasing the mean figures.}

Breakdown of expenses for contractor GPs

Table 3.3: GMS contractor GPs - breakdown of mean expenses by dispensing status, Wales, 2021/22

Note:

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

Table 3.4: GMS salaried GPs - average earnings, expenses and income before tax, Wales, 2020/21 and 2021/22

Notes:

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

^{2.Though the percentage increases appear large, they are based on a small sample and so should be treated with caution and, in the case of total expenses, equate to a relatively small cash amount.}

Median gross earnings, total expenses and income before tax of salaried GPs

Table 3.5: GMS salaried GPs - median earnings, expenses and income before tax, Wales, 2020/21 and 2021/22

Note: 

^{1. The median figures are all lower than the mean figures in Table 3.4, indicating that a small number of salaried GPs on high earnings are increasing the mean estimates.}

Table 3.6: GMS combined GPs - mean earnings, expenses and income before tax, Wales, 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 income before tax

Table 3.7: GMS combined GPs - median income before tax, Wales, 2020/21 and 2021/22

Note:

^{1. As was the case for contractor and salaried GPs separately, the median income before tax estimates are lower than the mean for both years for combined GPs in Wales.}