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At the heart of general practice since 1960

PCTs break rules and snoop on us during QOF visits, say GPs

SALARIED Gp

Just over a year ago, I moved from a partnership where I had been for 19 years to take up a salaried post in an APMS practice. Why would anyone want to take such a step? The simple answer is that I wanted a change.

I'd always had a portfolio career, and a new role every five years or so. The only post I hadn't altered was my practice. I had been feeling a bit envious of colleagues who had made a move but couldn't see much point in just becoming a partner in another practice when I was already working in a good team.

Within a week of making the decision to go, I saw an advert for my current post in Stockton. It was in a greenfield site and the salaried status would ensure I didn't bear any of the risk of being singlehanded.

The practice was also nurse led and with patient-held records, it met my criterion of being different!

Negotiating contracts

I did a lot of research into salaried posts and contracts so I had a clear idea of what I should expect. The most useful help came from the BMA which scrutinised my draft contract and suggested amendments. Other sources of information included the National Association of Sessional GPs (NASGP) and the North East Locum Group (NELG).

You need to find out what the local going rate for salaried posts is because it varies considerably from area to area. There is a national scale. If you have additional skills (I am a trainer) or additional responsibilities, you may be able to negotiate a rate above the top of the recommended scale. You might

also want to discuss bonuses for QOF etc.

Avoiding pitfalls

PCTs and GMS practice employers are obliged to use the standards of the BMA model contract as a minimum. This does not apply to PMS and APMS practices but you should still ensure you have appropriate terms and conditions of service ­ read the small print.

If you work for an APMS provider, you are no longer employed by the NHS and will need to agree that your benefits such as sickness and maternity leave are treated as if you had been in continuous service. Your NHS pension is unaffected.

I exchanged a drop in salary for less work. Moving practices was a good opportunity to re-evaluate other parts of my life. We decided we would sell one car which would offset some loss of income. The sale of my share in my previous practice in Hartlepool enabled us to pay off our mortgage and reduce that outgoing. I also had to start paying PAYE tax while still having three more tax payments from my partnership. I still need to save some money for tax as I have three salaried posts, all of which are still on the basic rate.

I needed to apply to the national insurance contributions agency to cancel my class 2 payments and you can also claim for any excessive contributions already made.

Other changes

I had reduced my practice commitment by one session so was able to take on something else as well. I have become a PPD undergraduate tutor for medical students which has the bonus of being a term-time post and fits in better with my family.

If you have moved PCT, you will need to apply for the performers list. You can apply to transfer your PACT number and use this as a salaried GP as long as you only work in one practice.

The PCT can do this but you will need to check that the PPA correctly processes the prescriptions and that your new practice doesn't pay for the last quarter's prescriptions.

With the advent of the new contract, your patients are not routinely notified that you are leaving. For me, this was the hardest bit and I avoided telling them until the news got out. A notice was put up in the surgery months before I left but quite a number of patients didn't find out until after I had gone. I hated having to repeatedly say goodbye.

Retrospectively

I have no regrets. It was hard having a completely new set of patients, some of whom were used to a different style of GP. As all the patients were new, initially there were no notes and information gathering was much slower. I now realise how easy it is to become professionally isolated.

For part of last year I was the only doctor and would have had no peer group contact if I hadn't had other teaching commitments and a pre-existing support network.

I don't take work home any more. I play more sport and my family tell me I am more relaxed. However, I still like change and wouldn't rule out other moves in the future!

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