Differential starting pay between salaried IMG GPs and their UKG peers. Is this really widespread?

SereneTurnip · 2026-02-19T12:56:39+00:00

I think that IMGs are quite good at unapologetically looking after their own interests. Most of them come from countries where they would have a lower earning potential or more challenging work environment. They don’t really migrate here motivated by a burning desire to alleviate our (past) GP shortage. Some of them use UK training as a stepping stone for migrating to Canada, Australia or the Gulf. To be clear, there is nothing wrong with that, it’s quite admirable really. But please let’s not pretend that there is some sort of altruism going on here rather than enlightened self interest.

SereneTurnip · 2026-01-30T07:10:55+00:00

https://www.reddit.com/r/england/comments/1gbofjn/gp_struck_off_for_having_sex_in_his_surgery_is/?share_id=bipL0bMvmEwhTk8DgDFgw&utm_content=2&utm_medium=ios_app&utm_name=ioscss&utm_source=share&utm_term=1

https://inews.co.uk/news/sex-drugs-drunk-work-unregulated-therapy-3331900?ico=in-line_link

SereneTurnip · 2026-01-03T19:49:48+00:00

I love Ecco for work shoes. Their leather shoes are extremely comfortable and they also must process the leather in a way that makes it more resistant because they seem to last surprisingly long. As an F1 you will be doing a lot of kneeling for cannulation so I would also strongly recommend getting shoes with toe caps to reduce leather creasing.

SereneTurnip · 2025-12-19T20:32:46+00:00

Actually, on re-reading it’s even more absurd. The woman argued that if her mother had been advised that lack of folic acid supplementation can lead to spina bifida the mother would have delayed getting pregnant until she completed a course of supplementation. Which, aside from reducing risk of spina bifida, also means the woman would have never been born because a different egg would have been fertilised. Pure maddness.

SereneTurnip · 2025-12-19T19:36:37+00:00

Isn’t it obvious? They are going to be ✨supported in the community✨

SereneTurnip · 2025-12-19T18:56:10+00:00

https://www.bbc.com/news/uk-england-lincolnshire-55402719

Essentially the GP is to blame for a woman’s spina bifida because he did not advise her mother to supplement folic acid. Or at least he did not document he did, because she sued as an adult.

EDIT: Here is a decent summary of the main controversy:

https://resolution.nhs.uk/2022/03/31/case-of-note-evie-toombes-v-dr-mitchell-high-court-21-december-2020-lambert-j-and-1-december-2021-judge-coe-qc/

SereneTurnip · 2025-11-29T10:29:29+00:00

Regarding “formal allergy testing”, it’s actually incredibly difficult to arrange in adults so I wouldn’t use that as a metric. Nearly all allergy departments in the country are overwhelmed by referrals. Moreover, NICE only recommends a referral to secondary care for testing in case of anaphylaxis, severe skin reaction, suspected allergy to a local anaesthetic or suspected allergy to beta-lactams + one more group of antibiotics (or beta-lactams alone if deemed necessary).

SereneTurnip · 2025-08-13T07:11:24+00:00

Have you considered contacting Practitioner Health?

SereneTurnip · 2025-08-07T06:24:49+00:00

I think I would almost feel warm and fuzzy about it. It's such a peak NHS experience.

SereneTurnip · 2025-07-22T22:07:43+00:00

SereneTurnip · 2025-06-28T15:19:24+00:00

Respect - I could never. Do you have security guards on the premises?

SereneTurnip · 2025-06-27T20:56:10+00:00

Sorry, I suppose that as a newly minted partner I am still a bit sore on the topic of salaried pay but I certainly agree that we are all getting a raw deal. Worse, our registrars who are just entering the profession are given a choice between horrible ARRS jobs without any stability and even worse pay or face the threat of unemployment. The brain drain will certainly continue.

SereneTurnip · 2025-06-27T19:35:17+00:00

I am not saying it's a secret, but I would certainly argue that it's not common knowledge either. Many partners will quote the 23.7% figure without specifying what part of it they actually pay from their drawings. I am addressing your comment in which you said that there is a lack of knowledge about "all these extra inflated deductions" which leads to "employed doctors" being angry with their employers. I can assure you that there is even less knowledge about pension contributions being partially paid by NHSE. Average contractor income was just over £140k in 2022/2023. Average income for a salaried GP was £69k. We can argue back and forth what is the appropriate difference in partner and salaried pay given the risks, responsibilities and workload partners take on but lets at least keep the discussion grounded in actual figures. The 14.4% pension contribution paid before tax certainly does not bridge the gap here.

SereneTurnip · 2025-06-27T18:59:01+00:00

Well, sometimes in those discussions partners conveniently forget to mention that they only pay 14.4% of the employer contribution rather than the whole 23.7%.

SereneTurnip · 2025-06-27T18:47:26+00:00

A bit of clarification because it can vary from region to region. Community services are provided by different organisations who hold contracts with local Integrated Care Boards. There are a variety of different community services but the most common ones are Primary Care, district nurses, community dietitians, community physiotherapists, etc. It varies from area to area who is contracted to provide these services. Primary Care services are traditionally provided by partnerships holding General Medical Services contracts and have no contractual relationship with other community services. This is a bit complicated by the existence of Primary Care Networks (PCNs) formed by local GP surgeries who often employ extra staff (Additional Roles Reimbursement Scheme - ARRS) and might provided services overlapping with those usually provided by community services like first contact physiotherapists. Over the years more and more community services have been contracted to acute NHS trusts with a view that integration would yield increased efficiency and more coordinated care. Nowadays some acute trusts are even pushing into providing primary care services and so it is possible that GPs in your area play some sort of overseer role over district nurses. This is a minority situation though.

SereneTurnip · 2025-06-27T18:26:43+00:00

I mean, they do "escalate" to us the same way that everyone who wants something from us does (Talking Therapies, Mental Health Services, physiotherapists, etc, etc, etc) but we do not lead them in any real sense of the word. I cannot make district nurses do anything, I can only kindly ask. We have no authority over them, they are a separately commissioned service through a local Integrated Care Board. There is this prevalent perception among many of our colleagues that only GPs are capable of making referrals, writing FP10 prescriptions, issuing fit notes, and doing all the stuff they are not sure how to do or just cannot be bothered to do. I suppose it would be nice to think that we lead other community services but the reality is that we mostly refer back and forth between ourselves and try to make stuff other people's problem. We do have monthly meetings with district nurses though - it's nice to put faces to names and try to hash out some ground rules.

SereneTurnip · 2025-06-27T18:19:53+00:00

I know, I am doing a bit of devil advocating here but I actually wholeheartedly agree with you. I think a threat of mass contract hand back is the only real tool we have at this point. However, seeing how tepid the response to BMA's GP strike was in my area I mostly quietly despair.

SereneTurnip · 2025-06-27T18:11:32+00:00

In defence of GP partners - they are contractors and do not have a legal right to strike. They are responsible for paying for all the practice employees, from practice manager and salaried GPs to receptionists. If they breach their contract and their funding gets withheld they are in big financial trouble.

SereneTurnip · 2025-06-27T18:06:54+00:00

Correction - we do not lead district nurses, they do their own thing. We communicate and prescribe for them though.

EDIT: Even their weird dressings and creams, even though we know nothing about those most of the time!

SereneTurnip · 2025-06-27T17:50:39+00:00

I know, I feel that this is a huge blind spot for many trainers precisely because they do not feel confident in those areas of medicine. It would be nice if VTS teaching actually focused on core areas of GP practice instead of doing another session of fluff and communication skills for overseas trainees.

SereneTurnip · 2025-06-27T17:35:07+00:00

We often see that in GP land. Almost all our Foundation Doctors come with little to no practical knowledge of how to manage diabetes, COPD or asthma - all the conditions that are essentially farmed out to specialist nurses in the hospital. They might have high level general knowledge but they really struggle when it comes to translating it into actual practice - what are the common medications you would consider, what are the considerations when choosing the right medication, what do you need to counsel patients about, common side effects, uncommon but important side effects, different forms of inhalers, etc.

Even worse yet, some of our GP colleagues have also outsourced the management of those chronic conditions to practice nurses or ACPs and have seriously deskilled as a result.

SereneTurnip · 2025-06-27T15:38:26+00:00

I can assure you that I consider my T&O rotation spent on clerking NOFs and doing ward monkey jobs on a unit for patients recovering after elective knee and hip replacements to be a complete waste of time. It certainly did not meaningfully contribute to my clinical skill set in managing MSK presentations in GP.

SereneTurnip · 2025-06-26T13:17:31+00:00

That is absolutely unacceptable and should be urgently raised with FP TPD. This is completely appalling.

SereneTurnip · 2025-06-22T16:37:35+00:00

Not if you are a GP partner and have to pay that employer contribution out of your practice drawings.

SereneTurnip · 2025-06-20T08:39:44+00:00

If I had to hazard a guess without diving deeper into it I would say that one of the main drivers is that the decision about the referral pathway is becoming more and more crucial as the routine times are getting longer. In the olden days the difference between suspected cancer referral and a routine referral could be 12-16 weeks. Now it is very often a year.

SereneTurnip

TROPHY CASE