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Paula Wright examines the practical implications for salaried GPs of adopting the new model contract
examines the practical implications for salaried GPs of adopting the new model contract
Under the new contract a salaried GP's commitment is much more carefully defined in terms of hours, with full-time being 37.5 hours and a session being four hours and 10 minutes. This is key in determining reckonable service (pensions) and also for determining allowances for holidays, public holidays, and time for continuing professional development (CPD).
Time for CPD
The new contract includes one session per week of CPD for full-timers and pro-rata for part-timers. This brings GP contracts into line with those of other NHS doctors and recognises the demands of keeping up to date, appraisal and revalidation.
Is this unfair for self-employed GPs? Not really. As self-employed contractors they decide how much work they wish to take on based on what income they wish to earn. Under the old contract principals earned PGEA payments for attending educational events; this has been incorporated into the global sum.
One big theme of the new contract was to protect all GPs, especially 'principals', from being expected to work for free and take on work previously done by hospitals, for example by ensuring fair reward for all work done. This is echoed in the salaried contract, which no longer says 'you may be expected to carry out additional duties to cover the absence of partners due to sickness, holidays, etc'.
Partners sometimes agree to take on additional work for additional income, such as teaching students, covering an extra nursing home, doing appraisals, PCT work etc. In contrast the salaried GP might find himself covering additional GMS for no extra reward.
Under the new contract salaried GPs only have to work over and above contracted hours if they want to (excepting of course in emergencies such as the first 48 hours after a doctor is taken ill). If they do, they can either have time back in lieu or additional pay (to be agreed with the practice before the work is done). So, for example, the maternity leave of a partner will require explicit discussion regarding what if any additional hours the salaried doctor may wish to take on.
And this applies to any additional duties such as daytime on-call duties that might need to be covered but which are not part of the original job plan.
A team player and a balanced role
Discussing patients within a clinical team, developing clinical practice, analysing critical incidents, reviewing performance through audit, and team educational events: these are all very important activities for GPs, whether you are a self-employed contractor or an employee. The new salaried contract directs practices to involve their employees in these activities within paid work time.
Where such meetings occur outside normal duties days, time in lieu or additional pay must be given. Consultants have issued guidance on job planning recommending that in general the ratio of clinical activities to 'supporting professional activities' should be roughly 7.5 to 2.5. General practice too has important activities outside of direct clinical care for which time needs to be 'budgeted'.
Continuity of service
If a friend of yours told you that despite working for 15 years for her company she was only going to get the minimum statutory benefits when she went on maternity leave you would be appalled. Until recently a GP with 15 years of NHS experience and 10 years' partnership experience can enter a salaried position and be entitled to little more than statutory benefits.
Their sick pay and maternity pay have been out of line with the entitlements of other doctors in the NHS; even a first-year SHO would have received better terms. This is because standard NHS contracts of employment recognise all NHS work as 'continuous' for the purpose of sick and maternity pay. Thus NHS terms provide benefits that not only improve with each year of employment (sick pay especially) but also do not penalise the doctor for the unavoidable need to change employers in the course of their training and NHS career.
These Whitley Council terms and conditions are now part of the model contract so GPs do not need to worry about taking short-term contracts.
Guidance from the Department of Trade and Industry is reflected in the contract, and attention must be paid to ensuring, for example, that the employee gets a fair share of bank holidays regardless of the days of the week they work.
The job plan is what specifies not only the salaried GP's role but also delivers those all-important components such as time for meetings, CPD and supporting administration time. It should be considered carefully at the start of the post, both as regards quantity and quality of work and the specific skills and experience of the doctor, and the features of the practice (eg 'paper-light', high ethnic minority population etc).
Upgrading a contract with the same employer issues to address
the same employer
issues to address
·Is the part-time contract correctly described in terms of its fraction of full-time? For example, five sessions is classed as five-ninths of full-time not 50 per cent and this has consequences for pension contributions, annual leave, CPD, bank holidays etc
·Do actual hours worked exceed contracted hours? A diary may be helpful to clarify this. Is there an established mechanism for time in lieu or locum payments for this?
·Is there a job plan recognising necessary time for paperwork, meetings and CPD?
·Is there an agreed date for 'continuous NHS service' upon which sick and maternity leave and pay will be based? This is the date you started working as a doctor unless you have had a lengthy break.
Pitfalls for prospective salaried doctors
Annual pay rises Although GPC guidance accompanying the model contract recommends annual salary uplift both for inflation (as per Review Body awards) and in recognition of experience (seniority), the wording of the current model contract is not watertight here. The BMA/GPC recommends that you include this in your contract before signing with your employer.
Continuity of service You need to agree when your date of continuous service is: usually this is the date you started working as a doctor unless you have had a long lay off.
Amendments Applicants should beware of employers who try to amend the model contract always consult the local BMA office; nGMS practices are required to offer the model contract or better terms but cannot offer less favourable terms.
PMS practices Sadly these are not required to offer the contract but it is recommended good practice. Despite earning on average £18,000 more per partner, PMS practices have a poor record of offering good employment terms. Retainer or Flexible Careers Scheme posts are covered by additional requirements monitored by deaneries, many of whom set a minimum quality benchmark as far as employment practices go.
Questions that are frequently asked by employers
Does the new contract herald a generation of clock-watchers ?
Salaried doctors are part of Generation X who are trying to juggle portfolio careers or work and family responsibilities.
This means defining working hours is important and it should not be assumed that a doctor working a four-hour session is happy to extend it to five hours just because others are on leave as he/she may have responsibilities elsewhere at the end of that session.
Salaried doctors can still contribute to the fluctuations in workload inherent in clinical practice thanks to the provision for additional payments or time in lieu, but cannot be made to extend their hours or change their role without their agreement.
Won't it will cost
too much ?
The statement of financial entitlement provides for reimbursement of locum costs to cover absence of salaried doctors on sickness or maternity leave with a few exceptions.
There doesn't seem to be much time left for seeing patients
Salaried doctors will not see many patients. There will certainly be less time to see patients as the contract reflects the importance of continuing professional development and team working as integral parts of a clinician's role.
Can they be involved in
PCT and GP employers who want to involve salaried GPs in management will need to consider carefully how appropriate time will be earmarked within their job plan for this role and how this will be reflected in their pay. GP employers (partners) retain overall responsibility for the profitability of their business (the financial management side) but there are many important management areas to which salaried GPs may contribute such as clinical governance, risk management, staff training, protocol development.
Providers (principals) don't
get CPD time
Principals, now called providers, continue to be self-employed and as such decide how to balance the time they spend on income-generating work as opposed to time spent on self-development. Many PCTs, however, now also fund deputising cover for practices in a locality to 'shut down' for educational events.
Does the contract mean the salaried GP can only work up to eight hours 20 minutes in a day or four hours 10 minutes in a half-day?
No. There is no reason why the job plan cannot include duty periods of, for example, 3.5 hours (common for retainer GPs) or 5.5 hours (9am - 2pm) to fit in with school hours, though neither of these can now be referred to as a 'session'.
Equally, a traditional 10-hour day with surgeries at 8.30am and 3.30 finishing at 6.30pm is possible as long as hours worked reflect hours agreed in the contract and job plan: again a 10-hour day does not equate to two sessions but to 2.4 sessions. All contracted (and worked hours) are then divided by 37.5 hours to work out entitlements to leave, CPD, pensionable service etc.
Our educational meetings are on Tuesdays, when the salaried GP doesn't work. How does he access CPD time?
There are a number of options: rotate the days of meetings, offer to change the doctor's days, offer time in lieu (time off) for coming in on their day off (which can be very difficult if this means arranging additional childcare for preschool children), time off to attend a course, time in lieu (time off work) for a range of other educational activities: educational meetings outside the practice, courses, etc.
is a freelance GP and GP tutor for non-principals, Northern Deanery