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Focus on...the salaried GP model contract

As the divide between partners and salaries GPs widens, the BMA faces a struggle to keep the model contract alive. By Nigel Praities investigates.

By Nigel Praities

As the divide between partners and salaries GPs widens, the BMA faces a struggle to keep the model contract alive. By Nigel Praities investigates.

A storm has been brewing for some time over salaried GPs' contractual terms and conditions - but the publication of guidance telling practices how they can ‘escape the dreaded' BMA model contract has thrust a decidedly large stick into the hornet's nest.

The explicit step-by-step advice from the Law for Business Corporation, revealed by Pulse last week, urges GMS practices to water down the employment conditions of their salaried GPs and tells PMS practices they are ‘off the hook' and can ignore the model contract altogether.

The advice was swiftly condemned by the BMA but it stuck a chord with GP partners who are feeling the pinch and ruefully analysing their staff costs.

Along with many other small businesses, practice income is sliding and costs are soaring. This situation is unlikely to improve in the next few years, with GPC negotiators warning that even the 2% pay rise which ministers are expected to back would be swallowed up by spiralling expenses.

And a Pulse investigation this week reveals that GMS practices looking to avoid offering the salaried model contract may well be able to get away with it.

The BMA insists GMS practices have a legal obligation to offer conditions ‘no less favourable' than the model contract - and warns that ‘in extreme circumstances' a non-complying practice could have its contract with the PCT cancelled.

But a Pulse survey of 32 PCTs found just four could confirm that all their GMS practices offered the model contract to all salaried GPs. Most said they did not even record the information and it was up to individual practices which contract they chose.

BMA officials, meanwhile, admit they are not aware of any case in which a PCT has intervened to force a practice to offer the model contract, making their threat appear somewhat hollow.

Meanwhile, a recent Pulse survey of nearly 50 salaried GPs, carried out in conjunction with the National Association of Sessional GPs, found 14% of salaried GPs in GMS practices did not have their contracts based on the model contract. Predictably, the picture was even less rosy in PMS practices, with just 52% of salaried GPs on the model contract. The survey also uncovered a big pay gap between salaried GPs who were on the model contract and those who weren't.

One of the tactics advocated by Law for Business to sidestep the model contract is for practices to recruit would-be salaried GPs as fixed share partners. This means ‘the GP, although a partner in name, would have no employment rights, few voting rights and the surgery could negotiate freely with the GP without having to worry about the BMA contract whatsoever'.

While the GPC has condemned the model, Law for Business claim they are aware of at least 200 practices considering fixed-share partnerships - and for many practices, it is already proving a success.

Vida Healthcare Partners, a PMS practice based in King's Lynn, Norfolk, has a team of 14 GPs – six of whom are fixed share partners.

Graham Dickerson, managing partner at the practice, defends the model.

‘We wanted to recruit good quality doctors, but being an equity partner requires a fair bit of capital and so we give them the flexibility if they don't want to buy into a practice,' he says.

‘We are also able to offer top of the range deals that have been attractive to them, but we expect a lot from them. We are not expecting them to say "It is five o'clock and I am going".'

Darius Ferrigno, managing director of Law for Business, says he is increasingly approached by partners who feel the model contract is weighted in favour of the employee. He singles out generous sickness and maternity provision for particular criticism.

‘Any small business which ends up having to pay its most highly paid employees when they are not there finds this has an enormous impact upon practice income and service delivery. Many have complained to us that they feel salaried GPs are on a "better deal" than they are, without carrying any of the risks,' he says.

Some GPC members are beginning to break ranks and call for a review of the model contract.

Dr Clarissa Fabre, a GPC member and a GP in Uckfield, East Sussex, says the contract is deeply unpopular with partners.

‘A lot of GPs are going to other places for contracts because the model contract penalises practices far too much. For example, if a woman goes off on maternity leave it costs the practice about £20,000. The PCT gives some reimbursement but it is not enough,' she says.

Dr Fabre says the provisions for continuing professional education are also ‘quite generous', working out as one session a week for a full-time doctor.

But on the other side of the divide, salaried GPs are furious that as well as facing an ever tougher labour market with a dearth of partnerships, partners are now seeking to downgrade their terms and conditions.

Dr Andy Parkin, a salaried GP in Whitstable, Kent, claims many of his colleagues are struggling on ‘awful' contracts paying as little as £6,000 a year per session.

He warns: ‘If partners try to squeeze salaried colleagues, they will only have themselves to blame when they go bust and we go to work for Virgin et al.'

Intriguingly, it appears that just as GMS practices try to avoid using the model contract, APMS providers are beginning to use it n– even though they are under no legal obligation to do so.

Dr Rory McCrea, chair of Chilvers McCrea, told Pulse the company was ‘moving towards' adopting the BMA model contract.

And one in five off the PCTs contacted by Pulse said they required bidders for the new wave of GP-led health centres to offer the contract, even though Government procurement advice for the Darzi centres only specifies that bidders must keep within employment law and codes of practice.

Even those which aren't yet ordering bidders to offer the model contract, such as Devon PCT, are considering doing so in future. A trust spokesperson told Pulse ‘Devon PCT has decided that all future APMS contracts will include the requirement.'

With APMS providers seeking to provide the terms and conditions for GPs that GMS partners are looking to abandon, it's hard to see how the model contract can survive in its current form – but opinions differ about how it could be revised.

Some favour scrapping the whole model contract and starting again from scratch. Dr Ravi Mene, Salford and Trafford LMC secretary, says the current contract is out of date with the current conditions.

‘We need to start with a clean slate and base the contract on what is happening at the moment and into the future. It needs to have more flexibility built into it and some kind of risk sharing needs to be built into it,' he says.

GPC negotiator and workforce spokesperson, Dr Beth McCarron-Nash admits GPC members are calling for it to be revised but insists there is enough flexibility in it for it to be retained.

‘I think relooking at the model contract is more of a risk than leaving it as it is. Diluting the terms and conditions will not help general practice in the long-term, because we will then all end up salaried. Practices need to think about taking on more partners,' she said.

This may be the case, but the BMA faces an uphill struggle to keep the model contract alive.


What is the BMA model contract?

The BMA model contract is the minimum level of terms and conditions that GMS practices have to offer to salaried GPs. Under NHS (GMS Contracts) Regulations 2004 a contract between a PCT and GMS practice requires the practice to offer its salaried GPs terms and conditions which are at least no less favourable than the BMA model contract.

Does the model contract determine how much salaried GPs are paid?

No. The independent Doctors' and Dentists' Review Body sets the pay band for salaried GPs and this is incorporated in the model contract. The DDRB recommended a salary range of £51,332 to £77,462,for 2007/08. However, the results of a Pulse survey of salaried GPs reveals those on a model contract are often paid much more than those not on a model contract.

What happens if a GMS practice does not offer the model contract?

The BMA says a practice offering terms and conditions less favourable than the model contract could face sanctions from the PCT and in extreme situations could have their contract with the PCT terminated. In practice, the legal basis for this is secondary legislation and PCTs often do not monitor what contracts GMS practices offer to salaried GPs.

What about PMS and APMS practices?

PMS and APMS practices are not legally required to offer the BMA model contract, but the BMA recommends they base their contracts on the terms and conditions contained in the model contract.

The BMA is facing a struggle to keep the model contract for salaried GPs alive

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