Analysis: Pay in the NHS

By Nick Triggle
Health reporter, BBC News

  • Published

When it comes to high pay in the NHS, it is hard to see past GPs - as the Panorama figures illustrate.

Of the three non-BBC staff in the top 10 highest earners, two are GPs, both of whom earn up to £500,000 a year.

What is more, official figures show that despite pay freezes in recent years, average pay is still a healthy £105,000.

The common perception is that the British Medical Association ran rings around the government negotiators during the two years of talks prior to the introduction of the 2004 deal.

Speaking to the BBC several years ago, Dr Simon Fradd, one of the BMA's key negotiators on the deal, let slip that doctors were shocked by the generosity at times.

Referring to the offer that allowed doctors to opt out of weekend and night care for relinquishing just 6% of their pay, he said it was "stunning" and a "bit of laugh".


Ministers have since admitted that they should have been tougher, particularly over how difficult they made getting the bonuses. Only about half of the average earnings is actually basic pay. Most of the rest is made up from hitting targets, which GPs have proved very good at.

But those earning the highest salaries do much more than just day-to-day GP care.

Many will be dispensing GPs, who effectively run in-house chemists, while others may be in charge of a network of practices.

Some of the most innovative and experienced have started to diversify into areas that have traditionally been the domain of hospitals, such as minor surgery, diabetes clinics and dermatology services. All this brings in many thousands of pounds a year.

Some of the numbers are also related to size. NHS Hertfordshire has the most GPs earning above £100,000 in the UK. But it points out that it is the second biggest trust in the country and has a large number of "top achievers".

Consultants have also done well under their new contract which started in 2003.

Average basic pay has broken through the £100,000 barrier too. But this can be tripled once merit awards, waiting time bonuses and overtime is taken into account as the £300,000-plus salaries in Cardiff, Staffordshire and Northumbria show.

In fact, the way they are paid has led to murmurings within the Department of Health and questions are now being asked behind the scenes about how transparent and fair the system is.

Of course, a critique of pay is not complete without mention of managers. Trust chief executives now earn nearly £150,000 on average after a series of pay rises since the 1990s.

But that has not come without a cost. There is much less job security than there once was - half now spend less than two years in the job.

Within central government, Sir David Nicholson, the chief executive of the NHS in England, is the fifth best paid official at £278,800 a year when benefits such as his London house it taken into account, according to Panorama. However, he is in charge of one of the largest employers in the world.


The NHS also crops up in the list of quangos which have the highest number of £100,000-plus earners.

NHS Blood and Transport comes third in the list, behind the London Development Agency and Bank of England.

It has 43 staff earning above the threshold and with a workforce of 6,000 is far from the largest quango in the country.

But the body is quick to point out it employs a range of leading experts, including scientists and doctors, who have responsibility for transporting life-saving blood supplies and organs across the NHS.

But when assessing pay, the key question is whether the NHS is getting value for money. Figures from the Office for National Statistics suggest not. Productivity has actually decreased every year since the mid 1990s.

However, Professor John Appleby, chief economist at the King's Fund health think-tank, is more generous. "We are probably not yet getting value for money, but it is not just about quantity. What I would say is that the quality of the care has improved and that is not always so easy to measure."

And while the high pay of GPs, hospital consultants and trust bosses grab the headlines, the vast majority of NHS staff are less well paid.

The average nurse salary is just above £20,000, while a host of other staff from hospital porters to health visitors earn even less.

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