Post on 14-Jun-2015
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