Self-monitoring cuts BP and GPs' consultations
Non-partners, whether they are salaried GPs, retainers or returners, need to know exactly what the extent of their duties are and a job plan is essential Dr Paula Wright offers some timely advice
All practices should have a clear job plan for their employed GPs. This is important both for the practice and for the employed doctors in question. Salaried posts can be very varied in their range of responsibility, specialisation and degree of flexibility.
Whether the post is a 'salaried principal', returner, flexible career scheme, retainer or simply salaried GP, a well-prepared job plan will ensure the expectations of both employers and employees are met.
GPs seeking salaried posts usually want a clearly-defined work commitment rather than the open-ended commitment of partnership. They may want to develop a portfolio career. They may be the main carer in their family and thus unable to contemplate partnership.
Though some salaried posts continue to be modelled on the roles of the partners in the practice, most posts now recognise that this is not appropriate.
This is because partners define their role and income in terms of profit share and expect to share workload whenever necessary and at any given time. Employed doctors are under contract and are paid on a time-worked basis.
Additional work pressure (for example a doctor on maternity leave or off sick) should not as a rule cause variations in an employed doctor's workload or hours of employment. Indeed this may constitute a breach of contract unless entered into by mutual agreement.
How should job plans be developed?
Job plans should be developed collaboratively between the employer and the employee. They should be revised only by mutual agreement.
Appropriate times for revision would be eight to 12 weeks after appointment, annually, or when major changes are suggested by either party. For what should be included see box, opposite page.
Defining the workload
In addition, the amount of workload needs to be defined, with provisions for fluctuations in exceptional circumstances.
The workload must reflect the employee's abilities, must realistically match contracted hours and must provide an appropriate balance of clinical and non-clinical work.
The ratio of clinical work to administrative work should usually be in the region of three to one, excluding meetings.
The building blocks of job plans are sessions, breaks and additional duties. Although a session is defined as four hours and 10 minutes, periods of duty do not need to be exact multiples of sessions. Short days are permissible so long as time is made up.
The main point of defining a session is to help calculate entitlements such as continuing professional development time or bank holidays.
Surgery times should make a realistic allowance for late arrival of patients and overrunning as well as the time it takes to make urgent referrals which cannot wait till the next worked session. Thus a session finish time of 5.30pm with a last booked appointment at 5.20pm is unrealistic.
The job plan should outline arrangements for recognising extra-contractual duties where these have been agreed. Recognition might involve time off in lieu or additional payments being made.
If an employed doctor is helping to cover another doctor's absence for whatever reason, it is most important that their efforts are acknowledged.
Breaks are essential to a healthy workforce. Unpaid breaks fail to recognise the professional attitude of GPs who have traditionally been prepared to have 'working lunches'.
The whole question of breaks needs to be addressed in the job plan.
Continuing professional development
The new model contract of employment includes one session per week for continuing professional development (pro-rata for part-timers). It is important to identify early on how this will be taken.
Its should include a mix of practice-based educational activities and activities accessed outside the practice such as self-directed learning groups, internet learning,
courses, private study, clinical attachments and so on.
The personal development plan should guide the way this time is used.
It should be noted that not all meetings in practice are educational. Primary care team meetings are an essential part of the work of all GPs.
These meetings may prioritise co-ordinating the care that the team provides to patients, discussing clinical practice standards and developing practice protocols, as well as providing mutual support for the individual practitioners.
Many of these activities are essential to the management of the practice and to clinical governance. The model contract of employment (GMS) makes provision for attendance at these meetings separately from the CPD entitlement.
Some of the informal discussions that occur over coffee may meet the doctors' mentoring needs.
Reviewing job plans
Job plans need to be reviewed regularly, either by instigation of the employer or by the employee. There can be a number of reasons for review.
Exploring opportunities for career development could be a reason, or imbalances in the current plan may have emerged, or the plan may have been badly designed from the outset. It is worth all parties making notes over a period of time to collect relevant information.
Salaried GPs posts have evolved considerably in the past 15 years. Once there were basically just two types of post.
Today the portfolio of working options is very much more complex and terms of employment have been standardised with the BMA model contract.
Guidance on Job Planning will be issued later this year by the GPC.
Paula Wright is a freelance and portfolio GP
What should be included in a job plan
in a job plan
The job plan needs to include all the duties and entitlements of the post. Obviously these will vary from practice to practice, but the following should certainly be included:
·Clinical duties These would include appointments, visits, dealing with telephone queries
from patients or other health care professionals
·Administrative/ paperwork duties
·Primary care team meetings that need to be attended
Where these occur on an ad hoc basis, adjustments to clinical workload may be required
·Personal continuing professional development time entitlement
This may include a mix of in-house meetings and events and time away from the practice, either in private study, attending educational events or 'time in lieu' for attending educational events outside of working hours
·Time for personal mentoring
·Specific specialist roles in the practice
Teaching medical students, different areas of the QOF, etc