Career Options in GP

June 2004

Post VTS

Freelance GP

Salaried GP

Profit SharingPartner

Portfolio GP

Freelance GP.

Advantages/disadvantages Getting work Finance Pay Resources and support

Advantages and Disadvantages.Advantages Flexibility and freedom of

working Exposure and experience of

different practices Top-up your income “Try before you buy” Local knowledge about

prospective posts Increased profile Workload is less stressful than

being a principal in GP

Disadvantages. Unpredictable income. Holidays, sick and maternity leave. No paid study leave (initiatives to

fund education for non-principals). Practices may cancel bookings at

very short notice. Locums may be seen as second

best or as a new opportunity to get a second opinion on!

Continuity of care difficult. Different practices will different

systems and procedures, e.G computers.

Requirements to Work As a FGP

Supplementary list VT certificate GMC Medical defence CV

– Details of previous employment – References

Getting Work.

Start early Circulate your CV to local practices and LHBs Register with LHBs locum list Mention to drug reps that you are looking for

locums Advertise in local postgraduate centre Contact local co-operatives and deputising

services if you want "out-of-hours" work Locum agency

Communication

Mobile phone Answering machine Email Fax at home Check and respond even if not able to

do work

Agreeing to Work

Make sure you know exactly what you are expected to do!– Surgery, calls, on call, emergency appointments

Agree a fee– BMA rates? Travelling costs– When will you get paid– Weekly rate versus daily rate

Invoice, copy for practice and keep a copy for accountant

The Accountant

You get the following note from your accountant.

Dear Dr Please can you provide me with details of your

income and expenditure for the last financial year so that I can prepare your practice and personal accounts.

What do you do?What information does he need

Finance

Being self employed doctors requires you Keep records of all your income and work

related expenses To pay your own national insurance

contributions To collect the income tax that you have to pay

to the inland revenue at the end of the tax year– Keep 1/3rd income for tax.

Finance

Personal. Meet the accountant. Income and expenditure. Check what the accountant wants from

you and how he wants it presented. National Insurance

Personal Expenses

Motoring Petrol and oil Repairs and servicing Road Tax Insurance Breakdown Car parking/washing Mileage log 3 months,

watch out for this!

Other Books magazines and

journals Home study Clothing allowance Drugs and equipment Courses Telephone Home Computer Locum payments Locum insurance Subscriptions

National Insurance Contributions

Self employed people are liable to pay two classes of contributions:

Class 2 contributions.– Flat rate, direct debit, set this up ASAP.– Penalties for late payment.

Class 4 contributions which are paid on profits at or above a certain level.– Calculated by accountant.

NHS Superannuation.

If you are a 'freelance' GP locum performing GP locum work and work for a GMS, PMS or a PMS+ GP or GP practice, you will be able to pay NHS pension scheme contributions on the gross pay you receive (less expenses of 10%).

Any NHS GMS, PMS or PMS+ work can be pensionable, provided there is a clear and direct transaction for the work, between yourself and the employing GP practice or absent GP.

You will be able to claim tax relief at your usual rate in your annual tax return on the contributions you pay.

Pensionable Pay.

Examples of GP locum work that WILL be pensionable. 'Out of hours' cover based on a direct transaction between the GP

locum and a named GP, e.G. One who is unable to do their scheduled shift will be pensionable.

Additional work performed for a specific GP practice will also be pensionable.

Examples of GP locum work that WILL NOT be pensionable. GP locum work that has been arranged and paid through a third

party, such as a commercial deputising firm, a commercial agency or a co-operative itself, is not pensionable under the NHS pension scheme.

Remember

Appraisal and revalidation Professional development Local NP facilitator Holidays Sickness

– Insurance– Critical illness

Resources

NANP NP Network Wales BMA NHS pension National Insurance Contributions

Salaried GP

Options for working as a salaried GP Salaried v partnership Who pays your salary? Does it matter? Salaried contract what to look for?

Options

Who can you work for as a salaried GP? Department of PG medicine

– GP assistant scheme– Research fellow with sessions in practice

Primary care organisation e.g.LHB Individual practices Deputising and private firms Others, armed forces

Salary or Partnership

Advantages Introduction to life as a G.P.

without the business worries Flexibility no long term

commitment, and working hours can be easily negotiated to suit family or outside work interests(?)

Less paperwork and administration than partners

Guaranteed income Superannuation scheme is

maintained No equity to bring or financial

risk involved

Disadvantages Usually lower income

than peers who go into partnership

May be viewed by some as "lower" status than partnership

Short term contract Full maternity and sick

pay may have to be negotiated)

Who Pays Your Salary?

Does it matter? May determine how much you get but

also additional benefits and security.

Contracted to Whom?

Trust 1 or more practices Full holiday, study

leave, maternity and sickness (Whitley)

Difficult to change contract and working conditions

Individual Practice Single practice May need to negotiate

leave entitlements Negotiate car, defence

subs Easier to change

working conditions ? Salary higher

GPC and RCGP Recommendations for Salaried GP Contract

Paid, protected time for educational activities of 30 hours per year.

Financial support towards continuing education activities when undertaken in support of the employing authority's objectives.

Payment for bank holidays, adjusted pro rata for part-time employees.

A minimum of six weeks paid annual leave. Financial recognition of the costs incurred in securing childcare

where necessary. Car allowance, where the provision of transport is a necessary

requirement to discharge the responsibilities of the contract.

GPC and RCGP Recommendations for Salaried GP Contract

Telephone allowance, where telephone access at home is a necessary requirement of the contract and which should include recognition of the costs of mobile phone provision where necessary to fulfil in hours or out of hours obligations under the contract of employment.

Maternity leave in full compliance with current statutory provisions.

Full compliance with statutory provisions on parental leave and dependants leave.

An undertaking to treat the employee with freedom from discrimination on the grounds of race, religion, gender, sexual orientation, disability or contractual status.

Profit Sharing Partnership

Why? Choosing a practice? What to look for?

Advantages of Partnership

Higher income? “Ownership.” Own boss with equal say. Ability to develop skills.

– Clinical.– Non clinical.

Security. New contract. Pension opportunities.

Pitfalls of Partnership

Pitfalls are many and varied and, although not all can be predicted, they tend to concern the five Ps:

Profits, ? parity Property, fixtures, capital account, buying in

to property Patients, registration rules Performance, who does what? Personalities, mutual assessment

Choosing a Practice

Before looking for a practice you will need a checklist of essentials and desirables for your ideal practice.

Many factors that you need to consider when looking for a practice.

Geography.– Do you want to work in a particular part of the country?– Do you want to work in an urban or rural practice?– Where do you want to live?– What sort of schools out of hours.

Work commitments. Partnership size and characteristics. Buildings.There may be other major factors. At the end prioritize how important

each of the factors are to you and your family.

What to look for?

The partners– What are their interests? – Outside commitments? – Approach to PHCT?, RCGP

Practice Agreement – Is there one? – Study leave – Holidays – Practice meetings – Maternity leave – Sabbaticals – On call

What to Look for?

Income What goes into the pot What sort of income should one aim for How is the income distributed and what will be your share What about parity Is there a mutual assessment period Buying in. What share will you be expected to buy and when How is tax dealt with, do you have to manage your own tax Private income and its distribution Will you be expected to have an outside appointment Are targets met How are the drawings decided Accounts When will you be able to see an set of the practice accounts

At the End of the Day Ask Yourself?

Does the practice suit me as a doctor? Do the existing partners share my

professional values? Am I going to get a fair deal? Is this a practice I want to call my own? Do I need to take advice?

Portfolio Medical Career

General practitioners have opportunities to control both their career development and the shape of their working week

Flexible working, with a variety of hours and posts, is increasingly becoming accepted

Interests and areas of expertise from your hospital training can be brought with you into general practice in the form of clinical assistantships

Education, research, and medical writing are examples of non-clinical "add ons" to clinical life

Sessional posts, such as community health, lend themselves to being mixed with part time general practice

GMS

HospitalGPSI

C.A

Education

UG GPR

CPDApp

Trainer C.O

CMO

Research

Medical Advisor

LHB DSS

Medical Politics

Forensic

OTHERS!!

Advantages

Motivation Reduce burnout Continuous development Change with time and needs Income generation Meet new people

But Watch Out for

Time management– Allow plenty of time for family and self

Often work more than your “salary” May cause resentment

– Patients– Partners– Relatives

Options

Clinical Assistant GP SI Retainer