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What lies ahead under the new contract proposals

A salaried option

Younger GPs are particularly keen on the idea of working as salaried doctors without being expected to invest in premises or have their income dependent upon practice profits and (all too often) the way a senior partner decrees that these should be shared out. Many PMS practices already employ salaried GPs, and the contract will bring GMS into line with this and provide nationally applicable salary scales. Although the salaried option has been created with younger GPs in mind, and is intended primarily to allow recently qualified GPs to develop their skills by working in a variety of practices and having the flexibility to combine day-to-day general practice with posts which provide training and experience in areas of particular interest, GPs at any stage in their career will be able to switch to salaried posts if they wish.

Independent contractor status

This option will remain. Many GPs appreciate the benefits of being notionally self-employed and owning their premises, and the contract will not remove these privileges.

Special interest development

At present, work done outside GMS is treated separately with regard to taxation and pension status. Under the contract, activities such as hospital sessions, undergraduate and postgraduate education, research work, specialist chronic disease management, occupational health and being an appraiser could become part of

GMS and ­ most importantly ­ be pensionable in the same way as other GMS activities.

Clinical leadership

Face-to-face consultations with patients are the bread and butter of general practice, but many GPs feel the need for

a change of direction at some stage in

their working life. This is particularly true of older GPs who may have been doing the same job in the same practice for 20 or 30 years. Under the contract, it will be possible for GPs to replace some of the time they spend in direct patient contact with roles such as education, mentoring, and work for PCOs or medico-political bodies.

Family friendly working

The negotiators have recognised that

many trained GPs are not currently working in the profession, or are working only very limited hours as retainees or locums, because of a shortage of good-quality affordable childcare. Under the contract, PCOs will be encouraged to provide accessible childcare for GPs and other members of the primary care team. The current document also hints at an improvement in financial benefits to parents. No specific details are available at present, nor is any attempt made to reconcile the apparently mutually exclusive demands for family-friendly working conditions for GPs and additional provision of routine GP services out of office hours for the convenience of patients.

Wisdom payments

These will replace seniority payments and will be linked to years since qualification, offering financial recognition for the time GPs may have spent in hospital jobs or other relevant activities prior to taking up a post in general practice.

Pensions

Under the contract, all NHS income earned by GPs, including locum fees earned by assistants and principals, will be superannuable. The GPC is still pressing for other improvements in GPs' pension arrangements, and is particularly keen to see an end to the situation whereby more than 11per cent

of average net remuneration is excluded from the calculation of the pension dynamising factor, a discrepancy the Government has refused to

address to date.

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