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How much will I earn?

With reports of some GPs making £250,000 a year, many registrars are wondering what they can really expect to earn when they first qualify – Dr Jim Sherifi takes a hard look at the figures

With reports of some GPs making £250,000 a year, many registrars are wondering what they can really expect to earn when they first qualify – Dr Jim Sherifi takes a hard look at the figures

Summer heralds the time of year when most GP registrars come to the end of their vocational training and can embark on the rest of their professional lives. In doing so they can finally begin to realise the true earnings potential of their chosen career.

Traditionally, trained doctors have moved into general practice as GP principals (partners) but such openings are becoming rare as practices move to new business models based on annual global budgets and uncertainty over the future of PMS contracts, leading to an increased demand for salaried doctors (associate GP).Other options including direct employment by alternative medical services (AMS – 'commercial') or PCT health care providers. Primary care has been opened up to the marketplace with a resulting impact not only on the delivery of health care but also on the opportunities for and conditions of employment. There is no longer a single job description. So what are the financial opportunities for a GP registrar about to complete his or her training?

GP principal/partner

Although lucrative, joining a practice may involve a sizeable investment in equity in the property and infrastructure. Depending on the practice, there may also be a lag time of up to two years (beware if it is longer) before full parity takes place.

This should be reflected in the buying-in period. Applicants should ensure they and their specialist advisers have full sight of the practice accounts and partnership agreement before joining. Any reticence shown by the practice can be overcome by signing a legally binding 'non-disclosure agreement'.Average incomes for full parity, full-time partners in non-dispensing practices in England and Wales for 2005/6 were around £115,000 but the range varied between £70,000 to a headline-grabbing £250,000.

Associate GP/salaried GP

The main advantage is flexibility of employment to both parties. The incoming GP should have a standard contract of employment covering duties, hours, salary, pension, holiday, sick leave, study leave and notice period as the main headings.

The average remuneration across England and Wales for a doctor working the equivalent of eight sessions, ie four full days in 2005/6, was around £70,000.

PCT

Many PCTs employ doctors directly to either run PCT-managed general practices or work in GP practices in their area. The contract of employment is almost identical to that of a salaried GP within a general practice, although remuneration is likely to be around 10 per cent lower.

AMS

AMS, commercial, often international health care providers, are still scarce on the ground. Since they are profit-making organisations with the responsibility of delivering dividends to their shareholders, their rate of pay is likely to be on a par or lower than that of a PCT.

Part-time/locum

Locum work balances flexibility against in-security. Doctors may choose to work through a commercial locum agency (national or local), through the PCT or independently. Current hourly rates vary from £60-£80 depending on market demand.

Out-of-hours

As from October 2004, most PCTs have opted to contract night-time and weekend health care to commercial providers. Doctors may choose to work any number of sessions with a local OOH provider but they do need to be registered with the GMC, health authority and Criminal Records Bureau and carry full medical indemnity insurance.

An eight-hour night shift can attract anything from £450 to £750 depending on the time of year and market demand.

GPSI (GP with a specialist interest)

A role as a 'hospital specialist' may be part of a portfolio of jobs for any doctor. It helps to have a genuine interest in the specialty as well as a postgraduate qualification, usually a specialist diploma.

Contracts are locally negotiated and variable but the remuneration tends to be around £180 for a three-and-a-half-hour session.Non-'mainstream' positions for qualified GPs may also include those in occupational health, health screening, walk-in centres, DWP sickness review and the pharmaceutical industry.It is notoriously difficult to truly estimate the hourly rate of pay for any job, but the table on the left assumes that a doctor is working a 36-hour week for 45 weeks a year.When embarking upon any career path, registrars should ensure they take into account all aspects of the role, including peripheral items such as keeping personal accounts, taxation, superannuation /pension (ensure that SOLO forms are completed for all NHS work), medical indemnity and sickness insurance.

Jim Sherifi is a GP in Suffolk

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