‘Do salaried GPs have adequate employment rights?’
Dr Katie Musgrave reflects on the devastation of workload dump in general practice and ponders what adequate employment rights for GPs would look like
Do UK salaried doctors have adequate employment rights? Do they find themselves working within their contracted hours, with a safe and manageable workload? If not, why not?
All GPs – indeed all doctors – started out on the same pathway. We were put upon junior doctors in the hospitals: harangued, overworked, sleep-deprived, perennially exhausted, verbally abused. We soldiered on, received a few battle scars, dusted ourselves down, and escaped to general practice. There, at least, we would sleep – we told ourselves. We were told we would get our evenings and weekends back. Heaven knows, we might even find time for a social life!
But then arriving in general practice we found new problems. Sure, the hours might be limited (in theory) but the workload was not. Instead of receiving abuse from unsympathetic nurses or hospital consultants, it’s the drip-drip of incessant demand – just one more task, just one extra phone call, just a few more results! As a general rule, we have, as a profession, accepted and normalised unhealthy working patterns. The workload currently undertaken by UK GPs is unsustainable, and makes people ill.
I remember moving from a junior doctor post in a particularly short-staffed geriatrics ward, to a new post in a rehab hospital. On my first day, I was like a coiled spring: ‘Where does the ward round start?’ ‘Who needs bloods taking?’ ‘Where is my jobs list?’ My jaw metaphorically dropped when I was told I had two days of induction, and someone else would be doing the ward round. The post continued in this vein – there was always a registrar or consultant available to provide advice, and finishing on time was a given. We all took a lunch break. Sometimes I had time to complete ‘life admin’ like researching a holiday or looking into educational courses on my morning coffee break.
I found it almost inconceivable that I had a safe and manageable workload, with adequate senior support, and that I could leave work at the designated time. It is possible to sometimes normalise dangerously overstretched working conditions, to the point that we struggle to adjust to the ‘normal’.
But back to salaried GPs. What would adequate employment rights look like? It is hard to imagine. Say you were a salaried doctor and had an emergency situation to deal with on a duty afternoon. You were held up, pathology results were unchecked, you had several complicated tasks to attend to. You found yourself staying late in the practice until half seven, though your working hours finish at six. But of course, you have an overtime sheet that the practice manager urges you to complete each week. Today you fill in the extra 1.5 hours. Tomorrow it might be 45 minutes. Next week is better and you only stay 15 minutes late each day. But at the end of the month the extra hours are tallied up, and you receive the equivalent of a whole extra day’s pay. Because you have fair employment rights.
Next month there is a host of mandatory online training you need to complete. Again, the practice is proactive: ‘When shall we block time off for you to attend the safeguarding update, or do you want time in lieu?’. That is what fair employment rights look like.
Now I’m afraid that I find it difficult to accept that these basic requirements – fair pay for hours of work done, time back for mandatory training, and (more difficult to specify) a safe and manageable workload – are beyond achievable in the UK. If GP partners insist that these basics cannot be met, they should be handing back their contracts, or withdrawing their services (in a more robust fashion than has been undertaken). Because it cannot be right to run a service that depends on the abuse of the workers.
In my experience, salaried doctors too often find themselves working in practices that do not respect their employment rights. But general practice is a small world (and GPs can be cowardly), so salaried GPs don’t complain for fear of their ‘reputation’. Instead, they battle on until they burn out, can move onto pastures new, or become partners themselves. Then, of course, they ask the salaried doctors they employ to stay ever later, and the cycle repeats itself…
Dr Katie Musgrave is a GP in Devon
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READERS' COMMENTS [9]
Please note, only GPs are permitted to add comments to articles
I too am a salaried GP. To me it seems unhelpful that the article frames workload and bureaucracy as specifically “salaried GP” problems. All the problems Katie reports affect both salaried GPs and partners. To look at just one side of the picture fosters a sense of “us and them” which is unhelpful.
These are “GP problems”, not “salaried GP problems”.
Yes Katie , all the legislation favours employees not the employers ( partners). . Please recognise partners are under just as much stress as you and probably a whole lot more . Most of them would love the BMA standard contract which is why so many are leaving partnership. I can assure you a large corporate provider would probably treat you worse. If you feel you are being abused use the BMA to help and use your employment rights, but remember hopefully we all have a vocation!
I am not a partner !
Our salaried GPs are firmly rounded up before 6.30 and told to go home. Admin is shared. We proactively work together to share the load-partners/salaried/retainer/trainees. I think it’s practice culture that needs addressing here. I remember as a junior there were seniors who shared the load and we all went home on time, and there were those who made the juniors do all the work whilst they read comics or watched the cricket (both real examples). Culture and teamwork trumps every time in a practice. If one leaves late- everyone does. If you make an effort to share- no one needs to leave late in my view. Push back on workload dump- don’t take it lying down, support salaried colleagues and remember that a job shared is a job halved.
Toxic workload and toxic expectations regardless of position. The eternal unpolishable turd.
My salaried doctor has advised me that there the contract we have shows that their on-call requirement for the rest of the year is 0.45 sessions per week taking leave into account. I find this article highly entertaining
It depends (on both sides), what sort of Practice you work in.
Some Practices are excellent, and some are definitely not.
Are salaried GPs an asset or part of the problem? Salaried effectively synonymous with part-time.
Part time working; less continuity of care.
Part time working, particularly early in career; less clinical experience, less learning, poorer skills.
Costs of training are identical for full or part-timers; return on that investment significantly poorer for part-timers.
Costs of employment are proportionately higher per hour worked for part-timers.
The shift to increased part-time working has increased costs and lowered quality of GP services.
Except Dave Haddock, where the opposite is true.
In the last 2 places I’ve worked only salaried GPs were full time (myself included), and partners were half-time or less.
Be careful not to generalise about who does the bulk of consulting.
Where partners respect themselves and manage time and workload effectively they can be more likely to understand and respect the roles of other workers including salaried GPs. Those with insight also realise that they are increasingly ‘salaried’ in the way they are treated by ‘the system’ and may well be managed on similar lines in the near future. If they want to argue for their own rights then, they need to start now by demonstrating what sustainable and fair work force practices are…