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Insuring your career against the contract

Uncertainty over the contract has seen more GPs than ever before considering their career alternatives ­ Dr Lorna Gold looks at the options

n our everyday clinical practice, GPs are expert at living with uncertainty. Since the introduction of fundholding and health promotion clinics in the early 1990 we have become accustomed to living with a degree of organisational uncertainty too.

For more than a year, many practices and individual GPs have put their decision-making on hold while awaiting the new contract. The supposedly definitive contract document, followed by repeated suggestions of how it might be modified, has left many GPs no clearer about what the future of GMS will be.

We are left wondering what the contract means for our patients and ourselves, as well as whether the profession will accept or reject it. This has led more GPs than ever to examine their career options. Here are a few.

Personal medical services

It could be argued that PMS GPs are already benefiting from the advantages the contract was expected to bring to GMS practices, such as greater control over how to spend staff budgets and access to salaried posts. There are two ways in which GPs currently in GMS practices might use the PMS system to their advantage.

 · Become a partner in a PMS practice Any practice that has not already done so would be well advised to ask its PCO for an assessment of what moving to PMS would mean. This does not carry any commitment.

 · Become a salaried GP A salaried PMS GP working nine sessions a week can expect to earn £54,000-£60,000 a year and have protected time for personal development, no out-of-hours responsibilities, and no administrative work apart from their own referral letters. This may appeal to GPs who enjoy clinical work but are frustrated by paperwork and data-inputting, or those who want clearly defined duties, rights and hours of work.

Full-time locum work

Practices often have to pay premium rates to attract reliable locums. Which of us has not thought, while signing a locum's pay cheque, that it looks like a lot of money for relatively little work. Being a locum will keep any GP comfortably off the breadline, with the advantage of being able to choose whether or not to work on any particular day, or of combining GP locums with other interests in a portfolio career.

GPs willing to work the most unsociable out-of-hours shifts can command impressive hourly rates. Although locum work has all the advantages of self-employment, it also has the disadvantages, particularly the lack of paid holiday, sickness and maternity leave. GPs relying on locum work for an income need to take out adequate insurance against becoming unable to work due to ill-health.

Early retirement

GPs approaching 50 have spent most of their working lives jumping through apparently random administrative hoops and may be very tempted to seek early retirement.

Both both the tax-free lump sum and annual income are considerably reduced for GPs retiring with less than 40 years of service, so only those who have made additional provision are likely to be able to live comfortably on their pension alone.

Piecework

Many GPs already supplement their income by doing medical examinations for the Benefits Agency, insurance companies, legal firms and private health care providers. It is possible to make a reasonable living doing this type of work alone, with the advantage of being able to choose when and how much to work. The main disadvantage is that doing such work full-time soon becomes grindingly monotonous.

Private practice

In major cities and more affluent areas, there are people willing to pay for GP services which they perceive as offering more than those available through the NHS. This is rarely a sinecure, however. Often the expectation is that the GP will be available at short notice or outside normal working hours. The infrastructure costs of setting up a private practice can be substantial.

The most effective way to earn a living from private practice is to develop a special interest in an area in which NHS provision is poor, such as sports medicine, or to take advantage of the public's willingness to pay for products marketed under the alternative health umbrella.

Hospital medicine

Could that clinical assistantship in the diabetes or dermatology clinic lead to a career change? For most GPs, this remains a dream. The flow of traffic is still overwhelmingly from the hospital specialties into general practice rather than vice versa. Could you really face SHO jobs and specialist exams, not to mention the research?

A complete career change

You only live once ­ do you want to spend your entire allocation on general practice, or is there something else you have always dreamed of doing? Now could be the time to make some serious inquiries about the feasibility of an alternative career.

In 12 months, you could be managing multi-million pound funds in the City, securing an advance for your first novel, or running a hospital in a remote corner of Africa while your former GP colleagues are still wondering when they will be able to vote on the contract.

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