After countless exams, lectures and placements, having your name added to the Medical Register is a cause for celebration. Sadly, not long after this proud moment has passed, what should be an exciting time for medical graduates is often marred by a barrage of bills.
I was taken aback by these costs when I qualified in 1983. Back then, though, we weren’t charged tuition fees. It’s even tougher for graduates these days.
Most doctors will find their first few years in the profession the most financially challenging. According to the NHS Pay and Conditions Circular, first year foundation doctors earn £26,614 per year, while second year foundation doctors earn £30,805, with additional allowances for on-call and weekend work. And they’re continuing to pay for further exams. I hear about these concerns when I’m out talking to colleagues and friends through my work as a consultant. These views have also been shared with us by those representing doctors in training.
Which is why I’m pleased we can do something to help. In April 2018 we will change our fee model, so that newly qualified doctors will pay less than those who have been practising for some time. It’s important that we offer financial support at this early stage, as well as the support we provide to protect the quality of doctors’ training.
Newly qualified doctors will receive a fixed-term discount from 1 April 2018. Those eligible from the beginning could save over £1000 – you can find out more about how much you’ll save on our website.
Every doctor on the register will benefit
On top of this, all doctors who have been fully registered for more than five years will save £35 on their annual retention fee, meaning they’ll pay £390 instead of £425 from April 2018. This means every doctor on the register will benefit from these reductions.
We’re well positioned to offer these reductions after making significant savings since 2015, which has included the relocation of around 130 jobs from London to Manchester.
It’s only right that we pass these savings on to doctors.
A proactive approach to regulation
I want to assure you that our careful stewardship of our finances will continue. Where we can make further savings, we will.
To do this without increasing our fees, we need more flexibility in how we carry out our work, particularly our investigations of complaints which account for about 55% of our budget.
We’ve made some progress with this. In 2016 we reduced the number of full investigations through a number of reforms, including using more early stage filtering – known as making ‘provisional enquiries’ – to quickly identify less serious complaints (such as those involving one-off clinical mistakes). This has allowed us to reduce the stress on patients and doctors, focus on more serious cases and ultimately reduce costs – our expenditure on fitness to practise was £2.8 million under budget in 2016.
To really modernise the way that we carry out investigations – and put your annual fee to much better use – we need to be given more discretion and flexibility. This can’t happen without a change in the outdated and highly prescriptive law which rigidly controls so many aspects of how we work. The Government is currently consulting on changes to the regulation of healthcare professionals. Once that consultation closes in January, we hope they’ll quickly bring forward plans to update our legislation.
Moving forward, we want to change our emphasis and boost our support for all doctors to help them provide good care for patients. We’ll make that commitment in our new three-year strategy which we’ll publish in early 2018.
We will be working more proactively to help prevent doctors from getting involved in the fitness to practise process in the first place, by investing more in our support teams in England and across the UK along with tools to help doctors understand and apply our guidance.
We believe this will lead to better outcomes for both doctors and patients.
Improving medical education and practice across the UK 
What about reducing further the ARF for those on reduced income, eg med legal or expert witness work after retiring from clinical practice?
Hi – how do you stay on the register not doing clinical work ? GP appraisal is so inflexible that I have given up all and will soon be removed from the register due to missing appraisals. The country cannot afford to loose this workforce yet it carries on regardless. GMC was £30 when I qualified! (1984)
Hi Robert,
You may be eligible for a 50% discount on your fee if your income falls below a certain threshold. You can read more about the threshold and the discounts we provide on our website here – https://www.gmc-uk.org/doctors/fees/lowerincomes.asp
I know; but £32000 including pension etc…
How about raising it as part of this (laudable)
endeavour?
Great news – Thank you. For me the most important thing in this post is ‘we want to change our emphasis and boost our support for all doctors to help them provide good care for patients’. Up until now – in my experience, the GMC could have been more helpful to Doctors dealing with the increasing number of spurious complaints from patients.
How does this affect retired medics like myself who remain on the register (for old times sake) but without a licence to practice?
Hi John,
We have reduced the annual retention fee for doctors without a license to practise to £140. You can see the breakdown here: https://www.gmc-uk.org/doctors/fees.asp
You may also be eligible for a 50% discount on your fees should your gross annual worldwide income fall below our income threshold. You can find more about this here: https://www.gmc-uk.org/doctors/fees/lowerincomes.asp
You, me, and many more could do the odd session or offer our expertise to the health services but for the nonsense of jumping through the hoops of the ” licence to practise”, which is not that cheap.
Do wake up GMC and consider the size of the resource that you have effectively shut down.
£35 a year. That will really offset the 20% annual increases in medical indemnity that we’re all paying…
I wonder how many other professionals have to pay for their own inquisition?
Given that the GMC seems utterly oblivious to the concept of system failures, and is repeatedly scapegoating individual doctors trying their best under dangerous and impossible working conditions, to have to pay for the Sword of Damocles over our heads seems particularly nasty.
I don’t know of any doctor who holds the GMC in high regard.
I would strongly suggest you look at the aviation industry for how to assess risk in complex systems, and the Swiss cheese model for attributing blame when serious errors occur. Maybe then you’ll stop persecuting doctors – which ironically increases risk for the patients – the very thing you are meant to minimise.
Oh, and by the way, the whole NHS is falling apart due to savage chronic underfunding, and that is the most severe threat to patients – if you said something about THAT, that would be useful. “Beyond our remit” I hear you reply – pitiful. Patients are dying in their thousands unnecessarily, and you continue to blame the very individuals trying to help them, not the people actually responsible.
Yes to all this and to cheer yourself up even more, have a look at The General Dental Council; I was registered with them too, until 1.1.18
I couldn’t agree more, Ben Douglas. Until we move to a blame free culture patient risk becomes greater, and v sadly the GMC appears to be at the forefront of the inquisitional approach.
Well said Ben!!
Couldn’t agree more Ben. I do not know a single doctor who holds the GMC in high regard. The GMC is so politically driven that it has forgotten the humanity of doctors, who often can be patients themselves. This culture of blame is disgusting, it takes no account of system failures and it has created a culture of defensive medicine.
Doctors and all healthcare professionals live in fear of litigation or of making the simplest of mistakes. They are automatically assumed to be guilty until proven otherwise. Fitness to practice hearings are a witch hunt. I don’t even need to begin to mention the swathe of suicides or mental health issues which result from this.
A £35 discount on an already exhorbitant annual fee is meaningless. As Ben said, what other professional pays to have their own inquisition? Why should doctors have to pay these ludicrous yearly amounts to a corporation who’s sole aim seems to be persecuting doctors? The GMC tries to talk empathically about healthcare professionals but the true agenda is thinly veiled.
Doctors want to provide the best service they can, and the overwhelming majority care for their patients, but until we live in this climate of blame we’re only going to see more defensive (and expensive) medicine being practice.
Dear GMC, start acting like you actually care for doctors, take care of their morale, and you’ll be surprised at the overwhelming effect this will have on the issues the NHS is facing today.
Is it true GMC employees have private medical insurance?
If so how much of my annual fee goes toward it?
When will NHS employees get the same benefits?
Hi Dr Cook,
You can find out more about how doctors fees are spent on our website here: https://www.gmc-uk.org/doctors/fees/31438.asp
To cheer yourselves up, look at The Gen Dental Council…I was registered with them too until 1.1.18
I’ve had a look but it doesn’t address the concern that GMC is providing private health care for its employees. It’s this true? Please could you let us know?
Hi Jessica,
Like many organisations, we offer a range of benefits to attract and retain staff. We have to offer a competitive package to make sure we can recruit the best possible people from across the private, public and not for profit sectors. The health insurance scheme is optional and not all staff choose to take it up.
Interesting lack of financial detail on the GMC web site!
Hi Mr Piper – you can find our annual report, which includes full financial statements, on our website at https://www.gmc-uk.org/publications/31326.asp.
The GMC is a charity living on demanded money from doctors and not as a charity. If the government wants to regulate doctors they need to pay for it and not take from doctors
‘All doctors will benefit from the savings’. This is false. GMC seems to have conveniently ignored doctors from overseas who are highly skilled and relatively new on the register. How do they benefit from it? Either way, they don’t qualify for discounts as stated.
Hi Mudiaga,
All doctors registered in the UK are eligible for the £35 reduction on the annual retention fee. Both overseas and UK graduates are also eligible for the just announced discount for newly qualified doctors, provided they meet the criteria listed in Q1. on our website here: https://www.gmc-uk.org/doctors/fees/31437.asp
Great news about reducing fees. But, to put this into perspective, I have just paid 85 euros for my retention in Holland and that is for the next FIVE years. Over there the public bears the costs for fitness to practise proceedings, whilst in the UK the Doctors themselves pay for the privilege of being investigated!
Precisely Nick! The governments says it wants an NHS. It wants doctors to be regulated (and rightly so) but it expects those who are providing the service to pay for it! The absurdity of the situation is astounding.
Hi Dr Hateboer,
We are focused on making the fitness to practise process more efficient and we have made some progress on this. As Terence Stephenson mentions in his blog, our expenditure on fitness to practise was under budget in 2016.
With greater flexibility to our underpinning legislation – something we hope the Government will deliver as quickly as possible once its current consultation is over – we could deliver further benefits for doctors and patients, even more efficiently.
Over the next three years, we want to invest more in initiatives that support doctors with their practice. You can find out more about how we use registrants’ fees here.
A number of colleagues have drawn attention to the financial situation regarding the GMC.
I wish to add a comment about the TIME cost generated by the Revalidation/Appraisal processes.
Those involved in developing the processes were keen to tell us that it would ‘only involve a few hours’ each year. If only that were true!
I have worked in my practice for over 33 years and am still happy to do so. Patients telling me how well the practice is working used to be a weekly occurrence; now it is a daily occurrence, often several times a day.
Despite this I have had to waste 4 hours simply re-typing my Appraisal submission the year before last (software upgrade needed but not provided) and last year l was subjected to a bullying approach from my Appraiser over the fact that I hadn’t submitted my ‘Quality Improvement Activity ‘ in time. (Incidentally this was an audit of NHS Health Checks on virtually my whole 40-74 population over the preceding 4 years…).
To be fair to my Appraiser he seemed more stressed than I was, and he seemed to be simply transmitting the bullying approach of the Appraisal hierarchy.
I have fed back comments to them, and separately asked for guidance on the MINIMUM I need to do this year (practice under some stress owing to our youngest partner leaving because she couldn’t hack it) ; but no replies received.
Patients are increasingly commenting on how things are much worse in other practices, and I know that partners leaving is a widespread problem.
In a top-down system- which the GMC must inevitably be- the rot starts at the top. In the hope that ‘it’s never too late to start doing things right ‘ I look forward to seeing substantial changes in the very near future.
Best wishes
Tony Kelpie
Dear GMC,
Your headline is now “Working with Doctors, Working for patients” so please explain why only the fraction of patients who also happen to be doctors have to pay for this service? This is false advertising, and discriminatory. Please do not reply with “further benefits for doctors and patients.” The question that my colleagues and I have asked multiple times is why should doctors pay for fitness to practice? Can we please have a straight answer.
To me it all looks like a PR exercise following the Shipman Scandal where the system failed to detect a mass murdering psychopath. After obtaining a FACHARZT (MD) from Germany and becoming a member of the RCP London, I find the whole process a demeaning tick- box exercise. What was so wrong with the clinical director appraisal ?
Now as a locum consultant in a specialty so short in human resource, I am so fed up of having to be appraised by (sometimes ) totally clueless individuals, I am almost ready to hang up my stethoscope in 2018.
Well done GMC ! Lung cancer patients can wait!
Unusally for me I happen to have a few minutes at my lunch break to open e-mails that I would have otherwise ‘parked’, and only because during the Christmas break the pace slows down to a level that doctors should be working at rather than the slave driving conditions that have relentlessly crept up over the years. The burden, intensity and pressure of work, ironically, had moved up the career ladder leaving those in the driving seat wondering how it is all going to pan out in the long run.
From comments made above I agree that we either do things exactly the way the CAA conducts matters or stop pretending that the CAA framework works for medicine. A typical scenario is a working environment where one is relentlessly asked to do more for less and when management starts to notice cracks at the stressed seems they advertise ‘Resilience Training’.
On another exceptionally pertinent note, it is inconceivable to even consider the thought that a regulatory body that has fleased the medical profession with inflation busting registration fees has the audacity of hiding under the guise of a ‘Registered Charity’. And under whose authority had it decided to offer its employees free private health insurance if what is said is true. Not only does it disguise itself as a registered charity but appears to be self serving as well.
I am in no doubt that there are individuals in the GMC who are dedicated and proficient at what they do and have all the right intentions in mind and heart but the whole basis of it is flawed. Those who benefit from such perks are, I assume, honest tax payers who are eligible to the high quality of service the NHS provides (minus the plush Hotel charges and unnnecessary plush facilities). Fine if they wish to have private health insurance but that’s a choice they will have to make considering their own budget and priorities and not scavenge from revenue generated from fees of unsuspecting doctors. The GMC cannot hide under the guise of a charity and the term ‘council’ no longer applies owing to its increasingly obvious regulatory role. The annual registration needs to be abolished and like the CAA run on a fee -based basis for Licence to Practice, revalidation etc. As to ‘Council’ each doctor should have their own medical indemnity represenatatives should anything untoward happen. So that is where our money would be wisely spent as an insurance policy.
First definition of a Charity on the Oxford Dictionary: ‘An organization set up to provide help and raise money for those in need.’
Note that the raising of money relies on an act of good will and not on compulsory payments, at least in my view.
Food for thought.
Dear GMC
Individual health boards can contribute significantly to wellbeing of doctors, but are not held accountable for their failure to do so.
Just adequate administrative support can already make the daily work much more achieveble.
Agreements with local public transport for NHS discount, with local fitness centres for better discount will also go a far way.
Further, reassurance by local health boards that they will support individual doctors and do not treat them like criminals in the local complaints process will help doctors to retain their professional self esteem.
Working over and beyond duty outside of remit with no time for CPD had contributed to doctors leaving local NHS.
This together with a blame culture, scapegoating and subtle corporate bullying for which the top management are not held to account are leading to doctors voting with there feet and recruitment becoming near impossible.
This obviously results in locum appointments which result in breaks in continuity of care.
Unbalanced power in the hands top management is what make our job impossible.
Doctors need support.
I suggest GMC speaking out loud and clear.
In parlement
In media
To NHS top management
And support those on the frontline