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Perks of an island GP: seals, scenery and £300,000

This article is more than 17 years old
Britain's highest-paid family doctor was staggered by how much his practice in the Hebrides would earn - and wants a partner to split the cash

David Bickles did not go into the medical profession for the money. He simply liked the idea of being a local doctor working in one of the remotest spots in the British Isles. But he now finds himself in the extraordinary position of being possibly the best-paid GP in Britain. Through no wheeler-dealing or duplicity on his part, he is on course to earn £300,000 this year, simply because he works by himself, seeing patients across five remote islands in the Outer Hebrides - and because he still comes out at night to see his patients.

Last week, the medical profession was embroiled in a furious row when specialist medical accountants revealed that some GPs were earning as much as £250,000 a year. The news led to accusations from policy-makers that taxpayers and patients were getting a poor deal for their money.

But Bickles - the most extreme example of inflated salary that has since emerged - would dearly love to share these earnings, if he could only find a young doctor willing to join him. For months, he has been advertising for a young GP to become his partner, and split the generous proceeds from his practice in the Western Isles - but so far there have been no suitable applicants.

What Bickles offers is the kind of family doctor service immortalised in Dr Finlay's Casebook, one that has disappeared from most regions of Britain but which most of us would love to have. Many of his 1,200 patients know him very well, having come to him for years, and he has delivered scores of children on the isle of Barra. Its stunning scenery with coastal paths, wild flowers and sandy beaches where you can spot seals or dolphins, makes it one of the jewels of the Hebrides.

'I know everyone here, and it's a good community. The work's very varied - you have to be a bit of an expert in everything. I don't think there are many of my ilk now.'

A few weeks ago, the GP was staggered to find out that his small practice would earn around £300,000 this year. When his partner went into retirement last January, he tried to recruit another doctor, but has not been able to attract anyone to the post. He therefore faces taking the two shares himself. 'It's a staggering sum, isn't it? It's certainly not of my choosing. I would love to find someone to share the work. The problem is that younger doctors have this terrible impression of what out-of-hours work means. They don't realise that most nights, you don't get woken up at all.'

When asked what he would consider to be a fair wage, he said: 'I don't know, about £100,000? I was quite happy when I was earning £50,000.'

Explaining his situation to other doctors through the medical network Doctors.net, he said: 'The new contract has been good for some of us, probably not so good for others.'

After uproar over earnings erupted last week, the British Medical Association argued that only a tiny minority was earning that much and that the average salary was closer to just under £100,000 a year. Dr Hamish Meldrum, the lead GP negotiator for the BMA, said that many GPs were earning more money because they had been encouraged to expand their surgeries and treat more patients with more complex illnesses.

The Health Secretary, Patricia Hewitt, also defended the pay rises, which saw the NHS spend £300m more than predicted last year. She pointed out that doctors' pay was now tied to the work that they did rather than the size of their patient list. 'There are thousands of patients who are alive and well today as a direct result of this new contract,' she said. 'This is the kind of preventive healthcare that people want.'

When Bickles first came to Barra, he worked single-handed, but after Conservative government changes to the doctors' contract, he took on a partner as it was going to mean more work.

Six years ago the government offered GPs a more modern contract which would reward those who treated more patients, but also those who could demonstrate that what they did in the surgery had made a difference. Long and arduous negotiations accompanied attempts to renegotiate the contract, a procedure complicated by the fact that, unlike hospital consultants, GPs had always operated as businessmen, managing the finances themselves.

Under the more Byzantine procedures, a last-minute deal was hatched for inducement practices. Under what became known as the Medical Practices Income Guarantee (MPIG), the profits from dispensing medicines were kept outside the deal, boosting the earnings of Bickles's practice considerably. Then, in a move which surprised many, the then Health Secretary, John Reid, allowed GPs to give up their out-of-hours work and lose only £6,000 a year income.

For Bickles, working on a remote island, there was no possibility of a nine-to-five job. His health board had to offer his practice a further £25,000 a year to carry on. All this meant his income leapt to around £300,000.

When asked what he intends to spend his money on, now that he has so much of it, Bickles said: 'I'm having a boat built so that I can sail around the world.' Then he added: 'Apart from that, there isn't much I need here.'

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