Salaried GPs and partners: a fair division of workload
John Couch is a GP in Ashford, Middlesex
Successfully integrating salaried GPs into
practices will be vital for success under
the new contract writes Dr John Couch
Salaried GPs are not a new phenomenon but numbers are increasing rapidly as new GMS approaches on April 1, 2004. The removal of the old GMS 'partner specific' allowances permits employment of salaried GPs without financial penalty, and for some practices the current difficulty recruiting partners means that salaried GPs could be their only hope of filling empty consulting rooms.
However, if you are not able to meet the fully justified expectations of salaried GPs, you will find recruitment and retention is still difficult.
Issues for salaried GPs
Prospective salaried GPs are fully aware that, for now at least, this is still a seller's market. So they need to be satisfied about many issues relating to a practice before they will sign up.
Salary level is important, but other factors must also be right. Currently the going rate is between £55-70,000 depending on experience, the practice location and local market. A few practices also offer to pay medical defence subscriptions.
Salaried GPs quite rightly want to avoid being exploited and value fairness above all else. They expect the BMA model contract to be used by the practice that wishes to employ them, and they want holiday, study, sickness, maternity and paternity leave to be agreed and included in their contract.
Working hours must be also be agreed and must include surgery length (maximum 2.5 hours) the number of consultations (15 per surgery), telephone calls (up to 6) and maximum number of visits per working day (usually 2).
Paperwork is also an issue. Expectations are that salaried GPs will do their own paperwork together with an equal share of the paperwork for any GP who is absent.
Most salaried GPs want to be included in any partnership educational and/or training sessions. They expect some induction time to become familiarised with practice systems and a slot in their regular timetable for self-directed learning.
Issues for partnerships
Fairness and openness are the things most likely to succeed in recruitment and retention of salaried GPs. Obviously it is important to get the matter of salary right. Pitch too low and you will not recruit. Pitch too high and your partners will wonder why they don't become salaried too.
Principals rightly expect value for money but must beware of being seen to do less work than their salaried employees. If partners do reduce consulting time to make space for work on the quality framework or for administrative or
finance work, this must be explained to the salaried GP.
It is not unreasonable to ask salaried GPs to do insurance reports on the patients they know best as part of their contract.
It is to your advantage to generate enthusiasm and integrate salaried GPs quickly as all clinicians must be working efficiently to maximise new contract benefits.
Finally, remember it is likely that many salaried GPs will eventually take the further step of becoming full-time partners and providing a fair and stimulating environment in the practice encourages this.
So what can you do to ensure you attract good salaried GPs and, having attracted them, maintain a good working relationship with them?
Look at how the best adverts are phrased before creating your own. Your advert must stand out in a crowded 'jobs on offer' section.
Pitch your salary offer carefully. Look at the BMA contract to ensure you offer comparable conditions. Be aware of the 'norm' by talking to other practices, registrars and salaried GPs.
Be prepared for some pre-contract negotiation and allow reasonable requests. Ensure that quality framework issues, such as template use, are included.
Plan an induction of one to two days with longer appointments for the first one to two weeks. One of the partners should act as mentor with regular meetings. Encourage problem-airing to deal with them quickly.
Include the salaried GP in your educational rota, explain the local annual appraisal system
and encourage self-directed learning. Help with training issues. Encourage and expand any
clinical or non-clinical skills your new salaried
Remember to include the salaried GP in the 'loop' of team information, discussions and, where possible, decision-making. Your aim is to make them feel part of the team.
My practice has just taken on our first salaried GP. We have tried to implement all the above. So far the results are very encouraging.
Attracting a salaried GP and keeping them happy
· Devise a good advert
· Get your salary offer right
· Offer good working conditions
· Be flexible about special requests
· Provide an induction period
· Provide a mentor
· Include salaried GP in educational rota
· Explain local annual appraisal system
· Encourage self-directed learning
· Help with training issues
· Encourage all salaried GPs' special skills
· Make sure your salaried GP feels part of team